RESUMO
BACKGROUND: Early reperfusion therapy is acknowledged as the most effective approach for reducing case fatality rates in patients with ST-segment elevation myocardial infarction (STEMI). OBJECTIVE: Estimate the clinical and economic consequences of delaying reperfusion in patients with STEMI. METHODS: This retrospective cohort study evaluated mortality rates and the total expenses incurred by delaying reperfusion therapy among 2622 individuals with STEMI. Costs of in-hospital care and lost productivity due to death or disability were estimated from the perspective of the Brazilian Unified Health System indexed in international dollars (Int$) adjusted by purchase power parity. A p < 0.05 was considered statistically significant. RESULTS: Each additional hour of delay in reperfusion therapy was associated with a 6.2% increase (95% CI: 0.3% to 11.8%, p = 0.032) in the risk of in-hospital mortality. The overall expenses were 45% higher among individuals who received treatment after 9 hours compared to those who were treated within the first 3 hours, primarily driven by in-hospital costs (p = 0.005). A multivariate linear regression model indicated that for every 3-hour delay in thrombolysis, there was an increase in in-hospital costs of Int$497 ± 286 (p = 0.003). CONCLUSIONS: The findings of our study offer further evidence that emphasizes the crucial role of prompt reperfusion therapy in saving lives and preserving public health resources. These results underscore the urgent need for implementing a network to manage STEMI cases.
FUNDAMENTO: A terapia de reperfusão precoce é reconhecida como a abordagem mais eficaz para reduzir as taxas de letalidade de casos em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST). OBJETIVO: Estimar as consequências clínicas e econômicas do atraso da reperfusão em pacientes com IAMCSST. MÉTODOS: O presente estudo de coorte retrospectivo avaliou as taxas de mortalidade e as despesas totais decorrentes do atraso na terapia de reperfusão em 2.622 indivíduos com IAMCSST. Os custos de cuidados hospitalares e perda de produtividade por morte ou incapacidade foram estimados sob a perspectiva do Sistema Único de Saúde indexado em dólares internacionais (Int$) ajustados pela paridade do poder de compra. Foi considerado estatisticamente significativo p < 0,05. RESULTADOS: Cada hora adicional de atraso na terapia de reperfusão foi associada a um aumento de 6,2% (intervalo de confiança de 95%: 0,3% a 11,8%, p = 0,032) no risco de mortalidade hospitalar. As despesas gerais foram 45% maiores entre os indivíduos que receberam tratamento após 9 horas em comparação com aqueles que foram tratados nas primeiras 3 horas, impulsionados principalmente pelos custos hospitalares (p = 0,005). Um modelo de regressão linear multivariada indicou que para cada 3 horas de atraso na trombólise, houve um aumento nos custos hospitalares de Int$ 497 ± 286 (p = 0,003). CONCLUSÕES: Os achados do nosso estudo oferecem mais evidências que enfatizam o papel crucial da terapia de reperfusão imediata no salvamento de vidas e na preservação dos recursos de saúde pública. Estes resultados enfatizam a necessidade urgente de implementação de uma rede para gerir casos de IAMCSST.
Assuntos
Mortalidade Hospitalar , Reperfusão Miocárdica , Infarto do Miocárdio com Supradesnível do Segmento ST , Tempo para o Tratamento , Humanos , Feminino , Masculino , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/economia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Pessoa de Meia-Idade , Fatores de Tempo , Brasil , Idoso , Tempo para o Tratamento/economia , Reperfusão Miocárdica/economia , Resultado do Tratamento , Custos Hospitalares/estatística & dados numéricos , Terapia Trombolítica/economiaRESUMO
OBJECTIVE: To evaluate the cost-effectiveness of treating young children with chronic hepatitis C virus (HCV) with new direct-acting antivirals. STUDY DESIGN: A state-transition model of chronic HCV was developed to conduct a cost-effectiveness analysis comparing treatment at age 6 years vs delaying treatment until age 18 years. Model inputs were derived from recently conducted systematic reviews, published literature, and government statistics. Medical care costs were obtained from linked population level laboratory and administrative data (Ontario, Canada). Outcomes are expressed in expected quality-adjusted life-years and costs (CAD$). Analysis included a base-case to estimate the expected value and one-way and probabilistic sensitivity analyses to evaluate the impact of uncertainty of the model inputs. RESULTS: After 20 years, treating 10 000 children early would prevent 330 cases of cirrhosis, 18 cases of hepatocellular carcinoma, and 48 liver-related deaths. The incremental cost-effectiveness ratio of early treatment compared to delayed treatment was approximately $12 690/quality-adjusted life-years gained and considered cost-effective. Model results were robust to variation in fibrosis progression rates, disease state-based costs, treatment costs, and utilities. CONCLUSIONS: Delaying treatment until age 18 years results in an increased lifetime risk of late-stage liver complications. Early treatment in children is cost effective. Our work supports clinical and health policies that broaden HCV treatment access to young children.
Assuntos
Antivirais/economia , Hepatite C Crônica/terapia , Avaliação de Resultados em Cuidados de Saúde/economia , Adolescente , Antivirais/uso terapêutico , Carcinoma Hepatocelular/prevenção & controle , Criança , Estudos de Coortes , Análise Custo-Benefício , Progressão da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Hepatite C Crônica/economia , Humanos , Cirrose Hepática/prevenção & controle , Neoplasias Hepáticas/prevenção & controle , Anos de Vida Ajustados por Qualidade de Vida , Tempo para o Tratamento/economiaRESUMO
INTRODUCTION AND OBJECTIVES: Weekend admissions has previously been associated with worse outcomes in conditions requiring specialists. Our study aimed to determine in-hospital outcomes in patients with ascites admitted over the weekends versus weekdays. Time to paracentesis from admission was studied as current guidelines recommend paracentesis within 24h for all patients admitted with worsening ascites or signs and symptoms of sepsis/hepatic encephalopathy (HE). PATIENTS: We analyzed 70 million discharges from the 2005-2014 National Inpatient Sample to include all adult patients admitted non-electively for ascites, spontaneous bacterial peritonitis (SBP), and HE with ascites with cirrhosis as a secondary diagnosis. The outcomes were in-hospital mortality, complication rates, and resource utilization. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models. RESULTS: Out of the total 195,083 ascites/SBP/HE-related hospitalizations, 47,383 (24.2%) occurred on weekends. Weekend group had a higher number of patients on Medicare and had higher comorbidity burden. There was no difference in mortality rate, total complication rates, length of stay or total hospitalization charges between the patients admitted on the weekend or weekdays. However, patients admitted over the weekends were less likely to undergo paracentesis (OR 0.89) and paracentesis within 24h of admission (OR 0.71). The mean time to paracentesis was 2.96 days for weekend admissions vs. 2.73 days for weekday admissions. CONCLUSIONS: We observed a statistically significant "weekend effect" in the duration to undergo paracentesis in patients with ascites/SBP/HE-related hospitalizations. However, it did not affect the patient's length of stay, hospitalization charges, and in-hospital mortality.
Assuntos
Plantão Médico/tendências , Ascite/terapia , Cirrose Hepática/terapia , Paracentese/tendências , Admissão do Paciente/tendências , Tempo para o Tratamento/tendências , Plantão Médico/economia , Ascite/diagnóstico , Ascite/economia , Ascite/mortalidade , Bases de Dados Factuais , Feminino , Preços Hospitalares/tendências , Mortalidade Hospitalar/tendências , Humanos , Pacientes Internados , Tempo de Internação , Cirrose Hepática/diagnóstico , Cirrose Hepática/economia , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Paracentese/efeitos adversos , Paracentese/economia , Paracentese/mortalidade , Admissão do Paciente/economia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tempo para o Tratamento/economia , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To characterize maternal deaths in the department of Santander, Colombia, and the delays that contributed to these deaths during the period 2012-2015, through a systematic review of health care, in order to offer an input that allows proposing actions that contribute to reduce these fatal outcomes. MATERIALS AND METHODS: Descriptive, retrospective, cross-sectional study that determines the characteristics of maternal mortality in pregnant or postpartum women who were administered complete analysis units and whose death was not caused by external or violent causes. RESULTS: The most frequent delay in the 49 cases of maternal deaths was type IV, which refers to the delay in receiving adequate and timely medical treatment (87.8%), mainly due to deficiencies in promotion and prevention strategies (63.2%). The majority of the deaths were avoidable (61.2%) in the puerperium (84%), and in users of the subsidized insurance scheme (57.1%). CONCLUSIONS: Although 98% of mothers were affiliated to the health system (subsidized, contributory, special or exceptional schemes), it was possible to demonstrate that women who were affiliated to the subsidized regime showed a greater frequency of the event, which reflects that there are important opportunities for improvement in the care provided to pregnant women in this type of scheme.
OBJETIVO: Caracterizar las muertes maternas en el departamento de Santander y las demoras que contribuyeron a dichas muertes, durante los años 2012 a 2015, mediante los análisis de las atenciones en salud, con el fin de ofrecer un insumo que permita plantear acciones para disminuir desenlaces fatales. MATERIALES Y MÉTODOS: Estudio descriptivo, retrospectivo, de corte transversal, en el cual se determinaron las características de la mortalidad materna en las mujeres gestantes o en puerperio a quienes se les realizaron unidades de análisis completas y que no fueron por causas externas o violentas. RESULTADOS: La demora que más se presentó en los 49 casos de muertes maternas fue la tipo IV relacionada con recibir un tratamiento médico adecuado y oportuno (87,8%), debido principalmente a deficiencias en los servicios de promoción y prevención (63,2%). La mayor parte de las muertes fueron evitables (61,2%), en el puerperio (84%) y en usuarias del régimen subsidiado (57,1%). CONCLUSIONES: Las mujeres afiliadas al régimen subsidiado presentaron mayor frecuencia del evento, lo cual refleja que existen importantes oportunidades de mejora en la atención que se brinda a las gestantes en el régimen subsidiado.
Assuntos
Mortalidade Materna , Adulto , Colômbia , Estudos Transversais , Diagnóstico Tardio/economia , Diagnóstico Tardio/estatística & dados numéricos , Atenção à Saúde/economia , Atenção à Saúde/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Serviços de Saúde Materna/economia , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Complicações na Gravidez/economia , Complicações na Gravidez/mortalidade , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/estatística & dados numéricos , Transtornos Puerperais/economia , Transtornos Puerperais/mortalidade , Transtornos Puerperais/prevenção & controle , Estudos Retrospectivos , Determinantes Sociais da Saúde , Tempo para o Tratamento/economia , Tempo para o Tratamento/estatística & dados numéricosRESUMO
INTRODUCTION: The availability of curative hepatitis C therapies has created an opportunity to improve treatment delivery and access. Local providers, government, industry, and community groups in Prince Edward Island developed an innovative province-wide care model. Our goal was to describe the first year of program implementation. MATERIAL AND METHODS: Using a communitybased prospective observational study design, all chronic hepatitis C referrals received from April 2015 to April 2016 were recorded in a database. Primary analysis assessed the time from referral to assessment/treatment, as well as the number of referrals, assessments, and treatment initiations. Secondary objectives included: (1) treatment effectiveness using intention-to-treat analysis; and (2) patient treatment experience assessed using demographics, adverse events, and medication adherence. RESULTS: During the study period 242 referrals were received, 123 patients were seen for intake assessments, and 93 initiated direct-acting antiviral therapy based on medical need. This is compared to 4 treatment initiations in the previous 2 years. The median time from assessment to treatment initiation was 3 weeks. Eighty-two of 84 (97.6%, 95% CI 91.7 - 99.7%) patients for whom outcome data were available achieved sustained virologic response at 12 weeks post-treatment; 1 was lost to follow-up and 1 died from an unrelated event. In the voluntary registry, 39.7% of patients reported missed treatment doses. CONCLUSION: In conclusion, results from the first 12 months of this multi-phase hepatitis C elimination strategy demonstrate improved access to treatment, and high rates of safe engagement and cure for patients living with chronic hepatitis C genotype 1 infections.
Assuntos
Antivirais/economia , Antivirais/uso terapêutico , Serviços de Saúde Comunitária/economia , Prestação Integrada de Cuidados de Saúde/economia , Custos de Medicamentos , Acessibilidade aos Serviços de Saúde/economia , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/economia , Adulto , Idoso , Antivirais/efeitos adversos , Bases de Dados Factuais , Feminino , Genótipo , Hepacivirus/genética , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ilha do Príncipe Eduardo/epidemiologia , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Encaminhamento e Consulta/economia , Fatores de Tempo , Tempo para o Tratamento/economia , Resultado do Tratamento , Adulto JovemRESUMO
Introducción. El pronóstico de una mujer con cáncer de mama está relacionado con el tiempo que transcurre desde la aparición de los síntomas hasta el diagnóstico y el tratamiento integral. Las mujeres colombianas enfrentan barreras que afectan su acceso efectivo al sistema de salud. Objetivo. Establecer los factores determinantes del tratamiento oportuno de un grupo de mujeres con cáncer de mama apoyadas por una organización no gubernamental en Bogotá. Materiales y métodos. Se llevó a cabo un estudio observacional analítico de 136 mujeres con cáncer de mama apoyadas por una organización no gubernamental de Bogotá. El punto de corte para el tratamiento oportuno se estableció en 90 días calculados a partir de la aparición de los síntomas y hasta el inicio del tratamiento. Se exploraron los factores predictores de oportunidad mediante un análisis multivariado. Resultados. El 96 % de las mujeres contaba con aseguramiento en salud; el 26,4 % tuvo un tratamiento oportuno, y en 36 casos se negaron los servicios. El 23 % interpuso tutelas para acceder a los servicios de salud. En el análisis multivariado se establecieron asociaciones significativas entre un tratamiento oportuno, el hecho de pertenecer a los estratos socioeconómicos IV y V (razón de probabilidad=3,39), y escolaridad superior a la secundaria (razón de probabilidad=2,72). Conclusiones. Según la literatura científica, el pronóstico de las mujeres con cáncer de mama se modifica cuando se accede de manera oportuna al tratamiento. En este grupo de mujeres de Bogotá se encontraron factores socioeconómicos que al parecer determinaron su acceso efectivo al tratamiento, lo que revelaría la existencia de inequidades´ determinadas socialmente.
Introduction: The prognosis for a woman with breast cancer is related to the time that elapses before diagnosis and integral treatment. Colombian women face barriers that determine effective access to the health system. Objective: To establish the determinants of timely treatment for breast cancer in a group of women supported by a non-governmental organization in Bogotá. Materials and methods: An observational analytical study was carried out on 136 women with breast cancer supported by the non-governmental organization. The cut-off point for timely treatment was defined as 90 days, calculated as the time between the appearance of symptoms and the initiation of treatment. Predictors of timely treatment were explored by means of multivariate analysis. Results: Although 96% of the women had health insurance only 26.4% received timely treatment, and 36 of them reported being denied medical services. Of these women, 23% took legal action to gain access to their healthcare rights. Significant associations were established by multivariate analysis for timely treatment among women belonging to socioeconomic strata IV and V (OR=3.39), as well as those with higher education (OR=2.72). Conclusions: According to the international literature, the prognosis for women with breast cancer improves when they are able to access opportune treatment. In this group of women socioeconomic factors appeared to determine effective access to treatment, revealing the existence of inequalities that may be socially determined.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias da Mama/terapia , Organizações , Disparidades em Assistência à Saúde , Tempo para o Tratamento , Previdência Social , Fatores Socioeconômicos , Neoplasias da Mama/epidemiologia , Estudos Retrospectivos , Colômbia/epidemiologia , Cobertura do Seguro , Cobertura Universal do Seguro de Saúde , Escolaridade , Tempo para o Tratamento/economia , Tempo para o Tratamento/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/legislação & jurisprudênciaRESUMO
INTRODUCTION: The prognosis for a woman with breast cancer is related to the time that elapses before diagnosis and integral treatment. Colombian women face barriers that determine effective access to the health system. OBJECTIVE: To establish the determinants of timely treatment for breast cancer in a group of women supported by a non-governmental organization in Bogotá. MATERIALS AND METHODS: An observational analytical study was carried out on 136 women with breast cancer supported by the non-governmental organization. The cut-off point for timely treatment was defined as 90 days, calculated as the time between the appearance of symptoms and the initiation of treatment. Predictors of timely treatment were explored by means of multivariate analysis. RESULTS: Although 96% of the women had health insurance only 26.4% received timely treatment, and 36 of them reported being denied medical services. Of these women, 23% took legal action to gain access to their healthcare rights. Significant associations were established by multivariate analysis for timely treatment among women belonging to socioeconomic strata IV and V (OR=3.39), as well as those with higher education (OR=2.72). CONCLUSIONS: According to the international literature, the prognosis for women with breast cancer improves when they are able to access opportune treatment. In this group of women socioeconomic factors appeared to determine effective access to treatment, revealing the existence of inequalities that may be socially determined.