Alceu S. Camargo

Avaliação econômica em saúde: triagem neonatal da galactosemia

This study assesses the efficiency of the galactosemia add-on test in neonatal screening performed on regular Guthrie card blood spots. Based on estimated average incidence of galactosemia (1:19,984 newborns) in São Paulo State, Brazil, the study develops a cost-benefit analysis model, using a B/C ratio and a 9.25% annual interest rate in order to decapitalize the results. Sensitivity analysis is also performed, varying (as a function of the interest or discount rate) from 0 and 20% and according to the 95% confidence interval (1:7,494-1:59,953 newborns). The results show that the savings obtained by improved health of galactosemic patients detected early by add-on neonatal screening is superior to the costs (B/C=1.33), characterizing galactosemia add-on testing in neonatal screening as an efficient policy. The lower the prevailing interest rate in the economy, the more efficient the neonatal screening policy.Este trabalho avalia a eficiencia da adicao do exame da galactosemia junto ao Teste do Pezinho. Baseado na incidencia media estimada de galactosemia, de 1:19.984 recem-nascidos, no Estado de Sao Paulo, Brasil, este estudo desenvolve um modelo de analise de custo-beneficio, utilizando a relacao beneficio/custo (B/C), a taxa de juros de 9,25% ao ano para descapitalizacao dos resultados obtidos. Tambem se realiza uma analise de sensibilidade, em funcao da variacao da taxa de juros entre 0 e 20% e do intervalo de 95% de confianca da incidencia da galactosemia (1:7.494 a 1:59.953 recem-nascidos). A economia obtida com a melhora da saude das criancas doentes identificadas precocemente e superior aos custos (B/C = 1,33), caracterizando como eficiente a politica de adicao do exame neonatal para galactosemia no Teste do Pezinho. Quanto menor a taxa de juros vigente na economia, mais eficiente e a politica de triagem neonatal, nao considerados os custos sociais intangiveis evitados.

Galactosaemia in a Brazilian population: High incidence and cost–benefit analysis

SummaryObjectives:To study the incidence of galactosaemia in the state of São Paulo and the benefit/cost (B/C) ratio of the introduction of neonatal screening for galactosaemia, comparing it with a selective approach.Methods:An enzymatic-colorimetric assay was used for the screening of total galactose (TG) in a sample of 10% of the births in São Paulo in one year and positive cases were confirmed by the activity of galactose-1-phosphate uridyltransferase (GALT). Detected and referred cases were genotyped using enzyme restriction studies for Q188R, N314D and S135L mutations of the GALT gene. The economic analysis was determined by calculating the B/C ratio and by analysis of sensitivity as a function of the incidence of the disease detected and the variation of the interest rate in the economy.Results:59 953 newborns were screened for TG, with 3 cases of galactosaemia being identified (0.26% false positives), corresponding to a frequency of 1:19 984 liveborns (95% confidence interval: 1:7494 to 1:59 953). One classical case and one Duarte 2 variant referred to as a selective approach were confirmed. With an incidence of 1:19 984, the B/C ratio was 1.04 for the 11.75% interest rate in effect in Brazil, with values already decapitalized. With a maximum possible incidence of 1:7494, the B/C ratio was 2.79.Discussion:There is an economic advantage in introducing neonatal screening for galactosaemia in the national neonatal screening programme. This advantage could increase with a reduction of the current interest rates in the economy.

Innovation in innovation system in a large service corporation in Colombia

This research focuses on the innovation system of a large service corporation and its evolution over the last ten years. This corporation has business companies such as property insurance, health insurance, a clinic, and business capitalization. It is the largest insurance corporation in Colombia. Different from other service firms with comparable size, this corporation has centralized its innovation activities with functions such as quality assurance and project management since 2004. The corporation adopts a fast follower strategy for innovation. This research analyzes the evolution of innovation system after centralization, including the key tasks in its development funnel such as technology and market monitoring. We also discuss barriers and challenges confronted by management when implementing the centralization and to improve the performance of this innovation system in the last few years. Finally, the findings of this case study are compared with the literature of service innovation. This paper contributes to the understanding of innovation management in service corporations which are increasing the main providers of employment in most large metropolitan areas in the world.