Giácomo Balbinotto Neto

Os custos da doença cardiovascular no Brasil: um breve comentário econômico

Cardiovascular diseases / epidemiology; health care costs; health economics.Dear readers, we believe that the first step to understand a problem is to know its dimensions and costs. Thus, the objective of this editorial is to show the importance and limitations of the economic studies of the cost-of-illness (COI), especially the severe cardiovascular diseases and the recent contributions that can emerge from a health economic assessment. According to data from the National Household Sample Survey (

Cost-effectiveness of the vaccine against human papillomavirus in the brazilian Amazon region

OBJECTIVE To assess the cost-utility of the human papillomavirus (HPV) vaccination on the prevention of cervical cancer in the Brazilian Amazon region. METHODS A Markov cohort model was developed to simulate the natural evolution of HPV and its progress to cervical cancer, considering the current preventive programs and treatment costs. The one-year transition probabilities were mainly based on empirical data of local and national studies. The model evaluated the addition of the vaccine to three cervical cancer-screening scenarios (0, 3 or 10 exams throughout life). RESULTS The scenario of three Pap tests resulted in satisfactory calibration (base case). The addition of HPV vaccination would reduce by 35% the incidence of cervical cancer (70% vaccination coverage). The incremental cost-effectiveness ratio was US

Eficiência dos estados brasileiros e do Distrito Federal no sistema público de transplante renal: uma análise usando método DEA (Análise Envoltória de Dados) e índice de Malmquist

825 for each quality-adjusted life year gained. The sensitivity analysis confirms the robustness of this result, and duration of immunity was the parameter with greater variation in incremental cost-effectiveness ratio. CONCLUSION Vaccination has a favorable profile in terms of cost-utility, and its inclusion in the immunization schedule would result in a substantial reduction in incidence and mortality of invasive cervical cancer in the Brazilian Amazon region.

Cost-Effectiveness of Primary and Secondary Prevention Strategies for Cervical Cancer in Brazil: A Systematic Review

The objective of this study was to evaluate the efficiency of Brazilian States and the Federal District in the public kidney transplant system and their productivity trends from 2006 to 2011. The authors used Data Envelopment Analysis (DEA) with slack and the Malmquist index with slack. Inputs included spending on hospital services and health professionals in the system. The output was the number of kidney transplants performed in each State. The data showed a significant discrepancy between States in the number of kidney transplants. The transplant systems inefficiency may result from inadequate management, failure to comply with national guidelines, inactive hospital transplant committees, and overburdened hospital staff. Institutional changes promoted by the Brazilian Ministry of Health (procedures improvement and standardization) failed to increase productivity in most States during this period.O objetivo foi avaliar a eficiencia dos estados brasileiros e do Distrito Federal no sistema publico de transplante renal e a mudanca de produtividade deles entre 2006 e 2011. Utilizou-se a Analise Envoltoria de Dados (DEA) baseada em folgas e o indice de Malmquist com folgas. Os inputs usados foram os gastos dos servicos hospitalares e dos profissionais no sistema. Como output, o numero de transplantes renais realizados por cada estado. Existe uma discrepância significativa em relacao a captacao e ao numero de transplantes renais entre os estados. Evidencia-se uma ineficiencia nesse sistema, que poder ser causada por sua gestao inadequada; nao seguimento de regras nacionais; comissoes intra-hospitalares nao ativas e equipes hospitalares sobrecarregadas. As mudancas institucionais promovidas pelo Ministerio da Saude (aperfeicoamento e padronizacao dos processos) nao geraram aumento de produtividade na maioria dos estados nesse periodo.

Efficiency of Brazilian States and the Federal District in the public kidney transplant system based on DEA (Data Envelopment Analysis) and the Malmquist index

Background: Although Cervical Cancer (CC) can be effectively prevented, it is still a serious public health problem, especially in developing countries. In Brazil, almost 18,000 new cases are expected in 2013, and it is the type of neoplasia that claims the most lives of young women. New secondary prevention strategies (such as the HPV-DNA test) and primary prevention strategies (vaccination against HPV) have been developed. However, applying these strategies to large populations is costly, and their use is limited in Brazil. Because financial resources are scarce in Brazilian scenario, studies about the economic implications of the new preventative technologies for CC may support rational and evidence-based decisions in public health. Methods: A systematic search of the articles (1970 to 2013) was conducted in MEDLINE, EMBASE, Cochrane Collaboration of Systematic Reviews, and LILACS. The aim was original articles that evaluated the cost-effectiveness of primary and/or secondary prevention strategies for cervical cancer in Brazil. Results: A total of 6 articles were included in this review. Two articles described economic analyses of population screening strategies in comparison to the current strategy in Brazil (oncotic cytology). Four articles evaluated the addition of a vaccine against the HPV (genotypes 16 and 18) for Brazil in comparison to population screening. Conclusion: Despite raising the costs of preventing cervical cancer, new preventive technologies reveal a favorable cost-effectiveness profile for the case of Brazil. Ignoring the new preventative technologies for CC can lead to misguided and perverse consequences in a country where programs based on the Papanicolaou technique have only been partially successful.

Quem vai à igreja? um teste de regressão logística ordenada do modelo de Azzi-Ehrenberg para o Brasil

The objective of this study was to evaluate the efficiency of Brazilian States and the Federal District in the public kidney transplant system and their productivity trends from 2006 to 2011. The authors used Data Envelopment Analysis (DEA) with slack and the Malmquist index with slack. Inputs included spending on hospital services and health professionals in the system. The output was the number of kidney transplants performed in each State. The data showed a significant discrepancy between States in the number of kidney transplants. The transplant systems inefficiency may result from inadequate management, failure to comply with national guidelines, inactive hospital transplant committees, and overburdened hospital staff. Institutional changes promoted by the Brazilian Ministry of Health (procedures improvement and standardization) failed to increase productivity in most States during this period.O objetivo foi avaliar a eficiencia dos estados brasileiros e do Distrito Federal no sistema publico de transplante renal e a mudanca de produtividade deles entre 2006 e 2011. Utilizou-se a Analise Envoltoria de Dados (DEA) baseada em folgas e o indice de Malmquist com folgas. Os inputs usados foram os gastos dos servicos hospitalares e dos profissionais no sistema. Como output, o numero de transplantes renais realizados por cada estado. Existe uma discrepância significativa em relacao a captacao e ao numero de transplantes renais entre os estados. Evidencia-se uma ineficiencia nesse sistema, que poder ser causada por sua gestao inadequada; nao seguimento de regras nacionais; comissoes intra-hospitalares nao ativas e equipes hospitalares sobrecarregadas. As mudancas institucionais promovidas pelo Ministerio da Saude (aperfeicoamento e padronizacao dos processos) nao geraram aumento de produtividade na maioria dos estados nesse periodo.

A economia da religião e seus fundamentos: teste de um modelo de escolha religiosa

The modern landmark for the Economics of Religion is the model proposed by Azzi and Ehrenberg in 1975 to religious frequency. This model has several empirical studies in the literature in order to test their hypotheses. In this article, we test the hypothesis of the model of Azzi and Ehrenberg applying an ordered logistic regression with survey data of the Brazilian Social Research (PESB) 2004 on religious attendance. According to our results, women tend to attend more religious services; religious frequency showed an increase with age and negatively correlated with income

Cost-effectiveness of whole-body bone scans in the pre-liver transplant assessment of patients with hepatocellular carcinoma in Southern Brazil.

O objetivo deste trabalho é expor, com base na literatura de Economia da Religião, a premissa de racionalidade humana relacionada ao comportamento religioso. Serão abordados conceitos e definições da Economia da Religião, o objeto de interesse dessa disciplina, isto é, as questões com as quais se preocupa, além de discutir-se, sucintamente, a origem e a evolução da Economia da Religião. Discutem-se dois dos fundamentos teóricos da Economia da Religião: a Escolha Racional e a Teoria do Consumidor aplicada à religião. Como contribuição empírica, realizou-se um teste de um modelo de escolha religiosa empregando a técnica de Análise de Discriminante. Por último, serão discutidas as vantagens, objeções e críticas relativas à Teoria da Escolha Racional Religiosa. This paper aim, based on the literature of Economics of Religion, to the premise of human rationality related to religious behavior. Are discussed concepts and definitions of the Economics of Religion, the object of interest in this discipline, ie, the most important issues, and discuss briefly the origin and evolution of discipline. Rational Choice and Consumer Theory applied to the Religion, two of the theoretical fundamentals of Economics of Religion are discussed. As an empirical contribution, we carried out a test of a model of religious choice employing the technique of Discriminant Analysis. Finally, we discuss the advantages, objections and criticisms regarding the Rational Choice Theory of Religion.

Drug-Related Morbidity in Brazil: A Cost-of-Illness Model

Bone metastases (BM) are rare in patients with early‐stage hepatocellular carcinoma (HCC). In many centers, liver transplantation (LTx) policies require patients with HCC to undergo bone scans (BSs).

Activity-Based Costing and Time-Driven Activity-Based Costing for Assessing the Costs of Cancer Prevention, Diagnosis, and Treatment: A Systematic Review of the Literature

OBJECTIVES To estimate the proportion of patients with drug-related morbidities (DRMs), DRM preventability, and the cost of illness of the DRMs in Brazil. METHODS We used the decision-analytic model initially developed by Johnson and Bootman (Drug-related morbidity and mortality. A cost-of-illness model. J Manag Care Pharm 1996;2:39-47), which was adapted to the reality of the present study. A hypothetical cohort of patients in ambulatory care setting was simulated considering the perspective of the Brazilian public health system. Direct costs related to health care were obtained from the national databases, and the probability of occurrence of DRMs was established by a panel of clinical experts. Sensitivity analyses were conducted. RESULTS An estimated 59% ± 14% of all patients assisted by the health system suffer some DRMs. Given these cases, 53% ± 18% were considered preventable. The average cost of managing a patient with any DRM was US