A relação inversa entre o preço e a dimensão das propriedade rurais em mercados especificos

Orientador: Bastiaan Philip ReydonDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de EconomiaResumo: Esta dissertação tem por objetivo colocar em evidência a relação que existe entre a dimensão de uma propriedade rural negociada e seu preço de mercado. Isto é, o que se observa na prática é que o preço por hectare de um imóvel de grande área é menor que o preço por hectare de um imóvel de menor área, e vice-versa. Pretende-se mostrar e discutir as causas da existência de uma correlação negativa significativa e quantificar a relação entre o preço por hectare e a área dos imóveis negociados.O referido trabalho que encontra como parâmetro o estudo do mercado de Terras, trás como pano de fundo a teoria pós-keynesiana interpretada e desenvolvida por Reydon (1992) em sua tese de doutorado e que teve sua demonstração empírica apresentada por Plata (2001) no seu doutoramento. Estas teorias têm como marco inicial a historicidade de Polanyi, que abordou sobre a criação e institucionalização dos mercados, entre eles o Mercado de terras. A dissertação deve relacionar os aspectos econômicos que influenciam no preço da terra e mostrar que a mesma pode ter dois fins, produtivo ou especulativo. Teoricamente se mostra que a terra pode ser compreendida como um ativo que apresenta uma dupla utilização: tanto na atividade produtiva quanto na especulativa e que seu preço é formado pela capitalização das rendas futuras obtidas com a terra nestas atividades mais os custos de manutenção deste ativo no portfólio dos agentes. No entendimento então de vários autores, fator relevante que torna o tamanho da propriedade uma variável central. Para tanto se pretende entender, demonstrar e quantificar as causas mais importantes dentro da relação inversa do tamanho da propriedade e seu preço.A partir desta perspectiva de análise, pode-se compreender de forma mais articulada os impactos das políticas econômicas e agrícolas no mercado de terras. Isto além de viabilizar uma interpretação mais adequada dos movimentos do preço da terra, sendo que os resultados positivos apresentados nas regressões, então confirmando as hipóteses levantadas, acabam por dar suporte na decisão de futuras políticas agrícolas que tenham alguma relação com o mercado de terrasMestradoEconomia Regional e UrbanaMestre em Desenvolvimento Econômic

LEVANTAMENTO DE VARIÁVEIS PARA O IMPACTO ORÇAMENTÁRIO DE VACINAS

Introdução e objetivos: A imunização é conhecida como uma das intervenções em saúde que mais obtiveram sucesso, estando sempre em crescente desenvolvimento. A incorporação de uma nova vacina afeta os custos, o que justifica a importância da avaliação econômica dessas vacinas no programa de imunização, além de auxiliar os gestores na tomada de decisão mais consciente1. A análise de impacto orçamentário (AIO) é uma ferramenta importante para os gestores, uma vez que possibilita a predição do impacto financeiro global da incorporação da tecnologia estudada2. Ela sintetiza o conhecimento disponível e fornece um conjunto de previsões específicas, gerando melhor visualização por parte do gestor e consequentemente facilitando a tomada de decisão3. O objetivo do trabalho foi realizar o levantamento das variáveis necessárias para a AIO em vacinas, uma vez que não se tem uma padronização para esse tipo de análise. Metodologia: As variáveis propostas pela Diretriz metodológica: análise de impacto orçamentário2 e o Principles of Good Practice for Budget Impact Analysis3, foram avaliadas, sendo mantidas ou excluídas, e outras foram incluídas, sempre levando em conta a aplicabilidade em vacinas. Resultados e discussões: As variáveis levantadas, que se mostraram necessárias para AIO de vacinas são: população elegível; incidência da doença; custo do tratamento; custo da comercialização da vacina; custo de implementação; custos evitados; perda técnica; cobertura vacinal e orçamento do Programa Nacional de Imunização. Conclusões: A adaptação da AIO para vacinas é importante, uma vez que as atuais diretrizes para a tal análise não apresentam aplicação para esse tipo de tecnologia. A primeira etapa consiste no levantamento das variáveis necessárias para a análise, realizado nesse trabalho, baseando-se nas diretrizes citadas

Annual national direct and indirect cost estimates of the prevention and treatment of cervical cancer in Brazil

OBJECTIVE: To estimate the annual direct and indirect costs of the prevention and treatment of cervical cancer in Brazil. METHODS: This cost description study used a "gross-costing" methodology and adopted the health system and societal perspectives. The estimates were grouped into sets of procedures performed in phases of cervical cancer care: the screening, diagnosis and treatment of precancerous lesions and the treatment of cervical cancer. The costs were estimated for the public and private health systems, using data from national health information systems, population surveys, and literature reviews. The cost estimates are presented in 2006 USD. RESULTS: From the societal perspective, the estimated total costs of the prevention and treatment of cervical cancer amounted to USD $1,321,683,034, which was categorized as follows: procedures (USD$213,199,490), visits (USD $325,509,842), transportation (USD$106,521,537) and productivity losses (USD $676,452,166). Indirect costs represented 51% of the total costs, followed by direct medical costs (visits and procedures) at 41% and direct non-medical costs (transportation) at 8%. The public system represented 46% of the total costs, and the private system represented 54%. CONCLUSION: Our national cost estimates of cervical cancer prevention and treatment, indicating the economic importance of cervical cancer screening and care, will be useful in monitoring the effect of the HPV vaccine introduction and are of interest in research and health care management

Editorial: Wheat biofortification to alleviate global malnutrition

According to the latest FAO report on the state of food security and nutrition in the world (1), more than 720 million people faced hunger, and around 3 billion people did not have access to a healthy diet. All these problematics, exacerbated by the current COVID-19 crisis, led to an increase in the number of people affected by the so-called hidden hunger, caused by an inadequate intake of essential micronutrients (MNs) such as iron (Fe), zinc (Zn), selenium (Se) and provitamin A. Biofortification, intended as the improvement of the nutritional quality of food crops through either conventional breeding, agronomic practices ormodern biotechnologies, represents a sustainable, costeffective and long-term approach to alleviate micronutrient-deficiency. Staple crops are typically the major target of most biofortification studies, given their central role in human diet. Wheat, specifically, contributes to around 20% of the total energy and protein intake and to around 30% of the Fe and Zn intake worldwide. However, the current level of MNs present in most wheat-derived food products is not enough to meet the minimum daily intake, especially in the poorest regions of the world. For these reasons, continuing to work on wheat biofortification is fundamental to ensure the production of nutritious and sustainable food and to contribute to the reduction of MNs deficiency

Analysis and determination of specific costs and socioeconomic consequences in the incorporation of the vaccine against meningitis and Meningococcal Disease C conjugate in the routine national immunization program / NIP

As avaliações econômicas em saúde, que se propõe a estudar a alocação mais eficiente de recursos, apresentam expansão nos últimos 20 anos. Para as vacinas especificamente, há crescente surgimento das avaliações econômicas de programas de vacinação dado aumento dos preços das novas vacinas. Nesse cenário tem-se que a doença meningocócica continua sendo um agravo de extrema importância na população mundial, com características peculiares quando se consideram manifestações, morbi-mortalidade e ocorrência nas diferentes regiões. Não são suficientemente conhecidas as causas do início de uma epidemia em um dado momento e lugar, mas sabe-se que são necessários a presença concomitante de múltiplos fatores, como características do agente etiológico, do hospedeiro e do meio ambiente. Isto inclui a susceptibilidade da população, condições climáticas favoráveis, situação socioeconômica precária, tornando a prevenção primária da doença difícil, sendo necessária uma intervenção específica como as vacinas. Há diversas complicações da doença meningocócica, principalmente as sequelas, sendo as mais comuns a perda auditiva, as amputações, necrose de pele e convulsões. O Brasil, através do Programa Nacional de Imunizações / PNI, incluiu em sua agenda de Avaliação de Tecnologias em Saúde, via Secretaria de Vigilância Sanitária do Ministério da Saúde, avaliações econômicas locais para introdução de novas vacinas no calendário nacional de vacinação, sendo uma delas a vacina antimeningocócica C conjugada. Assim o objetivo desta tese é desenvolver um estudo complementar de custo-efetividade para a vacina conjugada contra a doença meningocócica C, com inclusão de estimativas suplementares de custos adicionais, para análise da sua repercussão sobre as razões incrementais encontradas em estudo original. A fim de aprofundar os estudos que medem as proporções de sequelas e os custos indiretos, bem como a inserção de novos custos. A hipótese sugere que a medição e valoração de custos envolvidos com sequelas da doença, aprimora os resultados do estudo de custo-efetividade e agregar elementos adicionais nas decisões dos gestores. Foram realizadas na cidade de Sorocaba entrevistas junto aos doentes e familiares com questionários de rotina de gastos e de qualidade de vida - EuroQol (EQ-5D), sendo inseridos nas análise de custoefetividade, os gastos diversos realizados pelas famílias, ora denominado de Gastos Familiares . A tese teve como resultado o fato que o melhor detalhamento e inserção de gastos familiares no tratamento de pessoas que adquiriram deficiências em consequência de sequelas, alterou a relação de custo-efetividade no programa de vacinação da doença meningocócica. A análise de sensibilidade mostrou que esses dados, quando extrapolados resultam num valor incremental ainda mais próximo no valor ideal de custo-efetividadeThe economic evaluations in health, which proposes to study the more efficient allocation of resources, an expansion in the last 20 years. For vaccines specifically, there is increasing emergence of economic evaluations of vaccination programs because price increases of new vaccines. In this scenario have that meningococcal disease still a disorder of extreme importance in the world population with peculiar characteristics when considering events, morbidity, mortality and incidence in different regions. Are not sufficiently known cause of the beginning of an epidemic in a given time and place, but it is known that it takes the concomitant presence of multiple factors like characteristics of the agent, host and environment. This includes the susceptibility of the population, favorable climatic conditions, poor socioeconomic situation, making the primary prevention of the disease hard and requires specific interventions such as vaccines. There are several complications of meningococcal disease, mostly the sequels, the most common hearing loss, amputations, skin necrosis and seizures. Brazil, through the National Immunization Program / PNI, included in its agenda for Technology Assessment in Health via the Health Surveillance Secretariat of the Ministry of Health, local economic assessments for the introduction of new vaccines in national vaccination schedule, one of which meningococcal C conjugate vaccine. So the purpose of this thesis is to develop a complementary study of cost-effectiveness for the conjugate vaccine against meningococcal C disease, with inclusion of supplementary estimates of additional costs for analysis of its impact on the incremental ratios found in the original study. In order to deepen the studies that measures the proportions of sequels and indirect costs, as well as the inclusion of new costs. The hypothesis suggests that the measurement and valuation of costs involved with sequelae of disease, improves the results of cost-effectiveness and add additional elements in the decisions of managers. Were held in the city of Sorocaba interviews with the patients and family questionnaires for routine expenditures and quality of life - EuroQol (EQ-5D), and inserted into the cost-effectiveness, the spending made by many families, sometimes called \"Family Expenditures\". The thesis resulted in the fact that better detail and inclusion of family spending in treating people who have acquired disabilities as a result of disability, has changed the costeffectiveness in the program of vaccination for meningococcal meningitis. The sensitivity analysis showed that these data, when extrapolated result in incremental value even closer to the ideal value of cost-effectivenes

Original article | artigO Original 313 Authors Cost-effectiveness analysis of paricalcitol versus calcitriol for the treatment of SHPT in dialytic patients from the SUS perspective

Resumo Palavras-chave: avaliação de custo-efetividade; hiperparatireoidismo secundário; insuficiência renal crônica. Introduction: Secondary hyperparathyroidism (SHPT) is a consequence of chronic kidney disease. The treatment at the Brazilian Unified Heath System (SUS) is performed with calcitriol, a drug which favors hypercalcemia and/or hyperphosphatemia, hindering the control of SHPT. Another option is paricalcitol, which causes parathormone (PTH) suppression faster than calcitriol, with minor changes in calcium-phosphorus product and calcium and phosphorus serum levels. Objective: This study aims to develop a cost-effectiveness analysis of paricalcitol versus calcitriol for patients in dialytic treatment with SHPT, from the SUS perspective. Methods: A Markov decision model was developed for patients ≥ 50 years old with end stage renal disease in dialytic treatment and SHPT. Quarterly cycles and a lifetime time horizon were considered. Life years (LY) gained were assessed as clinical outcome. Clinical and economic inputs were obtained from systematic literature review and official databases. Costs are presented in Brazilian real (BRL), for the year 2014. Results: In the base case: paricalcitol generated a clinical benefit of 16.28 LY gained versus 14.11 LY gained with calcitriol, total costs of BRL 131,064 and BRL 114,262, respectively, determining an incremental cost-effectiveness ratio of BRL 7,740 per LY gained. The data robustness was confirmed by the sensitivity analysis. Conclusions: According to cost-effectiveness threshold recommended by the World Health Organization for 2013, the treatment of SHPT in patients on dialysis with paricalcitol is cost-effective when compared to calcitriol, from the public healthcare system perspective, in Brazil. AbstRAc

Cost-effectiveness analysis of paricalcitol versus calcitriol for the treatment of SHPT in dialytic patients from the SUS perspective

Abstract Introduction: Secondary hyperparathyroidism (SHPT) is a consequence of chronic kidney disease. The treatment at the Brazilian Unified Heath System (SUS) is performed with calcitriol, a drug which favors hypercalcemia and/or hyperphosphatemia, hindering the control of SHPT. Another option is paricalcitol, which causes parathormone (PTH) suppression faster than calcitriol, with minor changes in calcium-phosphorus product and calcium and phosphorus serum levels. Objective: This study aims to develop a cost-effectiveness analysis of paricalcitol versus calcitriol for patients in dialytic treatment with SHPT, from the SUS perspective. Methods: A Markov decision model was developed for patients ≥ 50 years old with end stage renal disease in dialytic treatment and SHPT. Quarterly cycles and a lifetime time horizon were considered. Life years (LY) gained were assessed as clinical outcome. Clinical and economic inputs were obtained from systematic literature review and official databases. Costs are presented in Brazilian real (BRL), for the year 2014. Results: In the base case: paricalcitol generated a clinical benefit of 16.28 LY gained versus 14.11 LY gained with calcitriol, total costs of BRL 131,064 and BRL 114,262, respectively, determining an incremental cost-effectiveness ratio of BRL 7,740 per LY gained. The data robustness was confirmed by the sensitivity analysis. Conclusions: According to cost-effectiveness threshold recommended by the World Health Organization for 2013, the treatment of SHPT in patients on dialysis with paricalcitol is cost-effective when compared to calcitriol, from the public healthcare system perspective, in Brazil

The Potential Impact of Different Taxation Scenarios towards Sugar-Sweetened Beverages on Overweight and Obesity in Brazil: A Modeling Study

The adoption of fiscal policies based on the specific taxation of sugar-sweetened beverages (SSBs) has been recommended by international health agencies, as they are measures that potentially reduce consumption. This study is an ex ante risk comparison that estimates the impact of three tax scenarios (20, 25, and 30%) with a 100% pass-on rate to SSBs on the prevalence of high weight and obesity in the Brazilian population. Data on the consumption habits, weight, and height of 46,164 adults aged 20 years or over from Brazilian recent national surveys were used. The shift in consumption after taxation was estimated based on the price elasticity of the demand. The percentage changes in overweight for 20, 25, and 30% taxation were 1.84% (95%CI: 1.82; 1.86), 1.89% (95%CI: 1.87; 1.90), and 2.25% (95%CI: 2.24; 2.27), respectively. The change in the prevalence of obesity was 1.93% (95%CI: 1.87; 2.00), 2.90% (95%CI: 2.80; 3.02), and 4.16% (95%CI: 4.01; 4.32), respectively. Taxes on SSBs may have a more favorable result among the heaviest consumers, who are young adults (20–29 years), especially men, thereby promoting a greater reduction in the prevalence of high weight and obesity

Simple but not simpler: a systematic review of Markov models for economic evaluation of cervical cancer screening

The aim of this study was to critically evaluate the quality of the models used in economic evaluations of screening strategies for cervical cancer prevention. We systematically searched multiple databases, selecting model-based full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses) of cervical cancer screening strategies. Two independent reviewers screened articles for relevance and performed data extraction. Methodological assessment of the quality of the models utilized formal checklists, and a qualitative narrative synthesis was performed. Thirty-eight articles were reviewed. The majority of the studies were conducted in high-income countries (82%, n=31). The Pap test was the most used screening strategy investigated, which was present in 86% (n=33) of the studies. Half of the studies (n=19) used a previously published Markov model. The deterministic sensitivity analysis was performed in 92% (n=35) of the studies. The mean number of properly reported checklist items was 9 out of the maximum possible 18. Items that were better reported included the statement of decision problem, the description of the strategies/comparators, the statement of time horizon, and information regarding the disease states. Compliance with some items of the checklist was poor. The Markov models for economic evaluation of screening strategies for cervical cancer varied in quality. The following points require improvement: 1) assessment of methodological, structural, heterogeneity, and parameter uncertainties; 2) model type and cycle length justification; 3) methods to account for heterogeneity; and 4) report of consistency evaluation (through calibration and validation methods)