Competência no setor saúde: análise da reforma sueca (1992-1995)

The paper reviews the outcomes and failures of the Swedish health care reform, as well as the lessons learned for accomplishing better financial results and quality standards.El artículo revisa los éxitos y fracasos de la reforma sueca de salud, así como las lecciones que dejó en su afán de alcanzar mejores resultados financieros y estándares de calidad.O artigo revisa os êxitos e fracassos da reforma do setor de saúde sueco, assim como as lições que deixou em sua proposta de alcançar melhores resultados financeiros e padrões de qualidade

O conceito de willingness to pay em questão

São revisadas as limitações do uso do conceito de willingness to pay (disposição a pagar) nas avaliações econômicas que se realizam no campo da saúde. Há na literatura econômica muitos investigadores que assinalam os múltiplos problemas metodológicos inerentes às estimações de willingness to pay. Por outro lado, o debate teórico-conceitual acerca da agregação das preferências individuais dentro de uma demanda agregada não está totalmente resolvido. Contudo, durante os últimos 20 anos, a estimação da disposição a pagar calculada pelos estudos tem aumentado de forma significativa, sendo em muitos casos um dos principais fatores de tomada de decisão em políticas de saúde. São apresentadas algumas das limitações desta técnica, assim como o possível efeito de distorção que poderia ter sobre as avaliações econômicas em saúde.The adequacy of the concept of willingness to pay within health economics evaluations is reviewed. A considerable number of researchers in the literature have pointed out multiple methodological issues involving willingness-to-pay estimates. On the other hand, the theoretical discussion about the aggregation of individual preferences within an aggregate demand remains open. However, over the last 20 years, willingness-to-pay estimates alongside health economics research significantly increased and in many cases they are one of the key factors for decision making on issues of health policies. The article describes some limitations of this approach as well as the potential distorting effect that it might have on health economics evaluations.La idoneidad del concepto de willingness to pay (disponibilidad a pagar) es revisado en las evaluaciones económicas que se realizan en el campo de la salud. Por un lado, existe dentro de la literatura económica un número importante de investigadores que señalan los múltiples problemas metodológicos que entrañan las estimaciones de willingness to pay. Por otro lado, aún el debate teórico-conceptual acerca de la agregación de las preferencias individuales dentro de una demanda agregada no ésta del todo resuelto. Sin embargo, durante los últimos 20 años la estimación de la disponibilidad a pagar dentro de las investigaciones económicas ha aumentado de forma significativa, siendo en muchos casos uno de los principales factores de la toma de decisión en políticas de salud. Plantease alguna de las limitaciones de esta técnica, así como el posible efecto distorsionador que podría tener sobre las evaluaciones económicas que se realizan en el área de la economía de la salud

Cost-effectiveness analysis for joint pain treatment in patients with osteoarthritis treated at the Instituto Mexicano del Seguro Social (IMSS): Comparison of nonsteroidal anti-inflammatory drugs (NSAIDs) vs. cyclooxygenase-2 selective inhibitors

<p>Abstract</p> <p>Background</p> <p>Osteoarthritis (OA) is one of the main causes of disability worldwide, especially in persons >55 years of age. Currently, controversy remains about the best therapeutic alternative for this disease when evaluated from a cost-effectiveness viewpoint. For Social Security Institutions in developing countries, it is very important to assess what drugs may decrease the subsequent use of medical care resources, considering their adverse events that are known to have a significant increase in medical care costs of patients with OA. Three treatment alternatives were compared: celecoxib (200 mg twice daily), non-selective NSAIDs (naproxen, 500 mg twice daily; diclofenac, 100 mg twice daily; and piroxicam, 20 mg/day) and acetaminophen, 1000 mg twice daily. The aim of this study was to identify the most cost-effective first-choice pharmacological treatment for the control of joint pain secondary to OA in patients treated at the Instituto Mexicano del Seguro Social (IMSS).</p> <p>Methods</p> <p>A cost-effectiveness assessment was carried out. A systematic review of the literature was performed to obtain transition probabilities. In order to evaluate analysis robustness, one-way and probabilistic sensitivity analyses were conducted. Estimations were done for a 6-month period.</p> <p>Results</p> <p>Treatment demonstrating the best cost-effectiveness results [lowest cost-effectiveness ratio $17.5 pesos/patient ($1.75 USD)] was celecoxib. According to the one-way sensitivity analysis, celecoxib would need to markedly decrease its effectiveness in order for it to not be the optimal treatment option. In the probabilistic analysis, both in the construction of the acceptability curves and in the estimation of net economic benefits, the most cost-effective option was celecoxib.</p> <p>Conclusion</p> <p>From a Mexican institutional perspective and probably in other Social Security Institutions in similar developing countries, the most cost-effective option for treatment of knee and/or hip OA would be celecoxib.</p

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Surface enhanced Raman spectroscopy of phenolic antioxidants: A systematic evaluation of ferulic acid, p-coumaric acid, caffeic acid and sinapic acid

Surface-Enhanced Raman Spectroscopy (SERS) is a powerful surface-sensitive technique to study the vibrational properties of analytes at very low levels of concentration. In particular, detection of bioactive molecules, specifically antioxidants, is an area of interest to gain insights into the reproducible and quantitative SERS-determination. In this study, SERS measurements were systematically evaluated for ferulic acid, p-coumaric acid, caffeic acid and sinapic acid. The study objective in this research was to: 1) prepare and characterize SERS-active silver colloids; 2) cluster the as-obtained colloids through Principal Component Analysis on the basis of concentration and nanoparticle size; and 3) develop a highly sensitive SERS-based method for phenolic antioxidant detection. The reliability of the proposed method was demonstrated through detection of the phenolic antioxidants evaluated at low levels of concentration. In particular, sinapic acid was evaluated for the first time, with a limit of detection of 2.5 × 10−9 M.acceptedVersio

Surface enhanced Raman spectroscopy of phenolic antioxidants: A systematic evaluation of ferulic acid, p-coumaric acid, caffeic acid and sinapic acid

Surface-Enhanced Raman Spectroscopy (SERS) is a powerful surface-sensitive technique to study the vibrational properties of analytes at very low levels of concentration. In particular, detection of bioactive molecules, specifically antioxidants, is an area of interest to gain insights into the reproducible and quantitative SERS-determination. In this study, SERS measurements were systematically evaluated for ferulic acid, p-coumaric acid, caffeic acid and sinapic acid. The study objective in this research was to: 1) prepare and characterize SERS-active silver colloids; 2) cluster the as-obtained colloids through Principal Component Analysis on the basis of concentration and nanoparticle size; and 3) develop a highly sensitive SERS-based method for phenolic antioxidant detection. The reliability of the proposed method was demonstrated through detection of the phenolic antioxidants evaluated at low levels of concentration. In particular, sinapic acid was evaluated for the first time, with a limit of detection of 2.5\ua0×\ua010−9\ua0M. © 2017 The Author

El concepto de willingness-to-pay en tela de juicio O conceito de willingness to pay em questão The willingness-to-pay concept in question

La idoneidad del concepto de willingness to pay (disponibilidad a pagar) es revisado en las evaluaciones económicas que se realizan en el campo de la salud. Por un lado, existe dentro de la literatura económica un número importante de investigadores que señalan los múltiples problemas metodológicos que entrañan las estimaciones de willingness to pay. Por otro lado, aún el debate teórico-conceptual acerca de la agregación de las preferencias individuales dentro de una demanda agregada no ésta del todo resuelto. Sin embargo, durante los últimos 20 años la estimación de la disponibilidad a pagar dentro de las investigaciones económicas ha aumentado de forma significativa, siendo en muchos casos uno de los principales factores de la toma de decisión en políticas de salud. Plantease alguna de las limitaciones de esta técnica, así como el posible efecto distorsionador que podría tener sobre las evaluaciones económicas que se realizan en el área de la economía de la salud.São revisadas as limitações do uso do conceito de willingness to pay (disposição a pagar) nas avaliações econômicas que se realizam no campo da saúde. Há na literatura econômica muitos investigadores que assinalam os múltiplos problemas metodológicos inerentes às estimações de willingness to pay. Por outro lado, o debate teórico-conceitual acerca da agregação das preferências individuais dentro de uma demanda agregada não está totalmente resolvido. Contudo, durante os últimos 20 anos, a estimação da disposição a pagar calculada pelos estudos tem aumentado de forma significativa, sendo em muitos casos um dos principais fatores de tomada de decisão em políticas de saúde. São apresentadas algumas das limitações desta técnica, assim como o possível efeito de distorção que poderia ter sobre as avaliações econômicas em saúde.The adequacy of the concept of willingness to pay within health economics evaluations is reviewed. A considerable number of researchers in the literature have pointed out multiple methodological issues involving willingness-to-pay estimates. On the other hand, the theoretical discussion about the aggregation of individual preferences within an aggregate demand remains open. However, over the last 20 years, willingness-to-pay estimates alongside health economics research significantly increased and in many cases they are one of the key factors for decision making on issues of health policies. The article describes some limitations of this approach as well as the potential distorting effect that it might have on health economics evaluations