Cost-effectiveness analysis of preventive methods for occlusal surface according to caries risk: results of a controlled clinical trial

This study presents the results of a cost-effectiveness analysis in a controlled clinical trial on the effectiveness of a modified glass ionomer resin sealant ( Vitremer, 3M ESPE) and the application of fluoride varnish (Duraphat, Colgate) on occlusal surfaces of first permanent molars in children 6-8 years of age (N = 268), according to caries risk (high versus low). Children were examined semiannually by the same calibrated dentist for 24 months after allocation in six groups: high and low risk controls (oral health education every three months); high and low risk with varnish (oral health education every three months + varnish biannually); and high and low risk with sealant (oral health education every three months + a single application of sealant). Economic analysis showed that sealing permanent first molars of high-risk schoolchildren showed a C/E ratio of US$119.80 per saved occlusal surface and an incremental C/E ratio of US$ 108.36 per additional saved occlusal surface. The study concluded that sealing permanent first molars of high-risk schoolchildren was the most cost-effective intervention.Este estudo apresenta o resultado de uma avaliação de custo-efetividade conduzida ao longo de um ensaio clínico controlado para avaliar a efetividade do selamento com ionômero de vidro modificado por resina (Vitremer, 3M ESPE) e da aplicação de verniz fluoretado (Duraphat, Col-gate) em superfícies oclusais de primeiros molares permanentes, em crianças de 6 a 8 anos (N = 268), segundo o risco de cárie (alto risco; baixo risco). As crianças foram examinadas semestralmente, ao longo de 24 meses, pelo mesmo dentista calibrado, após alocação em seis grupos: controle alto risco e baixo risco (educação em saúde bucal trimestral); verniz alto risco e baixo risco (educação em saúde bucal trimestral + aplicação semestral de verniz); e selante alto risco e baixo risco (educação em saúde bucal trimestral + única aplicação do selante). A análise mostrou que o selamento de primeiros molares permanentes em crianças de alto risco apresentou razão de C/E de R$225,21(US$ 119,80) por superfície oclusal salva, e razão incremental de C/E de R$203,71(US$ 108,36) por superfície oclusal adicional salva. Conclui-se que uma única aplicação de selante, em escolares de alto risco, foi a intervenção mais custo-efetiva.En este estudio se presentan los resultados de una evaluación de costo-efectividad (C/E) durante un ensayo clínico controlado para evaluar la efectividad de la obturación con ionómero de vidrio modificado con resina (Vitremer, 3M ESPE) y la aplicación de barniz de flúor (Duraphat, Colgate) en las superficies oclusales de los primeros molares permanentes, para niños de 6-8 años (N = 268) de edad, de acuerdo con el riesgo de caries (alto riesgo-bajo riesgo). Los niños fueron examinados cada seis meses por el mismo dentista calibrado, durante 24 meses, después de haberle sido asignados seis grupos: control alto riesgo y bajo riesgo (educación de salud bucal cada tres meses); barniz alto riesgo y bajo riesgo (educación de salud bucal cada tres meses + barniz semestralmente); obturación alto riesgo y bajo riesgo (educación de salud bucal cada tres meses + una sola aplicación de ionómero de vidrio). El análisis económico mostró que la obturación de los primeros molares permanentes de escolares de alto riesgo presenta una relación C/E de US$119.80 de ahorro por superficie oclusal y una ratio C/E incremental de US$ 108.36 de ahorro adicional por superficie oclusal.s121s130Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

The study of vancomycin use and its adverse reactions associated to patients of a brazilian university hospital

<p>Abstract</p> <p>Background</p> <p>Vancomycin is an antibiotic of growing importance in the treatment of hospital infections, with particular emphasis on its value in the fight against methicillin-resistant <it>Staphylococcus aureus</it>. However its usage profile must be evaluated to assure maximum benefit and minimum risk.</p> <p>Findings</p> <p>A cross-sectional retrospective study was carried out among inpatients that received vancomycin in a Brazilian quaternary hospital. The occurrence of adverse reactions reported was evaluated in medical records relating to patients taking vancomycin during a one year period. Males comprised 52% (95% CI: 41.7-60.2%) of the sample population, with a mean age of 50.6 (95% CI: 47.2-54.0) years and mean treatment period of 9.7 (95% CI: 8.0-11.5) Days. It was verified that nephrotoxicity occurred in 18.4% (95% CI: 11.3-27.5) of patients, Red man syndrome occurred in 2% (95% CI 0.2-7.2), while the occurrence of thrombocytopenia was 7.1% (95% CI: 2.9-14.2).</p> <p>Conclusions</p> <p>It may be noted that even after 50 years of use, adverse reactions associated with vancomycin continue with high frequency, presenting a public health problem, especially considering its current use in cases of multidrug resistant infections. In this context, we emphasize the importance of intensive pharmacovigilance in hospital as a surveillance tool after drug approval by the sanitary authority.</p

Study of the main adverse drug reaction related to vancomicyn

Made available in DSpace on 2014-11-14T10:57:10Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 139.pdf: 852207 bytes, checksum: a570ff508bbaffc876e85d9b7e39c86c (MD5) Previous issue date: 2005Fundação Oswaldo Cruz. Instituto Nacional de Controle de Qualidade em SaúdeEste estudo foi realizado com o intuito de avaliar a prevalência das principais reações adversas à vancomicina. A metodologia utilizada se baseou em um estudo seccional retrospectivo, analisando 131 prontuários de pacientes do HUCFF/UFRJ que utilizaram vancomicina durante o período de um ano, sendo analisados efetivamente 98 pacientes devido aos critérios de exclusão. Destes 98 pacientes, 27 (27,6 por cento) apresentaram algum tipo de reação adversa à vancomicina; 18 (18,4 por cento) apresentaram insuficiência renal, 7 (7,1 por cento) apresentaram trombocitopenia, 2 (2 por cento) apresentaram neutropenia, 2 (2 por cento) apresentaram a Síndrome do Homem Vermelho e 1 (1 por cento) apresentou ototoxicidade. A causalidade destas reações adversas foi avaliada pelos algoritmos de Naranjo & col. e de Lasagna & col., analisando também a aplicabilidade comparativa dos mesmos para a detecção destas reações adversas. Como principal conclusão deste estudo destaca-se a constatação que mesmo após 50 anos de utilização da vancomicina, das alterações no processo de purificação desta, as reações adversas a este fármaco permanecem com elevada ocorrência, mostrando-se como um problema de saúde pública a ser resolvido, ressaltando a importância da farmacovigilância como ferramenta de controle pós registro de medicamentos.The present project was performed to evaluate the main adverse drug reaction prevalence related to vancomicyn. The methodology employed was a cross seccional study using 131 charts of patients treated with vancomicyn in Hospital Universitário Clementino Fraga Filho. In fact only 98 patients filled the inclusion criteria, and were analyzed. 27 patients (27.6%) showed some kind of adverse drug reaction to vancomicyn, of whom 18 (18.4%) showed renal impairment, 2 (2%) showed Neutropenia, 2 (2%) showed red man syndrome, 1 (1%) showed ototoxicity, and 7 (7.1%) showed thrombocytopenia. The cause-effect relationships of these adverse drug reactions were determinated by Naranjo et al. and Lasagna et al. algorithms. These algorithms were also analyzed for their comparative applicability on the detection of theses adverse drug reactions. The main conclusion was that after 50 year of using this drug, the new purification process, adverse drug reactions due to vancomycin still with high occurrence and by this way continue to be a permanent health problem that needs to be solved

Mapping potential risks for the transmission of spotted fever rickettsiosis: The case study from the Rio de Janeiro state, Brazil.

Spotted fever rickettsiosis is a zoonosis transmitted by ticks, having a varied clinical course that can lead to death if not managed properly. In Brazil it is more commonly observed in the Southeast, being an emerging public health problem. Hazard mapping models are common in different areas of knowledge, including public health, as a way of inferring reality and seeking to reduce or prevent damage. The aim of this study is to offer a spatial heuristic methodology for assessing the potential risk of transmission of spotted fever in the Rio de Janeiro state, located in the southeastern region of Brazil. For this, we used geospatial tools associated with eco-epidemiological data related to the clinical profile of the disease. The results achieved were substantially encouraging, considering that there are territories with greater or lesser expectation of risk for spotted fever in the study area. We observed that there are important distinctions between the two rickettsiosis scenarios in the same geographic space and that the areas where there is a greater potential risk of contracting rickettsiosis coincide with the administrative regions that concentrated the cases of hospitalization and deaths from the disease, concluding that the scenery found are relevant to the case series for the disease and that the planning of surveillance actions can gain in quality if the use of this spatial analysis tool is incorporated into the routine of local health management

Multi-user equipment, core-facilities and technological platforms: the evolution of organizational strategies for translational health research

This paper examines how institutions organize and manage the research and development (R&amp;D) infrastructure and facilities required to stimulate innovation and convert research into practical applications (`translational research'). We have focused our analysis on universities and biomedical institutions that have created dedicated facilities to optimize this type of activity either working in isolation or in partnership with the industrial sector. We have detected three main types of infrastructure arrangements: multi-user equipment, core facilities and technological platforms. Although most of the institutions share a common vision and definition for the first two categories, we have identified different perceptions on the nature, role and mission of existing, self denominated `technological platforms'. A review of these structures has led us to propose a unifying categorization and nomenclature system of these critical components of health innovation systems. Based on this conceptual framework we have analyzed the evolution of organizational R&amp;D structures and initiatives of Fiocruz and developed a web-based system for the strategic planning, implementation and management of its network of translational research facilities located in several cities in Brazil. This approach may prove useful for organizations facing similar transitions and challenges.This paper examines how institutions organize and manage the research and development (R&amp;D) infrastructure and facilities required to stimulate innovation and convert research into practical applications (‘translational research’). We have focused our analysis on universities and biomedical institutions that have created dedicated facilities to optimize this type of activity either working in isolation or in partnership with the industrial sector. We have detected three main types of infrastructure arrangements: multi-user equipment, corefacilities and technological platforms. Although most of the institutions share a common vision and definition for the first two categories, we have identified different perceptions on the nature, role and mission of existing, self denominated ‘technological platforms’. A review of these structures has led us to propose a unifying categorization and nomenclature system of these critical components of health innovation systems. Based on this conceptual framework we have analyzed the evolution of organizational R&amp;D structures and initiatives of Fiocruz and developed a web-based system for the strategic planning, implementation and management of its network of translational research facilities located in several cities in Brazil. This approach may prove useful for organizations facing similar transitions and challenge

Cost-effectiveness of diagnostic and therapeutic interventions for chronic hepatitis C: a systematic review of model-based analyses

Abstract Background Decisions about which subgroup of chronic hepatitis C (CHC) patients should be treated with direct acting anti-viral agents (DAAs) have economic importance due to high drug prices. Treat-all DAA strategies for CHC have gained acceptance despite high drug acquisition costs. However, there are also costs associated with the surveillance of CHC to determine a subgroup of patients with significant impairment. The aim of this systematic review was to describe the modelling methods used and summarise results in cost-effectiveness analyses (CEAs) of both CHC treatment with DAAs and surveillance of liver disease. Methods Electronic databases including Embase and Medline were searched from inception to May 2015. Eligible studies included models predicting costs and/or outcomes for interventions, surveillance, or management of people with CHC. Narrative and quantitative synthesis were conducted. Quality appraisal was conducted using validated checklists. The review was conducted following principles published by NHS Centre for Research and Dissemination. Results Forty-one CEAs met the eligibility criteria for the review; 37 evaluated an intervention and four evaluated surveillance strategies for targeting DAA treatment to those likely to gain most benefit. Included studies were of variable quality mostly due to reporting omissions. Of the 37 CEAs, eight models that enabled comparative analysis were fully appraised and synthesized. These models provided non-unique cost-effectiveness estimates in a specific DAA comparison in a specific population defined in terms of genotype, prior treatment status, and presence or absence of cirrhosis. Marked heterogeneity in cost-effectiveness estimates was observed despite this stratification. Approximately half of the estimates suggested that DAAs were cost-effective considering a threshold of US$30,000 and 73$50,000. Two models evaluating surveillance strategies suggested that treating all CHC patients regardless of the staging of liver disease could be cost-effective. Conclusions CEAs of CHC treatments need to better account for variability in their estimates. This analysis suggested that there are still circumstances where DAAs are not cost-effective. Surveillance in place of a treat-all strategy may still need to be considered as an option for deploying DAAs, particularly where acquisition cost is at the limit of affordability for a given health system

Análise de custo-efetividade de métodos preventivos para superfície oclusal de acordo com o risco de cárie: resultados de um ensaio clínico controlado

This study presents the results of a cost-effectiveness analysis in a controlled clinical trial on the effectiveness of a modified glass ionomer resin sealant ( Vitremer, 3M ESPE) and the application of fluoride varnish (Duraphat, Colgate) on occlusal surfaces of first permanent molars in children 6-8 years of age (N = 268), according to caries risk (high versus low). Children were examined semiannually by the same calibrated dentist for 24 months after allocation in six groups: high and low risk controls (oral health education every three months); high and low risk with varnish (oral health education every three months + varnish biannually); and high and low risk with sealant (oral health education every three months + a single application of sealant). Economic analysis showed that sealing permanent first molars of high-risk schoolchildren showed a C/E ratio of US$119.80 per saved occlusal surface and an incremental C/E ratio of US$ 108.36 per additional saved occlusal surface. The study concluded that sealing permanent first molars of high-risk schoolchildren was the most cost-effective intervention.Este estudo apresenta o resultado de uma avaliação de custo-efetividade conduzida ao longo de um ensaio clínico controlado para avaliar a efetividade do selamento com ionômero de vidro modificado por resina (Vitremer, 3M ESPE) e da aplicação de verniz fluoretado (Duraphat, Col-gate) em superfícies oclusais de primeiros molares permanentes, em crianças de 6 a 8 anos (N = 268), segundo o risco de cárie (alto risco; baixo risco). As crianças foram examinadas semestralmente, ao longo de 24 meses, pelo mesmo dentista calibrado, após alocação em seis grupos: controle alto risco e baixo risco (educação em saúde bucal trimestral); verniz alto risco e baixo risco (educação em saúde bucal trimestral + aplicação semestral de verniz); e selante alto risco e baixo risco (educação em saúde bucal trimestral + única aplicação do selante). A análise mostrou que o selamento de primeiros molares permanentes em crianças de alto risco apresentou razão de C/E de R$225,21(US$ 119,80) por superfície oclusal salva, e razão incremental de C/E de R$203,71(US$ 108,36) por superfície oclusal adicional salva. Conclui-se que uma única aplicação de selante, em escolares de alto risco, foi a intervenção mais custo-efetiva.En este estudio se presentan los resultados de una evaluación de costo-efectividad (C/E) durante un ensayo clínico controlado para evaluar la efectividad de la obturación con ionómero de vidrio modificado con resina (Vitremer, 3M ESPE) y la aplicación de barniz de flúor (Duraphat, Colgate) en las superficies oclusales de los primeros molares permanentes, para niños de 6-8 años (N = 268) de edad, de acuerdo con el riesgo de caries (alto riesgo-bajo riesgo). Los niños fueron examinados cada seis meses por el mismo dentista calibrado, durante 24 meses, después de haberle sido asignados seis grupos: control alto riesgo y bajo riesgo (educación de salud bucal cada tres meses); barniz alto riesgo y bajo riesgo (educación de salud bucal cada tres meses + barniz semestralmente); obturación alto riesgo y bajo riesgo (educación de salud bucal cada tres meses + una sola aplicación de ionómero de vidrio). El análisis económico mostró que la obturación de los primeros molares permanentes de escolares de alto riesgo presenta una relación C/E de US$119.80 de ahorro por superficie oclusal y una ratio C/E incremental de US$ 108.36 de ahorro adicional por superficie oclusal