The direct and indirect costs of breast cancer in Poland : estimates for 2017 - 2019

Background: In Poland, breast cancer (BC) is the most frequently diagnosed cancer in women and the second most common cause of death after lung cancer. This disease has important economic implications for patients, public payers, and the whole Polish economy. This study aimed to estimate the total National Health Fund (NHF) expenditures on the diagnosis and treatment of patients with breast cancer. In addition, the costs of productivity losses were also calculated. Methods: Cost estimation was prepared using a top-down approach. Direct cost calculations were based on data reported by NHF for patients with the diagnosis of breast cancer. Medical care costs included the following components: screening program, oncological package, surgical treatment, hospitalization, drug program, chemotherapy, radiotherapy, and outpatient care. Indirect costs in the form of absenteeism costs were calculated based on data from Statistics Poland (gross domestic product, number of employees) and the Social Insurance Institution database (the number of sick leave days). Results: Total expenditures for BC including direct costs and indirect costs amounted to EUR 305,371, EUR 332,998, and EUR 344,649, respectively in 2017, 2018, and 2019. Total healthcare costs in 2019 were EUR 4114 lower than in 2018, which resulted from the reduction in expenditure on the drug program (decrease of EUR 13,527), despite the observed increase in all remaining resources. From direct costs, the highest expense was spent on the drug program (nearly 50% of total direct costs), but this expense dropped significantly in 2019. For the remaining parameters, the costs increased year by year, of which the most expensive were surgical treatment (15%), radiotherapy (12%), and the screening program (10%). BC generated over EUR 120 thousand of social costs in 2019 and compared to 2017, there was an increase in productivity loss by 26%. Conclusions: Our results from 2017–2019 demonstrated that total expenditure for BC in Poland increased from year to year. Breast cancer generated almost EUR 345 thousand expenses in 2019, which translates into a significant burden on the public payer’s budget and the society in Poland

Microambientes e conservação preventiva em áreas indoor: o caso do espaço interior não climatizado da Casa de Dona Yayá, em São Paulo (Brasil)

Neste artigo, buscou-se resgatar criticamente o histórico do processo de consolidação da noção de conservação preventiva de bens culturais materiais baseada em controle ambiental e expor uma síntese do estado da arte dos conhecimentos sobre a ação dos agentes ambientais nos processos de degradação física, química e biológica dos materiais que tipicamente compõem tais bens. A discussão, desenvolvida principalmente na perspectiva de recintos interiores de instituições envolvidas na preservação da cultura material, perpassou por uma reflexão sobre o conceito de microambientes e microclimas e sobre a conveniência de sua afirmação na abordagem do problema. Os temas tratados foram contextualizados mediante o estudo do caso específico das áreas interiores da Casa de Dona Yayá, em São Paulo, no qual foram apresentadas e debatidas algumas possibilidades de atuação no processo de caracterização dos espaços indoor, suas potencialidades e limitações.This paper makes a critical assessment of the historical consolidation process of the notion of preventive conservation of tangible cultural heritage based on environmental control. Within this aim, a summary of the state-of-the-art of the knowledge on the role of environmental factors in the physical, chemical and biological degradation of the materials that typically compose such artefacts is also presented. The discussion, focused on the perspective of indoor areas of institutions concerned with cultural preservation, encompassed a number of considerations on the concept of microenvironment and microclimate and on the adequacy of their assertion in the approach to the problem. The topics were contextualised through the specific case-study of the indoor areas of the historical building Casa da Dona Yayá (Sao Paulo, Brazil), in which some of the characterisation possibilities, their potentials and limitations, were highlighted and debated