Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system

Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private health system Objectives: To compare costs and clinical benefits of three additional therapies to metformin (MF) for patients with diabetes mellitus type 2 (DM2). Methods: A discrete event simulation model seas built to estimate the cost-utility ratio (cost per quality-adjusted life years [QALY)) of saxagliptine as an additional therapy to MF when compared to rosiglitazone or pioglitazone. A budget impact model (BIM) was built to simulate the economic impact of saxagliptine use in the context of the Brazilian private health system. Results: The acquiring medication costs for the hypothetical patient group analyzed in a time frame of three years, were R$ 10,850,185, R$ 14,836,265 and R$ 14,679,099 for saxagliptine, pioglitazone and rosiglitazone, respectively. Saxagliptine showed lower costs and greater effectiveness in both comparisons, with projected savings for the first three years of R$ 3,874 and R$ 3,996, respectively. The BIM estimated cumulative savings of R$ 417,958 with the repayment of saxagliptine in three years from the perspective of a health plan with 1,000,000 covered individuals. Conclusion: From the perspective of private paying source, the projection is that adding saxagliptine with MF save costs when compared with the addition of rosiglitazone or pioglitazone in patients with DM2 that have not reached the HbA1c goal with metformin monotherapy. The BIM of including saxagliptine in the reimbursement lists of health plans indicated significant savings on the three-year horizon.

Groundwater resources in Brazil: a review of possible impacts caused by climate change

Groundwater has a strategic role in times of climate change mainly because aquifers can provide water for long periods, even during very long and severe drought. The reduction and/or changes on the precipitation pattern can diminish the recharge mainly in unconfined aquifer, causing available groundwater restriction. The expected impact of long-term climate changes on the Brazilian aquifers for 2050 will lead to a severe reduction in 70% of recharge in the Northeast region aquifers (comparing to 2010 values), varying from 30% to 70% in the North region. Data referring to the South and Southeast regions are more favorable, with an increase in the relative recharge values from 30% to 100%. Another expected impact is the increase in demand and the decrease in the surface water availability that will make the population turn to aquifers as its main source of water for public or private uses in many regions of the country. Thus, an integrated use of surface and groundwater must therefore be considered in the water use planning. The solution of water scarcity is based on three factors: society growth awareness, better knowledge on the characteristics of hydraulic and chemical aquifers and effective management actions.

Small-scale landfills: impacts on groundwater and soil

In Brazil, the large quantities of solid waste produced are out of step with public policies, technological developments, and government budgets for the division. In small municipalities, the common lack of technological knowledge and financial conditions for suitable waste disposal has resulted in a large number of illegal dumps. Therefore, small sanitary landfill facilities are working with simplified operations focusing on cost reduction and meeting the economic and technological standards of the city without endangering the environment or public health. Currently, this activity is regulated at a federal level although there is some uncertainty regarding the risk of soil and aquifer contamination as theses facilities do not employ liners. Thus, this work evaluates a small landfill to identify changes in soil and groundwater using geotechnical parameters, monitoring wells, and geophysical tests performed by electrical profiling. It is verified that based on current conditions, no contaminants have migrated via underground water aquifers, and overall no significant changes have occurred in the soil. It is concluded that, despite its simplicity, the method investigated is a viable alternative for the final disposal of municipal solid waste from small cities, especially in developing countries.