On the provision of global public goods : experimental evidence on climate change mitigation issues

Magdeburg, Univ., Fak. für Wirtschaftswiss., Diss., 2011

Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System

Background:Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial.Objective:To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective.Methods:We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied.Results:Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios.Conclusions:Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.

Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

AbstractBackground:Heart surgery has developed with increasing patient complexity.Objective:To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS).Method:All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups.Results:Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata.Conclusion:Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.

Negotiating cultural values in bi-national relationships : a comparative research on children from German-Chinese families

Magdeburg, Univ., Fak. für Geistes-, Sozial- und Erziehungswiss., Diss., 2012

Sulfur fractions and carbon-nitrogen-phosphorus-sulfur relationships in some Brazilian and Iowa soils

O atual conhecimento relativo à distribuição em percentagem das várias frações de enxofre nos solos provem principalmente dos estudos dos solos de regiões temperadas. Em vista disso, este estudo foi conduzido para determinar as frações do S e as relações C-N-P-S em alguns solos da região subtropical dos Estados de São Paulo e do Paraná, Brasil, e comparar estes valores nestes solos com aqueles nos solos do Estado de Iowa, dos Estados Unidos da América do Norte. As análises das frações de enxofre nos solos dos dois países, indicaram que os solos do Brasil contem sulfato inorgânico adsorvido. Expressos como percentagem do S total, os solos do Brasil acusaram de 5 a 23% (média 11%) de S-sulfato inorgânico, de 20 a 65% (média 40%) de S-ester sulfato, de 5 a 12% (média 7%) de S-ligado ao Carbono e de 24 a 59% (média 42%) de S orgânico não identificado. As percentagens correspondentes nos solos de Iowa foram de 2 a 8% (média 5%) de S-sulfato inorgânico, de 43 a 60% (média 50%) de S-ester sufato, de 7 a 18% (média 11%) de enxofre ligado ao carbono e de 30 a 39% (média 34%) de S orgânico, não identificado. Outrossim, não foi encontrado o enxofre inorgânico não-sulfato em nenhum dos solos analisados. Houve grandes variações nas relações C, N, Ρ e S entre solos brasileiros quando comparados com aqueles do Iowa.

Geographic variation and evolutionary relationships among broad-clawed shrews of the Cryptotis goldmani-group (Mammalia, Insectivora, Soricidae) / Neal Woodman, Robert M. Timm.

n.s. no.91(1999)

The differentiation of character state relationships by binary coding and the monothetic subset method / Hymen Marx, George B. Rabb and Harold K. Voris.

v.72:no.1(1977)

Relationships among the living genera of beaked whales with classifications, diagnoses, and keys. a selection from the collection of Mr. and Mrs. Harold G. Duckworth. [Exhibition] December 1, 1968-January 12, 1969.

v.53:no.4(1968)

The larval characters of featherwing and limulodid beetles and their family relationships in the Staphylinoidea (Coleoptera : Ptiliidae and Limulodidae) / Henry S. Dybas.

v.70:no.3(1976)

The red ocher culture of the upper Great Lakes and adjacent areas / Robert E. Ritzenthaler, Curator of Anthropology, Milwaukee Public Museum, and George I. Quimby, Curator of North American Archaeology and Ethnology, Chicago Natural History Museum.

v.36:no.11(1962)

Structural features and phylogenetic relationships among larvae of genera of gyrophaenine staphylinids (Coleoptera: Staphylinidae: Aleocharinae) / James S. Ashe.

n.s. no.30(1986)

Vocalizations and comments on the relationships of Hypsiboas ericae (Amphibia, Hylidae)

The vocalizations of Hypsiboas ericae (Caramaschi & Cruz, 2000) are described and new information on the external morphology and osteology of the species are presented. H. ericae presents a bony spine in the prepolex and the individuals can present green or brown dorsal color, as other species of the Hypsiboas pulchellus (Duméril & Bibron, 1841) species group. The vocalizations of H. ericae are similar to the vocalizations of Hypsiboas bischoffi (Boulenger, 1887), Hypsiboas guentheri (Boulenger, 1886), and other species in the H. polytaenius (Cope, 1870 "1869") clade of the H. pulchellus species group, but some osteological aspects are different to those found in the majority of the species of this group.

Osteology of Simosaurus gaillardoti and the relationships of stem-group Sauropterygia / Olivier Rieppel --.

n.s. no.28(1992)

The South American gracile mouse opossums, genus Gracilinanus Gardner and Creighton, 1989 (Marmosidae, Marsupialia) : a taxonomic review with notes on general morphology and relationships / Philip Hershkovitz.

n.s. no.70(1992)