Acidentes de motocicleta em Paranavaí-PR: uma análise para o Sistema Único de Saúde e para o DPVAT

O presente trabalho visa caracterizar os acidentes com envolvimento de motocicletas no perímetro urbano de Paranavaí-PR, em 2007, e estimar o impacto econômico das internações advindas destes, na perspectiva do Sistema Único de Saúde (SUS) e para o Seguro obrigatório que cobre danos pessoais causados por veículos automotores de via terrestre (DPVAT). Trata-se de um estudo transversal, retrospectivo, que se baseia em buscas e análises das bases de dados do Serviço integrado de atendimento ao trauma e emergência (SIATE), do DPVAT e do Sistema de informações sobre internações do SUS (SIH-SUS), com vias a análise das variáveis: gênero, idade, tipo de acidente, condição da vítima no acidente, mês da ocorrência, gravidade, frequência de internação hospitalar, custo, componentes de custo, óbitos e tempo médio de permanência no SUS. A busca ocorreu, primeiramente, no sistema do SIATE para conhecer todos os acidentados com envolvimento de motocicletas no perímetro urbano de Paranavaí, no ano de 2007. De posse desses nomes, as buscas seguintes ocorreram no sistema interno do DPVAT e no SIH-SUS. O profissional do SIATE, no momento da abordagem da ocorrência julga a gravidade da vítima conforme códigos, sendo 1 para ferimentos leves, 2 para graves sem risco à vida, 3, graves com risco à vida e 4, os óbitos. A população estudada constou de 655 vítimas (440 homens e 215 mulheres), com média de idade de 29,5 anos, sendo que 598 (91,3%) saíram lesionadas e 11 (1,7%) vieram a óbito. O condutor de motocicleta foi o mais acometido e o tipo de acidente mais comum aconteceu entre um automóvel e uma motocicleta. Com relação à frequência da internação hospitalar (pelo SUS, DPVAT ou ambos), foi, em média, de 27% (177 de 655). Do total de vítimas internadas verificou-se que 106 tiveram cobertura do DPVAT, 58 do SUS e 13 de ambos. As internações pelo DPVAT geraram um custo total de R$ 191.423,43, custo médio de R$ 1.608,60 por internação. Com relação aos custos das internações do SUS, os referidos acidentes geraram o pagamento de R$ 42.342,20, perfazendo a média de R$ 450,44 por AIH e de R$ 596,37 por paciente. O custo médio da internação dos acidentes de trânsito com envolvimento de motocicletas foi de R$ 1.321,00, sendo que para o código 1 foi de R$ 885,00, para o código 2 de R$ 1.377,00 e para o código 3 de R$ 2.034,00. Portanto, foi possível caracterizar os acidentes e chegar a estimativas de quanto se gasta com as internações advindas destes, além disso, este é um indicativo claro da necessidade de adotar políticas públicas que priorizem a aplicação dos recursos financeiros e humanos na redução dos acidentes e da sua gravidade.

Programa Aqui tem Farmácia Popular: expansão entre 2006-2012 e comparação com os custos da assistência farmacêutica na Secretaria Municipal de Saúde do Rio de Janeiro

Em 2004 o governo federal anunciou um novo mecanismo para melhorar o acesso da população brasileira aos medicamentos, chamado de "Programa Farmácia Popular do Brasil" (PFPB) que disponibiliza um rol de produtos subsidiados pelo governo, utilizando ou não sistema de copagamento. O PFPB está dividido em três vertentes: (a) no setor público, chamada Rede Própria; (b) expansão em 2006, com o comércio farmacêutico denominado "Aqui Tem Farmácia Popular" (ATFP) e; (c) isenção de copagamento, em 2011, em todas as farmácias no âmbito do Programa, para anti-hipertensivos, antidiabéticos e antiasmáticos. Este estudo examinou o modelo de provisão de medicamentos na versão ATFP, comparando-o ao tradicionalmente praticado na Secretaria Municipal de Saúde do Rio de Janeiro (SMS-Rio), com vistas a avaliar seus custos para os setores públicos envolvidos. Foram levantados os gastos do Ministério da Saúde (MS) com pagamentos no Programa ATFP em fontes secundárias, como o Fundo Nacional de Saúde e a Sala de Apoio à Gestão Estratégica, de 2006 a 2012. Dados sobre o volume de pagamentos por medicamentos, perfil dos usuários atendidos e unidades farmacotécnicas (UF) dispensadas foram mapeados por contato direto com o Sistema Eletrônico do Serviço de Informações ao Cidadão. Estimativas dos custos da SMS-Rio, com aquisição, logística e dispensação de 25 medicamentos, restritas ao ano de 2012, foram realizadas. No período ocorreu forte expansão do Programa ATFP, tanto de unidades credenciadas, como de municípios cobertos, de 750% e 528%, respectivamente. Gastos federais com medicamentos no ATFP foram de aproximadamente R$ 3,4 bilhões, em valores ajustados para 31/12/2012. Houve inversão do fluxo dos pagamentos para entidades com matriz fora das capitais, representando aumento da capilaridade do Programa, e relativa concentração de pagamentos em grandes redes varejistas. No município do Rio de Janeiro, estes gastos foram superiores a R$ 260 milhões e, desde 2008, são maiores que as transferências do MS para aquisição de medicamentos básicos. Custos comparativos entre o menor Valor de Referência (VR) do Programa ATFP, e o custo estimado por UF na SMS-Rio dos medicamentos mostrou-se, na média geral, quase 255% vezes maior que o custo municipal. A comparação de custo foi mais favorável à SMS-Rio em 20 dos 25 itens comuns. Simulação considerando a demanda de cada medicamento consumido pela SMS-Rio em 2012 mostrou que, se a municipalidade os adquirisse pelo menor VR, incorreria em mais de R$ 95 milhões no custo global para os mesmos 25 produtos. O programa ministerial representou melhoria no acesso a medicamentos, mas os gastos expressivos repercutem em sua interface com o sistema descentralizado de financiamento da assistência farmacêutica. Alguns dos VR poderiam ser objetos de exame e avaliação, frente aos custos sistematicamente mais favoráveis nos valores levantados para a SMS-Rio.

Economic valuation of natural resources: a handbook for coastal resource policymakers

Professionals who are responsible for coastal environmental and natural resource planning and management have a need to become conversant with new concepts designed to provide quantitative measures of the environmental benefits of natural resources. These amenities range from beaches to wetlands to clean water and other assets that normally are not bought and sold in everyday markets. At all levels of government — from federal agencies to townships and counties — decisionmakers are being asked to account for the costs and benefits of proposed actions. To non-specialists, the tools of professional economists are often poorly understood and sometimes inappropriate for the problem at hand. This handbook is intended to bridge this gap. The most widely used organizing tool for dealing with natural and environmental resource choices is benefit-cost analysis — it offers a convenient way to carefully identify and array, quantitatively if possible, the major costs, benefits, and consequences of a proposed policy or regulation. The major strength of benefit-cost analysis is not necessarily the predicted outcome, which depends upon assumptions and techniques, but the process itself, which forces an approach to decision-making that is based largely on rigorous and quantitative reasoning. However, a major shortfall of benefit-cost analysis has been the difficulty of quantifying both benefits and costs of actions that impact environmental assets not normally, nor even regularly, bought and sold in markets. Failure to account for these assets, to omit them from the benefit-cost equation, could seriously bias decisionmaking, often to the detriment of the environment. Economists and other social scientists have put a great deal of effort into addressing this shortcoming by developing techniques to quantify these non-market benefits. The major focus of this handbook is on introducing and illustrating concepts of environmental valuation, among them Travel Cost models and Contingent Valuation. These concepts, combined with advances in natural sciences that allow us to better understand how changes in the natural environment influence human behavior, aim to address some of the more serious shortcomings in the application of economic analysis to natural resource and environmental management and policy analysis. Because the handbook is intended for non-economists, it addresses basic concepts of economic value such as willingness-to-pay and other tools often used in decision making such as costeffectiveness analysis, economic impact analysis, and sustainable development. A number of regionally oriented case studies are included to illustrate the practical application of these concepts and techniques.

Marine eutrophication review. Part 1: Quantifying the effects of nitrogen enrichment on phytoplankton in coastal ecosystems; Part 2: Bibliography with abstracts

Professionals who are responsible for coastal environmental and natural resource planning and management have a need to become conversant with new concepts designed to provide quantitative measures of the environmental benefits of natural resources. These amenities range from beaches to wetlands to clean water and other assets that normally are not bought and sold in everyday markets. At all levels of government — from federal agencies to townships and counties — decisionmakers are being asked to account for the costs and benefits of proposed actions. To non-specialists, the tools of professional economists are often poorly understood and sometimes inappropriate for the problem at hand. This handbook is intended to bridge this gap. The most widely used organizing tool for dealing with natural and environmental resource choices is benefit-cost analysis — it offers a convenient way to carefully identify and array, quantitatively if possible, the major costs, benefits, and consequences of a proposed policy or regulation. The major strength of benefit-cost analysis is not necessarily the predicted outcome, which depends upon assumptions and techniques, but the process itself, which forces an approach to decision-making that is based largely on rigorous and quantitative reasoning. However, a major shortfall of benefit-cost analysis has been the difficulty of quantifying both benefits and costs of actions that impact environmental assets not normally, nor even regularly, bought and sold in markets. Failure to account for these assets, to omit them from the benefit-cost equation, could seriously bias decisionmaking, often to the detriment of the environment. Economists and other social scientists have put a great deal of effort into addressing this shortcoming by developing techniques to quantify these non-market benefits. The major focus of this handbook is on introducing and illustrating concepts of environmental valuation, among them Travel Cost models and Contingent Valuation. These concepts, combined with advances in natural sciences that allow us to better understand how changes in the natural environment influence human behavior, aim to address some of the more serious shortcomings in the application of economic analysis to natural resource and environmental management and policy analysis. Because the handbook is intended for non-economists, it addresses basic concepts of economic value such as willingness-to-pay and other tools often used in decision making such as costeffectiveness analysis, economic impact analysis, and sustainable development. A number of regionally oriented case studies are included to illustrate the practical application of these concepts and techniques.

Feasibility of combined wind-wave energy platforms

The European Union has set out an ambitious 20% target for renewable energy use by 2020. It is expected that this will be met mainly by wind energy. Looking towards 2050, reductions in greenhouse gas emissions of 80-95% are to be sought. Given the issues securing this target in the transport and agriculture sectors, it may only be possible to achieve this target if the power sector is carbon neutral well in advance of 2050. This has permitted the vast expansion of offshore renewables, wind, wave and tidal energy. Offshore wind has undergone rapid development in recent years however faces significant challenges up to 2020 to ensure commercial viability without the need for government subsidies. Wave energy is still in the very early stages of development so as yet there has been no commercial roll out. As both of these technologies are to face similar challenges in ensuring they are a viable alternative power generation method to fossil fuels, capitalising on the synergies is potentially a significant cost saving initiative. The advent of hybrid solutions in a variety of configurations is the subject of this thesis. A singular wind-wave energy platform embodies all the attributes of a hybrid system, including sharing space, transmission infrastructure, O&M activities and a platform/foundation. This configuration is the subject of this thesis, and it is found that an OWC Array platform with multi-MegaWatt wind turbines is a technically feasible, and potentially an economically feasible solution in the long term. Methods of design and analysis adopted in this thesis include numerical and physical modelling of power performance, structural analysis, fabrication cost modelling, simplified project economic modelling and time domain reliability modelling of a 210MW hybrid farm. The application of these design and analysis methods has resulted in a hybrid solution capable of producing energy at a cost between €0.22/kWh and €0.31/kWh depending on the source of funding for the project. Further optimisation through detailed design is expected to lower this further. This thesis develops new and existing methods of design and analysis of wind and wave energy devices. This streamlines the process of early stage development, while adhering to the widely adopted Concept Development Protocol, to develop a technically and economically feasible, combined wind-wave energy hybrid solution.

Burning a hole in the budget: tobacco spending and its crowd-out of other goods.

Smoking is an expensive habit. Smoking households spend, on average, more than $US1000 annually on cigarettes. When a family member quits, in addition to the former smoker's improved long-term health, families benefit because savings from reduced cigarette expenditures can be allocated to other goods. For households in which some members continue to smoke, smoking expenditures crowd-out other purchases, which may affect other household members, as well as the smoker. We empirically analyse how expenditures on tobacco crowd-out consumption of other goods, estimating the patterns of substitution and complementarity between tobacco products and other categories of household expenditure. We use the Consumer Expenditure Survey data for the years 1995-2001, which we complement with regional price data and state cigarette prices. We estimate a consumer demand system that includes several main expenditure categories (cigarettes, food, alcohol, housing, apparel, transportation, medical care) and controls for socioeconomic variables and other sources of observable heterogeneity. Descriptive data indicate that, comparing smokers to nonsmokers, smokers spend less on housing. Results from the demand system indicate that as the price of cigarettes rises, households increase the quantity of food purchased, and, in some samples, reduce the quantity of apparel and housing purchased.

Spending on postapproval drug safety.

Withdrawals of high-profile pharmaceuticals have focused attention on post-approval safety surveillance. There have been no systematic assessments of spending on postapproval safety. We surveyed drug manufacturers regarding safety efforts. Mean spending on postapproval safety per company in 2003 was 56 million dollars (0.3 percent of sales). Assuming a constant safety-to-sales ratio, we estimated that total spending on postapproval safety by the top twenty drug manufacturers was 800 million dollars in 2003. We also examined, using regression analysis, the relationship between the number of safety personnel and the number of initial adverse-event reports. This study offers information for the debate on proposed changes to safety surveillance.

Returns to R&D on new drug introductions in the 1980s.

This study finds that the mean IRR for 1980-84 U.S. new drug introductions is 11.1%, and the mean NPV is 22 million (1990 dollars). The distribution of returns is highly skewed. The results are robust to plausible changes in the baseline assumptions. Our work is also compared with a 1993 study by the OTA. Despite some important differences in assumptions, both studies imply that returns for the average NCE are within one percentage point of the industry's cost of capital. This is much less than what is typically observed in analyses based on accounting data.

The price of innovation: new estimates of drug development costs.

The research and development costs of 68 randomly selected new drugs were obtained from a survey of 10 pharmaceutical firms. These data were used to estimate the average pre-tax cost of new drug development. The costs of compounds abandoned during testing were linked to the costs of compounds that obtained marketing approval. The estimated average out-of-pocket cost per new drug is 403 million US dollars (2000 dollars). Capitalizing out-of-pocket costs to the point of marketing approval at a real discount rate of 11% yields a total pre-approval cost estimate of 802 million US dollars (2000 dollars). When compared to the results of an earlier study with a similar methodology, total capitalized costs were shown to have increased at an annual rate of 7.4% above general price inflation.

The distribution of sales revenues from pharmaceutical innovation.

OBJECTIVE: This report updates our earlier work on the returns to pharmaceutical research and development (R&D) in the US (1980 to 1984), which showed that the returns distributions are highly skewed. It evaluates a more recent cohort of new drug introductions in the US (1988 to 1992) and examines how the returns distribution is emerging for drugs with life cycles concentrated in the 1990s versus the 1980s. DESIGN AND SETTING: Methods were described in detail in our earlier reports. The current sample included 110 new drug entities (including 28 orphan drugs), and sales data were obtained for the period 1988 to 1998, which represented between 7 and 11 years of sales for the drugs included. 20 years was chosen as the expected market life for this cohort, and a 2-step procedure was used to project future sales for the drugs--during the period until patent expiry and then beyond patent expiry until the 20-year time-horizon was completed. Thus, the values in the first half of the life cycle are essentially based on realised sales, while those in the second half are projected using information on patent expiry and other inputs. MAIN OUTCOME MEASURES AND RESULTS: Peak annual sales for the top decile of drugs introduced between 1988 and 1992 in the US amounted to almost $US1.1 billion compared with peak sales of less than $US175 million (1992 values) for the mean compound. In particular, the top decile accounted for 56% of overall sales revenue. Although the sales distributions were skewed in both our earlier and current analysis, the top decile in the later time-period exhibited more rapid rates of growth after launch, a peak that was more than 50% greater in real terms than for the 1980 to 1984 cohort, and a faster rate of expected decline in sales after patent expiry. One factor contributing to the distribution of sales revenues becoming more skewed over time is the orphan drug phenomenon (i.e. most of the orphan drugs are concentrated at the bottom of the distribution). CONCLUSION: The distribution of sales revenues for new drug compounds is highly skewed in nature. In this regard, the top decile of new drugs accounts for more than half of the total sales generated by the 1988 to 1992 cohort analysed. Furthermore, the distribution of sales revenues for this cohort is more skewed than that of the 1980 to 1984 cohort we analysed in previous research.

Economic return of clinical trials performed under the pediatric exclusivity program.

CONTEXT: In 1997, Congress authorized the US Food and Drug Administration (FDA) to grant 6-month extensions of marketing rights through the Pediatric Exclusivity Program if industry sponsors complete FDA-requested pediatric trials. The program has been praised for creating incentives for studies in children and has been criticized as a "windfall" to the innovator drug industry. This critique has been a substantial part of congressional debate on the program, which is due to expire in 2007. OBJECTIVE: To quantify the economic return to industry for completing pediatric exclusivity trials. DESIGN AND SETTING: A cohort study of programs conducted for pediatric exclusivity. Nine drugs that were granted pediatric exclusivity were selected. From the final study reports submitted to the FDA (2002-2004), key elements of the clinical trial design and study operations were obtained, and the cost of performing each study was estimated and converted into estimates of after-tax cash outflows. Three-year market sales were obtained and converted into estimates of after-tax cash inflows based on 6 months of additional market protection. Net economic return (cash inflows minus outflows) and net return-to-costs ratio (net economic return divided by cash outflows) for each product were then calculated. MAIN OUTCOME MEASURES: Net economic return and net return-to-cost ratio. RESULTS: The indications studied reflect a broad representation of the program: asthma, tumors, attention-deficit/hyperactivity disorder, hypertension, depression/generalized anxiety disorder, diabetes mellitus, gastroesophageal reflux, bacterial infection, and bone mineralization. The distribution of net economic return for 6 months of exclusivity varied substantially among products (net economic return ranged from -$8.9 million to $507.9 million and net return-to-cost ratio ranged from -0.68 to 73.63). CONCLUSIONS: The economic return for pediatric exclusivity is variable. As an incentive to complete much-needed clinical trials in children, pediatric exclusivity can generate lucrative returns or produce more modest returns on investment.

Valuing drinking water provision as an ecosystem service in the neuse river basin

The valuation of ecosystem services such as drinking water provision is of growing national and international interest. The cost of drinking water provision is directly linked to the quality of its raw water input, which is itself affected by upstream land use patterns. This analysis employs the benefit transfer method to quantify the economic benefits of water quality improvements for drinking water production in the Neuse River Basin in North Carolina. Two benefit transfer approaches, value transfer and function transfer, are implemented by combining the results of four previously published studies with data collected from eight Neuse Basin water treatment plants. The mean net present value of the cost reduction estimates for the entire Neuse Basin ranged from $2.7 million to $16.6 million for a 30% improvement in water quality over a 30-year period. The value-transfer approach tended to produce larger expected benefits than the function-transfer approach, but both approaches produced similar results despite the differences in their methodologies, time frames, study sites, and assumptions. © 2010 ASCE.

Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.

BACKGROUND: Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilization and feeding after surgery. We investigated the feasibility, clinical effectiveness, and cost savings of an ERAS program at a major U. S. teaching hospital. METHODS: Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, before and after implementation of an ERAS protocol. Data collected included patient demographics, operative, and perioperative surgical and anesthesia data, need for analgesics, complications, inpatient medical costs, and 30-day readmission rates. RESULTS: There were 99 patients in the traditional care group, and 142 in the ERAS group. The median length of stay (LOS) was 5 days in the ERAS group compared with 7 days in the traditional group (P < 0.001). The reduction in LOS was significant for both open procedures (median 6 vs 7 days, P = 0.01), and laparoscopic procedures (4 vs 6 days, P < 0.0001). ERAS patients had fewer urinary tract infections (13% vs 24%, P = 0.03). Readmission rates were lower in ERAS patients (9.8% vs 20.2%, P = 0.02). DISCUSSION: Implementation of an enhanced recovery protocol for colorectal surgery at a tertiary medical center was associated with a significantly reduced LOS and incidence of urinary tract infection. This is consistent with that of other studies in the literature and suggests that enhanced recovery programs could be implemented successfully and should be considered in U.S. hospitals.

Algae-Based Purification of Landfill Biogas Using a CO2 Removal System and Helical Photobioreactor in Series

Biogas is a mixture of methane and other gases. In its crude state, it contains carbon dioxide (CO2) that reduces its energy efficiency and hydrogen sulfide (H2S) that is toxic and highly corrosive. Because chemical methods of removal are expensive and environmentally hazardous, this project investigated an algal-based system to remove CO2 from biogas. An anaerobic digester was used to mimic landfill biogas. Iron oxide and an alkaline spray were used to remove H2S and CO2 respectively. The CO2-laden alkali solution was added to a helical photobioreactor where the algae metabolized the dissolved CO2 to generate algal biomass. Although technical issues prevented testing of the complete system for functionality, cost analysis was completed and showed that the system, in its current state, is not economically feasible. However, modifications may reduce operation costs.

Applications of statistical models in proportioning medium strength self-compacting concrete

Self-compacting concrete (SCC) is generally designed with a relatively higher content of finer, which includes cement, and dosage of superplasticizer than the conventional concrete. The design of the current SCC leads to high compressive strength, which is already used in special applications, where the high cost of materials can be tolerated. Using SCC, which eliminates the need for vibration, leads to increased speed of casting and thus reduces labour requirement, energy consumption, construction time, and cost of equipment. In order to obtain and gain maximum benefit from SCC it has to be used for wider applications. The cost of materials will be decreased by reducing the cement content and using a minimum amount of admixtures. This paper reviews statistical models obtained from a factorial design which was carried out to determine the influence of four key parameters on filling ability, passing ability, segregation and compressive strength. These parameters are important for the successful development of medium strength self-compacting concrete (MS-SCC). The parameters considered in the study were the contents of cement and pulverised fuel ash (PFA), water-to-powder ratio (W/P), and dosage of superplasticizer (SP). The responses of the derived statistical models are slump flow, fluidity loss, rheological parameters, Orimet time, V-funnel time, L-box, JRing combined to Orimet, JRing combined to cone, fresh segregation, and compressive strength at 7, 28 and 90 days. The models are valid for mixes made with 0.38 to 0.72 W/P ratio, 60 to 216 kg/m3 of cement content, 183 to 317 kg/m3 of PFA and 0 to 1% of SP, by mass of powder. The utility of such models to optimize concrete mixes to achieve good balance between filling ability, passing ability, segregation, compressive strength, and cost is discussed. Examples highlighting the usefulness of the models are presented using isoresponse surfaces to demonstrate single and coupled effects of mix parameters on slump flow, loss of fluidity, flow resistance, segregation, JRing combined to Orimet, and compressive strength at 7 and 28 days. Cost analysis is carried out to show trade-offs between cost of materials and specified consistency levels and compressive strength at 7 and 28 days that can be used to identify economic mixes. The paper establishes the usefulness of the mathematical models as a tool to facilitate the test protocol required to optimise medium strength SCC.