MARCELO CRISTIANO DE AZEVEDO RAMOS
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
Agora exibindo 1 - 4 de 4
- Cost effectiveness of the cancer prevention program for carriers of the BRCA1/2 mutation(2018) RAMOS, Marcelo Cristiano de Azevedo; FOLGUEIRA, Maria Aparecida Azevedo Koike; MAISTRO, Simone; CAMPOLINA, Alessandro Goncalves; SOAREZ, Patricia Coelho de; BOCK, Geertruida Hendrika de; NOVAES, Hillegonda Maria Dutilh; DIZ, Maria Del Pilar EstevezOBJECTIVE: To analyze the cost effectiveness of the diagnostic program for the germline mutation in BRCA1/2 genes and of preventative strategies for the relatives of patients diagnosed with ovarian cancer associated with this mutation. METHODS: The study analyzed the cost effectiveness by developing an analysis of the Markov decision process from the perspective of the National Health System. The strategies compared reflect upon the adoption of genetic testing and preventative strategies for relatives or the usual care currently proposed. The incremental cost-effectiveness ratio was expressed in terms of cost per case avoided. The sensitivity analysis was performed in a univariate and deterministic manner. RESULTS: The study showed increments for effectiveness and for costs when performing genetic testing and adopting prophylactic measures for family members. The incremental cost-effectiveness ratio was estimated at R$908.58 per case of cancer avoided, a figure considered lower than the study's cost-effectiveness threshold (R$7,543.50). CONCLUSIONS: The program analyzed should be considered a cost-effective strategy for the national situation. Studies in various other countries have reached similar conclusions. One possible ramification of this research might the need to perform a budgetary-impact analysis of making the program one of the country's health policies.
- Performance evaluation of hospitals that provide care in the public health system, Brazil(2015) RAMOS, Marcelo Cristiano de Azevedo; CRUZ, Lucila Pedroso da; KISHIMA, Vanessa Chaer; POLLARA, Wilson Modesto; LIRA, Antonio Carlos Onofre de; COUTTOLENC, Bernard FrancoisOBJECTIVE: To analyze if size, administrative level, legal status, type of unit and educational activity influence the hospital network performance in providing services to the Brazilian Unified Health System. METHODS: This cross-sectional study evaluated data from the Hospital Information System and the Cadastro Nacional de Estabelecimentos de Saude (National Registry of Health Facilities), 2012, in Sao Paulo, Southeastern Brazil. We calculated performance indicators, such as: the ratio of hospital employees per bed; mean amount paid for admission; bed occupancy rate; average length of stay; bed turnover index and hospital mortality rate. Data were expressed as mean and standard deviation. The groups were compared using analysis of variance (ANOVA) and Bonferroni correction. RESULTS: The hospital occupancy rate in small hospitals was lower than in medium, big and special-sized hospitals. Higher hospital occupancy rate and bed turnover index were observed in hospitals that include education in their activities. The hospital mortality rate was lower in specialized hospitals compared to general ones, despite their higher proportion of highly complex admissions. We found no differences between hospitals in the direct and indirect administration for most of the indicators analyzed. CONCLUSIONS: The study indicated the importance of the scale effect on efficiency, and larger hospitals had a higher performance. Hospitals that include education in their activities had a higher operating performance, albeit with associated importance of using human resources and highly complex structures. Specialized hospitals had a significantly lower rate of mortality than general hospitals, indicating the positive effect of the volume of procedures and technology used on clinical outcomes. The analysis related to the administrative level and legal status did not show any significant performance differences between the categories of public hospitals.
- HEALTH JUDICIALIZATION: A CASE STUDY INVOLVING HIGH-COST MEDICATION(2023) RAMOS, Marcelo Cristiano de Azevedo; AMARAL JUNIOR, Jose Levi Mello doCurrently, there has been a significant number of lawsuits in health area from the perspective of individual conflicts of interest. In this sense, the objective of this paper was to conduct a case study on the content of court decisions involving provision of a high-cost medication called eculizumab. To this end, sentences available on State of Sao Paulo Justice Court website were evaluated. The results showed concentration of demands in district of capital, with the state of Sao Paulo as preferred passive pole. It was observed that a significant proportion of decisions ignored the need to prove adequacy and necessity of the drug, as well as demonstration of ineffectiveness of drugs available at Sistema unico de Saude (SUS - Brazilian Unified Health System). The results pointed to a greater concern of judges in verifying the existence of san-itary registration of the drug at National Health Surveillance Agency and in recogniz-ing the patient's financial inability to handle the costs of treatment. Conversely, ver-ification of incorporation of the drug for paying source and diagnosis showed less value among the magistrates. This phenomenon can present perverse contours and potential to modify planning and prioritization processes in health, improperly restricting economic resources.
- Overcoming barriers to providing comprehensive inpatient care during the COVID-19 pandemic(2020) MIETHKE-MORAIS, Anna; PERONDI, Beatriz; HARIMA, Leila; MONTAL, Amanda C.; BALDASSARE, Renato Madrid; MORAES, Danielle P.; PEDROSO, Lucila; RAMOS, Marcelo C. A.; FUSCO, Solange R. G.; PEREIRA, Antonio Jose; BARROS-FILHO, Tarci Prime Sio E. P.; BONFA, Eloisa; UTIYAMA, Edivaldo M.; SEGURADO, Aluisio C.