Abstract In Brazil, insulin analogs stand out as one of the most demanded medications by judicial means. However, the guarantee of judicial access does not guarantee rational use. In context, pharmacotherapeutic follow-up (PF) is shown to be clinical effective strategy for patients with diabetes. To evaluate direct medical costs one year after performing PF in patients with type 1 diabetes mellitus using insulin analogs ordered by court in Public Health System (Sistema Único de Saúde - SUS). This is a partial economic analysis, nested within a quasi-experimental study. Patients with T1DM who receive insulin analogs by judicialization in a medium-sized Brazilian city participated. The PF was conducted following the method adapted from the Pharmacotherapy workup (PW). Data were collected considering the period of one year before the start of the intervention and one year after the start of the intervention. Direct medical costs were evaluated and the difference in costs was calculated. 28 patients participated in the intervention. After PF, direct costs were -$3,696.78. Sensitivity analysis showed that there is a 33.4 % chance for PF to present cost savings when compared to baseline. The PF has the potential to reduce direct medical costs from the perspective of the SUS.

ABSTRACT OBJECTIVE: To perform a cost-benefits analysis of a clinical pharmacy (CP) service implemented in a Neurology ward of a tertiary teaching hospital. METHODS: This is a cost-benefit analysis of a single arm, prospective cohort study performed at the adult Neurology Unit over 36 months, which has evaluated the results of a CP service from a hospital and Public Health System (PHS) perspective. The interventions were classified into 14 categories and the costs identified as direct medical costs. The results were analyzed by the total and marginal cost, the benefit-cost ratio (BCR) and the net benefit (NB). RESULTS: The total 334 patients were followed-up and the highest occurrence in 506 interventions was drug introduction (29.0%). The marginal cost for the hospital and avoided cost for PHS was US$182±32 and US$25,536±4,923 per year; and US$0.55 and US$76.4 per patient/year. The BCR and NB were 0.0, -US$26,105 (95%CI −31,850 − –10,610), -US$27,112 (95%CI −33,160–11,720) for the hospital and; 3.0 (95%CI 1.97–4.94), US$51,048 (95%CI 27,645–75,716) and, 4.6 (95%CI 2.24–10.05), US$91,496 (95%CI 34,700–168,050; p < 0.001) for the PHS, both considering adhered and total interventions, respectively. CONCLUSIONS: The CP service was not directly cost-benefit at the hospital perspective, but it presented savings for forecast cost related to the occurrence of preventable morbidities, measuring a good cost-benefit for the PHS.

ABSTRACT OBJECTIVE: To perform a cost-benefits analysis of a clinical pharmacy (CP) service implemented in a Neurology ward of a tertiary teaching hospital. METHODS: This is a cost-benefit analysis of a single arm, prospective cohort study performed at the adult Neurology Unit over 36 months, which has evaluated the results of a CP service from a hospital and Public Health System (PHS) perspective. The interventions were classified into 14 categories and the costs identified as direct medical costs. The results were analyzed by the total and marginal cost, the benefit-cost ratio (BCR) and the net benefit (NB). RESULTS: The total 334 patients were followed-up and the highest occurrence in 506 interventions was drug introduction (29.0%). The marginal cost for the hospital and avoided cost for PHS was US$182±32 and US$25,536±4,923 per year; and US$0.55 and US$76.4 per patient/year. The BCR and NB were 0.0, -US$26,105 (95%CI −31,850 − –10,610), -US$27,112 (95%CI −33,160–11,720) for the hospital and; 3.0 (95%CI 1.97–4.94), US$51,048 (95%CI 27,645–75,716) and, 4.6 (95%CI 2.24–10.05), US$91,496 (95%CI 34,700–168,050; p < 0.001) for the PHS, both considering adhered and total interventions, respectively. CONCLUSIONS: The CP service was not directly cost-benefit at the hospital perspective, but it presented savings for forecast cost related to the occurrence of preventable morbidities, measuring a good cost-benefit for the PHS.

Objetivou-se avaliar a influência da altura do pasto (30, 50, 70 e 90 cm) de capim-tanzânia sobre características morfológicas do dossel, comportamento em pastejo e processo de ingestão de forragem por cabras anglonubianas. Adotou-se o delineamento inteiramente casualizado, com duas repetições no espaço e duas repetições no tempo. Para a avaliação do comportamento em pastejo foram utilizadas seis cabras e do processo de ingestão, quatro cabras. O aumento na altura do dossel resultou em aumento na massa de forragem e de folhas, da porcentagem de colmo e material morto, e redução na razão folha colmo-1. Acima de 50 cm ocorreu aumento no tempo de pastejo e diminuição no tempo de ócio. A correlação entre altura do dossel e a profundidade de bocados foi linear positiva. A massa de forragem consumida, taxa de ingestão e consumo diário foram maiores aos 50 cm, indicando que nas demais alturas houve restrição ao processo de ingestão. A correlação entre a altura do pasto e a taxa de bocados foi negativa e, positiva com o tempo por bocado. A altura de 50 cm apresenta melhor combinação de características que favorecem o comportamento em pastejo e ingestivo de cabras.

This study evaluated the influence of Tanzania-grass sward height (30, 50, 70 and 90 cm) on the morphological characteristics of the canopy, grazing behavior and forage intake by adult Anglo Nubian female goats. A completely randomized experimental design was employed, with two replicates in space and two replicates in time. Six animals were used to assess the grazing behavior, and four, the ingestion process. The rise in sward height increased the forage and leaf mass, the percentages of stem and dead material, and reduced the leaf stem-1 ratio. Above 50 cm there was an increase in grazing time and a decrease in leisure time. A positive linear correlation was detected between sward height and bite depth. The consumed forage mass, ingestion rate and daily intake were higher at 50 cm, indicating that the other heights reduced the intake process. The sward height was negatively correlated to the bite rate and positively to the bite time. The sward height of 50 cm presents the best combination of features, favoring the grazing and ingestive behavior of female adult goats.

Esta pesquisa foi desenvolvida durante a estação chuvosa no setor de caprinos do Departamento de Zootecnia da Universidade Federal do Piauí com o objetivo de avaliar a estrutura do pasto e o valor nutritivo para ovinos de pastos dos capins Marandu e Tanzânia aos 22 e 36 dias de crescimento. Foram avaliadas a massa de forragem, altura, porcentagem de folhas, de colmos e de material morto do pasto, a composição químicobromatológica, digestibilidade e o consumo de forragem por ovinos. A ocorrência de veranicos durante o período de rebrota de 36 dias resultou no menor crescimento das plantas, sem que houvesse diferença entre as idades para a massa de forragem, altura do pasto e porcentagem de folhas. O prolongamento do período de crescimento resultou em aumento na proporção de material morto no pasto, queda do valor nutritivo da forragem, com redução do teor de proteína bruta e da digestibilidade e elevação dos teores de fibras em detergente neutro e acido. O consumo de forragem foi equivalente entre as gramíneas, sendo que aos 36 dias de rebrota o consumo de nutrientes seria suficiente apenas para a mantença, e o prolongamento do período de rebrota de 22 para 36 dias leva à redução no consumo de forragem por ovinos devido à queda na qualidade da forragem, tanto do seu valor nutritivo como da estrutura do dossel.

This research was conducted during the rainy season in the goats sector of the Department of Animal Science of Federal University of Piauí with the objective to evaluate the morphology and nutritive value of sward for sheep in pastures of Marandu and Tanzania at 22 and 36 days of growth. It were evaluated the herbage mass, sward height, percentage of leaf, stem and dead material, the chemical composition, digestibility and forage intake by sheep. The occurrence of dry spells during the regrowth period of 36 days, resulted in lower growth of plants, with no difference between ages for herbage mass, sward height and percentage of leaves. The extension of the growing season resulted in increased proportion of dead material in pasture, decrease in nutritional value of forage, with a reduction in crude protein content and digestibility and increased in neutral detergent fiber and acid detergent fiber. Forage intake was similar among the grasses, whereas at 36 days of regrowth nutrient intake would be sufficient only for maintenance and the extension of regrowth period of 22 to 36 days leads to a reduction in forage intake by sheep due to a drop in forage quality, much of its nutritional value as the sward structure.