A inclusão dos pequenos produtores agrícolas nos nichos de mercado de produtos sustentáveis e solidários pode contribuir para a agregação de valor e ampliação das alternativas de comercialização da produção familiar. Dentre as opções disponíveis para acessar estes mercados está a certificação Fairtrade ou de comércio justo, direcionada exclusivamente para associações e cooperativas com predominância de agricultores familiares em países em desenvolvimento. Para exibir o selo Fairtrade e se beneficiar das melhores condições de comercialização deste mercado, as organizações de produtores precisam cumprir com os critérios do padrão Fairtrade que incluem aspectos organizacionais, sociais, trabalhistas e ambientais, bem como cobrir os custos de certificação. O presente artigo busca identificar e discutir os impactos sociais e ambientais da certificação de cooperativas de produtores familiares no Brasil. Para tanto, foram analisadas organizações certificadas de café nas regiões das Matas de Minas e Montanhas do Espírito Santo e de manga no Polo Frutícola Petrolina-Juazeiro. Estas regiões foram escolhidas por sua localização periférica, alta dependência socioeconômica na atividade agrícola, relevância da produção familiar e baixos índices de renda per capita e de desenvolvimento humano. A análise qualitativa se baseia em entrevistas com gerentes e técnicos das cooperativas, órgãos governamentais, associações de produtores rurais, sindicato de produtores e trabalhadores rurais, consultora regional da FLO e visitas a produtores membros e unidades de beneficiamento das cooperativas.
Objectives: European registries of Rheumatoid Arthritis (RA) patients treated by biological agents suggest that 70-80% are maintained in first line at 1 year despite potential insufficient efficacy. Post hoc analyses of certolizumab pegol (CZP) studies indicate that a 3 month clinical response had a high predictive value of the 1 year outcome. The objective was to examine the efficiency of a strategy consisting of early switching from CZP to a second line TNF inhibitor in case of insufficient clinical response at 3 months (3M) in the French setting versus current clinical practices. MethOds: A decision-tree model was built to estimate the clinical outcomes (ACR50 cumulated time) and the direct costs of different cohorts of RA patients over a 2 year period. ACR50 was considered as an RA satisfying clinical outcome. The "3M tight control" strategy consisted of stopping CZP at 3 months in patients not achieving the ACR50 criterion and switching them to other biologics. Three reference cohorts treated with first line CZP, etanercept or adalimumab, respectively, according to current clinical practices were considered as comparators (reference). All TNF inhibitors were assumed to have equal efficacy in first line. Costs were estimated at 2013 French public prices. Results: The proportion of patients achieving ACR50 after a 2 year follow-up was 58% in all reference cohorts and 75% in the "3M tight control" CZP strategy cohort. The costs per patient-year in ACR50 were € 19,326 with the "3M tight control" strategy cohort and € 23,588, € 26,774 and € 30,285 for the CZP, etanercept and adalimumab reference cohorts, respectively. The strategy "3M tight control" had an incremental cost-effectiveness ratio of € 5,605/patient-year in ACR50 versus CZP reference, and was dominant versus etanercept or adalimumab reference. cOnclusiOns: A 3-month tight control management of RA patients with CZP as first line treatment is cost-effective compared to alternatives.
To profile the use of an operator in immunobiological supplemental health Fortaleza -Brazil, to identify the most prescribed therapeutic regimens and costs. METHODS: Cross-sectional study in two hospitals accredited service provider, from March to November/2012. Data were recorded by medical expertise in computerized management system (Sabius ® ) performed after the medical consultation. Later, these were entered in Microsoft Excell 2007 and analyzed by pharmacists auditors. The cost was calculated from the value contained in Brasíndice Unit 765, using the Consumer Price Max. The doses used for rheumatoid arthritis Etanercept 50 mg, 40 mg Adalimumab, abatacept 750 mg, 300 mg infliximab, 560 mg Tocilizimabe, Rituximab 1g and Golimumab 50 mg based on a 70 kg adult. RESULTS: We analyzed 64 patients with a mean weight 67 kg, of which 70.31% (n = 45) were women aged 30-59 years whose most frequent indications were rheumatoid arthritis (n = 33, 51.56%) and ankylosing spondylitis (n = 19; 29.69%). The most immunobiological commonly prescribed were Infliximab (n = 36; 56.25%), Tocilizimabe (n = 11, 17.19%), abatacept, and Rituximab (n = 8; 12, 50%) and golimumab (n = 1, 1.56%). It was observed that 67% (n = 43) patients were naïve immunobiological and 33% (n = 21) initiated with anti-TNF, whereas 61.9% (n = 13) moved into one another with immunobiological mechanism of action and 38.1% (n = 8) continued with an anti-TNF, changing only the drug. The average cost of treatment/dose first line
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