Public Health Network Research Articles

The creation of the autonomous social service Instituto Hospital de Base as a new model for public hospital management in the Federal District, Brazil.

The public health network of the Federal District, as in the rest of the Brazilian Unified Health System, suffers from inefficiencies related to the difficulty in hiring and managing professionals, as well as the implementation of supply and maintenance contracts. In Brasilia, a new management model was implemented in 2018 in its largest hospital. With the creation of the autonomous social service "Instituto Hospital de Base", a health unit in operation since 1960, the possibility of providing agility to these contracts was opened, in addition to establishing a management based on goals and outcome indicators, with expressive efficiency gains. This article reports the steps for the implementation of this decentralized model of hospital management, the alternatives considered, the difficulties faced and some of the first results of this new model. One can already verify and affirm the success of the legal-administrative model of "Instituto Hospital de Base", which can serve as a paradigm for other health units in the Federal District and in Brazil.

Children overdue for immunisation: a question of coverage or reporting? An audit of the Australian Immunisation Register

ObjectiveVaccinations in Australia are reportable to the Australian Immunisation Register (AIR). Following major immunisation policy initiatives, the New South Wales (NSW) Public Health Network undertook an audit to estimate true immunisation coverage of NSW children at one year of age, and explore reasons associated with under‐reporting. MethodsCross‐sectional survey examining AIR immunisation records of a stratified random sample of 491 NSW children aged 12≤15 months at 30 September 2017 who were >30 days overdue for immunisation. Survey data were analysed using population weights. ResultsEstimated true coverage of fully vaccinated one‐year‐old children in NSW is 96.2% (CI:95.9‐96.4), 2.1% higher than AIR reported coverage of 94.1%. Of the children reported as overdue on AIR, 34.9% (CI:30.9‐38.9) were actually fully vaccinated. No significant association was found between under‐reporting and socioeconomic status, rurality or reported local coverage level. Data errors in AIR uploading (at provider level) and duplicate records contributed to incorrect AIR coverage recording. ConclusionsDespite incentives to record childhood vaccinations on AIR, under‐reporting continues to be an important contributor to underestimation of true coverage in NSW. Implications for public healthMore reliable transmission of encounters to AIR at provider level and removal of duplicates would improve accuracy of reported coverage.

Incidence and underreporting of leptospirosis comparing three diagnostic methods in the endemic region of Urabá, Colombia

Introduction: Leptospirosis represents a public health problem and is a significant cause of morbidity and mortality in the region of Urabá. However, its notification reveals diagnostic limitations. Objective: To establish the incidence of leptospirosis in the municipalities of the so-called eje bananero in the Urabá region, to describe the magnitude of underreporting, and to propose guidelines for laboratory diagnosis by the public health network. Materials and methods: Two leptospirosis information sources were used: The national official surveillance system and a cross-sectional study of 479 acute-phase patients from April, 2010, to May, 2012. The diagnosis was made using three different tests: Indirect immunofluorescence, microagglutination test, and blood cultures. The exhaustiveness percentage of each information source was calculatedusing the capture and recapture test. Results: From the total number of cases, 58% (278/479) were positive for leptospirosis at least by a test and 10.43% (29/278) of cases were positive by all three methods. The inclusion of a native strain in the microagglutination test panel increased the percentage of positivity by 15%. The cumulative incidence rate was 66.5/100,000 inhabitants and the case fatality ratio was 2.15%. The underreporting rates of leptospirosis in the Urabá region were 27.8% in morbidity and 66.6% in mortality. Conclusion: Under-registration of leptospirosis in the region highlights the necessity to use more than one diagnostic test to identify Leptospira in patients from endemic areas. Underregistration could be a common situation throughout the country.

Infrastructure-building for Public Health : The World Health Organization and Tuberculosis Control in South Korea, 1945-1963.

This paper examines WHO's involvement in South Korea within the context of the changing organization of public health infrastructure in Korea during the years spanning from the end of the Japanese occupation, through the periods of American military occupation and the Korean War, and to the early years of the Park Chung Hee regime in the early 1960s, in order to demonstrate how tuberculosis came to be addressed as a public health problem. WHO launched several survey missions and relief efforts before and during the Korean War and subsequently became deeply involved in shaping government policy for public health through a number of technical assistance programs, including a program for tuberculosis control in the early 1960s. This paper argues that the principal concern for WHO was to start rebuilding the public health infrastructure beyond simply abolishing the remnants of colonial practices or showcasing the superiority of American practices vis-à-vis those practiced under a Communist rule. WHO consistently sought to address infrastructural problems by strengthening the government's role by linking the central and regional health units, and this was especially visible in its tuberculosis program, where it attempted to take back the responsibilities and functions previously assumed by voluntary organizations like the Korea National Tuberculosis Administration (KNTA). This interest in public health infrastructure was fueled by WHO's discovery of a cost-effective, drug-based, and communityoriented horizontal approach to tuberculosis control, with a hope that these practices would replace the traditional, costly, disease-specific, and seclusion-oriented vertical approach that relied on sanatoria. These policy imperatives were met with the unanticipated regime change from a civilian to a military government in 1961, which created an environment favorable for the expansion of the public health network. Technology and politics were intricately intertwined in the emergence of a new infrastructure for public health in Korea, as this case of tuberculosis control illustrates.

Creencias, conocimientos y prácticas de madres respecto a la salud bucal en Popayán, Colombia

Antecedentes: Las madres ejercen influencia frente a hábitos en salud de la familia y de los niños, el estudio de los conocimientos, prácticas y creencias de las madres con respecto a la salud y la enfermedad bucodental de sus hijos es relevante para la salud pública local y regional, situación que ha sido muy poco estudiada. Objetivo: Determinar las creencias, conocimientos y prácticas acerca de la salud bucal que tienen las madres de niños menores de cinco años que asisten a la red pública de salud de la ciudad de Popayán, Colombia. Métodos: Estudio observacional descriptivo analítico, encuesta a 288 madres que llevan a sus hijos al programa de crecimiento y desarrollo, se realizó análisis estadístico según frecuencia y distribución a través del SK Test, Test de Chi Cuadrado, test de Fischer o prueba T Student, considerándolos estadísticamente significativos cuando p ≤ 0,05. Resultados: El promedio de edad de las mujeres encuestadas fue de 28 años, 20,5 % consideró que los dientes solo deben durar algunos años, 76,4 % cree que el riesgo de padecer caries dentales es debido a malos hábitos, 55,9 % manifestó no conocer lo qué es la caries dental, 87,1 % conoce como se evita la caries dental, 35,9 % de los menores duermen en mayor medida con el tetero. Conclusiones: Las madres presentan un nivel adecuado de conocimientos para salud dental, enfermedades de la boca y prevención, Se observó que las madres más jóvenes llevan a sus mayoritariamente a servicios de prevención.

POSSIBILIDADES E LIMITAÇÕES DA TERAPIA NUTRICIONAL ENTERAL NA COMPREENSÃO DE CUIDADORES E PROFISSIONAIS DE UMA REDE PÚBLICA DE SAÚDE EM REGIÃO DE FRONTEIRA

Objetivo: Analisar possibilidades, limites e desafios da terapia de nutrição enteral domiciliar na rede pública de saúde e o perfil nutricional de pacientes pós-alta hospitalar de Foz do Iguaçu, PA. Métodos: Estudo de delineamento transversal e quanti-qualitativo. Participaram do estudo 12 indivíduos usuários de nutrição enteral domiciliar (com e sem acompanhamento nutricional); 12 cuidadores e oito profissionais de saúde. Na coleta de dados, utilizaram-se anamnese nutricional (usuários) e entrevistas (profissionais e cuidadores). As entrevistas foram gravadas, transcritas e analisadas na perspectiva teórica de Bardin; para o perfil nutricional, utilizaram-se fita inelástica e adipômetro, comparando-se os resultados às recomendações. Resultados e discussão: Houve predomínio do gênero feminino e de adultos para cuidadores e profissionais, enquanto entre os indivíduos em nutrição enteral, de idosos e mulheres. Sete destes estavam sob dieta manipulada; a frequência de complicações foi maior no grupo sem acompanhamento nutricional, assim como de óbitos e perfil antropométrico menos satisfatório. Os cuidadores mostraram-se desorientados e inseguros em relação à condução da nutrição enteral no domicílio, sobretudo no grupo desassistido por nutricionista. Profissionais e cuidadores apontaram a importância de acompanhamento profissional após a alta hospitalar e de oferta de dietas; fragilidades na rede pela ausência de fluxo, orientações padronizadas e encaminhamentos; com indicação de protocolo em rede para a condução da terapia de nutrição enteral domiciliar. Conclusões: Estes resultados mostram a notoriedade de formação dos cuidadores, equipe multiprofissional e intervenção gestora no cuidado domiciliar.DOI: 10.12957/demetra.2019.36926

Innovative Approaches to Improve Public Health Practice in the Eastern Mediterranean Region: Findings From the Sixth Eastern Mediterranean Public Health Network Regional Conference.

Public health professionals in the Eastern Mediterranean region (EMR) have limited access to continuing education, including workshops and conferences in public health. Held under the theme Innovative Approaches: Adapting to the Current EMR Context, the Eastern Mediterranean Public Health Network (EMPHNET) organized and conducted the Sixth EMPHNET Regional Conference from March 26 to 29, 2018. This paper summarizes the key activities including workshops, roundtable discussions, oral and poster presentations, keynote speeches, and side meetings. Before the opening, 5 preconference workshops were held: “Field Epidemiology Training Program (FETP) Accreditation,” “Innovative Public Health Surveillance,” “Human and Animal Brucellosis,” “Rapid Response Teams,” and “Polio Transition and Routine Immunization.” The conference hosted 6 roundtable discussions: “Consolidation of the FETP Network,” “One Health to Achieve Global Health Security,” “Polio Eradication Efforts and Transition Planning for Measles Elimination,” “Mobile Data Collection and Other Innovative Tools to Enhance Decision Making,” “Confronting Candida auris: An Emerging Multidrug-resistant Global Pathogen,” and “Functioning and Sustainable Country Public Health Emergency Response Operation Framework.” One of the conference’s key objectives was to provide a space for FETP residents, graduates, and public health professionals to showcase achievements. A total of 421 abstracts were submitted and after professional review, 34.9% (147/421) were accepted (111 for oral presentations and 36 for poster presentations) and published by Iproceeding. The conference met the primary objectives of showcasing the public health accomplishments and contributions of the EMR, encouraging the exchange of ideas and coordination among stakeholders, and engaging cross-sectoral workforce in producing recommendations for approaching regional and global health concerns. Moreover, the conference presented a unique opportunity for FETPs and other public health professionals from the Mediterranean region to present their significant scientific work and also facilitated networking among professionals. EMPHNET strives to continue to present similar exchange opportunities for public health professionals in the region.

"Breast milk is important": what do nursing mothers in Fortaleza think about breastfeeding?

Abstract Objectives: to analyze the meaning of breastfeeding for nursing mothers, users of the public health network in Fortaleza city, Ceará. Methods: a cross-sectional study was carried out with nursing mothers from nine health units. The data were collected through the application of a socioeconomic and health questionnaire and the Word Free Association Test, using "breastfeeding" as an induced stimulus. The terms referred to in the Word Free Association Test were grouped into categories and analyzed by the EVOC 2000 ®software, which showed the results in a fourcell table, where the categories were distributed according to the level of meaning to the mothers. Results: the sample consisted of 279 nursing mothers. More than 60% of these women referred in receiving guidance on breastfeeding in prenatal, puerperal and childcare consultations, and 68% of them reported having no difficulties in breastfeeding. The most significant categories identified by the Word Free Association Test were: Milk, Important, Health, and Love. Conclusions: for the nursing mothers, breastfeeding is an important practice, represented by the breast milk itself, which is permeated by positive meanings. Knowing these meanings helps to understand the factors associated to early weaning, making it possible to reconstruct care directed to this public.

Description and cost-analysis of emergency department attendances for hand and wrist injuries.

Injuries to the hand and wrist are estimated to account for between 10% and 30% of all ED presentations. The economic burden placed on the healthcare system can be extensive and rise sharply with increase in injury severity. This cost-analysis was performed with the aim of estimating the economic implications of ED attendances for hand and wrist injuries from the perspective of one Australian public health network. Data from two EDs were retrieved from the electronic billing records of one large health network across two financial year periods (2014-2015 and 2015-2016) using ICD-10 codes. All costs that resulted from the treatment of any acute hand or wrist injury across the 2 year period were calculated and are presented by age, sex, injury type and mechanism of injury. A total of 10 024 individuals presented to the two EDs in the 2 year period, accounting for approximately 5.4% of all presentations. The most common presentations were males (62.2%), people aged 25-34 years (26.9%) and lacerations (31.2%). The total cost in the 2 year study period was $3 959 535.38 ($1 923 852.38 in 2014-2015; $2 035 683.00 in 2015-2016). The mean cost per presentation was $383 (95% CI [$373, $393]) in 2014-2015 and $407 (95% CI [$394, $421]) in 2015-2016. Acute hand and wrist injuries contribute to a significant volume of ED presentations each year in one Australian public health network leading to significant expenditure and health resources. Further research into how to best utilise resources and reduce avoidable injuries should be priority areas to reduce the cost of these injuries to the healthcare system and society.

Nutritional and hematological factors associated with the progression of Alzheimer's disease: a cohort study.

We studied the users of the Specialized Drug Distribution Program of the public health network. A prospective cohort examined the elderly at two intervals of three years and included 30 patients in phase I and 16 in phase II. The methodology was composed of home visits, anthropometric, nutritional and hematological evaluation. For the progression of AD, the Clinical Dementia Rating (CDR) scale was used. According to the CDR, the disease evolved, since in 2014 most of the patients were in CDR 3. In the analysis of the micronutrients, only the B vitamins (B1, B2, B3, B5, B6) presented a significant reduction in 2014. The consumption of carbohydrates and lipids increased in the 2014 evaluation, and protein consumption decreased. As for the average weight of the elderly, there was an increase in 2014, 65.9 (± 15.6) Kg, with a BMI of 26.75 (± 4, 5), in 2011 the average weight was 62.44 kg (± 14, 36), BMI 24.64 (± 4.97). The hypothesis that patients are likely to be overweight or obese before the development of AD and that this may be associated with an increased risk of dementia is suggested.

The Neonatal Screening Program in Brazil, Focus on Sickle Cell Disease (SCD).

Since 2001, the Brazilian Ministry of Health has been coordinating a National Neonatal Screening Program (NNSP) that now covers all the 26 states and the Federal District of the Brazilian Republic and targets six diseases including sickle cell disease (SCD) and other hemoglobinopathies. In 2005, the program coverage reached 80% of the total live births. Since then, it has oscillated between 80% and 84% globally with disparities from one state to another (>95% in São Paulo State). The Ministry of Health has also published several Guidelines for clinical follow-up and treatment for the diseases comprised by the neonatal screening program. The main challenge was, and still is, to organize the public health network (SUS), from diagnosis and basic care to reference centers in order to provide comprehensive care for patients diagnosed by neonatal screening, especially for SCD patients. Considerable gains have already been achieved, including the implementation of a network within SUS and the addition of scientific and technological progress to treatment protocols. The goals for the care of SCD patients are the intensification of information provided to health care professionals and patients, measures to prevent complications, and care and health promotion, considering these patients in a global and integrated way, to reduce mortality and enhance their quality of life.

Municipal officials’ propensity toward active transportation: A rural-urban comparison

IntroductionBuilt environments can influence physical activity habits. Their features vary according to population size and density. In developed countries, rural populations often display higher rates of obesity and lower levels of physical activity compared with urban populations. This study aims to 1) assess municipal officials’ propensity to improve their community's environment to render it conducive to active transportation (AT), and 2) assess whether the level of propensity varies between municipal officials from rural and urban communities. MethodsIn 2015, 412 of an invited 1661 municipal officials in Quebec (Canada) completed an online survey. Among them, 57% served a rural community. The Theory of Planned Behavior served as the theoretical framework for measuring participants’ propensity to implement policies conducive to citizens’ AT. Structural Equation Modeling was used to analyze relations between variables. Tests of invariance compared rural and urban municipal officials. ResultsAntecedent actions related to AT and perceived control were the two key factors that predicted officials’ intentions to take action toward AT. Attitudes also predicted intentions toward AT to a lesser extent. The contribution from subjective norms was not significant. In summary, the model accounted for 60% of explained variance (R2) in intentions. The model applied to both groups, but urban officials reported more antecedent actions and a higher perceived control than rural officials. ConclusionsImproving municipal officials’ competencies and support from public health networks along with a greater investment of time and resources could increase their perceived control and involvement in AT-related policies, especially in rural communities.

Quality of Intra-Hospital Nutritional Counseling in Patients with STEMI in the Public and Private Health Networks of Sergipe: The VICTIM Register.

BackgroundHaving appropriate dietary habits is part of the recommendations after ST-Elevation Myocardial Infarction (STEMI), however, the quality of intra-hospital nutritional counselling in the different health services has been minimally explored.ObjectiveTo evaluate the quality of intra-hospital nutritional counselling among patients with STEMI in the public and private health systems in Sergipe.MethodsA cross-sectional, with data from the Via Crucis for the Treatment of Myocardial Infarction (VICTIM) Register, conducted from April to November of 2017, with individuals aged ≥ 18 years diagnosed with STEMI, in one public health service hospital and three private hospitals. The occurrence and quality of nutritional counselling were analyzed based on current guidelines and the administration of questionnaires. A significance level of 0.05 was adopted.ResultsA total of 188 patients were analyzed; 80.3% were from the public health service facility. Among the interviewees, 57.6% of the public health service, and 70.3% of the private hospital patients received intra-hospital nutritional counselling (p = 0.191). The documentation of this practice, in medical records, was lower in the public service (2.6% vs. 37.8%, p < 0.001). A predominance of restrictive orientations was found in the public and private sectors, mainly regarding salt and fat, 52.3% and 70.3% respectively (p = 0.064). Patients from the private service were more counselling to introduce of cardioprotective foods, mainly fruit, vegetable/legume consumption (48.6% vs. 13.2%, p < 0.001). Among those who received counselling, nutritional knowledge was higher in the private sector (68.2% vs. 26.3%, p < 0.001).ConclusionThe intra-hospital nutritional counselling provided to patients with STEMI, in Sergipe, still presents poor quality in both services, especially in the public health system.

Assessment of public oral healthcare services in Curitiba, Brazil: a cross-sectional study using the Primary Care Assessment Tool (PCATool)

ObjectivesTo compare two different models of public oral health in primary care services, a so-called family health strategy (FHS), as opposed to non-FHS services designated as ‘conventional’ healthcare (CHC), regarding...

Perception and knowledge about oral health of caregivers of children with microcephaly

ABSTRACT Objective: To understand the perception and knowledge of caregivers of children with microcephaly on oral health care. Methods: This is a qualitative study with a research-action method, in which semi-structured interviews - diagnostic and evaluative - and oral health workshop were adopted as techniques for data collection and intervention.The study was conducted in a group aimed at caregivers of children with microcephaly, offered in the public health network of the capital Maceió, Alagoas. Nine women caring for children with microcephaly participated in the study. The participants statements were transcribed and, through the thematic analysis, the data was categorized and discussed. Results: The main caregivers of children with microcephaly were mothers and grandmothers. Of these, 45% had incomplete secondary education. Most reported self-care with their impaired oral health, were unaware of the risk of transmission of dental caries-related bacteria, did not offer exclusive breastfeeding until 6 months of age, and offered artificial milk to the children with sugared and farinaceous milk. Conclusion: For caregivers of children with microcephaly, oral health care is a less valuable topic when compared to other demands, both at home and other physical treatments. Responsibility for care is aimed at the maternal figures, which makes it difficult for them to take care of their own oral health. Educational action on oral health minimized doubts and fragilities for the self-care and care of children related to oral health.

A casa de parto de São Sebastião/DF: Um exercício de APO em unidade do sistema único de saúde

O Centro de Parto Normal (CPN) de São Sebastião/DF, também nominado Casa de Parto de São Sebastião, é uma unidade do Sistema Único de Saúde (SUS) que oferece atendimento às gestantes de baixo risco da Região de Saúde Leste do Distrito Federal que desejam um parto humanizado na rede pública de saúde. Criada em 2001, com o objetivo de assistir e conduzir o parto normal, é composta por 4 quartos PPP (pré-parto, parto e pós-parto) e tem o intuito de atender toda a demanda da gestação ao parir, seguindo a linha de cuidados propostos pela Rede Cegonha. Em 2011, o Ministério da Saúde (MS) criou essa rede de cuidados como uma estratégia de política pública que sistematiza e institucionaliza um modelo de atenção ao parto e ao nascimento. No entanto, a ausência de infraestrutura de apoio inviabiliza as ações propostas pela rede. Sendo assim, faz-se necessária a avaliação e implementação de soluções viáveis.Com base na avaliação pós-ocupação (APO) da Casa de Parto de São Sebastião, serão avaliados o projeto existente do ponto de vista arquitetônico considerando o espaço físico e seu conforto ambiental (térmico, luminoso e sonoro), a percepção dos usuários (puérperas, acompanhantes e funcionários) por meio de aplicação de questionário e a conformidade com a legislação vigente. Tendo em vista as informações obtidas, a intenção é identificar os principais aspectos que necessitam de melhoria, visando uma arquitetura sustentável, que qualifique o ambiente.

Cascade of care for people living with HIV infection in Southern Brazil: results from a public health network.

The cascade of care for people living with HIV infection (PLHIV) describes steps in diagnosis, linkage and retention in care, as well as the provision and success of combination antiretroviral therapy (cART). The aim of this study was to evaluate the rates regarding the retention in care, on cART, and suppressed viral load for PLHIV attended at a Brazilian public health network. Data on PLHIV from 116 cities of Paraná, Southern Brazil, attended from 2012 to 2015, were retrospectively collected through the Laboratory Tests Control System (SISCEL). The number of PLHIV related to care increased about 22.5% from 2012 to 2015 (4,106 to 5,030 individuals). The proportion of PLHIV retained in care showed a trend toward stabilization around 81.7-86.9%. Every year, the use of cART increased up to 90.3% for PLHIV retained in care. Viral load suppression was achieved by 72.8% of patients on cART and 57.1% by those linked to care. Retention in care and HIV viral suppression were more likely to occur in older PLHIV than younger ones; similarly, patients living in medium-sized cities were more susceptible to these factors than in large- or small-sized cities. In conclusion, the study showed a high level of retention in care and HIV suppression on cART, as well as emphasized that current efforts for treating already-infected PLHIV remain a challenge for our health public institutions and may contribute to highlight steps for improvement of the HIV cascade of care in our population.

The Demise of Community Responsibility: Unintended Consequences of Coverage Expansions on California Public Hospitals

Abstract Long before the establishment of Medicaid or the passage of the Affordable Care Act, California counties provided their poorest residents with access to comprehensive medical care. This article analyzes the creation and closure of public hospitals in the state of California. It combines both qualitative historical research and event history analysis to assess what led first to the creation of the nation's most comprehensive public health network and then to its gradual demise. Strong evidence is presented that the implementation of Medicaid in California significantly altered the calculus of local governments with regard to the operation of public hospitals. In particular, Medicaid shifted county hospitals from the realm of allocational politics to that of redistributive politics. Subsequently, reforms at the state and federal levels further encouraged this development. Because of this shift, many counties decided to close their hospitals. Moreover, as expected for redistributive policies, the continued operation of public hospitals was driven not by need but instead merely by fiscal capacity: more affluent counties continue to maintain them while poorer, needier counties close their doors.

Epidemiology, public health and complex networks

Health differences across socioeconomic strata have always pointed out that poorer and minorities have higher mortality and morbidity than richer and majorities. This difference is exacerbated for particular populations such as the victims of ongoing armed conflict, who are also much harder to quantify due to the conflict itself. This study uses complex network analysis applied to a combination of three large administrative records for the health system and mortality records in the province of Risaralda (Colombia) between 2011 and 2016. We estimate the most common causes of morbi-mortality for both victims of violence and the poorest inhabitants of Risaralda, defined as those who qualify as recipients of subsidies from the Colombian welfare program, called SISBEN, in the categories of those with the highest need, levels I and II. Both populations show high morbidity frequencies for non-communicable diseases such as Type II diabetes, hypertension and hyperglyceridaemia, mostly associated with exposure to unhealthy lifestyles. However, these mortality outcomes reflect the different treatments and lifestyles of both subpopulations. While the poorest replicate the same causes identified for morbidity, the victims of armed conflict die of additional causes including Type I diabetes, which reflects the even worse conditions they face.

Economics of Acromegaly Treatment in Brazil: A Budget Impact Analysis of Pituitary Surgery Compared with Long-Term Octreotide LAR.

BackgroundAcromegaly is a rare, chronic and debilitating disease whose treatment places a high burden on health systems. In the reality of the Brazilian public health network, many patients are kept on drug treatment because of barriers to access to surgery.ObjectiveThe aim of this study was to estimate the costs and budget impact of routine transsphenoidal endoscopic surgery in relation to those of long-term drug treatment with octreotide long-acting release (LAR) from a cohort of patients followed at the referral medical centre for acromegaly treatment in the Federal District, Brazil.MethodsBased on micro-costing data collected using mixed methods from a local perspective of the public health system, we performed a budget impact analysis (BIA) on a 3-year time horizon. Uncertainty was handled with deterministic (tornado and scenario) and probabilistic (Monte Carlo simulations) sensitivity analyses.ResultsCompared with the continued use of octreotide LAR at a dose of 30 mg every 28 days, the incremental budget impact of conducting two surgeries per month, considering a cure rate of 55%, could bring savings of approximately US$879,362.18 (95% CI 860,176.29–898,548.08) over 3 years. Depending on the key variable values, the savings amplitude ranged from US$431,836.39 to US$1,519,132.04.ConclusionsImproving access to surgery could result in significant cost reductions in acromegaly treatment. The present study stands out for being the first to estimate the costs of transsphenoidal surgery in the context of the public health system in Brazil.Electronic supplementary materialThe online version of this article (10.1007/s41669-018-0103-2) contains supplementary material, which is available to authorized users.