Antônio Miguel Gonçalves Bós

Cost-Effectiveness Analysis of a Low-Fat Diet in the Prevention of Breast and Ovarian Cancer

BACKGROUND Results of the Womens Health Initiative Randomized Controlled Dietary Modification Trial (WHI-DM) suggest that a low-fat diet may be associated with beneficial health outcomes for specific groups of women. OBJECTIVE The objective is to assess how cost-effective the WHI-DM would be if implemented as a public health intervention and under the sponsorship of private health insurers and Medicare. Breast and ovarian cancers are the health outcomes of interest. PARTICIPANTS Two groups of WHI-DM participants form the target population for this analysis: participants consuming >36.8% of energy from fat at baseline, and participants at high risk for breast cancer with 32% or more of energy from fat at baseline. METHODS This study uses Markov cohort modeling, following societal and health care payer perspectives, with Monte Carlo simulations and one-way sensitivity analyses. WHI-DM records, nationally representative prices, and published estimates of medical care costs were the sources of cost information. Simulations were performed for hypothetical cohorts of women aged 50, 55, 60, 65, or 70 years at the beginning of the intervention. Effectiveness was estimated by quality-adjusted life years (QALYs) and the main outcome measure was the incremental cost-effectiveness ratio (ICER). RESULTS Following the societal perspective, the ICERs for the 50-year old cohort are

Management systems as technology: Japanese, US and national firms in the Brazilian electronic sector

13,773/QALY (95% confidence interval

Factors related to the self-perception of health status in older adults living in the rural environment of Brazil

7,482 to

Impacto clínico, socioeconômico e da autopercepção de saúde na funcionalidade de idosos

20,916) for women consuming >36.8% of energy from fat at baseline and

Determinantes na escolha entre atendimento de saúde privada e pública por idosos

10,544/QALY (

Fatores determinantes e conseqüências econômicas da depressão entre os idosos no Brasil

2,096 to

The financial protection impact of the public health system and private insurance in Brazil

23,673) for women at high risk for breast cancer. The comparable ICER from a private health care payer perspective is

Efectos de protección financiera del sistema de salud pública y del seguro privado en Brasil

66,059/QALY (

A participação dos idosos gaúchos no mercado de trabalho e a força da relação renda/saúde

30,155 to

Determinants of catastrophic health expenditures in Brazil: the impact of the public system and private insurance

121,087) and from a Medicare perspective, it is