Claudia Cristina de Aguiar Pereira

Health economic evaluations of visceral leishmaniasis treatments: a systematic review.

Visceral leishmaniasis (VL) is a severe form of the leishmaniasis-disease complex. Its importance to public health relies on its high fatality rate in non-treated cases, the socio-economic impact related to its morbidity, and its endemicity on different continents. The estimated burden of disease of VL varies from 1,969,000 to 2,357,000 Disability Adjusted Life Years (DALYs). VL is classified as a Neglected Tropical Disease (NTD), and is strongly related to poverty and its consequences. Visceral leishmaniasis calls for the development of cost-effective technologies for diagnosis and treatment. Objective The main objective of this study was to identify, describe, classify and analyze the scientific health economic evidence of VL-related technologies. Methods A web search of combinations of free text and Mesh terms related to the economic evaluation of visceral leishmaniasis was conducted on scientific publication databases (Web of Science, Scopus, Medline via the Pubmed and Lilacs). A manual search of references lists of articles previously identified by the authors was also included. Articles written in English, Portuguese, Spanish or French were considered suitable for inclusion. Articles that matched the inclusion criteria were screened by at least two researchers, who extracted information regarding the epidemiologic scenario and methodological issues on a standardized form. Results The initial search retrieved 107 articles, whose abstracts were inspected according to the inclusion criteria leading to a first selection of 49 (46%) articles. After the elimination of duplicates, the list was reduced to 21 (20%) articles. After careful reading and application of exclusion criteria, 14 papers were eligible according to the description, classification and analysis process proposed by the study. When classified by type of economic evaluation, articles were 7 (50%) cost-effectiveness, 5 (36%) cost-minimization, 1(7%) cost-benefit, and 1(7%) budget impact. When classified by methodology, studies were mainly nested to clinical-trials (“piggy back”) 8(57%). Discount rates for outcomes and costs were present in 3 (43%) of the cost-effectiveness studies, and according to WHOs recommendations, the discount rate of 3% was used in all studies. Conclusions This article showed that health economic evaluations on visceral leishmaniasis used a wide range of technologies and methods. Nevertheless it is important to point out the geographic concentration of studies, which makes their transferability uncertain to different epidemiological scenarios, especially those concerning visceral leishmaniasis caused by Leishmania infantum.

Race and preference-based health-related quality of life measures in the United States.

BackgroundHealth-related quality of life instruments (HRQoL) are widely used to produce measures that summarize population health and to inform decision-making and health policy. Although the literature about the relationship between health and race in the United States is quite extensive, there is a lack of studies that comprehensively examine the relationship between race and preference-based HRQoL. Given the widespread use of these measures, it becomes important to understand the extent of the race differences in HRQoL scores and factors associated with any such differences.MethodsWe examined the differences in HRQoL, between blacks and whites and associated factors, using the summary scores of the SF-6D, EQ-5D, QWB-SA, HUI2, HUI3, administered by telephone to a nationally representative sample of 3,578 black and white US adults between the ages of 35 and 89 in the National Health Measurement Study (NHMS).ResultsBlack women had substantially lower HRQoL than white women. The difference was largely explained by sociodemographic and socioeconomic variables. Black men did not differ significantly from white men, except for the EQ-5D. HRQoL among black men was higher at higher income levels, while the HRQoL of black women was especially low compared to other groups at high income levels.

Avaliação de oito Protocolos Clínicos e Diretrizes Terapêuticas (PCDT) do Ministério da Saúde por meio do instrumento AGREE II: um estudo piloto

Ha, mundialmente, um crescente aumento de publicacoes de diretrizes clinicas, acompanhado de preocupacoes quanto a qualidade. Em 2000, o Ministerio da Saude iniciou a elaboracao de Protocolos Clinicos e Diretrizes Terapeuticas (PCDT). O objetivo deste trabalho foi avaliar os PCDT elaborados apos 2009, quanto a sua qualidade, utilizando o instrumento AGREE II (Appraisal of Guidelines for Research and Evaluation). Entre 2009 e 2012, foram identificados 59 PCDT, dos quais oito foram sorteados e avaliados por tres avaliadores independentes. Para o item recomendacao do uso da diretriz, dois avaliadores recomendaram o uso de todas, mas com modificacoes, e um nao recomendou qualquer diretriz. Para o item classificacao da qualidade global da diretriz, cuja avaliacao poderia variar de 1 a 7, obteve-se media de 4,25 (DP = 0,46). Esses resultados apontam a necessidade de adequacoes nos PCDT, quanto aos dominios do AGREE II. Devido a limitacao do instrumento utilizado, existe necessidade de novos estudos, inclusive sobre a qualidade das evidencias utilizadas na elaboracao dos PCDT.

Cost-effectiveness analysis of preventive methods for occlusal surface according to caries risk: results of a controlled clinical trial

This study presents the results of a cost-effectiveness analysis in a controlled clinical trial on the effectiveness of a modified glass ionomer resin sealant ( Vitremer, 3M ESPE) and the application of fluoride varnish (Duraphat, Colgate) on occlusal surfaces of first permanent molars in children 6-8 years of age (N = 268), according to caries risk (high versus low). Children were examined semiannually by the same calibrated dentist for 24 months after allocation in six groups: high and low risk controls (oral health education every three months); high and low risk with varnish (oral health education every three months + varnish biannually); and high and low risk with sealant (oral health education every three months + a single application of sealant). Economic analysis showed that sealing permanent first molars of high-risk schoolchildren showed a C/E ratio of US

Henrica C. W. de Vet, Caroline B. Terwee, Lidwine B. Mokkink, and Dirk L. Knol: Measurement in medicine: a practical guide

119.80 per saved occlusal surface and an incremental C/E ratio of US

Estimativa dos custos da assistência do câncer de pulmão avançado em hospital público de referência

108.36 per additional saved occlusal surface. The study concluded that sealing permanent first molars of high-risk schoolchildren was the most cost-effective intervention.This study presents the results of a cost-effectiveness analysis in a controlled clinical trial on the effectiveness of a modified glass ionomer resin sealant ( Vitremer, 3M ESPE) and the application of fluoride varnish (Duraphat, Colgate) on occlusal surfaces of first permanent molars in children 6-8 years of age (N = 268), according to caries risk (high versus low). Children were examined semiannually by the same calibrated dentist for 24 months after allocation in six groups: high and low risk controls (oral health education every three months); high and low risk with varnish (oral health education every three months + varnish biannually); and high and low risk with sealant (oral health education every three months + a single application of sealant). Economic analysis showed that sealing permanent first molars of high-risk schoolchildren showed a C/E ratio of US

Fatores associados à adequação do cuidado pré-natal e à assistência ao parto em São Tomé e Príncipe, 2008-2009

119.80 per saved occlusal surface and an incremental C/E ratio of US

[Evaluation of eight Clinical Protocols and Therapeutic Guidelines under the Brazilian Ministry of Health using the AGREE II instrument: a pilot study].

108.36 per additional saved occlusal surface. The study concluded that sealing permanent first molars of high-risk schoolchildren was the most cost-effective intervention.

Análise de custo-efetividade de métodos preventivos para superfície oclusal de acordo com o risco de cárie: resultados de um ensaio clínico controlado

Medical and health research presents many unique challenges for developing and assessing measurement instruments. While the fields of psychometrics and clinimetrics have long and for the most part distinct traditions, there has been surprisingly little work aimed at integrating the two disciplines. In Measurement in Medicine, de Vet et al. [1] nicely fill that gap by bringing measurement concepts traditionally restricted to psychological and educational testing, to the medical and health research community. To that extent, it provides researchers with practical guidance and advice to aid in the development and review of healthspecific measurement instruments. The book is not intended to present state-of-the-art measurement techniques but rather focuses on the techniques that are well established and widely used. This work may be viewed as an outgrowth of the COSMIN initiative (Conesus-based Standards for the selection of health Measurement Instruments; [4]. The COSMIN checklist provides a standardized tool for evaluating the methodological properties of health-related patient-reported outcomes (HR-PRO) measurement instruments (Mokkink et al. [5]. By adopting the COSMIN terminology and taxonomy, this book provides a uniform set of guidelines and standards that researchers and health professionals can use to develop and assess measurement instruments (Mokkink et al. [6]. An overview of the book

Feasibility of visual aids for risk evaluation by hospitalized patients with coronary artery disease: results from face-to-face interviews

ABSTRACT OBJECTIVE To estimate the direct medical costs of advanced non-small cell lung cancer care. METHODS We assessed a cohort of 277 patients treated in the Brazilian National Cancer Institute in 2011. The costs were estimated from the perspective of the hospital as a service provider of reference for the Brazilian Unified Health System. The materials and procedures used were identified and quantified, per patient, and we assigned to them monetary values, consolidated in phases of the assistance defined. The analyses had a descriptive character with costs in Real (R