Luís de Lima Pinheiro

Embolia pulmonar em Portugal : epidemiologia e mortalidade intra-hospitalar

INTRODUCTION In Portugal, the epidemiology of acute pulmonary embolism is poorly understood. In this study, we sought to characterize the pulmonary embolism from the hospital data and evaluate its in-hospital mortality and respective prognostic factors. MATERIAL AND METHODS The study used diagnostic related groups data from National Health System hospitals from 2003 to 2013 and National Statistics Institute population data to establish the evolution of admissions with the diagnosis of pulmonary embolism, their inhospital mortality rates and the population incidence rates. Diagnosis-related group microdata were used in a logit regression modeling in-hospital mortality as a function of individual characteristics and context variables. RESULTS Between 2003 and 2013 there were 35,200 episodes of hospitalization in patients with 18 or more years in which one of the diagnoses was pulmonary embolism (primary diagnosis in 67% of cases). The estimated incidence rate in 2013 was 35/100,000 population (≥ 18 years). Between 2003 and 2013, the annual number of episodes kept increasing, but the in-hospital mortality rate decreased (from 31.8% to 17% for all cases and from 25% to 11.2% when pulmonary embolism was the main diagnosis). The probability of death decreases when there is a computerized tomography scan registry or when patients are females and increases with age and the presence of co-morbidities. DISCUSSION In the last decade there was an increased incidence of pulmonary embolism likely related to an increased number of dependents and bedridden. However, there was a in-hospital mortality reduction of such size that the actual mortality in the general population was reduced. One possible explanation is that there has been an increase in episodes of pulmonary embolism with incrementally lower levels of severity, due to the greater capacity of diagnosis of less severe cases. Another possible explanation is greater effectiveness of hospital care. According to the logistic regression analysis, improvements in hospital care effectiveness in recent years are primarily responsible for the mortality reduction. CONCLUSION About 79% of the reduction of in-hospital mortality of pulmonary embolism between 2003 and 2013 can be attributed to greater effectiveness of hospital care and the rest to the favorable change in patient characteristics associated with risk of death.

Custo‐efetividade dos novos anticoagulantes orais na fibrilhação auricular em Portugal

INTRODUCTION AND OBJECTIVES Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients. METHODS A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). RESULTS Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were €5529/QALY and €9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% probability of being cost-effective (at a threshold of €20 000/QALY) compared to all the other therapeutic options. CONCLUSIONS Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons, but despite this limitation, the information is useful for healthcare decision-makers.

Carga e custo da fibrilhação auricular em Portugal

INTRODUCTION AND OBJECTIVES Atrial fibrillation is the most prevalent sustained arrhythmia. This paper estimates the burden and cost of illness attributable to atrial fibrillation in Portugal based on demographic and health statistics. METHODS Mortality data by cause of death came from the European Detailed Mortality Database of the World Health Organization (WHO). Hospital data were taken from the Portuguese diagnosis-related groups database. The burden of disease was measured using DALYs (disability-adjusted life years), a metric adopted by the WHO. Costs studied included resource use and lost productivity. The burden and cost of illness are those attributable to atrial fibrillation and its main complication, ischemic stroke. RESULTS In Portugal, 4070 deaths were attributable to atrial fibrillation in 2010, corresponding to 3.8% of all deaths. In total, the burden of disease attributable to atrial fibrillation was estimated at 23,084 DALYs: 10,521 resulting from premature deaths (1.7% of the total DALYs due to death in 2010 in Portugal), and 12,563 resulting from disability. The total estimated direct costs attributable to atrial fibrillation at 2013 prices were €115 million: €34 million for inpatient care and €81 million for outpatient care. Indirect costs resulting from lost production due to disability were estimated at €25 million. CONCLUSIONS Atrial fibrillation has an important social impact in Portugal due to its associated mortality and morbidity, and was responsible in 2013 for a total cost of €140 million, about 0.08% of gross domestic product.

Cost-Effectiveness Of The Non-Vitamin K Antagonist Oral Anticoagulants For Atrial Fibrillation In Portugal

Costa J1. Fiorentino F2. Caldeira D1. Inês M3. Pereira C2. Pinheiro L4. Vaz Carneiro A2. Gouveia M5. Borges M1 1Institute of Molecular Medicine. Lisbon. Portugal. 2Center for Evidence Based Medicine. Faculty of Medicine. University of Lisbon. Lisbon. Portugal. 3Laboratórios Pfizer Lda.. Lisbon. Portugal. 4Centro Hospitalar Lisboa Norte. Lisbon. Portugal. 5Católica Lisbon School of Business and Economics. Lisbon. Portugal

Corruption in International Commercial Contracts – A Portuguese Substantive and Private International Law Perspective

The contribution examines the effects of corruption on the validity of bribery contracts and on the validity and binding force of contracts obtained through corruption in international trade, and the consequences of invalidity. Regarding the contracts obtained through corruption, the main focus is in private law contracts, but issues raised by corruption in administrative contracts are also briefly addressed.

Cost and Burden of Non-Small Cell Lung Cancer's in Portugal.

Borges M1,2,3, Gouveia M4, Alarcão J1, Sousa R1, Teixeira E5, Barata F6, Laranjeira E1, Lopes F1, Parente B7, Pinheiro L1, Vaz-Carneiro A1, Costa J1,2 1 Center for Evidence Based Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal 2 Clinical Pharmacology Unit, Institute of Molecular Medicine, Lisbon, Portugal 3 Centro Hospitalar Lisboa Central, Lisbon Portugal 4 Católica Lisbon School of Business and Economics, Lisbon, Portugal 5 Centro Hospitalar Lisboa Norte, Lisbon, Portugal 6 Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal 7 Hospital CUF Porto, Porto, Portugal

1047PNON-SMALL CELL LUNG CANCER'S BURDEN OF DISEASE IN PORTUGAL

ABSTRACT Aim: To estimate the Disability Adjusted Life-Years (DALY) associated with Non-Small Cell Lung Cancer (NSCLC) during 2012 in Portugal. Methods: DALY combines Years of Life Lost (YLL) due to premature mortality and Years Lost due to Disability (YLD). The YLL correspond to the number of deaths multiplied by the present valued socially weighted life expectancy at the age at which death occurs using a standardized life table. For the distribution of lung cancer mortality by age and gender the WHO European mortality database was used. To estimate the proportion of these deaths that is due to NSCLC we applied a ratio (85.7%) based on data from the Diagnosis-Related Groups database. To estimate YLD in a particular time period, the number of incident cases in that period is multiplied by the average duration of the disease on a scale ranging from 0 (perfect health) to 1 (death). NSCLC incidence was estimated from Portuguese National and Regional Cancer Registry. The average duration of the disease was derived from the survival curves published by the International Association for the Study of Lung Cancer. Disability weights were taken from the Disability Weights for Diseases in the Netherlands Study. Results: A total of 3,180 deaths in Portugal in 2012 were caused by NSCLC, which corresponds to 2.0% of the total deaths in Portugal. The DALYs resulting from premature deaths caused by NSCLC in 2012 totaled 25,071 representing 4.5% of years lost generated by all deaths in the country. For 2012 it is estimated that 3,236 life years were lost due to disability. The total disease burden attributable to NSCLC is thus estimated at 28,307 DALY. Conclusions: NSCLC is an important cause of disease burden in Portugal and should receive adequate attention from policy makers. Disclosure: M.F. Borges: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; M. Gouveia: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; J. Alarcao: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; R. Sousa: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; F. Barata: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; E. Laranjeira: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; F. Lopes: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; B. Parente: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; L. Pinheiro: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; M.E. Teixeira: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; A. Vaz-Carneiro: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study; J. Costa: The Faculty of Medicine, University of Lisbon received an unrestricted grant from Laboratorios Pfizer Lda. to conduct this study.