Mariana Peixoto Socal

Clinical and Epidemiological Factors Associated with Mortality in Parkinson's Disease in a Brazilian Cohort.

Background. Prognosis of PD is variable. Most studies show higher mortality rates in PD patients compared to the general population. Clinical and epidemiologic factors predicting mortality are poorly understood. Methods. Clinical and epidemiologic features including patient history and physical, functional, and cognitive scores were collected from a hospital-based cohort of PD patients using standardized protocols and clinical scales. Data on comorbidities and mortality were collected on follow-up. Results. During a mean follow-up of 4.71 years (range 1–10), 43 (20.9%) of the 206 patients died. Those who died had higher mean age at disease onset than those still alive at the last follow-up (67.7 years versus 56.3 years; p < 0.01). In the univariate analysis, age at baseline was associated with decreased survival. In the adjusted Cox proportional hazards model, age at disease onset and race/ethnicity were predictors of mortality. Conclusions. Late age at disease onset and advanced chronological age are associated with decreased survival. Comorbidities and PD characteristics were not associated with decreased survival in our sample. Race/ethnicity was found in our study to be associated with increased hazard of mortality. Our findings indicate the importance of studying survival among different populations of PD patients.

Reducing branded prescription drug prices: A review of policy options

The high prices of specialty pharmaceuticals are causing some public programs to ration care and many private insurers, including Medicare drug plans, to place specialty drugs on high cost‐sharing tiers. As a result, access to these drugs is often restricted, and only a small portion of the population with a disease may receive treatment. This concern has generated a wide range of proposed solutions. We conducted a literature review and identified 52 solutions in the peer‐reviewed literature that we classified into five broad categories: revising the patent system, encouraging research to increase development of new drugs, altering pharmaceutical regulation, decreasing market demand, and developing innovative pricing strategies. We discuss the rationale for these five approaches and summarize the proposed solutions. We also discuss four empirical issues that are particularly important in any discussion of policy options.

Links Between Chronic Illness and Late-Life Cognition: Evidence From Four Latin American Countries:

Objectives: We explored the links between chronic diseases and cognitive ability using datasets of community-dwelling older adults from Brazil, Chile, Mexico, and Uruguay from the SABE (Health, Well-Being, and Aging) survey. Methods: Ordinary least squares (OLS), Tobit and linear probability models, adjusting for extensive health and socio-demographic factors, were implemented separately for men and women and complemented by a series of robustness checks. Results: We find a negative association between the number of chronic conditions and cognitive decline that has the following characteristics: (a) differs across gender, (b) increases with the number of chronic conditions, (c) is larger among those individuals in the bottom of the cognitive distribution, (d) and is different across types of chronic conditions. Discussion: These results suggest that returns from preventive policies to reduce cognitive decline would increase if they were targeted to seniors with chronic conditions and implemented before the impact from multiple comorbidities makes the cognitive decline too steep to be reversed.

Judicialization 2.0: Understanding right-to-health litigation in real time

ABSTRACT Over the past two decades, debate over the whys, the hows, and the effects of the ever-expanding phenomenon of right-to-health litigation (‘judicialization’) throughout Latin America have been marked by polarised arguments and limited information. In contrast to claims of judicialization as a positive or negative trend, less attention has been paid to ways to better understand the phenomenon in real time. In this article, we propose a new approach—Judicialization 2.0—that recognises judicialization as an integral part of democratic life. This approach seeks to expand access to information about litigation on access to medicines (and health care generally) in order to better characterise the complexity of the phenomenon and thus inform new research and more robust public discussions. Drawing from our multi-disciplinary perspectives and field experiences in highly judicialized contexts, we thus describe a new multi-source, multi-stakeholder mixed-method approach designed to capture the patterns and heterogeneity of judicialization and understand its medical and socio-political impact in real time, along with its counterfactuals. By facilitating greater data availability and open access, we can drive advancements towards transparent and participatory priority setting, as well as accountability mechanisms that promote quality universal health coverage.

Branded prescription drug spending: a framework to evaluate policy options

BackgroundHigh drug spending is a concern for policy makers due to limits on access for patients. Numerous policies have been proposed to address high drug spending. The existence of multifarious proposals makes it difficult for policy makers to consider all the alternatives. We developed an approach to select the most viable options to present to policy makers.MethodsWe identified 41 different proposals in the peer-reviewed literature to reduce the level of spending or change the incentives for branded prescription drugs; ten of which we identified as promising proposals. Based on criterion used to assess various legislative proposals regarding branded pharmaceuticals we developed a framework to evaluate the ten promising proposals. We then used a modified Delphi technique to iteratively evaluate these ten proposals starting with the initial criterion. During each iteration, five researchers independently evaluated the ten policies based on available criterion and assessed how to modify the criterion to achieve consensus on what attributes the criterion were intended to measure. We highlight areas of disagreement to show where modifications to existing criterion are needed.ResultsWe found general agreement for most policy-criterion combinations after three iterations. Areas with the greatest remaining disagreement include possible unintended consequences, the concept of value implied by many of the policies, and secondary effects by the pharmaceutical industry, insurers, and the FDA.ConclusionsOur analysis provides an approach that can be applied to evaluate policy proposals. It also suggests factors that policy analysts and researchers should consider when they propose policy options and where additional research is needed to assess policy impacts. Developing an objective approach to compare alternatives may facilitate the adoption of policies for branded prescription drugs in the U.S. by allowing policy makers to focus on the most viable options.

A natureza desafiadora de coletar evidências e analisar a judicialização da saúde no Brasil

We read with great interest the article Studies Published in Indexed Journals on Lawsuits for Medicines in Brazil: A Systematic Review, by Gomes & Amador, published in Cadernos de Saúde Pública 1. We applaud Gomes & Amador’s goal of contributing to the effort of “explain(ing) the judicialization phenomenon, identifying the general profile of lawsuits, drawing inferences on the claims, describing the various issues involved, and proposing alternatives to solve problems” (p. 2). The review examined 17 studies that looked at lawsuits seeking access to medicines in Brazil, including our analysis of 1,080 lawsuits filed against the state of Rio Grande do Sul and published in Between the Court and the Clinic: Lawsuits for Medicines and the Right to Health in Brazil 2. We are writing to correct two errors in the authors’ description of our study. In Table 4 of their article Gomes & Amador (p. 6) state: 1. That the drugs most frequently requested by legal claims in our study were “teriparatide, clopidogrel, insulin glargine, rituximab, and infliximab”. In fact, they were budesonide, acetylsalicylic acid, formoterol, simvastatin, and hydrochlorothiazide; 2. That the medical prescriptions supporting legal claims in our study originated from public health services. In fact, our results showed that 36.8% of the prescriptions came from private practices. CarTaS LetteRS