Economic analysis of antenatal screening for human T-cell lymphotropic virus type 1 in Brazil: an open access cost-utility model.

BACKGROUND: Human T-cell lymphotropic virus type 1 (HTLV-1) is a retrovirus that causes severe diseases, such as aggressive cancer or progressive neurological disease. HTLV-1 affects mainly people in areas with low human development index and can be transmitted from mother to child, primarily through breastfeeding. Refraining from breastfeeding is an effective intervention to reduce the risk of infection in infants. However, HTLV-1 antenatal screening is not offered globally. According to WHO, the scarcity of cost-effectiveness studies is considered one of the major barriers to the implementation of policies to prevent HTLV-1 infection. Therefore, this study aimed to assess the cost-effectiveness of antenatal screening and postnatal interventions to prevent HTLV-1 mother-to-child transmission in Brazil and to develop an open-access, editable, mathematical model that can be used by other countries and regions to assess different scenarios. METHODS: In this cost-utility analysis, we constructed a decision tree and a Markov model to assess the cost-effectiveness of HTLV-1 antenatal screening and postnatal interventions (ie, avoidance of breastfeeding, by suppression of lactation with cabergoline, and provision of formula feed) to reduce transmission. For our model, we used data from Brazil and we took the perspective of the public health-care system to estimate costs. FINDINGS: The implementation of both screening and interventions would result in the prevention of 1039 infections in infants every year in Brazil with an incremental cost-effectiveness ratio (ICER) of US$11 415 per quality-adjusted life-year (QALY). 88% of all probabilistic sensitivity analysis simulations had ICER values lower than the Brazilian cost-effectiveness threshold ($18 107·74 per QALY). HTLV-1 prevalence in pregnant women, the risk of HTLV-1 transmission when breastfeeding lasts for 6 months or more, and the cost of screening tests were the variables with the largest effect on ICER. INTERPRETATION: HTLV-1 antenatal screening is cost-effective in Brazil. An open-access model was developed, and this tool could be used to assess the cost-effectiveness of such policy globally, favouring the implementation of interventions to prevent HTLV-1 mother-to-child transmission worldwide. FUNDING: None. TRANSLATIONS: For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

Economic analysis of antenatal screening for human T-cell lymphotropic virus type 1 in Brazil: an open access cost-utility model

Background Human T-cell lymphotropic virus type 1 (HTLV-1) is a retrovirus that causes severe diseases, such as aggressive cancer or progressive neurological disease. HTLV-1 affects mainly people in areas with low human development index and can be transmitted from mother to child, primarily through breastfeeding. Refraining from breastfeeding is an effective intervention to reduce the risk of infection in infants. However, HTLV-1 antenatal screening is not offered globally. According to WHO, the scarcity of cost-effectiveness studies is considered one of the major barriers to the implementation of policies to prevent HTLV-1 infection. Therefore, this study aimed to assess the cost-effectiveness of antenatal screening and postnatal interventions to prevent HTLV-1 mother-to-child transmission in Brazil and to develop an open-access, editable, mathematical model that can be used by other countries and regions to assess different scenarios. Methods In this cost-utility analysis, we constructed a decision tree and a Markov model to assess the cost-effectiveness of HTLV-1 antenatal screening and postnatal interventions (ie, avoidance of breastfeeding, by suppression of lactation with cabergoline, and provision of formula feed) to reduce transmission. For our model, we used data from Brazil and we took the perspective of the public health-care system to estimate costs. Findings The implementation of both screening and interventions would result in the prevention of 1039 infections in infants every year in Brazil with an incremental cost-effectiveness ratio (ICER) of US$11415 per quality-adjusted lifeyear (QALY). 88% of all probabilistic sensitivity analysis simulations had ICER values lower than the Brazilian costeffectiveness threshold ($18 107·74 per QALY). HTLV-1 prevalence in pregnant women, the risk of HTLV-1 transmission when breastfeeding lasts for 6 months or more, and the cost of screening tests were the variables with the largest effect on ICER. Interpretation HTLV-1 antenatal screening is cost-effective in Brazil. An open-access model was developed, and this tool could be used to assess the cost-effectiveness of such policy globally, favouring the implementation of interventions to prevent HTLV-1 mother-to-child transmission worldwide. (AU)

Caracterização de pessoas jovens com infarto agudo do miocárdio / Caracterización de personas jóvenes con infarto agudo de miocardio / Characterization of young people with acute myocardium infarction

Objetivo caracterizar a apresentação clínica de adultos jovens diagnosticados com infarto agudo do miocárdio. Método pesquisa documental com abordagem quantitativa. Utilizou-se um formulário sobre aspectos sociodemográficos e clínicos. A amostra foi composta por 12 prontuários, de pacientes com idade entre 25 e 45 anos. Os dados coletados foram tabulados em uma planilha do Excel e, após análise, foram apresentados em frequências absolutas. Resultados predominou o sexo masculino, com Supra de ST, faixa etária entre 35 e 45 anos de idade, com sobrepeso e sem antecedentes familiares. Dor torácica foi encontrada em 91,66% dos jovens, 58,33% não faziam uso de medicação contínua e 100% tiveram elevação da troponina e realizaram cateterismo cardíaco. Conclusão o quadro de apresentação clínica na população jovem estudada ficou dentro dos parâmetros gerais para o diagnóstico do infarto agudo do miocárdio.

Objetivo caracterizar el cuadro clínico de adultos jóvenes con diagnóstico de infarto agudo de miocardio. Método investigación documental con enfoque cuantitativo. Se utilizó un formulario sobre aspectos sociodemográficos y clínicos. La muestra estuvo compuesta por 12 registros médicos de pacientes entre 25 y 45 años de edad. Los datos se recolectaron en una planilla de Excel y, después del análisis, se presentaron en frecuencias absolutas. Resultados se registró un predominio del sexo masculino, con Supra de ST, grupo etario de 35 a 45 años, con sobrepeso y sin antecedentes familiares. Se encontró dolor de tórax en el 91,66% de los jóvenes, el 58,33% no tomaban ningún medicamento en forma continua y el 100% tuvo una suba de la troponina y se sometían a cateterismo cardíaco. Conclusión el cuadro de presentación clínica en la población joven estudiada estuvo dentro de los parámetros generales correspondientes al diagnóstico de infarto agudo de miocardio.

Objective to characterize the clinical presentation of young adults diagnosed with acute myocardial infarction. Method a documentary research with a quantitative approach. A form on sociodemographic and clinical aspects was used. The sample consisted of 12 medical records, from patients aged between 25 and 45 years old. The collected data were tabulated in an Excel spreadsheet and, after analysis, were presented in absolute frequencies. Results predominantly males, with Supra ST, aged between 35 and 45 years old, overweight and without family history. Chest pain was found in 91.66% of the young people, 58.33% did not use continuous medication and 100% had troponin elevation and cardiac catheterization. Conclusion the clinical presentation in the studied young population was within the general parameters for acute myocardial infarction diagnosis.

Segurança e efetividade da fisioterapia respiratória em abscesso pulmonar: estudo de casos / Safety and effectiveness of chest physiotherapy in lung abscess: a two-case study

O abscesso pulmonar é uma lesão necrótica geralmente devida a germes piogênicos. A fisioterapia respiratória (FR) é indicada, porém há poucos relatos na literatura, não havendo consenso quanto ao uso e às técnicas de FR para esse caso. O objetivo deste estudo de dois casos foi verificar a segurança e efetividade da FR no tratamento do abcesso pulmonar. O caso 1 foi um paciente de 30 anos, internado; a terapia consistiu em posicioná-lo em Trendelenburg semi-lateral direito para ventral por 30 minutos, três vezes ao dia, com saída de grande quantidade de secreção. Após 5 dias, o radiograma de tórax demonstrou redução de 90% do nível hidroaéreo, verificando-se o esvaziamento completo do abscesso após 14 dias de internação. O caso 2 foi uma paciente de 28 anos igualmente com diagnóstico de abscesso pulmonar, também tratada com drenagem postural, nos mesmos posicionamento e freqüência que o caso 1, sendo drenada grande quantidade de secreção amarelada e fluida. Após 7 dias de tratamento evidenciou-se redução importante do nível líquido do abscesso pulmonar. Conclui-se que a drenagem postural isoladamente é uma técnica de fisioterapia efetiva e segura no tratamento do abcesso pulmonar.

Lung abscess is a necrotic lesion mostly caused by pyogenic germs. Chest physical therapy (CPT) is indicated, but there are few studies available and no consensus on CPT use and techniques for theses cases. The purpose of this study was to assess safety and effectiveness of postural drainage in treating lung abscess in two cases. Patient 1, male, 30 years old, was laid in Trendelenburg, in semi-lateral to ventral decubitus for 30 minutes, three times a day. After five days of therapy, X-ray showed a 90% decrease of sputum, and on the 14th day full drainage was achieved. Case 2 was a female patient, 28 years old, treated at the same position and frequency as case 1. After seven days of therapy, exams showed a great decrease of pus from the abscess. It may thus be said that postural drainage alone is a safe and effective chest physical therapy technique for treating lung abscesses.