Cost-Effectiveness Analysis of Digital Breast Tomosynthesis Added to Synthetic Mammography in Breast Cancer Screening in Brazil.

BACKGROUND: Literature meta-analysis results show that digital breast tomosynthesis (DBT) combined with synthesized two-dimensional (s2D) mammograms can reduce recalls and improve breast cancer detection. Uncertainty regarding the screening of patients with breast cancer presents a health economic challenge, both in terms of healthcare resource use and quality of life impact on patients. OBJECTIVE: This study aims to estimate the cost effectiveness of DBT + s2D versus digital mammography (DM) used in a biennial breast cancer screening setting of women aged 40-69 years with scattered areas of fibroglandular breast density and heterogeneous dense breasts in the Brazilian supplementary health system. METHODS: A cost-effectiveness analysis was performed on the basis of clinical data obtained from a systematic review with meta-analysis performed to evaluate the analytical validity and clinical utility of DBT + s2D compared with DM. The search was conducted in the PubMed, Cochrane Library and Embase databases, with the main descriptors of the technology, a comparator, and the clinical condition in question, on 9 June 2022. The hybrid economic model (decision tree plus Markov model) simulated costs and outcomes over a lifetime for women aged 40-69 years with scattered areas of fibroglandular breast density and heterogeneous dense breasts. We analyzed incremental cost-effectiveness ratio (ICER) to measure the incremental cost difference per quality-adjusted life year (QALY) of adding DBT + s2D to breast cancer screening. RESULTS: DBT + s2D incurred a cost saving of € 954.02 per patient, in the time horizon of 30 years, compared with DM, and gained 5.1989 QALYs, which would be considered a dominant intervention. These results were confirmed in sensitivity analyses. CONCLUSION: Switching from DM to biennial DBT + s2D was cost effective. Furthermore, reductions in false-positive recall rates should also be considered in decision making.

The different clinical guideline standards in Brazil: High cost treatment diseases versus poverty-related diseases.

Each year, evidence-based clinical guidelines gain more space in the health professionals' practice and in services organization. Due to the scarcity of scientific publications focused on diseases of poverty, the development of well-founded clinical guidelines becomes more and more important. In view of that, this paper aims to evaluate the quality of Brazilian guidelines for those diseases. The AGREE II method was used to evaluate 16 guidelines for poverty-related diseases (PRD) and 16 guidelines for global diseases whose treatment require high-cost technologies (HCD), with the ultimate aim of comparing the results. It was found that, in general, the guideline development quality standard is higher for the HCD guidelines than for the PRD guidelines, with emphasis on the "rigour of development" (48% and 7%) and "editorial independence" (43% and 1%) domains, respectively, which had the greatest discrepancies. The HCD guidelines showed results close to or above international averages, whereas the PRD guidelines showed lower results in the 6 domains evaluated. It can be concluded that clinical protocol development priorities need some redirecting in order to qualify the guidelines that define the healthcare organization and the care of vulnerable populations.

Biosensing breast cancer cells based on a three-dimensional TIO2 nanomembrane transducer.

The early diagnosis of breast cancer is crucial for the successful treatment and recovery phases of the patients suffering from the disease. Although mammography is considered the gold standard for diagnosis, it fails to detect some cancers in high-density breasts. In this work, we propose for the first time a tridimensional biosensor platform, to be used on an electrochemical point-of-care device. The bioconjugated platform is constructed on a series of covalent linkages between lectin molecules and a cysteine layer immobilized over gold-coated TiO2 butterfly-like tridimensional nanomembranes. Through the use of vegetal lectins, we managed to take advantage of the markedly atypical glycomic profile of the cancerous mammalian cell membrane and successfully made a distinction between highly invasive (T47D) and less invasive (MCF7) cancer cell lines. The selectivity of the biosensor was tested by using normal human skin-fibroblast. The proposed cytosensor demonstrated limits of detection as low as 10 cells mL-1 for every cell line and a linear range from 10 to 1.0×106 cells mL-1. Considering that electrochemical impedance values can be correlated with the number of breast cancer cells present in the sample, we suggest that the proposed platform could be useful in facilitating the diagnosis of cancer.

Effectiveness evaluation of public policy incentive R&D in technological innovation in Brazil: a focus on law of the well / Avaliação da efetividade das políticas públicas de incentivo a p & d na inovação tecnológica no Brasil: um enfoque na lei do bem

The present paper will address pharmaceutical industries that carry out research, development and innovation (RD&I) Brazil and their consequent adherence to tax incentives based on 'Law of the Well' (Brazilian, Law No. 11,196 / 2005). Our hypothesis evaluates if public policies of incentives for transformation of technological knowledge could encourage firms to invest in RD&I. Our research was based on Government Annual Reports that reported the use of tax incentives during a period between 2006 and 2012; and legal framework destined for supporting research, both provided by Ministry of Science, Technology and Innovation of Brazil. During the studied period, an increase of 800% of the participating companies of the 'Law of the Well' was observed, demonstrating a need to invest in R&D. The sum of the expenditure of defrayal for the computation of the incentives the companies that operated in real income regime and have chosen to take advantage of tax incentives 'Law of the Well' amounted to R $ 40.52 billion. Well although one of the purposes of the 'Law of the Well' is to subsidize the establishment of researchers in companies, the total value of capital expenditure does not exceed 4% of the total amount invested in R & D activities. Similarly it is observed that the percentage of encouraging the development and patenting did not exceed 1%. In spite of Good Law be used as institutional apparatus for improvement of the efficiency and competitivity of the companies for the global market, recent indicators of spending on R&D in Brazil demonstrate stagnation of investments in various sectors.

O presente artigo abordará sobre as indústrias farmacêuticas que realizam atividades de pesquisa, desenvolvimento e inovação (PD&I) no Brasil, e sua consequente adesão aos incentivos fiscais da Lei do Bem (Brasil, Lei nº 11.196/2005). Nossa hipótese avalia se as políticas públicas de incentivo para transformação do conhecimento tecnológico poderiam incentivar as empresas investirem em PD&I. Nossa pesquisa foi baseada em relatórios do governo que relataram o uso de incentivos fiscais durante o período de 2006 e 2012; e o arcabouço legal de amparo à pesquisa, ambos fornecidos pelo Ministério de Ciência, Tecnologia e Inovação do Brasil. Durante o período estudado, observou-se um aumento de 800% das empresas participantes do Lei do Bem, demonstrando a necessidade de investir em P & D. A soma das despesas com custeio para efeito do cálculo dos incentivos as empresas que operaram em regime de lucro real e que optaram por usufruir dos incentivos fiscais da Lei do Bem atingiram o valor de R$ 40,52 bilhões. Embora um dos propósitos da Lei do Bem seja subsidiar a fixação de pesquisadores nas empresas, os valores totais das despesas capitais não ultrapassam a 4% do valor total investido em atividades de P&D. Semelhantemente observa-se que os percentuais de incentivo ao desenvolvimento e registro de patentes também não ultrapassam a 1%. Embora a Lei do Bem se apresente como um aparato institucional que contribui para as empresas se tornarem eficientes e competitivas para enfrentar o acirrado mercado globalizado, indicadores recentes sobre os gastos com P&D no Brasil demonstram certa estagnação nos investimentos nos diversos setores.

Impacto da atenção farmacêutica na função pulmonar de pacientes com asma grave / Impact of pharmaceutical care on lung function in patients with severe asthma

O estudo avaliou a influência do serviço de Atenção Farmacêutica na otimização dos resultados terapêuticos de pacientes com asma grave não controlada, em uso de formoterol associado à budesonida. Utilizou-se o Método Dáder de Seguimento Farmacoterapêutico e o Teste do Controle de Asma (ACT™) para avaliação de resultados, assim como a espirometria. Foram acompanhados 26 pacientes por um período não inferior a seis meses, cuja média de idade foi 55 ± 11 anos, destes, 22 (84%) foram do gênero feminino. Na pesquisa verificou-se que 22 (84,6%) pacientes apresentaram mais de uma enfermidade associada à asma grave e 24 (92%) faziam uso de dois ou mais fármacos. Foram detectados 58 resultados negativos associados aos medicamentos (RNM), com incidência de 2,2 ± 0,99 RNM por usuário. O RNM mais frequente foi insegurança não quantitativa identificada em 11 usuários (43%), sendo 31% desses devido às reações adversas ao medicamento. Foram realizadas 65 intervenções farmacêuticas para resolver os RNM, com média de 2,5 ± 1,2 por paciente, das quais 85% ocorreram na farmácia sem a necessidade de voltar ao médico. Dos resultados clínicos, após as intervenções farmacêuticas, todos os usuários tiveram melhora significativa da asma (p<0,05), porém 2 deles (7,6%) ainda apresentaram asma não controlada. Assim, o estudo sinalizou a necessidade do acompanhamento farmacoterapêutico aos usuários com asma grave não controlada para otimização dos resultados clínicos.

The aim of the present study was to analyze the influence of pharmaceutical care on the optimization of therapeutic results in patients with severe asthma using formoterol combined with budesonide. Evaluations were performed with spirometry, the Dáder Pharmacotherapeutic Follow Up method and Asthma Control Test (ACT™). Twenty-six patients (mean age: 55 ± 11 years; 22 females) were monitored for not less than six months. Twenty-two patients (84.6%) had more than one health condition associated with severe asthma and 24 (92%) made use of two or more drugs. The research identified 58 negative results associated with medication (NRM), corresponding to an individual incidence of 2.2 ± 0.99 NRMs per patient. The most frequent NRM was a non-quantitative uncertainty identified in 11 patients (43%), with 31% of cases due to adverse reactions to the drug. Sixty-five pharmaceutical interventions were carried out to resolve the NRMs, with a mean of 2.5 ± 1.2 per patient, 85% of which occurred in the pharmacy without the need to see a doctor. Subsequently to medical treatment following pharmaceutical intervention, all patients experienced a clear improvement in symptoms (p < 0.05). However, two subjects (7.6%) continued to experience uncontrolled asthma. The present findings reveal a need for the pharmacotherapeutic monitoring of patients with severe uncontrolled asthma in order to optimize clinical outcomes.