Pediatric COVID-19 in Argentina: a comprehensive analysis of disease and economic burden through official data and a systematic literature review.

Background: Limited data are available on the clinical impact and economic burden of COVID-19 in the pediatric population in Argentina. We aimed to estimate the disease and economic burden of COVID-19 on children and adolescents. Methods: We analyzed official national databases and conducted a supplemental systematic review of the published literature with meta-analysis in children aged 0-18. The period of interest was from March 2020 to August 2021, before the introduction of vaccination in this age group as a national strategic plan. In addition, we used a cost of illness analysis to estimate the direct medical costs associated with COVID-19. All costs are reported in US dollars 2023. Results: A total of 450,503 confirmed COVID-19 cases and 180 multisystem inflammatory syndrome (MIS-C) were reported in Argentina in the study period. Fourteen observational clinical studies were identified. The meta-analyses of severity level from hospital patients showed that according to different studies 15%-28% of cases were asymptomatic, 68%-88% were mild or moderate, and 3%-10% were severe or critical. About 28% of children had an underlying disease. In addition, the estimated economic burden associated with COVID-19 was 80 million dollars and 4 million dollars corresponded to MISC. Conclusion: Significant impact of COVID-19 on the healthcare system and substantial economic implications for the pediatric population in Argentina were identified. The findings should help policymakers to make informed decisions and allocate resources effectively.

Burden of COVID-19 during the omicron predominance in Brazil: a nationwide retrospective database study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has imposed significant burden on Brazil's health system. This study aimed to examine clinical characteristics, overall vaccine uptake, and to assess healthcare resource utilization (HCRU) and costs associated with acute COVID-19 in Brazil during the Omicron predominant period. METHODS: A nationwide retrospective study was conducted using various Brazilian databases including, COVID-19 related databases, public health systems, and other surveillance/demographic datasets. Individuals with positive COVID-19 test results between January 1 2022 and April 30 2022, during Omicron BA.1/BA.2 wave, were identified. Patients' demographics, vaccine uptake, HCRU and corresponding costs were described by age groups. RESULTS: A total of 8,160,715 (3.80%) COVID-19 cases were identified in the study cohort, ranging from 2.43% in <5 years to 62.05% in 19-49 years. The uptake of partial (Dose 1) or full immunization (Dose 2) was less than 0.1% in children aged <5 years, whereas in individuals ≥ 19 years, it exceeded 89.78% for Dose 1 and 84.07% for Dose 2. Overall booster vaccine uptake was 38.06%, which was significantly higher among individuals aged ≥ 65 years, surpassing 74.79%. Regardless of vaccination status, 87.2% cases were symptomatic, and 1.48% were hospitalized due to acute COVID-19 (<5 years: 2.33%, 5-11 years: 0.99%, 12-18 years: 0.32%, 19-49 years: 0.40%; 50-64 years: 1.50%, 65-74 years: 5.43%, and ≥ 75 years: 17.89%). Among the hospitalized patients (n = 120,450), 32.57% were admitted to ICU, of whom 31,283 (79.75%) individuals required mechanical ventilation (MV) support. The average cost per day in normal ward and ICU without MV in public/general hospital settings was $104.36 and $302.81, respectively. While average cost per day in normal ward and ICU with MV was $75.91 and $301.22 respectively. CONCLUSIONS: This study quantified the burden of COVID-19 in Brazil, suggesting substantial healthcare resources required to manage the COVID-19 pandemic.

Estenose valvular aórtica e o uso de TAVI: revisão narrativa das evidências publicadas e avaliação básica de custos / Aortic valve stenosis and the use of TAVI: narrative review of published evidences and basic costs assessment

Objetivo: Revisar as evidências clínicas da estenose valvular aórtica em suas dimensões médica e econômica, analisando as alternativas de tratamento cirúrgico em pacientes de alto risco cirúrgico com foco na tecnologia do implante transcateter de válvula aórtica (TAVI). Métodos: Foi elaborada uma revisão narrativa das publicações relacionadas à estenose vascular aórtica e às metodologias de tratamento cirúrgico, assim como a comparação entre a metodologia TAVI e as abordagens convencionais (substituição cirúrgica de válvula aórtica por esternotomia, valvuloplastia por balão intra-aórtico e tratamento farmacológico), abordando ainda dados sobre algumas diferentes marcas e gerações de dispositivos de TAVI oferecidas no mercado brasileiro, avaliando a eficácia, a segurança e o custo de tratamento. Resultados: Em pacientes portadores de estenose aórtica grave sintomática e inoperáveis pela abordagem convencional, o uso do TAVI mostrou ser uma alternativa mais segura, eficaz e econômica em comparação aos tratamentos convencionais. Estudos com robustez metodológica mostram que esse procedimento alcança taxas superiores a 80% de sobrevida em um ano e aproximadamente 30% em cinco anos, mesmo em pacientes de alto risco. No entanto, foram observadas diferenças significativas nos desfechos entre diferentes estudos, que podem ser atribuídas não apenas ao desenho e à amostragem, mas às diferenças entre as diversas opções de gerações e marcas de dispositivos para TAVI disponíveis no mercado. Essas opções diferem principalmente na estrutura, via de inserção e modo de expansão. As válvulas de terceira geração vêm apresentando os melhores resultados em termos de eficácia, segurança e facilidade no procedimento, que resultam em mais benefícios aos pacientes e equilibram os custos de tratamento em médio e longo prazos. Conclusões: Estudos com evidências robustas avaliando desfechos representativos para o tratamento da estenose aórtica grave e sintomática mostram que a tecnologia minimamente invasiva TAVI é eficaz, segura no tratamento de pacientes de alto risco ou inoperáveis, com melhorias significativas nos dispositivos de terceira geração.

Objective: To review the clinical evidences of aortic valve stenosis in its medical and economical settings, reviewing the surgical treatment alternatives in patients at high surgical risk focused on the transcatheter aortic valve implantation (TAVI) technology. Methods: A structured review of the publications related to the disease and to the surgical treatment methodologies was conducted, followed by a search for information about the TAVI methodology, with comparisons between this method and conventional approaches (surgical aortic valve replacement by means of sternotomy, valvuloplasty via intra-aortic balloon and pharmacological treatment) and comparisons between different brands and generations of TAVI devices, evaluating the treatment efficacy, safety and cost. Results: In patients with severe symptomatic aortic stenosis who cannot be operated using the conventional approach, the use of TAVI was shown to be a safer, more effective and more economical alternative compared to the conventional treatments. The studies of the best methodology show that this is a safe, effective and curative procedure, reaching rates above 80% in 1-year survival and of approximately 30% in 5-year survival, even in patients at high risk. However, significant differences in the outcomes among different studies were observed, which may be attributed to the design and sampling as well as to the differences among the several options of TAVI devices available on the market. These options differ in structure, insertion route, expansion mode and in the several generations of valves. Third-generation valves have been presenting the best results in terms of efficacy, safety and procedure easiness, which result in more benefits to patients and balance the medium-term and long-term treatment cost. Conclusions: The most robust studies evaluating the TAVI valves show that this minimally invasive technology is effective and safe for the treatment of severe symptomatic aortic stenosis in patients at high risk or who cannot be operated.