Economic and budgetary impact evaluation of isavuconazole (Cresemba®) versus voriconazole (Vfend®) for the treatment of patients with possible invasive aspergillosis from the perspective of the Brazilian supplementary health system.

OBJECTIVES: This study aims to evaluate the cost-utility and the budgetary impact of isavuconazole compared to voriconazole in patients with suspected invasive aspergillosis (IA) from the perspective of the Brazilian supplementary health system (SHS). METHODS: In this model, a decision tree was developed and included patients with possible IA. Efficacy parameters were extracted from the clinical studies. Drug acquisition, hospitalization costs and adverse events were also collected. Alternative 3- and 10-year time horizon scenarios were used. In addition, deterministic and probabilistic sensitivity analyses were simulated. A budget impact analysis of isavuconazole versus voriconazole was performed, assuming a time horizon of 5 years. In addition, sensitivity analyses were conducted to assess the robustness of the model. Results are reported in Brazilian Real (BRL), year values 2022. RESULTS: The economic analysis of the base case showed that isavuconazole is associated with a saving of 95,174.00 BRL per patient compared to voriconazole. All other simulated scenarios showed that isavuconazole is dominant versus comparators when considering a willingness to pay 40,688.00 BRL/Quality-Adjusted Life Years (QALY). The results were considered robust by the sensitivity analyses. The budget impact analysis showed that the incorporation of isavuconazole generates savings to the SHS, compared to voriconazole, of approximately 20.5 million BRL in the first year. This reaches about 54 million BRL in the fifth incorporation year, considering the market penetration of 20% in the first year, and 50% in the fifth year. CONCLUSION: Compared with voriconazole, isavuconazole is regarded as a dominant treatment strategy for patients with suspected IA and generates savings for the SHS.

Performance of Metarhizium rileyi Nm017: nutritional supplementation to improve production and quality conidia.

This study aimed to analyze the effect of nutritional supplements on improving conidia production of Metarhizium rileyi Nm017 at laboratory scale (yields of conidia/substrate and biomass/substrate, and substrate consumption). Also, the influence on quality parameters were evaluated (germination at 36 and 48 h, enzymatic activity, and insecticidal activity on Helicoverpa zea). Six treatments (T1-T6) were assessed and all of them reached maximum conidia concentration after 7 days fermentation, a feasible production timetable. Yields from treatment T6 (yeast extract + V8 juice) were 1.5-threefold higher than the other treatments. Conidia from T6 reached germinations of 56% and 12% at 36 and 48 h, respectively, higher than T1 (without supplements), which had the lowest values found. M. rileyi conidia obtained from treatment T6 had the highest enzymatic activity (0.45 U chitinase g-1, 0.28 U lipase g-1, and 1.29 U protease g-1). However, treatments with the highest conidia yields and enzymatic activity were not positively correlated to the efficacy against H. zea. When M. rileyi was produced on T5 (yeast hydrolysate + V8 juice), conidia were 35% more virulent than treatment T6. The findings evidenced the noticeable impact of nutritional substrate amended for conidia production and quality. This work showed the relevance of insecticidal activity assessment as a selection criterion in the mass production development of a biocontrol agent.

Análise de impacto orçamentário de dispositivos contraceptivos na saúde suplementar brasileira / Budget impact analysis of contraceptive devices on Brazilian supplementary health

Objetivo: Analisar o impacto orçamentário da adoção de dispositivos contraceptivos reversíveis de longa duração em uma operadora de plano de saúde localizada no Sul do Brasil. Especificamente, analisamos a incorporação do implante subdérmico de etonogestrel (Implanon®) como alternativa ao sistema intrauterino de levonorgestrel (DIU Mirena® ou DIU Kyleena®), ao longo de um período de 15 anos. Métodos: Realizamos uma análise do impacto orçamentário incremental, considerando a inclusão gradual do implante subdérmico de etonogestrel. Foram considerados dados de uma operadora de planos de saúde com mais de 600.000 beneficiários. O horizonte temporal de 15 anos permitiu uma avaliação abrangente dos efeitos financeiros. Resultados: Identificamos 5.345 pacientes elegíveis para a utilização de contraceptivos reversíveis de longa duração. No cenário em que somente o sistema intrauterino de levonorgestrel era adotado, projetou-se um impacto orçamentário total de R$ 746.379.857,80 ao longo de 15 anos. No cenário alternativo, com a incorporação gradual do implante subdérmico, o impacto orçamentário total foi calculado em R$ 689.800.196,83. Isso resultou em um impacto orçamentário incremental negativo de -R$ 56.579.660,97 ao longo do período. Conclusão: A análise de impacto orçamentário realizada indica um potencial benefício financeiro ao adotar o implante subdérmico de etonogestrel como alternativa ao sistema intrauterino de levonorgestrel para contracepção. Esse achado sugere possíveis reduções de custos na área de saúde suplementar no Brasil, reforçando a importância de avaliar opções economicamente viáveis.

Objective: To analyze the budgetary impact of the adoption of long-acting reversible contraceptive devices in a health plan operator located in southern Brazil. Specifically, we analyzed the incorporation of the etonogestrel subdermal implant (Implanon®) as an alternative to the levonorgestrel intrauterine system (Mirena® IUD or Kyleena® IUD), over a period of 15 years. Methods: We performed an analysis of the incremental budgetary impact, considering the gradual inclusion of the etonogestrel subdermal implant. Data from a health plan operator with more than 600,000 beneficiaries were considered. The 15-year time horizon allowed for a comprehensive assessment of the financial effects. Results: We identified 5,345 patients eligible for the use of long-acting reversible contraceptives. In the scenario where only the levonorgestrel intrauterine system was adopted, a total budget impact of BRL 746,379,857.80 was projected over 15 years. In the alternative scenario, with the gradual incorporation of the subdermal implant, the total budgetary impact was calculated at BRL 689,800,196.83. This resulted in a negative incremental budgetary impact of -R$56,579,660.97 over the period. Conclusion: The budget impact analysis carried out indicates a potential financial benefit in adopting the etonogestrel subdermal implant as an alternative to the levonorgestrel intrauterine system for contraception. This finding suggests possible cost reductions in the supplementary healthcare area in Brazil, reinforcing the importance of evaluating economically viable options.

COVID-19 in real world: Survival and medical costs of hospitalized patients in Brazil´s first wave.

OBJECTIVE: To evaluate survival and direct medical costs of patients admitted in private hospitals with COVID-19 during the first wave. METHODS: A retrospective, observational study analyzing survival and the economic data retrieved on hospitalized patients with COVID-19. Data from March 2020 to December 2020. The direct cost of hospitalization was estimated using the microcosting method with each individual hospitalization. RESULTS: 342 cases were evaluated. Median age of 61.0 (95% CI 57.0‒65.0). 194 (56.7%) were men. The mortality rate was higher in the female sex (p = 0.0037), ICU (p < 0.001), mechanical ventilation (p<0.001) and elderly groups. 143 (41.8%) patients were admitted to the ICU (95% CI 36.6%-47.1%), of which 60 (41.9%) required MV (95% CI 34.0%-50.0%). Global LOS presented median of 6.7 days (95% CI 6.0-7.2). Mean costs were US$ 7,060,00 (95% CI 5,300.94-8,819,00) for each patient. Mean cost for patients discharged alive and patients deceased was US$ 5,475.53 (95% CI 3,692.91-7,258.14) and US$ 12,955.19 (95% CI 8,106.61-17,803.76), respectively (p < 0.001). CONCLUSIONS: Patients admitted with COVID-19 in these private hospitals point to great economic impact, mainly in the elderly and high-risk patients. It is key to better understand such costs in order to be prepared to make wise decisions during the current and future global health emergencies.

COVID-19 in real world: Survival and medical costs of hospitalized patients in Brazils first wave

ABSTRACT Objective: To evaluate survival and direct medical costs of patients admitted in private hospitals with COVID-19 during the first wave. Methods: A retrospective, observational study analyzing survival and the economic data retrieved on hospitalized patients with COVID-19. Data from March 2020 to December 2020. The direct cost of hospitalization was estimated using the microcosting method with each individual hospitalization. Results: 342 cases were evaluated. Median age of 61.0 (95% CI 57.0-65.0). 194 (56.7%) were men. The mortality rate was higher in the female sex (p = 0.0037), ICU (p < 0.001), mechanical ventilation (p<0.001) and elderly groups. 143 (41.8%) patients were admitted to the ICU (95% CI 36.6%-47.1%), of which 60 (41.9%) required MV (95% CI 34.0%-50.0%). Global LOS presented median of 6.7 days (95% CI 6.0-7.2). Mean costs were US$ 7,060,00 (95% CI 5,300.94-8,819,00) for each patient. Mean cost for patients discharged alive and patients deceased was US$ 5,475.53 (95% CI 3,692.91-7,258.14) and US$ 12,955.19 (95% CI 8,106.61 -17,803.76), respectively (p < 0.001). Conclusions: Patients admitted with COVID-19 in these private hospitals point to great economic impact, mainly in the elderly and high-risk patients. It is key to better understand such costs in order to be prepared to make wise decisions during the current and future global health emergencies.

Clinical trial and detection of SARS-CoV-2 by a commercial breath analysis test based on Terahertz technology.

Public health threats such as the current COVID-19 pandemics have required prompt action by the local, national, and international authorities. Rapid and noninvasive diagnostic methods may provide on-site detection and immediate social isolation, used as tools to rapidly control virus spreading. Accordingly, the aim of the present study was to evaluate a commercial breath analysis test (TERA.Bio®) and deterministic algorithm for detecting the SARS-CoV-2 spectral signature of Volatile Organic Compounds present in exhaled air samples of suspicious persons from southern Brazil. A casuistic total of 70 infected and 500 non-infected patients were sampled, tested, and results later compared to RT-qPCR as gold standard. Overall, the test showed 92.6% sensitivity and 96.0% specificity. No statistical correlation was observed between SARS-CoV-2 positivity and infection by other respiratory diseases. Further studies should focus on infection monitoring among asymptomatic persons. In conclusion, the breath analysis test herein may be used as a fast, on-site, and easy-to-apply screening method for diagnosing COVID-19.

Uma revisão integrativa das sequelas da COVID-19 / An integrative review of sequelae of COVID-19 / Una revisión integradora de las secuelas del COVID-19

Objetivo: Identificar na literatura disponível as sequelas de saúde desenvolvidas pela população adoecida pela COVID-19. Métodos: Revisão integrativa com publicações recuperadas a partir do acesso ao Medline via PubMed e ao Portal Regional da Biblioteca Virtual em Saúde (BVS) em abril de 2021 que responderam à questão norteadora: Quais as principais sequelas de saúde desenvolvidas pela população adoecida pela COVID-19?. A estratégia de busca incluiu os descritores: Coronavirus Infections, COVID-19, SARS-COV-2, Complications, Disease, Adult, Long COVID. Identificaram-se 348 publicações, 196 da BVS e 152 no PubMed. Após análise dos critérios de inclusão/exclusão, permaneceram 66 publicações para leitura na íntegra, restando 27 artigos que compuseram a amostra. Resultados: As evidências selecionadas dos 27 artigos permitiram identificação das principais sequelas: neurológicas, saúde mental, cardíacas, no olfato e paladar, vasculares, cutâneas, respiratórias e gastrointestinais. A maior prevalência de sequelas neurológicas ocorreu em mulheres, bem como as cardíacas nos homens; não havendo distinção da prevalência de sintomas de saúde mental entre homens e mulheres. Conclusão: Com base nesses achados, evidenciou-se a importância do acompanhamento em longo prazo das pessoas que tiveram COVID-19, uma vez que os sintomas desenvolvidos como sequelas não são exclusivos dessa doença e podem impactar na qualidade de vida.

Objective: To identify, in the literature available, the health sequelae developed by the population affected by COVID-19. Methods: This is an integrative review of publications retrieved from Medline via PubMed and the Regional Portal of the Virtual Health Library (Biblioteca Virtual em Saúde ­ BVS) in April 2021 that answered the research question: What are the main health sequelae developed by the population affected by COVID-19? The search strategy included the descriptors: Coronavirus Infections, COVID-19, SARS-COV-2, Complications, Disease, Adult, Long COVID. 348 publications were identified: 196 on BVS and 152 on PubMed. After analyzing the inclusion/exclusion criteria, 66 publications remained for full reading, with a final 27 articles included in the sample. Results: The selected evidence from the 27 articles allowed the identification of the main sequelae: neurological, mental health, cardiac, smell and taste, vascular, cutaneous, respiratory and gastrointestinal sequelae. The highest prevalence of neurological sequelae was found in women, whereas cardiac sequelae were found mostly in men; there was no difference in the prevalence of mental health symptoms between men and women. Conclusion: Based on these findings, the importance of long-term follow-up of people who had COVID-19 was highlighted since the symptoms developed as sequelae are not exclusive to this disease and can impact quality of life.

Objetivo: Identificar en la literatura disponible las secuelas de salud desarrolladas por la población enfermada por COVID-19. Métodos: Revisión integradora con publicaciones recuperadas a partir del acceso al Medline por PubMed y al Portal Regional dela Biblioteca Virtual en Salud (BVS) en abril de 2021 que contestaron a la cuestión norteadora: ¿Cuáles las principales secuelas de salud desarrolladas por la población enfermada por COVID-19?. La estrategia de búsqueda incluyó los descriptores: Coronavirus Infections, COVID-19, SAR-COV-2, Complications, Desease, Adult, Long COVID. Fueron identificadas 348 publicaciones, 196 de la BVS Y 152 en PubMed. Después del análisis de los criterios de inclusión/exclusión, permanecieron 66 publicaciones para lectura completa, restando 27 artículos que compusieron la muestra. Resultados: Las evidencias seleccionadas de los 27 artículos permitieron la identificación de las principales secuelas: neurológicas, salud mental, cardíacas, en el olfato y paladar, vasculares, cutáneas, respiratorias y gastrointestinales. La mayor prevalencia de secuelas neurológicas ocurrió en mujeres, y las cardíacas en los hombres; no habiendo distinción de la prevalencia de síntomas de salud mental entre hombres y mujeres. Conclusión: Con base en estos hallazgos, se evidenció la importancia del acompañamiento a largo plazo de las personas que tuvieron COVID-19, ya que los síntomas desarrollados como secuelas no son exclusivos de esta enfermedad y pueden impactar en la calidad de vida.

Análise de custo-efetividade de um painel genético no câncer de mama precoce na saúde suplementar brasileira / Cost-effectiveness analysis of a genetic panel in early breast cancer in Brazilian supplementary health

Objetivo: Avaliar o custo-efetividade do uso de um painel genético de 21 genes em pacientes adultas diagnosticadas com câncer de mama em estádio inicial em uma operadora de saúde com mais de 500.000 vidas. Métodos: Foi utilizada uma coorte prospectiva seguida de um estudo de custo-efetividade entre os pacientes que utilizaram Oncotype DX® em 2020. Calcularam-se as despesas totais de cada esquema de quimioterapia (QT), somando-se os custos dos produtos e taxas de infusão. Resultados: Das 35 pacientes que utilizaram o teste de 21 genes no período avaliado, 60% (n = 21) não necessitaram de QT. Quando aplicadas simulações, houve custo evitado de R$ -1.945.448,88 (custos incrementais potenciais de R$ -6.488.207,56 até R$ 443.485,26, dependendo do esquema de QT escolhido). Conclusão: A inserção do teste de 21 genes na jornada do tratamento de câncer de mama na saúde suplementar evidenciou significativa relevância, pois contribuiu com o uso adequado da terapêutica, garantindo a sustentabilidade do sistema de saúde. Apresentando-se como uma opção custo-efetiva para a maioria dos esquemas de QT em comparação com a sua não utilização no tratamento, para a saúde suplementar brasileira

Objective: To evaluate the cost-effectiveness of the use of a genetic panel of 21 genes in adult patients diagnosed with early stage breast cancer in a healthcare provider with more than 500,000 lives. Methods: A prospective cohort study was conducted, followed by cost-effectiveness, among patients who used Oncotype DX® , in 2020. The total costs of each chemotherapy scheme (QT) were calculated, adding the costs of the products and infusion fees. Results: Of the 35 patients who used 21 gene tests in the evaluation period, 60% (n = 21) did not require QT. When simulations were applied, there was an avoided cost of R$ -1.945.448,88 (Potentials incremental costs from -R$ 6.488.207,56 to +R$ 443.485,26, depending on the chosen QT scheme). Conclusion: The insertion of 21-Gene recurrence score in the breast cancer treatment journey in supplementary health showed significant relevance, as it contributes to the appropriate use of therapy, guaranteeing the sustainability of the health system. Presenting itself as a cost-effective option for most QT schemes compared to not being used in treatment, for Brazilian supplementary health System

Terahertz Spectroscopy Applied to Diagnostics in Public Health: A Review

Abstract Terahertz (THz) spectroscopy is an emerging technology that is that is bringing a number of technical breakthroughs in several scientific applications. This review aimed to describe potential applications of THz spectroscopy at the biochemistry and molecules detection for food industry, environment monitoring and diagnostics, and present the importance of such technological platform in disease control and Public Health.

Elective surgeries in the "new normal" post-COVID-19 pandemic: to test or do not test?

The new coronavirus (SARS-CoV-2) pandemic has been wreaking havoc all over the planet. In a precautionary measure, populations have been forced and kept under quarantine to contain the outbreak of the COVID-19 disease. The quarantine primary goal is to avoid the overload to the hospitals, which should be available for the care of COVID-19 patients. However, the virus does not have a uniform spread throughout the planet, and Brazil is no different. Although all the world's attention is now on the COVID-19 pandemic, there is no similar pattern of spread, and other diseases are still a real problem. Given the risks of transmission between patients and healthcare providers, there is a great challenge for healthcare institutions who must balance resources to assure safe care to patients and professionals while they take care of other disease patients, and perform surgical procedures that need to be carried out. Under such circumstances, as COVID-19 can also present pre- or asymptomatic transmission, it can be challenging to identify patients who are carrying and spreading the virus. Studies and information on mandatory testing for who are candidates to undergo elective surgery are scarce. Thus, the authors have reviewed the literature, and discuss the need to test these patients under the current context.

Custo-minimização da troca entre imunoglobulinas de diferentes vias e marcas: sustentabilidade relacionada ao tratamento na saúde suplementar / Cost minimizing the switching between immunoglobulin of different routes and brands: of treatment-related in the supplementary health

Objetivo: Avaliar custo-minimização da troca entre as versões intravenosa (IVIg) e subcutânea (SCIg) das imunoglobulinas (Ig) em operadora de saúde com mais de 500.000 vidas. Métodos: Estudo retrospectivo, transversal, descritivo, seguido de custo-minimização entre os pacientes que utilizaram IVIg, de 1º de outubro de 2018 a 30 de setembro de 2019. Simulou-se a troca entre as IVIg e SCIg, objetivando descrever a economia de uma hipotética substituição. Estabeleceram-se como critérios de exclusão: o não pagamento e a liberação com dose acima de 60.000 mg. Após exclusão, calcularam-se as despesas totais, somando-se os custos do produto e taxas de infusão. Resultados: Evidenciou-se que 133 pacientes, totalizando 1.175 liberações, utilizaram IVIg no período avaliado. Identificou-se a utilização de 34.797.500 mg de IVIg, por 10 especialidades, totalizando R$ 12.408.192,50 de despesas. Quando aplicada simulação, há uma potencial economia de recursos de até 29,83%, dependendo da SCIg escolhida. Conclusão: A análise econômica no tratamento com imunoglobulinas evidenciou significativa relevância, pois contribui com o uso adequado da terapêutica garantindo a sustentabilidade do sistema de saúde. Medicamentos subcutâneos apresentam-se como uma opção custo-minimizatória em comparação ao tratamento intravenoso para saúde suplementar brasileira.

Objective: Cost-minimization evaluation of the switch from intravenous (IVIg) to subcutaneous (SCIg) immunoglobulin (Ig) in a Brazilian Health Maintenance Organization (HMO), with more than 500.000 lives. Methods: This is a retrospective, transversal and descriptive study, followed by a cost-minimization analysis among patients using IVIg between 2018, October, 1st and 2019, September, 30th. The simulation was performed supposing the exchange from IVIg to SCIg, in order to calculate possible savings. Exclusion criteria: non-payment (gloss), and infusions with doses above 60.000 miligrams. After exclusion, total expenditures were calculated by summing product and infusion costs. Results: There were133 patients, with1,175 IVIg infusion events in the period evaluated. It was identified the use of 34,797,500 milligrams of IVIg, for 10 specialties, with R$ 12,408,192.50 of final expenditure. The simulation previews hypothetical reduction in the final cost of up to 29.83%, depending on the SCIg brand chosen. Conclusion: The economic analysis in the treatment with immunoglobulins showed significant relevance, as it contributes to the appropriate use of therapy ensuring the sustainability of the health system. Subcutaneous drugs are a cost-minimizing option compared to intravenous treatment for Brazilian HMOs.

Elective surgeries in the new normal post-COVID-19 pandemic: to test or do not test? / Cirurgias eletivas no novo normal pós-pandemia da COVID-19: testar ou não testar?

ABSTRACT The new coronavirus (SARS-CoV-2) pandemic has been wreaking havoc all over the planet. In a precautionary measure, populations have been forced and kept under quarantine to contain the outbreak of the COVID-19 disease. The quarantine primary goal is to avoid the overload to the hospitals, which should be available for the care of COVID-19 patients. However, the virus does not have a uniform spread throughout the planet, and Brazil is no different. Although all the world's attention is now on the COVID-19 pandemic, there is no similar pattern of spread, and other diseases are still a real problem. Given the risks of transmission between patients and healthcare providers, there is a great challenge for healthcare institutions who must balance resources to assure safe care to patients and professionals while they take care of other disease patients, and perform surgical procedures that need to be carried out. Under such circumstances, as COVID-19 can also present pre- or asymptomatic transmission, it can be challenging to identify patients who are carrying and spreading the virus. Studies and information on mandatory testing for who are candidates to undergo elective surgery are scarce. Thus, the authors have reviewed the literature, and discuss the need to test these patients under the current context.

RESUMO A pandemia do novo coronavírus (SARS-CoV-2) vem causando estragos em todo o planeta. As populações estão sendo forçadas a quarentena - e assim mantidas - como medida de precaução para conter o surto da doença COVID-19. O principal objetivo da quarentena é evitar a sobrecarga dos hospitais, o que pode ser determinante para o atendimento aos pacientes COVID-19. O vírus não tem propagação uniforme pelo planeta, e no Brasil não é diferente. Contudo, as pessoas continuam a adoecer por outras causas não relacionadas ao SARS-CoV-2, demandando atendimento médico-hospitalar. Assim, os governos estão avaliando e liberando regiões para a realização de cirurgias eletivas em Estados e Municípios onde a COVID-19 está sob controle. Nesse contexto, há preocupação inerente à transmissão SARS-CoV-2 entre pacientes e prestadores de serviços de saúde, uma vez que há poucas informações sobre testes obrigatórios a serem realizados em pacientes com indicação cirúrgica. Esse problema é causado principalmente porque todos os pacientes durante o período de incubação são assintomáticos e, portanto, difíceis de serem avaliados. Assim sendo, os autores avaliam a literatura pertinente à microbiologia do SARS-CoV-2 e discutem a necessidade de testar esses pacientes com testes mais utilizados até o momento.

Top 10 evidence-based recommendations from the Brazilian Society of Infectious Diseases for the Choosing Wisely Project

The Choosing Wisely Initiative aims to collect statements from medical societies all over the world on medical interventions that result in no benefit to patients, with the potential to cause harm. In this article we present the views of the Diagnostic Laboratory Group at the Brazilian Society of Infectious Diseases (SBI). Ten experts from SBI were asked to list 10 diagnostic tests that were perceived as unnecessary in the field of infectious diseases. After voting for the more relevant topics, a questionnaire was sent to all SBI members, in order to select for the most important items. A total of 482 votes were obtained, and the top 10 results are shown in this manuscript. The Choosing Wisely statements of SBI should facilitate clinical practice by optimizing the use of diagnostic resources in the field of infectious diseases

Top 10 evidence-based recommendations from the Brazilian Society of Infectious Diseases for the Choosing Wisely Project.

The Choosing Wisely Initiative aims to collect statements from medical societies all over the world on medical interventions that result in no benefit to patients, with the potential to cause harm. In this article we present the views of the Diagnostic Laboratory Group at the Brazilian Society of Infectious Diseases (SBI). Ten experts from SBI were asked to list 10 diagnostic tests that were perceived as unnecessary in the field of infectious diseases. After voting for the more relevant topics, a questionnaire was sent to all SBI members, in order to select for the most important items. A total of 482 votes were obtained, and the top 10 results are shown in this manuscript. The Choosing Wisely statements of SBI should facilitate clinical practice by optimizing the use of diagnostic resources in the field of infectious diseases.

Early switch/early discharge opportunities for hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections in Brazil.

BACKGROUND: Early antibiotic switch and early discharge protocols have not been widely studied in Latin America. Our objective was to describe real-world treatment patterns, resource use, and estimate opportunities for early switch from intravenous to oral antibiotics and early discharge for patients hospitalized with methicillin-resistant Staphylococcus aureus complicated skin and soft-tissue infections. MATERIALS/METHODS: This retrospective medical chart review recruited 72 physicians from Brazil to collect data from patients hospitalized with documented methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections between May 2013 and May 2015, and discharged alive by June 2015. Data collected included clinical characteristics and outcomes, hospital length of stay, methicillin-resistant Staphylococcus aureus-targeted intravenous and oral antibiotic use, and early switch and early discharge eligibility using literature-based and expert-validated criteria. RESULTS: A total of 199 patient charts were reviewed, of which 196 (98.5%) were prescribed methicillin-resistant Staphylococcus aureus -active therapy. Only four patients were switched from intravenous to oral antibiotics while hospitalized. The mean length of methicillin-resistant Staphylococcus aureus-active treatment was 14.7 (standard deviation, 10.1) days, with 14.6 (standard deviation, 10.1) total days of intravenous therapy. The mean length of hospital stay was 22.2 (standard deviation, 23.0) days. The most frequent initial methicillin-resistant Staphylococcus aureus-active therapies were intravenous vancomycin (58.2%), intravenous clindamycin (19.9%), and intravenous daptomycin (6.6%). Thirty-one patients (15.6%) were discharged with methicillin-resistant Staphylococcus aureus -active antibiotics of which 80.6% received oral antibiotics. Sixty-two patients (31.2%) met early switch criteria and potentially could have discontinued intravenous therapy 6.8 (standard deviation, 7.8) days sooner, and 65 patients (32.7%) met early discharge criteria and potentially could have been discharged 5.3 (standard deviation, 7.0) days sooner. CONCLUSIONS: Only 2% of patients were switched from intravenous to oral antibiotics in our study while almost one-third were early switch eligible. Additionally, one-third of hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections were early discharge eligible indicating opportunity for reducing intravenous therapy and days of hospital stay. These results provide insight into possible benefits of implementation of early switch/early discharge protocols in Brazil.

Early switch/early discharge opportunities for hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections in Brazil

ABSTRACT Background: Early antibiotic switch and early discharge protocols have not been widely studied in Latin America. Our objective was to describe real-world treatment patterns, resource use, and estimate opportunities for early switch from intravenous to oral antibiotics and early discharge for patients hospitalized with methicillin-resistant Staphylococcus aureus complicated skin and soft-tissue infections. Materials/methods: This retrospective medical chart review recruited 72 physicians from Brazil to collect data from patients hospitalized with documented methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections between May 2013 and May 2015, and discharged alive by June 2015. Data collected included clinical characteristics and outcomes, hospital length of stay, methicillin-resistant Staphylococcus aureus-targeted intravenous and oral antibiotic use, and early switch and early discharge eligibility using literature-based and expert-validated criteria. Results: A total of 199 patient charts were reviewed, of which 196 (98.5%) were prescribed methicillin-resistant Staphylococcus aureus -active therapy. Only four patients were switched from intravenous to oral antibiotics while hospitalized. The mean length of methicillin-resistant Staphylococcus aureus-active treatment was 14.7 (standard deviation, 10.1) days, with 14.6 (standard deviation, 10.1) total days of intravenous therapy. The mean length of hospital stay was 22.2 (standard deviation, 23.0) days. The most frequent initial methicillin-resistant Staphylococcus aureus-active therapies were intravenous vancomycin (58.2%), intravenous clindamycin (19.9%), and intravenous daptomycin (6.6%). Thirty-one patients (15.6%) were discharged with methicillin-resistant Staphylococcus aureus -active antibiotics of which 80.6% received oral antibiotics. Sixty-two patients (31.2%) met early switch criteria and potentially could have discontinued intravenous therapy 6.8 (standard deviation, 7.8) days sooner, and 65 patients (32.7%) met early discharge criteria and potentially could have been discharged 5.3 (standard deviation, 7.0) days sooner. Conclusions: Only 2% of patients were switched from intravenous to oral antibiotics in our study while almost one-third were early switch eligible. Additionally, one-third of hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections were early discharge eligible indicating opportunity for reducing intravenous therapy and days of hospital stay. These results provide insight into possible benefits of implementation of early switch/early discharge protocols in Brazil.

Burden of acute kidney injury in HIV patients under deoxycholate amphotericin B therapy for cryptococcal meningitis and cost-minimization analysis of amphotericin B lipid complex.

Deoxycholate amphotericin B (d-AMB) has a higher rate of acute kidney injury (AKI) in comparison of lipid formulations. However, lipid amphotericin B has high costs in developing countries. The aim of this study is to assemble a model of cost-minimization of amphotericin B lipid complex (ABLC) in patients with cryptococcal meningitis. This is a retrospective study done in a cohort of patients with cryptococcal meningitis to study the economic impact of its use in developing countries. Cost analysis were based on direct cost of different antifungal therapies, chronic dialysis after discharge, and survival of patients based on a retrospective cohort of 102 patients infected with human immunodeficiency virus with confirmed diagnosis of cryptococcal meningitis. From 102 patients treated with d-AMB, 60.78% developed any grade of AKI and 10.78% developed AKI demanding hemodialysis. The percentage of patients with meningeal cryptococcosis treated with d-AMB that requeired chronic HD was 2.39%. The same model was performed for patient that would be treated with ABLC, which resulted in 0.20% of patients demanding chronic HD due to its lower nephrotoxicity. When the model is applied in 100 patients, the total costs with d-AMB would be US$ 184,543 and with ABLC would be US$ 1,640,109 in 5 years. Treatment with ABLC would be cost saving in comparison to d-AMB treatment, if early switch of treatment occurred in patients presenting AKI. The change should be as soon as possible to avoid further complication, like dialysis, which is associated with a lower life expectancy.

Microbiological profile and susceptibility pattern of surgical site infections related to orthopaedic trauma.

BACKGROUND: Understanding the epidemiology of microorganisms associated with surgical site infections related to orthopaedic trauma (SSI-ROT) is important in establishing treatment protocols. The aim of this study was to evaluate the etiology and susceptibility pattern of SSIs related to orthopaedic trauma in a Brazilian reference hospital for trauma. METHODS: Patients with SSI-ROT in a Brazilian reference hospital for trauma were retrospectively analyzed. All patients with orthopaedic trauma who underwent a surgical procedure and developed SSI within one year were included. All patients had culture samples from the surgical site obtained from biopsy of bone or soft tissue. Clinical and epidemiological data of the patients were collected. RESULTS: A total of 147 patients with trauma-related infection were included in the analysis. The mean time to infection was 55.5 days, and the mean duration of hospitalization was 20.0 days. The in-hospital mortality rate after infection was 5.4%. Cultures were obtained from all patients, with 104 samples obtained from soft tissues and 43 samples from bone. The positivity rate was 93.2%. Among the isolates, 56.5% (77 patients) were gram-negative bacteria and 43.8% (60 patients) were gram-positive bacteria. Staphylococcus aureus was identified in 34%, Enterobacter spp. in 14.9%, and Pseudomonas aeruginosa in 11.6%. Staphylococcus aureus presented a higher positivity in bone samples (odds ratio, 1.29; 95% CI, 1.01-1.70; p = 0.04). Few microorganisms were multi-resistant. CONCLUSION: SSI in orthopaedic trauma can be associated with gram-negative bacilli, the susceptibility profile of which suggested that most infections occur after discharge. Staphylococcus aureus infections were commonly caused by methicillin-susceptible isolates, and this susceptibility to oral antibiotic options helps in the dehospitalization of patients.

Polymyxin B and colistin-the economic burden of nephrotoxicity against multidrug resistant bacteria.

BACKGROUND: Polymyxin B and colistin are nephrotoxic drugs used in the treatment of carbapenem-resistant Enterobacteriaceae. The aim of this study is to evaluate the burden of costs due to polymyxin associated AKI and propose a simulated break-even price for new therapies. METHODS: The pharmacoeconomic model is based on two large cross-sectional studies of polymyxin nephrotoxicity. Total direct costs in patients with and without renal failure were compared. The direct cost of each hemodialysis section (USD82.94) and daily hospital charges (USD934.85) were based on the values used in a major public hospital in the city where the clinical study was performed. The break-even price of new drugs was simulated considering eventual new drugs as effective as polymyxins, but less nephrotoxic in different percentages. Outcomes of patients after hospital discharge were not evaluated. RESULTS: Total direct cost of the group of patients who survived without AKI was significantly lower than total direct cost of the groups either with AKI or the group who died without AKI. There was a tendency of even higher costs in those who died with AKI and dialysis. Direct cost of hemodialysis was not as important as the longer hospitalization after sepsis. Considering daily cost of polymyxin is USD60, drugs with 50% less AKI could be considered cost-beneficial if the daily cost is lower than USD160. CONCLUSIONS: AKI in patients with carbapenem-resistant Enterobacteriaceae treated with polymyxin increases both length of stay in hospital and total costs.

Cost-effectiveness of posaconazole in private and public Brazilian hospitals.

BACKGROUND: Posaconazole is used for the prophylaxis of invasive fungal disease (IFD). Previous studies have shown it to be cost-effective compared to fluconazole/itraconazole. However, posaconazole has never been economically evaluated in developing countries. AIMS: The aim of the present study was to perform a cost-effectiveness analysis of posaconazole compared to fluconazole in public (SUS) and private hospitals (PHS) in Brazil. METHODS: A cost-effectiveness simulation was conducted on the basis of a pivotal study on the use of posaconazole in acute myeloid leukemia (AML) patients, adjusting the costs to Brazilian data. RESULTS: A pharmacoeconomic analysis was performed on a hypothetical sample of 100 patients in each drug group. The total cost of posaconazole use alone was USD$ 220,656.31, whereas that for fluconazole was USD$ 83,875.00. Our results showed that patients with IFD remain hospitalized for an additional 12 days, at an average cost of USD$ 850.85 per patient per day. The total money spent by PHS for 100 patients for 100 days was USD$ 342,318.00 for the posaconazole group and USD$ 302,039.00 for the fluconazole group. An analysis of sensitivity (10%) revealed no intergroup difference. CONCLUSIONS: In Brazil posaconazole is cost-effective, and should be considered for the prophylaxis of patients with AMD/myelodysplasia (AML/MDS) undergoing chemotherapy.