Nutrition Therapy Cost-Effectiveness Model Indicating How Nutrition May Contribute to the Efficiency and Financial Sustainability of the Health Systems.

BACKGROUND: Malnutrition is highly prevalent in hospitalized patients but seldom recognized and treated. Malnutrition poses several adverse events, such as increased infection rates, length of hospital stay, and mortality, as well as costs. Early nutrition interventions have been shown to decrease the associated malnutrition burdens, leading to relevant savings. Thus, this study aims to evaluate the cost-effectiveness of nutrition therapy, including oral supplements to at-risk or malnourished adult inpatients admitted to the Brazilian Public System (SUS) hospitals. METHOD: A cost-effectiveness model, encompassing a 1-year period and regarding total costs, length of hospital stay, readmissions, and mortality related to malnutrition, was developed, having the provision of early nutrition therapy as the intervention variable. The number of avoided hospitalization days, prevented hospital readmissions, and prevented deaths defined the effectiveness of the model. All the costs were estimated based on the SUS database. RESULTS: Early nutrition therapy provided to all at-risk or malnourished patients would represent cost-effectiveness of US $92.24, US $544.59, US $1848.12, and US $3698.92, for each day of hospitalization avoided, for additional patients having access to hospitalization, for preventing readmission, and for prevented death, respectively. The highest impact on savings was represented by the mean reduction in the length of hospital stay. CONCLUSION: Early oral nutrition intervention for patients malnourished or at risk of malnutrition resulted in overall reduced hospital costs. These findings provide a rationale to tackle the implementation of educational programs focusing on the care of inpatients with malnutrition or its risk.

Cost-utility of quadrivalent versus trivalent influenza vaccine in Brazil - comparison of outcomes from different static model types.

BACKGROUND: Influenza burden in Brazil is considerable with 4.2-6.4 million cases in 2008 and influenza-like-illness responsible for 16.9% of hospitalizations. Cost-effectiveness of influenza vaccination may be assessed by different types of models, with limitations due to data availability, assumptions, and modelling approach. OBJECTIVE: To understand the impact of model complexity, the cost-utility of quadrivalent versus trivalent influenza vaccines in Brazil was estimated using three distinct models: a 1-year decision tree population model with three age groups (FLOU); a more detailed 1-year population model with five age groups (FLORA); and a more complex lifetime multi-cohort Markov model with nine age groups (FLORENCE). METHODS: Analysis 1 (impact of model structure) compared each model using the same data inputs (i.e., best available data for FLOU). Analysis 2 (impact of increasing granularity) compared each model populated with the best available data for that model. RESULTS: Using the best data for each model, the discounted cost-utility ratio of quadrivalent versus trivalent influenza vaccine was R$20,428 with FLOU, R$22,768 with FLORA (versus R$20,428 in Analysis 1), and, R$19,257 with FLORENCE (versus R$22,490 in Analysis 1) using a lifetime horizon. Conceptual differences between FLORA and FLORENCE meant the same assumption regarding increased all-cause mortality in at-risk individuals had an opposite effect on the incremental cost-effectiveness ratio in Analysis 2 versus 1, and a proportionally higher number of vaccinated elderly in FLORENCE reduced this ratio in Analysis 2. DISCUSSION: FLOU provided adequate cost-effectiveness estimates with data in broad age groups. FLORA increased insights (e.g., in healthy versus at-risk, paediatric, respiratory/non-respiratory complications). FLORENCE provided greater insights and precision (e.g., in elderly, costs and complications, lifetime cost-effectiveness). CONCLUSION: All three models predicted a cost per quality-adjusted life year gained for quadrivalent versus trivalent influenza vaccine in the range of R$19,257 (FLORENCE) to R$22,768 (FLORA) with the best available data in Brazil (Appendix A).

The role of globalization in drug development and access to orphan drugs: orphan drug legislation in the US/EU and in Latin America.

Compared to a decade ago, nearly three times as many drugs for rare diseases are slated for development. This article addresses the market access issues associated with orphan drug status in Europe and the United States in contrast to the legislation in five Latin American (LA) countries that have made strides in this regard--Mexico, Brazil, Colombia, Chile and Argentina. Based on the success of orphan drug legislation in the EU and US, LA countries should strive to adopt similar strategies with regard to rare diseases and drug development. With the implementation of new targeted regulations, reimbursement strategies, and drug approvals, accessibility to treatment will be improved for people afflicted with rare diseases in these developing countries.

Economic evaluation of clodronate and zoledronate in patients diagnosed with metastatic bone disease from the perspective of public and third party payors in Brazil.

BACKGROUND: Metastatic bone disease (MBD) is responsible for >99% of malignant tumors that affect the bone. MBD patients have increased risk of skeletal complications that are often dramatic and result in loss of function or disability, leading to rapid deterioration of quality of life. Bisphosphonates have become the standard therapy for the treatment and prevention of skeletal-related events (SREs). OBJECTIVE: The objective of this study was to evaluate the cost-effectiveness of zoledronate and clodronate in the prevention of SREs in patients with MBD. METHODS: A pharmacoeconomic analysis was performed for a hypothetical cohort of patients with MBD to compare the costs and consequences of the use of clodronate and zoledronate for treatment and prevention of SREs in MBD in Brazil. The model was constructed using decision analysis techniques. Costs were described in 5 categories-drugs, physician visits, hospitalizations, surgical/medical care, and laboratory tests-and were reported in 2008 Brazilian reais (1 BRL = 0.54 US dollar). Quality-adjusted life years gained was considered as an outcome. Sensitivity analyses tested model robustness. RESULTS: The total cost of treatment of MBD in Brazil for a 5-year time-horizon was R$46,313 with clodronate and R$50,319 with zoledronate. The estimated number of quality-adjusted life years was 2.00 and 1.90 for clodronate and zoledronate, respectively. Cost-effectiveness ranking was unchanged when model time-horizon was changed to 1 or 10 years. Univariate analysis revealed the incidence of osteonecrosis as a sensitive parameter in the model. Multivariate analysis confirmed base-case results, in which >60% of model iterations favored clodronate over zoledronate. CONCLUSION: The present pharmacoeconomic evaluation, under the premises presented, found that clodronate was dominant over zoledronate from both the public and the private health care perspectives in Brazil.