Systematic review of economic evaluations on stereotactic ablative radiotherapy (SABR) compared to other radiotherapy techniques or surgical procedures for early-stage non-small cell lung cancer.

BACKGROUND: Stereotactic ablative radiotherapy (SABR) is recommended as first-choice treatment to inoperable early-stage non-small cell lung cancer (NSCLC). However, it is not widely adopted in developing countries, and its cost-effectiveness is unclear. We aimed to perform a systematic review of full economic evaluations (EE) that compared SABR with other radiotherapy or surgical procedures to assess the results and methodological approach. METHODS: The protocol was registered on PROSPERO (CRD42021241640). We included full EE studies with early-stage NSCLC in which one group was submitted to SABR. Studies that were partial EE, included advanced NSCLC or other neoplasm were excluded. We performed the last search on June 2021 in Medline, EMBASE and other databases. The reporting quality were assessed by CHEERS checklist. The main characteristics of each study were tabulated, and the results were presented by a narrative synthesis. RESULTS: We included nine studies. Three compared radiotherapy techniques, in which SABR was found to be dominant or cost-effective. Six compared SABR with surgery, and in this group, there was not a unanimous decision. All included only direct healthcare costs but varied about categories included. The parameters used in the model-based studies were highly heterogeneous using mixed data from various sources. The items properly reported varied from 29 to 67%. CONCLUSIONS: The studies were all from developed countries and lacked in reporting quality. We recommend that developing countries produce their own studies. More strict alignment to reporting guidelines and use of robust evidence as model parameters are also advised.

Palliative cancer care: costs in a Brazilian quaternary hospital.

Palliative care (PC) improves the quality of life of patients with diseases such as cancer, and several studies have shown a reduction in costs among patients who use PC services when compared with those receiving standard oncological treatments. Most studies on PC costs are carried out in high-income countries. There is a lack of these types of studies in middle-income and low-income countries and of better evidence about this intervention. OBJECTIVE: To describe resource utilisation and costs among patients with cancer in a Brazilian quaternary hospital by cancer localisation and per month of treatment before death. METHODS: This study is a description of retrospective costs to estimate the costs of formal healthcare sector associated with PCs, from the perspective of a public quaternary cancer hospital. Unit costs were estimated using microcosting and macrocosting approaches. SETTING/PARTICIPANTS: Patients older than 18 years old who died from 2010 to 2013 and who had at least two visits in PC and/or made use of hospice care. RESULTS: Among the 2985 patients included in the study, the average cost per patient was US$12 335, ranging from US$8269 for patients with pancreatic cancer to US$19 395 for patients with brain cancer. The main costing item was hospital admission (47.6% of the total cost), followed by hospice care (29.5%) and medical and other supplies (11.1%). CONCLUSIONS: The study clarified the direct medical costs and the profile and use of resources of patients with cancer who need PC, and can help in the planning and allocation of resources in cancer care.

Factors associated with the costs of palliative care: a retrospective cost analysis at a university Cancer hospital in Brazil

Background: There have been few studies evaluating the costs of palliative care (PC) in low- and middle-income countries (LMICs), especially for patients with cancer. Objectives: The objective of this study was to identify the sociodemographic and clinical variables that could explain the cost per day of PC for cancer in Brazil. Methods: This was a retrospective cost analysis of PC at a quaternary cancer center in São Paulo, Brazil, between January 2010 and December 2013. Factors influencing the cost per day were assessed with generalized linear models and generalized linear-mixed models in which the random effect was the site of the cancer. Results: The study included 2985 patients. The mean total cost per patient was $12,335 (standard deviation [SD] = 14,602; 95% confidence interval [CI] = 11,803 to 12,851). The mean cost per day per patient was $325.50 (SD = 246.30, 95% CI = 316.60 to 334.30). There were statistically significant differences among cancer sites in terms of the mean cost per day. Multivariate analysis revealed that the drivers of cost per day were Karnofsky performance status, the number of hospital admissions, referral to PC, and place of death. Place of death had the greatest impact on the cost per day; death in a hospital and in hospice care increased the mean cost per day by $1.56 and $1.83, respectively. Conclusion: To allocate resources effectively, PC centers in LMICs should emphasize early enrollment of patients at PC outpatient clinics, to avoid hospital readmission, as well as advance planning of the place of death.

Systematic Review of Health Economic Evaluation Studies Developed in Brazil from 1980 to 2013.

BACKGROUND: Brazil has sought to use economic evaluation to support healthcare decision-making processes. While a number of health economic evaluations (HEEs) have been conducted, no study has systematically reviewed the quality of Brazilian HEE. The objective of this systematic review was to provide an overview regarding the state of HEE research and to evaluate the number, characteristics, and quality of reporting of published HEE studies conducted in a Brazilian setting. METHODS: We systematically searched electronic databases (MEDLINE, EMBASE, Latin American, and Caribbean Literature on Health Sciences Database, Scientific Electronic Library Online, NHS Economic Evaluation Database, health technology assessment Database, Bireme, and Biblioteca Virtual em Saúde Economia da Saúde); citation indexes (SCOPUS, Web of Science), and Sistema de Informação da Rede Brasileira de Avaliação de Tecnologia em Saúde. Partial and full HEEs published between 1980 and 2013 that referred to a Brazilian setting were considered for inclusion. RESULTS: In total, 535 studies were included in the review, 36.8% of these were considered to be full HEE. The category of healthcare technologies more frequently assessed were procedures (34.8%) and drugs (28.8%) which main objective was treatment (72.1%). Forty-four percent of the studies reported their funding source and 36% reported a conflict of interest. Overall, the full HEE quality of reporting was satisfactory. But some items were generally poorly reported and significant improvement is required: (1) methods used to estimate healthcare resource use quantities and unit costs, (2) methods used to estimate utility values, (3) sources of funding, and (4) conflicts of interest. CONCLUSION: A steady number of HEE have been published in Brazil since 1980. To improve their contribution to inform national healthcare policy efforts need to be made to enhance the quality of reporting of HEEs and promote improvements in the way HEEs are designed, implemented (i.e., using sound methods for HEEs) and reported.

Early Palliative Care and Its Impact on End-of-Life Care for Cancer Patients in Brazil.

BACKGROUND: Integrating palliative care into standard oncology care has been recommended for cancer patients. Early palliative care is associated with less aggressive treatment at the end of life. OBJECTIVE: To describe cancer patients receiving palliative care in Brazil, determining the time from entry into palliative care to death, and investigating whether late referral to palliative care is associated with aggressive end-of-life treatment. DESIGN: This was a cross-sectional study of cancer patients receiving palliative care in Brazil. SETTING/SUBJECTS: Subjects were 2985 cancer patients ≥18 years of age who received at least two palliative care visits at the São Paulo State Cancer Institute, in the city of São Paulo, Brazil, and died between 2010 and 2013. MEASUREMENTS: We evaluated the time from the first palliative care consult to death, stratifying cases by the timing of entry into palliative care (≥3 or <3 months before death). The associations between early palliative care and indicators of aggressive treatment were assessed by Pearson's chi-square test and Fisher's exact test. RESULTS: The overall median time between entry into palliative care and death was 34 days (mean, 72 days) and was significantly shorter in 2013 than in 2010 (p < 0.001). The number of emergency department visits was significantly lower among the patients who entered palliative care earlier (p < 0.001). CONCLUSIONS: Among cancer patients in Brazil, late referral to palliative care is common. Patients who enter palliative care earlier appear to receive less aggressive end-of-life treatment.

Systematic Review of Health Economic Evaluations of Diagnostic Tests in Brazil: How accurate are the results?

The aim of this study is to identify and characterize the health economic evaluations (HEEs) of diagnostic tests conducted in Brazil, in terms of their adherence to international guidelines for reporting economic studies and specific questions in test accuracy reports. We systematically searched multiple databases, selecting partial and full HEEs of diagnostic tests, published between 1980 and 2013. Two independent reviewers screened articles for relevance and extracted the data. We performed a qualitative narrative synthesis. Forty-three articles were reviewed. The most frequently studied diagnostic tests were laboratory tests (37.2%) and imaging tests (32.6%). Most were non-invasive tests (51.2%) and were performed in the adult population (48.8%). The intended purposes of the technologies evaluated were mostly diagnostic (69.8%), but diagnosis and treatment and screening, diagnosis, and treatment accounted for 25.6% and 4.7%, respectively. Of the reviewed studies, 12.5% described the methods used to estimate the quantities of resources, 33.3% reported the discount rate applied, and 29.2% listed the type of sensitivity analysis performed. Among the 12 cost-effectiveness analyses, only two studies (17%) referred to the application of formal methods to check the quality of the accuracy studies that provided support for the economic model. The existing Brazilian literature on the HEEs of diagnostic tests exhibited reasonably good performance. However, the following points still require improvement: 1) the methods used to estimate resource quantities and unit costs, 2) the discount rate, 3) descriptions of sensitivity analysis methods, 4) reporting of conflicts of interest, 5) evaluations of the quality of the accuracy studies considered in the cost-effectiveness models, and 6) the incorporation of accuracy measures into sensitivity analyses.

Systematic Review of Health Economic Evaluations of Diagnostic Tests in Brazil: How accurate are the results?

The aim of this study is to identify and characterize the health economic evaluations (HEEs) of diagnostic tests conducted in Brazil, in terms of their adherence to international guidelines for reporting economic studies and specific questions in test accuracy reports. We systematically searched multiple databases, selecting partial and full HEEs of diagnostic tests, published between 1980 and 2013. Two independent reviewers screened articles for relevance and extracted the data. We performed a qualitative narrative synthesis. Forty-three articles were reviewed. The most frequently studied diagnostic tests were laboratory tests (37.2%) and imaging tests (32.6%). Most were non-invasive tests (51.2%) and were performed in the adult population (48.8%). The intended purposes of the technologies evaluated were mostly diagnostic (69.8%), but diagnosis and treatment and screening, diagnosis, and treatment accounted for 25.6% and 4.7%, respectively. Of the reviewed studies, 12.5% described the methods used to estimate the quantities of resources, 33.3% reported the discount rate applied, and 29.2% listed the type of sensitivity analysis performed. Among the 12 cost-effectiveness analyses, only two studies (17%) referred to the application of formal methods to check the quality of the accuracy studies that provided support for the economic model. The existing Brazilian literature on the HEEs of diagnostic tests exhibited reasonably good performance. However, the following points still require improvement: 1) the methods used to estimate resource quantities and unit costs, 2) the discount rate, 3) descriptions of sensitivity analysis methods, 4) reporting of conflicts of interest, 5) evaluations of the quality of the accuracy studies considered in the cost-effectiveness models, and 6) the incorporation of accuracy measures into sensitivity analyses.

A systematic review of health economic evaluations of vaccines in Brazil.

BACKGROUND: In Brazil, since 2005, the Ministry of Health requires Health Economic Evaluation (HEE) of vaccines for introduction into the National Immunization Program. OBJECTIVES: To describe and analyze the full HEE on vaccines conducted in Brazil from 1980 to 2013. METHODS: Systematic review of the literature. We searched multiple databases. Two researchers independently selected the studies and extracted the data. The methodological quality of individual studies was evaluated using CHEERS items. RESULTS: Twenty studies were reviewed. The most evaluated vaccines were pneumococcal (25%) and HPV (15%). The most used types of HEE were cost-effectiveness analysis (45%) and cost-utility analysis (20%). The research question and compared strategies were stated in all 20 studies and the target population was clear in 95%. Nevertheless, many studies did not inform the perspective of analysis or data sources. CONCLUSIONS: HEE of vaccines in Brazil has increased since 2008. However, the studies still have methodological deficiencies.

Surto de toxinfecção alimentar em funcionários de uma empreiteira da construção civil no muncípio de Cubatão, São Paulo/Brasil / Food-borne infection outbreak among the employees of an engineering and construction company in Cubatão, São Paulo/Brazil

Foi notificado, em dezembro de 2007, um surto de toxinfecção alimentar em 54 funcionários de uma empreiteira da construção civil a serviço em uma refinaria do município de Cubatão, SP. Sintomas de diarréia, cólica abdominal, náuseas, mal estar, cefaléia, vômitos, tontura e febre foram observados. A Vigilância Sanitária Municipal coletou amostras de alimentos preparados no dia seguinte da notificação e de águas utilizadas na empresa produtora de alimentos e no restaurante da empreiteira. As amostras foram analisadas segundo a metologia descrita no Compendium APHA(2001) e Standard methods(2005); os resultados foram comparados aos padrões microbilógicos estabelecidos pela Resolução RDC nº12/2001 e pela Portaria nº 518/2004. Coliformes fecais totais foram observados nas amostras de água da empresa e do restaurante; colformes termotolerantes foram identificados na amostra de carne assada servida no restaurante da empresa (N.M.P.28/g). Staphyloccus coagulase positiva, Bacillus cereus, Salmonella spp e clostrídios sulfito-redutores não foram detectados. Em janeiro de 2008, a Vigilância Sanitária colheu nos estabelecimentos envolvidos amostras de alimentos, as quais encontravam-se dentro dos padrões microbiológicos estabelecidos pela Resolução RDC nº12/2001. Este relato mostra a importância do trabalho em conjunto entre os serviços municipais e o laboratório de saúde publica.

[Mycobacterium tuberculosis drug resistance in HIV patients in Baixada Santista, São Paulo, Brazil]. / Resistência do Mycobacterium tuberculosis às drogas em pacientes HIV+ em cinco municípios da Baixada Santista, São Paulo, Brasil.

Since the early 1990s, an increase in Mycobacterium tuberculosis drug resistance has been reported, with high prevalence among HIV+ patients. We evaluated the sensitivity patterns of M. tuberculosis, resistance rate, and predisposing factors among HIV+ patients in Santos, São Vicente, Cubatão, Praia Grande, and Guarujá, São Paulo State, Brazil. The medical charts of 301 patients with positive cultures for M. tuberculosis from 1993 to 2003 were reviewed. Resistance occurred in 57 patients (18.9%), as follows: 32 (10.6%) displayed multidrug-resistant tuberculosis (resistant to at least Rifampicin and Isoniazid); 4 (1.3%) were resistant to two or more drugs; and 21 (7%) were resistant to a single drug. Acquired resistance was observed in 70.1% of cases. Drug resistance was significantly associated with previous tuberculosis treatment, duration of HIV diagnosis, and previous hospitalization. In logistic regression analysis, only previous tuberculosis treatment adjusted by age remained as an independent risk factor (OR = 5.49; 95%CI: 2.60-11.60). Drug resistance to at least one drug in 18.9% and multidrug resistance in 10.6% of cases highlight the relevance of this problem in HIV patients in the Baixada Santista.

Resistência do Mycobacterium tuberculosis às drogas em pacientes HIV+ em cinco municípios da Baixada Santista, São Paulo, Brasil / Mycobacterium tuberculosis drug resistance in HIV patients in Baixada Santista, São Paulo, Brazil

No início dos anos 90, observou-se aumento da resistência do Mycobacterium tuberculosis às drogas antituberculose, com alta prevalência entre pacientes HIV+. Neste estudo, foram avaliados a freqüência de resistência, o perfil de sensibilidade do M. tuberculosis às drogas e os fatores predisponentes à resistência entre indivíduos HIV+ nos municípios de Santos, São Vicente, Cubatão, Praia Grande e Guarujá, Estado de São Paulo, Brasil. Foram pesquisados os prontuários de 301 pacientes com resultado de cultura positivo entre 1993 e 2003. A resistência ocorreu em 57 (18,9 por cento) pacientes com a seguinte distribuição: 32 (10,6 por cento) apresentaram tuberculose multirresistente (resistência ao menos à Rifampicina e Isoniazida); 4 (1,3 por cento) casos apresentaram resistência a duas ou mais drogas e 21 (7 por cento) à monorresistência. Observou-se resistência secundária em 70,2 por cento dos casos. Estatisticamente associadas à tuberculose resistente foram: tratamento anterior com drogas antituberculose, tempo de diagnóstico de HIV e hospitalização prévia. Em análise multivariada, apenas tratamento anterior, ajustado por faixa etária, mostrou-se associado (OR = 5,49; IC95 por cento: 2,60-11,60). A ocorrência de resistência em 18,9 por cento dos casos e multirresistência em aproximadamente 10 por cento confirmam a relevância deste problema entre pacientes HIV+ na Baixada Santista.

Since the early 1990s, an increase in Mycobacterium tuberculosis drug resistance has been reported, with high prevalence among HIV+ patients. We evaluated the sensitivity patterns of M. tuberculosis, resistance rate, and predisposing factors among HIV+ patients in Santos, São Vicente, Cubatão, Praia Grande, and Guarujá, São Paulo State, Brazil. The medical charts of 301 patients with positive cultures for M. tuberculosis from 1993 to 2003 were reviewed. Resistance occurred in 57 patients (18.9 percent), as follows: 32 (10.6 percent) displayed multidrug-resistant tuberculosis (resistant to at least Rifampicin and Isoniazid); 4 (1.3 percent) were resistant to two or more drugs; and 21 (7 percent) were resistant to a single drug. Acquired resistance was observed in 70.1 percent of cases. Drug resistance was significantly associated with previous tuberculosis treatment, duration of HIV diagnosis, and previous hospitalization. In logistic regression analysis, only previous tuberculosis treatment adjusted by age remained as an independent risk factor (OR = 5.49; 95 percentCI: 2.60-11.60). Drug resistance to at least one drug in 18.9 percent and multidrug resistance in 10.6 percent of cases highlight the relevance of this problem in HIV patients in the Baixada Santista.

Tuberculose resistente nos indivíduos HIV positivos em cinco municípios da Baixada Santista - SP / Drug resistance tuberculosis in HIV patients in Baixada Santista - São Paulo - Brazil

Desde o início dos anos 90 vários estudos relatam aumento do número de casos de Mycobacterium tuberculosis resistentes às drogas tuberculostáticas, inclusive nos países desenvolvidos, com alta prevalência entre os pacientes HIV+. Objetivos: avaliar a frequência de resistência, o perfil de sensibilidade do Mycobacterium tuberculosis às drogas e os fatores predisponentes à resistência entre os indivíduos HIV positivos nos municípios de Santos, São Vicente, Cubatão, Praia Grande e Guarujá. Métodos: Levantamento dos prontuários de 301 pacientes que apresentaram resultado de cultura positivo e teste de sensibilidade às drogas tuberculostáticas entre 1993 e 2003. Resultados: A resistência às drogas foi diagnosticada em 57 pacientes (18,9 por cento) com a seguinte distribuição: 32 (10,6 por cento) apresentaram TB multirresistente (resistência a pelo menos rifampicina e isoniazida); 4 (1,3 por cento) casos apresentaram resistência a duas ou mais drogas e 21 (7 por cento) monorresistência. A resistênca adquirida foi observada em 70,1 por cento dos casos. Não houve associação entre tuberculose resistente e as variáveis: alcoolismo, uso de drogas injetáveis, contagem de CD4+, falta de domicílio e uso de antiretrovirais. As variáveis estatisticamente associadas a TB resistente foram: tratamento anterior com tuberculostáticos, tempo de diagnóstico de HIV e hospitalização prévia. Em análise multivariada apenas tratamento anterior ajustado por faixa etária, mostrou-se estatisticamente associado (OR = 5,49: IC95 por cento 2,60-11,60). Conclusões: A ocorrência de resistência em 18,9 por cento dos casos e multirrestência em aproximadamente 10 por cento confirmam a relevância deste problema entre pacientes HIV+ na Baixada Santista. Entre os fatores de risco analisados apenas tratamento anterior com tuberculostáticos esteve estatisticamente associado.