Custo-efetividade de cateteres periféricos com plataforma de estabilização integrada sob a perspectiva hospitalar no Brasil / Cost-effectiveness of peripheral catheters with integrated stabilization platform under the perspective of hospitals in Brazil

A presente avaliação tem como finalidade determinar a custo-efetividade de cateteres periféricos com dispositivo de segurança, válvula antirrefluxo e plataforma de estabilização integrada durante seu uso em pacientes hospitalizados e submetidos à terapia de infusão, sob a perspectiva da Saúde Suplementar do Brasil. Foi elaborado modelo analítico de decisão para estimar a razão de custo-efetividade incremental (RCEI), em horizonte de 96 horas, entre cateteres periféricos com plataforma de estabilização integrada versus dispositivos sem plataforma de estabilização. Os desfechosclínicos aplicados ao modelo foram taxa de sucesso da punção venosa e taxa de permanência do cateter, obtidos através de revisão sistemática da literatura. A estimativa de custos médicos diretos totais para o tratamento das complicações associadas à punção venosa foi elaborada por opiniãode especialistas, e coletada a partir de de bases de dados secundárias. O resultado para o Caso Base do modelo evidenciou economia de recursos financeiros de R$ 138,31 por complicações evitadas e R$ 558,33 por punção venosa com sucesso ou novas punções evitadas. O estudo indica que o uso de cateteres periféricos com plataforma de estabilização integrada pode constituir uma alternativa viável aos hospitais brasileiros, gerando redução de custos totais de tratamento e ganhos em efetividadeclínica, especialmente em função da menor tendência de surgimento de eventos adversos decorrentes da mobilização inadvertida dos cateteres periféricos ao longo do tempo.

The current evaluation aims at determining the cost-effectiveness of peripheral catheters with securement device, blood control septum and integrated stabilization platform in use in patients admitted to hospitals and submitted to infusion therapy, under the perspective of Supplementary HealthCare in Brazil. A decision tree was elaborated for estimating the incremental cost-effectiveness ratio (ICER) between two types of peripheral catheters, with or without an integrated stabilization platform, in a time horizon of 96 hours. Clinical outcomes applied to the model were obtained from systematic review of literature published up to 31.08.2015 and include rates of venipuncture success and catheter indwell time. The average of total direct medical costs for treatment of adverse events was estimated by expert opinion and data was collected from secondary databases. The Base Caseresults reflect cost-savings of about 138,31 Brazilian Reais per avoided complications and 558,33 Brazilian Reais per successful venipuncture or new venipunctures avoided. Ours study points out the use of peripheral catheters with stabilization platforms integrated to the device constitutes feasible alternatives for Brazilian private hospitals. Their use can generate reduction of total treatment costs and gains in effectiveness specially due to lower tendencies for development of securement-related adverse reactions, caused by inadvertent mobilization of peripheral access over time.

Cost-effectiveness and cost-utility analyses of dabigatran compared with warfarin in patients with non valvular atrial fibrillation and risk factors for stroke and systemic embolism with in Brazilian private and public health care systems perspectives

Objective: To analyze the cost-effectiveness and cost-utility of dabigatran compared with warfarin in patients with non valvular atrial fibrillation with moderate to high risk of ischemic stroke or systemic embolism and eligible for treatment with anticoagulants. Methods: Markov-based economic analysis was performed to estimate treatment costs and outcomes. Epidemiologicalandefficacy data were determined after a critical revision of the medical literature. Unit costs were taken from Brazilian official databases. Only direct medical costs were covered. Costs and benefits were discounte data rate of 5% per year. Outcomes were expressed as life-year (LY) and quality-adjusted life-year (QALY). Results: Dabigatranuseis cost-effective intermsofLYandQALY considering a willingness-to-pay thresholdof 3times gross domestic product per capita of 2010 (Brazilian rea l57,048/US$24,275.74) perLYand QALY saved in both analyzed perspectives (private and public health care systems). Conclusions: Dabigatran use improves patient survival and quality of life compared with warfarin. This represents the best therapeutic option in terms of cost and effectiveness in the prevention of ischemi cstroke and systemic embolism in patients with non valvular atrial fibrillation.

The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study.

BACKGROUND: Obesity is a major global epidemic and a burden to society and health systems. It is well known risk factor for a number of chronic medical conditions with high morbidity and mortality. This study aimed to provide an estimate of the direct costs associated to outpatient and inpatient care of overweight and obesity related diseases in the perspective of the Brazilian Health System (SUS). METHODS: Population attributable risk (PAR) was calculated for selected diseases related to overweight and obesity and with the following parameters: Relative risk (RR) ≥ 1.20 or RR ≥ 1.10 and < 1.20, but important problem of public health due its high prevalence. After a broad search in the literature, two meta-analysis were selected to provide RR for PAR calculation. The prevalence rates of overweight and obesity in Brazilians with ≥ 18 years were obtained from large national survey. The national health database (DATASUS) was used to estimate the annual cost of the Brazilian Unified Health System (SUS) with the diseases included in the analysis. The extracted values were stratified by sex, type of service (inpatient or outpatient care) and year. Data were collected from 2008 to 2010 and the results reflect the average of 3 years. Brazilian costs were converted into US dollars during the analysis using a purchasing power parity basis (2010). RESULTS: The estimated total costs in one year with all diseases related to overweight and obesity are US$ 2,1 billion; US$ 1,4 billion (68.4% of total costs) due to hospitalizations and US$ 679 million due to ambulatory procedures. Approximately 10% of these cost is attributable to overweight and obesity. CONCLUSION: The results confirm that overweight and obesity carry a great economic burden for Brazilian health system and for the society. The knowledge of these costs will be useful for future economic analysis of preventive and treatment interventions.

Análise de custo-efetividade do ácido zoledrônico na prevenção da fratura osteoporótica proximal de fêmur no cenário do Sistema Suplementar de Saúde Brasileiro / Cost-effectiveness analysis of zoledronic acid for the prevention of osteoporotic hip fracture in the private health care system in Brazil

Objetivo: realizar análise de custo-efetividade do ácido zoledrônico na prevenção de fraturas osteoporóticas proximais de fêmur. Método: modelo analítico de decisão para comparar ácido zoledrônico versus risedronato, na prevenção de fraturas, no ano 2007. A população-alvo da análise foi uma coorte hipotética de mulheres com osteoporose, idade inicial de 65 anos, horizonte de tempo de cinco anos. Dados epidemiológicos e eficácia dos fármacos foram obtidos de revisão e análise crítica da literatura. Custos foram valorados para o Sistema Suplementar de Saúde. O desfecho analisado foi o custo por fratura de fêmur evitada. Resultados: no cenário base, o ácido zoledrônico reduziu a incidência de fraturas (0,297 fraturas versus 0,460 fraturas), com custo anual do ácido zoledrônico de R$ 21.630,85 versus R$ 21.872,55 do risedronato. Conclusão: o uso do ácido zoledrônico comparado ao risedronato pode prevenir mais fraturas proximais de fêmur, com menores custos, no cenário do Sistema Suplementar de Saúde.

Objective: To assess cost-effectiveness of zoledronic acid for the prevention of osteoporotic hip fracture. Methods: Decision analytic model to compare zoledronicacid versus risedronate, for the prevention of fracture, in 2007. The target population was a hypothetic cohort of women with osteoporosis aged 65 years in a time horizon of five years. The epidemiological data related to osteoporosisand drug’s efficacy were obtained from critical appraisal of scientific literature. The costs were collected from electronic claims databases of patients enrolled in Brazilian health plans. The outcome analyzed was the cost per hip fracture avoided. Results: In the base case scenario, zoledronic acid reduced the incidenceof fractures (0.297 fractures against 0.460 fractures), with annual costs of R$21,630.85 versus R$ 21,872.55 for the risedronate. Conclusions: The use of zoledronic acid compared to risedronate could prevent more hip fractures, withless costs in the Brazilian private health system.

Análise de custo-efetividade do peptídeo natriurético tipo-B comparado ao julgamento clínico em pacientes com dispnéia aguda no contexto do Sistema Único de Saúde / Analysis of the cost-effectiveness of B-type natriuretic compared to clinical judgment in patients presenting acute dyspnea withim the context of Brazil's Unified Healthcare System

Fundamentos: O peptídeo natriurético tipo-B é um marcador da insuficiência cardíaca que parece ser útil no diagnóstico de pacientes com dispnéia aguda no atendimento de emergência. Objetivo: Avaliar o custo-efetividade da avaliação diagnóstica guiada pelo peptídeo natriurético tipo-B comparado ao julgamento clínico isolado, na dispnéia aguda, no cenário do Sistema ùnico de Saúde. Métodos: Um modelo analítico de decisão foi desenvolvido para avaliar o custo-efetividade da avaliação diagnóstica guiada pelo peptídeo natriurético tipo-B comparado ao julgamento clínico isolado. Foram utilizados dados de efetividade, publicados em ensaio clínico controlado e randomizado, e dados de custos do tratamento da insuficiência cardíaca obtidos de estudos brasileiros. As unidade de efetividade mensuradas no modelo foram "hospitalização evitada" e "ecocardiogramas evitados" (mensurados em percentual), no período de 60 dias. A árvore de decisão e as análises estatísticas foram conduzidas no programa TreeAge Pro Healthcare. Resultados: O uso de peptídeo natriurético tipo-B na avaliação diagnóstica dos pacientes com dispnéia aguda, proporcionou maior realização de ecocardiogramas...