Consumer willingness to pay for a hypothetical Zika vaccine in Brazil and the implications

ABSTRACT : Background: Zika virus is a newly emerging infection, associated with increasingly large outbreaks especially in tropical countries such as Brazil. A future Zika vaccine can contribute to decreasing the number of cases and associated complications. Information about consumers’ willingness to pay (WTP) for a hypothetical Zika vaccine can help price setting discussions in the future in Brazil, starting with the private market. Methods: A cross-sectional study conducted among residents of Minas Gerais, Brazil, regarding their WTP for a hypothetical Zika Vaccine. The mean effective protection was 80%, with the possibility of some local and systemic side- effects. Results: 517 people were interviewed. However, 28 would not be vaccinated even if the vaccine was free. Most of the resultant interviewees (489) were female (58.2%), had completed high school (49.7%), were employed (71.2%), had private health insurance (52.7%), and did not have Zika (96.9%). The median individual maximum WTP for this hypothetical Zika vaccine (one dose) was US$31.34 (BRL100.00). Conclusion: Such discussions regarding WTP can contribute to decision-making about prices once a Zika vaccine becomes available in Brazil alongside other ongoing programs to control the virus

Economic and epidemiological impact of dengue illness over 16 years from a public health system perspective in Brazil to inform future health policies including the adoption of a dengue vaccine

Introduction: Dengue is a serious global health problem endemic in Brazil. Consequently, our aim was to measure the costs and disease burden of symptomatic dengue infections in Brazil from the perspective of the Brazilian Public Health System (SUS) between 2000 and 2015 using Brazilian public health system databases. Specific age group incidence estimates were used to calculate the disability-adjusted life years (DALYs) to gain a better understanding of the disease burden. Areas covered: SUS spent almost USD159 million and USD10 million to treat dengue and severe dengue, respectively, between 2000-2015. This is principally hospitalization costs with the majority of patients self-treated at home with minor symptoms. The average notification rate for dengue was 273 per 100,000 inhabitants and 3 per 100,000 for severe dengue, with annual DALYs estimates ranging between 72.35 to 6,824.45 during the 16 years. Expert commentary: The epidemiological and morbidity burden associated with dengue is substantial in Brazil, with costs affected by the fact that most patients self-treat at home with these costs not included in SUS. The Brazilian government urgently needs to proactively evaluate the real costs and clinical benefits of any potential dengue vaccination program by the National Immunization Program to guide future decision making

Efficacy of Mobile Apps to Support the Care of Patients With Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background- Diabetes Mellitus (DM) is a chronic disease that is considered a global public health problem. Education and self-monitoring by diabetic patients help to optimize and make possible a satisfactory metabolic control enabling improved management and reduced morbidity and mortality. The global growth in the use of mobile phones makes them a powerful platform to help provide tailored health, delivered conveniently to patients through health applications (apps). Objective- Evaluate the efficacy of mobile apps through a systematic review and meta-analysis to assist diabetes mellitus patients in treatment. Methods- We conducted searches in the electronic databases MEDLINE (Pubmed), CENTRAL/ Cochrane Register of Controlled Trials and LILACS, manual search in references of publications included, systematic reviews, specialized journals and gray literature. We considered eligible randomized controlled trials (RCTs) conducted after 2008 with participants of all ages, diabetes mellitus patients and users of apps to help manage the disease. The meta-analysis of glycated hemoglobin (HbA1c) was performed in Review Manager Software 5.3. Results- The literature search identified 1236 publications. From these, 13 studies were included that evaluated 1263 patients. In six RCTs, there were a statistical significant reduction (P < 0.05) of HbA1c at the end of studies in the intervention group. The HbA1c data were evaluated by meta-analysis with the following results (MD = - .44; CI: - .59, - .29; P < .10; I² = 32%).The evaluation favored the treatment in patients who used apps without significant heterogeneity. Conclusions - The use of apps by diabetic patients could help improve the control of HbA1c. In addition, the apps seem to strengthen the perception of self-care contributing better information and health education to patients. Patients also become more self-confident to deal with their diabetes, mainly, by reducing fear of not knowing how to deal with potential hypoglycemic episodes that may occur

Avaliação econômica de uma vacina da dengue no Brasil baseado em seu valor terapêutico no Sistema Único de Saúde

Exportado OPUSMade available in DSpace on 2019-08-13T19:51:27Z (GMT). No. of bitstreams: 1 tese_completa_isabella_piassi_godoi_ppgmaf_27062018.pdf: 6617576 bytes, checksum: 63a905fbf3e2f89d65727b4e5b3db20b (MD5) Previous issue date: 12INTRODUÇÃO: A dengue é uma doença infecciosa e tem como agente causador um vírus. No Brasil a doença é de notificação compulsória, sendo um potencial mercado para a primeira vacina aprovada (CYD-TDV) no país em 2015. OBJETIVOS: Avaliar a eficácia, segurança e imunogenicidade de CYD-TDV; estimar a disposição a pagar do consumidor brasileiro para esta vacina; demonstrar o impacto econômico e epidemiológico da dengue no Brasil na perspectiva do SUS, bem como estimar a razão custo efetividade de CYD-TDV no Brasil na perspectiva do SUS. MÉTODOS: A) Revisão Sistemática Foi realizada uma revisão sistemática com metanálise para avalição da segurança, eficácia e imunogenicidade de CYDTDV. Foram incluídos ensaios clínicos randomizados controlados de fase II e III, disponíveis nas bases de dados PUBMED, LILACS, COCHRANE (até março de 2016). Todas as etapas foram realizadas de acordo com Handbook Cochrane. B) Disposição a Pagar Realizou-se um estudo transversal com residentes da Grande Belo Horizonte, Minas Gerais, a respeito da disposição a pagar pela vacina (valor mediano) CYD-TDV. C) A partir do pareamento probabilístico determinístico nas bases de dados do SUS (SIA/SIH/SIM) foram avaliados todos os registros referente a indivíduos que utilizaram o SUS para o tratamento de dengue ou dengue grave no país no período de 2000 a 2015. D) Análise Custo Efetividade A partir das probabilidades de transição de cada estado de saúde associado ao tratamento de dengue e dengue grave pelo SUS foi elaborado um modelo de Markov, considerado a vacina CYDTDV (60% eficácia), horizonte temporal de 16 anos com ciclos anuais em uma população hipotética de 100 000 indivíduos. A efetividade foi mensurada a partir dos DALYs. RESULTADOS: A) Revisão Sistemática Foram incluídos 9 estudos (6 fase II e 3 fase III). A partir de três ensaios clínicos verificou-se uma eficácia média de 60%. Esta vacina demonstrou-se segura. B) Disposição a pagar O estudo de disposição a pagar demonstrou que o consumidor brasileiro da região metropolitana de Belo Horizonte está disposto a pagar R$120,00 pelo esquema de três doses da vacina CYD-TDV para a prevenção da dengue. C) No período de 2000 a 2015, o SUS gastou, aproximadamente, US$ 159 milhões e US$10 milhões para o tratamento da dengue e da dengue grave, respectivamente com mais de 700 mil indivíduos que utilizaram os serviços públicos de saúde. A estratégia de vacinação com CYD-TDV apresentou maior benefício clínico, contudo com um elevado custo incremental USD10,029.30 (RCEI: USD 101,579,881.63) comparado com a estratégia de não vacinação. CONCLUSÕES: A) Revisão Sistemática e Meta-análise A vacina CYD-TDV foi aprovada e indicada para indíviduos entre 9 e 45 anos, com eficácia moderada e necessidade de maiores avaliações. B) Disposição a Pagar pela Vacina CYD-TDV A disposição a pagar da população estudada para a vacina da dengue foi estimada em R$120,00 (valor mediano) por esquema terapêutico de três doses (R$40,00 por dose). O valor encontrado expressa a disposição a pagar do consumidor privado e é coerente com valores observados na literatura. C) A dengue representa um substancial gasto para o SUS durante os 16 anos de avaliação do perfil de serviços e procedimentos realizados, fazendo-se necessário a continua promoção de ações preventivas de combate ao vetor. D) Os atuais preços praticados no mercado para Dengvaxia® demonstraram serem elevados para uma potencial incorporação no SUS. Reforçase a necessidade de estudos de soroprevalência para DENV no país, a fim de melhor contribuir para as discussões referente a necessidade de incorporação de uma vacina no país e/ou melhor avaliar potenciais grupos etários a serem público alvo de uma possível vacinação.INTRODUCTION: Dengue is an infectious disease and its causal agent is a virus. In Brazil, the disease is notifiable, being a potential market for the first approved vaccine (CYD-TDV) in the country in 2015. OBJECTIVES: To evaluate the efficacy, safety and immunogenicity of CYD-TDV; to estimate the Brazilian consumer's willingness to pay for this vaccine; to demonstrate the economic and epidemiological impact of dengue in Brazil from a SUS perspective, as well as to estimate the cost-effectiveness ratio of CYD-TDV in Brazil from a SUS perspective. METHODS: A) Systematic review - A systematic review with metaanalysis was performed to evaluate the safety, efficacy and immunogenicity of CYD-TDV. Randomized controlled trials of phase II and III, available in the databases PUBMED, LILACS, COCHRANE (until March 2016) were included. All steps were performed according to the Cochrane Handbook. B) Disposal to Pay - A cross-sectional study was conducted with residents of Greater Belo Horizonte, Minas Gerais, regarding the disposition to pay for the vaccine (median value) CYD-TDV. C) From the deterministic probabilistic matching in the SUS databases (SIA / SIH / SIM), all the records referring to individuals who used the SUS for the treatment of severe dengue or dengue in the country from 2000 to 2015 were evaluated. D) Analysis Cost Effectiveness - Based on the transition probabilities of each health condition associated with the treatment of dengue and severe dengue by SUS, a Markov model was elaborated, considering the CYD-TDV vaccine (60$ 120.00 for the three doses of the CYD-TDV vaccine for the prevention of dengue. C) In the period from 2000 to 2015, the SUS spent approximately US $159 million and US$ 10 million for the treatment of dengue and severe dengue, respectively, with more than 700 thousand individuals who used public health services. The vaccination strategy with CYD-TDV presented greater clinical benefit, however with a high incremental cost USD10,029.30 (ICER: USD 101,579,881.63) compared to the non-vaccination strategy. CONCLUSIONS: A) Systematic review and meta-analysis - The CYD-TDV vaccine was approved and indicated for individuals between 9 and 45 years old, with moderate efficacy and the need for further evaluation. B) Provision to pay for the CYDTDV vaccine - The willingness to pay of the population studied for the dengue vaccine was estimated at R $120.00 (median value) for a three-dose therapeutic regimen (R$ 40,00 per dose). The value found expresses the willingness to pay of the private consumer and is consistent with values observed in the literature. C) Dengue represents a substantial expense for the SUS during the 16 years of evaluation of the profile of services and procedures performed, making it necessary to continuously promote preventive actions to combat the vector. D) The current market prices for Dengvaxia® have been shown to be high for a potential incorporation into the SUS. It reinforces the need for seroprevalence studies for DENV in the country in order to better contribute to the discussions regarding the need to incorporate a vaccine in the country and / or to better evaluate potential age groups to be the target of a possible vaccination

Willingness to pay for a hypothetical malaria vaccine in Brazil: a cross-sectional study and the implications

Aim: Malaria is an infection caused by protozoa of genus Plasmodium, considered the one associated with increasingly large outbreaks. Methods: A cross-sectional study was conducted with residents in the northern region of Brazil on the willingness to pay (WTP) for a hypothetical vaccine against malaria (effective protection of 80%). Results: Of 616 people interviewed, most interviewees were female (61%) and were employed (97%). The median individual maximum WTP for a hypothetical malaria vaccine was US$11.90 (BRL 50). Conclusion: The northern region of Brazil is one of the largest markets for a malaria vaccine due to its epidemiological relevance. Consequently, economic studies will be important to assist in the assessment of the potential price and value of new vaccines

Supplementary material: Acceptability and consumers’ willingness to pay for comprehensive medication management services in Brazil

These are peer-reviewed supplementary questionnaire and consent forms for the article 'Acceptability and consumers’ willingness to pay for comprehensive medication management services in Brazil' published in the Journal of Comparative Effectiveness Research.Aim: Comprehensive medication management (CMM) is a clinical service that aims to optimize the therapeutic results of patients at the individual level. Studies carried out in Brazil and in several parts of the world have found a positive impact of the service, mainly in the resolution of drug therapy problems and in improving clinical outcomes and patients’ quality of life. This service is not widespread and its acceptability and willingness to pay were not defined by the population yet. Objective: This work aims to conduct a study with users of private health services to determine the acceptability and willingness to pay for CMM services. Methods: This is a cross-sectional survey conducted through face-to-face interviews, among residents over 18 years of age of the metropolitan region of Belo Horizonte, capital of Minas Gerais State, Brazil. Results: For this study, 563 individuals were interviewed. Most respondents were female (55.1%), had completed high school (46.8%) and were employed (62.5%). The acceptability for the service was 93,25%, and among all respondents, 37 would not accept the service even if it was free. The amount of consumers’ willingness to pay for the CMM service was estimated at $17.75 (40.00 BRL). Conclusion: The research results show that most people are willing to pay for the CMM service. This study can contribute to the decision-making regarding the implementation and pricing of the service in Brazil.</p

Strategies to improve antimicrobial utilization with a special focus on developing countries

Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.https://www.mdpi.com/journal/lifeam2022Pharmacolog

The current situation regarding long-acting insulin analogues including biosimilars among african, Asian, European, and South American countries : findings and implications for the future

Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers. Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders. Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries. Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production. Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities