Conduta no diagnóstico e tratamento dos pacientes com artrite reumatóide no Brasil - respostas dos médicos a um questionário de avaliação

Objectives: The aim of this study was to evaluate in relation to diagnosis and treatment for Rheumatoid Arthritis (RA) patients Brazilian population, and compare the management offered to patients who are followed up in the public and private sectors.Material and Methods: An electronic questionnaire was sent to 650 rheumatologists, members of the Brazilian Rheumatology Society (SBR) and who were attending adult RA patients in the public and/or private sector, who had a contact e-mail address available in the SBR register and agreed to take part in the survey.Results: The rheumatologists estimated that 51.7% of the patients had had their disease diagnosed and of these, 56.1% were undergoing treatment. It was also estimated that 53.9% of the RA patients that was under treatment were being followed up by rheumatologists. The mean time interval estimated by the rheumatologists, between the appearance of the first symptoms of RA and the diagnosis made by a doctor, was greater among the patients who sought attendance in public services (1.8 years). There was no difference in clinical and radiographic assessment measures between the two types of service, with the exception of the application of HAQ, which was used more in public services. The principal drug association reported in both types of services was methotrexate and chloroquine. The rate of usage of associations between biological agents and methotrexate ranged from 6 to 8%. The main treatment-related difficulties were: access to the health system (public services) and cost of medication (private services).Conclusion: Approximately 50% of RA patients are being diagnosed and half of these are under treatment. There was no great difference in attendance within the public and private systems for these patients, whereas the main difficulty for the public system was access to attendance, for the private system it was the cost of the medication.Univ Fed Sao Paulo, EPM, CPES, BR-04023062 Sao Paulo, BrazilUniv Fed Sao Paulo, Disciplina Reumatol, BR-04023062 Sao Paulo, BrazilUniv Fed Sao Paulo, EPM, CPES, BR-04023062 Sao Paulo, BrazilUniv Fed Sao Paulo, Disciplina Reumatol, BR-04023062 Sao Paulo, BrazilWeb of Scienc

Cost effectiveness of the cancer prevention program for carriers of the BRCA1/2 mutation

OBJECTIVE: To analyze the cost effectiveness of the diagnostic program for the germline mutation in BRCA1/2 genes and of preventative strategies for the relatives of patients diagnosed with ovarian cancer associated with this mutation. METHODS: The study analyzed the cost effectiveness by developing an analysis of the Markov decision process from the perspective of the National Health System. The strategies compared reflect upon the adoption of genetic testing and preventative strategies for relatives or the usual care currently proposed. The incremental cost-effectiveness ratio was expressed in terms of cost per case avoided. The sensitivity analysis was performed in a univariate and deterministic manner. RESULTS: The study showed increments for effectiveness and for costs when performing genetic testing and adopting prophylactic measures for family members. The incremental cost-effectiveness ratio was estimated at R$908.58 per case of cancer avoided, a figure considered lower than the study's cost-effectiveness threshold (R$7,543.50). CONCLUSIONS: The program analyzed should be considered a cost-effective strategy for the national situation. Studies in various other countries have reached similar conclusions. One possible ramification of this research might the need to perform a budgetary-impact analysis of making the program one of the country's health policies

Rotavirus morbidity and mortality in children in Brazil

Objective. To study the epidemiology of rotavirus and estimate rotavirus- associated morbidity and mortality in children <= 5 years of age in Brazil in 2004 before introducing the rotavirus vaccine in Brazil`s National Immunization Program ( Programa Nacional de Imunizacoes, PNI). Methods. To estimate rotavirus morbidity, published studies ( 1999 - 2006) addressing incidence of acute diarrhea among children <= 5 years of age and frequency of rotavirus infection among children with diarrhea in Brazil were reviewed. Diarrhea episodes were divided into three categories of severity by level of care: mild cases requiring only home- based care; moderate cases requiring a visit to an outpatient healthcare facility; and severe cases requiring hospitalization. To estimate rotavirus mortality, information on the number of registered deaths from diarrhea in children <= 5 years of age was obtained from the Mortality Information System ( Sistema de Informacao, sobre Mortalidade, SIM) of Brazil`s public healthcare system ( Sistema Unico de Sa de, SUS) and the proportion of deaths due to rotavirus was calculated. Results. Rotavirus infections were estimated to cause 3 525 053 episodes of diarrhea, 655 853 visits to outpatient healthcare facilities, 92 453 hospitalizations, and 850 deaths of children <= 5 years of age each year in Brazil. Conclusion. Rotavirus infections are an important cause of child morbidity and mortality in Brazil

Costos de la atención sanitaria en los últimos cuatro años de vida de beneficiarios de seguros privados de salud en Brasil

Objective. To examine health care use and expenditures by Brazilians covered by private health care plans in the last four years of life.Methods. Health plan provider enrollee files and death certificate data were used for 274 health plan beneficiaries who died in 1998, 1999, and 2000. Resources used for a beneficiary in the year of death and in the three years prior to death were identified. Descriptive statistical analyses were used for clinical and socio-demographic characteristics and to describe the costs.Results. Of the 274 deaths included in this analysis, 92 occurred in 1998, 82 in 1999, and 100 in 2000. Most of the deceased were males (61.4%). Distribution in terms of type of health plan coverage (full versus hospitalization-only coverage) was similar among beneficiaries (53% had hospitalization only and 47% had full coverage). The total health plan expenditure in the last four years of life for the 274 decedents was US$26 300 283 (US$ 12 287 723 for beneficiaries with hospitalization-only and US$ 14 012 560 for those with full coverage). Expenditures increased progressively in the four years preceding death. About 70% of medical expenses for decedents in the four years of this analysis were incurred in the last year of life.Conclusion. Relatively large amounts of health care resources are used by Brazilian private health plan participants in their last year of life, suggesting that specific strategies are needed to optimize the allocation of medical care resources for these patients.Univ Fed Sao Paulo, Div Rheumatol, Sao Paulo, BrazilSao Paulo Ctr Hlth Econ, Sao Paulo, BrazilUniv Fed Sao Paulo, Div Rheumatol, Sao Paulo, BrazilWeb of Scienc

Cost-effectiveness analysis of universal childhood hepatitis A vaccination in Brazil: Regional analyses according to the endemic context

Objective: To To conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazil. Methods: An age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately according to the pattern of regional endemicity, one for South + Southeast (low endemicity) and one for the North + Northeast + Midwest (intermediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data from a nationwide seroprevalence survey of viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from both the health system and societal perspectives. Costs are expressed in 2008 Brazilian currency (Real). Results: A universal immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths for the disease and a 62% decrease of life years lost, in a national perspective. With a vaccine price of R$16.89 (US$7.23) per dose, vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from both health system and society perspective. Results were most sensitive to the frequency of icteric hepatitis, ambulatory care and vaccine costs. Conclusions: Universal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results are useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program. (C) 2012 Elsevier Ltd. All rights reserved.Ministry of Health of BrazilMinistry of Health of BrazilNational Council of Technological and Scientific Development (CNPq)National Council of Technological and Scientific Development (CNPq)National Institute of Science and Technology for Health Technology Assessment (IATS)National Institute of Science and Technology for Health Technology Assessment (IATS)CNPq [306489/2010-4, 308311/2009-4]CNP