Análise de custo-efetividade de análogos da somatostatina no tratamento de acromegalia no Brasil

This study aims to compare economic and patient impacts of the treatment of acromegaly with two different somatostatin analogues (octreotide LAR and lanreotide SR) in Brazil. A cost-effectiveness analysis was carried out under the Brazilian Public Health Care System (SUS) perspective. A decision analytical model was developed based on the Brazilian Public Health Care System Clinical Guideline for Acromegaly. A hypothetical cohort of 276 patients was followed for two years. Data were extracted from literature and administrative databases. Based on the analytical model, treatment with octreotide LAR would avoid 12 and 17 cases of GH and IGF-I elevated serum levels, respectively. Octreotide LAR was a cost-saving strategy, with net savings of R$10,448,324 (US$4,465,096) to SUS. Annual net savings per patient were R$18,928 (US$8,089). Treatment of acromegaly with octreotide LAR is a dominant strategy when compared to the treatment with lanreotide SR in Brazil. Sensitivity analysis did not alter the cost-saving status.O objetivo deste estudo é comparar o impacto econômico e o impacto nos pacientes com acromegalia do tratamento com dois diferentes análogos de somatostatina (octreotida LAR e lanreotide SR) no Brasil. Um estudo de custoefetividade foi realizado a partir da perspectiva do Sistema Único de Saúde (SUS). Foi desenvolvido um modelo analítico de decisão baseado no Protocolo Clínico e Diretrizes Terapêuticas de Acromegalia do SUS. Uma coorte hipotética de 276 pacientes foi seguida por dois anos. Dados foram obtidos da literatura e bases de dados oficiais do SUS. Baseado no modelo analítico, o tratamento com octreotida LAR evitaria 12 e 17 casos com níveis elevados de GH e IGF-I, respectivamente. Octreotida LAR foi uma estratégia econômica, gerando economia de R$10.448.324 (US$4.465.096) para o SUS. A economia anual por paciente foi de R$18.928 (US$8.089). O tratamento de acromegalia com octreotida LAR é estratégia dominante quando comparado com o tratamento com lanreotida SR no Brasil. A análise de sensibilidade não alterou seu status de econômica

Chapter 29: Restoration Priorities and Benefits within Landscapes and Catchments and Across the Amazon Basin

Restoration can be applied in many different Amazonian contexts but will be most effective at leveraging environmental and social benefits when it is prioritized across the Amazon Basin and within landscapes and catchments. Here we outline the considerations that are most relevant for planning and scaling restoration

Chapter 28: Restoration Options for the Amazon

This chapter examines site-specific opportunities and approaches for restoring terrestrial and aquatic systems, focusing on local actions and their immediate benefits. Landscape, catchment, and biome-wide considerations are addressed in Chapter 29. Conservation approaches are addressed in Chapter 2

Chapter 27: Conservation measures to counter the main threats to Amazonian biodiversity

Present-day human activities are reducing and altering Amazonian biodiversity and disrupting the functioning of terrestrial and aquatic ecosystems (Chapter 19 & 20). This chapter outlines some of the approaches required to address the main threats to the Amazon’s biodiversity and ecosystems, i.e.,deforestation, damming of rivers, mining, hunting, illegal trade, drug production and trafficking, illegal logging, overfishing, and infrastructure expansion. The role of restoration is addressed in Chapters 28 and 29

Multicriteria decision analysis to support HTA agencies : benefits, limitations, and the way forward

Objective Recent years have witnessed an increased interest in the use of multicriteria decision analysis (MCDA) to support health technology assessment (HTA) agencies for setting healthcare priorities. However, its implementation to date has been criticized for being “entirely mechanistic,” ignoring opportunity costs, and not following best practice guidelines. This article provides guidance on the use of MCDA in this context. Methods The present study was based on a systematic review and consensus development. We developed a typology of MCDA studies and good implementation practice. We reviewed 37 studies over the period 1990 to 2018 on their compliance with good practice and developed recommendations. We reached consensus among authors over the course of several review rounds. Results We identified 3 MCDA study types: qualitative MCDA, quantitative MCDA, and MCDA with decision rules. The types perform differently in terms of quality, consistency, and transparency of recommendations on healthcare priorities. We advise HTA agencies to always include a deliberative component. Agencies should, at a minimum, undertake qualitative MCDA. The use of quantitative MCDA has additional benefits but also poses design challenges. MCDA with decision rules, used by HTA agencies in The Netherlands and the United Kingdom and typically referred to as structured deliberation, has the potential to further improve the formulation of recommendations but has not yet been subjected to broad experimentation and evaluation. Conclusion MCDA holds large potential to support HTA agencies in setting healthcare priorities, but its implementation needs to be improved

Economic evaluations of vaccination programmes: cost estimates of preventive interventions

Esta tese representa o aprofundamento do estudo das estimativas de custos, componente integrante e determinante das avaliações econômicas, enquanto parte do projeto de pesquisa Estudos de custo-efetividade da incorporação de novas vacinas à rotina do Programa Nacional de Imunizações: Rotavírus, Varicela, Pneumocócica conjugada, Meningocócica C conjugada e Hepatite A desenvolvido por solicitação do Programa Nacional de Imunização/PNI da Secretaria de Vigilância em Saúde/SVS do Ministério da Saúde, a partir de 2005. A tese teve como objetivo analisar as condições de uso, dificuldades e repercussões de diferentes métodos de estimativas de custos em estudos de custo-efetividade de vacinas de duas tecnologias específicas, vacinas contra rotavírus e varicela, assim como a relação entre as estimativas de custos e os resultados. As estimativas de custos estão condicionadas pelas características gerais da doença sob análise (aguda no caso de rotavírus e com seqüela no caso de varicela), assim como por questões metodológicas gerais (escolha teórico-conceitual, métodos e fontes de dados) e especificidades do caso brasileiro. Para esta tese, houve maior detalhamento das estimativas de custos diretos no cuidado da doença, com a inclusão de custos específicos do sistema de saúde suplementar para as duas doenças, inclusão de participação pública na dispensação de medicamentos no caso de rotavírus e inclusão de custos de medicamentos do sistema público de saúde no caso de varicela. Como resultado, houve aumento do custo total da doença estimado de 16% para rotavírus e 11% para varicela, assim como aumento de economia (custo total da doença evitado) de 18% e 16%, respectivamente, com a introdução de cada vacina. Apesar do maior detalhamento das estimativas de custos ter reduzido a razão de custo-efetividade incremental em 20% para rotavírus e 4% para varicela, o nível de custo-efetividade dos dois programas de vacinação não foi alterado. Os resultados das avaliações econômicas de vacinação contra rotavírus e varicela mostraram-se mais sensíveis às estimativas de custos do programa de vacinação, em especial o preço da vacina, apontando a relevância do custo da tecnologia sob análise para incorporação em comparação aos demais custosThis thesis represents a deeper study of the cost estimates, an integrant and determinative component of economic evaluations, as part of the project Costeffectiveness studies of the incorporation of new vaccines into the routine of the National Immunisation Program: Rotavirus, Varicella, Pneumococcal conjugate, Meningococcal C conjugate and Hepatitis A. The project has been developed on the request of the National Immunisation Program/PNI of the Secretary of Sanitary Surveillance/SVS of the Ministry of Health since 2005. The objective of the thesis was to analyse the conditions of use, difficulties and repercussions of different cost estimates methods in the cost-effectiveness studies of two specific technologies, vaccines against rotavirus and varicella, as well as the relationship between the cost estimates and the results. The cost estimates are conditioned by general characteristics of the disease under analysis (acute in the case of rotavirus and with long-term disability in the case of varicella), general methodological issues (theoretical choice, methods and sources of data) and specificities to the Brazilian case. This thesis brings a more detailed estimation of direct medical costs, with the inclusion of specific costs of the private health care system for the two diseases, inclusion of public participation for dispensing drugs in the case of rotavirus and inclusion of drugs costs in the public health care system in the case of varicella. As a result, there was an estimated disease total cost increase of 16% for rotavirus and 11% for varicella, as well as increase of savings (disease total cost avoided) of 18% and 16%, respectively, with the introduction of each vaccine. Although the more detailed cost estimates have reduced the incremental cost-effectiveness ratio by 20% for rotavirus and 4% for varicella, the cost-effectiveness level of the two vaccination programs was not altered. The results of the economic evaluations of vaccination against rotavirus and varicella were more sensitive to the vaccination program cost estimates, especially the vaccine price, pointing out the relevance of the cost of the technology under analysis for incorporation comparatively to the other cost

Politica de medicamentos genericos : um estudo do caso brasileiro

Orientador: Geraldo Di GiovanniDissertação (mestrado) - Universidade Estadual de Campinas, Instituto de EconomiaMestrad

Becoming a teacher of French in Brazil: the experience of les crabes projet for the implementation of public linguistics policies

Reflect on the teaching-learning of foreign languages in Brazil implies discuss linguistic policies. Such reflection invites us to seek an original articulation between public authorities, high education and classroom. From the perspective of language as social practice of interaction, the purpose of this work is to discuss alternative projects to the implementation of plural and inclusive curricula.</span

The potential of agroforestry systems to reconcile human well-being and environmental conservation in the Amazon

The article presents the potential of so-called Agroforestry, Agroforestry Systems (SAFs) or simply Consortia, for the sustainable development of the Amazon. SAFs play an important role in the transition to more sustainable forms of agricultural production because they conserve the natural environment, minimize climate change, reduce impacts on biodiversity and benefit Indigenous Peoples and Local Communities. Agroforests, if well planned and managed, score highly in all these aspects: they increase biodiversity, carbon stocks and have great potential for restoring degraded agricultural areas.O artigo apresenta o potencial das chamadas Agroflorestas, Sistemas Agroflorestais (SAFs) ou simplesmente Consórcios, para o desenvolvimento sustentável da Amazônia. Os SAFs têm um papel importante na transição para formas mais sustentáveis de produção agropecuária porque conservam o meio natural, minimizam as mudanças climáticas, reduzem impactos sobre a biodiversidade e beneficiam os Povos Indígenas e Comunidades Locais. As agroflorestas, se bem planejadas e manejadas, pontuam em todos estes aspectos: aumentam biodiversidade, estoques de carbono e têm grande potencial para restaurar áreas agrícolas degradadas

Rotavirus morbidity and mortality in children in Brazil Morbilidad y mortalidad por rotavirus en niños en Brasil

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 Imunizações, 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 Informação sobre Mortalidade, SIM) of Brazil's public healthcare system (Sistema Único de Saúde, 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.<br>OBJETIVOS: Analizar la epidemiología del rotavirus y estimar la morbilidad y la mortalidad asociadas con las infecciones por rotavirus en niños < 5 años de edad en Brasil en 2004, antes de incluir la vacuna contra el rotavirus en el Programa Nacional de Inmunizaciones (PNI). MÉTODOS: Para estimar la morbilidad por rotavirus se revisaron los estudios publicados (1999-2006) que abordaban la incidencia de diarrea aguda en niños < 5 años de edad y la frecuencia de las infecciones por rotavirus en niños con diarrea en Brasil. Los casos de diarrea se dividieron en tres categorías de gravedad según el nivel de atención que requirieron: casos leves que solo requirieron atención domiciliaria, casos moderados que requirieron la visita a un servicio ambulatorio de salud y casos graves que requirieron hospitalización. Para estimar la mortalidad por rotavirus se utilizó el número de muertes registradas por diarrea en niños de < 5 años, según el Sistema de Información sobre Mortalidad (SIM) del Sistema Único de Salud (SUS) de Brasil, y se calculó la proporción de muertes causadas por este virus. RESULTADOS: Se estimó que las infecciones por rotavirus causan anualmente 3 525 053 casos de diarrea, 655 853 visitas a servicios ambulatorios de salud, 92 453 hospitalizaciones y 850 muertes en niños < 5 años de edad en Brasil. CONCLUSIONES: Las infecciones por rotavirus constituyen una importante causa de morbilidad y mortalidad en Brasil