Network meta-analysis of pembrolizumab as monotherapy and in combination with chemotherapy for first-line treatment of recurrent or metastatic head and neck squamous cell carcinoma / Metanálise em rede comparativa de pembrolizumabe como monoterapia e em combinação com quimioterapia para tratamento de primeira linha de carcinoma de células escamosas da cabeça e pescoço recorrente ou metastático

Pembrolizumab monotherapy or in combination with chemotherapy is approved as first-line treatment in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) based on improved overall survival (OS) versus EXTREME regimen in the KEYNOTE-048 trial. The clinical outcomes of pembrolizumab were compared with other recommended first-line treatments in R/M HNSCC in this study through a Bayesian network meta-analysis. A systematic literature review was conducted in July 2022, from which six trials that matched the KEYNOTE-048 patient eligibility criteria were included in the network. The OS and progression-free survival (PFS) outcomes were compared in the approved pembrolizumab indication (i.e., total population for pembrolizumab in combination with chemotherapy and combined positive score [CPS] ≥ 1 population for pembrolizumab monotherapy). A significant OS improvement was observed for pembrolizumab in combination with chemotherapy and pembrolizumab monotherapy versus EXTREME regimen (hazard ratio, 95% credible interval: 0.72, 0.60-0.86; 0.73, 0.60-0.88), platinum+5- FU (0.58, 0.43-0.76; 0.58, 0.44-0.78), and platinum+paclitaxel (0.53, 0.35-0.79; 0.53, 0.35-0.81), respectively. A non-significant numeric trend in OS improvement was observed versus the TPEx regimen. PFS was comparable with most first-line treatments and was improved versus platinum+5-FU (0.48, 0.36-0.64; 0.59, 0.45-0.79). Additional analyses in higher CPS subgroups also showed consistent results. Overall, our study results showed an improvement in OS outcomes versus alternative first-line treatments, consistent with the findings of the KEYNOTE-048 trial. These data support using pembrolizumab as a suitable firstline treatment option in R/M HNSCC.

Pembrolizumabe em monoterapia ou em combinação com quimioterapia é aprovado como tratamento de primeira linha em carcinoma de células escamosas recorrente/metastático de cabeça e pescoço (CECCP R/M) com base na melhora da sobrevida global (OS), em comparação com o esquema EXTREME no estudo KEYNOTE-048. Esse estudo comparou os resultados clínicos de pembrolizumabe com outros tratamentos recomendados de primeira linha em CECCP R/M por meio de uma metanálise de rede bayesiana. Uma revisão sistemática da literatura foi conduzida em julho de 2022, a partir da qual seis ensaios clínicos que atendiam aos critérios de elegibilidade de pacientes do KEYNOTE-048 foram incluídos na rede. Os desfechos de OS e sobrevida livre de progressão (PFS) foram comparados na indicação de pembrolizumabe (população total para pembrolizumabe em combinação com quimioterapia e população com escore positivo combinado [CPS] ≥ 1 em monoterapia com pembrolizumabe). Foi observada melhora significativa na OS para pembrolizumabe em combinação com quimioterapia e monoterapia com pembrolizumabe versus o esquema EXTREME (razão de risco, intervalo de confiança de 95%: 0,72, 0,60-0,86; 0,73, 0,60-0,88), platina+5-FU (0,58, 0,43-0,76; 0,58, 0,44-0,78) e platina+paclitaxel (0,53, 0,35-0,79; 0,53, 0,35-0,81), respectivamente. Uma tendência numérica não significativa de melhoria na OS foi observada em relação ao esquema TPEx. A PFS foi comparável com a maioria dos tratamentos de primeira linha e melhor em relação à platina+5-FU (0,48, 0,36-0,64; 0,59, 0,45-0,79). Análises adicionais em subgrupos com CPS mais elevado também mostraram resultados consistentes. No geral, os resultados de nosso estudo mostraram melhora nos desfechos de OS em comparação aos tratamentos de primeira linha alternativos, consistentes com os achados do estudo KEYNOTE-048. Esses dados apoiam o uso de pembrolizumabe como opção de tratamento em primeira linha em pacientes com CECCP R/M.

Mental health services in Gauteng, South Africa: A proxy evaluation using pharmaceutical data

Background: South African legislation advocates for equitable access to mental healthcare services integrated into general healthcare settings. Mental, neurological, and substance use (MNS) disorders are often comorbid. Pharmacoepidemiology provides indirect evidence of service provision for conditions amenable to medicine treatment. Aim: The study aims to evaluate medicine procurement for MNS disorders at different service levels in the health system. Setting: The Public health sector, Gauteng province formed the setting for the study. Method: A secondary analysis of the Gauteng pharmaceutical database was conducted using Anatomic Therapeutic Chemical (ATC) and defined daily dose (DDD) methodology. Anatomic Therapeutic Chemical classes of medicines for MNS disorders were included. Defined daily doses and costs were calculated per 1000 population served by each facility and service level. Statistical comparisons were made using chi-square testing. Results: General healthcare settings accounted for 90% (R118 638 248) and specialised hospitals for 10% (R13 685 032) of expenditure on medicines for MNS disorders, procuring 94% (n = 49 442 474) and 6% (n = 3 311 528) of DDDs, respectively. Although district clinics procured 60% of DDDs, they procured the least per 1000 population served, whereas district hospitals procured the most. For almost all ATC classes, procurement differed significantly between municipalities at every service level and between specialised hospitals. Conclusion: In Gauteng province, most medicines for MNS disorders are procured by general healthcare services, but access to care may not be equitable. While population coverage at district clinics appears low, district hospitals may experience the greatest care burden. Research regarding quality of care at each service level is recommended. Contribution: This study provides insight into service provision for MNS disorders.

Primary healthcare training in the Democratic Republic of the Congo

Family medicine is a relatively new discipline in the Democratic of the Congo. It was developed under South­South and Churches Collaboration with the aim of responding in a cost-efficient manner to the crisis of health practitioners in mostly Christian and protestant hospitals based in rural areas in the Democratic Republic of the Congo.

The cost of primary care: An experience analysis in an urban setting

Objectives@#PhilHealth’s present health benefit scheme is largely centered on in-patient services. This inadvertently incentivizes hospital admissions for increased access to benefit coverage. To address this problem, this study proposes a costing method to comprehensively finance outpatient care. The objective of this paper is to estimate an annual primary care benefit package (PCBP) cost based on experience analysis (actual benefit usage) on the first year of implementation at an urban pilot site. @*Methods@#A cost analysis was conducted to assess a disease-agnostic primary care benefit package for an urban outpatient government facility over the first year of implementation. Costing information was gathered through staff interviews, accounting documents, and usage data from the electronic health records system available on-site. @*Results@#The annual primary care cost was defined as the estimated financial coverage for eligible employees and their eligible dependents (n=15,051). The annual utilization rate for consultations was reported at 51%. Of patients who consulted, approximately 38% accessed free available diagnostic procedures and 48% availed of free available medicines. Based on these usage rates, the annual primary care cost for the first year was computed at PhP 403.22 per capita. @*Conclusion@#Our study shows that on the first year of coverage in a government run urban outpatient facility, an allocation of PhP 403.22 per capita can allow coverage for a disease-agnostic package (comprehensive); this amount excludes out-of-pocket expenses incurred by the target population of this study. This amount is feasible only when coopted with opportunistic registration, reduction of untargeted check-ups, prior contextual community engagement, and streamlining of patient-transactions through an electronic health record (EHR).

Engagement and resource considerations in developing and implementing mobile health technologies for COVID-19 Pandemic: Filipino developers’ perspectives

Objective@#This paper aims to provide a better understanding of the different engagement, cost, and resource considerations in developing and implementing mHealth solutions in the Philippines during the COVID-19 pandemic. @*Methods@#First, six participants completed a form to document the estimated costs of developing a pseudo mobile application with features to mitigate the pandemic. Second, ten key informant interviews determined the facilitators, barriers, and resource requirements in developing mHealth tools. @*Results@#The average cost estimate to develop and roll out a mobile application with public health and epidemiology features is Php 4,018,907 (US $78,650). The analysis of the interviews resulted in 12 themes organized in three domains: 1) facilitators and barriers in developing and sustaining mHealth solutions; 2) costs of sustaining mHealth technologies; and 3) factors affecting the costs of development and maintenance of mHealth technologies. @*Conclusion@#While differences in the cost estimates are evident, it provides a ballpark figure and the different factors that implementers need to sustain and maintain an mHealth solution. This paper hopes to inform policies and practices in engaging technology solution partners and in scaling up mHealth technologies.

Physiological responses of tambaqui (Colossoma macropomum) fed diets supplemented with silage from fish and vegetables residues / Respostas fisiológicas de tambaqui (Colossoma macropomum) alimentado com dietas suplementadas com silagem de resíduos de pescado e vegetais

The demand for products to replace high-cost raw materials, such oil and fish meal, in the manufacture of feed for use in aquaculture, while also guaranteeing the nutritional quality of the diets, is increasing. Silage produced with fish and vegetables residues is a low-cost and efficient protein source. The objective of the present study was to evaluate the physiological and biochemical responses of tambaqui fingerlings fed four different levels of silage included in commercial feed with 28% crude protein, over two periods: 45 and 90 days. Each treatment was carried out over three replications, with 10 tambaqui in each 100 L experimental tank. At the end of each established period, blood samples were collected from five animals from each repetition to determine the hematological and biochemical variables. Body weight and total length, hepatosomatic and liposomal indices and hematocrit of specimens fed with diets supplemented with silage did not exhibit significant changes in both assessment period. After 45 days of feeding, the hemoglobin concentration increased when tambaqui were fed a diet including 20% silage. The red blood cell count, mean corpuscular volume and mean corpuscular hemoglobin did not change between treatments in either period. The total protein concentrations increased significantly in the plasma of tambaqui fed with diets with the inclusion of 5 and 10% of silage, evaluated after feeding for 45 days. It was found that the groups which had silage included in their diet did not exhibit significant alterations in the evaluated parameters, and the diet was therefore not consider harmful to the health of tambaqui. Therefore, the use of silage as a feed supplement during tambaqui farming is a sustainable alternative for producers, as it leads to a reduction of impacts of fish and vegetables waste disposal.

A procura por insumos que substituam produtos de alto custo, como óleo e farinha de peixe, na fabricação de rações para uso na aquicultura é crescente, sendo necessário garantir a qualidade nutricional das dietas. A silagem produzida a partir de resíduos de pescado e de vegetais apresenta-se como uma alternativa de baixo custo e eficiente fonte proteica. O objetivo do presente estudo foi avaliar as respostas fisiológicas e bioquímicas de alevinos de tambaqui alimentados com quatro níveis de inclusão de silagem em ração comercial com 28% de proteína bruta, em dois períodos: 45 e 90 dias. Cada tratamento foi realizado em três repetições, com 10 tambaquis em cada caixa experimental de 100 L. Ao término de cada período estabelecido, amostras sanguíneas foram coletadas de cinco animais de cada repetição para determinação das variáveis hematológicas e bioquímicas. Peso, comprimento total e índices hepatossomático e lipossomático de espécimes alimentados com silagem não mostraram alterações significativas em ambos os períodos de avaliação, bem como os valores de hematócrito. A concentração de hemoglobina de tambaqui após 45 dias de alimentação aumentou quando foi fornecida dieta com inclusão de 20% de silagem. A contagem de eritrócitos, volume corpuscular médio e hemoglobina corpuscular média não apresentaram alterações entre os tratamentos, em ambos os períodos. As proteínas totais aumentaram significativamente no plasma de tambaquis que receberam dietas com inclusão de 5 e 10% de silagem, avaliados após 45 dias de alimentação. Evidenciou-se que os grupos com inclusão de silagem na dieta não apresentaram alterações significativas nos parâmetros avaliados, assim não sendo prejudiciais à higidez do tambaqui. Portanto, o uso da silagem como suplemento alimentar durante o cultivo do tambaqui é uma alternativa sustentável para produtores, por promover a redução do descarte de resíduos de pescado e da agricultura.

Hospitalization and mortality rates of malignant prostatic neoplasms in Brazil: A cross-sectional study from 2008 to 2018

Abstract Prostate cancer (PCa) is a highly prevalent condition among men worldwide, resulting in reduced quality of life and increased costs to health systems due to hospitalization and death. This study aimed to explore and understand the evolution of PCa in Brazil from 2008 to 2018. Data were obtained from the National Health System Department of Informatics (DATASUS) using code C61 for malignant prostatic neoplasms. We presented the hospitalization and mortality rates in a temporal-, regional- and age-dependent manner. From 2008 to 2018, a year-dependent increase in hospital admissions due to PCa was reported in Brazil, in which the Southeast region showed the highest prevalence. Men aged ≥80 and those 70-79 years old had similar hospitalization rates, followed by men aged 60-69, 50-59, 40-49 and 30-39 years old. Similarly, an increase in deaths due to PCa was reported during this period, with the highest rates seen in the Southeast. Men aged ≥80 years had higher mortality rates, followed by those aged 70-79, 60-69, 50-59, 40-49 and 30-39 years old. The results obtained indicate an age- and region-dependent increase in PCa morbidity and mortality in Brazil overtime and may contribute to the ongoing discussion on the role and future perspective of the health care system in Brazil

Canasta alimentaria normativa: perspectivas actuales e implicaciones para la salud pública en Venezuela / Normative Food Basket current perspectives and implications for public health in Venezuela

La Canasta Alimentaria Normativa (CAN) es un instrumento estratégico de planificación y seguimiento, que impacta el ámbito económico (fijación del salario mínimo SM y del umbral de la pobreza relativa), la seguridad alimentaria y la salud pública. El objetivo fue describir la evolución histórica de la CAN en Venezuela, contrastando su valoración económica respecto al SM durante el período 1990 ­ 2023. Tipo de estudio: Descriptivo. Se empleó la CAN del Instituto Nacional de Estadísticas/Instituto Nacional de Nutrición (INE/INN) y su comparación con la canasta del Centro de Documentación y Análisis Social de la Federación Venezolana de Maestros(CENDAS ­ FVM). Los valores mensuales de la CAN y del SM se recalcularon a dólares USA, de acuerdo a la tasa de cambio oficial. No se incluyó evaluación de la estructura interna, ni sus expresiones en términos de aporte de energía y nutrientes. Resultados: Desde 1990 hasta el año 2015, se requirieron entre1,0 y 1,8 SM y entre 0,6 y 1,7 Ingresos Mínimos Legales (IML)para acceder a la CAN. Para el año 2023 se requirieron hasta 78,3SM y 51,6 IML. El valor promedio de la canasta del CENDAS-FVM fue superior al valor de la CAN INE/INN, en una proporción de 1,7: 1. Conclusiones: la CAN resultó sensible en identificar los cambios y tendencias de su estimación económica, en el ambiente inflacionario venezolano. El uso de sus resultados está sujeta a cierto grado de discrecionalidad política. El costo de la CAN, expresa una contracción del poder de compra de los hogares venezolanos con potenciales impactos sobre la nutrición y la salud física y mental a corto y largo plazo.

The Normative Food Basket (NFB) represents astrategic planning and monitoring instrument, which impactsthe economic sphere (setting of the minimum wage (MW) andthe relative poverty threshold), food security and public health.The objective was to describe the historical evolution of the NFB in Venezuela, contrasting its economic valuation with respect to the MW during the period 1990 ­ 2023. Type of study: Descriptive. The NFB of the National Institute of Statistics/National Institute of Nutrition (NIS/NIN) was used and itscomparison with the basket of the Center for Documentationand Social Analysis of the Venezuelan Federation of Teachers (CENDAS ­ FVM). The monthly values of the NFB and theMW were recalculated into dollars (US$), according to theofficial exchange rate. No evaluation of the internal structurewas included, nor its expressions in terms of energy and nutrientcontribution. Results: From 1990 to 2015, between 1.0 and1.8 MW and between 0.6 and 1.7 Minimum Legal Income(MLI) were required to access the NFB. By 2023, up to 78.3MW and 51.6 MLI were required. The average value of the CENDAS-FVM basket was higher than the value of the NFBNIS/NIN, in a proportion of 1.7: 1. Conclusions: As a statistical operation, the NFB was sensitive in identifying changes andtrends in its estimate economic, in the Venezuelan inflationaryenvironment. The use of its results is subject to a certain degree ofpolitical discretion. The cost of CAN expresses a contraction inthe purchasing power of Venezuelan households with potentialimpacts on nutrition and physical/mental health in the shortand long term.

Gestão de custos: microcusteio por absorção em um pronto-socorro durante a pandemia de COVID-19 / Cost management: microcosting by absorption in an emergency room during the COVID-19 pandemic / Gestión de costos: microcosteo por absorción en un servicio de urgencias durante la pandemia de COVID-19

Objetivo: analisar os custos operacionais de um pronto-socorro relacionados ao atendimento de pacientes COVID-19 em 2020 e 2021. Método: estudo transversal, descritivo de abordagem quantitativa. A mensuração dos custos utilizou-se da perspectiva do gestor hospitalar, por meio de microcusteio por absorção. Custos diretos, indiretos e variáveis, foram avaliados de cima para baixo (top-down). Resultados: o perfil predominante foi de homens, com idades entre 61 e 70 anos, casados, brancos e moradores de Londrina (Paraná, Brasil). O tempo médio de internação para pacientes graves foi 12,20 dias e, para os demais, 8,38 dias. O desfecho principal foi a alta hospitalar. Os custos operacionais em 2020 foram de R$28.461.152,87, já em 2021 os valores encontrados foram R$43.749.324,61. O custo médio do paciente-dia foi de R$2.614,45 em 2020 para R$3.351,93 em 2021. Conclusão: verificou-se aumento dos custos no período estudado. Conhecer os custos operacionais do pronto-socorro, possibilita o planejamento financeiro institucional contribuindo para qualificar a tomada de decisões gerenciais(AU)

Objective: to analyze the operating costs of an emergency room related to the care of COVID-19 patients in 2020 and 2021. Method: cross-sectional, descriptive study with a quantitative approach. The measurement of costs was used from the perspective of the hospital manager, through absorption micro-costing. Direct, indirect and variable costs were evaluated from top to bottom (top-down). Results: the predominant profile was men, aged between 61 and 70 years, married, white and living in Londrina (Paraná, Brazil). The mean length of stay for critically ill patients was 12.20 days and for the others, 8.38 days. The main outcome was hospital discharge. Operating costs in 2020 were BRL 28,461,152.87, while in 2021 the values found were BRL 43,749,324.61. The average patient-day cost went from R$2,614.45 in 2020 to R$3,351.93 in 2021. Conclusion: costs increased in the study period. Be aware of the operational costs of emergency room, enablement or institutional financial planning, contributing to qualify management decision-making(AU)

Objetivo: analizar los costos operativos de un servicio de urgencias relacionado con la atención de pacientes con COVID-19 en los años 2020 y 2021. Método: estudio descriptivo transversal con enfoque cuantitativo. Se utilizó la medición de costos desde la perspectiva del gestor del hospital, a través del microcosteo por absorción. Los costos directos, indirectos y variables se evaluaron de arriba hacia abajo (top-down). Resultados: el perfil predominante fue el de hombres, con edad entre 61 y 70 años, casados, blancos y residentes en Londrina (Paraná, Brasil). La estancia media de internación de los pacientes críticos fue de 12,20 días y, de los demás, de 8,38 días. El resultado principal fue el alta hospitalaria. Los costos operacionales en 2020 fueron de R$ 28.461.152,87, mientras que en 2021 los valores encontrados fueron de R$ 43.749.324,61. Los costos medios del paciente/día aumentaron de R$2.614,45 en 2020 a R$3.351,93 en 2021. Conclusión: se observó un aumento de los costos en el periodo estudiado. Conocer los costos operativos de un servicio de urgencias posibilita la planificación financiera institucional, contribuyendo a calificar la toma de decisiones gerenciales(AU)

Resource utilization and costs related to the management of obstructive hypertrophic cardiomyopathy under the Brazilian supplementary healthcare system´s perspective: results from a modified Delphi panel / Utilização de recursos e custos relacionados ao manejo da cardiomiopatia hipertrófica obstrutiva sob a perspectiva do sistema de saúde suplementar brasileiro: resultados de um painel Delphi modificado

Objective: To generate data on the costs associated with the diagnosis and treatment of obstructive ypertrophic cardiomyopathy (HCM) from the perspective of the private health system in Brazil. Methods: A modified Delphi panel including seven different specialists (three clinical cardiologists with experience in obstructive HCM, two hemodynamicists with experience in septal ablation and two cardiac surgeons with expertise in myectomy), from two Brazilian states (São Paulo and Pernambuco), was conducted between August and November 2022. Two rounds of questions about the use of healthcare resources according to the functional class (NYHA I-IV) and a panel in a virtual platform were conducted to obtain the final consensus. Micro-costing defined costs and unit values were determined based on official price lists. Results: The total diagnosis cost per patient was estimated at BRL 11,486.81. The obstructive HCM management costs analysis showed average annual costs per patient of BRL 17,026.74, BRL 19,401.46, BRL 73,310.07, and BRL 94,885.75 for the functional classes NYHA I, NYHA II, NYHA III, and NYHA IV, respectively. The average costs per patient related to procedures in a year were BRL 12,698.53, BRL 13,462.30, BRL 58,841.67, and BRL 75,595.90 for the functional classes NYHA I, II, III, and IV, respectively. Conclusions: The annual costs of HCM management increased according to the functional class, highlighting the need for safe and effective strategies to improve patient's NYHA functional class while promoting a decrease in the need for invasive therapies.

Objetivo: Gerar dados acerca dos custos associados ao diagnóstico e tratamento da cardiomiopatia hipertrófica (CMH) obstrutiva, sob a perspectiva do sistema de saúde privado no Brasil. Métodos: Um painel Delphi modificado incluindo sete especialistas (três cardiologistas clínicos com experiência em CMH obstrutiva, dois hemodinamicistas com experiência em ablação de septo e dois cirurgiões cardíacos com experiência em miectomia) de dois estados brasileiros (São Paulo e Pernambuco) foi conduzido entre agosto e novembro de 2022. Foram realizadas duas rodadas de perguntas acerca da utilização de recursos de acordo com a classe funcional (NYHA I-IV) e uma reunião virtual para obtenção do consenso final. Os custos foram definidos por meio de microcusteio, e os valores unitários foram definidos com base em listas de preço oficiais. Resultados: O custo total do diagnóstico por paciente foi estimado em R$ 11.486,81. A análise de custos de manejo da CMH obstrutiva mostrou custos médios anuais por paciente de R$ 17.026,74, R$ 19.401,46, R$ 73.310,07 e R$ 94.885,75 para as classes funcionais NYHA I, NYHA II, NYHA III e NYHA IV, respectivamente. Os custos médios por paciente relacionados a procedimentos em um ano foram de R$ 12.698,53, R$ 13.462,30, R$ 58.841,67 e R$ 75.595,90 para as classes NYHA I, II, III e IV, respectivamente. Conclusões: Os custos anuais com o manejo da CMH aumentam de acordo com a classe funcional, destacando a necessidade de estratégias seguras e eficazes capazes de melhorar a classe funcional NYHA do paciente, ao mesmo tempo que promove diminuição da necessidade de terapias invasivas.

Análise de custo de sequência de tratamento de câncer de ovário avançado, HRD/ BRCAwt, sob a perspectiva do sistema de saúde suplementar brasileiro / Cost Analysis of advanced ovarian cancer treatment sequence, HRD/BRCAwt from the Brazilian supplementary healthcare system perspective

Objetivo: Estimar o custo da sequência de tratamento considerando as terapias com niraparibe e bevacizumabe, respectivamente, como terapias de manutenção de 1L e 2L para pacientes com câncer de ovário (CO) epitelial com deficiência de recombinação homóloga (HRD) e BRCA selvagem (BRCAwt) em um horizonte temporal de cinco anos, sob a perspectiva do sistema de saúde suplementar brasileiro. Métodos: Foi desenvolvido um modelo de sobrevida particionado com três transições de estados de saúde, considerando os seguintes regimes em 1L e 2L, respectivamente: carboplatina + paclitaxel seguido de terapia de manutenção com niraparibe; carboplatina + gencitabina + bevacizumabe seguido pela continuação de bevacizumabe. As posologias em bula e as curvas de sobrevida livre de progressão dos respectivos estudos pivotais em cada uma das linhas terapêuticas foram utilizadas na análise, e o custo de tratamento foi calculado a partir da lista oficial de preços de medicamentos da CMED de abril de 2023. Resultados: O custo em 1L e 2L foi de BRL 868.830 e BRL 403.407, totalizando BRL 1.272.237 em um horizonte temporal de cinco anos, com 2,28 e 0,52 anos de vida livre de progressão, respectivamente, na 1L e 2L, com o total de 2,8 anos. Conclusões: O resultado da análise de custo de sequência de tratamento de câncer de ovário HRD/BRCAwt apresentou um custo total estimado de BRL 1.272.237, com 2,8 anos de vida livre de progressão. Essa análise contribui no entendimento dos custos e da eficácia esperada com o uso da terapia de manutenção de niraparibe em 1L e bevacizumabe em 2L em um horizonte temporal de cinco anos.

Objective: To estimate the cost of the treatment sequence, considering the maintenance therapies niraparib and bevacizumab, respectively, as maintenance therapies in 1L and 2L for patients with epithelial ovarian cancer with homologous recombination deficiency (HRD) and BRCA wild-type (BRCAwt) over a 5-year time horizon from the perspective of the Brazilian supplementary health system. Methods: A partitioned survival model was developed with three health state transitions, considering the following regimens in the 1L and 2L, respectively: carboplatin + paclitaxel followed by maintenance therapy with niraparib; carboplatin + gemcitabine + bevacizumab followed by the continuation of bevacizumab. The product's label and progression-free survival curves from the respective pivotal studies in each of the therapeutic lines were used in the analysis and the cost of treatment was calculated using as a reference the official CMED drug price list from April 2023. Results: The cost in 1L and 2L was BRL 868,830 and BRL 403,407, totaling BRL 1,272,237 over a 5-year period, with 2.28 and 0.52 years of progression-free survival, respectively in 1L and 2L, with a total of 2.8 years. Conclusions: The result of the analysis of the cost of the treatment sequence of ovarian cancer HRD/BRCAwt presented an estimated total cost of 1,272,237 with 2.8 year of progression-free survival. This analysis contributes to understand the expected cost and effectiveness with the use of maintenance therapy niraparib in 1L and bevacizumab in 2L over a 5-year time horizon.

Feridas complexas: abordagem por equipa multidisciplinar. Uma scoping review. / Complex wounds: approach by a multidisciplinary team. A scoping review

Objetivos: - reconhecer a importância da equipa multidisciplinar na abordagem à pessoa com ferida complexa na cicatrização de feridas; - mapear a evidência/conhecimento sobre a temática em estudo. Método: Scoping review realizada entre 04 de janeiro e 01 de fevereiro de 2020, nas bases de dados Repositório Científico de Acesso Aberto de Portugal (RCAAP), EBSCO host (CINAHL e Medline) e Web of Science, utilizando estratégias de pesquisa adaptadas a cada base de dados. Resultados e discussão: A evidência científica demonstra a importância das equipas multidisciplinares na abordagem à pessoa com ferida complexa. Conclusão: Tratando-se de um processo complexo, é fundamental ter em consideração todos os elementos que influenciam e atrasam a cicatrização, para se conseguir melhorar os resultados no tratamento e nos custos associados.(AU)

Objectives: - to recognize the importance of the multidisciplinary team in the approach to the person with a complex wound in wound healing; - to map the evidence/knowledge on the subject under study. Method: Scoping review carried out between January 4 and February 1, 2020, in the databases Repositório Científico de Acesso Aberto de Portugal (RCAAP), EBSCO host (CINAHL and Medline) and Web of Science, using search strategies adapted to each database. Results and discussion: The scientific evidence demonstrates the importance of multidisciplinary teams in dealing with people with complex wounds. Conclusion: As this is a complex process, it is essential to take into account all the elements that influence and delay healing, in order to improve treatment results and associated costs. (AU)

Objetivos: - reconocer la importancia del equipo multidisciplinar en el abordaje de la persona con herida compleja en la cicatrización de heridas; - mapear la evidencia/conocimiento sobre el tema objeto de estudio. Método: Revisión de alcance realizada entre el 04 de enero y el 01 de febrero de 2020, en las bases de datos Repositório Científico de Acesso Aberto de Portugal (RCAAP), EBSCO host (CINAHL y Medline) y Web of Science, utilizando estrategias de búsqueda adaptadas a cada base de datos. Resultados y discusión: La evidencia científica demuestra la importancia de los equipos multidisciplinares en el abordaje de las personas con heridas complejas. Conclusión: Al tratarse de un proceso complejo, es fundamental tener en cuenta todos los elementos que influyen y retrasan la cicatrización para mejorar los resultados del tratamiento y los costes asociados.(AU)

The impact of COPD on the private healthcare system in Brazil: an economic analysis / Impacto da DPOC no sistema de saúde privado no Brasil: uma análise econômica

Objective: To assess healthcare resource utilization and hospitalization costs of patients with chronic obstructive pulmonary disease (COPD) exacerbations in the Brazilian private healthcare system. Methods: A retrospective cohort study, considering data from an administrative database of a private company (Orizon). Patients aged ≥40 years old and with at least one COPD-related claim identified by the ICD-10 code (J40 to J44) at any time during the eligibility period (January/2010 to December/2013) were included in the analysis. Follow-up was performed until December/2014, death or inactivation of a health plan. Sociodemographic characteristics, number of emergency visits, hospital admissions (number and length of stay), length of hospital stay in an intensive care unit (ICU), number of severe COPD exacerbations, therapeutic approach, and hospitalization costs were assessed. Results: The analysis included 8,254 COPD patients. Emergency visits, hospital admission, and exacerbation rates were 0.4, 0.2, and 0.1 per person-year, respectively. The mean length of hospital stays and the length of stay of patients requiring or not ICU stay were 16.6 (SD = 77.0), 8.7 (SD = 36.9), and 27.6 (SD = 109.7), respectively. Mean costs associated to emergency department visits and hospitalizations were 258.2 BRL (SD = 383.1) and 38,165.4 BRL (SD = 124,683.5), respectively. Hospitalizations costs without ICU stay were 11,810.1 BRL (SD = 31,144.1) and 74,585.3 BRL (SD = 182,808.1) for those with ICU utilization. Conclusion: Costs for COPD management during disease exacerbation are very high and may reach almost 75 thousand BRL per hospitalization. The prevention of COPD exacerbations and better disease control may reduce the economic burden on the private healthcare system in Brazil.

Objetivo: Avaliar a utilização de recursos e custos de pacientes com exacerbação da doença pulmonar obstrutiva crônica (DPOC) no sistema de saúde suplementar (SSS) do Brasil. Métodos: Estudo de coorte retrospectiva, considerando banco de dados administrativo de uma empresa privada (Orizon). Pacientes com ≥40 anos e pelo menos um registro de admissão relacionado à DPOC identificado com CID-10 J40-J44, entre janeiro/2010 e dezembro/2013, foram incluídos e acompanhados até dezembro/2014, morte ou inativação no plano. Características sociodemográficas, número de visitas de emergência, admissões hospitalares (número e tempo de hospitalização), tempo de hospitalização em unidade de terapia intensiva (UTI), número de exacerbações graves, estratégias terapêuticas e custos hospitalares foram as variáveis analisadas. Resultados: A análise incluiu 8.254 pacientes com DPOC. As taxas de visita à emergência, internação hospitalar e exacerbação da doença foram de 0,4, 0,2 e 0,1 por pessoa-ano, respectivamente. Os tempos médios de hospitalização, hospitalização sem utilização de UTI e hospitalização com necessidade de UTI foram de 16,6 (DP = 77,0), 8,7 (DP = 36,9) e 27,6 (DP = 109,7) dias, respectivamente. Os custos médios relacionados à visita de emergência e por hospitalização foram de 258,2 BRL (DP = 383,1) e 38.165,4 BRL (DP = 124.683,5), respectivamente. Os custos para pacientes que não utilizaram UTI foram de 11.810,1 BRL (DP = 31.144,1) e de 74.585,3 BRL (DP = 182.808,1) para aqueles com necessidade desse serviço. Conclusão: Os custos para o manejo dos pacientes com exacerbação da DPOC são muito elevados, podendo chegar a 75.000 BRL por hospitalização. A prevenção de exacerbações e o melhor controle da doença podem reduzir esse impacto econômico no SSS.

Flebite associada ao cateter venoso periférico em cardiologia: incidência, fatores de risco e custos associados / Phlebitis associated with peripheral venous catheter in cardiology: incidence, risk factors and associated costs

Objetivo: Determinar a incidência de flebite, fatores de risco associados e custos diretos de tratamento. Métodos: Estudo descritivo, correlacional, com análise de custo direto. Utilizaram-se dados da documentação dos enfermeiros entre janeiro 2019 e agosto 2021. Resultados: Incluíram-se 2.374 pessoas com cateter venoso periférico, com internamento na cardiologia. A incidência de flebite foi de 12,38%, das quais 78,23% eram de grau 1 de severidade. Verificou-se associação estatística entre o desenvolvimento de flebite e a administração de amiodarona endovenosa, dias de hospitalização e serviço de internamento. Estimaram-se 1662€ de custos adicionais ao tratamento da flebite, em material clínico e horas de cuidados de enfermagem. Conclusão: Os cuidados de enfermagem são eficazes na identificação precoce e tratamento da flebite, promovendo redução de custos adicionais e garantindo melhores cuidados e ganhos em saúde.

Objective: This study aimed to identify the incidence rate of phlebitis, associated risk factors and treatment direct costs. Methods: Descriptive, correlational study with direct cost analisys. Data from the nurses' clinical records between January 2019 and August 2021 were used. Results: Included 2,374 files of people with peripheral venous catheter who were admitted to Cardiology. The phlebitis incidence rate was 12.38% and regarding severity 78.23% were grade 1. The phlebitits was significantly related with intravenous amiodarone administration, length of stay and physical department. This represents €1662 of additional treatment costs, in clinical supplies and nursing time. Conclusion: Nursing care is effective in the early identification and treatment of phlebitis, reducing costs and improve clinical and economic outcomes.

The impact of depression in the Brazilian private healthcare system: patient journey and economic burden study associating claim database and expert's opinion approach / O impacto da depressão no sistema de saúde privado brasileiro: estudo da jornada do paciente e da carga econômica associando banco de dados de sinistros e abordagem de opinião de especialistas

Objective: The study aimed to describe the profile and economic burden of patients with depression from the perspective of the Brazilian Private Healthcare System (PHS). Methods: A two-step methodological quantitative-qualitative research design was performed: retrospective descriptive analysis of the Orizon database of patients with at least one claim of depression (F33, F38, or F39) in PHS (2013-2019) and experienced physicians perspective from an expert meeting. Results: 1,802 patients fulfilling the eligibility criteria counted BRL 74,978 million across the 4-year period. Over this period, nearly 60% of patients had a medical appointment (6.6 appointments per patient, on average), 61% had a psychologist, 9.8% had a psychiatrist appointment, and an average of 115.2 exams and 8.7 emergency visits per patient were performed. According to the experts, the economic impact of depression is more significant when considering the indirect costs related to productivity loss and impairment in occupational and interpersonal functioning. Conclusion: Identifying and diagnosing patients with depression and their real burden is challenging; even with significant costs identified in the claim database analyses in the Brazilian PHS, the real impact must be higher if indirect costs are considered. The depressive disorder should be prioritized in the Brazilian PHS to establish more adequate health policies.

Objetivo: O estudo teve como objetivo descrever o perfil e a carga econômica de pacientes com depressão na perspectiva do Sistema Único de Saúde (SUS). Métodos: Foi realizado um projeto de pesquisa quantitativo-qualitativo metodológico em duas etapas: análise descritiva retrospectiva do banco de dados Orizon de pacientes com pelo menos uma alegação de depressão (F33, F38 ou F39) no PHS (2013- 2019) e perspectiva de médicos experientes de uma reunião de especialistas. Resultados: 1.802 pacientes que preencheram os critérios de elegibilidade totalizaram R$ 74,978 milhões no período de 4 anos. Nesse período, cerca de 60% dos pacientes tiveram consulta médica (6,6 consultas por paciente, em média), 61% tiveram psicólogo, 9,8% consulta com psiquiatra e foram realizados em média 115,2 exames e 8,7 atendimentos de emergência por paciente . Segundo os especialistas, o impacto econômico da depressão é mais significativo quando considerados os custos indiretos relacionados à perda de produtividade e prejuízo no funcionamento ocupacional e interpessoal. Conclusão: Identificar e diagnosticar pacientes com depressão e sua real carga é desafiador; mesmo com custos significativos identificados nas análises da base de sinistros do SUS brasileiro, o impacto real deve ser maior se considerados os custos indiretos. O transtorno depressivo deve ser priorizado na APS brasileira para o estabelecimento de políticas de saúde mais adequadas.

Cout réel de la prise en charge des cancers du col de l'utérus en radiothérapie au Cameroun / The real cost of the management of cervical cancers by radiotherapy in Cameroon

Introduction. Le cancer du col utérin est le deuxième cancer de la femme au Cameroun. La radiothérapie reste une des modalités thérapeutiques phares dans la prise en charge de cette pathologie et l'État participe en y apportant une subvention. Toutefois, plusieurs patientes n'accèdent pas au traitement en raison des difficultés financières. Notre objectif était d'évaluer le coût réel de la prise en charge afin de servir de support aux politiques d'aide aux patientes. Méthodologie. Uneétude descriptive, transversale portant sur les patientes traitées en radiothérapie à l'Hôpital Général de Douala pour cancer du col de l'utérus a été réalisée d'octobre 2020 à janvier 2021.Résultats. Au total 35 dossiers de patientes ont été inclus. Lespatientes avaient de faibles revenus (<108.810 XAF /mois, 51,3%), étaient sans assurance maladie (88,6%), provenant en majorité des villes hors de Douala (54,3%), avec des cancers localement évolués. Le coût global moyen du traitement était de 511 264 XAF+/-103479 XAF (779,42 +/-157,75 euros) pour chaque patiente. La durée moyenne de traitement était de 57,34 jours, avec un nombre médian de 27 séances. Les frais supplémentaires pendant le traitement provenaient de la chimiothérapie, de la gestion des effets secondaires, notamment des transfusions sanguines, et du bilan de suivi. Plus de la moitié des patientes ont eu besoin d'une prise en charge supplémentaire par chimiothérapie ou chirurgie. Conclusion. La prise en charge du cancer du col utérin par radiothérapie est coûteuse et peu accessible à la majorité des patientes Camerounaises.

Introduction.Cervix cancer is the second cancer among women in Cameroon. Radiotherapy is often warranted in its management. Many patients do not access treatment due to financial difficulties. Our objective was to assess the real cost of care in order to support patient assistance policies. Methodology. A descriptive cross over study of women treated by radiotherapy at the Douala General Hospital from October 2020 to January 2021 was conducted. Results. A total number of 35 patient files were included in the study. Patients generally had low income (<108.810 XAF /month), without medical insurance, lived out of Douala, and were diagnosed at locally advanced stages of their disease. Average cost of treatment for radiotherapy alone was 511,264 XAF +/-103,479 XAF. Average duration of treatment was 57.34 days, with a median number of 27 sessions. Extra cost came from chemotherapy, management of side effects especially from blood transfusions, and imaging. More than half of the patients required additional expense for adjunct chemotherapy or surgery. Conclusion. The total cost of treatment for cervix cancer by radiotherapy is quite expensive, and not accessible to the average Cameroonian

COVID­19 pandemic fatigue among well­educated Egyptian population: cross­sectional study

Aim: The study explores the emergence of COVID 19 pandemic fatigue among well educated Egyptians measured in terms of their level of adherence toward COVID 19 protective measures along 20 months since the beginning of the pandemic. Setting and Design: A cross sectional study was conducted in October 2021, using an online questionnaire for well educated Egyptians in different governorates. Results: A total of 888 participants completed the questionnaire, their mean age was 39 ± 7.2 years and 60% of them were females. There was a strong association between the presence of either behavioral risk factors or chronic conditions and % of infection. The main sources of COVID 19 information were social media, followed by the Egyptian Ministry of health and population and WHO websites. A pandemic fatigue was observed after nearly 7 to 10 months from the pandemic emergence. The participant's age, previous COVID 19 infection, and occupation status were significant predictors for adherence to COVID 19 protective measures. The participants claimed that difficulty in remaining at home, feeling uncomfortable with face masks, the high cost of protective supplies, absence of governmental enforcement, and forgetfulness are the most perceptive barriers hindering their adherence to COVID 19 protective measures. They suggested some strategies for better adherence and reduced pandemic fatigue that includes: the implementation of governmental enforcement measures, including penalties for nonwearing masks, educational health programs, and availability of free protective supplies at the workplace. Conclusions: Pandemic fatigue was observed after 7 to 10 months from the pandemic emergence even though the high education level of the participants

On addressing the burden of uncorrected refractive errors

@#Uncorrected or unaddressed refractive error (URE) is the leading cause of treatable visual impairment (VI) globally. A significant factor is the prohibitive costs of corrective options. The World Health Organization recently recommended the use of effective refractive error coverage (eREC) to determine the burden and management of URE. To increase eREC, spectacles should be made available and affordable. Most developing countries use ready-made glasses produced in bulk to address presbyopia. Timor-Leste employed a tiered- pricing for these ready-made spectacles which were found to be effective. The Philippines can adopt similar initiatives considering that prescription spectacles are not covered by its national health insurance. Prescription spectacles should also receive coverage from the national insurance. Policies should also be created that will set-up optical units inside government hospitals and primary health care units that can dispense low cost or free prescription spectacles. Dedicated government posts for optometrists should be created to man the said units. Existing colleges of optometry can partner with nearby public health facilities to man their optical units similar to partnerships made for other health professions. State universities can also consider opening colleges of optometry where they can tie up return services conditions or follow ladderized programs based on community demands similar to existing ones for other health professions

Análise das solicitações de medicamentos não padronizados de um hospital universitário terciário / Analysis of requests for non-standard medicines from a tertiary university hospital

Introdução: O uso extensivo de medicamentos não padronizados causa aumento de custos em saúde, além de potencial redução de segurança e uso racional de medicamentos. A Comissão de Farmácia e Terapêutica orienta a prescrição de medicamentos, por meio da avaliação e seleção de medicamentos a serem incluídos no formulário de medicamentos padronizados, com base nas melhores evidências científicas disponíveis e no perfil dos pacientes locais, promovendo o uso racional de medicamentos. O objetivo deste trabalho foi analisar as solicitações de fornecimento de medicamentos não padronizados na instituição. Métodos: Trata-se de um estudo observacional e descritivo onde foram analisadas as solicitações de medicamentos não padronizados realizadas entre fevereiro de 2016 e dezembro de 2021, identificando os medicamentos envolvidos e seus respectivos custos. Resultados: Foram realizadas 203 solicitações no período, sendo 174 incluídas no estudo. Os medicamentos que tiveram mais solicitações foram o rituximabe (41), a imunoglobulina humana (31), o sucralfato (23), a nitazoxanida (12) e o eltrombopague (7). As solicitações com maior custo foram as de imunoglobulina humana (US$ 799,702.38), rituximabe (US$ 717,320.26), eltrombopague (US$ 281,062.50), ruxolitinibe (US$ 167,867.46) e bortezomibe (US$ 149,033.52). As principais clínicas que solicitaram medicamentos não padronizado foram a neurologia (47), a hematologia (30), as moléstias infecciosas e parasitárias (17), e a anestesiologia (12). As solicitações de maior custo foram realizadas pela neurologia (US$ 145,519.08), hematologia (US$ 120,980.25), transplante de medula óssea (US$ 51,635.11) e dermatologia (US$ 44,813.40). Conclusão: O estudo demonstrou que há um fluxo estruturado de solicitação de medicamentos não padronizados na instituição, sendo uma importante ferramenta de gerenciamento dessas solicitações, evitando a aquisição desnecessária de itens que não compõem o elenco terapêutico do hospital.

Introduction: Widespread use of non-formulary drugs (NFD) increases cost and may reduce safety and rational use of medicines. The Pharmacy and Therapeutics Committee provides guidance on drug prescription by evaluating and selecting medications to be included in a hospital's formulary based on best scientific evidence available and local patients' profile, promoting rational use of medicines. The objective of this study was to assess non-formulary drugs prescriptions at a tertiary hospital. Methods: This was a retrospective study. NFD prescribed and its associated costs were assessed through NFD request forms received from February 2016 to December 2021. Results: A total of 203 NFD request forms were received, from which 174 were included in this study. The most frequently prescribed NFD included rituximab (n = 41), immunoglobulin (31), sucralfate (23), nitazoxanide (12), and eltrombopag (7), with the highest costs being with immunoglobulin (US$ 799,702.38), rituximab (US$ 717,320.26), eltrombopag (US$ 281,062.50), ruxolitinib (US$ 167,867.46), and bortezomib (US$ 149,033.52). The most frequent requesting specialties were neurology (n = 47), hematology (30), infectious disease (17) and anesthesiology (12), and highest costs requests were from neurology (US$ 145,519.08), hematology (US$ 120,980.25), bone marrow transplant unit (US$ 51,635.11), and dermatology (US$ 44,813.40). Conclusion: This study showed that a structured request flow for NFD prescription is a critical procedure in order to better manage drug prescription within the hospital, promoting rational use of medicines and preventing unnecessary spending with drugs for which the clinical indication may be covered by a drug already in the hospital's formulary.