RESUMO
Objectives: Mucormycosis is a rare invasive fungal infection with high lethality, affecting mainly patients with hematological neoplasia, decompensated diabetes, and covid-19 infection. The aim was to perform a cost-effectiveness analysis of liposomal Amphotericin B (standard treatment) versus isavuconazole for treating mucormycosis in the consolidation phase from the perspective of the Brazilian Unified Health System. Method(s): A decision tree model was built. The analysis considered the costs of the treatment over a six-month time horizon. This included hospitalization during the entire course of treatment and the expenditures related to dialysis, complication occurring in 5% (3%-6%) of cases treated with the Amphotericin B. Appointments with specialists were included in the isavuconazole arm, and amphotericin B was used if the patient failed to respond to isavuconazole. The utility of the patient with mucormycosis, cured and with renal failure was estimated. Uncertainties were assessed through probabilistic and deterministic sensitivity analyses. Result(s): The average cost of amphotericin B and isavuconazole arm was R$1.054.874,39 and R$522.344,05, respectively. The utility was 0.479 with amphotericin B and 0.480 with isavuconazole. The ICER was R$ -684,494,237 (dominant). In deterministic sensitivity analysis, the probability of dialysis was the variable with the greatest impact. In probabilistic analysis, the ICER is distributed in the right and left lower quadrant, the acceptability curve for all the scenarios analyzed is favorable for isavuconazole. The budget impact suggests a potential savings of between R$ 350 million and R$ 415 million over five years. Conclusion(s): The treatment of mucormycosis during the consolidation phase with isavuconazole represents a lower cost, besides the convenience of oral treatment and reduced incidence of severe adverse events, with mortality similar to the Amphotericin B arm. In Brazil, the formulation of posaconazole approved is inadequate for treating mucormycosis during the consolidation phase, therefore isavuconazole is the single oral drug available.Copyright © 2023
RESUMO
We analyze the Brazilian production and diffusion of scientific literature on COVID-19 in 2020, to assess what was the protagonism of this country during this event. All documents were obtained from Web of Science and considered under bibliometric and altmetric analysis. We used the production and citation indicators crossed with other variables like author, institutional affiliation, impact factors, funding organizations, research areas, etc. A total of 2,703 articles were found, mostly published in December and in English, having received 10,190 citations, with an average of 3.77 citations per document, a value lower than that found for other countries. Ten journals concentrated publications, being only one of those not Brazilian. Sao Paulo University was the most producing institution. Analyzing the top 100 most cited articles with an altmetric tool, the average Altmetric Attention Score (AAS) was 392.22. From the 40,062 mentions on social media, 94.8% came from Twitter, mainly by general public (78.6%). The top 10 articles with the highest AAS concentrated 79,5% of all attention;eight of them were original investigations. We propose a content analysis to verify which specific topics are attracting greater interest from the general public, but not so much from the scientific community.