Health care accessibility and mobility in breast cancer: a Latin American perspective.

BACKGROUND: Latin America (LATAM) encompasses a vast region with diverse populations. Despite publicly funded health care systems providing universal coverage, significant socioeconomic and ethno-racial disparities persist in health care access across the region. Breast cancer (BC) incidence and mortality rates in Brazil are comparable to those in other LATAM countries, supporting the relevance of Brazilian data, with Brazil's health care policies and expenditures often serving as models for neighboring countries. We evaluated the impact of mobility on oncological outcomes in LATAM by analyzing studies of patients with BC reporting commuting routes or travel distances to receive treatment or diagnosis. METHODS: We searched MEDLINE (PubMed), Embase, Cochrane CENTRAL, LILACS, and Google Scholar databases. Studies eligible for inclusion were randomized controlled trials and observational studies of patients with BC published in English, Portuguese, or Spanish and conducted in LATAM. The primary outcome was the impact of mobility or travel distance on oncological outcomes. Secondary outcomes included factors related to mobility barriers and access to health services. For studies meeting eligibility, relevant data were extracted using standardized forms. Risk of bias was assessed using the Newcastle-Ottawa Scale. Quantitative and qualitative evidence synthesis focused on estimating travel distances based on available data. Heterogeneity across distance traveled or travel time was addressed by converting reported travel time to kilometers traveled and estimating distances for unspecified locations. RESULTS: Of 1142 records identified, 14 were included (12 from Brazil, 1 from Mexico, and 1 from Argentina). Meta-analysis revealed an average travel distance of 77.8 km (95% CI, 49.1-106.48) to access BC-related diagnostic or therapeutic resources. Nonetheless, this average fails to precisely encapsulate the distinct characteristics of each region, where notable variations persist in travel distance, ranging from 88 km in the South to 448 km in the North. CONCLUSION: The influence of mobility and travel distance on access to BC care is multifaceted and should consider the complex interplay of geographic barriers, sociodemographic factors, health system issues, and policy-related challenges. Further research is needed to comprehensively understand the variables impacting access to health services, particularly in LATAM countries, where the challenges women face during treatment remain understudied. TRIAL REGISTRATION: CRD42023446936.

Quality of life in children and adolescents with hemophilia A: A systematic review and meta-analysis.

Background: Various instruments have been used to assess health-related quality of life (HRQoL) in children and adolescents with hemophilia A. Objective: We systematically reviewed the literature to summarize HRQoL measurement instruments and outcomes in this population. Methods: MEDLINE, Embase, Cochrane CENTRAL, and LILACS databases were searched. Studies published from 2010 to 2021, reporting HRQoL assessed by generic or hemophilia-specific instruments in individuals aged 0 to 18 years were included. Two independent reviewers performed screening, selection, and data abstraction. Data were meta-analyzed using the generic inverse variance method with the random-effects model for single-arm studies reporting instrument-specific mean total HRQoL scores. Prespecified subgroup meta-analyses were performed. Heterogeneity among studies was assessed using the I 2 statistic. Results: Six instruments were identified in 29 studies meeting the following inclusion criteria: 4 generic instruments (PedsQL [5 studies], EQ-5D-3L [3 studies], KIDSCREEN-52 [1 study], and KINDL [1 study]) and 2 hemophilia-specific instruments (Haemo-QoL [17 studies] and CHO-KLAT [3 studies]). The overall risk of bias was moderate to low. There was a substantial variability in the primary outcome (mean total HRQoL score) among studies using the same instrument (Haemo-QoL), with scores ranging from 24.10 to 89.58 on a scale from 0 to 100 (higher scores indicating higher HRQoL). Meta-regression with 14 studies using the Haemo-QoL questionnaire demonstrated that 79.34% (R 2 ) of the observed 94.67% total heterogeneity (I 2 ) was explained by the proportion of patients receiving effective prophylactic treatment. Conclusion: HRQoL assessment in young people with hemophilia A is heterogeneous and context specific. The proportion of patients on effective prophylactic treatment is positively correlated with HRQoL. The review protocol was registered prospectively with PROSPERO (CRD42021235453).

Effect of different protocols for estrus synchronization on reproductive performance of Santa Inês ewes under Amazon environmental conditions

The objective of this study was to evaluate the effect of different hormonal protocols on the reproductive performance of Santa Inês ewes in Amazon environmental conditions. Twenty-two Santa Inês ewes between 3 and 4 years-old were distributed in a randomized block experimental design, where the treatments consisted of two protocols for estrus synchronization (short and long) with eleven animals each. Data on the occurrence of estrus were described for each protocol. Data of estrus, pregnancy, and prolificity were firstly subjected to ANOVA and a subsequent Tukeys test. Results were considered significant at p 0.05. The short-term protocol presented an interesting successful rate, where above 70% ewes tested had estrus. The long-term protocol also achieved a high successful rate, where above 80% ewes tested had estrus. However, comparing the protocols, the long-term protocol presented better results of positive estrus and pregnancy rates in ewes. Thus, it can be concluded that both protocols presented satisfactory results regarding estrus manifestation, and prolificity (lambs produced per ewe). However, under Amazon environmental conditions, the long-term protocol presented better results regarding positive manifestation of estrus and pregnancy rate.(AU)

Effect of different protocols for estrus synchronization on reproductive performance of Santa Inês ewes under Amazon environmental conditions

The objective of this study was to evaluate the effect of different hormonal protocols on the reproductive performance of Santa Inês ewes in Amazon environmental conditions. Twenty-two Santa Inês ewes between 3 and 4 years-old were distributed in a randomized block experimental design, where the treatments consisted of two protocols for estrus synchronization (short and long) with eleven animals each. Data on the occurrence of estrus were described for each protocol. Data of estrus, pregnancy, and prolificity were firstly subjected to ANOVA and a subsequent Tukeys test. Results were considered significant at p 0.05. The short-term protocol presented an interesting successful rate, where above 70% ewes tested had estrus. The long-term protocol also achieved a high successful rate, where above 80% ewes tested had estrus. However, comparing the protocols, the long-term protocol presented better results of positive estrus and pregnancy rates in ewes. Thus, it can be concluded that both protocols presented satisfactory results regarding estrus manifestation, and prolificity (lambs produced per ewe). However, under Amazon environmental conditions, the long-term protocol presented better results regarding positive manifestation of estrus and pregnancy rate.

Comparative Study of the Osteointegration of Irradiated and Non-irradiated Bone Grafts Used in Patients with Revision Hip Arthroplasty.

Objective To evaluate and compare the osteointegration of irradiated and non-irradiated frozen bone grafts used in 21 patients undergoing revision hip arthroplasty procedures with the Exeter technique. Methods A retrospective study of 21 patients undergoing revision hip arthroplasty with the Exeter technique using bone tissues treated or not with gamma radiation between 2013 and 2014. The patients were divided into two groups according to the use of grafts treated or not with ionizing radiation (gamma rays); as such, these groups were classified as irradiated or non-irradiated. The osteointegration results determined by radiographic analysis of these grafts were compared in the postoperative period of 6 and 12 months. Results Comparing the graft osteointegration in all patients at 6 and 12 months postoperatively, we noticed a significant difference in the radiographic evaluations in this period ( p = 0.031). Out of the patients studied, 7 were from the irradiated group, and 14 belonged to the non-irradiated group. No statistically significant differences were observed ( p = 0.804) regarding osteointegration when we compared the irradiated and non-irradiated groups. Conclusion There was no significant difference in the use of irradiated or non-irradiated grafts in revision hip arthroplasty procedures with the Exeter technique.

Comparative Study of the Osteointegration of Irradiated and Non-irradiated Bone Grafts Used in Patients with Revision Hip Arthroplasty / Estudo comparativo da osteointegração de enxertos ósseos irradiados e não irradiados utilizados em pacientes com revisão de artroplastia do quadril

Abstract Objective To evaluate and compare the osteointegration of irradiated and nonirradiated frozen bone grafts used in 21 patients undergoing revision hip arthroplasty procedures with the Exeter technique. Methods A retrospective study of 21 patients undergoing revision hip arthroplasty with the Exeter technique using bone tissues treated or not with gamma radiation between 2013 and 2014. The patients were divided into two groups according to the use of grafts treated or not with ionizing radiation (gamma rays); as such, these groups were classified as irradiated or non-irradiated. The osteointegration results determined by radiographic analysis of these grafts were compared in the postoperative period of 6 and 12months. Results Comparing the graft osteointegration in all patients at 6 and 12months postoperatively, we noticed a significant difference in the radiographic evaluations in this period (p = 0.031). Out of the patients studied, 7 were from the irradiated group, and 14 belonged to the non-irradiated group. No statistically significant differences were observed (p = 0.804) regarding osteointegration when we compared the irradiated and non-irradiated groups. Conclusion There was no significant difference in the use of irradiated or nonirradiated grafts in revision hip arthroplasty procedures with the Exeter technique.

Resumo Objetivo Avaliar e comparar a osteointegração dos enxertos ósseos congelados irradiados e não irradiados utilizados em 21 pacientes submetidos a revisão de prótese do quadril pela técnica Exeter. Métodos Foi realizado estudo retrospectivo de 21 pacientes submetidos a revisão de artroplastia do quadril pela técnica Exeter comutilização de tecidos ósseos tratados ou não com radiação gama no período entre 2013 e 2014. Dividimos os pacientes em dois grupos, de acordo com o uso do enxerto tratado ou não com radiação ionizante (raios gama), que foram, portanto, classificados como: grupo irradiado e não irradiado. Os resultados da osteointegração por análise radiográfica destes enxertos foram comparados no pós-cirúrgico de 6 e 12 meses. Resultados Quando comparamos a osteointegração dos enxertos no pós-cirúrgico de 6 e 12 meses de todos os pacientes, notamos que houve diferença significativa entre as avaliações radiográficas neste período (p= 0,031). Dos pacientes estudados, 7 pertenciam ao grupo irradiado, e 14, ao grupo não irradiado. Não foram observadas diferenças estatisticamente significativas (p= 0,804) quando a osteointegração entre os grupos irradiados e não irradiados foi comparada. Conclusão Não houve diferença significativa no uso de enxerto irradiado e não irradiado nas revisões de artroplastias do quadril pela técnica Exeter.

Fish by-product meal in diets for commercial laying hens / Farinha de resíduo de pescado em rações de poedeiras comerciais leves

This study aimed to evaluate the increasing levels (0, 1, 2, 3 e 4%) of fish by-product meal in diets for laying hens on performance, egg quality and economic analysis. A total of 160 Dekalb White hens with 52-wk old were distributed in a completely randomized design with five treatments and four replicates of eight birds each. The experiment lasted 84 days divided into four periods of 21 days. Estimates of fish by-product meal levels were determined by polynomial regression. Differences (p 0.05) were detected for all variables of performance, in egg weight, yolk and albumen percentage, yolk and albumen height, feed cost and production cost, in which the inclusion of fish by-product meal in the diets showed better results. It can be concluded that fish by-product meal can be used in diets for hens as alternative feed, with better results in egg production, feed conversion, egg weight, yolk-albumen ratio and a reduction in feed cost and production cost.

Objetivou-se com este estudo avaliar a inclusão de níveis crescentes (0, 1, 2 3 e 4%) de farinha de resíduo de pescado na dieta de poedeiras comerciais leves sobre o desempenho, qualidade do ovo e análise econômica. Foram utilizadas 160 poedeiras da linhagem Dekalb White com 52 semanas de idade. O experimento teve duração de 84 dias divididos em quatro períodos de 21 dias. O delineamento experimental foi o inteiramente casualizado com cinco tratamentos contendo quatro repetições de oito aves cada. As estimativas dos níveis de farinha de resíduo de pescado foram determinadas por meio de regressão polinomial. Foram observadas diferenças (p < 0,05) em todas as variáveis de desempenho, no peso do ovo, percentagem de gema e albúmen, altura de gema e albúmen, custo alimentar e custo de produção, onde a inclusão de farinha do resíduo de pescado proporcionou melhores resultados. Concluiu-se que a farinha de resíduo de pescado pode ser utilizada como alimento alternativo em rações para poedeiras comerciais leves, proporcionando melhora na produção de ovos, conversão alimentar, peso do ovo, relação gema-albúmen, redução no custo alimentar e no custo de produção.

Fish by-product meal in diets for commercial laying hens / Farinha de resíduo de pescado em rações de poedeiras comerciais leves

This study aimed to evaluate the increasing levels (0, 1, 2, 3 e 4%) of fish by-product meal in diets for laying hens on performance, egg quality and economic analysis. A total of 160 Dekalb White hens with 52-wk old were distributed in a completely randomized design with five treatments and four replicates of eight birds each. The experiment lasted 84 days divided into four periods of 21 days. Estimates of fish by-product meal levels were determined by polynomial regression. Differences (p 0.05) were detected for all variables of performance, in egg weight, yolk and albumen percentage, yolk and albumen height, feed cost and production cost, in which the inclusion of fish by-product meal in the diets showed better results. It can be concluded that fish by-product meal can be used in diets for hens as alternative feed, with better results in egg production, feed conversion, egg weight, yolk-albumen ratio and a reduction in feed cost and production cost.(AU)

Objetivou-se com este estudo avaliar a inclusão de níveis crescentes (0, 1, 2 3 e 4%) de farinha de resíduo de pescado na dieta de poedeiras comerciais leves sobre o desempenho, qualidade do ovo e análise econômica. Foram utilizadas 160 poedeiras da linhagem Dekalb White com 52 semanas de idade. O experimento teve duração de 84 dias divididos em quatro períodos de 21 dias. O delineamento experimental foi o inteiramente casualizado com cinco tratamentos contendo quatro repetições de oito aves cada. As estimativas dos níveis de farinha de resíduo de pescado foram determinadas por meio de regressão polinomial. Foram observadas diferenças (p < 0,05) em todas as variáveis de desempenho, no peso do ovo, percentagem de gema e albúmen, altura de gema e albúmen, custo alimentar e custo de produção, onde a inclusão de farinha do resíduo de pescado proporcionou melhores resultados. Concluiu-se que a farinha de resíduo de pescado pode ser utilizada como alimento alternativo em rações para poedeiras comerciais leves, proporcionando melhora na produção de ovos, conversão alimentar, peso do ovo, relação gema-albúmen, redução no custo alimentar e no custo de produção.(AU)

Effects of ionizing radiation on proteins in lyophilized or frozen demineralized human bone.

OBJECTIVE: The aim was to study the effects of application of ionizing radiation (gamma and electrons) as sterilizing agents at doses of 15 kGy, 25 kGy and 50 kGy, on lyophilized or frozen demineralized bone tissue for use in transplants. METHODS: Five human femoral diaphyses from different donors of musculoskeletal tissue were demineralized and preserved as lyophilized or frozen at -80 °C. The samples were divided into two groups: non-irradiated (control) and irradiated by means of gamma rays or an electron beam. The bone proteins were extracted and used to determine the concentrations of total protein and BMP 2 and 7. RESULTS: Decreases in total protein and BMP 2 and 7 concentrations were observed. The decreases in total protein concentrations, in comparison with the respective control groups, were significant in the lyophilized and frozen samples that were irradiated at a dose of 50 kGy of gamma radiation and electron beam, with reductions of more than 30%. Significant decreases in the levels of BMP 2 and 7 were also observed at higher doses and especially through use of the electron beam. CONCLUSION: The reductions in the concentrations of total proteins and osteoinductive proteins (BMP 2 and 7) were related to the radiation dose, i.e. they increased with higher doses of ionizing radiation type and the type of bone preservation. The largest reductions in concentrations were observed in the bones irradiated by means of an electron beam and at a dose of 50 kGy. However, this type of radiation and this high dose are not usual practices for sterilization of bone tissue.

OBJETIVO: Estudar os efeitos da aplicação das radiações ionizantes (gama e elétrons) como agentes esterilizantes, nas doses de 15 kGy, 25 kGy e 50 kGy, nos tecidos ósseos desmineralizados congelados e liofilizados para uso em transplantes. MÉTODOS: Cinco diáfises femorais humanas de doadores distintos de tecidos musculoesqueléticos foram desmineralizadas e preservadas como liofilizadas ou congeladas a −80 °C. As amostras foram divididas em grupos não irradiados (controle) e irradiados por raios gama ou feixe de elétrons. As proteínas ósseas foram extraídas e dosadas as concentrações de proteínas totais, BMP 2 e 7. RESULTADOS: Foi observada diminuição das concentrações de proteínas totais e BMP 2 e 7. A diminuição das concentrações de proteínas totais, quando comparada com o respectivo controle, foi significativa nos grupos de amostras liofilizadas e congeladas e irradiadas na dose de 50 kGy por radiação gama e feixe de elétrons com redução superiores a 30%. A diminuição significativa nas concentrações das BMP 2 e 7 também foi observada nas maiores doses e principalmente por feixe de elétrons. CONCLUSÃO: As reduções nas concentrações das proteínas totais e em proteínas osteoindutoras (BMP 2 e 7) foram relacionadas à dose de radiação, ou seja, aumentam com maiores doses, tipo de radiação ionizante e ao tipo de preservação dos ossos. As maiores reduções das concentrações foram observadas nos ossos irradiados por feixe de elétrons e na dose de 50 kGy. Porém esse tipo de radiação e essa alta dose não são práticas usuais para a esterilização dos tecidos ósseos.

Effects of ionizing radiation on proteins in lyophilized or frozen demineralized human bone / Efeitos da radiação ionizante nas proteínas presentes em ossos humanos desmineralizados, liofilizados ou congelados

OBJECTIVE: The aim was to study the effects of application of ionizing radiation (gamma and electrons) as sterilizing agents at doses of 15 kGy, 25 kGy and 50 kGy, on lyophilized or frozen demineralized bone tissue for use in transplants. METHODS: Five human femoral diaphyses from different donors of musculoskeletal tissue were demineralized and preserved as lyophilized or frozen at -80 °C. The samples were divided into two groups: non-irradiated (control) and irradiated by means of gamma rays or an electron beam. The bone proteins were extracted and used to determine the concentrations of total protein and BMP 2 and 7. RESULTS: Decreases in total protein and BMP 2 and 7 concentrations were observed. The decreases in total protein concentrations, in comparison with the respective control groups, were significant in the lyophilized and frozen samples that were irradiated at a dose of 50 kGy of gamma radiation and electron beam, with reductions of more than 30%. Significant decreases in the levels of BMP 2 and 7 were also observed at higher doses and especially through use of the electron beam. CONCLUSION: The reductions in the concentrations of total proteins and osteoinductive proteins (BMP 2 and 7) were related to the radiation dose, i.e. they increased with higher doses of ionizing radiation type and the type of bone preservation. The largest reductions in concentrations were observed in the bones irradiated by means of an electron beam and at a dose of 50 kGy. However, this type of radiation and this high dose are not usual practices for sterilization of bone tissue.

OBJETIVO: Estudar os efeitos da aplicação das radiações ionizantes (gama e elétrons) como agentes esterilizantes, nas doses de 15 kGy, 25 kGy e 50 kGy, nos tecidos ósseos desmineralizados congelados e liofilizados para uso em transplantes. MÉTODOS: Cinco diáfises femorais humanas de doadores distintos de tecidos musculoesqueléticos foram desmineralizadas e preservadas como liofilizadas ou congeladas a -80 °C. As amostras foram divididas em grupos não irradiados (controle) e irradiados por raios gama ou feixe de elétrons. As proteínas ósseas foram extraídas e dosadas as concentrações de proteínas totais, BMP 2 e 7. RESULTADOS: Foi observada diminuição das concentrações de proteínas totais e BMP 2 e 7. A diminuição das concentrações de proteínas totais, quando comparada com o respectivo controle, foi significativa nos grupos de amostras liofilizadas e congeladas e irradiadas na dose de 50 kGy por radiação gama e feixe de elétrons com redução superiores a 30%. A diminuição significativa nas concentrações das BMP 2 e 7 também foi observada nas maiores doses e principalmente por feixe de elétrons. CONCLUSÃO: As reduções nas concentrações das proteínas totais e em proteínas osteoindutoras (BMP 2 e 7) foram relacionadas à dose de radiação, ou seja, aumentam com maiores doses, tipo de radiação ionizante e ao tipo de preservação dos ossos. As maiores reduções das concentrações foram observadas nos ossos irradiados por feixe de elétrons e na dose de 50 kGy. Porém esse tipo de radiação e essa alta dose não são práticas usuais para a esterilização dos tecidos ósseos.

Avaliação do perfil metabólico em diferentes fases do periparto de ovelhas Santa Inês na Amazônia Ocidental / Evaluation of metabolic profile at different stages of peripartum of Santa Inês ewes in the Western Amazon

Objetivou-se com este trabalho avaliar a condição metabólica nutricional de ovelhas Santa Inês no período pré-parto e pós-parto, a fim de evitar a toxemia. Foram utilizadas 50 ovelhas adultas da raça Santa Inês criadas sobre a mesma condição de manejo e alimentação, distribuídas em cinco grupos, de acordo com o período de gestação: T -60 (60 dias antes do parto), T-30 (30 a 21 dias antes do parto), T0 (no parto até 4 dias após o parto), T+30 (30 dias após parto) e T+60 (60 dias após o parto). A coleta de sangue foi conduzida pela manhã por venopunção da jugular em dois tubos a vácuo. Foram avaliados os seguintes metabólitos: protéico (proteína total, albumina, globulina e uréia), energético (glicose e ß-hidroxibutirato) e mineral (magnésio (Mg), cálcio (Ca) e fósforo (P)). Para determinar as diferenças entre as médias foi aplicado o teste Tukey a 5% de probabilidade.

This study aimed to evaluate the nutritional metabolic condition of Santa Ines ewes in antepartum and postpartum period, in order to avoid toxemia. Were used 50 Santa Ines ewes management under the same condition of handling and feeding, distributed into five groups, according to the gestation period: G1 - P-60 (60 days before partum), G2 - P-30 (30 to 21 days before partum), G3 - P0 (at partum to 4 days post partum), G4 - P+30 (30 days after partum) and G5 - P+60 (60 days after partum). The blood collection was conducted in the morning by venipuncture of the jugular in two vacuum tubes. The metabolites evaluated were: protein metabolism (total protein, albumin, globulin and urea), energy (glucose) and mineral (magnesium (Mg), calcium (Ca) and phosphorus (P)). To determine the differences between the means was applied the Tukey test at 5% probability.

Avaliação do perfil metabólico em diferentes fases do periparto de ovelhas Santa Inês na Amazônia Ocidental / Evaluation of metabolic profile at different stages of peripartum of Santa Inês ewes in the Western Amazon

Objetivou-se com este trabalho avaliar a condição metabólica nutricional de ovelhas Santa Inês no período pré-parto e pós-parto, a fim de evitar a toxemia. Foram utilizadas 50 ovelhas adultas da raça Santa Inês criadas sobre a mesma condição de manejo e alimentação, distribuídas em cinco grupos, de acordo com o período de gestação: T -60 (60 dias antes do parto), T-30 (30 a 21 dias antes do parto), T0 (no parto até 4 dias após o parto), T+30 (30 dias após parto) e T+60 (60 dias após o parto). A coleta de sangue foi conduzida pela manhã por venopunção da jugular em dois tubos a vácuo. Foram avaliados os seguintes metabólitos: protéico (proteína total, albumina, globulina e uréia), energético (glicose e ß-hidroxibutirato) e mineral (magnésio (Mg), cálcio (Ca) e fósforo (P)). Para determinar as diferenças entre as médias foi aplicado o teste Tukey a 5% de probabilidade.(AU)

This study aimed to evaluate the nutritional metabolic condition of Santa Ines ewes in antepartum and postpartum period, in order to avoid toxemia. Were used 50 Santa Ines ewes management under the same condition of handling and feeding, distributed into five groups, according to the gestation period: G1 - P-60 (60 days before partum), G2 - P-30 (30 to 21 days before partum), G3 - P0 (at partum to 4 days post partum), G4 - P+30 (30 days after partum) and G5 - P+60 (60 days after partum). The blood collection was conducted in the morning by venipuncture of the jugular in two vacuum tubes. The metabolites evaluated were: protein metabolism (total protein, albumin, globulin and urea), energy (glucose) and mineral (magnesium (Mg), calcium (Ca) and phosphorus (P)). To determine the differences between the means was applied the Tukey test at 5% probability.(AU)

Custo-Efetividade Incremental do Tratamento Cirúrgico vs. Percutâneo da Persistência do Canal Arterial com o Amplatzer® Duct Occluder em Crianças: Revisão Sistemática / Incremental Cost-Effectiveness of Surgical vs. Percutaneous Treatment of Patent Ductus Arteriosus with the AmplatzerTM Duct Occluder in Children: A Systematic Review

Introdução: A persistência do canal arterial (PCA) é uma cardiopatia congênita relativamente comum e as alternativas para o tratamento de canais > 2,5 mm são a cirurgia ou a oclusão percutânea com próteses do tipo rolha. Essas últimas, apesar de consideradas o método de escolha, não estão previstas pelo Sistema Único de Saúde (SUS). Nosso objetivo foi comparar a razão de custo-efetividade incremental (RCEI) de ambas as estratégias. Métodos: Revisão sistemática em relação a desfechos clínicos e criação de modelo de decisão para avaliação da RCEI do Amplatzer® Duct Occluder (ADO) em comparação ao tratamento cirúrgico, para o fechamento da PCA. Os custos para ambos os métodos foram aqueles reembolsados pelo SUS em 2010, e o custo do conjunto (dispositivo + materiais de apoio) foi estimado em R$ 10.000,00. Foi considerado como limiar uma disposição para pagar equivalente a três vezes o Produto Interno Bruto brasileiro, resultando em R$ 57.000,00 por ano de vida salvo. Resultados: As duas técnicas foram seguras e eficazes, com menor morbidade e tempo de internação no fechamento percutâneo. A expectativa de vida ajustada foi similar nos dois grupos, sendo um pouco melhor para o ADO. O custo total foi calculado em R$ 8.507,00 para cirurgia e em R$ 11.000,00 para o ADO. A RCEI foi calculada em R$ 71.380,00 por ano de vida ganho. Uma análise de limiar demonstrou que a redução do valor do conjunto completo do ADO em R$ 492,65 traria a RCEI para o limiar aceitável para incorporação ao SUS nos dias de hoje. Conclusões: O tratamento percutâneo apresentou morbidade e tempo de internação menores, além de efetividade incremental semelhante àquela do tratamento cirúrgico. Com os...

Background: Patent ductus arteriosus (PDA) is a relatively common congenital heart disease and the alternatives for the treatment of PDA > 2.5 mm are surgery or percutaneous occlusion with plugs. The latter, although considered the method of choice, are not provided by the Brazilian National Health System (Sistema Único de Saúde - SUS). Our objective was to compare the incremental cost-effectiveness ratio (ICER) of both strategies. Methods: Systematic review of clinical outcomes and development of a decision-making algorithm to evaluate the ICER of AmplatzerTM Duct Occluder (ADO) vs. surgical treatment for the closure of PDA. Costs for both methods were calculated based on the reimbursement figures paid by the SUS in 2010 and the cost of the percutaneous kit (device + support materials) was estimated at R$ 10,000.00. We used as a threshold the willingness to pay the equivalent of three times the Brazilian Gross Domestic Product, i.e., R$ 57,000.00 per year of life saved. Results: Both techniques were safe and effective with less morbidity and shorter hospitalization time for percutaneous closure. Adjusted life expectancy was similar in both groups, and slightly better for the ADO group. Total cost was calculated as R$ 8,507 for surgery and R$ 11,000.00 for ADO. ICER was calculated as R$ 71,380.00 per year of life saved. A threshold analysis showed that a reduction of R$ 492.65 in the cost of the ADO kit would reduce the ICER to an acceptable value for the incorporation of this technology by the SUS. Conclusions: Percutaneous occlusion was associated with less morbidity and shorter hospital stay with similar incremental effectiveness when compared to the surgical treatment. With the direct costs used in this study and considering that the entire population with PDA is treated with the ADO, percutaneous occlusion was less cost-effective. However, a slight reduction in the costs of the percutaneous kit would result...