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Zimmermann IR, Alves Fernandes RR, Santos da Costa MG, Pinto M, Peixoto HM. Simulation-based economic evaluation of the Wolbachia method in Brazil: a cost-effective strategy for dengue control. LANCET REGIONAL HEALTH. AMERICAS 2024; 35:100783. [PMID: 38911346 PMCID: PMC11190723 DOI: 10.1016/j.lana.2024.100783] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 05/01/2024] [Accepted: 05/10/2024] [Indexed: 06/25/2024]
Abstract
Background Dengue virus (DENV) is an arbovirus transmitted by Aedes aegypti mosquitoes, which can cause severe conditions such as hemorrhagic fever and dengue shock syndrome. These conditions are associated with adverse social, clinical, and economic consequences in Brazil. Herein, the Wolbachia mosquito replacement method is a promising dengue control strategy. Methods We estimated the economic impact of implementing the Wolbachia mosquito replacement method in seven Brazilian cities. A mathematical microsimulation model tracked nearly 23 million inhabitants over a 20-year period, considering the transitions between five different health states (susceptible, inapparent, outpatient, hospitalised and death). Direct costs included local dengue control programs, Wolbachia implementation and dengue care. Indirect costs related to death and productivity loss, as well as disability-adjusted life-years (DALY) averted were also considered. Findings Without Wolbachia, the model projected 1,762,688 reported dengue cases over 20 years. Implementing the Wolbachia method would avert at least 1,295,566 dengue cases, resulting in lower costs and greater effectiveness in all simulated cities. On average, for every 1000 inhabitants followed for 20 years, the Wolbachia method yielded a cost difference of USD 538,233.68 (BRL 2,691,168.40) and averted 5.56 DALYs. Net monetary benefits (NMB) were positive in all seven cities, ranging from USD 110.72 (BRL 553.59) to USD 1399.19 (BRL 6995.95) per inhabitant. Alternative scenarios have also shown a favourable return on investment with a positive benefit-cost ratio (BCR). Interpretation Wolbachia is likely a cost-effective strategy in the Brazilian context, consistent with international studies. Sensitivity analysis and alternative scenarios confirmed the robustness of the results. Funding This study was funded by the Wellcome Trust under a grant (224459/Z/21/Z).
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Affiliation(s)
| | | | | | - Márcia Pinto
- Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Gogayeva OK. Algorithms of Perioperative Management of High-Risk Cardiac Surgery Patients with Coronary Artery Disease and Polymorbidity. UKRAINIAN JOURNAL OF CARDIOVASCULAR SURGERY 2023. [DOI: 10.30702/ujcvs/23.31(01)/g005-1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
The aim. To analyze the effectiveness of the developed algorithms for the perioperative management of high-risk cardiac surgery patients with coronary artery disease (CAD) and polymorbidity.
Materials and methods. We analyzed perioperative management of 354 high-risk cardiac surgery patients with CAD with EuroSCORE II predicted mortality >5%, among which 194 (54.8%) underwent isolated coronary artery bypass grafting, and 160 (45.2%) had surgical myocardial revascularization with accompanying valvular pathology correction or left ventricular postinfarction aneurysm resection. All the patients were discharged after cardiac surgery performed at the Department of Surgical Treatment of CAD of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 2009 to 2019. As part of the study, general clinical examinations, electrocardiography, echocardiography, coronary angiography, cardiosurgical treatment were provided, and perioperative patient management protocols were developed and implemented.
Results. Based on the conducted detailed analysis, it was established that the success of surgical revascularization of the myocardium depends not only on cardiac factors, but also on the compensation of concomitant diseases, the work of an experienced cardiac team consisting of a cardiologist, an interventionist, an anesthesiologist, a cardiac surgeon, and an intensivist. Treatment and prevention measures should be personalized and aimed at timely response to changes in laboratory and hemodynamic indicators of patients at all stages of their management, as well as stabilization of concomitant diseases. An important point in the preoperative preparation of cardiac surgery patients is verification of concomitant diseases with the aim of their timely compensation. The implemented algorithm for searching for comorbid conditions made it possible to improve the diagnosis of initial disorders of glucose metabolism, abnormal uric acid levels and cerebrovascular disease. Lowering the glucose level according to the developed algorithm of management of patients with impaired glucose metabolism in the perioperative period made it possible to reduce the number of postoperative wound infections by 3.4% and arrhythmological complications by 19.4%. Correction of drug therapy taking into account the glomerular filtration rate made it possible to avoid postoperative hemodialysis. Preventive prescription of therapeutic doses of proton pump inhibitors against the background of dual antiplatelet therapy, according to the developed protocol, led to a decrease in postoperative gastroduodenal complications from 5.1% to 0.3%.
Conclusions. Implementation of the system of personalized treatment and preventive management of patients in the perioperative period made it possible to reduce postoperative complications from 16.7% to 4% (p=0.0190).
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Kuper H, Lyra TM, Moreira MEL, de Albuquerque MDSV, de Araújo TVB, Fernandes S, Jofre-Bonet M, Larson H, Lopes de Melo AP, Mendes CHF, Moreira MCN, do Nascimento MAF, Penn-Kekana L, Pimentel C, Pinto M, Simas C, Valongueiro S. Social and economic impacts of congenital Zika syndrome in Brazil: Study protocol and rationale for a mixed-methods study. Wellcome Open Res 2019; 3:127. [PMID: 31667356 PMCID: PMC6807146 DOI: 10.12688/wellcomeopenres.14838.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2019] [Indexed: 12/22/2022] Open
Abstract
Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes-congenital Zika syndrome (CZS)-and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback. A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Tereza Maciel Lyra
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil.,Faculty of Medicine, University of Pernambuco, Recife, Brazil
| | | | | | | | - Silke Fernandes
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Paula Lopes de Melo
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil.,Public Health Department, Federal University of Pernambuco, Recife, Brazil
| | | | | | | | - Loveday Penn-Kekana
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Marcia Pinto
- Fernando Figueira Maternal and Children's Institute, Rio de Janeiro, Brazil
| | - Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Valongueiro
- Postgraduate Programme in Public Health, Federal University of Pernambuco, Recife, Brazil
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4
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Kuper H, Lyra TM, Moreira MEL, de Albuquerque MDSV, de Araújo TVB, Fernandes S, Jofre-Bonet M, Larson H, Lopes de Melo AP, Mendes CHF, Moreira MCN, do Nascimento MAF, Penn-Kekana L, Pimentel C, Pinto M, Simas C, Valongueiro S. Social and economic impacts of congenital Zika syndrome in Brazil: Study protocol and rationale for a mixed-methods study. Wellcome Open Res 2019; 3:127. [PMID: 31667356 DOI: 10.12688/wellcomeopenres.14838.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2018] [Indexed: 11/20/2022] Open
Abstract
Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes-congenital Zika syndrome (CZS)-and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback. A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Tereza Maciel Lyra
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil.,Faculty of Medicine, University of Pernambuco, Recife, Brazil
| | | | | | | | - Silke Fernandes
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Paula Lopes de Melo
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil.,Public Health Department, Federal University of Pernambuco, Recife, Brazil
| | | | | | | | - Loveday Penn-Kekana
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Marcia Pinto
- Fernando Figueira Maternal and Children's Institute, Rio de Janeiro, Brazil
| | - Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Valongueiro
- Postgraduate Programme in Public Health, Federal University of Pernambuco, Recife, Brazil
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Silva GSD, Colósimo FC, Sousa AGD, Piotto RF, Castilho V. Coronary Artery Bypass Graft Surgery Cost Coverage by the Brazilian Unified Health System (SUS). Braz J Cardiovasc Surg 2017; 32:253-259. [PMID: 28977196 PMCID: PMC5613716 DOI: 10.21470/1678-9741-2016-0069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/22/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Cost management has been identified as an essential tool for the general
control and evaluation of health organizations. Objectives To identify the coverage percentage of transferred funds from the Unified
Health System for coronary artery bypass grafts in a philanthropic hospital
having a consolidated costing system in the municipality of São
Paulo. Methods A quantitative, descriptive and cross-sectional research with information
provided from a database composed of 1913 patients undergoing coronary
artery bypass graft from March 13 to September 30, 2012, including isolated
elective coronary artery bypass graft with the use of extracorporeal
circulation. It excluded 551 (28.8%) patients, among them 76 (4.0%) deaths
and 8 hospitalized patients, since the cost was compared according to the
length of hospital stay. Therefore, the sample consisted of 1362
patients. Results The average total cost per patient was $7,992.55. The average fund transfer
by the Unified Health System was $3,450.73 (48.66%), resulting in a deficit
of $4,541.82 (51.34%). Conclusion The Unified Health System transfers covered 48.66% of the average total cost
of hospitalization. Although the amount transferred increased with
increasing costs, it was not proportional to the total cost, resulting in a
percentage difference in revenue that was increasingly negative for each
increase in cost and hospital stay. Those hospitalized for longer than seven
days presented higher costs, older age, higher percentage of diabetics and
chronic kidney disease patients and more postoperative complications.
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Affiliation(s)
- Gilmara Silveira da Silva
- Real e Benemérita Associação Portuguesa de Beneficência (Hospital Beneficência Portuguesa de São Paulo), São Paulo, SP, Brazil
| | - Flávia Cortez Colósimo
- Real e Benemérita Associação Portuguesa de Beneficência (Hospital Beneficência Portuguesa de São Paulo), São Paulo, SP, Brazil
| | - Alexandre Gonçalves de Sousa
- Real e Benemérita Associação Portuguesa de Beneficência (Hospital Beneficência Portuguesa de São Paulo), São Paulo, SP, Brazil
| | - Raquel Ferrari Piotto
- Real e Benemérita Associação Portuguesa de Beneficência (Hospital Beneficência Portuguesa de São Paulo), São Paulo, SP, Brazil
| | - Valéria Castilho
- Escola de Enfermagem da Universidade de São Paulo (EE-USP), São Paulo, SP, Brazil
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Arthur CPS, Mejia OAV, Osternack D, Nakazone MA, Goncharov M, Lisboa LAF, Dallan LAO, Pomerantzeff PMA, Jatene FB. Do We Need to Personalize Renal Function Assessment in the Stratification of Patients Undergoing Cardiac Surgery? Arq Bras Cardiol 2017; 109:290-298. [PMID: 28876374 PMCID: PMC5644208 DOI: 10.5935/abc.20170129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/29/2017] [Indexed: 11/29/2022] Open
Abstract
Background Renal dysfunction is an independent predictor of morbidity and mortality in
cardiac surgery. For a better assessment of renal function, calculation of
creatinine clearance (CC) may be necessary. Objective To objectively evaluate whether CC is a better risk predictor than serum
creatinine (SC) in patients undergoing cardiac surgery. Methods Analysis of 3,285 patients registered in a prospective, consecutive and
mandatory manner in the Sao Paulo Registry of Cardiovascular Surgery
(REPLICCAR) between November 2013 and January 2015. Values of SC, CC
(Cockcroft-Gault) and EuroSCORE II were obtained. Association analysis of SC
and CC with morbidity and mortality was performed by calibration and
discrimination tests. Independent multivariate models with SC and CC were
generated by multiple logistic regression to predict morbidity and mortality
following cardiac surgery. Results Despite the association between SC and mortality, it did not calibrate
properly the risk groups. There was an association between CC and mortality
with good calibration of risk groups. In mortality risk prediction, SC was
uncalibrated with values > 1.35 mg /dL (p < 0.001). The ROC curve
showed that CC is better than SC in predicting both morbidity and mortality
risk. In the multivariate model without CC, SC was the only predictor of
morbidity, whereas in the model without SC, CC was not only a mortality
predictor, but also the only morbidity predictor. Conclusion Compared with SC, CC is a better parameter of renal function in risk
stratification of patients undergoing cardiac surgery.
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Affiliation(s)
- Camila P S Arthur
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Omar A V Mejia
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Diogo Osternack
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Maxim Goncharov
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz A F Lisboa
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luís A O Dallan
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pablo M A Pomerantzeff
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fabio B Jatene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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