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Cardoso MMDA, Machado-Rugolo J, Thabane L, da Rocha NC, Barbosa AMP, Komoda DS, de Almeida JTC, Curado DDSP, Weber SAT, de Andrade LGM. Application of natural language processing to predict final recommendation of Brazilian health technology assessment reports. Int J Technol Assess Health Care 2024; 40:e19. [PMID: 38605654 DOI: 10.1017/s0266462324000163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Health technology assessment (HTA) plays a vital role in healthcare decision-making globally, necessitating the identification of key factors impacting evaluation outcomes due to the significant workload faced by HTA agencies. OBJECTIVES The aim of this study was to predict the approval status of evaluations conducted by the Brazilian Committee for Health Technology Incorporation (CONITEC) using natural language processing (NLP). METHODS Data encompassing CONITEC's official report summaries from 2012 to 2022. Textual data was tokenized for NLP analysis. Least Absolute Shrinkage and Selection Operator, logistic regression, support vector machine, random forest, neural network, and extreme gradient boosting (XGBoost), were evaluated for accuracy, area under the receiver operating characteristic curve (ROC AUC) score, precision, and recall. Cluster analysis using the k-modes algorithm categorized entries into two clusters (approved, rejected). RESULTS The neural network model exhibited the highest accuracy metrics (precision at 0.815, accuracy at 0.769, ROC AUC at 0.871, and recall at 0.746), followed by XGBoost model. The lexical analysis uncovered linguistic markers, like references to international HTA agencies' experiences and government as demandant, potentially influencing CONITEC's decisions. Cluster and XGBoost analyses emphasized that approved evaluations mainly concerned drug assessments, often government-initiated, while non-approved ones frequently evaluated drugs, with the industry as the requester. CONCLUSIONS NLP model can predict health technology incorporation outcomes, opening avenues for future research using HTA reports from other agencies. This model has the potential to enhance HTA system efficiency by offering initial insights and decision-making criteria, thereby benefiting healthcare experts.
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Affiliation(s)
- Marilia Mastrocolla de Almeida Cardoso
- Health Technology Assessment Unit, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, Brazil
- Laboratory of Data Science and Predictive Analysis in Health, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, Brazil
| | - Juliana Machado-Rugolo
- Health Technology Assessment Unit, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, Brazil
- Laboratory of Data Science and Predictive Analysis in Health, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, Brazil
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Naila Camila da Rocha
- Laboratory of Data Science and Predictive Analysis in Health, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, Brazil
| | - Abner Mácula Pacheco Barbosa
- Laboratory of Data Science and Predictive Analysis in Health, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, Brazil
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Medical School (FMB) of São Paulo State University, Botucatu, Brazil
| | | | - Juliana Tereza Coneglian de Almeida
- Health Technology Assessment Unit, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, Brazil
- Laboratory of Data Science and Predictive Analysis in Health, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, Brazil
| | - Daniel da Silva Pereira Curado
- Department of Management and Incorporation of Health Technologies, Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Silke Anna Theresa Weber
- Health Technology Assessment Unit, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, Brazil
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Medical School (FMB) of São Paulo State University, Botucatu, Brazil
| | - Luis Gustavo Modelli de Andrade
- Laboratory of Data Science and Predictive Analysis in Health, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, Brazil
- Department of Internal Medicine, Medical School (FMB) of São Paulo State University, Botucatu, Brazil
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de Almeida Cardoso MM, Thabane L, Romeiro FG, Silva GF, Machado-Rugolo J, Fonseca AF, Dos Santos WM, de Almeida JTC, Thavorn K, Tarride JE. Economic evaluation of non-invasive liver tests for the diagnosis of liver fibrosis in chronic liver diseases: a systematic review protocol. JBI Evid Synth 2024; 22:681-688. [PMID: 37789815 DOI: 10.11124/jbies-23-00097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE The objective of this review is to determine the costs and benefits of non-invasive liver tests vs liver biopsy in patients with chronic liver diseases. INTRODUCTION Hepatic diseases can lead to liver fibrosis, cirrhosis, and hepatocellular carcinoma. In the past, liver biopsy was the only option for diagnosing fibrosis degree. Liver biopsy is an invasive procedure that depends on the sample size to be able to deliver an accurate diagnosis. In recent years, non-invasive liver tests have been increasingly used to estimate liver fibrosis degree; however, there is a lack of economic assessments of technology implementation outcomes. INCLUSION CRITERIA This review will include partial (cost studies) and complete economic evaluation studies on hepatitis B, hepatitis C, alcoholic liver disease, and non-alcoholic fatty liver disease that compare non-invasive liver tests with liver biopsies. Studies published in English, French, Spanish, German, Italian, or Portuguese will be included. No date limits will be applied to the search. METHODS This review will identify published and unpublished studies. Published studies will be identified using MEDLINE (PubMed), Cochrane Library (CENTRAL), Embase, Web of Science, Scopus, and LILACS. Sources of unpublished studies and gray literature will include sources from health technology assessment agencies, clinical practice guidelines, regulatory approvals, advisories and warnings, and clinical trial registries, as well as Google Scholar. Two independent reviewers will screen and assess studies, and extract and critically appraise the data. Data extracted from the included studies will be analyzed and summarized to address the review objective using narrative text, and the JBI dominance ranking matrix. REVIEW REGISTRATION PROSPERO CRD42023404278.
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Affiliation(s)
- Marilia Mastrocolla de Almeida Cardoso
- Health Technology Assessment Center, Hospital das Clínicas of Medical School (FMB), HCFMB, Botucatu, SP, Brazil
- The Brazilian Centre for Evidence-based Healthcare: A JBI Centre of Excellence, University of São Paulo, São Paulo, Brazil
| | - Lehana Thabane
- McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, ON, Canada
- St Joseph's Healthcare Hamilton, Biostatistics Unit, Hamilton, ON, Canada
- University of Johannesburg, Faculty of Health Sciences, Johannesburg, South Africa
| | - Fernando Gomes Romeiro
- São Paulo State University, Medical School (FMB), Department of Internal Medicine, Botucatu, SP, Brazil
| | - Giovanni Faria Silva
- São Paulo State University, Medical School (FMB), Department of Internal Medicine, Botucatu, SP, Brazil
| | - Juliana Machado-Rugolo
- Health Technology Assessment Center, Hospital das Clínicas of Medical School (FMB), HCFMB, Botucatu, SP, Brazil
| | - Alan Francisco Fonseca
- Health Technology Assessment Center, Hospital das Clínicas of Medical School (FMB), HCFMB, Botucatu, SP, Brazil
| | - Wendel Mombaque Dos Santos
- The Brazilian Centre for Evidence-based Healthcare: A JBI Centre of Excellence, University of São Paulo, São Paulo, Brazil
| | | | - Kednapa Thavorn
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jean-Eric Tarride
- McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Cananda
- Programs for Assessment of Technology in Health (PATH), The Research Institute of St Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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Luz PDO, de Souza AA, Boska GDA, Cardoso MMDA, Candido BDP, de Oliveira MAF. Nursing experiences in specialized services in child and adolescent mental health: a systematic review of qualitative studies. Rev Bras Enferm 2023; 76Suppl 2:e20220550. [PMID: 38088654 PMCID: PMC10704658 DOI: 10.1590/0034-7167-2022-0550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/14/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE to synthesize evidence from qualitative studies on nursing experiences regarding child and adolescent mental health care in specialized services. METHOD a systematic review with meta-synthesis of qualitative studies according to JBI guidelines. CINAHL, EMBASE, MEDLINE, LILACS, PSYCinfo, Scopus and Web of Science databases were used. The findings were classified according to the level of reliability and credibility and categorized by similarity between contents. RESULTS 229 articles were identified, and five were included in the final sample and organized into the categories: Emotional impact; and Understanding nursing role. The level of evidence found was moderate. FINAL CONSIDERATIONS nursing experiences are permeated by emotional exhaustion, feelings of frustration and difficulty in understanding their professional role. The need for training spaces that qualify this care is highlighted.
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Addad VV, Palma LMP, Vaisbich MH, Pacheco Barbosa AM, da Rocha NC, de Almeida Cardoso MM, de Almeida JTC, de Paula de Sordi MA, Machado-Rugolo J, Arantes LF, de Andrade LGM. A comprehensive model for assessing and classifying patients with thrombotic microangiopathy: the TMA-INSIGHT score. Thromb J 2023; 21:119. [PMID: 37993892 PMCID: PMC10664252 DOI: 10.1186/s12959-023-00564-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Thrombotic Microangiopathy (TMA) is a syndrome characterized by the presence of anemia, thrombocytopenia and organ damage and has multiple etiologies. The primary aim is to develop an algorithm to classify TMA (TMA-INSIGHT score). METHODS This was a single-center retrospective cohort study including hospitalized patients with TMA at a single center. We included all consecutive patients diagnosed with TMA between 2012 and 2021. TMA was defined based on the presence of anemia (hemoglobin level < 10 g/dL) and thrombocytopenia (platelet count < 150,000/µL), signs of hemolysis, and organ damage. We classified patients in eight categories: infections; Malignant Hypertension; Transplant; Malignancy; Pregnancy; Thrombotic Thrombocytopenic Purpura (TTP); Shiga toxin-mediated hemolytic uremic syndrome (STEC-SHU) and Complement Mediated TMA (aHUS). We fitted a model to classify patients using clinical characteristics, biochemical exams, and mean arterial pressure at presentation. RESULTS We retrospectively retrieved TMA phenotypes using automatic strategies in electronic health records in almost 10 years (n = 2407). Secondary TMA was found in 97.5% of the patients. Primary TMA was found in 2.47% of the patients (TTP and aHUS). The best model was LightGBM with accuracy of 0.979, and multiclass ROC-AUC of 0.966. The predictions had higher accuracy in most TMA classes, although the confidence was lower in aHUS and STEC-HUS cases. CONCLUSION Secondary conditions were the most common etiologies of TMA. We retrieved comorbidities, associated conditions, and mean arterial pressure to fit a model to predict TMA and define TMA phenotypic characteristics. This is the first multiclass model to predict TMA including primary and secondary conditions.
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Affiliation(s)
- Vanessa Vilani Addad
- Department of Internal Medicine - UNESP, Univ Estadual Paulista, Rubião Jr, s/n, Botucatu/SP, 18618-687, Brazil
| | - Lilian Monteiro Pereira Palma
- Department of Pediatrics, Universidade Estadual de Campinas, R. Tessália Vieira de Camargo, 126 - Cidade Universitária, Campinas/SP, 13083-887, Brazil
| | - Maria Helena Vaisbich
- Pediatric Nephrology Service, Child Institute, University of São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, São Paulo, SP, 05403-000, Brazil
| | | | - Naila Camila da Rocha
- Department of Internal Medicine - UNESP, Univ Estadual Paulista, Rubião Jr, s/n, Botucatu/SP, 18618-687, Brazil
| | | | | | | | - Juliana Machado-Rugolo
- Health Technology Assessment Center of Hospital das Clínicas - HCFMB, Botucatu, SP, Brazil
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Minato ACDS, Hannun PGC, Barbosa AMP, da Rocha NC, Machado-Rugolo J, Cardoso MMDA, de Andrade LGM. Machine Learning Model to Predict Graft Rejection After Kidney Transplantation. Transplant Proc 2023; 55:2058-2062. [PMID: 37730451 DOI: 10.1016/j.transproceed.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/07/2023] [Accepted: 07/04/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND There are few predictive studies about early posttransplant outcomes taking into account baseline and posttransplant variables. The objective of this study was to create a predictive model for 30-day graft rejection using machine learning techniques. METHODS Retrospective study with 1255 patients undergoing transplant from living and deceased donors at a tertiary health service in Brazil. Recipient, donor, transplantation, and postoperative period data were collected from physical and electronic records. We split the data into derivation (training) and validation (test) datasets. Five supervised machine learning algorithms were developed with this subset of variables in the training set: Simple Logistic Regression, Lasso, Multilayer Perceptron, XGBoost, and Light GBM. RESULTS There were 147 (12.48%) cases of graft rejection within 30 days of transplantation. The best model was XGBoost (accuracy, 0.839; receiver operating characteristic area under the curve, 0.715; precision, 0.900). The model showed that deceased donor transplantation, glomerulopathy as an underlying disease, and donor's use of vasoactive drugs had more than 20% importance as rejection risk factors. The variables with the greatest predictive values were thymoglobulin induction and delayed graft function. CONCLUSIONS We fitted a machine learning model to predict 30-day graft rejection after kidney transplantation that reaches a higher accuracy and precision. Machine learning models could contribute to predicting kidney survival using nontraditional approaches.
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Affiliation(s)
| | | | - Abner Macola Pacheco Barbosa
- Department of Internal Medicine, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Botucatu, Brazil
| | - Naila Camila da Rocha
- Department of Internal Medicine, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Botucatu, Brazil
| | - Juliana Machado-Rugolo
- Health Technology Assessment Center (NATS), Clinical Hospital of Botucatu Medical School (HCFMB), São Paulo State University (UNESP), Botucatu, Brazil
| | - Marilia Mastrocolla de Almeida Cardoso
- Department of Internal Medicine, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Botucatu, Brazil; Health Technology Assessment Center (NATS), Clinical Hospital of Botucatu Medical School (HCFMB), São Paulo State University (UNESP), Botucatu, Brazil
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Cardoso MMDA, Thabane L, Andrade LGMD, Curado DDSP, Komoda DS, Machado-Rugolo J, Lima SAM, Weber SAT. Exploring the COVID-19 Pandemic's Impact on the Health Technology Assessment Process of the National Commission for the Incorporation of Technologies Into the Brazilian Health System. Value Health Reg Issues 2023; 37:18-22. [PMID: 37196546 PMCID: PMC10184570 DOI: 10.1016/j.vhri.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVES This study aimed to evaluate the impact of the COVID-19 pandemic on Brazilian health technology assessment processes based on public reports from the National Committee for Health Technology Incorporation (CONITEC). METHODS This descriptive study analyzed CONITEC's official reports on Brazil available on its website between 2018 and 2021 that aimed to propose recommendations for technologies to be incorporated into its public healthcare system. We used descriptive statistics covering the number of technologies and number of reports about drugs per year, objective, type of technology, demanding sector, and outcome before 2018 to 2019 and during the COVID-19 pandemic (2020-2021). Furthermore, we used logistic regression to explore any association between the final decision labeled as "incorporated" and the emergence of the COVID-19 pandemic. RESULTS A total of 278 reports were analyzed. Approximately 85% (136 of 278), 79% (220 of 278), and 45% of the reports (125 of 278) were about drugs, for incorporation, and requested by the government, respectively. Moreover, 74 of 130 (57%) and 56 of 148 decisions (38%) were "incorporated" before and during the pandemic, respectively. No significant association was noted between incorporated decisions and the arrival of the COVID-19 pandemic for all technologies (odds ratio 1.43; 95% CI 0.84-2.46; P = .192) and for drugs (odds ratio 1.43; 95% confidence interval 0.81-2.53; P = .223) while adjusting for the type of technology and demandant. CONCLUSIONS The COVID-19 pandemic has brought many challenges, but it does not seem to have had a significant impact on the health technology assessment approval decisions of CONITEC in Brazil.
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Affiliation(s)
- Marilia Mastrocolla de Almeida Cardoso
- Health Technology Assessment Center, Hospital das Clínicas of Medical School (HCFMB), Brazil, São Paulo, Botucatu; Graduate Nursing Program, São Paulo State University, Brazil, São Paulo, Botucatu; Data Science and Predictive Analysis in Health Laboratory, Hospital das Clínicas of Medical School (HCFMB), Brazil, São Paulo, Botucatu.
| | - Lehana Thabane
- Graduate Nursing Program, São Paulo State University, Brazil, São Paulo, Botucatu; Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada, Ontario, Hamilton; Biostatistics Unit, St Joseph's Healthcare Hamilton, Canada, Ontario, Hamilton; Faculty of Health Sciences, University of Johannesburg, South Africa, Johannesburg
| | - Luis Gustavo Modelli de Andrade
- Data Science and Predictive Analysis in Health Laboratory, Hospital das Clínicas of Medical School (HCFMB), Brazil, São Paulo, Botucatu; Department of Internal Medicine, São Paulo State University, Brazil, São Paulo, Botucatu
| | - Daniel da Silva Pereira Curado
- Department of Management and Incorporation of Health Technologies, Ministry of Health, Brazil, Federal District, Brasilia
| | - Denis Satoshi Komoda
- Department of Collective Health, University of Campinas, Brazil, São Paulo, Campinas
| | - Juliana Machado-Rugolo
- Health Technology Assessment Center, Hospital das Clínicas of Medical School (HCFMB), Brazil, São Paulo, Botucatu; Data Science and Predictive Analysis in Health Laboratory, Hospital das Clínicas of Medical School (HCFMB), Brazil, São Paulo, Botucatu
| | - Silvana Andrea Molina Lima
- Health Technology Assessment Center, Hospital das Clínicas of Medical School (HCFMB), Brazil, São Paulo, Botucatu; Nursing Department, São Paulo State University, Brazil, São Paulo, Botucatu
| | - Silke Anna Theresa Weber
- Health Technology Assessment Center, Hospital das Clínicas of Medical School (HCFMB), Brazil, São Paulo, Botucatu; Department of Ophthalmology, Otorhinolaryngology and Head & Neck Surgery, São Paulo State University, Brazil, São Paulo, Botucatu
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Ponce D, Cardoso MMDA, Rúgolo JRM, Molina SA, de Andrade LGM, Curado DDSP. Cost-effectiveness analysis of cinacalcet vs. paricalcitol in the treatment of hyperparathyroidism secondary to chronic kidney disease. J Bras Nefrol 2023; 45:365-372. [PMID: 37015047 PMCID: PMC10697162 DOI: 10.1590/2175-8239-jbn-2022-0126en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/02/2023] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION For the reduction of PTH levels, two classes of drugs are available in the Brazilian market: non-selective and selective vitamin D receptor activators and calcimimetics. Among the mentioned drugs, the SUS provides oral calcitriol, paricalcitol and cinacalcet. OBJECTIVES Develop cost-effectiveness (CE) and budgetary impact (BI) analysis of cinacalcet versus paricalcitol for patients on dialysis with SHPT, from the perspective of SUS. METHODOLOGY A decision tree model was constructed for CE analysis, which considered the outcome of avoided parathyroidectomy and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of which was measured demand and other epidemiological, based on data from the Brazilian Society of Nephrology (BSN). RESULTS The CE analysis showed that the use of cinacalcet results in one-off savings of R$1,394.64 per year and an incremental effectiveness of 0.08, in relation to avoided parathyroidectomy. The incremental CE ratio (ICER) was - R$ 17,653.67 per avoided parathyroidectomy for cinacalcet, as it was more effective and cheaper compared to paricalcitol. As for the BI analysis, it was estimated that the incremental BI with the expansion of the use of cinacalcet in the SUS will be between - R$ 1,640,864.62 and R$ 166,368.50 in the first year, considering the main and the epidemiological scenarios. At the end of 5 years after the expansion of use, an BI was estimated between - R$ 10,740,743.86 and - R$ 1,191,339.37; considering the same scenarios. CONCLUSION Cinacalcet was dominant to avoid parathyroidectomies, being cost-effective.
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Affiliation(s)
- Daniela Ponce
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina, Hospital das Clínicas, Núcleo de Avaliação de Tecnologia em Saúde,
Botucatu, SP, Brazil
| | - Marilia Mastrocolla de Almeida Cardoso
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina, Hospital das Clínicas, Núcleo de Avaliação de Tecnologia em Saúde,
Botucatu, SP, Brazil
| | - Juliana Rodrigues Machado Rúgolo
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina, Hospital das Clínicas, Núcleo de Avaliação de Tecnologia em Saúde,
Botucatu, SP, Brazil
| | - Silvana Andrea Molina
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina, Hospital das Clínicas, Núcleo de Avaliação de Tecnologia em Saúde,
Botucatu, SP, Brazil
| | - Luis Gustavo Modelli de Andrade
- Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de
Medicina, Hospital das Clínicas, Núcleo de Avaliação de Tecnologia em Saúde,
Botucatu, SP, Brazil
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de Andrade LGM, Barbosa AMP, da Rocha NC, de Almeida Cardoso MM, de Almeida JTC, Machado-Rugolo J, Arantes LF, Pontes DFS, Ferreira GF. Impact of the COVID-19 Pandemic on Solid Organ Transplant and Rejection Episodes in Brazil's Unified Healthcare System. J Clin Med 2022; 11:6581. [PMID: 36362809 PMCID: PMC9658443 DOI: 10.3390/jcm11216581] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Brazil has the world's largest public organ transplant program, which was severely affected by the COVID-19 pandemic. The primary aim of the study was to evaluate differences in solid organ transplants and rejection episodes during the COVID-19 pandemic compared to the five years before the pandemic in the country. METHODS A seven-year database was built by downloading data from the DATASUS server. The pandemic period was defined as March 2020 to December 2021. The pre-pandemic period was from January 2015 to March 2020. RESULTS During the pandemic, the number of solid organ transplants decreased by 19.3% in 2020 and 22.6% in 2021 compared to 2019. We found a decrease for each evaluated organ, which was more pronounced for lung, pancreas, and kidney transplants. The seasonal plot of rejection data indicated a high rejection rate between 2018 and 2021. There was also an 18% (IRR 1.18 (95% CI 1.01 to 1.37), p = 0.04) increase in the rejection rate during the COVID-19 pandemic. CONCLUSIONS The total number of organ transplants performed in 2021 represents a setback of six years. Transplant procedures were concentrated in the Southeast region of the country, and a higher proportion of rejections occurred during the pandemic. Together, these findings could have an impact on transplant procedures and outcomes in Brazil.
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Affiliation(s)
- Luis Gustavo Modelli de Andrade
- Department of Internal Medicine—UNESP, Univ Estadual Paulista, Av. Prof. Montenegro—Distrito de, Rubião Jr., s/n, Botucatu 18618-687, SP, Brazil
| | - Abner Macola Pacheco Barbosa
- Department of Internal Medicine—UNESP, Univ Estadual Paulista, Av. Prof. Montenegro—Distrito de, Rubião Jr., s/n, Botucatu 18618-687, SP, Brazil
| | - Naila Camila da Rocha
- Department of Internal Medicine—UNESP, Univ Estadual Paulista, Av. Prof. Montenegro—Distrito de, Rubião Jr., s/n, Botucatu 18618-687, SP, Brazil
| | | | | | - Juliana Machado-Rugolo
- Health Technology Assessment Center Hospital das Clínicas—HCFMB, Botucatu 18618-970, SP, Brazil
| | - Lucas Frederico Arantes
- Health Technology Assessment Center Hospital das Clínicas—HCFMB, Botucatu 18618-970, SP, Brazil
| | - Daniela Ferreira Salomão Pontes
- Department of Internal Medicine—UNESP, Univ Estadual Paulista, Av. Prof. Montenegro—Distrito de, Rubião Jr., s/n, Botucatu 18618-687, SP, Brazil
| | - Gustavo Fernandes Ferreira
- Transplant Unit—Santa Casa Juiz de Fora, Av. Barão do Rio Branco, 3353-Passos, Juiz de Fora 36021-630, MG, Brazil
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Souza-Silva MVR, Ziegelmann PK, Nobre V, Gomes VMR, Etges APBDS, Schwarzbold AV, Nunes AGS, Maurílio ADO, Scotton ALBA, Costa ASDM, Glaeser AB, Farace BL, Ribeiro BN, Ramos CM, Cimini CCR, de Carvalho CA, Rempel C, Silveira DV, Carazai DDR, Ponce D, Pereira EC, Kroger EMS, Manenti ERF, Cenci EPDA, Lucas FB, dos Santos FC, Anschau F, Botoni FA, Aranha FG, de Aguiar FC, Bartolazzi F, Crestani GP, Vietta GG, Nascimento GF, Noal HC, Duani H, Vianna HR, Guimarães HC, de Alvarenga JC, Chatkin JM, de Morais JDP, Carvalho JDSN, Rugolo JM, Ruschel KB, Gomes LDBW, de Oliveira LS, Zandoná LB, Pinheiro LS, Pacheco LS, Menezes LDSM, Sousa LDD, de Moura LCS, Santos LEA, Nasi LA, Cabral MADS, Floriani MA, Souza MD, Carneiro M, de Godoy MF, Cardoso MMDA, Nogueira MCA, Lima MOSDS, de Figueiredo MP, Guimarães-Júnior MH, Sampaio NDCS, de Oliveira NR, Andrade PGS, Assaf PL, Martelli PJDL, Martins RC, Valacio RA, Pozza R, Menezes RM, Mourato RLS, de Abreu RM, Silva RDF, Francisco SC, Guimarães SMM, Araújo SF, Oliveira TF, Kurtz T, Fereguetti TO, de Oliveira TC, Ribeiro YCNMB, Ramires YC, Polanczyk CA, Marcolino MS. Hospital characteristics associated with COVID-19 mortality: data from the multicenter cohort Brazilian Registry. Intern Emerg Med 2022; 17:2299-2313. [PMID: 36153772 PMCID: PMC9510333 DOI: 10.1007/s11739-022-03092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022]
Abstract
The COVID-19 pandemic caused unprecedented pressure over health care systems worldwide. Hospital-level data that may influence the prognosis in COVID-19 patients still needs to be better investigated. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with in-hospital mortality in COVID-19 patients admitted to Brazilian institutions. This multicenter retrospective cohort study is part of the Brazilian COVID-19 Registry. We enrolled patients ≥ 18 years old with laboratory-confirmed COVID-19 admitted to the participating hospitals from March to September 2020. Patients' data were obtained through hospital records. Hospitals' data were collected through forms filled in loco and through open national databases. Generalized linear mixed models with logit link function were used for pooling mortality and to assess the association between hospital characteristics and mortality estimates. We built two models, one tested general hospital characteristics while the other tested ICU characteristics. All analyses were adjusted for the proportion of high-risk patients at admission. Thirty-one hospitals were included. The mean number of beds was 320.4 ± 186.6. These hospitals had eligible 6556 COVID-19 admissions during the study period. Estimated in-hospital mortality ranged from 9.0 to 48.0%. The first model included all 31 hospitals and showed that a private source of funding (β = - 0.37; 95% CI - 0.71 to - 0.04; p = 0.029) and location in areas with a high gross domestic product (GDP) per capita (β = - 0.40; 95% CI - 0.72 to - 0.08; p = 0.014) were independently associated with a lower mortality. The second model included 23 hospitals and showed that hospitals with an ICU work shift composed of more than 50% of intensivists (β = - 0.59; 95% CI - 0.98 to - 0.20; p = 0.003) had lower mortality while hospitals with a higher proportion of less experienced medical professionals had higher mortality (β = 0.40; 95% CI 0.11-0.68; p = 0.006). The impact of those association increased according to the proportion of high-risk patients at admission. In-hospital mortality varied significantly among Brazilian hospitals. Private-funded hospitals and those located in municipalities with a high GDP had a lower mortality. When analyzing ICU-specific characteristics, hospitals with more experienced ICU teams had a reduced mortality.
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Affiliation(s)
- Maira Viana Rego Souza-Silva
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais Brazil
| | - Patricia Klarmann Ziegelmann
- grid.8532.c0000 0001 2200 7498Departament of Statistics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul Brazil
| | - Vandack Nobre
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais Brazil
| | - Virginia Mara Reis Gomes
- grid.411452.70000 0000 9898 6728Centro Universitário de Belo Horizonte (UniBH), Belo Horizonte, Minas Gerais Brazil
| | | | | | | | | | | | | | - Andressa Barreto Glaeser
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul Brazil
| | - Bárbara Lopes Farace
- grid.490178.3Hospital Risoleta Tolentino Neves, Belo Horizonte, Minas Gerais Brazil
| | | | | | | | | | - Claudete Rempel
- grid.441846.b0000 0000 9020 9633Universidade Do Vale Do Taquari, Lajeado, Rio Grande do Sul Brazil
| | | | | | - Daniela Ponce
- grid.410543.70000 0001 2188 478XMedical School, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, São Paulo Brazil
| | | | | | | | | | | | | | - Fernando Anschau
- grid.414914.dHospital Nossa Senhora da Conceição, Porto Alegre, Rio Grande do Sul Brazil
| | | | | | - Filipe Carrilho de Aguiar
- grid.411227.30000 0001 0670 7996University Hospital, Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
| | | | - Gabriela Petry Crestani
- grid.414871.f0000 0004 0491 7596Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul Brazil
| | | | | | - Helena Carolina Noal
- grid.488599.10000 0004 0481 6891Hospital Universitário de Santa Maria, Santa Maria, Rio Grande do Sul Brazil
| | - Helena Duani
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais Brazil
| | - Heloisa Reniers Vianna
- grid.419130.e0000 0004 0413 0953Faculdade de Ciências Médicas de Minas Gerais, University Hospital, Belo Horizonte, Minas Gerais Brazil
| | | | | | - José Miguel Chatkin
- grid.411379.90000 0001 2198 7041Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul Brazil
| | - Júlia Drumond Parreiras de Morais
- grid.419130.e0000 0004 0413 0953Faculdade de Ciências Médicas de Minas Gerais, University Hospital, Belo Horizonte, Minas Gerais Brazil
| | | | - Juliana Machado Rugolo
- grid.410543.70000 0001 2188 478XHospital das Clínicas da Faculdade de Medicina de Botucatu, Botucatu, São Paulo Brazil
| | - Karen Brasil Ruschel
- grid.414871.f0000 0004 0491 7596Hospital Mãe de Deus, Porto Alegre, Rio Grande do Sul Brazil
| | | | | | - Liege Barella Zandoná
- grid.441846.b0000 0000 9020 9633Universidade Do Vale Do Taquari, Lajeado, Rio Grande do Sul Brazil
| | - Lílian Santos Pinheiro
- grid.411287.90000 0004 0643 9823Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Teófilo Otoni, Minas Gerais Brazil
| | - Liliane Souto Pacheco
- grid.488599.10000 0004 0481 6891Hospital Universitário de Santa Maria, Santa Maria, Rio Grande do Sul Brazil
| | - Luanna da Silva Monteiro Menezes
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais Brazil
| | | | | | - Luisa Elem Almeida Santos
- grid.441942.e0000 0004 0490 8155Centro Universitário de Patos de Minas, Patos de Minas, Minas Gerais Brazil
| | - Luiz Antonio Nasi
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul Brazil
| | - Máderson Alvares de Souza Cabral
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais Brazil
| | - Maiara Anschau Floriani
- grid.414856.a0000 0004 0398 2134Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul Brazil
| | - Maíra Dias Souza
- Hospital Metropolitano Odilon Behrens, Belo Horizonte, Minas Gerais Brazil
| | - Marcelo Carneiro
- Hospital Santa Cruz, Santa Cruz do Sul, Rio Grande do Sul Brazil
| | - Mariana Frizzo de Godoy
- grid.411379.90000 0001 2198 7041Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, Rio Grande do Sul Brazil
| | | | | | | | | | | | | | - Neimy Ramos de Oliveira
- grid.452464.50000 0000 9270 1314Hospital Eduardo de Menezes, Belo Horizonte, Minas Gerais Brazil
| | | | - Pedro Ledic Assaf
- Hospital Metropolitano Doutor Célio de Castro, Belo Horizonte, Minas Gerais Brazil
| | | | | | | | - Roberta Pozza
- Hospital Tacchini, Bento Gonçalves, Rio Grande do Sul Brazil
| | | | | | | | | | | | | | | | | | - Tatiana Kurtz
- Hospital Santa Cruz, Santa Cruz do Sul, Rio Grande do Sul Brazil
| | | | | | | | | | - Carísi Anne Polanczyk
- Institute for Health Technology Assessment (IATS/ CNPq), Porto Alegre, Rio Grande do Sul Brazil
- grid.8532.c0000 0001 2200 7498Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul Brazil
| | - Milena Soriano Marcolino
- grid.8430.f0000 0001 2181 4888Medical School and University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, sala 246, Belo Horizonte, Minas Gerais Brazil
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Cardoso MMDA, Machado-Rugolo J, Lima SAM, Andrade LGMD, Curado DDSP, Ponce D. Cost-effectiveness analysis of intravenous paricalcitol vs. oral calcitriol in the treatment of hyperparathyroidism secondary to chronic kidney disease. J Bras Nefrol 2022; 45:95-101. [PMID: 35980102 PMCID: PMC10139708 DOI: 10.1590/2175-8239-jbn-2022-0049en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/20/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Hyperparathyroidism (SHPT) secondary to chronic kidney disease (CKD) is characterized by high levels of parathyroid hormone (PTH), hyperplasia of the parathyroid glands and cardiovascular disease. Selective and non-selective and selective vitamin D-receptor activators, calcimimetics, are available in the Brazilian market to reduce PTH levels. OBJECTIVES To develop a cost-effectiveness (C/E) and budgetary impact (BI) analysis of intravenous paricalcitol vs. oral calcitriol for patients on dialysis with SHPT, from the perspective of the Brazilian Public Health Care System (SUS). METHODOLOGY We built a decision-tree model to analyze C/E, which considered the outcome of avoided death and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of demand and one of epidemiological approach, based on data from the Brazilian Society of Nephrology. RESULTS The analysis showed that the C/E ratio was R$ 1,213.68 per year, and an incremental effectiveness of 0.032, referring to avoided death. The incremental C/E ratio was R$37,927.50 per death averted by paricalcitol. It was estimated that the incremental BI with the expansion of paricalcitol use will be between R$1,600,202.28 and R$4,128,565.65 in the first year, considering the main and epidemiological scenarios. At the end of 5 years after the expansion of its use, an incremental BI was estimated between R$ 48,596,855.50 and R$ 62,90,555.73. CONCLUSION Intravenous paricalcitol has superior efficacy and similar safety to oral calcitriol, reducing the overall mortality of dialysis patients, although it implies a higher cost.
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Affiliation(s)
- Marilia Mastrocolla de Almeida Cardoso
- Hospital das Clínicas da Faculdade de Medicina de Botucatu, Departamento de Gestão de Atividades Acadêmicas, Núcleo de Avaliação de Tecnologia em Saúde, Botucatu, SP, Brazil
| | - Juliana Machado-Rugolo
- Hospital das Clínicas da Faculdade de Medicina de Botucatu, Departamento de Gestão de Atividades Acadêmicas, Núcleo de Avaliação de Tecnologia em Saúde, Botucatu, SP, Brazil
| | - Silvana Andrea Molina Lima
- Hospital das Clínicas da Faculdade de Medicina de Botucatu, Departamento de Gestão de Atividades Acadêmicas, Núcleo de Avaliação de Tecnologia em Saúde, Botucatu, SP, Brazil
| | - Luis Gustavo Modelli de Andrade
- Hospital das Clínicas da Faculdade de Medicina de Botucatu, Departamento de Gestão de Atividades Acadêmicas, Núcleo de Avaliação de Tecnologia em Saúde, Botucatu, SP, Brazil
| | | | - Daniela Ponce
- Hospital das Clínicas da Faculdade de Medicina de Botucatu, Departamento de Gestão de Atividades Acadêmicas, Núcleo de Avaliação de Tecnologia em Saúde, Botucatu, SP, Brazil
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Cardoso MMDA, Machado-Rugolo J, Lima SAM, Andrade LGMD, Curado DDSP, Ponce D. Análise de custo-efetividade do paricalcitol intravenoso vs. calcitriol oral no tratamento do hiperparatireoidismo secundário à doença renal crônica. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-0049pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Introdução: O hiperparatireoidismo secundário (HPTS) à doença crônica renal (DRC) é caracterizado por elevados níveis de paratormônio (PTH), hiperplasia das glândulas paratireoides e doença cardiovascular. Para a redução dos níveis do PTH, estão disponíveis no mercado brasileiro os ativadores não seletivos e seletivos do receptor da vitamina D e os calcimiméticos. Objetivos: Desenvolver análise de custo-efetividade (C/E) e de impacto orçamentário (IO) do paricalcitol intravenoso vs. calcitriol oral para pacientes em diálise com HPTS, na perspectiva do Sistema Único de Saúde. Metodologia: Foi construído um modelo de árvore de decisão para a análise de C/E, que considerou o desfecho morte evitada e um horizonte temporal de 1 ano. Quanto à análise de IO, foram considerados dois cenários, sendo um de demanda aferida e um de abordagem epidemiológica, baseado nos dados da Sociedade Brasileira de Nefrologia. Resultados: A análise mostrou que a relação de C/E foi de R$ 1.213,68 ao ano, e uma efetividade incremental de 0,032, referente à morte evitada. A razão de C/E incremental foi de R$ 37.927,50 por morte evitada para o paricalcitol. Estimou-se que o IO incremental com a ampliação do uso do paricalcitol estará entre R$ 1.600.202,28 e R$ 4.128.565,65 no primeiro ano, considerando os cenários principal e o epidemiológico. Já no fim de 5 anos após a ampliação do uso, estimou-se IO incremental entre R$ 48.596.855,50 e R$ 62.90.555,73. Conclusão: O paricalcitol intravenoso tem eficácia superior e segurança semelhante ao comparador calcitriol oral, diminuindo a mortalidade geral dos pacientes em diálise, embora implique maior custo.
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