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Loureiro RB, Guidoni LM, Fregona GC, de Oliveira SMDVL, Sacramento D, Pinheiro JDS, Gomes D, Maciel ELN. Follow-up of patients diagnosed with and treated for tuberculosis in Brazil: financial burden on the household. J Bras Pneumol 2023; 49:e20220368. [PMID: 37610956 PMCID: PMC10578937 DOI: 10.36416/1806-3756/e20220368] [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: 12/21/2022] [Accepted: 05/21/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To evaluate the implications of the proportion of annual family income spent in the pre- and post-diagnosis periods in tuberculosis patients followed for after at least one year after completing tuberculosis treatment in Brazil. METHODS This was a cross-sectional study of tuberculosis patients followed for at least one year after completing tuberculosis treatment in five Brazilian capitals (one in each region of the country). RESULTS A total of 62 patients were included in the analysis. The overall average cost of tuberculosis was 283.84 Brazilian reals (R$) in the pre-diagnosis period and R$4,161.86 in the post-diagnosis period. After the costs of tuberculosis disease, 71% of the patients became unemployed, with an overall increase in unemployment; in addition, the number of patients living in nonpoverty decreased by 5%, the number of patients living in poverty increased by 6%, and the number of patients living in extreme poverty increased by 5%. The largest proportion of annual household income to cover the total costs of tuberculosis was for the extremely poor (i.e., 40.37% vs. 11.43% for the less poor). CONCLUSIONS Policies to mitigate catastrophic costs should include interventions planned by the health care system and social protection measures for tuberculosis patients with lower incomes in order to eliminate the global tuberculosis epidemic by 2035-a WHO goal in line with the United Nations Sustainable Development Goals.
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Affiliation(s)
- Rafaela Borge Loureiro
- . Programa de Pós-Graduação em Saúde Coletiva - PPGSC - Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
| | - Leticia Molino Guidoni
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
| | - Geisa Carlesso Fregona
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
- . Programa de Tuberculose, Hospital Universitário Cassiano Antônio Moraes - HUCAM - Vitória (ES) Brasil
| | - Sandra Maria do Valle Leone de Oliveira
- . Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul - UFMS - Campo Grande (MS) Brasil
- . Fiocruz Mato Grosso do Sul, Campo Grande (MS) Brasil
| | - Daniel Sacramento
- . Núcleo de Controle da Tuberculose, Secretaria Municipal de Saúde de Manaus, Manaus (AM) Brasil
| | - Jair dos Santos Pinheiro
- . Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (AM) Brasil
- . Programa Estadual de Controle da Tuberculose do Amazonas/Fundação de Vigilância em Saúde - Dra. Rosemary Costa Pinto, Manaus (AM) Brasil
| | - Denise Gomes
- . Centro de Referência à Tuberculose - CRTB - GCC/SCS, Porto Alegre (RS) Brasil
| | - Ethel Leonor Noia Maciel
- . Programa de Pós-Graduação em Saúde Coletiva - PPGSC - Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
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Maciel ELN, Negri LDSA, Guidoni LM, Fregona GC, Loureiro RB, Daré IB, Prado TND, Sanchez MN, Diaz-Quijano FA, Tonini M, Zandonade E, Baena IG, Ershova J. Implementation of a methodological protocol for the national survey on tuberculosis catastrophic costs in Brazil. Rev Soc Bras Med Trop 2023; 56:e0493. [PMID: 36820663 PMCID: PMC9957116 DOI: 10.1590/0037-8682-0493-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/02/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
| | | | - Leticia Molino Guidoni
- Universidade Federal do Espírito Santo, Laboratório de Epidemiologia, Vitória, ES, Brasil
| | - Geisa Carlesso Fregona
- Hospital Universitário Cassiano Antônio Moraes, Programa de Tuberculose, Vitória, ES, Brasil
| | - Rafaela Borge Loureiro
- Universidade Federal do Espírito Santo, Laboratório de Epidemiologia, Vitória, ES, Brasil
| | - Isadora Bianchi Daré
- Universidade Federal do Espírito Santo, Laboratório de Epidemiologia, Vitória, ES, Brasil
| | | | - Mauro Niskier Sanchez
- Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva, Brasília, DF, Brasil
| | | | - Maiko Tonini
- Ministério da Saúde, Programa Nacional de Tuberculose, Brasília, DF, Brasil
| | - Eliana Zandonade
- Universidade Federal do Espírito Santo, Ciências da Saúde, Departamento de Estatística, Vitória, ES, Brasil
| | | | - Julia Ershova
- U. S. Centers for Disease Control and Prevention, Atlanta, USA
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Casas CPR, Albuquerque RDCRD, Loureiro RB, Gollner AM, Freitas MGD, Duque GPDN, Viscondi JYK. Cervical cancer screening in low- and middle-income countries: A systematic review of economic evaluation studies. Clinics (Sao Paulo) 2022; 77:100080. [PMID: 35905574 PMCID: PMC9335392 DOI: 10.1016/j.clinsp.2022.100080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/04/2022] [Indexed: 11/28/2022] Open
Abstract
Economic assessments are relevant to support the decision to incorporate more cost-effective strategies to reduce Cervical Cancer (CC) mortality. This systematic review analyzes the economic evaluation studies of CC prevention strategies (HPV DNA-based tests and conventional cytology) in low- and middle-income countries. Medline, EMBASE, CRD, and LILACS were searched for economic evaluation studies that reported cost and effectiveness measures of HPV DNA-based tests for CC screening and conventional cytology in women, without age, language, or publication date restrictions. Selection and data extraction were carried out independently. For comparability of results, cost-effectiveness measures were converted to international dollars (2019). Report quality was assessed using the CHEERS checklist. The Dominance Matrix Ranking (DRM) was used to analyze and interpret the results. The review included 15 studies from 12 countries, with cost-effectiveness analyzes from the health system's perspective and a 3% discount rate. The strategies varied in age and frequency of screening. Most studies used the Markov analytical model, and the cost-benefit threshold was based on the per capita GDP of each country. The sensitivity analysis performed in most studies was deterministic. The completeness of the report was considered sufficient in most of the items evaluated by CHEERS. The Dominance Interpretation (DRM) varied; in 6 studies, the HPV test was dominant, 5 studies showed a weak dominance evaluating greater effectiveness of the HPV test at a higher cost, yet in 2 studies conventional cytology was dominant. Although the context-dependent nature of economic evaluations, this review points out the challenge of methodological standardization in the analytical models.
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Affiliation(s)
- Carmen Phang Romero Casas
- Centro de Desenvolvimento Tecnológico em Saúde (CDTS), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
| | | | - Rafaela Borge Loureiro
- Laboratório de Epidemiologia (Lab-Epi), Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Angela Maria Gollner
- Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF/ EBSERH), Juiz de Fora, MG, Brazil
| | - Marina Gonçalves de Freitas
- Câmara de Regulação do Mercado de Medicamentos (CMED), Agência Nacional de Vigilância Sanitária (ANVISA), Brazil
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Loureiro RB, Maciel ELN, Caetano R, Peres RL, Fregona G, Golub JE, Braga JU. Cost-effectiveness of QuantiFERON-TB Gold In-Tube versus tuberculin skin test for diagnosis and treatment of Latent Tuberculosis Infection in primary health care workers in Brazil. PLoS One 2019; 14:e0225197. [PMID: 31725786 PMCID: PMC6855475 DOI: 10.1371/journal.pone.0225197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/30/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives The goal of this study was to perform a cost-effectiveness analysis from the public health system perspective, comparing five strategies for Latent Tuberculosis Infection (LTBI) diagnosis in primary health care workers in Brazil. Design Analytical model for decision making, characterized by cost-effectiveness analysis. Setting Primary Care Level, considering primary health care workers in Brazil. Participants An analytical model for decision making, characterized by a tree of probabilities of events, was developed considering a hypothetical cohort of 10,000 primary health care workers, using the software TreeAge Pro™ 2013 to simulate the clinical and economic impacts of new diagnostic technology (QuantiFERON®-TB Gold in-Tube) versus the traditional tuberculin skin test. Methods This model simulated five diagnostic strategies for LTBI in primary health care workers (HCW) in Brazil: tuberculin skin testing using ≥5 mm cut-off, tuberculin skin testing ≥10 mm cut-off, QuantiFERON®-TB Gold in-Tube, tuberculin skin testing using ≥5 mm cut-off confirmed by QuantiFERON®-TB Gold In-Tube if TST positive, tuberculin skin testing using ≥10 mm cut-off confirmed by QuantiFERON®-TB Gold In-Tube if TST positive. Primary and secondary outcome measures The outcome measures are the number of individuals correctly classified by the test and the number of Tuberculosis cases avoided. Results The most cost-effective strategy was the tuberculin skin test considering ≥10mm cut-off. The isolated use of the QuantiFERON®-TB Gold In-Tube revealed the strategy of lower efficiency with incremental cost-effectiveness ratio (ICER) of US$ 146.05 for each HCW correctly classified by the test. Conclusions The tuberculin skin test using ≥10 mm cut-off was the most cost-effective strategy in the diagnosis of Latent Tuberculosis Infection in primary health care works in Brazil.
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Affiliation(s)
- Rafaela Borge Loureiro
- Department of Epidemiology, Institute of Social Medicine (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
- Laboratory of Epidemiology (Lab-Epi), Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Ethel Leonor Noia Maciel
- Laboratory of Epidemiology (Lab-Epi), Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
- Graduate Program in Collective Health (PPGSC), Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Rosangela Caetano
- Department of Health Policy, Planning and Administration, Institute of Social Medicine (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Renata Lyrio Peres
- Laboratory of Epidemiology (Lab-Epi), Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
- Center of Infectious Diseases (NDI), Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Geisa Fregona
- Laboratory of Epidemiology (Lab-Epi), Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Jonathan E. Golub
- Division of Infectious Diseases, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - José Ueleres Braga
- Department of Epidemiology, Institute of Social Medicine (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
- * E-mail:
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de Souza FM, do Prado TN, Pinheiro JDS, Peres RL, Lacerda TC, Loureiro RB, Carvalho JA, Fregona G, Dias ES, Cosme LB, Rodrigues RR, Riley LW, Maciel ELN. Comparison of interferon-γ release assay to two cut-off points of tuberculin skin test to detect latent Mycobacterium tuberculosis infection in primary health care workers. PLoS One 2014; 9:e102773. [PMID: 25137040 PMCID: PMC4138087 DOI: 10.1371/journal.pone.0102773] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 06/23/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND An interferon-γ release assay, QuantiFERON-TB (QFT) test, has been introduced an alternative test for the diagnosis of latent Mycobacterium tuberculosis infection (LTBI). Here, we compared the performance of QFT with tuberculin skin test (TST) measured at two different cut-off points among primary health care work (HCW) in Brazil. METHODS A cross-sectional study was carried out among HCWs in four Brazilian cities with a known history of high incidence of TB. Results of the QFT were compared to TST results based on both ≥5 mm and ≥10 mm as cut-off points. RESULTS We enrolled 632 HCWs. When the cut-off value of ≥10 mm was used, agreement between QFT and TST was 69% (k = 0.31), and when the cut-off of ≥5 mm was chosen, the agreement was 57% (k = 0.22). We investigated possible factors of discordance of TST vs QFT. Compared to the TST-/QFT- group, risk factors for discordance in the TST+/QFT- group with TST cut-off of ≥5 mm included age between 41-45 years [OR = 2.70; CI 95%: 1.32-5.51] and 46-64 years [OR = 2.04; CI 95%: 1.05-3.93], BCG scar [OR = 2.72; CI 95%: 1.40-5.25], and having worked only in primary health care [OR = 2.30; CI 95%: 1.09-4.86]. On the other hand, for the cut-off of ≥10 mm, BCG scar [OR = 2.26; CI 95%: 1.03-4.91], being a household contact of a TB patient [OR = 1.72; CI 95%: 1.01-2.92] and having had a previous TST [OR = 1.66; CI 95%: 1.05-2.62], were significantly associated with the TST+/QFT- group. No statistically significant associations were found among the TST-/QFT+ discordant group with either TST cut-off value. CONCLUSIONS Although we identified BCG vaccination to contribute to the discordance at both TST cut-off measures, the current Brazilian recommendation for the initiation of LTBI treatment, based on information gathered from medical history, TST, chest radiograph and physical examination, should not be changed.
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Affiliation(s)
- Fernanda Mattos de Souza
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Núcleo de Doenças Infecciosas of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Thiago Nascimento do Prado
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Núcleo de Doenças Infecciosas of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Jair dos Santos Pinheiro
- Coordenador do Núcleo de Controle da Tuberculose - Secretaria Municipal de Saúde - Manaus, Amazonas, Brazil
| | - Renata Lyrio Peres
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Núcleo de Doenças Infecciosas of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Thamy Carvalho Lacerda
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Programa de Pós-graduação em Saúde Coletiva of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Rafaela Borge Loureiro
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Departamento de Epidemiologia do Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jose Américo Carvalho
- Programa de Controle de Tuberculose - Hospital Universitário Cassiano Antônio Moraes of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Geisa Fregona
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Programa de Pós-graduação em Saúde Coletiva of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Programa de Controle de Tuberculose - Hospital Universitário Cassiano Antônio Moraes of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Elias Santos Dias
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Estudantes de Graduação em Enfermagem e Obstetrícia da Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Lorrayne Beliqui Cosme
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Estudantes de Graduação em Enfermagem e Obstetrícia da Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Rodrigo Ribeiro Rodrigues
- Núcleo de Doenças Infecciosas of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Lee Wood Riley
- Division of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Ethel Leonor Noia Maciel
- Laboratório de Epidemiologia of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
- Programa de Pós-graduação em Saúde Coletiva of Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
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Peres RL, Palaci M, Loureiro RB, Dietze R, Johnson JL, Maciel EL. Reduction of contamination of mycobacterial growth indicator tubes using increased PANTA concentration. Int J Tuberc Lung Dis 2011; 15:281-i. [PMID: 21219695] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
We assessed the effect of a double concentration of supplemental polymyxin B, amphotericin B, nalidixic acid, trimethoprim and azlocillin (PANTA) added to the Mycobacterial Growth Indicator Tube (MGIT) on contamination and positivity rates in 216 sputum cultures. Contamination rates were respectively 12.9% and 5.5% for samples processed using standard and double PANTA concentrations (P = 0.0001, McNemar's test). Thirty-five per cent of cultures performed using standard PANTA and 36.5% of those performed using two-fold PANTA concentrations were positive for Mycobacterium tuberculosis, compared to 25.9% of cultures inoculated on Ogawa medium. These results suggest that the use of MGIT with 2× PANTA may be useful in reducing culture contamination without reducing the diagnostic yield.
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Affiliation(s)
- R L Peres
- Center for Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil
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