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Nascimento VDD, Abreu RNDC, Marinho DS, Lima DS, Santos FWRD, Aguilera IRM. PROTOCOLO DE INDICAÇÃO DA RECUPERAÇÃO INTRAOPERATÓRIA DE SANGUE NO TRAUMA TORACOABDOMINAL: RELATO DE EXPERIÊNCIA. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Castro R, Crathorne L, Perazzo H, Silva J, Cooper C, Varley-Campbell J, Marinho DS, Haasova M, Veloso VG, Anderson R, Hyde C. Cost-effectiveness of diagnostic and therapeutic interventions for chronic hepatitis C: a systematic review of model-based analyses. BMC Med Res Methodol 2018; 18:53. [PMID: 29895281 PMCID: PMC5998601 DOI: 10.1186/s12874-018-0515-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 05/31/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Decisions about which subgroup of chronic hepatitis C (CHC) patients should be treated with direct acting anti-viral agents (DAAs) have economic importance due to high drug prices. Treat-all DAA strategies for CHC have gained acceptance despite high drug acquisition costs. However, there are also costs associated with the surveillance of CHC to determine a subgroup of patients with significant impairment. The aim of this systematic review was to describe the modelling methods used and summarise results in cost-effectiveness analyses (CEAs) of both CHC treatment with DAAs and surveillance of liver disease. METHODS Electronic databases including Embase and Medline were searched from inception to May 2015. Eligible studies included models predicting costs and/or outcomes for interventions, surveillance, or management of people with CHC. Narrative and quantitative synthesis were conducted. Quality appraisal was conducted using validated checklists. The review was conducted following principles published by NHS Centre for Research and Dissemination. RESULTS Forty-one CEAs met the eligibility criteria for the review; 37 evaluated an intervention and four evaluated surveillance strategies for targeting DAA treatment to those likely to gain most benefit. Included studies were of variable quality mostly due to reporting omissions. Of the 37 CEAs, eight models that enabled comparative analysis were fully appraised and synthesized. These models provided non-unique cost-effectiveness estimates in a specific DAA comparison in a specific population defined in terms of genotype, prior treatment status, and presence or absence of cirrhosis. Marked heterogeneity in cost-effectiveness estimates was observed despite this stratification. Approximately half of the estimates suggested that DAAs were cost-effective considering a threshold of US$30,000 and 73% with threshold of US$50,000. Two models evaluating surveillance strategies suggested that treating all CHC patients regardless of the staging of liver disease could be cost-effective. CONCLUSIONS CEAs of CHC treatments need to better account for variability in their estimates. This analysis suggested that there are still circumstances where DAAs are not cost-effective. Surveillance in place of a treat-all strategy may still need to be considered as an option for deploying DAAs, particularly where acquisition cost is at the limit of affordability for a given health system.
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Affiliation(s)
- Rodolfo Castro
- Fundação Oswaldo Cruz, FIOCRUZ, Instituto Nacional de Infectologia Evandro Chagas, INI, Avenida Brasil, 4365, 21040-900, Manguinhos, Rio de Janeiro, Brazil
- Universidade Federal do Estado do Rio de Janeiro, UNIRIO, Instituto de Saúde Coletiva, Rio de Janeiro, Brazil
| | - Louise Crathorne
- University of Exeter Medical School, Evidence Synthesis & Modelling for Health Improvement, ESMI, Peninsula Technology Assessment Group, PenTAG, Exeter, UK
| | - Hugo Perazzo
- Fundação Oswaldo Cruz, FIOCRUZ, Instituto Nacional de Infectologia Evandro Chagas, INI, Avenida Brasil, 4365, 21040-900, Manguinhos, Rio de Janeiro, Brazil
| | - Julio Silva
- Fundação Oswaldo Cruz, FIOCRUZ, Instituto Nacional de Infectologia Evandro Chagas, INI, Avenida Brasil, 4365, 21040-900, Manguinhos, Rio de Janeiro, Brazil
| | - Chris Cooper
- University of Exeter Medical School, Evidence Synthesis & Modelling for Health Improvement, ESMI, Peninsula Technology Assessment Group, PenTAG, Exeter, UK
| | - Jo Varley-Campbell
- University of Exeter Medical School, Evidence Synthesis & Modelling for Health Improvement, ESMI, Peninsula Technology Assessment Group, PenTAG, Exeter, UK
| | - Daniel Savignon Marinho
- Fundação Oswaldo Cruz, FIOCRUZ, Centro de Desenvolvimento Tecnológico em Saúde, CDTS, Rio de Janeiro, Brazil
| | - Marcela Haasova
- University of Exeter Medical School, Evidence Synthesis & Modelling for Health Improvement, ESMI, Peninsula Technology Assessment Group, PenTAG, Exeter, UK
| | - Valdilea G. Veloso
- Fundação Oswaldo Cruz, FIOCRUZ, Instituto Nacional de Infectologia Evandro Chagas, INI, Avenida Brasil, 4365, 21040-900, Manguinhos, Rio de Janeiro, Brazil
| | - Rob Anderson
- University of Exeter Medical School, Evidence Synthesis & Modelling for Health Improvement, ESMI, Peninsula Technology Assessment Group, PenTAG, Exeter, UK
| | - Chris Hyde
- University of Exeter Medical School, Evidence Synthesis & Modelling for Health Improvement, ESMI, Peninsula Technology Assessment Group, PenTAG, Exeter, UK
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Tagliaferro EPDS, Marinho DS, Pereira CCDA, Pardi V, Ambrosano GMB, Meneghim MDC, Pereira AC. [Cost-effectiveness analysis of preventive methods for occlusal surface according to caries risk: results of a controlled clinical trial]. CAD SAUDE PUBLICA 2015; 29 Suppl 1:S121-30. [PMID: 25402241 DOI: 10.1590/0102-311x00021613] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 07/04/2013] [Indexed: 11/21/2022] Open
Abstract
This study presents the results of a cost-effectiveness analysis in a controlled clinical trial on the effectiveness of a modified glass ionomer resin sealant ( Vitremer, 3M ESPE) and the application of fluoride varnish (Duraphat, Colgate) on occlusal surfaces of first permanent molars in children 6-8 years of age (N = 268), according to caries risk (high versus low). Children were examined semiannually by the same calibrated dentist for 24 months after allocation in six groups: high and low risk controls (oral health education every three months); high and low risk with varnish (oral health education every three months + varnish biannually); and high and low risk with sealant (oral health education every three months + a single application of sealant). Economic analysis showed that sealing permanent first molars of high-risk schoolchildren showed a C/E ratio of US$ 119.80 per saved occlusal surface and an incremental C/E ratio of US$ 108.36 per additional saved occlusal surface. The study concluded that sealing permanent first molars of high-risk schoolchildren was the most cost-effective intervention.
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Affiliation(s)
| | - Daniel Savignon Marinho
- Centro de Desenvolvimento Tecnológico em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Vanessa Pardi
- Ostrow School of Dentistry, University of Southern, Los Angeles, U.S.A
| | | | | | - Antonio Carlos Pereira
- Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas, Piracicaba, Brasil
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Coêlho GR, Feitosa Neto BA, de G Teixeira CC, Marinho DS, Rangel MLM, Garcia JHP. Single-center transfusion rate for 555 consecutive liver transplantations: impact of two eras. Transplant Proc 2014; 45:3305-9. [PMID: 24182806 DOI: 10.1016/j.transproceed.2013.07.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 07/16/2013] [Accepted: 07/30/2013] [Indexed: 01/24/2023]
Abstract
Orthotopic liver transplantation (OLT) is the treatment of choice for patients with acute or chronic end-stage liver disease, irresectable primary liver tumor, and metabolic disorders. Historically, OLT has been associated with considerable blood loss and the need for transfusions. However, over the years there has been reduction is need for blood products. The aim of this article was to compare two distinct eras for perioperative blood transfusion rate among patients undergoing OLT; Era I, 200 transplantations in 188 patients, and Era II, 355 transplantations in 339 patients. The donor mean age was 33.70 (Era I) versus 35.34 (Era II). Cause of death in both eras was traumatic brain injury followed by cerebral vascular accident. Organ recipient data showed a mean age of 48.87 (Era I) versus 46.49 (Era II). During Era I patients with Child B (56.8%) prevailed, followed by Child C (35.4%) and Child A (7.8%). In Era II also patients with Child B (53.1%) prevailed, followed by Child C (39.6%) and Child A (7.3%). The prevalence of hepatocellular carcinoma (HCC) during Era I was 9% (18) and in Era II 20% (71). The use of blood products in the perioperative period: was as follows packed red blood cells 1.76 (Era I) versus 0.57 (Era II) units; fresh frozen plasma 1.89 (Era I) versus 0.49 (Era II) units; platelets 2.16 (Era I) versus 0.28 (Era II) units; and cryoprecipitate 0.08 (Era I) versus 0.03 (Era II) units. OLT using the piggyback technique was performed with a transfusion rate below <30%, and it reduced blood loss and prevented severe hemodynamic instability.
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Affiliation(s)
- G R Coêlho
- Department of Surgery, Hospital Universitário Walter Cantídio, Federal University of Ceará, Ceará, Brazil
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Marinho DS, Huf G, Ferreira BLA, Castro H, Rodrigues CR, de Sousa VP, Cabral LM. The study of vancomycin use and its adverse reactions associated to patients of a Brazilian university hospital. BMC Res Notes 2011; 4:236. [PMID: 21762507 PMCID: PMC3163212 DOI: 10.1186/1756-0500-4-236] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 07/15/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vancomycin is an antibiotic of growing importance in the treatment of hospital infections, with particular emphasis on its value in the fight against methicillin-resistant Staphylococcus aureus. However its usage profile must be evaluated to assure maximum benefit and minimum risk. FINDINGS A cross-sectional retrospective study was carried out among inpatients that received vancomycin in a Brazilian quaternary hospital. The occurrence of adverse reactions reported was evaluated in medical records relating to patients taking vancomycin during a one year period. Males comprised 52% (95% CI: 41.7-60.2%) of the sample population, with a mean age of 50.6 (95% CI: 47.2-54.0) years and mean treatment period of 9.7 (95% CI: 8.0-11.5) Days. It was verified that nephrotoxicity occurred in 18.4% (95% CI: 11.3-27.5) of patients, Red man syndrome occurred in 2% (95% CI 0.2-7.2), while the occurrence of thrombocytopenia was 7.1% (95% CI: 2.9-14.2). CONCLUSIONS It may be noted that even after 50 years of use, adverse reactions associated with vancomycin continue with high frequency, presenting a public health problem, especially considering its current use in cases of multidrug resistant infections. In this context, we emphasize the importance of intensive pharmacovigilance in hospital as a surveillance tool after drug approval by the sanitary authority.
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Aguiar MMGBD, Albuquerque RPD, Marinho DS, Braga BRS, Dornelas CB, Oliveira A, Sousa VPD, Torres SR, Alviano DS, Alviano CS, Cabral LM, Holandino C. Oral sustained release nystatin tablets for the treatment of oral candidiasis: formulation development and validation of UV spectrophotometric analytical methodology for content determination. Drug Dev Ind Pharm 2009; 36:594-600. [DOI: 10.3109/03639040903384729] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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