Background: Oseltamivir and zanamivir are recommended for treating and preventing influenza A (H1N1) worldwide. In Brazil, this official recommendation lacks an economic evaluation. Our objective was to assess the efficiency of influenza A chemoprophylaxis in the Brazilian context. Methods: We assessed the cost-effectiveness of oseltamivir and zanamivir for prophylaxis of influenza for high risk population, compared to no prophylaxis, in the perspective of Brazilian public health system. Quality-adjusted life years (QALY) and effectiveness data were based on literature review and costs in Brazilian real (BRL) were estimated from official sources and micro-costing of 2016’s H1N1 admissions at a university hospital. We used a decision-tree model considering prophylaxis and no prophylaxis and the probabilities of H1N1, ambulatory care, admission to hospital, intensive care, patient discharge, and death. Adherence and adverse events from prophylaxis were included. Incremental cost-effectiveness ratio was converted to 2016 United States dollar (USD). Uncertainty was assessed with univariated and probabilistic sensitivity analysis. Results: Adherence to prophylaxis was 0.70 [95% confidence interval (CI) 0.54; 0.83]; adverse events, 0.09 (95% CI 0.02; 0.18); relative risk of H1N1 infection in chemoprophylaxis, 0.43 (95% CI 0.33; 0.57); incidence of H1N1, 0.14 (95% CI 0.11; 0.16); ambulatory care, 0.67 (95% CI 0.58; 0.75); hospital admission, 0.43 (CI 95% 0.39; 0.42); hospital mortality, 0.14 (CI 95% 0.12; 0.15); intensive care unit admission, 0.23 (95% CI 0.20; 0.27); and intensive care mortality, 0.40 (95% CI 0.29; 0.52). QALY in H1N1 state was 0.50 (95% CI 0.46; 0.53); in H1N1 inpatients, 0.23 (95% CI 0.18; 0.28); healthy, 0.885 (95% CI 0.879; 0.891); death, 0. Adverse events estimated to affect QALY in –0.185 (95% CI –0.290; –0.050). Cost for chemoprophylaxis was BRL 39.42 [standard deviation (SD) 17.94]; ambulatory care, BRL 12.47 (SD 5.21); hospital admission, BRL 5,727.59 (SD 7,758.28); intensive care admission, BRL 19,217.25 (SD 7,917.33); and adverse events, BRL 292.05 (SD 724.95). Incremental cost-effectiveness ratio was BRL –4,080.63 (USD –1,263.74)/QALY and –982.39 (USD –304.24)/H1N1 prevented. Results were robust to sensitivity analysis. Conclusion: Chemoprophylaxis of influenza A (H1N1) is cost-saving in Brazilian health system context.
BACKGROUND: Oseltamivir and zanamivir have indication for treating symptomatic flu and in prophylaxis in epidemics for groups with high risk of complications. METHODS: Effectiveness data was identified in literature review, and costs were obtained from official systems and micro-costing. RESULTS: We adopted a decision-tree model to assess the effectiveness of chemoprophylaxis in Brazilian Unified Health System (SUS) perspective with willingness to pay BRL 30,000.00/QALY. The incremental cost-effectiveness ratio for chemoprophylaxis compared to no prophylaxis was - 2,921.14/QALY. CONCLUSION: Chemoprophylaxis is cost-effective in Brazilian scenario.
este estudo objetivou investigar os impactos da pandemia da COVID-19 sobre a publicação e editoração científica no Brasil. Foi realizado um inquérito on-line com editores de periódicos nacionais no segundo semestre de 2020. De 1.299 questionários preenchidos, 87 foram preenchidos por editores-chefes que identificaram o nome do periódico. A maior parte das revistas pertenciam às áreas de humanidades (n=43) e ciências da vida (n=41), eram open access (n=85). Observou-se aumento nas submissões de manuscritos (n=40) e mudança da maior parte das atividades para home office. Quinze periódicos passaram a aceitar manuscritos pré-publicados e a maioria (n=50) não aceita. Políticas de promoção de equidade de gênero e raça são pouco adotadas. A pandemia afetou as atividades editoriais dos periódicos nacionais.
Introduction:Influenza A (H1N1) virus is the most relevant virus in death by flu complications. Oseltamivir and zanamivir are used for influenza prophylaxis in epidemics. We aimed to evaluate the efficacy of chemoprophylaxis for influenza A (H1N1) for the Brazilian health care system.Methods:We systematically searched the literature to identify efficacy results. Costs assessed from the system perspective were obtained from official Brazilian Ministry of Health systems, and completed from medical care at a university hospital of Campinas, Sao Paulo. Model outcomes were quality-adjusted life years (QALY) with willingness to pay BRL 30,000 (USD 8,212)/QALY and prevention of H1N1. A decision-tree model was used to calculate the incremental cost-effectiveness ratios for prophylaxis, compared to no prophylaxis. Deterministic and probabilistic sensitivity analyses were used to test robustness of the model.Results:Prophylaxis had 70 percent adherence to treatment, 9 percent adverse events, effectiveness in avoiding H1N1 (relative risk = 0.43; 95% confidence interval: 0.33, 0.57); no evidence of prophylaxis efficacy for complication, hospitalization and death was found. Both scenarios had 14 percent H1N1 attack rate, 67 percent of ambulatorial consult, 43 percent of inpatient care, 14 percent of deaths in hospital, 23 percent of intensive care where death was 40 percent. Utility was 0.50 during H1N1 infection, 0.23 with hospitalization, 0.195 less with adverse events, 0 for deaths and 0.885 for healthy. Cost was BRL39 (USD 11) for chemoprophylaxis; BRL 12 (USD 4) for outpatient care; BRL 5,728 (USD 1,568) for hospital admission; BRL 19,217 (USD 5,260) for intensive care; and BRL 292 (USD 80) for adverse events. Incremental cost of prophylaxis was BRL 40 (USD 11) and utility increased 0.004, which mean saving of BRL 2,921 (USD 780)/QALY. Prophylaxis saves BRL 338 (USD 92) per H1N1 case avoided. Univariate and probabilistic sensitivity analysis assure the robustness of results, with 43 percent probability of being of lower cost and higher effectiveness.Conclusions:Prophylaxis is cost-effective from the health care system perspective using utility and avoided H1N1 cases outcomes.
BACKGROUND: In Brazil, the prophylaxis of influenza with the antivirals oseltamivir and zanamivir is cost-effective and recommended for the groups with higher risk of complications. In this study we estimated the impact of the chemoprophylaxis in the health system budget from 2017 to 2023. METHODS: We calculated the size of the risk population, expenditure with prophylaxis and the budget impact in 2017 to 2018 with official demographic and vaccine coverage data, and aqcuisition of antivirals by SUS. The estimative from 2019 to 2023 was conducted using trigonometric models. RESULTS AND CONCLUSION: The risk population variated from 2.3 to 5.5 millions of individuals and the budget impact variated from 0.74% (2018) and 6.9% (2019).
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