IntroductionPatient-Reported Outcomes (PRO) are directly reported by the patient without interpretation of the patient's response by a clinician or anyone else and pertains to the patient's health, quality of life, or functional status associated with health care or treatment. It can provide patients’ perspectives regarding treatment benefit and harm beyond survival and are often the outcomes of most importance to patients. This study aims to describe and analyze outcomes reported by Brazilian women diagnosed with breast cancer and rank the most important attributes for these patients.MethodsObservational descriptive study composed of exploratory interviews followed by online questionnaires applied to a convenience sample of women diagnosed with breast cancer.ResultsTwelve women were interviewed to explore the main outcomes and preferences about their treatments, such as the most common side effects and the most impacted aspects of life after diagnosis and BC treatment. Psychological, emotional, and sexual impacts were frequently described as impacted aspects. Fifty-three women, from all the five Brazilian regions, answered the online questionnaire. Following an order of importance ranking, the following outcomes were chosen, respectively: overall survival, progression-free survival; and quality of life. The treatment effects that were considered less important, among this sample, were pain and adverse events.ConclusionsThinking about expanding the therapeutic quality of users, it is essential to take into account the experiences of patients. PRO is a trend in current research to achieve this goal, in order to influence the decisions of HTA agencies about the importance of valuing outcomes that affect patients' lives.
IntroductionTranscatheter aortic valve implantation (TAVI) represents a new treatment option for aortic stenosis. This study aimed to evaluate the cost utility of TAVI, compared with clinical treatment, in patients with inoperable severe aortic stenosis from the perspective of the Brazilian public health system.MethodsA Markov model with monthly cycles and a five percent annual discount rate was constructed. A five-year time horizon was chosen, to minimize the uncertainties inherent with data extrapolations, based on the only randomized head-to-head trial, Placement of AoRTic TraNscathetER Valve Trial (PARTNER B). All costs were obtained from Brazil's official healthcare data. Utilities for clinical treatment 0.6 (range 0.56–0.63) and TAVI 0.71 (range 0.69–0.72) were based on studies that used the EuroQol-5D instrument. TAVI's utility measures were penalized by 25 percent in the first month, based on the estimate of the procedure's impact on quality of life provided by the National Institute of Health and Care Excellence in the United Kingdom. Lastly, deterministic and probabilistic sensitivity analyses were used to evaluate the robustness of the results.ResultsThe incremental cost-effectiveness ratio was USD35,880 per quality-adjusted life-year (QALY), a result that was mainly sensitive to TAVI's cost in the univariate analysis. In the probabilistic analysis, all values were above the reference willingness-to-pay threshold of three times the Brazilian per capita gross domestic product (USD18,042 per QALY).ConclusionsIn conclusion, even though there is no established willingness-to-pay threshold in Brazil, the cost of TAVI may represent an obstacle for its incorporation into the Brazilian public health system.
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