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- ItemA cost-effectiveness analysis of a novel algorithm to sequentially diagnose leprosy based on manufactured tests under the SUS perspective(Cadernos de Saúde Pública, 2024)Brazil has the second largest number of leprosy cases (a disease with a sig- nificant burden) in the world. Despite global and local efforts to eliminate this public health problem, inadequate or late diagnosis contribute to perpetuate its transmission, especially among household contacts. Tests such as the rapid IgM antibody detection (RT) and real-time polymerase chain reaction (RT-PCR) were developed to overcome the challenges of early diagnosis of leprosy. This study aimed to analyze the cost-effectiveness of a new diagnostic algorithm recommended by the Brazilian government to diagnose leprosy in household contacts of confirmed leprosy cases, which includes the RT and RT-PCR tests. A decision tree model was constructed and the perspective of the Brazilian Unified National Health System (SUS) and a 1-year time horizon were ad- opted. Only direct medical costs related to diagnostic tests were included. Ef- fectiveness was measured as the number of avoided undiagnosed leprosy cases. Different scenarios were analyzed. The sequential use of RT, slit-skin smear (SSS) microscopy, and RT-PCR as recommended by the Brazilian Ministry of Health was compared to a base case (isolated SSS microscopy), yielding an incremental cost-effectiveness ratio of USD 616.46 per avoided undiagnosed leprosy case. Univariate sensitivity analysis showed that the prevalence of lep- rosy among household contacts was the variable that influenced the model the most. This is the first economic model to analyze a diagnostic algorithm of leprosy. Results may aid managers to define policies and strategies to eradicate leprosy in Brazil.
- ItemEstimating an EQ‐5D‐Y‐3L Value Set for Brazil(PharmacoEconomics, 2024)Introduction The EQ-5D-Y-3L is a generic measure of health-related quality of life in children and adolescents. Although the Brazilian-Portuguese EQ-5D-Y-3L version is available, there is no value set for it, hampering its use in economic evalu- ations. This study aimed to elicit a Brazilian EQ-5D-Y-3L value set based on preferences of the general adult population. Methods Two independent samples of adults participated in an online discrete choice experiment (DCE) survey and a composite time trade-of (cTTO) face-to-face interview. The framing was “considering your views for a 10-year-old child”. DCE data were analyzed using a mixed-logit model. The 243 DCE predicted values were mapped into the observed 28 cTTO values using linear and non-linear mapping approaches with and without intercept. Mapping approaches’ performance was assessed to estimate the most valid method to rescale DCE predicted values using the model ft (R2 ), Akaike Information Criteria (AIC), root mean squared error (RMSE), and mean absolute error (MAE). Results A representative sample of 1376 Brazilian adults participated (DCE, 1152; cTTO, 211). The linear mapping without intercept (R2 = 96%; AIC, − 44; RMSE, 0.0803; MAE, − 0.0479) outperformed the non-linear without intercept (R2 = 98%; AIC, − 63; RMSE, 0.1385; MAE, − 0.1320). Utilities ranged from 1 (full health) to − 0.0059 (the worst health state). High- est weights were assigned to having pain or discomfort (pain/discomfort), followed by walking about (mobility), looking after myself (self-care), doing usual activities (usual activities), and feeling worried, sad, or unhappy (anxiety/depression). Conclusion This study elicited the Brazilian EQ-5D-Y-3L value set using a mixed-logit DCE model with a power parameter based on a linear mapping without intercept, which can be used to estimate the quality-adjusted life-years for economic evaluations of health technologies targeting the Brazilian youth population.
- ItemAdvancing health-care access with handheld echocardiography for rheumatic heart disease(The Lancet Global Health, 2024)
- ItemImpact and economic analysis of human T-cell lymphotropic virus type 1 (HTLV-1)-targeted antenatal screening, England and Wales, 2021(Euro Surveillance, 2024)Background: Human T-cell lymphotropic virus type 1 (HTLV-1) is a neglected virus that can cause severe dis- ease and be transmitted from mother to child through breastfeeding. Avoidance of breastfeeding prevents 80% of vertical transmission. The United Kingdom (UK) is currently assessing whether HTLV-1-targeted antenatal screening should be implemented. Aim: We aimed to assess the impact and cost-effectiveness of a targeted programme to prevent HTLV-1 vertical trans- mission in England and Wales. Methods: We estimated the number of pregnant women who have high risk of HTLV-1 infection based on their or their partner’s country of birth. With data from 2021, we used a math- ematical model to assess cost-effectiveness of HTLV-1 antenatal screening. We also estimated the annual number of infant infections and the number that could be prevented with screening and intervention. Results: We estimate that ca 99,000 pregnant women in England and Wales have high risk of HTLV-1 infec- tion. In the absence of screening, 74 (range: 25–211) HTLV-1 infections in infants would be expected to occur every year in England and Wales. Implementation of targeted screening would prevent 58 (range: 19–164) infant infections annually. The intervention is effec- tive (incremental 0.00333 quality-adjusted life years (QALY)) and cost-saving (GBP −57.56 (EUR −66.85)). Conclusion: Our findings support implementation of HTLV-1 targeted antenatal screening to reduce vertical transmission from mothers to infants in the UK.
- ItemMeasurement properties of the EQ-5D in children and adolescents: a systematic review protocol(Systematic Reviews, 2024)Background Although the EQ-5D instruments have been initially designed for adult populations, there are new studies evaluating and applying these instruments to children and adolescents. The EuroQol Group adapted and cre- ated two versions designed for these groups, i.e., the EQ-5D-Y versions. The measurement properties of the EQ-5D have been systematically reviewed in diferent health conditions. However, there is a lack of a proper systematic assessment including the studies’ risk of bias and focusing on recent studies assessing the EQ-5D instruments in chil- dren and adolescents. The lack of a systematic assessment of the EQ-5D versions does not allow us to have a com- prehensive evaluation of the validity, reliability, and responsiveness of these instruments among children and adoles- cents. This systematic review aims to critically appraise and summarize the evidence on the measurement properties of the EQ-5D instruments (self-reported version – answered by children and adolescents; and proxy versions – ver- sions reported by parents, caregivers, or health professionals) in children and adolescents. Methods A systematic review searching the following electronic databases: MEDLINE, EMBASE, CINAHL, EconLit, National Health Service Economic Evaluation Database (NHS-EED), Health Technology Assessment (HTA) database. Two independent reviewers will screen titles and abstracts and select full texts for eligibility. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology will be followed to conduct three main assessment steps: risk of bias, quality criteria for measurement properties, and evidence synthesis. Discussion This systematic review will provide comprehensive information about the evidence regarding the meas- urement properties of EQ-5D instruments in children and adolescents of diferent settings and countries.