Browsing by Author "Gouveia, M"
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- Antidiabéticos Orais e Internamentos Atribuíveis à Diabetes em PortugalPublication . Gouveia, M; Laires, P; Borges, M; Augusto, M; Martins, APIntrodução: O crescimento da despesa com antidiabéticos orais tem levado a preocupações questionando os ganhos de saúde e vantagens para o sistema de saúde gerados por esses medicamentos. Este estudo contribui para responder a estas questões. Material e Métodos: Numa primeira fase apresentam-se estimativas das três variáveis centrais a utilizar na análise: 1) a prevalência tratada da diabetes por ano e por região de saúde baseadas nos consumos de antidiabéticos orais, 2) o número de episódios de internamento hospitalar atribuíveis à diabetes com base nos riscos relativos das várias patologias e os seus custos e 3) uma caracterização quantitativa dos antidiabéticos orais consumidos através do cálculo da sua vintage média. Através do uso de observações para 10 anos e cinco regiões, perfazendo um total de 50 observações, foi possível estimar um modelo econométrico explicando estatisticamente os internamentos e os custos hospitalares atribuíveis à diabetes por características regionais, pela prevalência tratada e pela vintage média dos antidiabéticos orais. Resultados: Os resultados dos modelos de regressão múltipla mostram que as despesas hospitalares são proporcionais à prevalência tratada, tudo o mais constante mas que quanto mais recente for a vintage dos antidiabéticos orais usados menores são os custos hospitalares. Os efeitos para o número de internamentos são similares. Discussão e Conclusões: Para uma observação média na amostra, se a vintage média dos antidiabéticos orais fosse um ano superior então os custos hospitalares seriam 5,3% inferiores (cerca de € 11 milhões em 2009) e o número de internamentos seria 3,8% menor (cerca de menos 3965 episódios em 2009). Um exercício contra factual permite estimar que para o ano de 2009 a introdução da classe dos inibidores de DPP IV permitiu reduzir o número de internamentos atribuíveis à diabetes em 8480 e com isso poupar € 23,3 milhões em custos hospitalares.
- Atherosclerosis in the Primary Health Care Setting: A Real-Word Data StudyPublication . Ascenção, R; Alarcão, J; Araújo, F; Costa, J; Fiorentino, F; Gil, V; Gouveia, M; Lourenço, F; Mello e Silva, A; Vaz Carneiro, A; Borges, MIntroduction and objectives: To characterize patients with atherosclerosis, a disease with a high socioeconomic impact, in the Lisbon and Tagus Valley Health Region. Methods: A cross-sectional observational study was carried out through the Lisbon and Tagus Valley Regional Health Administration primary health care database, extracting data on the clinical and demographic characteristics and resource use of adult primary health care users with atherosclerosis during 2016. Different criteria were used to define atherosclerosis (presence of clinical manifestations, atherothrombotic risk factors and/or consumption of drugs related to atherosclerosis). Comparisons between different subpopulations were performed using parametric tests. Results: A total of 318 692 users were identified, most of whom (n=224 845 users; 71%) had no recorded clinical manifestations. The subpopulation with clinical manifestations were older (72.0±11.5 vs. 71.3±11.0 years), with a higher proportion of men (58.0% vs. 45.9%), recorded hypertension (78.3% vs. 73.5%) and dyslipidemia (55.8% vs. 53.5%), and a lower proportion of recorded obesity (18.2% vs. 20.8%), compared to those without clinical manifestations (p<0.001). Mean blood pressure, LDL-C and glycated hemoglobin values were lower in the subpopulation with manifestations (142/74 vs. 146/76 mmHg, 101 vs. 108 mg/dl, and 6.80 vs. 6.84%, respectively; p<0.001). Each user with atherosclerosis attended 4.1±2.9 face-to-face medical consultations and underwent 8.6±10.0 laboratory test panels, with differences in subpopulations with and without clinical manifestations (4.4±3.2 vs. 4.0±2.8 and 8.3±10.3 vs. 8.7±9.8, respectively; p<0.001). Conclusions: About one in three adult primary health care users with atherosclerosis have clinical manifestations. The results suggest that control of cardiovascular risk factors is suboptimal in patients with atherosclerosis.
- Can Kidney Deceased Donation Systems Be Optimized? A Retrospective Assessment of a Country PerformancePublication . Domingos, M; Gouveia, M; Nolasco, F; Pereira, JBACKGROUND: The intensive requirement of organs for transplantation generates the need for higher rates of donation. METHODS: Using the national database of diagnosis-related groups for 2006, the global annual 2006 in-hospital mortality of 34 hospitals with organ-retrieval schemes was evaluated. Potential donors were estimated excluding patients aged <1 year or >70 years and presenting International Classification of Diseases, Ninth Revision codes that contraindicated organ donation. RESULTS: We identified 3838 potential donors (12.6% of in-hospital deaths); 46% came from eight hospitals, 80% came from the larger hospitals and 21% from intensive care units (ICU). In hospitals with a neurosurgical department, an office coordinator of procurement and transplantation (OCPT), a transplant centre and co-location of neurosurgical and transplant centre, we identified, respectively, 54, 30, 32 and 30% of all potential donors. The causes of death were 23% cerebrovascular disease, 3% cerebral tumour, 2.6% anoxic lesion and 2.5% head trauma. In the same period, there were 189 effective deceased kidney donors with traumatic diseases as the main cause of death. The mean conversion rate was 4.9% and was associated with demographical and hospital characteristics. Age of potential donors, existence of OCPT or transplant centre, ratio between ICU and hospital acute beds and mortality from labour accidents were predictors of being an effective donor. CONCLUSIONS: Health policies need to maximize the conversion of potential to effective donors and the performance of organ donation systems must be considered as an index of the quality of care.
- Cost-Effectiveness of Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation in PortugalPublication . Costa, J; Fiorentino, F; Caldeira, D; Inês, M; Lopes Pereira, C; Pinheiro, L; Vaz-Carneiro, A; Borges, M; Gouveia, MINTRODUCTION AND OBJECTIVES:Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients. METHODS: A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). RESULTS:Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were €5529/QALY and €9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% probability of being cost-effective (at a threshold of €20 000/QALY) compared to all the other therapeutic options. CONCLUSIONS:Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons, but despite this limitation, the information is useful for healthcare decision-makers.
- Cost-Effectiveness of the 13-Valent Pneumococcal Conjugate Vaccine in Adults in Portugal Versus "No Vaccination" and Versus Vaccination with the 23-Valent Pneumococcal Polysaccharide VaccinePublication . Gouveia, M; Jesus, G; Inês, M; Costa, J; Borges, MThe burden of pneumococcal disease in adults is substantial from a social and economic point of view. This study assessed the cost-effectiveness of the 13-valent pneumococcal conjugate vaccine (PCV13) for the prevention of invasive pneumococcal disease and pneumococcal pneumonia in adults versus "no vaccination" and versus vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23). A Markov model was used to simulate three strategies: no vaccination, complete vaccination with PPSV23 and complete vaccination with PCV13. The comparison between strategies allowed the estimation of clinical and economic outcomes including incremental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICUR). The model took into account the distributions of age, risk profile, vaccination status, type of immunization and time since vaccination in the population. A societal perspective was adopted and a lifetime horizon was considered. Different sources of data and assumptions were used to calibrate PPSV23 and PCV13 effectiveness. Inpatient costs were based on the 2013 diagnosis-related group (DRG) database for National Health Service (NHS) hospitals and expert opinion; NHS official tariffs were the main source for unitary costs. PCV13 shows ICURs of €17,746/QALY and €13,146/QALY versus "no vaccination" and vaccination with PPSV23, respectively. Results proved to be robust in univariate sensitivity analyses, where all ratios were below a €20,000 threshold, with the exception of the scenario with PCV13 effectiveness halved. In a probabilistic sensitivity analysis, 94% of simulations showed cost-effectiveness ratios lower than €20,000/QALY, in both strategies. It was found that PCV13 is a cost-effective strategy to prevent pneumococcal disease in adults in Portugal.
- Cost-Effectiveness of the 13-Valent Pneumococcal Conjugate Vaccine in Children in PortugalPublication . Gouveia, M; Fiorentino, F; Jesus, G; Costa, J; Borges, MPneumococcal infections are the leading cause of vaccine-preventable death in children. In June 2015, the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the Portuguese Immunization Program. We evaluated the cost-effectiveness of children vaccinated with PCV13 versus no vaccination for preventing pneumococcal diseases.
- Economic Evaluation of Ticagrelor for Secondary Prevention Following Acute Coronary SyndromesPublication . Gouveia, M; Borges, M; Trindade, R; Rikner, KINTRODUCTION AND OBJECTIVES: To estimate the cost-effectiveness and cost-utility of ticagrelor in the treatment of patients with acute coronary syndromes (unstable angina or myocardial infarction with or without ST-segment elevation), including patients treated medically and those undergoing percutaneous coronary intervention or coronary artery bypass grafting. METHODS: A short-term decision tree and a long-term Markov model were used to simulate the evolution of patients' life-cycles. Clinical effectiveness data were collected from the PLATO trial and resource use data were obtained from the Hospital de Santa Marta database, disease-related group legislation and the literature. RESULTS: Ticagrelor provides increases of 0.1276 life years and 0.1106 quality-adjusted life years (QALYs) per patient. From a societal perspective these clinical gains entail an increase in expenditure of €610. Thus the incremental cost per life year saved is €4780 and the incremental cost per QALY is €5517. CONCLUSIONS: The simulation results show that ticagrelor reduces events compared to clopidogrel. The costs of ticagrelor are partially offset by lower costs arising from events prevented. The use of ticagrelor in clinical practice is therefore cost-effective compared to generic clopidogrel.
- Indirect Costs of Myocardial Infarction in PortugalPublication . Timóteo, AT; Gouveia, M; Soares, C; Cruz Ferreira, RIntroduction: Cardiovascular disease, and particularly myocardial infarction (MI), carries a significant economic burden, through productivity losses (indirect costs) associated with temporary absence from work, that has not yet been adequately studied in Portugal. Our objective was to quantify the indirect costs of MI in the first year after admission. Methods: Consecutive patients admitted to a single center aged <66 years who survived to discharge during a one-year period were included. Employment status on admission was assessed and for every employed patient, their monthly wage was estimated from market wage rates taken from the Ministry of Labor database according to gender and age. The duration of temporary absence from work was assessed in follow-up contacts for up to one year. Indirect costs were calculated in this sample and the results were applied to the number of MIs in Portugal during 2016 and separately to ST-elevation MI (STEMI) and non-ST-elevation acute coronary syndrome. Results: A total of 219 patients were included, of whom 66.2% were working. The mean monthly labor cost was 1802 euros. A total cost of 760 521.55 euros was obtained. At national level there were 4133 patients aged <66 years admitted with acute MI who survived to discharge. Costs were higher in STEMI patients and the total indirect cost was estimated at 10.12 million euros. Conclusions: In Portugal, the costs to society of disability-generated productivity losses exceed ten million euros in the first year after MI. Strategies to promote an earlier return to work are needed to lower these costs.
- A Prospective Assessment of Renal Transplantation Versus Haemodialysis: Which Therapeutic Modality Is Good Value for Society?Publication . Domingos, M; Gouveia, M; Pereira, J; Nolasco, FBackground: Economic evaluations help health authorities facing budget constraints. This study compares the health-related quality of life (HRQOL) and costs in patient subgroups on haemodialysis (HD) and renal transplantation (KT). Methods: In a prospective study with follow-up of 1-3 years, we performed a costutility analysis of KT vs. HD, adopting a lifetime horizon. A societal perspective was taken. Costs for organ procurement, KT eligibility, transplant surgery and follow-up of living donors were included. Key clinical events were recorded. HRQOL was assessed using the EuroQol instrument. Results: The HRQOL remained stable on HD patients. After KT, mean utility score improved at 3 months while mean EQ-VAS scores showed a sustained improvement. Mean annual cost for HD was 32,567.57€. Mean annual costs for KT in the year-1 and in subsequent years were, 60,210.09€ and 12,956.77€ respectively. Cost for initial hospitalization averaged 18,740.74€. HLA-mismatches increased costs by 75% for initial hospitalization (p < 0.001) and 41% in the year-1 (p < 0.05), and duplicate the risk of readmission in the year-1 (p < 0.05). The incremental costutility ratio was 5,534.46€/QALY, increasing 35% when costs for organ procurement were added. KT costs were 41,541.63€ more but provided additional 7.51 QALY. Conclusions: The KT is cost-effective compared with HD. Public funding should reflect the value created by the intervention and adapt to the organ demand.