bluuebunny/crossref_metadata_2025_split huggingface dataset:
PD15 Cost Effectiveness Of The Wolbachia Method For Dengue Control In Brazil
Authors: Zimmermann Ivan Ricardo , Fernandes Ricardo , da Costa Márcia Gisele , Pinto Márcia , Peixoto Henry Maia 
Published: January 2025

IntroductionDengue virus is a significant public health threat in Brazil. It is transmitted by Aedes aegypti mosquitoes and causes severe symptoms such as hemorrhagic fever and dengue shock syndrome. This study explored the economic evaluation of Wolbachia mosquito replacement as a promising dengue virus control strategy.Methods
The model considered Wolbachia mosquito replacement in seven Brazilian cities: Belo Horizonte, Campo Grande, Fortaleza, Goiânia, Manaus, Niterói, and São Paulo. A mathematical microsimulation model tracked 23 million residents over 20 years and considered transitions between five health states (susceptible, asymptomatic, ambulatory, hospitalized, and death). The current dengue control strategy and the incorporation of Wolbachia mosquito replacement were analyzed from both the health sector (public and private) and the Unified Health System perspectives. Direct costs included local dengue control program resources, Wolbachia replacement implementation, and care of patients with dengue virus. The primary outcome was disability-adjusted life-years (DALYs) averted. Sensitivity analyses were also performed.ResultsThe model projected 1,762,688 dengue cases over 20 years without Wolbachia replacement. Implementing Wolbachia replacement would prevent at least 1,295,566 cases, demonstrating a high benefit in all simulated cities. Except for Manaus and São Paulo, Wolbachia replacement was dominant (lower costs and higher effectiveness) over current control strategies. Nevertheless, estimated incremental cost-effectiveness ratios for Manaus and São Paulo, which ranged from BRL1,747.11 to BRL5,072.21 (USD309.51 to USD898.56), were well below the Brazilian cost-effectiveness threshold of BRL120,000 (USD21,258.50) for neglected diseases. Furthermore, all incremental net monetary benefit values remained positive for both scenarios in all cities—from BRL41.37 to BRL1,852.42 (USD7.33 to USD328.16).ConclusionsWolbachia replacement is a highly cost-effective option in the Brazilian context, aligning with previous international and diverse perspective studies. Sensitivity analysis and alternative scenarios confirmed the robustness of the findings.
PD25 Innovation In Facial Palsy Treatment: The Costs And Benefits Of Telerehabilitation Introduced Into Physical Therapy Pathways
Authors: Szczepura Ala , Khan Amir J , Nduka Charles , Neville Catriona , Martin Helen , Johnson Karen , Oxford Samuel W , Palmer Shea , Holliday Nikki , Bark Chris , Thomson David , Mistry Hema 
Published: January 2025

IntroductionThe incidence of facial palsy has been rising worldwide, with recent evidence emerging of links to COVID-19 infection. To date, guidance on cost-effective treatments is limited to medication (prednisolone). In terms of physical therapy, neuromuscular retraining (NMR) to restore balanced facial function has been most widely evaluated, but not in terms of cost effectiveness. The added value of telerehabilitation is unknown.MethodsA multistage technology assessment was conducted, which included the following:•a national survey of current therapy pathways in the UK and patients’ and clinicians’ views on the benefits and challenges of telerehabilitation;•a systematic review of clinical effectiveness trials evaluating facial NMR therapy;•calculation of long-term morbidity costs (national economic burden) based on incidence, patient recovery profiles, health-related quality of life, and national facial palsy treatment costs (valuation of clinical improvements in monetary terms was provided by a national Delphi panel); and•evaluation of the cost effectiveness of telerehabilitation (remote monitoring wearables) added to current face-to-face NMR delivery.ResultsNationally, approximately five percent of patients with facial palsy (17% of unresolved cases) are referred for facial NMR. The long-term economic burden associated with unresolved cases is estimated to range from GBP351 (EUR417) to GBP584 (EUR692) million, indicating substantial savings if long-term recovery can be improved. Medical treatment costs are GBP86.34 (EUR102) million per annual cohort, and physical and psychological therapy costs are GBP643,292 (EUR762,561). Economic modeling showed that telerehabilitation was cost effective, producing a health gain and a cost-saving of GBP468 (EUR555) per patient. If scaled to the national level for all patients who do not recover fully, an annual saving of GBP3.075 (EUR3.65) million is possible.ConclusionsEconomic modeling indicates that NMR could improve patient outcomes and reduce costs. The national survey demonstrated that access to NMR therapy services is limited, so introduction of telerehabilitation could improve access for currently underserved populations. Future clinical trials need to incorporate economic evaluations to help inform decision-making.
PD26 Seeking Sustainability For The Brazilian Public Healthcare System: Cost-Utility Analysis Of Pembrolizumab For Advanced Non-Small Cell Lung Cancer
Authors: Gargano Ludmila , Farinasso Cecilia , De Oliveira Junior Haliton Alves , Lucchetta Rosa 
Published: January 2025

IntroductionPembrolizumab is used as a monotherapy or in addition to chemotherapy for patients with non-small cell lung cancer (NSCLC) as an alternative to platinum-based chemotherapy. The objective was to conduct a cost-utility analysis for subgroups of patients with NSCLC using the Brazilian Unified Health System (SUS) threshold of BRL120,000 (USD24,458) per quality-adjusted life-year (QALY).MethodsWe built a partitioned survival model with three health states based on overall survival (OS) and progression-free survival (PFS) curves for three scenarios according to programed death ligand-1 (PD-L1) expression as follows: (i) pembrolizumab monotherapy for at least 50 percent PD-L1; (ii) pembrolizumab monotherapy for at least one percent PD-L1; and (iii) pembrolizumab plus chemotherapy for one to 49 percent PD-L1. The outcome of interest was QALYs, so utility values were derived from pre- and post-progression states according to the treatment received. Survival curves were extrapolated for 20 years using different distributions. The best fitted distribution was selected by visual inspection, clinical plausibility, and Akaike and Bayesian information criterion tests. Direct costs were also considered.ResultsPembrolizumab provided incremental gains of 1.23, 0.35, and 1.10 QALYs when compared with platinum-based chemotherapy for scenarios one, two, and three, respectively. The subgroup with the best incremental cost-utility ratio (ICUR) was pembrolizumab monotherapy for at least 50 percent PD-1 (BRL201.366 [USD41,041] per QALY gained), followed by pembrolizumab with chemotherapy for one to 49 percent PD-L1 (BRL267.216 [USD54,463] per QALY gained). When assessed for all PD-L1 positive patients, the ICUR reached BRL571.425 (USD116,465), which was 4.5 times the cost-effectiveness threshold. Sensitivity analysis showed that pembrolizumab must cost a maximum of BRL4.761 (USD970) per vial to be cost effective for the SUS, which is a 40.7 percent reduction in the base case price.ConclusionsEvidence shows that pembrolizumab alone or in combination with chemotherapy is more effective than platinum-based chemotherapy for treating patients with NSCLC, especially those with a high expression of PD-L1. However, price reduction is essential for pembrolizumab to be cost effective for treating these patients in the SUS.
PD31 The Significant Societal And Environmental Impact Of Chronic Kidney Disease Over The Next Decade In Brazil
Authors: Gobbi Talita , Moreira Ricardo , Montenegro Cinthia , Toledo-Chávarri Ana , Rao Naveen , Priest Stacey , Brown Stephen , Guiang Hannah , Zhao Ming-Hui , Chadban Steven 
Published: January 2025

IntroductionChronic kidney disease (CKD) is a progressively worsening condition that is often overlooked in its early stages. In Brazil, factors such as population aging and rising comorbidities are expected to shift CKD prevalence toward more advanced stages, leading to greater socioeconomic and environmental impacts. The significant burden of renal replacement therapy (RRT) suggests the need to prioritize preventive and early detection strategies.MethodsWe developed a patient-level simulation model to estimate the impact of CKD in Brazil over 10 years (from 2023 to 2032) on clinical, patient, health system, environmental, productivity, and societal outcomes. Validation was conducted against Brazilian demographic data and cross-validated with the Inside CKD model. We estimated productivity losses by multiplying CKD-related workdays missed by daily costs for patients and caregivers.ResultsThe number of Brazilians with CKD was projected to increase by 7.2 percent (approximately 27.7 million) over the next 10 years, mainly among patients with late-stage disease, while the number of patients undergoing dialysis was projected to increase by 170.8 percent (approximately 233,000) over the same period. CKD was projected to result in BRL198 billion (USD 38 billion) of lost income. From an environmental standpoint, freshwater consumption, fossil fuel depletion, and carbon dioxide emissions due to patients with CKD were projected to increase by 40 percent by 2032. RRT was projected to require the equivalent annual water usage of approximately 370,000 households and the annual power of approximately 11 million lightbulbs and will produce annual carbon dioxide emissions equivalent to approximately 1.5 million cars.ConclusionsWhile the overall number of patients with CKD will increase by 7 percent (from 25.8 million in 2022 to 27.7 million in 2032), the distribution toward later stages of CKD will cause significant impacts in terms of the healthcare system (resource use and costs), patients and caregivers, society, and the environment.
PD45 A Rapid Evidence Synthesis Method For Cancer Screening Recommendations In A Hospital Setting
Authors: Muñoz-Montecinos Carlos , González-Browne Catalina , Maza Felipe , Quirland Camila 
Published: January 2025

IntroductionInternational agencies advocate for population-based cancer screening to prevent cancer-related deaths. The Arturo Lopez Perez Oncology Institute is interested in implementing screening programs, but international recommendations differ on program details such as screening tests, target population, age range, and frequency. A review of international evidence-based recommendations is essential for advising stakeholders on the effective implementation of screening programs.MethodsA rapid scoping review was performed to identify international recommendations on cancer screening programs. Evidence-based recommendations derived from the World Health Organization and the European Union were analyzed. We also searched for evidence-based recommendations from the following health technology assessment agencies with specific sections for evaluating screening strategies: the Canadian Agency for Drugs and Technologies in Health (Canada), the Institute for Quality and Efficiency in Health Care (Germany), the Medical Services Advisory Committee (Australia), and the National Institute of Health and Care Excellence (UK). Additionally, we explored international cancer screening programs implemented by health systems in the aforementioned countries or in countries with implemented screening programs. Finally, we searched for recommendations from scientific societies on cancer screening strategies. This iterative process was repeated for five different cancers.ResultsWe found a total of 32 favorable or unfavorable recommendations for breast, cervical, colorectal, lung, gastric, and prostate cancer screening. Breast and cervical cancer had the highest number of favorable recommendations, with complete agreement on the type of test and only small differences regarding age range and periodicity. On the other hand, we found some recommendations against population-based screening for prostate and gastric cancer and limited agreement for both test type and target population. Direct comparisons between the recommendations served as a guide to elaborate a cancer screening program based on the most recommended strategies.ConclusionsThis rapid scoping review allowed us to assess the consistency of cancer screening recommendations. Major differences were found mainly between recommendations from international agencies and scientific societies. As a result, a cancer screening program was designed based on the most recommended strategies.
PD49 Developing Evidence-Based Optimal Testing Strategies To Monitor Long-Term Conditions In Primary Care
Authors: Elwenspoek Martha , O’Donnell Rachel , Charlwood Katie , Malpass Alice , Ward Mary , Thom Howard , Banks Jonathan , Thomas Clare , Jones Hayley , Sterne Jonathan , Palma Francesco , Stokes Christina , Hay Alastair , Watson Jessica , Whiting Penny 
Published: January 2025

IntroductionMost patients with long-term conditions (LTC) receive regular blood tests to monitor disease progression and response to treatment and to detect complications. There is currently no robust evidence to inform recommendations on monitoring. Creating this evidence base is challenging because the benefits and harms of testing are dependent on what is done in response to the test results.MethodsWe identified a list of commonly used tests. We defined a series of filtering questions to determine whether there was evidence to support the rationale of monitoring, such as “Can the general practitioner do anything in response to an abnormal test result?” Through a series of rapid reviews we identified evidence to answer each question. The evidence was presented at a consensus meeting where clinicians and patients voted for inclusion, exclusion, or further analysis. A process evaluation was performed alongside this. Further analyses were performed using routinely collected healthcare data and by performing incidence analyses, emulating randomized controlled trials (RCTs), and modeling disease progression.ResultsWe tested this methodology on three common LTCs: chronic kidney disease (CKD), type 2 diabetes mellitus (T2DM), and hypertension. We found sufficient evidence to include hemoglobin A1C and estimated glomerular filtration rate (eGFR) for monitoring patients with T2DM; hemoglobin and eGFR for patients with CKD; and eGFR for patients with hypertension. The consensus panel excluded four tests, while 10 tests were selected for further analysis. The emulated RCTs will investigate the effect of regular monitoring with certain tests on health outcomes among routinely monitored patients. In addition, we will investigate the signal-to-noise ratio of each test over time using a modeling approach.ConclusionsThe cost effectiveness of the evidence-based testing panels needs to be tested in clinical practice. We are currently developing an intervention package and are planning to run a feasibility trial. This program of work has the potential to change how LTCs are monitored in primary care, ultimately improving patient outcomes and leading to more efficient use of healthcare resources.
PD56 Long-Term Use Of Lisdexamfetamine For Attention-Deficit/Hyperactivity Disorder: What Does The Evidence Say?
Authors: Ramos Maíra Catharina , Silva Elias Flávia Tavares 
Published: January 2025

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is a neuropsychiatric disorder that can interfere with school and academic life, work, and even personal relationships. One of the alternative medications is lisdexamfetamine (LDX), a prodrug amphetamine preparation that lasts an average of 13 hours due to its gradual conversion. Since LDX is used continuously, it is necessary to evaluate its long-term efficacy and safety.MethodsA rapid health technology assessment (HTA) was performed. Searches were conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases using descriptors and their respective synonyms to identify studies on the long-term efficacy and safety of LDX in people with ADHD. Interventional and control group studies with a follow-up period of more than five weeks were included. Secondary studies were excluded. The reference lists of included studies were screened to identify potentially eligible publications that were not found in the database searches. Study selection was carried out in two stages, with screening of titles and abstracts and then assessment of full-text articles for eligibility.ResultsThis rapid HTA included 32 studies. The population included patients aged five to 55 years, and the longest follow-up was 108 weeks. In general, the literature reported a decrease in symptoms in the first five to six weeks of treatment, stabilizing thereafter. After 108 weeks, the mean change in ADHD Rating Scale-IV hyperactivity/impulsivity was -25.8 (95% confidence interval [CI]: -27.0, -24.5; p<0.001) and -13.1 (95% CI: -13.8, -12.4; p< 0.001) for the ADHD Rating Scale-IV inattention subscale. However, psychiatric disorder system organ class adverse events were frequent, including irritability, anxiety, and aggression, in addition to suicide attempts in severe cases.ConclusionsIt appears that long-term use of LDX has been associated with good clinical results in the treatment of ADHD, with treatment effectiveness remaining stable during the time observed (two-year follow-up). However, adverse events, especially psychiatric disorders, require attention as they can be confused with symptoms of the disease.
PD62 Judicialization Of Health In A Brazilian University Hospital: How Can We Reduce The Budget Impact?
Authors: Ribeiro Mayra Carvalho , Santos Fidelis Giovana Fernanda , Lopes Claudio , Silveira Correa Carlos Roberto , de Oliveira Conterno Lucieni , de Oliveira Motta Maia Flávia , Campello Carvalheira José Barreto 
Published: January 2025

IntroductionPublic hospitals in São Paulo can be held financially responsible for costs related to medications prescribed outside the recommendations of the Brazilian Unified Health System (SUS). The objective of this study was to describe these expenses in a public hospital and the measures implemented and evaluated to reduce this problem.MethodsIn January 2023, the Health Technology Assessment Center collected data on legal proceedings filed against a tertiary teaching hospital from January 2021 to November 2023. The data were obtained from monthly reports sent by the São Paulo State Department of Health (SES). The proceedings were categorized according to the type of technology and its availability in the SUS, costs, and the prescribing specialties. The indicators developed were used to plan improvement actions to guide care teams, negotiate with the SES, and resolve current legal proceedings.ResultsThe cost of legal proceedings for 136 patients was BRL4,410,278 (USD890,965). Four medicines for six patients constituted 56 percent of the total cost. A group created an informative folder explaining how to access the National List of Essential Medicines, prescribe medicines from the high-cost program, and make administrative requests. Other related actions were the creation of a standardized process for requesting medicines, monthly assessment of judicialization data, clinical discussions with prescribers, and educational activities with residents. The interventions reduced average monthly costs from BRL177,268 (USD35,811) to BRL85,493 (USD17,271) in the last trimester.ConclusionsKnowledge and measurement of judicialization costs allowed the hospital to implement improvements to help avoid new legal proceedings and to understand the demands of medical specialties regarding situations not covered by SUS guidelines. The Health Technology Assessment Center’s work with managers made it possible to identify opportunities for improving the education of professionals regarding the procedures and technologies available in the SUS.
PD66 Scalability Of Integral, Transversal, And Multidisciplinary Management Of Aortic Stenosis In Catalan Hospitals
Authors: Scheepen Franka Van , Fernandez-Barcelo Carla , Hagemeijer Bàrbara Vidal , Abbas Ismail , Carreño Marta Sitges , Sampietro-Colom Laura 
Published: January 2025

IntroductionA program for integral, transversal, and multidisciplinary management of aortic stenosis (MITMEVA) was implemented at the Clinic Barcelona University Hospital to provide adequate and personalized treatment for patients with aortic stenosis (AS). MITMEVA includes 11 actions in the AS care pathway. This study aimed to test the scalability of MITMEVA by gathering the perspectives of relevant stakeholders in two other Catalan hospitals.Methods
A mixed method study design was used to collect and analyze the views of relevant stakeholders on the scalability of the MITMEVA project. Qualitative and quantitative methods were used to answer the research question. All participants were interviewed individually using a semi-structured interview guide. The interviews were transcribed and analyzed by performing a content analysis with Atlas.ti software. Quantitative data were gathered and analyzed by adjusting the Intervention Scalability Assessment Tool (ISAT).Results
Nine participants were interviewed from two tertiary hospitals in Catalonia and eight ISAT questionnaires were completed. From the content analysis, 11 of the 15 themes identified related to actions implemented in the MITMEVA program. The results pointed toward a positive view of implementation of the MITMEVA program in general, showing a good scalability for all the ISAT domains. On a scale of zero to three, most domains were scored two or above.ConclusionsThe qualitative and quantitative results indicated that the MITMEVA program has potential for scaling up to other Catalan hospitals to improve the management of AS. Generally, stakeholders from the two participating hospitals were positive about the project. However, small adjustments will be needed to account for the culture and organizational characteristics of the hospitals when scaling up the MITMEVA program.