Panorama geral da qualidade dos estudos farmacoeconomicos nacionais e internacionais segundo as...

UNIVERSIDADE DE SO PAULO

FACULDADE DE CINCIAS FARMACUTICAS

Curso de Graduao em Farmcia-Bioqumica

Panorama geral da qualidade dos estudos farmacoeconomicos

nacionais e internacionais segundo as Diretrizes Metodolgicas de

Avaliaes Econmicas em Sade de 2009 (MS).

Andr Marques dos Santos

Trabalho de Concluso do Curso de

Farmcia-Bioqumica da Faculdade de

Cincias Farmacuticas da

Universidade de So Paulo.

Orientadora:

Profa. Dra Valentina Porta

So Paulo

2013

SUMRIO

LISTA DE ABREVIATURAS __________________________________________ 1

LISTA DE FIGURAS _______________________________________________ 1

LISTA DE QUADROS E TABELAS ____________________________________ 1

RESUMO ________________________________________________________ 2

1. INTRODUO __________________________________________________ 4

2. OBJETIVO _____________________________________________________ 6

3. MATERIAL E MTODOS __________________________________________ 6

3.1. Estratgias de pesquisa ________________________________________ 7

3.2. Critrios de incluso __________________________________________ 7

3.3. Critrios de excluso __________________________________________ 8

3.4. Coleta e anlise dos dados _____________________________________ 8

3.5. Anlise estatstica ___________________________________________ 14

4. RESULTADOS _________________________________________________ 14

4.1 Levantamento bibliogrfico de artigos nacionais ____________________ 14

4.2 Levantamento bibliogrfico de artigos internacionais _________________ 15

4.3 Resultados estatsticos ________________________________________ 16

5. DISCUSSO __________________________________________________ 18

6. CONCLUSO __________________________________________________ 19

7. REFERNCIA _________________________________________________ 21

8. ANEXOS _____________________________________________________ 37

ANEXO I ______________________________________________________ 37

ANEXO II _____________________________________________________ 39

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LISTA DE ABREVIATURAS

ICER Razo de custo-efetividade incremental

ICUR Razo de custo-utilidade incremental

MS Ministrio da Fazendo

SUS Sistema nico de Sade

LISTA DE FIGURAS

Figura 1. Descrio da incluso e excluso das publicaes nacionais. _________ 15

Figura 2. Descrio da incluso e excluso das publicaes internacionais. _____ 16

LISTA DE QUADROS E TABELAS

Quadro 1. Critrios para avaliao da qualidade metodolgica ________________ 9

Quadro 2. Relao entre a nota e a quantidade de critrios presentes no estudo. __________________________________________________________ 10

Tabela 1. Pontuao obtida pela aplicao do questionrio adaptado a cada um dos trabalhos do grupo Nacional. Os artigos foram agrupados de acordo com a nota atribuda a cada um. ________________________________ 16

Tabela 2. Pontuao obtida pela aplicao do questionrio adaptado a cada um dos trabalhos do grupo Internacional. Os artigos foram agrupados de acordo com a nota atribuda a cada um. ______________________________ 17

Tabela 3. Resultados para os grupos Nacional e Internacional. ______________ 17

Tabela 4. Resultado do teste de Mann-Whitney apresentado pelo Minitab _____ 18

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RESUMO

SANTOS, A.M. Panorama geral da qualidade dos estudos farmacoeconmicos nacionais e internacionais segundo as Diretrizes Metodolgicas de Avaliaes Econmicas em Sade de 2009 (MS). 2013. Trabalho de Concluso de Curso de Farmcia-Bioqumica Faculdade de Cincias Farmacuticas Universidade de So Paulo, So Paulo, 2013. Palavras-chave: Farmacoeconmia, Custo-efetividade, Brasil, Diretrizes Metodolgicas. INTRODUO: A sade constitui um direito social bsico para as condies de cidadania da populao, um pas somente pode ser denominado desenvolvido se seus cidados forem saudveis, o que depende tanto da organizao e do funcionamento do sistema de sade quanto das condies gerais de vida associadas ao modelo de desenvolvimento vigente. No Brasil o uso da farmacoeconmia ainda precrio, porm o prprio Ministrio da Sade identifica a necessidade de uma ferramenta que possa auxiliar na racionalizao dos custos. "A avaliao , em especial, parte fundamental no planejamento e na gesto do sistema de sade. Um sistema de avaliao efetivo deve reordenar a execuo de aes e servios, redimensionando-os de forma a contemplar as necessidades de seu pblico, dando maior racionalidade ao uso dos recursos." (Ministrio da sade). Os estudos de custo e das implicaes econmicas relacionadas s chamadas avaliaes econmicas compreendem um grande grupo de mtodos usados na avaliao de tecnologias em sade. Essa ferramenta vem sendo objeto de muita ateno tanto por parte dos planejadores de sade como das agncias e demais organismos responsveis pela avaliao de tecnologias em sade em diversos pases. Esse interesse tem sido alimentado pelas preocupaes com a elevao dos gastos em sade, pelas presses sobre os gestores nas decises sobre a alocao de recursos e pela necessidade dos produtores de demonstrar os benefcios de suas tecnologias. Como resultado, observa-se significativo incremento no nmero de avaliaes econmicas na literatura, bem como tem existido um refinamento dos mtodos envolvidos com sua execuo. OBJETIVO: Traar um panorama geral da qualidade de estudos farmacoeconmicos nacionais, alm de compar-los a estudos internacionais de regies de referncia (Reino Unido, Canad e Austrlia) sobre a perspectiva das Diretrizes Metodolgicas de Avaliaes Econmicas em Sade (Ministrio da Sade, 2009). MATERIAIS E MTODOS: Os estudos farmacoeconmicos nacionais e internacionais sero selecionados a partir de uma reviso bibliogrfica realizada nas bases de dados MEDLINE, LILACS, SCIELO e EMBASE atravs de termos livres quanto MeSH (PUBMED) ou Emtree (Embase). Apenas trabalhos produzidos a partir de 2009 e que realizaram uma analise de custo-efetividade completa sero considerados. Os trabalhos sero avaliados atravs da aplicao de um questionrio adaptado.

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RESULTADOS: Aps os filtros serem aplicados na reviso da literatura, obtivemos um total de 29 artigos nacionais e 152 artigos internacionais nos quais foi aplicado o questionrio. Para ambos os grupos, nacionais e internacionais, foi calculado a mdia, sendo 0,80 e 0,92, respectivamente, de um total de 1,00. Atravs de uma anlise estatstica podemos observar que houve diferena entre essas mdias. CONCLUSO: A qualidade dos estudos internacionais mostrou-se superior qualidade dos estudos nacionais. Apesar disso, podemos considerar que os estudos nacionais apresentaram nota mdia alta, indicando cumprimento da maior parte dos critrios definidos pelas Diretrizes Metodolgicas de Avaliaes Econmicas em Sade9, as quais definem os pontos considerados essenciais no desenvolvimento de estudos de avaliao econmica.

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1. INTRODUO

Os medicamentos, recursos de diagnstico e teraputica, so um dos

elementos que integram a relao entre o Estado e populao na rea da sade.1

Os avanos no setor da sade propiciam uma progressiva e relevante melhora na

reduo da morbidade e da mortalidade das doenas, aumentando assim a

expectativa em qualidade de vida e a quantidade de tratamentos possveis para as

enfermidades.8,5 Vrias fatores podem influenciar o aumento dos gastos com a

sade, como a expanso de cobertura de medicamentos e procedimentos

financiados, surgimento de novos frmacos, adoo de novas tecnologias,

dinamismo epidemiolgico, envelhecimento da populao (aumento de doenas

crnico-degenerativas) e o uso inadequado de frmacos em diversas situaes

clnicas.3,4,5

Para exemplificar podemos citar a tecnologia mdica de alto custo, que

proporcionou uma melhoria na qualidade e eficcia dos servios de sade, porm

elevou os custos, pois alm do capital investido (equipamentos) so necessrios

recursos humanos qualificados para operar e interpretar as novas tecnologias.5

A sade constitui um direito social bsico para as condies de cidadania

da populao. Um pas somente pode ser denominado desenvolvido se seus

cidados forem saudveis, o que depende tanto da organizao e do

funcionamento do sistema de sade quanto das condies gerais de vida

associadas ao modelo de desenvolvimento vigente.6

Atravs do aumento do acesso sade o Estado obtm ganhos futuros.

Indivduos com melhor estado de sade possuem uma maior produtividade (na

idade adulta) e um melhor desenvolvimento, atravs de uma maior capacidade de

aprendizado (na infncia), o que ocasiona maior crescimento e desenvolvimento

econmico do pas, assim como a reduo com os custos futuros relativos a

tratamentos de alta complexidade. 3,7

Admitindo-se que os recursos para a sade so finitos, a utilizao da

farmacoeconomia como um dos pilares para tomada de deciso faz-se de extrema

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importncia, porque a carncia de recursos exige que sejam alcanados melhores

resultados atravs do uso mnimo de recursos. 2,5

Assim a farmacoeconomia torna-se uma importante ferramenta que auxilia

no objetivo de alcanar melhores resultados. Essa cincia fornece informaes

crticas para a tima alocao dos recursos de cuidados sade. A rea abrange

especialistas de diversos segmentos, tais como economia da sade, anlise de

risco, avaliao de tecnologia, avaliao clnica, epidemiologia, cincias da

deciso e pesquisa em servios da sade. 3,8

A funo da farmacoeconomia na tomada de deciso a racionalizao

atravs da otimizao de recursos que visam escolha de alternativas que

permitam reduzir os custos sem que a qualidade da assistncia seja perdida, ou

seja, uma ferramenta que nos auxilia na escolha das opes mais eficientes (no

que se trata do custo/benefcio) e isso nos ajuda na distribuio de recursos de

uma forma mais justa e equilibrada. 1,2,3,5

Assim, essa ferramenta vem sendo objeto de muita ateno tanto por parte

dos planejadores de sade como das agncias e demais organismos

responsveis pela avaliao de tecnologias em sade em diversos pases.

Observamos um aumento significativo no nmero de avaliaes econmicas, em

funo das preocupaes com a elevao dos gastos em sade, das presses

sobre os gestores nas decises sobre a alocao de recursos e da necessidade

dos produtores de demonstrar os benefcios de suas tecnologias. Porm as

avaliaes econmicas no devem servir como nico ou principal determinante

nas decises em sade e no difcil processo de planejar servios e sistemas de

sade.9

Em alguns pases, como Austrlia e Inglaterra, a farmacoeconomia tem

trazido um grande avano na rea da sade, no s relacionado racionalizao

dos recursos, mas tambm deteco de possveis abusos no uso de

medicamentos ou ainda ocorrncia de eventos adversos, contribuindo assim

para o uso racional de medicamentos. 1,3

No Brasil o uso da farmacoeconomia ainda precrio, porm o prprio

Ministrio da Sade identifica a necessidade de uma ferramenta que possa

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auxiliar na racionalizao dos custos. "A avaliao , em especial, parte

fundamental no planejamento e na gesto do sistema de sade. Um sistema de

avaliao efetivo deve reordenar a execuo de aes e servios,

redimensionando-os de forma a contemplar as necessidades de seu pblico,

dando maior racionalidade ao uso dos recursos." (Ministrio da Sade). 3,7

Para exemplificar a importncia dessa informao podemos citar as

avaliaes econmicas no SUS. Essas avaliaes permitem identificar e mapear

problemas e oportunidades para uso e aplicao de solues tecnolgicas e em

que investigam a efetividade, os custos e os impactos do uso de uma tecnologia

no sistema de sade, podem auxiliar na seleo das intervenes mais efetivas

por menor custo e agregar elementos para alteraes e aprimoramento das

polticas de sade, aumentando a eficincia e a efetividade dos servios e a

qualidade do cuidado em sade prestado.9

2. OBJETIVO

O estudo tem como objetivos:

Avaliar a qualidade de estudos farmacoeconmicos nacionais, com

base nas diretrizes publicadas em 2009 pelo Ministrio da Sade9 e

em compar-los a estudos internacionais de pases referncia (Reino

Unido, Canad e Austrlia).10, 11

Verificar se os estudos farmacoeconmicos nacionais avaliados

apresentam padronizao em relao aos mtodos empregados e

resultados obtidos.

Todos os dados sero obtidos atravs da aplicao de questionrio.

3. MATERIAL E MTODOS

Realizou-se a busca de artigos descrevendo avaliaes econmicas

completas realizadas no Brasil, Reino Unido, Austrlia e Canad, a partir das

bases de dados MEDLINE, LILACS, SCIELO e EMBASE. Uma avaliao

econmica completa corresponde a uma anlise sistemtica e comparativa de

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duas ou mais intervenes na rea da sade, considerando-se os custos e

benefcios proporcionados.12

Os artigos obtidos foram divididos em dois grupos:

Nacional: artigos descrevendo estudos realizados no Brasil;

Internacional: artigos descrevendo estudos realizados no Reino Unido,

Austrlia e Canad.

3.1. Estratgias de pesquisa

Nesta reviso bibliogrfica foram empregadas as seguintes palavras

chaves, isoladas ou combinadas entre si: economia em sade, avaliao

econmica, anlise de custos, economia de custo, anlise custo-minimizao,

anlise de custo-efetividade, anlise de custo-utilidade e anlise de custo-

benefcio, alm dos nomes dos pases escolhidos (Brasil, Reino Unido, Austrlia e

Canad). Foram utilizados tanto termos livres quanto MeSH (PUBMED) ou Emtree

(Embase). O levantamento bibliogrfico foi realizado em junho de 2012, sem

restrio de idiomas.

3.2. Critrios de incluso

Consideramos os seguintes critrios para a incluso dos estudos:

Avaliao econmica completa, ou seja, a anlise comparativa de

custos e benefcios de pelo menos duas alternativas;

Avaliao ou aplicao com foco nas seguintes regies: Brasil, Reino

Unido, Austrlia e Canad;

Publicado entre 2009 2012;

Anlises que consideravam uma comparao entre medicamentos;

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3.3. Critrios de excluso

Como critrios de excluso foram selecionados os seguintes:

Estudos multicntricos, quando um dos centros includos no

correspondia s regies pr-definidas;

Revises, cartas, psteres e editorais foram excludos;

Anlises que comparavam equipamentos, procedimentos ou

cuidados dos profissionais da sade;

3.4. Coleta e anlise dos dados

A avaliao dos artigos foi realizada por meio da aplicao de questionrio

desenvolvido por Chiou e colaboradores15 e adaptado de acordo com as Diretrizes

Metodolgicas de Avaliaes Econmicas em Sade9.

O questionrio de Chiou e colaboradores15 aborda pontos como a clareza

do objetivo, a perspectiva da anlise, a execuo de anlise estatstica e quais

anlises foram realizadas, a apresentao dos desfechos a curto e longo prazo, a

apresentao dos resultados negativos e a clareza do modelo econmico

(incluindo a estrutura), entre outros. As questes com opes de reposta alm de

sim ou no foram excludas do questionrio adaptado.

As Diretrizes estabelecem recomendaes em relao caracterizao do

problema, populao-alvo, desenho do estudo, perspectiva do estudo, horizonte

temporal, taxa de desconto, etc.

O formulrio (Quadro 1) apresenta os critrios finais definidos para o

presente estudo, que incluram informaes sobre objetivo do estudo, desenho,

metodologia e base de dados, alm de identificao das fontes financiadoras.

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Quadro 1. Critrios para avaliao da qualidade metodolgica

1 O objetivo do estudo foi apresentado de forma clara e bem definido?

2 A perspectiva da anlise foi declarada? (pblico, privado, sociedade, etc)

3 Foi realizado anlise de incerteza? (teste estatstico e/ou de sensibilidade)

4 O horizonte temporal do estudo foi suficiente para obteno de todos os resultados relevantes e importantes?

5 Quando o horizonte temporal foi maior que um ano, a taxa de desconto foi aplicada?

6 O ICER/ICUR foi calculado?

7 O numerador e denominador do ICER/ICUR foram apresentados?

8 A efetividade das estratgias comparadas foi adequadamente estabelecida (obtida atravs de dados primrios, ensaios clnicos ou revises sistemticas/metanlises)?

9 Todos os custos e desfechos importantes de cada estratgia foram identificados (considerar se foram suficientemente abrangentes para os objetivos do estudo)?

10 A descrio da fonte para obteno dos valores dos custos foi adequada?

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As fontes utilizadas para obteno dos custos foram adequadas para os propsitos do estudo (por exemplo, valores de mercado, perspectiva dos pacientes ou usurios, perspectiva dos gestores, julgamento de profissionais de sade, etc)?

12 As limitaes do estudo foram apresentadas?

13 As concluses/recomendaes do estudo foram justificadas e com base nos resultados do estudo?

14 A fonte financiadora foi declarada?

As questes admitem dois tipos de respostas, sim ou no. Algumas

questes dependem de conhecimento prvio sobre a doena e do tipo de

desfecho esperado. As questo 4 e 9 so exemplos disso. As questes 10 e 11

exigem a avaliao das fontes dos dados e se estes so adequados perspectiva

do estudo, por exemplo, um estudo brasileiro sobre perspectiva pblica deve obter

custos do DATASUS (Banco de dados do Sistema nico de Sade), pois assim os

custos apresentados seriam os mesmos praticados pelo setor pblico.

10

Para todos os estudos, utilizaram-se apenas as informaes obtidas na

publicao original. No entanto, em alguns casos em que os dados fornecidos no

foram suficientemente detalhados, as referncias do artigo foram consultadas para

que as informaes relevantes fossem extradas. Por exemplo, se os autores

citaram um segundo estudo como fonte para efetividade, esse foi consultado para

determinar se continha as informaes citadas.

O sistema sim/no, recomendado pelo Centre for Reviews and

Disseminations14, foi utilizado para completar os itens presentes no formulrio. A

alternativa a este sistema o uso de scores (por exemplo, muito bom, bom,

regular, ruim, pssimo), mas esse apresenta a desvantagem de dificultar o

entendimento do leitor da reviso, enquanto o sistema sim/no ilustra claramente

os aspectos em que o artigo apresentou falhas ou foi bem executado. O peso

atribudo a cada item depende dos pontos fortes e fracos dos mtodos

empregados e dos resultados obtidos e de suas implicaes sobre a confiabilidade

das concluses. No atual trabalho todos os itens do questionrio tem igual

importncia para o resultado final, portanto o mesmo peso.

De acordo com a quantidade de critrios que o estudo apresentou foi

atribudo uma nota, sendo a menor nota 0,00 e a maior 1,00. A relao entre a

quantidade de critrios e a nota atribuda pode ser observada na Quadro 2.

Quadro 2. Relao entre a nota e a quantidade de critrios presentes no estudo.

Qtd. Critrios

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Nota 0,07 0,14 0,21 0,29 0,36 0,43 0,50 0,57 0,64 0,71 0,79 0,86 0,93 1,00

A seguir apresentamos um exemplo do tipo de informao que esperamos

em cada questo, o artigo utilizado foi Economic evaluation of high-dose (80

mg/day) atorvastatin treatment compared with standard-dose (20 mg/day to 40

mg/day) simvastatin treatment in Canada based on the Incremental Decrease in

End-Points Through Aggressive Lipid-Lowering (IDEAL) trial186. Esse artigo

recebeu nota mxima (1,00), portanto foi utilizado para que pudssemos

exemplificar todos os itens do nosso questionrio.

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1. O objetivo do estudo foi apresentado de forma clara e bem definido?

To assess the cost-effectiveness of high-dose atorvastatin versus standard-

dose simvastatin treatment in patients with a history of MI from a Canadian

societal perspective.186

Comentrio: Cita os medicamentos envolvidos, a doena, o tipo de anlise e a

perspectiva do estudo, definindo o objetivo com clareza.

2. A perspectiva da anlise foi declarada? (pblico, privado, sociedade, etc)

Canadian societal perspective.186

Comentrio: A perspectiva da anlise foi definida e informada.

3. Foi realizado anlise de incerteza? (teste estatstico e/ou de sensibilidade)

For the Markov model, uncertainty was assessed using deterministic and

probabilistic sensitivity analyses. For the probabilistic sensitivity analysis,

distributions of each model parameter (ie, all transition probabilities, resource

use data and utility data) were constructed using nonparametric

bootstrapping. 186

Comentrio: Informa a realizao de anlise de incerteza por meio de mtodos

determinsticos e probabilsticos.

4. O horizonte temporal do estudo foi suficiente para obteno de todos os

resultados relevantes e importantes?

Over the median follow-up of 4.8 years 186

Comentrio: O modelo de Markov demanda em mdia um acompanhamento

de 5 anos, o que descrito no estudo.

5. Quando o horizonte temporal foi maior que um ano, a taxa de desconto foi

aplicada?

12

All costs and benefits were discounted at 5% per year as recommended by

the guidelines of the Canadian Agency for Drugs and Technologies in

Health.186

Comentrio: Foi aplicada taxa de desconto de 5% para cada ano.

6. O ICER/ICUR foi calculado?

The resulting incremental cost-effectiveness ratio (ICER) was $17,573 per life-

year gained or $26,795/QALY gained from the societal perspective 186

Comentrio: Os dados so apresentados na Tabela 6 do referido artigo.

7. O numerador e denominador do ICER/ICUR foram apresentados?

Patients in the atorvastatin arm were projected to live an average of 0.0356

years longer and have 0.0234 more QALYs than patients in the simvastatin

arm. This improvement came at an increase of $1,375 in study drug costs;

33.9% of this incremental cost was offset by reduced expenditures for end

point-related hospitalization and an additional 20.5% by lower productivity

losses, leading to a total incremental cost of $627 per patient in the

atorvastatin arm. 186

Comentrio: Os dados so apresentados na Tabela 6 do referido artigo.

8. A efetividade das estratgias comparadas foi adequadamente estabelecida

(obtida atravs de dados primrios, ensaios clnicos ou revises

sistemticas/metanlises)?

a prospective, randomized, open-label, blinded end point trial. 186

Comentrios: A efetividade foi obtida atravs de dados primrios (ensaio

clnico).

9. Todos os custos e desfechos importantes de cada estratgia foram

identificados (considerar se foram suficientemente abrangentes para os

objetivos do estudo)?

13

During each one-year cycle, patients could experience a nonfatal MI and

transition into the post-MI state, undergo a revascularization procedure (PCI

or CABG) and transition into the postrevascularization state, or die from any

cause. Patients in the post-MI and postrevascularization states could remain

in their respective health states or die. 186

Comentrio: Os desfechos apresentam-se apropriados com base nas

indicaes e usos teraputicos dos medicamentos.

10. A descrio da fonte para obteno dos valores dos custos foi adequada?

The cost per 40 mg or 80 mg atorvastatin pill used in the model was $2.236

and the cost per generic simvastatin 20 mg or 40 mg pill was $1.100, as listed

in the current Ontario Drug Benefit Formulary (17). Dispensing fees were not

included. 186

Comentrio: A descrio da fonte de obteno dos dados foi includa,

possibilitando reprodutibilidade, e garantindo obteno dos mesmos dados por

outros pesquisadores que utilizem os mtodos propostos no estudo.

11. As fontes utilizadas para obteno dos custos foram adequadas para os

propsitos do estudo (por exemplo, valores de mercado, perspectiva dos

pacientes ou usurios, perspectiva dos gestores, julgamento de profissionais

de sade, etc)?

Alm da informao j citada na Questo 10, temos outro trecho: Each type

of end point-related hospitalization was assigned a total cost of hospitalization

(including overhead) based on the Ontario Case Costing Initiative (OCCI). 186

Comentrio: Ambos os trechos descrevem a utilizao de preos obtidos em

bases de dados que representam a perspectiva da sociedade.

12. As limitaes do estudo foram apresentadas?

The present study needs to be considered in light of its limitations. 186

Comentrio: Em seguida a esta frase, o estudo apresenta um tpico falando

de todas as limitaes.

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13. As concluses/recomendaes do estudo foram justificadas e com base nos

resultados do estudo?

high-dose atorvastatin (80 mg/day) is cost effective compared with

standard-dose simvastatin (20 mg/day to 40 mg/day) from a Canadian societal

perspective. Furthermore, a within-trial analysis suggested that atorvastatin

would result in cost savings compared with simvastatin over a median of 4.8

years. 186

Comentrio: Concluso baseada nos resultados apresentados.

14. A fonte financiadora foi declarada?

This study was funded by Pfizer Inc. 186

Comentrio: H informao referente ao patrocinador do estudo.

3.5. Anlise estatstica

A aplicao do formulrio gerou uma nota para cada artigo. A partir dessas

notas, foram obtidos obtivemos os valores de mdia e desvio padro e os valores

mnimos e mximos. A diferena na mdia para publicaes nacionais e

internacionais foi avaliada atravs do teste Mann-Whitney. O software Minitab foi

utilizado para realizao dos clculos.

4. RESULTADOS

4.1 Levantamento bibliogrfico de artigos nacionais

A busca da literatura inicialmente identificou 408 publicaes potenciais,

sendo 172 da base PUBMED, 216 da base Embase e 20 das bases Scielo e

Lilacs. Dessas 408, 86 foram selecionadas para anlise do texto completo. A

maioria dos artigos foi descartada principalmente devido aos critrios

estabelecidos e alguns outros devido duplicidade (Figura 1).

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Em resumo, dos 86 artigos cujo texto completo foi analisado, 28 foram

includos para serem avaliados de acordo com o formulrio desenvolvido (Quadro

1). As publicaes selecionadas so apresentadas no ANEXO I.

Figura 1. Descrio da incluso e excluso das publicaes nacionais.

4.2 Levantamento bibliogrfico de artigos internacionais

A busca da literatura inicialmente identificou 3.443 publicaes potenciais,

sendo 726 da base PUBMED e 2.717 da base Embase. Dessas 3.443, 388 foram

selecionadas para anlise do texto completo. A maioria dos artigos foi descartada

principalmente devido aos critrios estabelecidos e alguns outros devido

duplicidade (Figura 2).

Em resumo, dos 388 artigos cujo texto completo foi analisado, 152 foram

includos para serem avaliados de acordo com o formulrio (Quadro 1)

desenvolvido. As publicaes selecionadas so apresentadas no ANEXO II.

16

Figura 2. Descrio da incluso e excluso das publicaes internacionais.

4.3 Resultados estatsticos

A pontuao atribuda a cada artigo pela aplicao do questionrio

apresentada na Tabela 1 para os artigos nacionais e na Tabela 2 para os artigos

internacionais.

Tabela 1. Pontuao obtida pela aplicao do questionrio adaptado a cada um dos trabalhos do

grupo Nacional. Os artigos foram agrupados de acordo com a nota atribuda a cada um.

Artigos (Nmero da referncia bibliogrfica)

Nota Critrios presentes

21, 27, 30, 33 0,57 8

17, 18 0,64 9

29, 31, 35, 41 0,71 10

16, 23, 34, 36, 39, 40 0,79 11

18, 26 0,86 12

20, 24, 32, 37, 43 0,93 13

19, 22, 25, 38, 42 1,00 14

17

Tabela 2. Pontuao obtida pela aplicao do questionrio adaptado a cada um dos trabalhos do

grupo Internacional. Os artigos foram agrupados de acordo com a nota atribuda a cada um.

Artigos (Nmero da referncia bibliogrfica)

Nota Critrios presentes

166, 195 0,71 10

50, 57, 62, 74, 80, 83, 97, 101, 107, 110, 112, 122, 124, 126, 133, 144, 154, 180, 192, 193

0,79 11

47, 53, 60, 70, 76, 77, 86, 88, 91, 93, 96, 104, 108, 118, 119, 121, 132, 135, 136, 138, 140, 143, 150, 153, 158, 159, 161,

162, 185

0,86 12

44, 46, 48, 51, 52, 55, 58, 59, 66, 67, 69, 73, 84, 85, 90, 95, 98, 100, 102, 106, 111, 115, 117, 123, 125, 128, 129, 131, 139, 141, 142, 146, 149, 151, 156, 157, 164, 169, 176, 178, 179, 181, 182, 184, 188, 191,

194

0,93 13

45, 49, 54, 56, 61, 63, 64, 65, 68, 71, 72, 75, 78, 79, 81, 82, 87, 89, 92, 94, 99, 103, 105, 109, 113, 114, 116, 120, 127, 130, 134, 137, 145, 147, 148, 152, 155, 160, 163, 165, 167, 168, 170, 171, 172, 173, 174, 175, 177, 183, 186, 187, 189,

190

1,00 14

A Tabela 3 apresenta os valores mdios, mnimos e mximos de pontuao

obtidos pelos trabalhos dos grupos Nacional e Internacional.

Tabela 3. Resultados para os grupos Nacional e Internacional.

Nacional Internacional

Mdia 0,80 0,92

Desvio Padro 0,15 0,08

Nota Mnima 0,57 0,71

Nota Mxima 1,00 1,00

18

O teste de Mann-Whitney foi utilizado para testarmos estatisticamente a

diferena entre os resultados. Para isso utilizamos o software Minitab, o

resultado obtido apresentado na Tabela 4.

Tabela 4. Resultado do teste de Mann-Whitney apresentado pelo Minitab

5. DISCUSSO

O nmero absoluto de publicaes no Brasil ainda pequeno quando

comparado s regies do Reino Unido, Canad e Austrlia onde a avaliao

econmica uma das principais ferramentas para tomada de deciso poltica na

rea da sade. Porm existe sempre a possibilidade de vis de publicao, ou

seja, os estudos com resultado negativo ou nulo podem no terem sido

publicados. Portanto, nossos resultados podem subestimar o verdadeiro nmero

de anlises econmicas da sade na literatura.

Quando comparamos as mdias de ambos os grupos, nacional e

internacional, 0,80 e 0,92 respectivamente, observamos que os estudos

internacionais tem uma quantidade de informao maior do que os estudos

nacionais e portanto uma qualidade melhor segundo nosso formulrio de critrios

e podemos confirmar essa diferena atravs do teste de Mann-Whitney no qual

Grupo n Mediana

Nacional 28 0,7857

Internacional 152 0,9187

Estimao pontual -0,1429

Intervalo de Confiana (95%)

(-0,1428;-0,0715)

Soma das Categorias (sum of ranks)

1552,5

P 0,0001*

*considerou-se diferena significativa para p

19

consideramos ndice de confiabilidade de 95%, sendo assim a hiptese nula (que

as mdias eram iguais estatisticamente) foi negada (p=0,0001), portanto as

mdias apresentam diferena estatisticamente significante.

Porm ao avaliar o grupo nacional isoladamente de acordo com as

recomendaes apresentadas pelas Diretrizes Metodolgicas de Avaliaes

Econmicas em Sade9, observamos que a sua mdia (0,80) alta quando

comparada com a escala na qual est inserida (0,00 1,00), ou seja, apresenta

uma mdia de 11 critrios presentes no total de 14. Porm o desvio padro

tambm alto o que demonstra uma grande variao na qualidade dos estudos,

portanto mesmo com uma diretriz publicada ainda existem muitos pesquisadores

que no seguem o padro sugerido por essa.

A base para esta avaliao foram as Diretrizes Metodolgicas de

Avaliaes Econmicas em Sade9 explicitadas em um questionrio para coleta

de dados sobre presena ou ausncia de caractersticas consideradas importantes

para este tipo de estudo. Esta metodologia apresentou a limitao de que no foi

possvel validar os mtodos utilizados para calcular os custos em cada estudo,

bem como no foi analisada a influncia da fonte financiadora sobre o resultado

do estudo.

Alm disso, o formulrio foi aplicado por um nico avaliador, sendo que

todos os resultados esto sobre a perspectiva do conhecimento do avaliador,

podemos ter um vis de interpretao, portanto um pool de avaliadores seria mais

adequado para o atual estudo.

6. CONCLUSO

A qualidade dos estudos internacionais mostrou-se superior qualidade

dos estudos nacionais. Apesar disso, podemos considerar que os estudos

nacionais apresentaram nota mdia alta, indicando cumprimento da maior parte

dos critrios definidos pelas Diretrizes Metodolgicas de Avaliaes Econmicas

em Sade9, as quais definem os pontos considerados essenciais no

desenvolvimento de estudos de avaliao econmica.

20

Embora este resultado seja encorajador, os estudos ainda no esto

plenamente adequados s diretrizes que o Brasil possui e no podem ser

comparados a estudos de principais polos como Canada, Reino Unido e Austrlia.

O aumento da quantidade de estudos de avaliao econmica em sade deve ser

acompanhado de um aumento no rigor metodolgico do desenho do estudo,

construo do modelo, coleta de dados e outros aspectos.

Assim adequando nossos estudos as novas diretrizes podemos utilizar a

farmacoeconomia como um importante brao na tomada de deciso no nosso pas

e no apenas como um complemento de outros resultados.

21

7. REFERNCIA

1. MELO, D.O.; RIBEIRO, E.; STORPIRTIS, S. A importncia e a histria dos estudos de

utilizao de medicamentos. Revista Brasileira de Cincias Farmacuticas, v. 42, n. 4, p.

475 - 485, out./dez. 2006.

2. GUIMARES, H.P.; BARBOSA, L.M.; LARANJEIRA, L.N.; AVEZUM, A. Estudos de farmacoeconomia e anlises econmicas: conceitos bsicos. Revista Brasileira de

Hipertenso, v.14, n.4, p. 265 - 268, 2007.

3. AREDAL, C.A.; BONIZIO, R.C.; FREITAS, O. Pharmacoeconomy: an indispensable tool for the rationalization of health costs. Brazilian Journal of Pharmaceutical Sciences,

v.47, n.2, So Paulo, Abr./Jun, 2011.

4. MOTA, D.M.; SILVA, M.G.C.; SUDO, E.C.; ORTN, V. Uso racional de medicamentos: uma abordagem econmica para tomada de decises. Cinc. Sade Coletiva, p. 589-601,

2008.

5. SECOLI, S.R.; PADILHA, K.G.; LITVOC, J.; MAEDA, S.T. Farmacoeconomia: perspectiva emergente no processo de tomada de deciso. Cinc. Sade Coletiva. p. 287-

96, 2005.

6. BRASIL. Ministrio da Sade. MAIS SADE, Direito de Todos, 2008-2011. Braslia, p. 5-8, 2007. Disponvel em: http://bvsms.saude.gov.br/bvs/publicacoes/07_1052_M.pdf.

Acesso: 22 de agosto de 2012.

7. SARTI, F.M. e CYRILLO, D.C. A Farmacoeconomia do Ponto de Vista do Profissional da Economia. In: NITA, M.E.; SECOLI, S.R.; NOBRE, M.R.C; ONO-NITA, S; CAMPINO,

A.C.C.; SARTI, F.M.; COSTA, A.M.N. e CARRILHO, F.J. Avaliao de Tecnologias em

Sade: Evidncia Clinica, Anlise Econmica e Anlise de Deciso. Porto Alegre: Artmed.

cap.16, p. 237 243, 2010.

8. ISPOR. Custo em sade, qualidade e desfechos: o livro de termos da ISPOR = Health care cost, quality and outcomes: ISPOR book of terms / Traduo Fbio Amaral Di Fini. So

Paulo: Associao Brasileira de Farmacoeconomia e Pesquisa de Desfechos ISPOR Brasil, 2009.

9. BRASIL. Ministrio da Sade. Secretaria de Cincia, Tecnologia e Insumos Estratgicos. Departamento de Cincia e Tecnologia. Diretrizes metodolgicas: estudos de avaliao

econmica de tecnologias em sade. Braslia: Ministrio da Sade; 2009. 150 p.

10. RASCATI, K. L. Introduo farmacoeconomia. Porto Alegre: Artemed, 2010, p. 239-246.

11. LEUNG, H. W. et al. Systematic review and quality assessment of cost-effectiveness analysis of pharmaceutical therapies for advanced colorectal cancer. Ann Pharmacother,

v. 47, n. 4, p. 506-18, Apr 2013.

12. MORAES, E. et al. Conceitos introdutrios de economia da sade e o impacto social do abuso de lcool. Rev. Bras. Psiquiatr. [online]. 2006, vol.28, n.4, pp. 321-325. Epub Oct

22

18, 2006.

13. CHIOU, C.F. et al. Development and validation of a grading system for the quality of cost-effectiveness studies. Med Care. Vol.41, n.1, p.3244, 2003.

14. Centre for Reviews and Disseminations, University of York. Systematic reviews. CRDs guidance for undertaking reviews in health care. York: Centre for Reviews and

Disseminations, University of York; 2008.

15. Oxford Centre for Evidence-based Medicine - Levels of Evidence (March 2009). Disponvel em: http://www.cebm.net/?o=1025. Acesso em 26 de abril de 2013.

16. ALMEIDA, A. M. et al. Chronic hepatitis B treatment: the cost-effectiveness of interferon compared to lamivudine. In: (Ed.). Value Health. United States: 2011 International Society

for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc, v.14,

p. 24-8 2011.

17. ARAUJO, D. V. et al. Analysis of the cost-effectiveness of thrombolysis with alteplase in stroke. Arq Bras Cardiol, v. 95, n. 1, p. 12-20, Jul 2010.

18. ARAUJO, D. V. et al. [Analysis of cost-effectiveness of simvastatin versus atorvastatin in the secondary prevention of cardiovascular events within the Brazilian public healthcare

system]. In: (Ed.). Value Health. United States: 2011 International Society for

Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc, v.14,

p.S29-32, 2011.

19. ARGENTA, C. et al. Short-term therapy with enoxaparin or unfractionated heparin for venous thromboembolism in hospitalized patients: Utilization study and cost-minimization

analysis. Value in Health, v. 14, n. 5 SUPPL., p. S89-S92, 2011.

20. ASPLER, A. et al. Impact of treatment completion, intolerance and adverse events on health system costs in a randomised trial of 4 months rifampin or 9 months isoniazid for

latent TB. In: (Ed.). Thorax. England, v.65, p.582-7, 2010.

21. CARVALHO-FILHO, R. J.; DALGARD, O. Individualized treatment of chronic hepatitis C with pegylated interferon and ribavirin. Pharmgenomics Pers Med, v. 3, p. 1-13, 2010.

22. CUNIO MACHADO FONSECA, M. et al. Economic evaluation of clodronate and zoledronate in patients diagnosed with metastatic bone disease from the perspective of

public and third party payors in Brazil. In: (Ed.). Clin Ther. United States: Inc, v.33,

p.1769-1780, 2011.

23. DASTA, J. F. et al. A cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation in the intensive care unit. Critical Care Medicine, v. 38,

n. 2, p. 497-503, 2010.

24. DE SOAREZ, P. C. et al. Cost-effectiveness analysis of a universal infant immunization program with meningococcal C conjugate vaccine in Brazil. In: (Ed.). Value Health.

United States: 2011 International Society for Pharmacoeconomics and Outcomes Research

(ISPOR). Published by Elsevier Inc, v.14, p.1019-27, 2011.

23

25. FONSECA, M.; ARAUJO, G. T.; SAAD, E. D. Cost-effectiveness of anastrozole, in comparison with tamoxifen, in the adjuvant treatment of early breast cancer in Brazil. Rev

Assoc Med Bras, v. 55, n. 4, p. 410-5, Jul-Aug 2009.

26. FONSECA, M. C.; ARAUJO, G. T.; ARAUJO, D. V. Cost effectiveness of peginterferon alfa-2B combined with ribavirin for the treatment of chronic hepatitis C in Brazil. Braz J

Infect Dis, v. 13, n. 3, p. 191-9, Jun 2009.

27. LEE, B. Y. et al. The potential economic value of a hookworm vaccine. In: (Ed.). Vaccine. Netherlands: A 2010 Elsevier Ltd, v.29, p.1201-10, 2011.

28. LINDNER, L. M. et al. Economic evaluation of antipsychotic drugs for schizophrenia treatment within the Brazilian Healthcare System. Rev Saude Publica, v. 43 Suppl 1, p. 62-

9, Aug 2009.

29. MACHADO, M.; EINARSON, T. R. Lapatinib in patients with metastatic breast cancer following initial treatment with trastuzumab: An economic analysis from the Brazilian

public health care perspective. Breast Cancer: Targets and Therapy, v. 4, p. 173-182,

2012.

30. MANIGLIA-FERREIRA, C. et al. Clinical evaluation of the use of three anesthetics in endodontics. Acta Odontol Latinoam, v. 22, n. 1, p. 21-6, 2009.

31. MOREIRA, G. C. et al. Evaluation of the awareness, control and cost-effectiveness of hypertension treatment in a Brazilian city: populational study. J Hypertens, v. 27, n. 9, p.

1900-7, Sep 2009.

32. NITA, M. E. et al. Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the treatment of diabetes mellitus type 2 in the Brazilian private

health system. Rev Assoc Med Bras, v. 58, n. 3, p. 294-301, Jun 2012.

33. PALETTA GUEDES, R. A. et al. Topical versus peribulbar anesthesia in non-penetrating deep sclerectomy. A cost-effectiveness analysis. In: (Ed.). J Fr Ophtalmol. France: A 2011

Elsevier Masson SAS, v.34, p.629-33, 2011.

34. PEPE, C. et al. Cost-effectiveness of fondaparinux in patients with acute coronary syndrome without ST-segment elevation. Arq Bras Cardiol, v. 99, n. 1, p. 613-22, Jul

2012.

35. SARTORI, A. M.; DE SOAREZ, P. C.; NOVAES, H. M. Cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine into the universal immunisation of infants in

Brazil. In: (Ed.). J Epidemiol Community Health. England, v.66, p.210-7, 2012.

36. SASSE, A. D.; SASSE, E. C. [Cost-effectiveness analysis of adjuvant anastrozol in post-menopausal women with breast cancer]. Rev Assoc Med Bras, v. 55, n. 5, p. 535-40, Sep-

Oct 2009.

37. TSUJI, R. L. et al. An economic evaluation of antihypertensive therapies based on clinical trials. Clinics (Sao Paulo), v. 67, n. 1, p. 41-8, 2012.

38. VAN GRIENSVEN, J. et al. Combination therapy for visceral leishmaniasis. In: (Ed.).

24

Lancet Infect Dis. United States: 2010 Elsevier Ltd, v.10, p.184-94, 2010.

39. VANNI, T. et al. Cervical cancer screening among HIV-infected women: An economic evaluation in a middle-income country. International Journal of Cancer, v. 131, n. 2, p.

E96-E104, 2012.

40. VANNI, T. et al. Economic modelling assessment of the HPV quadrivalent vaccine in Brazil: a dynamic individual-based approach. In: (Ed.). Vaccine. Netherlands: 2012

Elsevier Ltd, v.30, p.4866-71, 2012.

41. VAZ, F. A. et al. Cost-effectiveness analysis on spinal anesthesia versus local anesthesia plus sedation for loop colostomy closure. Arq Gastroenterol, v. 47, n. 2, p. 159-64, Apr-

Jun 2010.

42. WIENS, A. et al. Cost-effectiveness of telbivudine versus lamivudine for chronic hepatitis B. Brazilian Journal of Infectious Diseases, v. 15, n. 3, p. 225-230, 2011.

43. ZAHDI, M. R.; JUNIOR, I. M.; MALUF, E. M. C. P. Hepatitis A: The costs and benefits of the disease prevention by vaccine, Parana, Brazil. Brazilian Journal of Infectious

Diseases, v. 13, n. 4, p. 257-261, 2009.

44. AFFLECK, A. G. et al. Cost effectiveness of the two-compound formulation calcipotriol and betamethasone dipropionate gel in the treatment of scalp psoriasis in Scotland. Current

Medical Research and Opinion, v. 27, n. 1, p. 269-284, 2011.

45. AL-BADRIYEH, D. et al. Cost-effectiveness evaluation of voriconazole versus liposomal amphotericin B as empirical therapy for febrile neutropenia in Australia. Journal of

Antimicrobial Chemotherapy, v. 63, n. 1, p. 197-208, 2009a.

46. AL-BADRIYEH, D. et al. Economic impact of caspofungin as compared with liposomal amphotericin B for empirical therapy in febrile neutropenia in Australia. Journal of

Antimicrobial Chemotherapy, v. 63, n. 6, p. 1276-1285, 2009b.

47. AL-BADRIYEH, D. et al. Pharmacoeconomic analysis of voriconazole vs. caspofungin in the empirical antifungal therapy of febrile neutropenia in Australia. Mycoses, v. 55, n. 3, p.

244-256, 2012.

48. ALI, T. et al. Cost-effectiveness of adalimumab in moderately to severely active ulcerative colitis. American Journal of Gastroenterology, v. 107, p. S641, 2012.

49. ANDREWS, N. J. et al. Impact and effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive pneumococcal disease in the elderly in England

and Wales. Vaccine, v. 30, n. 48, p. 6802-6808, 2012.

50. ATTARD, C. L. et al. Cost-effectiveness of FOLFIRINOX for first-line treatment of metastatic pancreatic cancer. Journal of Clinical Oncology, v. 30, n. 4, 2012.

51. ATTARD, C. L. et al. Cost-effectiveness of oxaliplatin in the adjuvant treatment of colon cancer in Canada. Current Oncology, v. 17, n. 1, p. 17-24, 2010. ISSN 1198-0052.

25

52. BARKUN, A. N. et al. A one-year economic evaluation of six alternative strategies for the management of uninvestigated upper gastrointestinal symptoms in Canadian primary care.

Canadian Journal of Gastroenterology, v. 24, n. 8, p. 489-498, 2010.

53. BEAUDET, A. et al. Cost-utility of exenatide once weekly compared with insulin glargine in patients with type 2 diabetes in the UK. Journal of Medical Economics, v. 14, n. 3, p.

357-366, 2011.

54. BELSEY, J. D. Choice of angiotensin receptor blocker in moderate hypertension. A UK-based costbenefit comparison of olmesartan- and candesartan-based regimens. Journal of

Medical Economics, v. 14, n. 5, p. 553-561, 2011b.

55. BELSEY, J. D. Optimizing adherence in hypertension: A comparison of outcomes and costs using single tablet regimens vs individual component regimens. Journal of Medical

Economics, v. 15, n. 5, p. 897-905, 2012.

56. BENEDICT, A. et al. Economic evaluation of duloxetine versus serotonin selective reuptake inhibitors and venlafaxine XR in treating major depressive disorder in Scotland.

Journal of Affective Disorders, v. 120, n. 1-3, p. 94-104, 2010.

57. BENEDICT, A. et al. An economic evaluation of docetaxel and paclitaxel regimens in metastatic breast cancer in the UK. PharmacoEconomics, v. 27, n. 10, p. 847-859, 2009.

58. BENEDICT, A.; VERDIAN, L.; MACLAINE, G. The cost effectiveness of rufinamide in the treatment of lennox-gastaut syndrome in the UK. PharmacoEconomics, v. 28, n. 3, p.

185-199, 2010.

59. BLACKHOUSE, G. et al. Cost-utility of Intravenous Immunoglobulin (IVIG) compared with corticosteroids for the treatment of Chronic Inflammatory Demyelinating

Polyneuropathy (CIDP) in Canada. Cost Effectiveness and Resource Allocation, v. 8,

2010.

60. BLACKHOUSE, G. et al. Canadian cost-utility analysis of intravenous immunoglobulin for acute childhood idiopathic thrombocytopenic purpura. Journal of Population

Therapeutics and Clinical Pharmacology, v. 19, n. 2, p. e166-e178, 2012.

61. BOND, M. et al. The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of technology

appraisal no. 111): A systematic review and Economic model. Health Technology

Assessment, v. 16, n. 21, p. 1-469, 2012.

62. BOTTEMAN, M. et al. Cost-effectiveness of denosumab (D) versus zoledronic acid (Z) for skeletal-related event (SRE) reduction in bone-metastatic prostate cancer (mPC) in the

United Kingdom. Journal of Clinical Oncology, v. 30, n. 15, 2012.

63. BRERETON, N. et al. A cost-effectiveness analysis of MMX mesalazine compared with mesalazine in the treatment of mild-to-moderate ulcerative colitis from a UK perspective.

Journal of Medical Economics, v. 13, n. 1, p. 148-161, 2010.

64. BRERETON, N.; WINN, B.; AKEHURST, R. The cost-effectiveness of celecoxib vs

26

diclofenac in the treatment of osteoarthritis in the UK; an update to the NICE model using

data from the CONDOR trial. Journal of Medical Economics, v. 15, n. 3, p. 465-472,

2012.

65. BROWN, R. E. et al. Lenalidomide for multiple myeloma: cost-effectiveness in patients with one prior therapy in England and Wales. European Journal of Health Economics, p.

1-8, 2012.

66. CARDOZO, L. et al. The cost-effectiveness of solifenacin vs fesoterodine, oxybutynin immediate-release, propiverine, tolterodine extended-release and tolterodine immediate-

release in the treatment of patients with overactive bladder in the UK National Health

Service. BJU International, v. 106, n. 4, p. 506-514, 2010.

67. CHALMERS, J.; BRADFORD, D.; JONES, C. The effect of methamphetamine and heroin price on polydrug use: A behavioural economics analysis in Sydney, Australia.

International Journal of Drug Policy, v. 21, n. 5, p. 381-389, 2010.

68. CHAMBERS, D. et al. Sugammadex for the reversal of muscle relaxation in general anaesthesia: A systematic review and economic assessment. Health Technology

Assessment, v. 14, n. 39, p. 1-211, 2010.

69. CHARLES, M. E. S. et al. Health economic comparison between continuous subcutaneous insulin infusion and multiple daily injections of insulin for the treatment of adult type 1

diabetes in Canada. Clinical Therapeutics, v. 31, n. 3, p. 657-667, 2009.

70. CHAUDHARY, M. A. et al. Cost-effectiveness of raltegravir in HIV/AIDS. Expert Review of Pharmacoeconomics and Outcomes Research, v. 11, n. 6, p. 627-639, 2011.

71. CHEN, Y. F. et al. Clinical and cost-effectiveness of epoprostenol, iloprost, bosentan, sitaxentan and sildenafil for pulmonary arterial hypertension within their licensed

indications: a systematic review and economic evaluation. Health Technol Assess, v. 13, n.

49, p. 1-320, Oct 2009.

72. CHENG, J. W.; VU, H. Dabigatran etexilate: an oral direct thrombin inhibitor for the management of thromboembolic disorders. In: (Ed.). Clin Ther. United States: Inc, v.34,

p.766-87, 2012.

73. CHERRY, M. G. et al. The clinical effectiveness and cost-effectiveness of primary stroke prevention in children with sickle cell disease: a systematic review and economic

evaluation. Health Technol Assess, v. 16, n. 43, p. 1-129, 2012.

74. CHILCOTT, J.; LLOYD JONES, M.; WILKINSON, A. Docetaxel for the adjuvant treatment of early node-positive breast cancer: a single technology appraisal. Health

Technol Assess, v. 13 Suppl 1, p. 7-13, Jun 2009.

75. CHIU, Y. et al. Access to the next wave of biologic therapies (Abatacept and Tocilizumab) for the treatment of rheumatoid arthritis in England and Wales Addressing treatment outside

the current NICE guidance. Clinical Rheumatology, v. 31, n. 6, p. 1005-1012, 2012.

76. CHOY, E. et al. Cost effectiveness of pregabalin in the treatment of fibromyalgia from a UK perspective. Current Medical Research and Opinion, v. 26, n. 4, p. 965-975, 2010.

27

77. COBIAC, L. J. et al. Improving the cost-effectiveness of cardiovascular disease prevention in Australia: a modelling study. In: (Ed.). BMC Public Health. England, v.12, p.398, 2012.

78. COWIE, M. R. et al. Cost-effectiveness of highly purified omega-3 polyunsaturated fatty acid ethyl esters in the treatment of chronic heart failure: Results of Markov modelling in a

UK setting. European Journal of Heart Failure, v. 13, n. 6, p. 681-689, 2011.

79. CRAIG, F. F. et al. UK Dermatology Clinical Trials Network's STOP GAP trial (a multicentre trial of prednisolone versus ciclosporin for pyoderma gangrenosum): Protocol

for a randomised controlled trial. Trials, v. 13, 2012.

80. DAKIN, H. et al. Cost effectiveness of tenofovir disoproxil fumarate for the treatment of chronic hepatitis b from a canadian public payer perspective. PharmacoEconomics, v. 29,

n. 12, p. 1075-1091, 2011.

81. DAVIES, M. J. et al. Cost-utility analysis of liraglutide compared with sulphonylurea or sitagliptin, all as add-on to metformin monotherapy in Type 2 diabetes mellitus. Diabet

Med, v. 29, n. 3, p. 313-20, Mar 2012.

82. DE NATALE, R.; LAFUMA, A.; BERDEAUX, G. Cost effectiveness of travoprost versus a fixed combination of latanoprost/timolol in patients with ocular hypertension or

glaucoma: Analysis based on the UK general practitioner research database. Clinical Drug

Investigation, v. 29, n. 2, p. 111-120, 2009.

83. DELEA, T. E. et al. Cost-effectiveness of zoledronic acid vs clodronic acid for newly-diagnosed multiple myeloma from the United Kingdom healthcare system perspective.


84. DELEA, T. E. et al. Cost-effectiveness of lapatinib plus capecitabine in women with HER2+ metastatic breast cancer who have received prior therapy with trastuzumab. Eur J

Health Econ, v. 13, n. 5, p. 589-603, Oct 2012.

85. DIAMANTOPOULOS, A. et al. Cost-effectiveness of rivaroxaban versus enoxaparin for the prevention of postsurgical venous thromboembolism in Canada. Thrombosis and

Haemostasis, v. 104, n. 4, p. 760-770, 2010.

86. DOAN, Q. V. et al. Cost-effectiveness of onabotulinumtoxinA for the treatment of wrist and hand disability due to upper-limb post-stroke spasticity in Scotland. European Journal

of Neurology, 2012.

87. DORIAN, P. et al. Cost-effectiveness of apixaban against current standard of care (SoC) for stroke prevention in atrial fibrillation patients. European Heart Journal, v. 33, 2012.

88. DRANITSARIS, G.; COLEMAN, R.; GRADISHAR, W. nab-Paclitaxel weekly or every 3 weeks compared to standard docetaxel as first-line therapy in patients with metastatic breast

cancer: an economic analysis of a prospective randomized trial. Breast Cancer Res Treat,

v. 119, n. 3, p. 717-24, Feb 2010.

89. DRETZKE, J. et al. A systematic review and economic evaluation of the use of tumour necrosis factor-alpha (TNF-alpha) inhibitors, adalimumab and infliximab, for Crohn's

28

disease. Health Technol Assess, v. 15, n. 6, p. 1-244, Feb 2011.

90. DUNLOP, W. et al. Quality of life benefits and cost impact of prolonged release oxycodone/naloxone versus prolonged release oxycodone in patients with moderate-to-

severe non-malignant pain and opioid-induced constipation: A UK cost-utility analysis.


91. EARNSHAW, S. R. et al. Cost-effectiveness of 2 + 1 dosing of 13-valent and 10-valent pneumococcal conjugate vaccines in Canada. BMC Infectious Diseases, v. 12, 2012.

92. EDWARDS, S. J.; WORDSWORTH, S.; CLARKE, M. J. Treating pneumonia in critical care in the United Kingdom following failure of initial antibiotic: A cost-utility analysis

comparing meropenem with piperacillin/tazobactam. European Journal of Health

Economics, v. 13, n. 2, p. 181-192, 2012.

93. EKMAN, M. et al. Cost effectiveness of quetiapine in patients with acute bipolar depression and in maintenance treatment after an acute depressive episode. In: (Ed.).

Pharmacoeconomics. New Zealand, v.30, p.513-30, 2012.

94. ESFAHANI, K. et al. Potential cost-effectiveness of rifampin vs. isoniazid for latent tuberculosis: implications for future clinical trials. Int J Tuberc Lung Dis, v. 15, n. 10, p.

1340-6, Oct 2011.

95. FAJUTRAO, L. et al. Cost-effectiveness of quetiapine plus mood stabilizers compared with mood stabilizers alone in the maintenance therapy of bipolar I disorder: results of a

Markov model analysis. In: (Ed.). Clin Ther. United States, v.31 Pt 1, p.1456-68, 2009.

96. GANI, R. et al. Economic analyses comparing tiotropium with ipratropium or salmeterol in UK patients with COPD. Primary Care Respiratory Journal, v. 19, n. 1, p. 68-74, 2010.

97. GETSIOS, D. et al. Cost effectiveness of donepezil in the treatment of mild to moderate Alzheimer's disease: A UK evaluation using discrete-event simulation.

PharmacoEconomics, v. 28, n. 5, p. 411-427, 2010.

98. GORDON, J. et al. A cost-utility study of the use of pregabalin in treatment-refractory neuropathic pain. J Med Econ, v. 15, n. 2, p. 207-18, 2012.

99. GUEST, J. F. et al. Cost-effectiveness of pentostatin compared with cladribine in the management of hairy cell leukemia in the United Kingdom. Clinical Therapeutics, v. 31,

n. PART. 2, p. 2398-2415, 2009.

100. GUTZWILLER, F. S. et al. Health economic assessment of ferric carboxymaltose in patients with iron deficiency and chronic heart failure based on the FAIR-HF trial: an

analysis for the UK. In: (Ed.). Eur J Heart Fail. Netherlands, v.14, p.782-90, 2012.

101. HANNOUF, M. B. et al. Cost-effectiveness of adding cetuximab to platinum-based chemotherapy for first-line treatment of recurrent or metastatic head and neck cancer. PLoS

ONE, v. 7, n. 6, 2012.

102. HAYCOX, A. et al. Cost effectiveness of rasagiline and pramipexole as treatment strategies in early Parkinson's disease in the UK setting: an economic Markov model

29

evaluation. In: (Ed.). Drugs Aging. New Zealand, v.26, p.791-801, 2009.

103. HE, J. et al. Cost-effectiveness analysis of antiviral treatments for HBeAg-positive chronic hepatitis B in Canada. Value in Health, v. 15, n. 6, p. 894-906, 2012.

104. HERSCHORN, S.; VICENTE, C.; PIWKO, C. Canadian cost-effectiveness analysis of solifenacin compared to oxybutynin immediate-release in patients with overactive bladder.


105. HERTEL, N. et al. Cost-effectiveness of available treatment options for patients suffering from severe COPD in the UK: A fully incremental analysis. International Journal of

COPD, v. 7, p. 183-199, 2012.

106. HOYLE, M. et al. Cost-effectiveness of temsirolimus for first line treatment of advanced renal cell carcinoma. In: (Ed.). Value Health. United States, v.13, p.61-8, 2010.

107. HOYLE, M. et al. Cost-effectiveness of dasatinib and nilotinib for imatinib-resistant or -intolerant chronic phase chronic myeloid leukemia. Value in Health, v. 14, n. 8, p. 1057-

1067, 2011.

108. IKENBERG, R. et al. Cost-effectiveness of tapentadol prolonged release compared with oxycodone controlled release in the UK in patients with severe non-malignant chronic pain

who failed 1st line treatment with morphine. Journal of Medical Economics, v. 15, n. 4, p.

724-736, 2012.

109. JANSEN, J. P. et al. Cost Effectiveness of Etoricoxib Versus Celecoxib and Non-Selective NSAIDS in the Treatment of Ankylosing Spondylitis. PharmacoEconomics, v. 28, n. 4, p.

323-344, 2010.

110. JIT, M. et al. Comparing bivalent and quadrivalent human papillomavirus vaccines: Economic evaluation based on transmission model. BMJ (Online), v. 343, n. 7825, 2011.

111. JONES, J. et al. Adefovir dipivoxil and pegylated interferon alpha for the treatment of chronic hepatitis B: an updated systematic review and economic evaluation. Health

Technol Assess, v. 13, n. 35, p. 1-172, iii, Jul 2009.

112. KANSAL, A. R. et al. Dabigatran versus rivaroxaban for the prevention of stroke and systemic embolism in atrial fibrillation in Canada: Comparative efficacy and cost-

effectiveness. Thrombosis and Haemostasis, v. 108, n. 4, p. 672-682, 2012.

113. KANSAL, A. R. et al. Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in UK patients with atrial fibrillation. Heart, v. 98, n. 7, p.

573-578, 2012.

114. KARNON, J. et al. Lifetime cost-utility analyses of deferasirox in beta-thalassaemia patients with chronic iron overload: A UK perspective. Clinical Drug Investigation, v. 32,

n. 12, p. 805-815, 2012.

115. KLARENBACH, S. et al. Cost-effectiveness of second-line antihyperglycemic therapy in patients with type 2 diabetes mellitus inadequately controlled on metformin. In: (Ed.).

CMAJ. Canada, v.183, p.E1213-20, 2011.

30

116. KNERER, G.; ISMAILA, A.; PEARCE, D. Health and economic impact of PHiD-CV in Canada and the UK: A Markov modelling exercise. Journal of Medical Economics, v. 15,

n. 1, p. 61-76, 2012.

117. LAFUMA, A. et al. Treatment persistence and cost-effectiveness of latanoprost/latanoprost-timolol, bimatoprost/bimatoprost-timolol, and travoprost/travoprost-

timolol in glaucoma: An analysis based on the United Kingdom general practitioner

research database. Clinical Ophthalmology, v. 5, n. 1, p. 361-367, 2011.

118. LENOX-SMITH, A. et al. Cost effectiveness of venlafaxine compared with generic fluoxetine or generic amitriptyline in major depressive disorder in the UK. Clin Drug

Investig, v. 29, n. 3, p. 173-84, 2009.

119. LEWIS, G. et al. Cost-effectiveness of erlotinib versus docetaxel for second-line treatment of advanced non-small-cell lung cancer in the United Kingdom. J Int Med Res, v. 38, n. 1,

p. 9-21, 2010 Jan-Feb 2010.

120. LIU, Z. et al. The economic value of primary prophylaxis using pegfilgrastim compared with filgrastim in patients with breast cancer in the UK. Applied Health Economics and

Health Policy, v. 7, n. 3, p. 193-205, 2009.

121. LLOYD, A. et al. Economic evaluation of etanercept in the management of chronic plaque psoriasis. British Journal of Dermatology, v. 160, n. 2, p. 380-386, 2009.

122. LLOYD, A. et al. Cost-effectiveness of insulin aspart compared to human insulin in pregnant women with type 1 diabetes in the UK. Current Medical Research and Opinion,

v. 25, n. 3, p. 599-605, 2009.

123. LORGELLY, P. K. et al. Oral versus i.v. antibiotics for community-acquired pneumonia in children: A cost-minimisation analysis. European Respiratory Journal, v. 35, n. 4, p.

858-864, 2010.

124. LU, L. et al. Cost-effectiveness analysis of degarelix for advanced hormone-dependent prostate cancer. BJU Int, v. 109, n. 8, p. 1183-92, Apr 2012a.

125. LU, L. et al. Cost-effectiveness of alemtuzumab for T-cell prolymphocytic leukemia. International Journal of Technology Assessment in Health Care, v. 28, n. 3, p. 241-248,

2012b.

126. MAHONEY, E. M. et al. Cost-effectiveness of prasugrel versus clopidogrel in patients with acute coronary syndromes and planned percutaneous coronary intervention: results

from the trial to assess improvement in therapeutic outcomes by optimizing platelet

inhibition with Prasugrel-Thrombolysis in Myocardial Infarction TRITON-TIMI 38. In:

(Ed.). Circulation. United States, v.121, p.71-9, 2010.

127. MARTIN, A. et al. Cost-effectiveness of infant vaccination with RIX4414 (Rotarix) in the UK. In: (Ed.). Vaccine. Netherlands, v.27, p.4520-8, 2009. .

128. MATZA, L. S. et al. Health state preferences associated with subcutaneous injections and intravenous infusions for treatment of bone metastases. Journal of Clinical Oncology, v.

31

30, n. 15, 2012.

129. MAUSKOPF, J. et al. Cost-effectiveness of combination therapy with etravirine in treatment-experienced adults with HIV-1 infection. AIDS, v. 26, n. 3, p. 355-364, 2012.

130. MCDONALD, H. et al. Cost-effectiveness of rivaroxaban in the prevention of venous thromboembolism: A Canadian analysis using the Ontario Ministry of Health Perspective.


131. MCINTYRE, R. S. et al. Comparison of the metabolic and economic consequences of long-term treatment of schizophrenia using ziprasidone, olanzapine, quetiapine and

risperidone in Canada: a cost-effectiveness analysis. In: (Ed.). J Eval Clin Pract. England,

v.16, p.744-55, 2010.

132. MCKENNA, C. et al. Cost-effectiveness of aldosterone antagonists for the treatment of post-myocardial infarction heart failure. Value in Health, v. 15, n. 3, p. 420-428, 2012.

133. NEOH, C. F. et al. Cost-effectiveness analysis of anidulafungin versus fluconazole for the treatment of invasive candidiasis. Journal of Antimicrobial Chemotherapy, v. 67, n. 4, p.

1052, 2012.

134. NUIJTEN, M. et al. Cost effectiveness of paricalcitol versus a non-selective vitamin D receptor activator for secondary hyperparathyroidism in the UK: A chronic kidney disease

markov model. Clinical Drug Investigation, v. 30, n. 8, p. 545-557, 2010.

135. O'DELL, J. R. et al. Rheumatoid arthritis comparison of active therapies in methotrexate suboptimal responders: Validation of the strategy of conventional disease modifying anti-

rheumatic drugs before biologicals. Arthritis and Rheumatism, v. 64, p. S551-S552, 2012.

136. O'REILLY, D. et al. Using the Cardiff Long Term Model to estimate the long-term cost-utility of adding Onglyza(trademark) (saxagliptin) versus a thiazolidinedione (TZD) in

patients with type 2 diabetes mellitus (T2DM) with insufficient glycemic control using

maximal doses of metformin monotherapy and after failure or contraindication to

sulfonylurea combination therapy. Journal of Population Therapeutics and Clinical

Pharmacology, v. 17, n. 1, p. e109, 2010.

137. PALMER, J. L. et al. Cost-effectiveness of switching to biphasic insulin aspart from human premix insulin in a US setting. Journal of Medical Economics, v. 13, n. 2, p. 212-

220, 2010.

138. PAN, F. et al. Cost utility analysis based on a head-to-head phase 3 trial comparing ustekinumab and etanercept in patients with moderate-to-severe plaque psoriasis: A

Canadian perspective. Value in Health, v. 14, n. 5, p. 652-656, 2011.

139. PAPAIOANNOU, D. et al. Rituximab for the first-line treatment of stage III-IV follicular lymphoma (review of Technology Appraisal No. 110): a systematic review and economic

evaluation. Health Technol Assess, v. 16, n. 37, p. 1-253, iii-iv, 2012.

140. PATEL, A. M. et al. Cost-effectiveness of biologics compared with disease-modifying antirheumatic drugs in rheumatoid arthritis. Current Rheumatology Reports, v. 13, n. 5,

p. 381-382, 2011.

32

141. PATON, F. et al. Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation. In: (Ed.).

Br J Anaesth. England, v.105, p.558-67, 2010.

142. PAVEY, T. et al. Dasatinib, nilotinib and standard-dose imatinib for the first-line treatment of chronic myeloid leukaemia: systematic reviews and economic analyses. Health Technol

Assess, v. 16, n. 42, p. iii-iv, 1-277, 2012.

143. PERICLEOUS, L. et al. The cost-effectiveness of aripiprazole in the management of adolescent schizophrenia in the United Kingdom. European Neuropsychopharmacology,

v. 21, p. S609, 2011.

144. PETROU, S. et al. Cost-effectiveness analysis of prostaglandin E2 gel for the induction of labour at term. BJOG, v. 118, n. 6, p. 726-34, May 2011.

145. PETTIGREW, M.; DEUSON, R.; GARCES, K. Comparative net cost impact of the utilization of romiplostim and intravenous immunoglobulin for the treatment of patients

with immune thrombocytopenia in Quebec. Blood, v. 118, n. 21, 2011.

146. PHILIPS, Z. et al. Economic evaluation of adjunctive eslicarbazepine acetate in patients with refractory partial-onset seizures. Epilepsia, v. 52, p. 255, 2011.

147. PICOT, J. et al. The clinical effectiveness and cost effectiveness of bortezomib and thalidomide in combination regimens with an alkylating agent and a corticosteroid for the

first-line treatment of multiple myeloma: A systematic review and economic evaluation.

Health Technology Assessment, v. 15, n. 41, p. i-204, 2011.

148. PINK, J. et al. Dabigatran etexilate versus warfarin in management of non-valvular atrial fibrillation in UK context: Quantitative benefit-harm and economic analyses. BMJ

(Online), v. 343, n. 7830, 2011.

149. POIRIER, B. et al. Cost-effectiveness of a 3-dose pneumococcal conjugate vaccine program in the province of Quebec, Canada. Vaccine, v. 27, n. 50, p. 7105-7109, 2009.

150. POLLOCK, R. F. et al. A UK Analysis of the Cost-Effectiveness of Humalog Mix75/25 and Mix50/50 Versus Long-Acting Basal Insulin. Advances in Therapy, p. 1-16, 2012.

151. PRATOOMSOOT, C. et al. An estimation of the long-term clinical and economic benefits of insulin lispro in Type 1 diabetes in the UK. Diabetic Medicine, v. 26, n. 8, p. 803-814,

2009.

152. RAUTENBERG, T. A. et al. Evaluating the cost utility of racecadotril for the treatment of acute watery diarrhea in children: The RAWD model. ClinicoEconomics and Outcomes

Research, v. 4, n. 1, p. 109-116, 2012.

153. REDDING, L. et al. Cost-effectiveness of febuxostat in managing Hyperuricemia in gout patients in Canada. Journal of Population Therapeutics and Clinical Pharmacology, v.

18, n. 2, p. e195-e196, 2011.

154. RITCHIE, M.; LIEDGENS, H.; NUIJTEN, M. Cost effectiveness of a lidocaine 5%

33

medicated plaster compared with pregabalin for the treatment of postherpetic neuralgia in

the UK: A Markov model Analysis. Clinical Drug Investigation, v. 30, n. 2, p. 71-87,

2010.

155. ROBINSON, R.; MOORE, K.; HAQ, A. Dysport(registered trademark) versus Botox(registered trademark) in the treatment of idiopathic detrusor overactivity: A financial

and outcome evaluation. International Urogynecology Journal and Pelvic Floor

Dysfunction, v. 22, p. S323, 2011.

156. RODGERS, M. et al. Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis: a systematic review and economic evaluation. Health Technol Assess, v. 15, n.

10, p. i-xxi, 1-329, Feb 2011.

157. RODGERS, M. Bevacizumab in combination with a taxane for the first-line treatment of HER2-negative metastatic breast cancer. Health Technol Assess, v. 15 Suppl 1, p. 1-12,

May 2011.

158. ROGERS, G. et al. Dasatinib and nilotinib for imatinib-resistant or -intolerant chronic myeloid leukaemia: a systematic review and economic evaluation. Health Technol Assess,

v. 16, n. 22, p. 1-410, 2012.

159. ROZENBAUM, M. H. et al. Vaccination of risk groups in England using the 13 valent pneumococcal conjugate vaccine: Economic analysis. BMJ (Online), v. 345, n. 7882, 2012.

160. RUSSELL, A. et al. Cost-effectiveness modeling of abatacept versus other biologic agents in DMARDS and anti-TNF inadequate responders for the management of moderate to

severe rheumatoid arthritis. Clinical Rheumatology, v. 28, n. 4, p. 403-412, 2009.

161. SCHLAMM, H. et al. Economic evaluation of voriconazole versus itraconazole for primary prophylaxis of invasive fungal infection in allogeneic haematopoietic stem cell

transplantation. Clinical Microbiology and Infection, v. 17, p. S623, 2011.

162. SCHWENKGLENKS, M. et al. Cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor in the treatment of acute ST-segment elevation myocardial

infarction. Heart, v. 98, n. 7, p. 544-551, 2012.

163. SHEPHERD, M. et al. Use of analogue insulin in patients with Type 2 diabetes: An unnecessary expense for the NHS. Diabetic Medicine, v. 29, p. 126, 2012.

164. SIDHU, M. K. et al. Cost-effectiveness analysis of micafungin versus caspofungin for treatment of systemic Candida infections in the UK. Current Medical Research and

Opinion, v. 25, n. 8, p. 2049-2059, 2009.

165. SIMPSON, K. N. et al. Economic and health-related quality-of-life (HRQoL) comparison of lopinavir/ritonavir (LPV/r) and atazanavir plus ritonavir (ATV+RTV) based regimens for

antiretroviral therapy (ART)-naive and -experienced United Kingdom patients in 2011. J

Med Econ, v. 15, n. 4, p. 796-806, 2012.

166. SORENSEN, S. V. et al. Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation: A Canadian payer perspective.

Thrombosis and Haemostasis, v. 105, n. 5, p. 908-919, 2011.

34

167. SQUIRES, H. et al. A systematic review and economic evaluation of cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent

claudication in people with peripheral arterial disease. Health Technol Assess, v. 15, n. 40,

p. 1-210, Dec 2011.

168. STEWART, W. C.; STEWART, J. A.; MYCHASKIW, M. A. Cost-effectiveness of latanoprost and timolol maleate for the treatment of glaucoma in Scandinavia and the

United Kingdom, using a decision-analytic health economic model. Eye, v. 23, n. 1, p. 132-

140, 2009.

169. TAHAMI MONFARED, A. A. et al. Economic evaluation of posaconazole versus standard azole therapy as prophylaxis against invasive fungal infections in patients with prolonged

neutropenia in Canada. Canadian Journal of Infectious Diseases and Medical

Microbiology, v. 23, n. 2, p. 59-64, 2012.

170. TAM, V. C. et al. Cost-effectiveness of systemic therapies for metastatic pancreatic cancer. Journal of Clinical Oncology, v. 29, n. 15, 2011.

171. TARRIDE, J. E. et al. Cost-effectiveness analysis of intranasal live attenuated vaccine (LAIV) versus injectable inactivated influenza vaccine (TIV) for Canadian children and

adolescents. ClinicoEconomics and Outcomes Research, v. 4, n. 1, p. 287-298, 2012.

172. TAYLOR, R. R.; GUEST, J. F. The cost-effectiveness of macrogol 3350 compared to lactulose in the treatment of adults suffering from chronic constipation in the UK.

Alimentary Pharmacology and Therapeutics, v. 31, n. 2, p. 302-312, 2010.

173. TAYLOR, R. R. et al. Cost-effectiveness of using an extensively hydrolysed formula compared to an amino acid formula as first-line treatment for cow milk allergy in the UK.

Pediatric Allergy and Immunology, v. 23, n. 3, p. 240-249, 2012.

174. THORLUND, K. et al. Budget impact analysis of boceprevir and telaprevir for the treatment of hepatitis C genotype 1 infection. ClinicoEconomics and Outcomes Research,

v. 4, n. 1, p. 349-359, 2012.

175. TOLLEY, K. et al. Cost effectiveness of deferasirox compared to desferrioxamine in the treatment of iron overload in lower-risk, transfusion-dependent myelodysplastic syndrome

patients. Journal of Medical Economics, v. 13, n. 3, p. 559-570, 2010.

176. TRAN, G. et al. Pharmaco-economic analysis of direct medical costs of metastatic colorectal cancer therapy with XELOX or modified FOLFOX-6 regimens: Implications for

health-care utilization in Australia. Asia-Pacific Journal of Clinical Oncology, 2012.

177. TUNIS, S. L. et al. Cost-effectiveness of insulin detemir compared to NPH insulin for type 1 and type 2 diabetes mellitus in the Canadian payer setting: Modeling analysis. Current

Medical Research and Opinion, v. 25, n. 5, p. 1273-1284, 2009.

178. TUNIS, S. L.; SAURIOL, L.; MINSHALL, M. E. Cost effectiveness of insulin glargine plus oral antidiabetes drugs compared with premixed insulin alone in patients with type 2

diabetes mellitus in Canada. Applied Health Economics and Health Policy, v. 8, n. 4, p.

267-280, 2010.

35

179. VAN HOEK, A. J. et al. The cost-effectiveness of a 13-valent pneumococcal conjugate vaccination for infants in England. Vaccine, v. 30, n. 50, p. 7205-7213, 2012.

180. VEGTER, S. et al. Cost-Effectiveness of Lanthanum Carbonate in the Treatment of Hyperphosphatemia in Dialysis Patients: A Canadian Payer Perspective. Clinical

Therapeutics, v. 34, n. 7, p. 1531-1543, 2012.

181. VEGTER, S. et al. Cost-effectiveness of lanthanum carbonate in the treatment of hyperphosphatemia in chronic kidney disease before and during dialysis. In: (Ed.). Value

Health. United States: 2011 International Society for Pharmacoeconomics and Outcomes

Research (ISPOR). Published by Elsevier Inc, v.14, p.852-8, 2011.

182. 1098-3015 (Linking).

183. VERDIAN, L.; YI, Y. Cost-utility analysis of rufinamide versus topiramate and lamotrigine for the treatment of children with Lennox-Gastaut Syndrome in the United Kingdom.

Seizure, v. 19, n. 1, p. 1-11, 2010.

184. VERHEGGEN, B. G. et al. Estimating the quality-of-life impact and cost-effectiveness of alpha-blocker and anti-muscarinic combination treatment in men with lower urinary tract

symptoms related to benign prostatic hyperplasia and overactive bladder. J Med Econ, v.

15, n. 3, p. 586-600, 2012.

185. WAGNER, M. et al. Cost-effectiveness of intensive lipid lowering therapy with 80 mg of atorvastatin, versus 10 mg of atorvastatin, for secondary prevention of cardiovascular

disease in Canada. Can J Clin Pharmacol, v. 16, n. 2, p. e331-45, Summer 2009.

186. WAGNER, M. et al. Economic evaluation of high-dose (80 mg/day) atorvastatin treatment compared with standard-dose (20 mg/day to 40 mg/day) simvastatin treatment in Canada

based on the Incremental Decrease in End-Points Through Aggressive Lipid-Lowering

(IDEAL) trial. Canadian Journal of Cardiology, v. 25, n. 11, p. e362-e369, 2009.

187. WALTER, E.; MERCSANITS, D. Cost effectiveness of Apomorphine infusion in the treatment of advanced Parkinson's disease in the UK. European Journal of Neurology, v.

19, p. 287, 2012.

188. WELSH, R. C. et al. Cost-effectiveness of enoxaparin compared with unfractionated heparin in ST elevation myocardial infarction patients undergoing pharmacological

reperfusion: A Canadian analysis of the Enoxaparin and Thrombolysis Reperfusion for

Acute Myocardial Infarction Treatment - Thrombolysis in Myocardial Infarction

(ExTRACT-TIMI) 25 trial. Canadian Journal of Cardiology, v. 25, n. 12, p. e399-e405,

2009.

189. WEX-WECHOWSKI, J. et al. HP-HMG versus rFSH in treatments combining fresh and frozen IVF cycles: Success rates and economic evaluation. Reproductive BioMedicine

Online, v. 21, n. 2, p. 166-178, 2010.

190. WIELAGE, R. et al. The cost-effectiveness of duloxetine in chronic low back pain: A Quebec societal perspective. Spine, 2012.

191. WILBUR, K.; LYND, L. D.; SADATSAFAVI, M. Low-molecular-weight heparin versus

36

unfractionated heparin for prophylaxis of venous thromboembolism in medicine patients-A

pharmacoeconomic analysis. Clinical and Applied Thrombosis/Hemostasis, v. 17, n. 5, p.

454-465, 2011.

192. WILSON, E. C. Cost effectiveness of imiquimod 5% cream compared with methyl aminolevulinate-based photodynamic therapy in the treatment of non-hyperkeratotic, non-

hypertrophic actinic (solar) keratoses: a decision tree model. In: (Ed.).

Pharmacoeconomics. New Zealand, v.28, p.1055-64, 2010.

193. WILSON, E. C. et al. Cost effectiveness of leukotriene receptor antagonists versus long-acting beta-2 agonists as add-on therapy to inhaled corticosteroids for asthma: a pragmatic

trial. Pharmacoeconomics, v. 28, n. 7, p. 597-608, 2010.

194. WILSON, E. C. et al. Cost effectiveness of leukotriene receptor antagonists versus inhaled corticosteroids for initial asthma controller therapy: a pragmatic trial.

Pharmacoeconomics, v. 28, n. 7, p. 585-95, 2010.

195. WOODS, B. et al. Bendamustine versus chlorambucil for the first-line treatment of chronic lymphocytic leukemia in England and Wales: A cost-utility analysis. Value in Health, v.

15, n. 5, p. 759-770, 2012.

8. ANEXOS

ANEXO I

Lista de publicaes nacionais que foram avaliados segundo nossos critrios de qualidade.

Ttulo Referncia

Chronic hepatitis B treatment: the cost-effectiveness of interferon compared to lamivudine. 16

Analysis of the cost-effectiveness of thrombolysis with alteplase in stroke. 17

[Analysis of cost-effectiveness of simvastatin versus atorvastatin in the secondary prevention of

cardiovascular events within the Brazilian public healthcare system]. 18

Short-term therapy with enoxaparin or unfractionated heparin for venous thromboembolism in

hospitalized patients: Utilization study and cost-minimization analysis 19

Impact of treatment completion, intolerance and adverse events on health system costs in a

randomised trial of 4 months rifampin or 9 months isoniazid for latent TB. 20

Individualized treatment of chronic hepatitis C with pegylated interferon and ribavirin. 21

Economic evaluation of clodronate and zoledronate in patients diagnosed with metastatic bone

disease from the perspective of public and third party payors in Brazil. 22

A cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation

in the intensive care unit. 23

Cost-effectiveness analysis of a universal infant immunization program with meningococcal C

conjugate vaccine in Brazil. 24

Cost-effectiveness of anastrozole, in comparison with tamoxifen, in the adjuvant treatment of early

breast cancer in Brazil. 25

Cost effectiveness of peginterferon alfa-2B combined with ribavirin for the treatment of chronic

hepatitis C in Brazil. 26

The potential economic value of a hookworm vaccine. 27

Economic evaluation of antipsychotic drugs for schizophrenia treatment within the Brazilian

Healthcare System. 28

Lapatinib in patients with metastatic breast cancer following initial treatment with trastuzumab: An

economic analysis from the Brazilian public health care perspective 29

Clinical evaluation of the use of three anesthetics in endodontics. 30

Continua

Continuao

Ttulo Referncia

Evaluation of the awareness, control and cost-effectiveness of hypertension treatment in a Brazilian

city: populational study. 31

Cost-effectiveness and budget impact of saxagliptine as additional therapy to metformin for the

treatment of diabetes mellitus type 2 in the Brazilian private health system. 32

Topical versus peribulbar anesthesia in non-penetrating deep sclerectomy. A cost-effectiveness

analysis. 33

Cost-effectiveness of fondaparinux in patients with acute coronary syndrome without ST-segment

elevation. 34

Cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine into the universal

immunisation of infants in Brazil. 35

[Cost-effectiveness analysis of adjuvant anastrozol in post-menopausal women with breast cancer]. 36

An economic evaluation of antihypertensive therapies based on clinical trials. 37

Combination therapy for visceral leishmaniasis. 38

Cervical cancer screening among HIV-infected women: an economic evaluation in a middle-income

country. 39

Economic modelling assessment of the HPV quadrivalent vaccine in Brazil: a dynamic individual-

based approach. 40

Cost-effectiveness analysis on spinal anesthesia versus local anesthesia plus sedation for loop

colostomy closure. 41

Cost-effectiveness of telbivudine versus lamivudine for chronic hepatitis B. 42

Hepatitis A: The costs and benefits of the disease prevention by vaccine, Parana, Brazil 43

ANEXO II

Lista de publicaes internacionais que foram avaliados segundo nossos critrios de qualidade.

Ttulo Referncia

Cost effectiveness of the two-compound formulation calcipotriol and betamethasone dipropionate gel

in the treatment of scalp psoriasis in Scotland 44

Cost-effectiveness evaluation of voriconazole versus liposomal amphotericin B as empirical therapy

for febrile neutropenia in Australia 45

Economic impact of caspofungin as compared with liposomal amphotericin B for empirical therapy in

febrile neutropenia in Australia 46

Pharmacoeconomic analysis of voriconazole vs. caspofungin in the empirical antifungal therapy of

febrile neutropenia in Australia 47

Cost-effectiveness of adalimumab in moderately to severely active ulcerative colitis 48

Impact and effectiveness of 23-valent pneumococcal polysaccharide vaccine against invasive

pneumococcal disease in the elderly in England and Wales 49

Cost-effectiveness of FOLFIRINOX for first-line treatment of metastatic pancreatic cancer 50

Cost-effectiveness of oxaliplatin in the adjuvant treatment of colon cancer in Canada 51

A one-year economic evaluation of six alternative strategies for the management of uninvestigated

upper gastrointestinal symptoms in Canadian primary care 52

Cost-utility of exenatide once weekly compared with insulin glargine in patients with type 2 diabetes in

the UK 53

Choice of angiotensin receptor blocker in moderate hypertension. A UK-based costbenefit

comparison of olmesartan- and candesartan-based regimens 54

Optimizing adherence in hypertension: A comparison of outcomes and costs using single tablet

regimens vs individual component regimens 55

Economic evaluation of duloxetine versus serotonin selective reuptake inhibitors and venlafaxine XR

in treating major depressive disorder in Scotland 56

An economic evaluation of docetaxel and paclitaxel regimens in metastatic breast cancer in the UK 57

The cost effectiveness of rufinamide in the treatment of lennox-gastaut syndrome in the UK 58

Cost-utility of Intravenous Immunoglobulin (IVIG) compared with corticosteroids for the treatment of

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) in Canada 59

Continua

Continuao

Ttulo Referncia

Canadian cost-utility analysis of intravenous immunoglobulin for acute childhood idiopathic

thrombocytopenic purpura 60

The effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for

the treatment of Alzheimer's disease (review of Technology Appraisal No. 111): a systematic review

and economic model.

61

Cost-effectiveness of denosumab (D) versus zoledronic acid (Z) for skeletal-related event (SRE)

reduction in bone-metastatic prostate cancer (mPC) in the United Kingdom 62

A cost-effectiveness analysis of MMX mesalazine compared with mesalazine in the treatment of mild-

to-moderate ulcerative colitis from a UK perspective 63

The cost-effectiveness of celecoxib vs diclofenac in the treatment of osteoarthritis in the UK; an

update to the NICE model using data from the CONDOR trial 64

Lenalidomide for multiple myeloma: cost-effectiveness in patients with one prior therapy in England

and Wales 65

The cost-effectiveness of solifenacin vs fesoterodine, oxybutynin immediate-release, propiverine,

tolterodine extended-release and tolterodine immediate-release in the treatment of patients with

overactive bladder in the UK National Health Service

66

The effect of methamphetamine and heroin price on polydrug use: A behavioural economics analysis

in Sydney, Australia 67

Sugammadex for the reversal of muscle relaxation in general anaesthesia: A systematic review and

economic assessment 68

Health economic comparison between continuous subcutaneous insulin infusion and multiple daily

injections of insulin for the treatment of adult type 1 diabetes in Canada 69

Cost-effectiveness of raltegravir in HIV/AIDS 70

Clinical and cost-effectiveness of epoprostenol, iloprost, bosentan, sitaxentan and sildenafil for

pulmona

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