HILLEGONDA MARIA DUTILH NOVAES
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Modelling the Force of Infection for Hepatitis A in an Urban Population-Based Survey: A Comparison of Transmission Patterns in Brazilian Macro-Regions(2014) XIMENES, Ricardo Arraes de Alencar; MARTELLI, Celina Maria Turchi; AMAKU, Marcos; SARTORI, Ana Marli C.; SOAREZ, Patricia Coelho de; NOVAES, Hillegonda Maria Dutilh; PEREIRA, Leila Maria Moreira Beltrao; MOREIRA, Regina Celia; FIGUEIREDO, Gerusa Maria; AZEVEDO, Raymundo Soares deBackground: This study aimed to identify the transmission pattern of hepatitis A (HA) infection based on a primary dataset from the Brazilian National Hepatitis Survey in a pre-vaccination context. The national survey conducted in urban areas disclosed two epidemiological scenarios with low and intermediate HA endemicity. Methods: A catalytic model of HA transmission was built based on a national seroprevalence survey (2005 to 2009). The seroprevalence data from 7,062 individuals aged 5-69 years from all the Brazilian macro-regions were included. We built up three models: fully homogeneous mixing model, with constant contact pattern; the highly assortative model and the highly assortative model with the additional component accounting for contacts with infected food/water. Curves of prevalence, force of infection (FOI) and the number of new infections with 99% confidence intervals (CIs) were compared between the intermediate (North, Northeast, Midwest and Federal District) and low (South and Southeast) endemicity areas. A contour plot was also constructed. Results: The anti-HAV IgG seroprevalence was 68.8% (95% CI, 64.8%-72.5%) and 33.7% (95% CI, 32.4%-35.1%) for the intermediate and low endemicity areas, respectively, according to the field data analysis. The models showed that a higher force of infection was identified in the 10- to 19-year-old age cohort (similar to 9,000 infected individuals per year per 100,000 susceptible persons) in the intermediate endemicity area, whereas a higher force of infection occurred in the 15-to 29-year-old age cohort (similar to 6,000 infected individuals per year per 100,000 susceptible persons) for the other macro-regions. Conclusion: Our findings support the shift of Brazil toward intermediate and low endemicity levels with the shift of the risk of infection to older age groups. These estimates of HA force of infection stratified by age and endemicity levels are useful information to characterize the pre-vaccination scenario in Brazil.
- Cost-effectiveness analysis of universal adult immunization with tetanus-diphtheria-acellular pertussis vaccine (Tdap) versus current practice in Brazil(2020) FERNANDES, Eder Gatti; SARTORI, Ana Marli Christovam; SOAREZ, Patricia Coelho de; AMAKU, Marcos; AZEVEDO NETO, Raymundo Soares de; NOVAES, Hillegonda Maria DutilhBackground: A pertussis outbreak occurred in Brazil from 2011 to 2014, despite high coverage of whole-cell pertussis containing vaccines in early childhood. Infants were the most affected. This study aimed to evaluate the cost-effectiveness of introducing universal adult vaccination with Tdap into the National Immunization Program in Brazil. Methods: Economic evaluation using a dynamic model to compare two strategies: (1) universal vaccination with single dose of Tdap at 20 years of age and (2) current practice (only pregnant women pertussis vaccination). The health system perspective was adopted. Temporal horizon was 10 years. Discount rate of 5% was applied to costs and benefits. Vaccine effectiveness (VE) was obtained from a population-based observational study. Epidemiological, resource utilization and cost estimates were obtained from the Brazilian Health Information Systems. The primary outcome was cost per life year saved (LYS), based on life expectancy at birth in Brazil in 2015. Univariate and multivariate sensitivity analysis were performed. Results: Adult vaccination with VE of 82.6% and coverage of 40%, at price of US$7.01 per dose, and assuming herd protection would avoid 167 infant deaths by pertussis, saving 12,325 years of life and costing a total of US$105495891.61, from the health system perspective. The universal immunization would result in ICER of US$8459.13. The results were highly sensitive to disease incidence. Conclusions: The results suggest that universal adult vaccination with Tdap would not be a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.
conferenceObject REGIONAL COST-EFFECTIVENESS ANALYSIS OF UNIVERSAL CHILDHOOD HEPATITIS A VACCINATION IN BRAZIL(2012) SOAREZ, P. C. De; SARTORI, A. M. C.; NOVAES, H. M. D.; AMAKU, M.; AZEVEDO, R. S.; XIMENES, R. A.; MARTELLI, C. M. T.OBJECTIVES: To conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazilian regions with different hepatitis A endemicity. METHODS: An age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately, according to the pattern of regional endemicity, one for Southern Southeast (low endemicity) and one for the North Northeast Midwest (inter-mediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data retrieved from a nationwide seroepidemiological survey for viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from the healthcare system and societal perspectives. Costs are expressed in 2008 Brazilian reals. RESULTS: In this model a universal national immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths due to disease and a 62 % decrease of life years lost, in a national perspective. With a vaccine price per dose of R$16.89 (US$7.23), vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from healthcare and society perspective. Results were most sensitive to icteric hepatitis incidence, ambulatory cases and vaccine costs. CONCLUSIONS: Universal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results may be useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program.- Cost-effectiveness analysis of universal childhood hepatitis A vaccination in Brazil: Regional analyses according to the endemic context(2012) SARTORI, Ana Marli C.; SOAREZ, Patricia Coelho de; NOVAES, Hillegonda Maria Dutilh; AMAKU, Marcos; AZEVEDO, Raymundo Soares de; MOREIRA, Regina Celia; PEREIRA, Leila Maria Moreira Beltrao; XIMENES, Ricardo Arraes de Alencar; MARTELLI, Celina Maria TurchiObjective: To To conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazil. Methods: An age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately according to the pattern of regional endemicity, one for South + Southeast (low endemicity) and one for the North + Northeast + Midwest (intermediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data from a nationwide seroprevalence survey of viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from both the health system and societal perspectives. Costs are expressed in 2008 Brazilian currency (Real). Results: A universal immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths for the disease and a 62% decrease of life years lost, in a national perspective. With a vaccine price of R$16.89 (US$7.23) per dose, vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from both health system and society perspective. Results were most sensitive to the frequency of icteric hepatitis, ambulatory care and vaccine costs. Conclusions: Universal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results are useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program.