JULIANA YUKARI KODAIRA VISCONDI

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LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 20 Citação(ões) na Scopus
    Cost-effectiveness analysis of universal maternal immunization with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in Brazil
    (2016) SARTORI, Ana Marli Christovam; SOAREZ, Patricia Coelho de; FERNANDES, Eder Gatti; GRYNINGER, Ligia Castellon Figueiredo; VISCONDI, Juliana Yukari Kodaira; NOVAES, Hillegonda Maria Dutilh
    Background: Pertussis incidence has increased significantly in Brazil since 2011, despite high coverage of whole-cell pertussis containing vaccines in childhood. Infants <4 months are most affected. This study aimed to evaluate the cost-effectiveness of introducing universal maternal vaccination with tetanus-diphtheria-acellular pertussis vaccine (Tdap) into the National Immunization Program in Brazil. Methods: Economic evaluation using a decision tree model comparing two strategies: (1) universal vaccination with one dose of Tdap in the third trimester of pregnancy and (2) current practice (no pertussis maternal vaccination), from the perspective of the health system and society. An annual cohort of newborns representing the number of vaccinated pregnant women were followed for one year. Vaccine efficacy were based on literature review. Epidemiological, healthcare resource utilization and cost estimates were based on local data retrieved from Brazilian Health Information Systems. Costs of epidemiological investigation and treatment of contacts of cases were included in the analysis. No discount rate was applied to costs and benefits, as the temporal horizon was one year. Primary outcome was cost per life year saved (LYS). Univariate and best- and worst-case scenarios sensitivity analysis were performed. Results: Maternal vaccination of one annual cohort, with vaccine effectiveness of 78%, and vaccine cost of USD$12.39 per dose, would avoid 661 cases and 24 infant deaths of pertussis, save 1800 years of life and cost USD$28,942,808 and USD$29,002,947, respectively, from the health system and societal perspective. The universal immunization would result in ICERs of USD$15,608 and USD$15,590 per LYS, from the health system and societal perspective, respectively. In sensitivity analysis, the ICER was most sensitive to discounting of life years saved, variation in case-fatality, disease incidence, vaccine cost, and vaccine effectiveness. Conclusion: The results indicate that universal maternal immunization with Tdap is a cost-effective intervention for preventing pertussis cases and deaths in infants in Brazil.
  • article 132 Citação(ões) na Scopus
    All-Cause Mortality Attributable to Sitting Time Analysis of 54 Countries Worldwide
    (2016) REZENDE, Leandro Fornias Machado de; SA, Thiago Herick de; MIELKE, Gregore Iven; VISCONDI, Juliana Yukari Kodaira; REY-LOPEZ, Juan Pablo; GARCIA, Leandro Martin Totaro
    Introduction: Recent studies have shown that sitting time is associated with increased risk of all-cause mortality, independent of moderate to vigorous physical activity. Less is known about the population-attributable fraction for all-cause mortality associated with sitting time, and the gains in life expectancy related to the elimination of this risk factor. Methods: In November 2015, data were gathered from one published meta-analysis, 54 adult surveys on sitting time distribution (from 2002 to 2011), in conjunction with national statistics on population size, life table, and overall deaths. Population-attributable fraction for all-cause mortality associated with sitting time > 3 hours/day was estimated for each country, WHO regions, and worldwide. Gains in life expectancy related to the elimination of sitting time > 3 hours/day was estimated using life table analysis. Results: Sitting time was responsible for 3.8% of all-cause mortality (about 433,000 deaths/year) among those 54 countries. All-cause mortality due to sitting time was higher in the countries from the Western Pacific region, followed by European, Eastern Mediterranean, American, and Southeast Asian countries. Eliminating sitting time would increase life expectancy by 0.20 years in those countries. Conclusions: Assuming that the effect of sitting time on all-cause mortality risk is independent of physical activity, reducing sitting time plays an important role in active lifestyle promotion, which is an important aspect of premature mortality prevention worldwide.