LUCIANA MARTINS ROZMAN
Projetos de Pesquisa
Unidades Organizacionais
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina
10 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 10
- Palliative cancer care: costs in a Brazilian quaternary hospital(2022) ROZMAN, Luciana Martins; CAMPOLINA, Alessandro Goncalves; LOPEZ, Rossana Mendoza; CHIBA, Toshio; SOAREZ, Patricia Coelho DePalliative care (PC) improves the quality of life of patients with diseases such as cancer, and several studies have shown a reduction in costs among patients who use PC services when compared with those receiving standard oncological treatments. Most studies on PC costs are carried out in high-income countries. There is a lack of these types of studies in middle-income and low-income countries and of better evidence about this intervention. Objective To describe resource utilisation and costs among patients with cancer in a Brazilian quaternary hospital by cancer localisation and per month of treatment before death. Methods This study is a description of retrospective costs to estimate the costs of formal healthcare sector associated with PCs, from the perspective of a public quaternary cancer hospital. Unit costs were estimated using microcosting and macrocosting approaches. Setting/Participants Patients older than 18 years old who died from 2010 to 2013 and who had at least two visits in PC and/or made use of hospice care. Results Among the 2985 patients included in the study, the average cost per patient was US$12 335, ranging from US$8269 for patients with pancreatic cancer to US$19 395 for patients with brain cancer. The main costing item was hospital admission (47.6% of the total cost), followed by hospice care (29.5%) and medical and other supplies (11.1%). Conclusions The study clarified the direct medical costs and the profile and use of resources of patients with cancer who need PC, and can help in the planning and allocation of resources in cancer care.
- The methodological quality of economic evaluations of measles outbreaks: A systematic review of cost-of-illness studies(2023) SOAREZ, Patricia Coelho de; ROZMANA, Luciana Martins; FONSECA, Taiane Siraisi; BORSARI, Pietro Rodrigo; PERCIO, Jadher; BARRERA, Lely Stella Guzman; SARTORI, Ana Marli ChristovamObjectives: To identify the main cost components included in the economic evaivations of measles outbreaks, their items and cost drivers, and evaluate the quality of costing methodology, analyzing the key features that may affect the validity of these studies in countries with different income leveis Methods: We systematically searched multiple databases EMBASE, MEDLINE (via PubMed), Biblioteca Virtual em Saude do Ministerio da Saude (BVS MS), NHS Economic Evaluation Database (NHS EED) and NHS Health Technology Assessment (NHS HTA) (via The Centre for Reviews and Dissemination Library - CRD), and EconLit, SCOPUS, and Web of Science, selecting cost analysis and cost of illness studies (COI) of measles outbreaks. Two independent reviewers screened articles for relevance and extracted the data. The quality of costing methods was assessed using a guide to critical evaluation of COI studies. We performed a qualitative narrative synthesis. Results: Twenty-two studies were reviewed. Most studies evaluated outbreaks that occurred from 2011 to 2013 and 2017 to 2019. Total costs varied from $40,147 to $39.3 million. Per case cost varied from $168 to $49,439. The main drivers of measles outbreak costs were outbreak response, personnel, and productivity losses. Most studies (20/22) did not report the costing methodology adonted, the degree of disaggregation used in the identification and measurement of resource and costs components and the method for the valuation of resource and cost components. Conclusions: The quality of the costing methodology, its transparency and accuracy are essential to the validity of these studies results and their potential use to allocate public health resources in the most efficient manner and to inform measles outbreak control strategies, with rapid and effective response. (c) 2023 Published by Elsevier Ltd.
- Systematic Review of Health Economic Evaluations of Diagnostic Tests in Brazil: How accurate are the results?(2017) OLIVEIRA, Maria Regina Fernandes; LEANDRO, Roseli; DECIMONI, Tassia Cristina; ROZMAN, Luciana Martins; NOVAES, Hillegonda Maria Dutilh; SOAREZ, Patricia Coelho DeThe aim of this study is to identify and characterize the health economic evaluations (HEEs) of diagnostic tests conducted in Brazil, in terms of their adherence to international guidelines for reporting economic studies and specific questions in test accuracy reports. We systematically searched multiple databases, selecting partial and full HEEs of diagnostic tests, published between 1980 and 2013. Two independent reviewers screened articles for relevance and extracted the data. We performed a qualitative narrative synthesis. Forty-three articles were reviewed. The most frequently studied diagnostic tests were laboratory tests (37.2%) and imaging tests (32.6%). Most were non-invasive tests (51.2%) and were performed in the adult population (48.8%). The intended purposes of the technologies evaluated were mostly diagnostic (69.8%), but diagnosis and treatment and screening, diagnosis, and treatment accounted for 25.6% and 4.7%, respectively. Of the reviewed studies, 12.5% described the methods used to estimate the quantities of resources, 33.3% reported the discount rate applied, and 29.2% listed the type of sensitivity analysis performed. Among the 12 cost-effectiveness analyses, only two studies (17%) referred to the application of formal methods to check the quality of the accuracy studies that provided support for the economic model. The existing Brazilian literature on the HEEs of diagnostic tests exhibited reasonably good performance. However, the following points still require improvement: 1) the methods used to estimate resource quantities and unit costs, 2) the discount rate, 3) descriptions of sensitivity analysis methods, 4) reporting of conflicts of interest, 5) evaluations of the quality of the accuracy studies considered in the cost-effectiveness models, and 6) the incorporation of accuracy measures into sensitivity analyses.
- Early Palliative Care and Its Impact on End-of-Life Care for Cancer Patients in Brazil(2018) ROZMAN, Luciana Martins; CAMPOLINA, Alessandro Goncalves; LOPEZ, Rossana Veronica Mendonca; KOBAYASHI, Silvia Takanohashi; CHIBA, Toshio; SOAREZ, Patricia Coelho deBackground: Integrating palliative care into standard oncology care has been recommended for cancer patients. Early palliative care is associated with less aggressive treatment at the end of life. Objective: To describe cancer patients receiving palliative care in Brazil, determining the time from entry into palliative care to death, and investigating whether late referral to palliative care is associated with aggressive end-of-life treatment. Design: This was a cross-sectional study of cancer patients receiving palliative care in Brazil. Setting/Subjects: Subjects were 2985 cancer patients 18 years of age who received at least two palliative care visits at the SAo Paulo State Cancer Institute, in the city of SAo Paulo, Brazil, and died between 2010 and 2013. Measurements: We evaluated the time from the first palliative care consult to death, stratifying cases by the timing of entry into palliative care (3 or <3 months before death). The associations between early palliative care and indicators of aggressive treatment were assessed by Pearson's chi-square test and Fisher's exact test. Results: The overall median time between entry into palliative care and death was 34 days (mean, 72 days) and was significantly shorter in 2013 than in 2010 (p<0.001). The number of emergency department visits was significantly lower among the patients who entered palliative care earlier (p<0.001). Conclusions: Among cancer patients in Brazil, late referral to palliative care is common. Patients who enter palliative care earlier appear to receive less aggressive end-of-life treatment.
- Factors Associated with the Costs of Palliative Care: A Retrospective Cost Analysis at a University Cancer Hospital in Brazil(2021) ROZMAN, Luciana Martins; CAMPOLINA, Alessandro Goncalves; PATINO, Elizabeth Gonzalez; SOAREZ, Patricia Coelho deBackground: There have been few studies evaluating the costs of palliative care (PC) in low- and middle-income countries (LMICs), especially for patients with cancer. Objectives: The objective of this study was to identify the sociodemographic and clinical variables that could explain the cost per day of PC for cancer in Brazil. Methods: This was a retrospective cost analysis of PC at a quaternary cancer center in Sao Paulo, Brazil, between January 2010 and December 2013. Factors influencing the cost per day were assessed with generalized linear models and generalized linear-mixed models in which the random effect was the site of the cancer. Results: The study included 2985 patients. The mean total cost per patient was $12,335 (standard deviation [SD] = 14,602; 95% confidence interval [CI] = 11,803 to 12,851). The mean cost per day per patient was $325.50 (SD = 246.30, 95% CI = 316.60 to 334.30). There were statistically significant differences among cancer sites in terms of the mean cost per day. Multivariate analysis revealed that the drivers of cost per day were Karnofsky performance status, the number of hospital admissions, referral to PC, and place of death. Place of death had the greatest impact on the cost per day; death in a hospital and in hospice care increased the mean cost per day by $1.56 and $1.83, respectively. Conclusion: To allocate resources effectively, PC centers in LMICs should emphasize early enrollment of patients at PC outpatient clinics, to avoid hospital readmission, as well as advance planning of the place of death.
conferenceObject Impact of Early Referral for Palliative Care in the Use of Emergency Care for Patients with Advanced Cancer(2017) ROZMAN, L. M.; CAMPOLINA, A. G.; V, R. Lopez; CHIBA, T.; SOAREZ, P. C. De- Economic evaluation of wheelchairs interventions: a systematic review(2023) FERRETTI, Eliana C.; SUZUMURA, Erica; ROZMAN, Luciana M.; COOPER, Rory A.; SOAREZ, Patricia C. deObjective: The overall aim of this systematic review was to identify and synthesise the best available evidence on effectiveness, resource use and costs involved in wheelchair interventions of adults with mobility limitations. Methodology: This systematic review was undertaken in accordance with the Centre for Reviews and Dissemination Guidelines. The protocol for this systematic review was registered with PROSPERO International Prospective Register of Systematic reviews. The following PICOS eligibility criteria were considered: (P) Population was individuals with mobility limitations that live in their community (e.g., non-institutionalized), with aged 18 or older; (I) Intervention was mobility assistive technologies (MAT), such as manual and powered wheelchairs; (C) Comparators (Not Applied); (O) Outcome, the primary outcome of interest, was established as the cost-effectiveness of wheelchair interventions. Direct and indirect costs per unit of effect were expressed in terms of clinical outcome units, quality-adjusted life years gained, utility scores, quality of life measures and incremental cost-effectiveness ratios to inform the economic outcomes. (S) Study design was considered as a health economic evaluation (i.e., including cost-effectiveness analysis, cost-utility analysis and cost benefit analysis as well as partial economic evaluations). The Consolidated Health Economic Evaluation Reporting Standards - CHEERS, checklist was used for summarising and interpreting the results of economic evaluations. Results: Sixteen studies were included, two were identified as full health economic evaluations and 14 were considered partial health economic evaluations. Conclusion: Only two full health economic analyses of wheelchair interventions have been conducted and both focussed on powered wheelchair provision. There are important gaps in current knowledge regarding wheelchair health economic methods and available outcome measures, which there is a great need for further research.
- Many Miles to Go: A Systematic Review of the State of Cost-Utility Analyses in Brazil(2017) CAMPOLINA, Alessandro G.; ROZMAN, Luciana M.; DECIMONI, Tassia C.; LEANDRO, Roseli; NOVAES, Hillegonda M. D.; SOAREZ, Patricia Coelho DeBackground Little is known about the quality and quantity of cost-utility analyses (CUAs) in Brazil. Objective The objective of this study was to provide a systematic review of published CUAs of healthcare technologies in Brazil. Methods We performed a systematic review of economic evaluations studies published in MEDLINE, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment) Database, Web of Science, Scopus, Bireme (Biblioteca Regional de Medicina), BVS ECOS (Health Economics database of the Brazilian Virtual Library of Health), and SISREBRATS (Sistema de Informacao da Rede Brasileira de Avaliacao de Tecnologias em Saude [Brazilian Network for the Evaluation of Health Technologies]) from 1980 to 2013. Articles were included if they were CUAs according to the classification devised by Drummond et al. Two independent reviewers screened articles for relevance and carried out data extraction. Disagreements were resolved through discussion or through consultation with a third reviewer. We performed a qualitative narrative synthesis. Results Of the 535 health economic evaluations (HEEs) relating to Brazil, only 40 were CUAs and therefore included in the analysis. Most studies adhered to methodological guidelines for quality of reporting and 77.5% used quality-adjusted life-years (QALYs) as the health outcome. Of these studies, 51.6% did not report the population used to elicit preferences for outcomes and 45.2% used a specific population such as expert opinion. The preference elicitation method was not reported in 58.1% of these studies. The majority (80.6%) of studies did not report the instrument used to derive health state valuations and no publication reported whether tariffs (or preference weights) were national or international. No study mentioned the methodology used to estimate QALYs. Conclusions Many published Brazilian cost-utility studies adhere to key recommended general methods for HEE; however, the use of QALY calculations is far from being the current international standard. Development of health preferences research can contribute to quality improvement of health technology assessment reports in Brazil.
- A systematic review of health economic evaluations of vaccines in Brazil(2017) SARTORI, Ana Marli Christovam; ROZMAN, Luciana Martins; DECIMONI, Tassia Cristina; LEANDRO, Roseli; NOVAES, Hillegonda Maria Dutilh; SOAREZ, Patricia Coelho deBackground: In Brazil, since 2005, the Ministry of Health requires Health Economic Evaluation (HEE) of vaccines for introduction into the National Immunization Program.Objectives: To describe and analyze the full HEE on vaccines conducted in Brazil from 1980 to 2013.Methods: Systematic review of the literature. We searched multiple databases. Two researchers independently selected the studies and extracted the data. The methodological quality of individual studies was evaluated using CHEERS items.Results: Twenty studies were reviewed. The most evaluated vaccines were pneumococcal (25%) and HPV (15%). The most used types of HEE were cost-effectiveness analysis (45%) and cost-utility analysis (20%). The research question and compared strategies were stated in all 20 studies and the target population was clear in 95%. Nevertheless, many studies did not inform the perspective of analysis or data sources.Conclusions: HEE of vaccines in Brazil has increased since 2008. However, the studies still have methodological deficiencies.
conferenceObject SYSTEMATIC REVIEW OF ECONOMIC EVALUATIONS ON STEREOTACTIC ABLATIVE RADIOTHERAPY FOR THE TREATMENT OF EARLY-STAGE NON-SMALL CELL LUNG CANCER(2022) MAIA, De Albuquerque F.; ROZMAN, L.; CARVALHO, De Andrade H.; SOAREZ, P. C. De