LUCIANA MARTINS ROZMAN
Projetos de Pesquisa
Unidades Organizacionais
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- 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.
- 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.
- Systematic review of economic evaluations on stereotactic ablative radiotherapy (SABR) compared to other radiotherapy techniques or surgical procedures for early-stage non-small cell lung cancer(2023) MAIA, Fernando Henrique de Albuquerque; ROZMAN, Luciana Martins; CARVALHO, Heloisa de Andrade; SOAREZ, Patricia Coelho deBackgroundStereotactic ablative radiotherapy (SABR) is recommended as first-choice treatment to inoperable early-stage non-small cell lung cancer (NSCLC). However, it is not widely adopted in developing countries, and its cost-effectiveness is unclear. We aimed to perform a systematic review of full economic evaluations (EE) that compared SABR with other radiotherapy or surgical procedures to assess the results and methodological approach.MethodsThe protocol was registered on PROSPERO (CRD42021241640). We included full EE studies with early-stage NSCLC in which one group was submitted to SABR. Studies that were partial EE, included advanced NSCLC or other neoplasm were excluded. We performed the last search on June 2021 in Medline, EMBASE and other databases. The reporting quality were assessed by CHEERS checklist. The main characteristics of each study were tabulated, and the results were presented by a narrative synthesis.ResultsWe included nine studies. Three compared radiotherapy techniques, in which SABR was found to be dominant or cost-effective. Six compared SABR with surgery, and in this group, there was not a unanimous decision. All included only direct healthcare costs but varied about categories included. The parameters used in the model-based studies were highly heterogeneous using mixed data from various sources. The items properly reported varied from 29 to 67%.ConclusionsThe studies were all from developed countries and lacked in reporting quality. We recommend that developing countries produce their own studies. More strict alignment to reporting guidelines and use of robust evidence as model parameters are also advised.
- 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.