PATRICIA COELHO DE SOAREZ
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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conferenceObject Introduction of universal human papillomavirus vaccination of girls aged 11 years to the National Immunization Program in Brazil: a cost-effectiveness analysis(2014) NOVAES, Hillegonda M. D.; SILVA, Gulnar Azevedo e; ITRIA, Alexander; RAMA, Cristina H.; SARTORI, Ana M.; SOAREZ, Patricia Coelho de; CLARK, Andrew; RESCH, Stephen- 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.
conferenceObject COST-EFFECTIVENESS ANA LYSIS OF INCORPORATION OF THE HPV VACCINE TO THE NATIONAL IMMUNIZATION PROGRAM / NIP OF BRAZIL(2013) NOVAES, H. M. D.; SILVA, G. Azevedo e; AYRES, A.; ITRIA, A.; RAMA, C.; SARTORI, A. M. C.; SOAREZ, P. C. De; CLARK, A.; RESCH, S.- A importância dos métodos de custeio e valoração nas avaliações econômicas em saúde: repercussões sobre os resultados de avaliação da vacina antimeningocócica C(2012) ITRIA, Alexander; NOVAES, Hillegonda Maria Dutilh; SOÁREZ, Patrícia Coelho de; NOBREGA, Laura de Andrade Lagoa; SARTORI, Ana Marli CristovamThis paper aims to present and compare the results of the cost-effectiveness of antimeningococcal C conjugate vaccine, which insert new cost data, collected by personal interviews with families of people with sequels, called ""family expenditures"" for treatment of sequelae, compared to the analytical model presented by De Soarez et al. (2011), resulting from a research project done for the NIP (National immunization Program) on the feasibility of meningococcal C vaccine in routine vaccination. It is shown that as a result of the inclusion of new costs have changed the cost-effectiveness of the vaccine in question, making the vaccine more cost effective.
- 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 a Universal Infant Immunization Program with Meningococcal C Conjugate Vaccine in Brazil(2011) SOAREZ, Patricia Coelho de; SARTORI, Ana Marli C.; NOBREGA, Laura de Andrade Lagoa; ITRIA, Alexander; NOVAES, Hillegonda Maria DutilhObjective: To analyze the cost-effectiveness of a meningococcal C vaccination program in Brazil. Methods: A hypothetical cohort of 3,194,038 children born in Brazil in 2006 was followed for 10 years. A decision tree model was developed using the TreeAge Pro 2007 software program to compare universal infant vaccination with the current program. Epidemiological and cost estimates were based on data retrieved from National Health Information Systems and the literature. The analysis was conducted from the public health care system and societal perspectives. Costs are expressed in 2006 Brazilian reals (R$). Results: At 94% coverage, the program would avoid 1,218 cases, 210 deaths, and 14,473 life-years lost, a reduction of, respectively, 45%, 44%, and 44%, for the 10-year period. Vaccination costs of R$320.9 million would not be offset by R$ 4 to R$7.9 million decreases in disease treatment costs. A national vaccination program would cost R$ 21,620 per life-year saved from the perspective of the health-care system and R$ 21,896 per life-year saved from society's perspective. Results were most sensitive to case fatality rate, disease incidence, and vaccine cost. Conclusions: A universal childhood vaccination program against meningococcal C proved to be a cost-effective strategy, supporting the recent decision of the Brazilian government. These results could contribute to defining the most favorable price of the vaccine and to monitoring its impact on the population.
- Challenges of interpreting epidemiologic surveillance pertussis data with changing diagnostic and immunization practices: the case of the state of Sao Paulo, Brazil(2018) FERNANDES, Eder Gatti; SARTORI, Ana Marli Christovam; SOAREZ, Patricia Coelho de; CARVALHANAS, Telma Regina M. P.; RODRIGUES, Marcela; NOVAES, Hillegonda Maria DutilhBackground: A significant increase in pertussis incidence occurred in Brazil, from 2011 to 2014, despite high coverage of childhood immunization with whole-cell-pertussis (wP) containing vaccines. This study presents pertussis surveillance data from Sao Paulo state and discusses the challenges to interpret them considering pertussis cyclic epidemic behavior, the introduction of new diagnostic techniques and new vaccination strategies, and enhanced disease awareness during epidemics. Methods: Observational study including pertussis cases reported to the Surveillance System in Sao Paulo state, from January 2001 to December 2015. Pertussis cases data were retrieved from the National Notifiable Diseases Information System (SINAN) website and from Sao Paulo state Epidemiological Surveillance Center (CVE/SP) database. Vaccination coverage and homogeneity data were collected from the Unified Health System Department of Informatics (DATASUS). We presented cases distribution by year, age group and diagnostic criteria and calculated pertussis incidence rates. The proportions of cases among different age groups were compared using chi-square test for trend. Results: Infants less than 1 year of age were the most affected during the whole period, but the proportions of cases in this age group had a significant decreasing trend, with significant increase in the proportions of cases reported among older age groups (1-4, 5-10 and >= 20 years). Cases among infants aged less than 6 months represented >= 90% of all cases in children less than 1 year of age in all but 2 years (2012 and 2015). A non-significant decrease in the proportion of cases among infants aged < 2 months was observed in parallel to a significant increase in the proportion of cases in infants aged 6-11 months. Conclusions: A pertussis outbreak has occurred in a state with universal use of wP vaccine. The disease cyclic behavior has probably had a major role in the increased incidence rates registered in Sao Paulo state, from 2011 to 2014, as well as in the decreased incidence in 2015. Maternal vaccination cannot explain the drop in the number of cases among all age groups, in 2015, as herd protection is not expected, but may have had an impact on the number of cases in infants aged < 2 months.
- Estimating health service utilization for treatment of pneumococcal disease: The case of Brazil(2013) SARTORI, A. M. C.; NOVAES, C. G.; SOAREZ, P. C. de; TOSCANO, C. M.; NOVAES, H. M. D.Background: Health service utilization (HSU) is an essential component of economic evaluations of health initiatives. Defining HSU for cases of pneumococcal disease (PD) is particularly complex considering the varying clinical manifestations and diverse severity. Objective: We describe the process of developing estimates of HSU for PD as part of an economic evaluation of the introduction of pneumococcal conjugate vaccine in Brazil. Methods: Nationwide inpatient and outpatient HSU by children under-5 years with meningitis (PM), sepsis (PS), non-meningitis non-sepsis invasive PD (NMNS), pneumonia, and acute otitis media (AOM) was estimated. We assumed that all cases of invasive PD (PM, PS, and NMNS) required hospitalization. The study perspective was the health system, including both the public and private sectors. Data sources were obtained from national health information systems, including the Hospital Information System (SIH/SUS) and the Notifiable Diseases Information System (SINAN); surveys; and community-based and health care facility-based studies. Results: We estimated hospitalization rates of 7.69 per 100,000 children under-5 years for PM (21.4 for children <1 years of age and 4.3 for children aged 1-4 years), 5.89 for PS (20.94 and 2.17), and 4.01 for NMNS (5.5 and 3.64) in 2004, with an overall hospitalization rate of 17.59 for all invasive PD (47.27 and 10.11). The estimated incidence rate of all-cause pneumonia was 93.4 per 1000 children under-5 (142.8 for children <1 years of age and 81.2 for children aged 1-4 years), considering both hospital and outpatient care. Discussion: Secondary data derived from health information systems and the available literature enabled the development of national HSU estimates for PD in Brazil. Estimating HSU for noninvasive disease was challenging, particularly in the case of outpatient care, for which secondary data are scarce. Information for the private sector is lacking in Brazil, but estimates were possible with data from the public sector and national population surveys.
- 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 DutilhBackground: 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.
conferenceObject NATIONAL SPENDING WITH SCREENING, DIAGNOSIS AND TREATMENT OF CERVICAL CANCER: ESTIMATES BASED ON HEALTH INFORMATION SYSTEMS, BRAZIL, 2006(2013) NOVAES, H. M. D.; SOAREZ, P. C. De; ITRIA, A.; SILVA, G. Azevedo e; SARTORI, A. M. C.; RAMA, C.