[Characteristics of the demand for cranial computerized tomography: reasons and costs of the exam]

Health Economic Evaluations of Cancer in Brazil: A Systematic Review

Background: A large number of health economic evaluation (HEE) studies have been published in developed countries. However, Brazilian HEE literature in oncology has not been studied.

OBJECTIVE

To investigate whether the scientific literature has provided a set of HEE in oncology capable of supporting decision making in the Brazilian context. Methods: A systematic review was conducted to identify and characterize studies in this field. We searched multiple databases selecting partial and full HEE studies in oncology (1998-2013). Results: Fifty-five articles were reviewed, of these, 33 (60%) were full health economic evaluations. Type of cancers most frequently studied were: breast (38.2%), cervical (14.6%), lung (10.9%) and colorectal (9.1%). Procedures (47.3%) were the technologies most frequently evaluated. In terms of the intended purposes of the technologies, most (63.6%) were treatments. The majority of the incremental cost-effectiveness ratios (ICERs) reported have been below the cost-effectiveness threshold suggested by the World Health Organization (WHO). Conclusions: There has been an increase in the number of HEEs related to cancer in Brazil. These studies may support decision-making processes regarding the coverage of and reimbursement of healthcare technologies for cancer treatment in Brazil.

Systematic Review of Health Economic Evaluations of Diagnostic Tests in Brazil: How accurate are the results?

The 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.

[Clinical epidemiological aspects of cerebral neoplasms in childhood in the State of Bahia, Brazil]

The aim of this study is to describe the relevant aspects of the medical treatment and epidemiology of brain tumors in children between 1 and 15 years old in the State of Bahia, Brazil, first semester of 1995. A cross-sectional design was used for the survey of all new cases and preexisting cases of brain tumors diagnosed through neuroimage among all the children who completed these examinations. Forty eight out of 2,128 were diagnosed as brain tumors, 19 of which being incident cases. In the clinical epidemiological study, the prevalence was 2.3 percent, and the incidence was 0.9 percent. In the prevalent cases, males predominated (1.4:1), and the average age of 10-15 years old (65%). Among the 1-4 years old group predominated incident cases. The astrocytoma was the most frequent brain tumor (41%), and the supratentorial localization predominated by 52%. The ataxia and/or paralysis of cranial nerve and the endocrine and/or visual disturbance symptomatic groups were the most prevalent (82% and 43%, respectively). We discuss the supratentorial localization and the adolescent group predomination in cerebral neoplasms in childhood.