Guidelines for Utility Measurement for Economic Analysis: The Brazilian Policy

INTRODUCTION

Health-related quality of life is expressed in utilities, also referred to as utility estimates or parameters. Considerations about the source and type of utility values are especially important in a modeling context, where the lack of transparency, including the lack of a hierarchy for utility data sources, is a major issue to any estimation and can potentially compromise model reliability.

OBJECTIVES

This document aims to present the first version of the Brazilian guidelines for utility measurement to support economic analysis.

METHODS

A virtual workshop and a modified Delphi panel with 10 health technology specialists followed a rapid evaluation of 110 technical documents and indexed publications. The recommendations are based on the proposition that has received the most votes, although contentious issues are addressed in the suggestion or discussion. The rationale for the final decision is included in the text.

RESULTS

The consensus includes 50 recommendations with the following topics: Transparency and Reliability, Model Design, Conditions Under Which Generic Questionnaires Are Not Sensible or Valid, Utility Evidence Hierarchy, Utility Data Searching, Modeling Utility Values, Extrapolating Quality Adjusted Life-Years for Models With Lifetime Horizons, Caregiver Utility, Utility Data Synthesis, Quality/Certainty of the Evidence, and Utility Estimates in End-of-Life Conditions.

CONCLUSIONS

The goal of this project is to create unified national standards for using utility metrics in economic analysis in Brazil. This set of recommendations is not obligatory, but it is meant to serve as a guide and lead to the development of better and more transparent economic models in the country.

Unravelling the relation between processed crude oils and the composition of spent caustic effluents as well as the respective economic impact

Spent caustic discharges are responsible for increasing oil and grease (O&G) matter in refineries wastewater, leading to increasing treatment costs due to low water quality and environmental constraints associated with high O&G concentration discharges. As a way to settle and optimize treatment technologies for such complex effluents, more insight regarding the effluents impact and deeper characterization is necessary. The present study intends to assess the possibility of a relationship between the processed crude oils with the polar O&G concentration in naphthenic spent caustic as well as in the final wastewater; Sines refinery was considered as case-study. Also, in order to get insights about the nature of the polar O&G compounds, their structures and their prevalence in the effluent treatment system was carried out through detailed analytical characterization studies. Proton nuclear magnetic resonance (¹H NMR), Fourier transform infrared spectroscopy (FT-IR) and gas chromatography-mass spectrometry (GC-MS) were chosen. It was found that, for the Sines refinery, spent caustic discharges may increase the refinery effluent management cost up to 3 €/ton of processed crude oil, every time a high kerosene cut acid crude oil is processed. It was also found that the typical spent caustic O&G effluents are composed by organic contaminants with low molecular weight (MW), with aromatic and polar arrangements, like phenolic groups and naphthenic acids. This outcome is crucial for subsequently establishing the best technologies able to deal with such complex effluents.

Patients' Preferences after Recurrent Coronary Narrowing: Discrete Choice Experiments

Fundamento:

Selecionar a estratégia de tratamento ideal para a revascularização coronária é um desafio. Um desfecho crucial a ser considerado no momento dessa escolha é a necessidade de refazer a revascularização, uma vez que ela se torna muito mais frequente após a intervenção coronária percutânea (ICP) do que após a cirurgia de revascularização do miocárdio (CRM).

Objetivo:

Pretende-se, com este estudo, trazer reflexões acerca das preferências dos pacientes pelas estratégias de revascularização sob a perspectiva de pacientes que tiveram que refazer a revascularização.

Métodos:

Selecionamos uma amostra de pacientes que haviam sido submetidos à ICP e hospitalizados para refazer a revascularização coronária e elicitamos suas preferências por nova ICP ou CRM. Morte perioperatória, mortalidade a longo prazo, infarto do miocárdio e repetir a revascularização foram utilizados para a construção de cenários a partir da descrição de tratamentos hipotéticos que foram rotulados como ICP ou CRM. A ICP era sempre apresentada como a opção com menor incidência de morte perioperatória e maior necessidade de se refazer o procedimento. O modelo logístico condicional foi empregado para analisar as escolhas dos pacientes, utilizando-se o software R. Valores de p <0,05 foram considerados estatisticamente significativos.

Resultados:

Ao todo, 144 pacientes participaram, a maioria dos quais (73,7%) preferiram a CRM à ICP (p < 0,001). Os coeficientes de regressão foram estatisticamente significativos para o rótulo ICP, mortalidade a longo prazo da ICP, morte perioperatória da CRM, mortalidade a longo prazo da CRM e refazer a CRM. O rótulo ICP foi o parâmetro mais importante (p < 0,05).

Conclusão:

A maioria dos pacientes que enfrentam a necessidade de refazer a revascularização coronária rejeitam uma nova ICP, com base em níveis realistas de riscos e benefícios. Incorporar as preferências dos pacientes à estimativa do risco-benefício e às recomendações de tratamento poderia melhorar o cuidado centrado no paciente.

Assessment of quality of life using the EQ-5D-3L instrument for hospitalized patients with femoral fracture in Brazil

BACKGROUND

Quality of life has become a key outcome in assessing the effectiveness of treatments and interventions in health.

METHODS

Accordingly, this research study aimed to measure quality of life using the EQ-5D-3L instrument for patients from the Jamil Haddad National Institute of Traumatology and Orthopedics (Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad - INTO) with femoral fractures, hospitalized between 11/2015 and 10/2016.

RESULTS

A total of 165 orthopedic trauma patients with femoral fractures, aged 18 years or older, who were hospitalized and operated upon in the INTO were assessed. The assessment instruments were applied at admission and in the first and second follow-up visits to the outpatient clinic. Most study subjects were women and older than 60 years. Proximal femoral fracture was the most commonly found fracture. The Visual Analog Scale (VAS) assessments over the study period showed an increasing gain in self-assessed quality of life. Similarly, the EQ-5D-3L showed significant improvements in quality of life assessed in the five dimensions of the instrument: mobility, self-care, usual activities, pain/discomfort and anxiety/depression.

CONCLUSION

This type of assessment may help in decision-making and cost-utility assessments related to orthopedic trauma.

Patient and physician preferences for attributes of coronary revascularization

BACKGROUND

Patients with a diagnosis of coronary artery disease (CAD) may face important decisions regarding treatment options, with the "right choice" depending on the relative weights of risks and benefits. Studies performed as discrete choice experiments are used to estimate these weights, and attribute selection is an essential step in the design of these studies. Attributes not included in the design cannot be analyzed. In this study, we aimed to elicit, rank, and rate attributes that may be considered important to patients and physicians who must choose between angioplasty and surgery for coronary revascularization.

METHODS

The elicitation process involved performing a systematic review to search for attributes cited in declared preference studies in addition to face-to-face interviews with cardiologists and experts. The interviews were audio-recorded in digital format, and the collected data were transcribed and searched to identify new attributes. The criterion used to finish the data collection process was sampling saturation.

RESULTS

A systematic review resulted in the selection of the following 14 attributes: atrial fibrillation, heart failure, incision scar, length of stay, long-term survival, myocardial infarction, periprocedural death, postoperative infection, postprocedural angina, pseudoaneurysm, renal failure, repeat coronary artery bypass grafting, repeat percutaneous coronary intervention, and stroke. The interviews added no new attributes. After rating, we identified significant differences in the values that patients and cardiologists placed on renal insufficiency (p<0.001), periprocedural death (p<0.001), and long-term survival (p<0.001).

CONCLUSION

Decisions regarding the best treatment option for patients with CAD should be made based on differences in risk and the patient's preference regarding the most relevant endpoints. We elicited, ranked, and rated 14 attributes related to CAD treatment options. This list of attributes may help researchers who seek to perform future preference studies of CAD treatment options.

Feasibility of visual aids for risk evaluation by hospitalized patients with coronary artery disease: results from face-to-face interviews

PURPOSE

Communicating information about risk and probability to patients is considered a difficult task. In this study, we aim to evaluate the use of visual aids representing perioperative mortality and long-term survival in the communication process for patients diagnosed with coronary artery disease at the National Institute of Cardiology, a Brazilian public hospital specializing in cardiology.

PATIENTS AND METHODS

One-on-one interviews were conducted between August 1 and November 20, 2017. Patients were asked to imagine that their doctor was seeking their input in the decision regarding which treatment represented the best option for them. Patients were required to choose between alternatives by considering only the different benefits and risks shown in each scenario, described as the proportion of patients who had died during the perioperative period and within 5 years. Each participant evaluated the same eight scenarios. We evaluated their answers in a qualitative and quantitative analysis.

RESULTS

The main findings were that all patients verbally expressed concern about perioperative mortality and that 25% did not express concern about long-term mortality. Twelve percent considered the probabilities irrelevant on the grounds that their prognosis would depend on "God's will." Ten percent of the patients disregarded the reported likelihood of perioperative mortality, deciding to focus solely on the "chance of being cured." In the quantitative analysis, the vast majority of respondents chose the "correct" alternatives, meaning that they made consistent and rational choices.

CONCLUSION

The use of visual aids to present risk attributes appeared feasible in our sample. The impact of heuristics and religious beliefs on shared health decision making needs to be explored better in future studies.

NiCl(2)(PCy(3))(2): a simple and efficient catalyst precursor for the Suzuki cross-coupling of aryl tosylates and arylboronic acids

NiCl(2)(PCy(3))(2) associated with PCy(3) promotes the selective cross-coupling of aryltosylates with arylboronic acids under relatively mild reaction conditions, and a variety of functional groups are tolerated in both arenes. This is one of the simplest and most efficient experimental procedures for the coupling of arylboronic acids with aryl tosylates reported to date. Reaction: see text.

Sulfur-containing palladacycles: efficient phosphine-free catalyst precursors for the Suzuki cross-coupling reaction at room temperature

[reaction: see text] Cyclopalladated compounds derived from the ortho-metalation of benzylic tert-butyl thioethers are excellent catalyst precursors for the Suzuki cross-coupling reaction of aryl bromides and chlorides with phenylboronic acid under mild reaction conditions. A broad range of substrates and functional groups are tolerated in this protocol, and highly catalytic activity is attained.