Background We evaluated the validity of clinical diagnosis compared with laboratory diagnosis of dengue in a retrospective sample of patients in São José do Rio Preto, Brazil. Methods Our sample included 148 299 clinically (56.3%) or laboratory-diagnosed (43.7%) dengue cases. We compared the sensitivity, specificity, positive and negative predictive value (PPV and NPV) of dengue patients’ demographic and clinical characteristics with laboratory-based diagnosis. We used logistic regressions to estimate the correlation between clinical and laboratory diagnosis of dengue and a full set of dengue signs and symptoms. Results We found substantial variability in sensitivity and specificity of signs and symptoms ranging from 0.8–81.1 and 21.5–99.6, respectively. Thrombocytopenia exhibited the highest PPV (92.0) and lowest NPV (42.2) and was the only symptom showing agreement with laboratory-confirmed dengue (φ = 0.38). The presence of exanthema and thrombocytopenia led to a greater likelihood of concordant clinical and laboratory diagnoses (exanthema: OR: 4.23; 95% CI: 2.09 to 8.57; thrombocytopenia: OR: 4.02; 95% CI: 1.32 to 12.27). Conclusions We found substantial variation in sensitivity, specificity, PPV and NPV of dengue signs and symptoms. For accuracy, clinical and laboratory diagnosis of dengue should be performed concurrently. When laboratory tests are not available, we suggest focusing on the clinical manifestations most associated with dengue.

Diabetes mellitus (DM) is a morbidity that presents a wide range of difficulties for the patient to reach the control. This reality not only has impact on the clinical practice but also has serious financial and social consequences for both the patient and the health system. Health technologies that are capable of improving glycemic control have been tested in cost-effectiveness analysis to assess the efficiency of DM care. According to the Brazilian Society of Diabetes, patients with glycated hemoglobin (A1c) within the values considered adequate, less than 6.5%, present a relative risk of developing complications (neuropathy, retinopathy, diabetic foot, pressure ulcers, cardiovascular diseases and renal disease) equal to that of a nondiabetic patient. In highlight, health technologies health technologies have presented positive impact on reducing A1c and, consequently, on reducing diabetes complications. Thus, new health technologies have been capable saving of 72% of resources spent on DM care.Keywords: diabetes mellitus, economics, pharmaceutical, technology assessment, biomedical Economic evaluation in healthHistorically, evaluation processes are part of the development of humanity as a society. After World War II, there was an increase in State activities in the control of services such as health and education in many countries. An economic current gained strength in the development of methodological processes to evaluate these State activities, assessing their © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.costs and their advantages. These processes conformed themselves into economic health assessments [1].In the course of time, economic evaluation in the area of health has been gaining more rigorous methodological contours, and nowadays, it is characterized as an important tool of public services, in the health economy sector. Health assessment has specific bodies in some developed countries such as the United States, Canada and France [1,2]. In Latin America, Brazil is considered one of the pioneers in the implementation of economic health assessment methodologies, and countries such as Colombia, Mexico, Argentina and Chile have advanced a lot in the area's development [3].The health area constantly goes through processes of technological innovation. Associated with the epidemiological changes of recent years, the incorporation of new health technologies has become a reality with which the management of health services has to deal constantly. This scenario has contributed to the increasing cost of maintaining health services and corroborated the increase in complexity in the administration and functioning of health services [2,4]. It is noteworthy that health has limited and finite resources, which makes health evaluation a complex task, with crit...