Análise de impacto orçamentário do uso da razão dos testes sFlt-1:PlGF na exclusão de pré-eclâmpsia em mulheres com suspeita clínica na perspectiva do sistema de saúde suplementar Budget impact analysis of sFlt-1/PlGF ratio to help rule-out pre-eclampsia in women presenting with clinical suspected in the private healthcare system perspective in Brazil RESUMO Objetivo: O objetivo do estudo foi avaliar o impacto econômico da incorporação da razão dos testes tirosina quinase-1 solúvel (sFlt-1):fator de crescimento placentário (PlGF) no auxílio da exclusão da pré-eclâmpsia na perspectiva do Sistema de Saúde Suplementar do Brasil (SSS). Métodos: Foi desenvolvido um modelo de decisão com o intuito de simular as decisões clínicas do manejo das pacientes com suspeita de pré-eclâmpsia entre a 24ª semana e a 36ª semana + 6 dias de gestação utilizando a razão dos testes sFlt-1:PlGF em comparação com cenário sem o teste. Os dados clínicos utilizados no modelo foram derivados do estudo PROGNOSIS. A análise incluiu apenas custos diretos que foram baseados na Tabela CBHPM (Classificação Brasileira Hierarquizada de Procedimentos Médicos) e na Tabela CMED PF 18% (Câmara de Regulação do Mercado de Medicamentos). Uma análise de sensibilidade univariada foi conduzida com variação de 15% dos parâmetros. Resultados: A razão dos testes sFlt-1:PlGF apresentou um potencial de economia de -R$ 4.532,04 por paciente comparado ao cenário sem teste. Considerando a incorporação no SSS, a razão dos testes sFlt-1:PlGF pode promover uma economia de -R$ 6.375.865,68 em 2021 e um acumulado de -R$ 136.495.533,87 em cinco anos. Conclusão: O uso da razão sFlt-1:PlGF no auxílio da exclusão da pré-eclâmpsia tem potencial de melhorar as decisões clínicas e, consequentemente, evitar hospitalizações desnecessárias. A incorporação do teste pode promover uma economia substancial para o sistema de saúde suplementar. ABSTRACTObjective: The aim of this study was to evaluate the economic impact of the incorporation of the soluble fms-like tyrosine kinase (sFlt-1) to placental growth factor (PlGF) ratio test in the private healthcare system in Brazil (SSS). Methods: A decision model was developed in order to simulate the clinical decisions of the management of women with suspected pre-eclampsia between 24 weeks and 36 weeks plus 6 days with sFlt-1:PlGF ratio test, compared with no test scenario. The clinical data used in the model were derived from PROGNOSIS study. The analysis included only direct costs that were based on CBHPM (Classificação Brasileira Hierarquizada de Procedimentos Médicos) and CMED PF 18% (Câmara de Regulação do Mercado de Medicamentos). A univariate sensitivity analysis was conducted Instituição onde o trabalho foi executado: Roche Diagnóstica do Brasil Ltda. Financiamento: Este estudo não teve financiamento. Palavras-chave: análise de impacto orçamentário, razão dos testes sFlt:PlGF, pré-eclâmpsia Keywords: budget impact analysis, sFlt-1:PlGF ratio test, pre-eclampsia 245 J Bras Econ Saúde 2019;11(3): 244-54Análise de impacto orçamentário d...

ObjectivesPublic engagement is an important pilar to add new perspectives as take into consideration participants' interests in research. We aim to share the potential of Cidacs experience with data administrative linkage for creating the Social Disparities Index for Covid-19 (SDI-Covid-19). ApproachDialogue is the core of our work. We invited policy makers, community groups and researchers based on their interest with the key themes of the project. Webinars, technical meetings, discussion groups, and individual conversations were the main methods explored to allow participants to know each other and to change experiences about social inequalities in Covid-19 pandemic. We used digital technologies to enable these interactions because of social distance measures. Website, posts on social media, guides, and minibiographies of participants were produced to share information periodically. Our engagement framework includes the following steps: inform, collect, consult, share, revise, disseminate, and evaluate. ResultsWe added new perspectives to SDI-Covid-19 suggested by the research participants during our events and individual conversations. Policy makers indicated a new level of information to make SDI-Covid-19 more useful for them in their daily work. We also discussed and interpreted some results with representatives of community groups from black movement, and slums. Besides that, they suggested some strategies to produce more accessible messages to support the scientific dissemination of research findings to civil society. Participants validated some information from SDI-Covid-19 and shared their impressions about how it can be used to design social policies. We connected 279 researchers, policy makers and representatives of community groups on two webinars; 29 policy makers on a technical meeting; 8 representatives of community groups on a discussion group. ConclusionsA more equitable and ethical research was possible with our engagement experience with SDI-Covid-19. The ideas added improved the quality of research, validated results, and supported dissemination. The use of linked administrative data has been recognized as useful resource for managers, community groups and researchers.

Análise de custo-efetividade do painel de sequenciamento de nova geração do DNA circulante tumoral no diagnóstico dos pacientes com câncer de pulmão de não pequenas células não escamoso metastático Cost-effectiveness analysis of next generation sequencing panel of circulating tumor DNA in the diagnosis of patient with metastatic non-squamous non-small cell lung cancer

Magnetic resonance enterography showed terminal ileitis and colonoscopy revealed a strictured ileocecal valve, with oedema and nodular appearance, and terminal ileitis with cobblestone mucosa. Polymerase chain reaction for the detection of the Mycobacterium tuberculosis complex in ileal mucosa was negative. Skin biopsy demonstrated dermatitis with a granulomatous pattern, with secondary ulceration and dermal fibrosis (Figs. 2-4). No fungal microorganisms or acid-fast bacilli were identified with the Periodic Acid-Schiff stain and Ziehl-Neelsen techniques.What is the most likely diagnosis?