Patricia Soarez

• MPH, PhD
• Professor at University of São Paulo

Background The extension of PrEP coverage for vulnerable populations depends on demand creation strategies that aim to inform, encourage usage, and facilitate access to health services. However, there are no cost estimates for Brazil or Latin America regarding demand creation strategies focused on populations with higher vulnerability and risk of H...

Objective To estimate the direct costs associated with the diagnosis, treatment, and control of measles cases in Brazil from 2018 to 2020. Methods This cost-of-illness study utilized a prevalence-based approach, considering direct costs incurred by the Brazilian Public Health System (SUS) related to measles outbreaks, including costs of inpatient...

Introduction Benefit-risk assessment (BRA) is an important component in decision-making throughout the lifecycle of a health technology. The BRA of comparative technologies was usually carried out informally, without the use of a systematized process, which can lead to inappropriate decisions. In the last two decades, efforts have been observed to...

Background Lung cancer is one of the leading causes of morbidity and mortality in Brazil. Radiotherapy is an important therapeutic option, but the techniques used remain subjects of discussion. In this study, we compared the costs of conventional radiotherapy (CRT) and stereotactic ablative radiotherapy (SABR) in the treatment of early-stage non-sm...

O artigo tem como objetivo apresentar um panorama teórico sobre os conceitos de Estado, sociedade civil e democracia, a fim de contextualizar o pano de fundo no qual os processos de participação social para incorporação de tecnologias no Sistema Único de Saúde (SUS) se inserem e sob os quais podem ser analisados. Aponta-se que a democracia brasilei...

A modalidade para contratualização hospitalar no SUS teve início em 2004, com o Programa de Reestruturação dos Hospitais de Ensino. Este estudo avaliou a qualidade da assistência e gestão de um hospital de ensino, sob a modalidade de convênio de gestão, com a Secretaria de Estado da Saúde de São Paulo. É um estudo de caso único, com abordagem por m...

Objectives To map the available methodological guidelines and documents for conducting and reporting benefit–risk assessment (BRA) during health technologies’ life cycle; and to identify methodological guidelines for BRA that could serve as the basis for the development of a BRA guideline for the context of health technology assessment (HTA) in Bra...

Background: In 2019, the São Paulo State Cancer Institute (ICESP) implemented a novel model integrating Oncology with Palliative Care specialists. We evaluated the impact of this model on healthcare resource utilization and costs. Methods: We analyzed data from all patients who passed away in February (1 month prior to implementation) and November...

Purpose: The proposed scoping review aims to explore and map wheelchair outcome measurement instruments for children in the literature. Method: The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology. The review question and eligibility criteria were developed using the PCC (population, conc...

Background Benefit–risk assessment (BRA) is used in multiple phases along the health technology’s life-cycle to evaluate the balance between the benefits and risks, as it is fundamental to all stakeholders. BRA and its methodological approaches have been applied primarily in the context of regulatory agencies. However, BRA’s application and extent...

The objective was to analyze the perceptions of primary health care (PHC) workers about interprofessional collaboration from the perspective of implementation science. This is a qualitative study that used in-depth interview as a data production technique. Interviews were conducted with 15 workers (three community health agents, one nursing assista...

O objetivo foi analisar as percepções de trabalhadores da atenção primária à saúde (APS) sobre a colaboração interprofissional na perspectiva da ciência de implementação. Trata-se de estudo qualitativo que utilizou a entrevista em profundidade como técnica de produção de dados. Foram entrevistados 15 trabalhadores (três agentes comunitários de saúd...

What is the impact of switching between biologics and biosimilars of adalimumab, etanercept, and infliximab on efficacy and safety for rheumatoid arthritis? A systematic review and network meta-analysis were performed to compare switching and non-switching groups of treatments. Pooled Risk Relative (RR) or standardised mean differences (SMD) with 9...

Background The aim of this work is to characterize the processes associated with patient and public involvement (PPI) in the form of public consultations (PC) during the first 10 years of operation of the National Committee for Health Technology Incorporation in the Unified Health System (Conitec) of Brazil, and to identify factors associated with...

Importance: Biosimilar drugs are potentially lower-cost versions of biologics that may improve access to therapy. However, there is a lack of adequate systematic reviews demonstrating equivalence between these drugs for the treatment of rheumatoid arthritis (RA). Objectives: To assess the efficacy, safety, and immunogenicity associated with bios...

Colorectal Cancer (CRC) is the third most common type of cancer worldwide and ranks second in mortality. Screening programs for early detection and treatment have been implemented in several countries. Economic evaluations are an important tool to support decision-making about reimbursement and coverage decisions in health systems and, therefore, t...

Background: The aim of this work is to characterize the processes associated with patient and public involvement (PPI) in the form of public consultations (PC) during the first 10 years of operation of the National Committee for Health Technology Incorporation in the Unified Health System (Conitec) of Brazil and to identify factors associated with...

Objectives: To identify the main cost components included in the economic evaluations 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 levels. Methods: We systematically searched multiple...

Background Stereotactic ablative radiotherapy (SABR) is recommended as first-choice treatment to inoperable early-stage non-small cell lung cancer (NSCLC). However, it is not widely adopted in developing countries, and its cost-effectiveness is unclear. We aimed to perform a systematic review of full economic evaluations (EE) that compared SABR wit...

Purpose: To identify and synthesise the available evidence on the effect of mobility on social participation and quality of life (QoL) of wheelchairs (WC) on adults who use WC as their primary means of mobility. Materials and methods: Systematic review undertaken in accordance with the Centre for Reviews and Dissemination Guidelines and register...

Objective To develop the logical model of the Alô Enfermeiro program aiming at elucidating the existing structure, activities carried out, and expected results, allowing the program implementation systematic evaluation. Method This is an evaluative study with a qualitative approach. The development of the logical model was based on systematic meth...

Objective: To develop the logical model of the Alô Enfermeiro program aiming at elucidating the existing structure, activities carried out, and expected results, allowing the program implementation systematic evaluation. Method: This is an evaluative study with a qualitative approach. The development of the logical model was based on systematic...

Resumo Nos processos de avaliação de tecnologias em saúde (ATS), critérios de decisão são considerados relevantes para apoiar o complexo processo deliberativo que requer consideração simultânea de múltiplos fatores. Objetivou-se identificar e analisar os critérios de decisão que têm sido utilizados pela Comissão Nacional de Avaliação de Tecnologias...

In health technology assessment (HTA), decision criteria are considered relevant to support the complex deliberative process that requires simultaneous consideration of multiple factors. The aim was to identify and analyze the decision criteria that have been used by the National Health Technology Assessment Commission (CONITEC) when recommending t...

Background In recent years, the potential of multi-criteria decision analysis (MCDA) in the health field has been discussed widely. However, most MCDA methodologies have given little attention to the aggregation of different stakeholder individual perspectives. Objective To illustrate how a paraconsistent theory-based MCDA reusable framework, desi...

Introduction Multicriteria decision analysis (MCDA) has been used to inform health decisions in health technology assessments (HTA) processes. This is particularly important to complex treatment decisions in oncology. Areas covered Five databases (PubMed, EMBASE, LILACS, Web of Science and CRD’s NHS Economic Evaluation Database) were searched for...

Objective The overall aim of this systematic review was to identify and synthesise the best available evidence on effectiveness, resource use and costs involved in wheelchair interventions of adults with mobility limitations. Methodology This systematic review was undertaken in accordance with the Centre for Reviews and Dissemination Guidelines. T...

The youth of Health Technology Assessment (HTA), as an institutional policy at the national level, signals the need to reflect on how its implementation took place under the perspective of its insertion in health policy and the scientific field. At the end of its first decade, these questions arise: has HTA translated into a health policy informed...

In Brazil, there is no consensus on the concept of hospital-based health technology assessment (HB-HTA). There is great variability in the existing models and difficulty in evaluating their results—whether in respect of clinical decisions, quality of care, and hospital policy and management or in respect of optimizing the use of resources. This stu...

Background Biologic drugs such as adalimumab, etanercept, and infliximab represent major first-line and second-line treatments for rheumatoid arthritis (RA) patients. However, their high cost poses a massive burden on healthcare systems worldwide. The expiration of patents for these biologics has driven the production of biosimilar drugs, which are...

PURPOSE To assess the effects of three-dimensional image-guided brachytherapy (3D BT) compared to bi-dimensional BT (2D BT) on clinical outcomes in patients with cervical cancer. METHODS AND MATERIALS We searched PubMed/MEDLINE, EMBASE, Scopus, CENTRAL, Web of Science, and LILACS for studies assessing the effects of 3D BT versus 2D BT on clinical...

Background: There have been few studies evaluating the costs of palliative care (PC) in low- and middle-income countries (LMICs), especially for patients with cancer. Objectives: The objective of this study was to identify the sociodemographic and clinical variables that could explain the cost per day of PC for cancer in Brazil. Methods: This was...

Objective: We conducted a systematic review and meta-analysis to access HPV vaccines' safety and immunogenicity in Systemic Lupus Erythematosus (SLE) women. Methods: The search was conducted in the most relevant databases. Meta-analyses to evaluate seroconversion rates for each HPV vaccine type and SLE flare rates after vaccination were performe...

Objective: The study aims to characterize and discuss the processes of patient and public involvement (PPI) in the Brazilian Health Regulatory Agency (Anvisa), the National Committee for Health Technology Incorporation (Conitec), and the National Agency for Supplementary Health (ANS) in Brazil. Methods: This is an exploratory, descriptive, and c...

BACKGROUND Mobile health (mHealth) interventions provide significant strategies for improving access to health services [1], offering one potential solution to reduce the mental health treatment gap. Economic evaluation can contribute with evidence to the local policy of and program development in mental health. OBJECTIVE This paper presents the p...

Background: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. Objective: This paper presents the protocol...

BACKGROUND: The Normalization Measure Development (NoMAD) tool is used to determine the contextual determinants in the process of implementing complex health interventions. The aim of this study is to translate and culturally adapt NoMAD to Brazilian Portuguese. METHODS: The cross-cultural adaptation was performed in five steps: 1) translation of...

Background: Health technology assessment (HTA) should provide an assessment of a technology's effects on health and of the related social, economic, organisational and ethical issues. HTA reports on biosimilars can specifically assess their immunogenicity, their extrapolation to one or more conditions, and the risks of interchangeability and subst...

Clinical criteria/Family history-based BRCA testing misses a large proportion of BRCA carriers who can benefit from screening/prevention. We estimate the cost-effectiveness of population-based BRCA testing in general population women across different countries/health systems. A Markov model comparing the lifetime costs and effects of BRCA1/BRCA2 te...

Cervical cancer is the second most prevalent cancer in the female population. Intracavitary brachytherapy is considered an essential component of the disease management. In conventional brachytherapy, treatment planning is performed using X-ray imaging to visualize the pelvic bones structures and applicators, considering point A as the reference fo...

Palliative care (PC) improves the quality of life of patients with diseases such as cancer, and several studies have shown a reduction in costs among patients who use PC services when compared with those receiving standard oncological treatments. Most studies on PC costs are carried out in high-income countries. There is a lack of these types of st...

BACKGROUND: Management of rectal cancer has become more complex with multimodality therapy (neoadjuvant chemoradiotherapy and surgery) and this has led to the need to organize multidisciplinary teams. The aim of this study was to report on the planning, implementation and evaluation of an integrated care pathway for neoadjuvant treatment of middle...

Objectives To evaluate cost-effectiveness and population-impact of unselected population-based BRCA-testing compared to clinical-criteria/family-history(FH) based BRCA-testing across Lower-middle-income/LMIC (India), Upper-middle-income/UMIC (Brazil/China) and High-income-countries/HIC (US/UK/Netherlands) health-systems. Methods Markov-modelling c...

Resumo O texto se propõe a discutir o problema das doenças raras e drogas órfãs no contexto da ciência e da prática médica, sobretudo no que se refere ao desenvolvimento tecnológico produzido nesse âmbito, e ao processo de avaliação e incorporação de tecnologias nos sistemas de saúde. Esses processos têm gerado impactos importantes sobre a teoria,...

Objectives: To review the literature on economic evaluation of dengue vaccination to produce evidence to support a local cost-effectiveness study and to subsidize the decision to introduce a dengue vaccine in the Brazilian National Immunization Program. Methods: We systematically searched multiple databases (MEDLINE (via PubMed), EMBASE, SCOPUS,...

The discussion on interchangeability and automatic substitution of biological drugs with biosimilars has divided opinions among experts, patients, and health policymakers in Brazil and elsewhere in the world. This article aims to contextualize the Brazilian situation in the international debate on the incorporation of biosimilars by health systems,...

OBJECTIVE: To analyze the cost effectiveness of the diagnostic program for the germline mutation in BRCA1/2 genes and of preventative strategies for the relatives of patients diagnosed with ovarian cancer associated with this mutation. METHODS: The study analyzed the cost effectiveness by developing an analysis of the Markov decision process from t...

The reemergence of pertussis in the last two decades led to the introduction of adolescents and adults immunization strategies of tetanus–diphtheria–acellular pertussis vaccines (Tdap) in several countries. The health authorities must consider economic aspects when deciding to recommend and fund new programs. Here we present a systematic review of...

Background: Recent trials have reported similar clinical outcomes between on-pump and off-pump coronary artery bypass graft (CABG). However, long-term cost-effectiveness of these strategies is unknown. Methods: A prespecified economic study was performed based on the MASS III trial. Costs were estimated for all patients based on observed healthc...

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. Metho...

The aim of this study was to critically evaluate the quality of the models used in economic evaluations of screening strategies for cervical cancer prevention. We systematically searched multiple databases, selecting model-based full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses) of cervical can...

Background: The quality of the evidence used in health technology assessment (HTA) agency reports has been considered essential for decision-making processes and their legitimacy. In Brazil, CONITEC is the agency responsible for defining data mandatory for the submission of proposals for the incorporation of new technologies. The objective of this...

O presente trabalho busca sistematizar tendências e prioridades das abordagens teórico-conceituais e das investigações empíricas sobre modalidades específicas de gestão de serviços no âmbito do Sistema Único de Saúde no Brasil. Foi realizada uma revisão narrativa da literatura que identificou, em 33 publicações, a localização e a natureza dos servi...

Objectives: To systematically review the economic evaluations of 23-valent pneumococcal polysaccharide vaccine (PPV23) in adults aged ≥60 years to inform the development of local studies through the discussion of parameters and assumptions that influence the results of the analyses. Methods: We searched the MEDLINE, Excerpta Medica, Cochrane Lib...

Abstract Background 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 São Paulo state and discusses the challenges to interpret them considering pertussis cyclic...

Background Brazil has sought to use economic evaluation to support healthcare decision-making processes. While a number of health economic evaluations (HEEs) have been conducted, no study has systematically reviewed the quality of Brazilian HEE. The objective of this systematic review was to provide an overview regarding the state of HEE research a...

Background: Integrating palliative care into standard oncology care has been recommended for cancer patients. Early palliative care is associated with less aggressive treatment at the end of life. Objective: To describe cancer patients receiving palliative care in Brazil, determining the time from entry into palliative care to death, and investi...

Multi-criteria decision analysis (MCDA) is an emerging tool that allows the integration of relevant factors for health technology assessment (HTA). This study aims to present a summary of the methodological characteristics of MCDA: definitions, approaches, applications, and implementation stages. A case study was conducted in the São Paulo State Ca...

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 o...

Introduction: Several countries require manufacturers to present a budget impact analysis (BIA), together with a cost-effectiveness analysis, to support national funding requests. However, guidelines for conducting BIA of vaccines are scarce. Objectives: To analyze the methodological approaches used in published budget impact analysis (BIA) of v...

Aim: Managed Flow C20 (MFC20) is an integrated care pathway (ICP) for rectal cancer implemented at a public teaching hospital. This study aims to quantify resource utilization and estimate direct costs and outcomes associated with the use of this ICP. Methods: We evaluated consecutive rectal cancer patients treated with neoadjuvant chemoradiothe...

BACKGROUND: In Brazil, since 2005, the Ministry of Health requires Health Economic Evaluation (HEE) of vaccines for introduction into the National Immunization Program. OBJECTIVES: To describe and analyze the full HEE on vaccines conducted in Brazil from 1980 to 2013. METHODS: Systematic review of the literature. We searched multiple databases. Two...

Health technology assessment (HTA) is consolidated as a scientific and technological practice. The aim of this study is to identify HTA organizations from different settings and analyze their relevant dimensions in terms of effectiveness/impact, in order to address the challenges they face in Brazil. Narrative literature review based on data and we...

Background Little is known about the quality and quantity of cost-utility analyses (CUAs) in Brazil. Objective The objective of this study was to provide a systematic review of published CUAs of healthcare technologies in Brazil. Methods We performed a systematic review of economic evaluations studies published in MEDLINE, EMBASE, LILACS (Latin Ame...

Objective:: Despite the progress in the implementation of health promotion programs in the workplace, there are no questionnaires in Brazil to assess the scope of health promotion interventions adopted and their scientific basis. This study aimed to translate into Brazilian Portuguese and culturally adapt the CDC Worksite Health ScoreCard (HSC) qu...

OBJECTIVE To describe methods and challenges faced in the health impact assessment of vaccination programs, focusing on the pneumococcal conjugate and rotavirus vaccines in Latin America and the Caribbean. METHODS For this narrative review, we searched for the terms “rotavirus”, “pneumococcal”, “conjugate vaccine”, “vaccination”, “program”, and “i...

The US definition of comparative effectiveness research (CER) is a new field of knowledge in Brazil. However, in the last three decades, CER activities described by various terms such as evidence-based medicine, and health economics (mainly economic evaluation of healthcare interventions) were performed as part of the health technology assessment p...

Objective: describe the quality of life of frail elderly assisted by the Centro de Referência à Saúde do Idoso (CRI), Campinas, São Paulo, Brazil. Methods: the convenience sample included 122 frail elderly being treated from January 2010 to July 2011, out of a total of 668 frail elderly who were referred to the CRI after application of the brief e...

Objective: To estimate annual direct costs of prevention and treatment of cervical cancer in Brazil. Methods: This cost description study used "gross and micro-costing" methodologies and adopted the health care system perspective. Estimates were grouped into sets of procedures performed in phases of cervical cancer care: screening, diagnosis and tr...