Background: Pharmacy interventions are a subset of public health interventions and its research is usually performed within the scope of a trial. The economic evaluation of pharmacy interventions requires certain considerations which have some similarities to those of public health interventions and to economic evaluations alongside trials. The objective of this research is to perform an overview of systematic reviews of economic evaluations of pharmacy services and triangulate results with recommendations for economic evaluations of both public health interventions and alongside trials. Methods:(1) Exploratory review of recommendations on the economic evaluation of public health interventions, (2)exploratory review of recommendations for conducting economic evaluations alongside trials, (3) overview of systematic reviews of economic evaluations of pharmacy interventions (protocol registered with PROSPERO 2016 outlining information sources, inclusion criteria, appraisal of reviews and synthesis methods). Results: Fourteen systematic reviews containing 75 index publications were included. Reviews reported favourable economic findings for 71% of studies with full economic evaluations. The types of economic analysis are diverse. Two critical quality domains are absent from most reviews. Key findings include the following: certain types of risk of bias, wider scope of study designs, and most economic quality criteria met but some issues unresolved or unclear. Triangulation revealed additional gaps. Limitations include choice of critical quality domains and potential biases in the overview process. Conclusions: Economic evaluations of pharmacy-based public health interventions seem to follow most economic quality criteria, but there are still some issues in certain key areas to improve. These findings may assist in improving the design of pilot trials of economic evaluations in pharmacy, leading to robust evidence for payers. Based on the findings, we propose a methodological approach for the economic evaluation of pharmacy-based public health interventions. Systematic review registration: PROSPERO CRD42016032768

Objectives: aliskiren is a direct human renin inhibitor that is efficacious in the treatment of high blood pressure in patients with diabetes mellitus type 2 and nephropathy. The purpose of this study is to provide an economic evaluation of aliskiren in a social perspective. We estimated the incremental cost-effectiveness of a therapeutical strategy based on aliskiren and losartan versus a strategy based on a losartan and placebo. The measures of effectiveness used were life expectancy, quality adjusted life years, and the incidence of end stage renal disease. Methods: the estimates of efficacy in clinical trials and other studies were extrapolated for a 20 years time horizon by using Markov chains with six month length cycles. We estimated the direct costs of the alternative strategies in the context of Portuguese clinical practice, including costs with aliskiren, losartan, other drugs, tests, doctor visits, and the costs of renal transplants. We also estimated indirect costs due to absenteeism and premature retirement from the labor market. Results: In the baseline case the strategy with aliskiren always dominates the placebo strategy, with mean costs inferior by €552,32 and superior effectiveness. The dominance result was robust to plausible variations in the time horizon, the management costs for patients with hypertension and type 2 diabetes and the transplant costs. The result was also robust to using different discount rates and to the non inclusion of indirect costs in the analysis. In a pessimistic alternative scenario with lower aliskiren efficacy in the initial cycle the incremental cost utility was €7246 per QALY ganied. Probabilistic sensitivity analysis shows that aliskiren is dominant witha 56,8% probability and that for willingnesses to pay between €20 000 and 30 000€ the probability aliskirenis cost-effective goes from 72,3% up to 76,6%. Conclusions: In the context of the Portuguese health system, the use of aliskiren is cost-effective. Thus aliskiren is a valuable addition to the therapeutic arsenal for the treatment of patients with diabetes mellitus type 2, high blood pressure and nephropathy.

Background From 2008 on, Novel Oral Anticoagulants are available on the European market. These offer an alternative to Warfarin in stroke prophylaxis in patients with atrial fibrillation. They present the advantage that they don’t need regular monitoring and have less interaction with both other medicines and food. The aim of this study is to understand which of the Novel Oral anticoagulant drug is more cost-effective in 5 different European countries, as well as understand which variables have more impact in the differences between the overall result of cost-effectiveness in these 5 settings. Methods An adaptation of a Markov decision model based on one from the article: “Cost Effectiveness of Novel Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation Depending on the Quality of Warfarin Anticoagulation Control” by Andrej Janžič and Mitja Kos (2014), was made. This allowed to answer the questions raised and mentioned before by performing the analyses for the 4 drugs (Warfarin, Apixaban, Dabigatran and Rivaroxaban) on the 5 countries (Slovenia, Portugal, Sweden, The Netherlands and the United Kingdom) under the same model. Six types of simulations were run having the Slovenian parameters has reference: 1 – Changing only the drug costs to the ones from each country; 2 – changing all the costs for the national-specific ones (event costs + drug costs); 3 – using only the national-specific life tables; 4 – using only the national-specific utilities and monthly disutilities; 5 – using all national-specific data except the life tables; 5 -using all the national-specific data. The cost-effectiveness analysis, more specifically the cost-utility analysis were made from each State’s healthcare payer perspective. Results Through Incremental Cost-effectiveness Ratio it was possible to conclude that Apixaban was the most cost-effective of the Novel Oral Anticoagulants in Slovenia, Portugal and The Netherlands while Dabigatran proved to be more cost-effective in the United Kingdom. It was also shown that event cost had relatively more impact that drug costs in the overall cost-effectiveness result for each country than drug costs. Life tables also had a great impact in the effectiveness outcome of each country. Countries with lower death probabilities in individuals from 79- to 85 years-old had higher effectiveness outcomes. Conclusion The Cost per Quality-adjusted Life Year varies highly between different European healthcare settings and mostly because of event costs and mortality tables. Also all of the Novel Oral Anticoagulant Drugs Incremental Cost-effectiveness Ratio were under the common reimbursement threshold of 20000€ per Quality-adjusted Life Year except for Rivaroxaban.

Ainda subsiste muita incerteza sobre a melhor maneira de utilizar novas terapias imunomoduladoras em doentes oncológicos, especialmente em doentes com cancro do pulmão. A prevalência global desta doença, a mortalidade e o mau prognóstico a ela associados justificam a necessidade de um rápido desenvolvimento e aplicação de novas terapias, capazes de mudar o atual paradigma complicado da doença. Dado que as imunoterapias, nomeadamente os inibidores de pontos de controlo imunitário (ICI), têm produzido resultados melhorados em doentes com cancro do pulmão, mas exigem despesas elevadas para as suas aquisições, este estudo procura sistematizar os dados atualmente publicados sobre ICIs para doentes com cancro do pulmão, de modo a ajudar a clarificar os métodos atuais mais custo-efetivo para as aplicar e a evidência que ainda falta ser gerada. As combinações com estas terapias possuem o potencial de melhorar a eficácia dos regimes, através do uso de mecanismos de ação sinérgicos, mas também representam riscos de eventos adversos agravados e custos elevados, sendo o foco do presente estudo. Foi construída uma revisão sistemática de estudos disponíveis que analisavam a eficácia, a relação custo-eficácia ou o custo-utilidade dos ICI no cancro do pulmão. Foram analisados 175 estudos através do respetivo resumo, tendo sido selecionados 85 para análise integral e, dos quais, 43 foram selecionados para inclusão no presente trabalho. Os estudos incluídos analisaram regimes variados com ICIs em monoterapia ou em combinação, quer entre ICIs quer com outras opções como a quimioterapia ou o bevacizumab. Embora a maioria dos regimes tenha apresentado resultados significativamente melhores em comparação com a quimioterapia clássica, apenas o Pembrolizumab e o Atezolizumab em monoterapia foram considerados custo-efetivos, em grupos de doentes selecionados por biomarcadores. Os preços elevados com que estes medicamentos entram no mercado foram considerados como a maior barreira à utilização generalizada dos ICI. Este estudo sugere a investigação de uma melhor utilização dos biomarcadores atuais ou estratégias de partilha de custos e riscos para contrariar esta dificuldade, permitindo, potencialmente, que os sistemas de cuidados de saúde possam adquirir de forma sustentável estas novas opções terapêuticas e utilizá-las nos subgrupos de doentes oncológicos que mais beneficiam com as mesmas, ao mesmo tempo que apoiam e incentivam a inovação.

Objectives: This study assesses the cost-effectiveness of sacubitril/valsartan versus enalapril in patients with symptomatic heart failure with reduced ejection fraction (HFrEF). Methods: We used a previously developed Markov model calibrated with patient-level data from the PARADIGM-HF trial, adapted to the Portuguese setting. The model considers two health states (alive or dead) and uses regression analyzes to estimate hospitalizations and deaths over time. A panel of experts estimated resource consumption in the outpatient setting. To estimate resource consumption with hospitalizations, the National Health Service Diagnosis Related Groups database was used. Unit costs were based on national legislation, and on the Infomed database. The model considers a societal perspective, a time horizon of 30-years, and a 5% annual discount rate. Sensitivity analyses assessed the robustness of results. Results: Sacubitril/valsartan increases life expectancy by 0.5 life-years, corresponding to 0.4 incremental quality adjusted life-years (QALY) versus enalapril. The estimated incremental cost-effectiveness ratio (ICER) is 22,702€/QALY. Sensitivity analysis shows that results are robust, but sensitive to the parameter estimates of the cardiovascular survival curve. Conclusion: Sacubitril/valsartan is a cost-effective therapeutic option in the treatment of Portuguese patients with HFrEF and translate into significant health gains and increased life expectancy versus the current standard of care.

Introduction Cancer chemotherapy increases the risk of heart failure. This cost-effectiveness study analyzes cardio-oncology imaging assessment of left ventricular ejection fraction (LVEF) using a Portuguese healthcare payer perspective and a five-year time horizon. Methods Two cardioprotective strategies were assessed: universal cardioprotection (UCP) for all patients and cardioprotection initiated on diagnosis of LVEF-defined cardiotoxicity (EF-CTX). A Markov model, informed by the retrospective clinical course of breast cancer patients followed in a Portuguese public hospital, was developed to assess the cost-effectiveness of LVEF cardio-oncology imaging assessment. Data on transition probabilities, costs and utilities were retrieved from both the retrospective data and published literature to assess the cost-effectiveness of LVEF echocardiographic assessment. Costs and utilities of the cardioprotective strategies were assessed over a five-year range, using probabilistic sensitivity analyses. Results In the reference case of a 63-year-old breast cancer patient treated with cardioprotection initiated on diagnosis of EF-CTX, the five-year time horizon (4.22 QALYs and €2594 cost over five years) dominated UCP (3.42 QALYS and €3758 cost over five years). Under a time horizon of five years at a willingness-to-pay threshold of €22 986, over 65.7% of simulations provided additional QALYs. Monte Carlo simulation of the Markov model had no effect on the model's conclusions. Conclusion In the Portuguese public healthcare system and under specific hypotheses, from a healthcare payer perspective, EF-CTX-guided cardioprotection for patients at risk of chemotherapy-related cardiotoxicity provides more QALYs at lower cost than UCP.

O Patient Blood Management, caracteriza-se como um programa que visa a promoção da segurança dos doentes, pois, aumentando a concentração de hemoglobina e as suas reservas de ferro, diminui a probabilidade de necessidade de transfusão. O PBM, corresponde a uma estratégia de boas práticas transfusionais, que permitem a melhor utilização do sangue e dos seus componentes, restringindo as transfusões a situações estritamente necessárias, preservando o doente aos riscos associados à transfusão. O PBM é um conceito de medicina baseada na evidência, em que, otimizando o doente e conservando o seu próprio sangue, visa a melhoria dos resultados em saúde, diminuindo a morbilidade e a taxa de mortalidade associada à transfusão, reduzindo não só o tempo de internamento como as taxas de reinternamento. O princípio do PBM assenta em três pilares, o primeiro pilar, consiste no estudo do doente antes da cirurgia, no sentido de diagnosticar e tratar uma anemia que possa existir; o segundo pilar, prende-se com a monitorização e a diminuição das perdas hemorrágicas e o terceiro pilar, consiste em otimizar o doente de modo a que haja uma tolerância à anemia, tentando restringir o mais possível a necessidade de transfusão. Objetivo: Caracterizar a segurança e custo-efetividade da implementação de um programa de Patient Blood Management. Metodologia: Realização de uma revisão de âmbito relativa à implementação de programas de Patient Blood Management em contexto hospitalar. A pesquisa foi conduzida na PubMed, utilizando termos de pesquisa como “anemia”, “patient blood management”, “transfusion”, “elective surgery”, utilizando o operador booleano “AND”. Foi ainda realizado um estudo retrospetivo no serviço de sangue e medicina transfusional do Hospital Professor Doutor Fernando Fonseca, EPE, com uma análise comparativa entre dois períodos temporais, antes e depois da implementação do referido programa. Resultados: Os resultados obtidos neste estudo refletem a importância de um programa de Patient Blood Management. A redução do número de doentes que consumiram concentrados eritrocitários comparando os anos de 2018 e 2019 foi de cerca de 24%. Nos serviços não cirúrgicos o número total de doentes transfundidos diminuiu de 535 em 2018 para 507 relativamente a 2019, o que corresponde a cerca de 6% de doentes. Nos serviços cirúrgicos o total de doentes transfundidos também diminuiu passando de 250 em 2018 para 232 em 2019 correspondendo a menos 8% de doentes cirúrgicos transfundidos. Durante o ano de 2019 foram integrados no programa, 134 doentes, 75 desses doentes foram integrados devido a cirurgia eletiva, e 118 de serviços não cirúrgicos. Nos doentes cirúrgicos verificamos um consumo de apenas sete concentrados eritrocitários. Nos serviços não cirúrgicos, comparando o consumo de sangue antes e depois da consulta de Patient Blood Management, verificou-se uma quebra bastante acentuada no consumo de concentrados eritrocitários passando de 100 unidades de concentrados eritrocitários para apenas 16. Conclusão: Os resultados demonstraram que um programa de Patient Blood Management é eficaz na redução do consumo de concentrado eritocitário. Verificou-se uma redução no número total de transfusões de um ano para o outro, e no decorrer do ano de 2019 verificou-se uma quebra acentuada no consumo de sangue, nos serviços não cirúrgicos, em doentes que foram integrados no programa. O consumo de sangue, em doentes propostos para cirurgia, foi significativamente baixo.

Plain radiography still accounts for the vast majority of imaging studies that are performed at multiple clinical instances. Digital detectors are now prominent in many imaging facilities and they are the main driving force towards filmless environments. There has been a working paradigm shift due to the functional separation of acquisition, visualization, and storage with deep impact in the imaging workflows. Moreover with direct digital detectors images are made available almost immediately. Digital radiology is now completely integrated in Picture Archiving and Communication System (PACS) environments governed by the Digital Imaging and Communications in Medicine (DICOM) standard. In this chapter a brief overview of PACS architectures and components is presented together with a necessarily brief account of the DICOM standard. Special focus is given to the DICOM digital radiology objects and how specific attributes may now be used to improve and increase the metadata repository associated with image data. Regular scrutiny of the metadata repository may serve as a valuable tool for improved, cost-effective, and multidimensional quality control procedures.

(Introduction) The increasing impact of environmental issues has driven the development of increasingly cleaner and renewable processes and products. Biomassderived carbons have gained significant attention due to their high specific surface areas, hierarchical porous structures, cost-effectiveness and widespread availability [1]. Given the growing interest in these materials, the substitution of carbon atoms with heteroatoms (N, B, P and S) within the carbonaceous structure emerges as a mechanism to enhance the material's acid-base character. It can also alter the electronic structure of carbon, potentially increasing its electrical conductivity, chemical stability, and electron-donation properties [2]. This study aims to develop carbon materials from pinecones with high surface area, doped with nitrogen.

Introdução: A análise custo-efetividade dos métodos de diagnóstico é cada vez mais importante, especialmente nas doenças cardiovasculares. Define-se na relação entre o custo e um efeito definido. A cintigrafia de perfusão do miocárdio (CPM) é realizada como método eficaz de estratificação do risco da doença arterial coronária (DAC). Contudo, a exposição à radiação e aquisições prolongadas podem influenciar o conforto e a segurança do paciente e os custos. Como resposta, a tecnologia de cádmio-zinco-telúrio (CZT) permite aquisições com maior sensibilidade e resolução temporal, permitindo diminuir o tempo da aquisição de imagem e/ou a atividade administrada. Assim, pretende-se caracterizar de forma sistemática as orientações, os procedimentos, os custos e os resultados atuais que constituem a análise custo-efetividade da CPM com detetores CZT. Metodologia: Realizou-se uma revisão sistemática, onde foram incluídos 16 artigos, pesquisados nas bases de dados eletrónicas, MEDLINE, Scopus, ScienceDirect e do cruzamento manual de referências dos artigos elegíveis publicados entre 2016 e 2021. Resultados: Verificou-se a existência de estudos que demonstram a eficácia das câmaras CZT na deteção de DAC, especificamente, com resultados de sensibilidade entre 62% e 93% e especificidade entre 66% a 100%. Obtiveram-se valores de prognóstico significativos em relação aos convencionais em resultados normais (taxas de eventos adversos entre 0.5 e 2.15). Verificou-se também a existência de possíveis benefícios económicos, i. e., cumpre com as estratégias de custo-efetividade, produzindo resultados mais seguros e contribuindo para a diminuição dos custos downstream. Conclusões: A CPM com recurso a câmaras-gama CZT é um método de diagnóstico eficaz, cuja aplicabilidade se traduz numa técnica potencialmente mais custo-efetiva que os métodos convencionais.

No Carcinoma da próstata (CaP) estima-se que 40% dos doentes, após prostatectomia radical, sofrem recidiva bioquímica, traduzido pelo aumento do Prostate-Specific Antigen (PSA). Ainda subsiste controvérsia relativamente ao diagnóstico subjacente e, aproximadamente, 50% dos doentes são propostos a radioterapia de salvação erroneamente. Esta abordagem resulta em custos elevados e prejuízos associados a um tratamento sem benefício, com efeitos secundários agressivos que potenciam atraso no tratamento. A Positron Emission Tomography (PET)/ Computer Tomography (CT) com 68Ga-Prostate-Specific Membrane Antigen (PSMA) é a técnica de imagem mais promissora no diagnóstico de recidiva bioquímica, permitindo detetar lesões com maior sensibilidade e especificidade, definindo um estadiamento mais preciso e precoce e auxiliando na decisão da terapêutica mais adequada. Objetivo: Avaliar o custo-efetividade da PET/CT com 68Ga-PSMA nos doentes de CaP em recidiva bioquímica após prostatectomia radical comparativamente à cintigrafia óssea. Metodologia: Estudo retrospetivo, desenvolvido na Unidade de Medicina Nuclear do Hospital Lusíadas Lisboa, constituído por uma amostra de 36 doentes: 17 realizaram a PET/CT com 68Ga-PSMA e 19 cintigrafia óssea. Procedeu-se à valorização dos custos e benefícios associados aos exames em estudo, e a influência na realização da radioterapia de salvação. Resultados: Dos doentes que realizaram PET/CT com 68Ga-PSMA no estadiamento do CaP, obteve-se um RCEI de 196,8 € por % de efetividade diagnóstica, com um incremento de 8,6% para obterem um benefício adicional comparativamente à cintigrafia óssea. Conclusão: A modalidade de imagem PET/CT com 68Ga-PSMA é mais efetiva comparativamente à cintigrafia óssea.

Introduction: Despite seasonal influenza vaccination programmes in most countries targeting individuals aged ≥ 65 (or ≥ 55) years and high risk-groups, significant disease burden remains. We explored the impact and cost-effectiveness of 27 vaccination programmes targeting the elderly and/or children in eight European settings (n = 205.8 million). Methods: We used an age-structured dynamic-transmission model to infer age- and (sub-)type-specific seasonal influenza virus infections calibrated to England, France, Ireland, Navarra, The Netherlands, Portugal, Scotland, and Spain between 2010/11 and 2017/18. The base-case vaccination scenario consisted of non-adjuvanted, non-high dose trivalent vaccines (TV) and no universal paediatric vaccination. We explored i) moving the elderly to "improved" (i.e., adjuvanted or high-dose) trivalent vaccines (iTV) or non-adjuvanted non-high-dose quadrivalent vaccines (QV); ii) adopting mass paediatric vaccination with TV or QV; and iii) combining the elderly and paediatric strategies. We estimated setting-specific costs and quality-adjusted life years (QALYs) gained from the healthcare perspective, and discounted QALYs at 3.0%. Results: In the elderly, the estimated numbers of infection per 100,000 population are reduced by a median of 261.5 (range across settings: 154.4, 475.7) when moving the elderly to iTV and by 150.8 (77.6, 262.3) when moving them to QV. Through indirect protection, adopting mass paediatric programmes with 25% uptake achieves similar reductions in the elderly of 233.6 using TV (range: 58.9, 425.6) or 266.5 using QV (65.7, 477.9), with substantial health gains from averted infections across ages. At €35,000/QALY gained, moving the elderly to iTV plus adopting mass paediatric QV programmes provides the highest mean net benefits and probabilities of being cost-effective in all settings and paediatric coverage levels. Conclusion: Given the direct and indirect protection, and depending on the vaccine prices, model results support a combination of having moved the elderly to an improved vaccine and adopting universal paediatric vaccination programmes across the European settings.

Background: The majority of chronic disease is caused by risk factors which are mostly preventable. Effective interventions to reduce these risks are known and proven to be applicable to a variety of settings. Chronic disease is generally developed long before the fatal outcome, meaning that a lot of people spend a number of years in poor health. Effective prevention measures can prolong lives of individuals and significantly improve their quality of life. However, the methods to measure cost-effectiveness are a subject to much debate. The Economics of Chronic Diseases project aims to establish the best possible methods of measuring cost-effectiveness as well as develop micro-simulation models apt at projecting future burden of chronic diseases, their costs and potential savings after implementation of cost-effective interventions. Method: This research project will involve eight European countries: Bulgaria, Finland, Greece, Lithuania, The Netherlands, Poland, Portugal and the United Kingdom (UK). A literature review will be conducted to identify scientific articles which critically review the methods of cost-effectiveness. Contact will be made health economists to inform and enrich this review. This evidence will be used as a springboard for discussion at a meeting with key European stakeholders and experts with the aim of reaching a consensus on recommendations for cost-effectiveness methodology. Epidemiological data for coronary heart disease, chronic kidney disease, type 2 diabetes and chronic obstructive pulmonary disease will be collected along with data on time trends in three major risk factors related to these diseases, specifically tobacco consumption, blood pressure and body mass index. Economic and epidemiological micro-simulation models will be developed to asses the future distributions of risks, disease outcomes, healthcare costs and the cost-effectiveness of interventions to reduce the burden of chronic diseases in Europe. Discussion: This work will help to establish the best methods of measuring cost-effectiveness of health interventions as well as test a variety of scenarios to reduce the risk factors associated with selected chronic diseases. The modelling projections could be used to inform decisions and policies that will implement the best course of action to curb the rising incidence of chronic diseases.

Introduction and Objectives: To estimate the cost-effectiveness and cost-utility of dabigatran in the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation in Portugal. A Markov model was used to simulate patients’ clinical course, estimating the occurrence of ischemic and hemorrhagic stroke, transient ischemic attack, systemic embolism, myocardial infarction, and intra- and extracranial hemorrhage. The clinical parameters are based on the results of the RE-LY trial, which compared dabigatran with warfarin, and on a meta-analysis that estimated the risk of each event in patients treated with aspirin or with no antithrombotic therapy. Results: Dabigatran provides an increase of 0.331 life years and 0.354 quality-adjusted life years for each patient. From a societal perspective, these clinical gains entail an additional expenditure of 2978 euros. Thus, the incremental cost is 9006 euros per life year gained and 8409 euros per quality-adjusted life year.The results show that dabigatran reduces the number of events, especially the most severe such as ischemic and hemorrhagic stroke, as well as their long-term sequelae. The expense of dabigatran is partially offset by lower event-related costs and by the fact that INR monitoring is unnecessary. It can thus be concluded that the use of dabigatran in clinical practice in Portugal is cost-effective.

Background: The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content. Objective: This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis will complement the study. Methods: The study includes 3 different randomized control trials. The trial in Switzerland comprises a waitlist control group and 2 active arms consisting of 2 delivery formats, standardized and self-tailored. In the Netherlands and in Portugal, the trials follow a 2-arm design that will be, respectively, complemented with focus groups on technology acceptance and cost-effectiveness analysis. The main target group will consist of adults aged >60 years from the general population in Switzerland (n≥85), the Netherlands (n≥40), and Portugal (n≥80) who lost their partner and seek help for coping with grief symptoms, psychological distress, and adaptation problems in daily life. The trials will test the intervention’s clinical efficacy for reducing grief (primary outcome) and depression symptoms and loneliness (secondary outcomes) after the intervention. Measurements will take place at baseline (week 0), after the intervention (week 10), and at follow-up (week 20). Results: The trials started in March 2022 and are expected to end in December 2022 or when the needed sample size is achieved. The first results are expected by January 2023. Conclusions: The trials will provide insights into the efficacy and acceptance of a web-based self-help intervention among older adults who have recently lost a partner. Results will extend the knowledge on the role of self-tailoring, working alliance, and satisfaction in the effects of the intervention. Finally, the study will suggest adaptations to improve the acceptance of web-based self-help interventions for older mourners and explore the cost-effectiveness of this intervention. Limitations include a self-selective sample and the lack of cross-cultural comparisons.

O presente trabalho, cujo objectivo foi avaliar o custo – efectividade da intervenção das Equipas de Rua na população utilizadora de drogas injectáveis, começa por fazer uma abordagem do Vírus de Imunodeficiência Humana – VIH e da Síndroma de Imunodeficiência Adquirida – SIDA. Após uma breve descrição da evolução da doença, da sua caracterização e da população infectada a nível mundial e nacional, é apontada a sua incidência nos diversos continentes, o estigma social dos seus portadores, para além de identificar a população (utilizadores de drogas injectáveis) onde o risco de contaminação é mais elevado. No quadro das políticas de prevenção, redução de riscos e minimização de danos, foi abordada a importância, do Programa de Troca de Seringas na prevenção da contaminação do VIH. Neste contexto e reflectindo o panorama europeu, as Equipas de Rua surgem como um alternativa de intervenção, num contexto de proximidade. Foram identificados os modelos de avaliação económica em saúde, os seus aspectos conceptuais, custos e respectivos benefícios, com relevo para o modelo custo-efectividade adequado à intervenção das Equipas de Rua. Foi utilizado o teste de Mann-Whitney e o coeficiente de Correlação de Spearman, que confirmaram o impacto das Equipas de Rua, para além de uma associação entre o aumento daquelas estruturas e a diminuição das infecções. Por fim foi efectuada a análise económica custo – efectividade com base no número de infecções pelo VIH evitadas pela intervenção das Equipas de Rua, concluindo-se que foram evitadas 1.007 infecções nos três anos do estudo, com um custo de cerca de € 3.075 por infecção evitada, contra um custo de tratamento de cerca de € 11.000 por infecção.

A Medicina é uma área de conhecimento em profundo desenvolvimento tecnológico e científico, tendo estes factores contribuído para um aumento da esperança e qualidade de vida das populações, à custa do crescimento das despesas com a Saúde. A aplicação da Economia no sector da Saúde permite uma maior eficiência através da avaliação da melhor estratégia a utilizar em determinada patologia, criando soluções na resolução do conflito qualidade/eficiência. O diagnóstico e estadiamento correcto da doença são fundamentais para uma correcta orientação terapêutica e previsão prognóstica. A técnica imagiológica PET/CT assume nos dias de hoje um papel inegável no contexto oncológico, permitindo avaliar o metabolismo e a anatomia do corpo inteiro, através da detecção precoce de alterações a nível celular. Apesar da acuidade e exactidão superior desta técnica de diagnóstico e estadiamento serem factos aceites na comunidade médica e científica, algumas dúvidas e lacunas persistem no que diz respeito ao seu valor de custo-efectividade. Com este trabalho propomo-nos analisar a viabilidade económica do PET/CT (rácio análise custo-efectividade e QALY’s) em relação à CT para estadiamento de carcinoma do pulmão. Este estudo assenta numa abordagem observacional, analítica e retrospectiva de uma amostra constituída por cinquenta e oito pacientes do serviço de Pneumologia Oncológica do Hospital Pulido Valente. No nosso estudo, o grupo que realizou PET/CT para estadiamento do carcinoma do pulmão, teve um ganho de 4,02 anos de vida e de 30% de efectividade, apesar de um incremento de 523 euros por efectividade diagnóstica.

Introduction: Rotavirus is one of the most common cause of severe gastroenteritis in children, with the largest mortality burden in low- and middle-income countries. To prevent rotavirus gastroenteritis, Mozambique introduced ROTARIX® vaccine in 2015, however, its cost-effectiveness has never been established in the country. In 2018, additional vaccines became available globally. This study estimates the cost-effectiveness of the recently introduced ROTARIX in Mozambique and compares the cost-effectiveness of ROTARIX®, ROTAVAC®, and ROTASIIL® to inform future use. Methods: We used a decision-support model to calculate the potential cost-effectiveness of vaccination with ROTARIX compared to no vaccination over a five-year period (2016–2020) and to compare the cost-effectiveness of ROTARIX, ROTAVAC, and ROTASIIL to no vaccination and to each other over a ten-year period (2021–2030). The primary outcome was the incremental cost per disability-adjusted life-year (DALY) averted from a government perspective. We assessed uncertainty through sensitivity analyses. Results: From 2016 to 2020, we estimate the vaccine program with ROTARIX cost US$12.3 million, prevented 4,628 deaths, and averted US$3.1 million in healthcare costs. The cost per DALY averted was US$70. From 2021 to 2030, we estimate all three vaccines could prevent 9,000 deaths and avert US$7.8 million in healthcare costs. With Global Alliance for Vaccines and Immunization (Gavi) support, ROTARIX would have the lowest vaccine program cost (US$31 million) and 98 % probability of being cost-effective at a willingness-to-pay threshold of 0.5x GDP per capita. Without Gavi support, ROTASIIL would have the lowest vaccine program cost (US$75.8 million) and 30 % probability of being cost-effective at the same threshold. Conclusion: ROTARIX vaccination had a substantial public health impact in Mozambique between 2016 and 2020. ROTARIX is currently estimated to be the most cost-effective product, but the choice of vaccine should be re-evaluated as more evidence emerges on the price, incremental delivery cost, wastage, and impact associated with each of the different rotavirus vaccines.

This paper examines offset method decisions under the US wetland mitigation program and compares the cost effectiveness of prescriptive on-site and market-based off-site approaches. By measuring costs through land values and benefits through flood control values, we highlight a clear trade-off between the two mechanisms. Prescriptive on-site compensation occurs in high-cost, high-benefit areas, whereas market-based off-site compensation occurs in low-cost, low-benefit areas. Our analysis also reveals that cost minimization heavily influences the regulator's choice of offset method, while flood control benefits appear to be absent from policy determinations. This finding, combined with the increased adoption of market-based offsets, suggests an overreliance on the market mechanism. Although policy guidelines promote market-based offsets due to their potential for environmental gains, they also require that both costs and benefits be considered in offset method determinations. Our findings indicate that regulatory decisions overlook the flood control benefits of prescriptive on-site compensation, revealing a divergence between policy intent and observed offset decisions.

Global changes require conservation planners to integrate environmental dynamics into their strategies. Forward-looking species-based conservation plans typically use data for a few time periods (ten to thirty years apart) to pinpoint the adaptive areas providing the conditions for species to follow their suitable climates and persist. With such gaps in time, species' responses to environmental conditions between the evaluated periods are not addressed. Here we test whether choices on the temporal resolution in analysis (length of time in between time slices) impact the location and perceived effectiveness of the resulting climate-adaptive areas and the value of established protected areas in providing ground for the spatial responses of species. We address these issues using a conservation exercise set up in Western France, where ten vertebrate species are targeted for persistence in the long term (i.e., 2050). For each species, the area prioritization solutions obtained by using three settings of temporal resolution (annual, decadal and tri-decadal) were largely dissimilar. The climate adaptive areas obtained with annual data defined convoluted adaptive trajectories, largely distinct from the trajectories achieved with decadal and tri-decadal data. This has reflections on the perceived effectiveness of established protected areas in encompassing those adaptive trajectories. In the final stages of planning, conservation planers need to provide rigorous proposals for the establishment of effective conservation actions. This study pinpoints the need for fine-resolute temporal data to reach such effectiveness in the design of climate-proof protected area networks.