Browsing by Author "Caldeira, Daniel"
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- Carga e custo da fibrilhação auricular em PortugalPublication . Gouveia, Miguel; Costa, João; Alarcão, Joana; Augusto, Margarida; Caldeira, Daniel; Pinheiro, Luís; Carneiro, António Vaz; Borges, MargaridaIntrodução e objetivos: A fibrilhação auricular é a disritmia persistente mais prevalente. Pretendemos estimar a carga e custos da doenc¸a atribuíveis à fibrilhac¸ão auricular em Portugal com base nas estatísticas demográficas e de saúde. Métodos: Utilizou-se informação sobre mortalidade por causa da OMS-Europa. Dados hospitalares foram provenientes da base de dados dos GDH. A carga da doença foi medida pelos DALY (disability-adjusted life years) ou anos de vida perdidos ajustados por incapacidade, uma métrica adotada pela Organização Mundial de Saúde. Os custos incluíram os consumos de recursos e as perdas de produtividade. A carga e os custos da doença estimados são os atribuíveis àfibrilhac¸ão auricular e à sua principal complicac¸ão, o acidente vascular cerebral isquémico.Resultados: Em Portugal, no ano 2010, podem atribuir-se à fibrilhação auricular 4070 mortes correspondendo a 3,8% do total das mortes ocorridas. A carga da doença atribuível à fibrilhação auricular foi estimada em 23.084 DALY: 10.521 decorrentes das mortes prematuras (1,7% dosDALY por morte em Portugal em 2010) e 12 563 devidos à incapacidade gerada pela morbilidade. O total estimado de custos diretos para o sistema de saúde a prec¸os de 2013 atribuíveis à fibrilhação auricular foi de 115 MD(milhões de euros): 34 MD em internamento e 81 MD em ambulatório. Os custos indiretos gerados pela produção perdida devidos à incapacidade causadapela doenc¸a foram estimados em 25 MD. Conclusões: A fibrilhação auricular tem um importante impacto social em Portugal devido à mortalidade e morbilidade geradas, podendo-se-lhe atribuir em 2013 um custo total de 140 MD,cerca de 0,08% do produto interno bruto.
- Custo-efetividade dos novos anticoagulantes orais na fibrilhação auricular em PortugalPublication . Costa, João; Fiorentino, Francesca; Caldeira, Daniel; Inês, Mónica; Pereira, Catarina Lopes; Pinheiro, Luís; Vaz-Carneiro, António; Borges, Margarida; Gouveia, MiguelIntrodução e objetivos: Os non-vitamin K antagonist oral anticoagulants (NOAC) foram recentemente comparticipados para a fibrilhação auricular não-valvular (FA), sendo relevante determinar o seu custo-efetividade para a realidade portuguesa. Métodos: Foi especificado um modelo Markov para simular a progressão dos doentes com FA no decurso da sua vida. Os dados de efetividade relativa para os eventos acidente vascular cerebral (isquémico e hemorrágico), hemorragia (intracraniana, outras hemorragias major ehemorragias não-major clinicamente relevantes), enfarte agudo do miocárdio e descontinuação do tratamento foram obtidos por comparações indiretas entre o apixabano, o dabigatrano e orivaroxabano (comparador comum: varfarina). As fontes dos dados de consumo de recursos de saúde foram a base de dados dos grupos de diagnóstico homogéneo e painel de peritos. Estimou-se os anos de vida ganhos, anos de vida ajustados pela qualidade (QALY), custos diretos e rácios de custo-efetividade incremental (ICER). Resultados: Os anos de vida ganhos e os QALY foram maiores com apixabano, com um ICER versus varfarina e dabigatrano de 5529 € /QALY e 9163 € /QALY, respetivamente. O apixabano foi dominante versus o rivaroxabano (maiores ganhos em saúde e menores custos). Estes resultados foram robustos nas análises de sensibilidade realizadas, tendo o apixabano uma probabilidade de 70% de ser custo-efetivo (threshold: 20 000 € /QALY) versus o conjunto das restantes opções esterapêuticas.
- Os custos da aterosclerose em PortugalPublication . Costa, João; Alarcão, Joana; Amaral‐Silva, Alexandre; Araújo, Francisco; Ascenção, Raquel; Caldeira, Daniel; Cardoso, Marta Ferreira; Correia, Manuel; Fiorentino, Francesca; Gavina, Cristina; Gil, Victor; Gouveia, Miguel; Lourenço, Francisco; Silva, Alberto Mello e; Pedro, Luís Mendes; Morais, João; Vaz‐Carneiro, António; Veríssimo, Manuel Teixeira; Borges, MargaridaIntroduction and objectives: Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease‐related costs. Methods: Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real‐world data from primary care, the 2014 National Health Interview Survey, and expert opinion. Results: The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%). Conclusions: Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.
- The burden of atherosclerosis in PortugalPublication . Costa, João; Alarcão, Joana; Araujo, Francisco; Ascenção, Raquel; Caldeira, Daniel; Fiorentino, Francesca; Gil, Victor; Gouveia, Miguel; Lourenço, Francisco; Silva, Alberto Mello E; Sampaio, Filipa; Carneiro, António Vaz; Borges, MargaridaAIMS: This article sought to estimate the burden of disease attributable to atherosclerosis in mainland Portugal in 2016. METHODS AND RESULTS: The burden of atherosclerosis was measured in disability-adjusted life years following the latest 2010 Global Burden of Disease (GBD) methodology. Disability-adjusted life years were estimated as the sum of years of life lost (YLL) with years lived with disability (YLD). The following clinical manifestations of atherosclerosis were included: ischaemic heart disease (IHD) (including acute myocardial infarction, stable angina, and ischaemic heart failure), ischaemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD). Years of life lost were estimated based on all-cause mortality data for the Portuguese population and mortality due to IHD, ICVD, and PAD for the year 2016 sourced from national statistics. Standard life expectancy was sourced from the GBD study. Years lived with disability corresponded to the product of the number of prevalent cases by an average disability weight for all possible combinations of disease. Prevalence data for the different clinical manifestations of atherosclerosis were sourced from epidemiological studies. Disability weights were sourced from the published literature. In 2016, 15 123 deaths were attributable to atherosclerosis, which corresponded to 14.3% of overall mortality in mainland Portugal. Disability-adjusted life years totalled 260 943, 75% due to premature death (196 438 YLL) and 25% due to disability (64 505 YLD). CONCLUSION: Atherosclerosis entails a high disease burden to society. A large part of this burden would be avoidable if evidence-based effective and cost-effective interventions targeting known risk factors, from prevention to treatment, were implemented.
- The current and future burden of heart failure in PortugalPublication . Gouveia, Miguel; Ascenção, Raquel; Fiorentino, Francesca; Costa, João; Caldeira, Daniel; Broeiro-Gonçalves, Paula; Fonseca, Candida; Borges, MargaridaAims: Heart failure (HF) is a clinical syndrome with significant social and economic burden. We aimed to estimate the burden of HF in mainland Portugal over a 22-year time horizon, between 2014 and 2036. Methods and results: Heart failure burden was measured in disability-adjusted life years (DALYs), resulting from the sum of years of life lost (YLL) due to premature death and years lost due to disability (YLD). YLL were estimated based on the Portuguese mortality rates reported by the European Detailed Mortality Database. For YLD, disease duration and the overall incidence were estimated using an epidemiological model developed by the World Health Organization (DISMOD II). Disability weights were retrieved from published literature. The impact of ageing was estimated with a shift-share analysis using official demographic projections. In 2014, 4688 deaths were attributed to HF, corresponding to 4.7% of the total deaths in mainland Portugal. DALYs totalled 21 162, 53.9% due to premature death (YLL: 11 398) and 46.1% due to disability (YLD: 9765). Considering only population ageing over a 22-year horizon, the deaths and burden of HF are expected to increase by 73.0% and 27.9%, respectively, reaching 8112 deaths and 27 059 DALYs lost due to HF in 2036. DALY's growth is mainly driven by the increase of YLL, whose contribution to overall burden will increase to 62.0%. Conclusions: Heart failure is an emerging and growing health problem where significant health gains may be obtained. The projected significant increase of HF burden highlights the need to set HF as a priority for healthcare system.
- World Heart Federation cholesterol roadmap: the Portuguese casePublication . Abreu, Ana; Dores, Hélder; Gonçalves, Lino; Franco, Fátima; Silveira, Conceição; Proença, Gonçalo; Timóteo, Ana Teresa; Cardim, Nuno; Pedro, Mónica; Fiuza, Manuela; Ferreira, Daniel; Bento, Luísa; Patrício, Lino; Caldeira, Daniel; Baptista, Sérgio Bravo; Santos, José; Rocha, Evangelista; Raimundo, Anabela; Catarino, Carlos; Carrageta, Manuel; Mexia, Ricardo; Araújo, Francisco; Pereira, Hélder; Santos, Raul; Pinto, Fausto J.Atherosclerotic cardiovascular disease (ASCVD) remains the major cause of premature death and disability; effective cardiovascular (CV) risk prevention is fundamental. The World Heart Federation (WHF) Cholesterol Roadmap provides a framework for national policy development and aims to achieve ASCVD prevention. At the invitation of the WHF, a group of experts from the Portuguese Society of Cardiology (SPC), addressed the cholesterol burden at nationally and discussed possible strategies to include in a Portuguese cholesterol roadmap. The literature review showed that the cholesterol burden in Portugal is high and especially uncontrolled in those with the highest CV risk. An infographic scorecard was built to include in the WHF collection, for a clear idea about CV risk and cholesterol burden in Portugal, which would also be useful for health policy advocacy. The expert discussion and preventive strategies proposal followed the five pillars of the WHF document: awareness improvement; population-based approaches for CV risk and cholesterol; risk assessment/population screening; system-level approaches; surveillance of cholesterol and ASCVD outcomes. These strategies were debated by all the expert participants, with the goal of creating a national cholesterol roadmap to be used for advocacy and as a guide for CV prevention. Several key recommendations were outlined: include all stakeholders in a multidisciplinary national program; create a structured activities plan to increase awareness in the population; improve the quality of continuous CV health education; increase the interaction between different health professionals and non-health professionals; increment the referral of patients to cardiac rehabilitation; screen cholesterol levels in the general population, especially high-risk groups; promote patient self-care, engage with patients’ associations; use specific social networks to spread information widely; create a national database of cholesterol levels with systematic registry of CV events; redefine strategies based on the evaluation of results; create and involve more patients’ associations – invert the pyramid order. In conclusion, ASCVD and the cholesterol burden remain a strong global issue in Portugal, requiring the involvement of multiple stakeholders in prevention. The Portuguese cholesterol roadmap can provide some solutions to help urgently mitigate the problem. Population-based approaches to improve awareness and CV risk assessment and surveillance of cholesterol and ASCVD outcomes are key factors in this change. A call to action is clearly needed to fight hypercholesterolemia and ASCVD burden.