Navegando por Autor "Ramalho, Daniela Maria de Paula"
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Item Cost-effectiveness of Xpert®MTB/RIF in the diagnosis of tuberculosis : pragmatic study.(2021) Silva, Suely Conceição Alves da; Vater, Maria Cláudia; Ramalho, Daniela Maria de Paula; Almeida, Isabela Neves de; Miranda, Silvana Spíndola de; Kritski, Afrânio LineuIntroduction: The intensification of research and innovation with the creation of networks of rapid and effective molecular tests as strategies for the end of tuberculosis are essential to avoid late diagnosis and for the eradication of the disease. We aimed to evaluate the cost-effectiveness of Xpert®MTB/RIF (Xpert) in the diagnosis of drug-resistant tuberculosis in reference units, in scenarios with and without subsidies, and the respective cost adjustment for today. Methods: The analyses were performed considering as criterion of effectiveness, negative culture or clinical improvement in the sixth month of follow-up. The comparison was performed using two diagnostic strategies for the drug susceptibility test (DST), BactecTMMGITTM960 System, versus Xpert. The cost effectiveness and incremental cost-effectiveness ratio (ICER) were calculated and dollar-corrected for American inflation (US$ 1.00 = R$ 5,29). Results: Subsidized Xpert had the lowest cost of US$ 33.48 (R$67,52) and the highest incremental average efficiency (13.57), thus being a dominated analysis. After the inflation was calculated, the mean cost was DST-MGIT=US$ 74.85 (R$ 396,73) and Xpert = US$ 37.33 (R$197,86) with subsidies. Conclusions: The Xpert in the diagnosis of TB-DR in these reference units was cost-effective with subsidies. In the absence of a subsidy, Xpert in TB-DR is not characterized as cost effective. This factor reveals the vulnerability of countries dependent on international organizations’ subsidy policies.Item Factors associated with non-completion of latent tuberculosis infection treatment in Rio de Janeiro, Brazil : a non-matched case control study.(2022) Aguiar, Roberta Marques de; Vieira, Maria Armanda Monteiro da Silva; Almeida, Isabela Neves de; Ramalho, Daniela Maria de Paula; Netto, Antonio Ruffino; Carvalho, Anna Cristina Calçada; Kritski, Afranio LineuIntroduction: There are scarce data on the routine latent tuberculosis infection treatment (LTBIT) and factors associated with a non-completion in high tuberculosis burden countries. Therefore, in this study we aimed to evaluate the factors associated with non-completion of LTBIT. Materials and methods: This was a non-matched case control study conducted at a University Hospital in Rio de Janeiro, Brazil. A total of 114 cases and 404 controls were enrolled between January/1999 and December/2009. Cases were close contacts who did not complete the LTBIT and controls were the contacts that completed it. Multivariate analysis was used to investigate risk factors associated with non-completion of LTBIT among contacts in two different periods of recruitment. Results: Factors associated with non-completion LTBIT included: drug use (OR 23.33, 95% CI 1.83---296.1), TB treatment default by the index case (OR 16.97, 95% CI 3.63---79.24) and drug intolerance. TB disease rates after two years of follow up varied from 0.4% to 1.9%. The number necessary to treat to prevent one TB case among contacts was 116. Conclusions: Non-completion treatment by the index case and illicit drug use were associated with not completing latent tuberculosis infection treatment and no tuberculosis disease was identified among those who completed latent tuberculosis infection treatment.