Background: Cholelithiasis is currently one of the most common diagnosis in Brazil. The aim of this study was to validate the Gastrointestinal Quality of Life Index (GIQLI) as a quality-of-life (QoL) assessment among the Brazilian population with syntomatic gallstone. Materials and Methods: The questionnaire was translated and culturally adapted after the linguistic validation process determined by the international methodology. Sixty-three patients who underwent laparoscopic cholecystectomy responded to the GIQLI-Brazil and Short-Form Health Survey (SF-36) instruments. For the evaluation of reproducibility, 30 patients responded to GIQLI-Brazil two more times after 2 and 4 weeks. After the University of São Paulo Ethics Commitee Board approval (UNIFESP/CEP: 1270/2019), the study was carryed out between May 2019 and February 2020 at the Gastroenterology outpatient clinic of Hospital São Paulo-Federal University of São Paulo (UNIFESP). Cronbach's alpha, the calculation of the intraclass correlation coefficient (ICC), and Spearman's correlation were used to assess the validity and reproducibility of the instrument translated into Portuguese, and to measure correlation between the domains of the GIQLI-Brazil and SF-36 (P < .05). Results: Seven questions were modified during the process of translation and cultural adaptation. The Brazilian version of the instrument presented a Cronbach's alpha of 0.89, and excellent reproducibility through the ICC, with the following variation between domains: meteorism (ICC = 0.918; P < .001) and gastrointestinal function (lower tract) (ICC = 0.956; P < .001). The dimensions of the GIQLI-Brazil and SF-36 demonstrated a significant correlation (P < .001), except between the domains: functional aspects of the SF-36 and gastrointestinal function (lower tract) of the GIQLI-Brazil (r = 0.211). Conclusion: The GIQLI was translated and validated for Portuguese-Brazil and can be used to assess the QoL of adult patients with gastrointestinal diseases and/or disorders.

Resumo Fundamento: A fibrilação atrial é um problema de saúde pública associado com um risco cinco vezes maior de acidente vascular cerebral e mortalidade. A análise de custos é importante para a introdução de novas terapias, e deve ser reconsiderada em situações especiais, tais como a pandemia do coronavírus em 2020. Objetivo: Avaliar os custos (em um período de um ano) relacionados à terapia anticoagulante e a qualidade de vida de pacientes com fibrilação atrial tratados em um hospital público universitário. Métodos: Os custos do paciente foram aqueles relacionados à anticoagulação e calculados pela média de custos mensais da varfarina ou de anticoagulantes orais diretos (DOACs). As despesas não médicas, como alimentação e transporte, foram calculadas a partir de dados obtidos de questionários. O questionário brasileiro SF-6D foi usado para medir a qualidade de vida. Valores p<0,05 foram considerados estatisticamente significativos. Resultados: A população do estudo consistiu em 90 pacientes, 45 em cada braço (varfarina vs. DOACs). Os custos foram 20% mais altos no grupo dos DOACs (US$55 532,62 vs. US$46 385,88), e principalmente relacionados ao preço dos medicamentos (US$23 497,16 vs. US$1903,27). Os custos hospitalares foram mais altos no grupo da varfarina (US$31 088,41 vs $24 604,74), e relacionados às visitas ao ambulatório. Ainda, as despesas não médicas foram duas vezes maiores no grupo varfarina ($13 394,20 vs $7 430,72). A equivalência de preço entre os dois medicamentos seria alcançada por uma redução de 39% no preço dos DOACs. Não foram observadas diferenças quanto à qualidade de vida. Conclusões: Os custos totais foram mais altos no grupo de pacientes tratados com DOACs que no grupo da varfarina. No entanto, uma redução de cerca de 40% no preço dos DOACs tornaria viável a incorporação desses medicamentos no sistema de saúde público brasileiro.

Background: Atrial fibrillation is a public health problem associated with a fivefold increased risk of stroke or death. Analyzing costs is important when introducing new therapies and must be reconsidered in special situations, such as the novel coronavirus pandemic of 2020. Objective: This study aimed to evaluate the costs related to anticoagulant therapy in a one-year period, and the quality of life of atrial fibrillation patients treated in a public university hospital. Methods: Patient costs were those related to the anticoagulation and calculated by the average monthly costs of warfarin or direct oral anticoagulants (DOACs). Patient non-medical costs (eg., food and transportation) were calculated from data obtained by questionnaires. The Brazilian SF-6D was used to measure the quality of life. P-values < 0.05 were considered statistically significant. Results: The study population consisted of 90 patients, 45 in each arm (warfarin vs direct oral anticoagulants). Costs were 20% higher in the DOAC group ($55,532.62 vs $46,385.88), and mainly related to drug price ($23,497.16 vs $1,903.27). Hospital costs were higher in the warfarin group ($31,088.41 vs $24,604.74) and related to outpatient visits. Additionally, non-medical costs were almost twice higher in the warfarin group ($13,394.20 vs $7,430.72). Equivalence of price between the two drugs could be achieved by a 39% reduction in the price of DOACs. There were no significant group differences regarding quality of life. Conclusions: Total costs were higher in the group of patients taking DOACs than those taking warfarin. However, a nearly 40% reduction in the price of DOACs could make it feasible to incorporate these drugs into the Brazilian public health system.

ObjectiveTo describe the willingness to pay (WTP) of infertile couples for in vitro fertilization (IVF) treatment.MethodThis was a prospective study with an anonymous questionnaire for infertile couples in an academic setting. Clinical characteristics were analyzed by a Student's t test or Mann-Whitney test, categorical variables were compared by a chi-square or Fisher exact test, and correlations were assessed using a Spearman's test. An alpha of 5% was adopted.ResultsMean female and male ages were 31.5 and 35.9 years, respectively; 80.2% were married; 19.8% were in consensual union; 48.1% of women had college degrees; and 49.4% of men had a high school education. Most women (77.8%) and men (75.3%) were white, with a household income of class C. Average duration of union was 8.5 years, and average infertility was 4.7 years. Using a willingness-to-pay (WTP) evaluation and the technique of "direct questioning," the average value was determined to be R$18 720.18 (by payment scale R$22 831.17). WTP positively correlated with household income and each woman's education level. Previous parenthood or use of public health system negatively correlated with WTP.ConclusionWe conclude that the higher the couple's monthly income and the woman's educational level, the higher the WTP for an IVF treatment; previous parenthood determined a lower WTP for an IVF treatment, and previous use of the Brazilian Unified Health System, determined a lower WTP for an IVF treatment.

Background Real-world evidence (RWE) is increasingly used to inform health technology assessments for resource allocation, which are valuable tools for emerging economies such as in America. Nevertheless, the characteristics and uses in South America are unknown. Objectives To identify sources, characteristics, and uses of RWE in Argentina, Brazil, Colombia, and Chile, and evaluate the context-specific challenges. The implications for future regulation and responsible management of RWE in the region are also considered. Methods A systematic literature review, database mapping, and targeted gray literature search were conducted to identify the sources and characteristics of RWE. Findings were validated by key opinion leaders attending workshops in 4 South American countries. Results A database mapping exercise revealed 407 unique databases. Geographic scope, database type, population, and outcomes captured were reported. Characteristics of national health information systems show efforts to collect interoperable data from service providers, insurers, and government agencies, but that initiatives are hampered by fragmentation, lack of stewardship, and resources. In South America, RWE is mainly used for pharmacovigilance and as pure academic research, but less so for health technology assessment decision making or pricing negotiations and not at all to inform early access schemes. Conclusions The quality of real-world data in the case study countries vary and RWE is not consistently used in healthcare decision making. Authors recommend that future studies monitor the impact of digitalization and the potential effects of access to RWE on the quality of patient care.

OBJECTIVES:To investigate the internal consistency of the SF-6D as a health status index in the Brazilian urban population.STUDY DESIGN:Cross-sectional population based study.METHODS:Five thousand individuals, older than the age of 15, were assessed in the five regions of the country. Two different methods of scoring the SF-6D where compared: "weighting the items" of the questionnaire through the Brazilian official weight coefficients, and "unweighting the items" through a parallel non preference scoring rule solely based on patients' answers to SF-6D health classification system (SF-6DHSI). Principal component factor analysis was used for the development of the SF-6DHSI. Pearson's, Spearman's, and intraclass correlation coefficients were used to assess the psychometric properties.RESULTS:The SF-6DHSI scoring formula summarized the pattern of factor loadings and the item-internal consistency (Cronbach's α = 0.858). The scale showed good item-internal consistency, exceeding the 0.70 standard. The association between weighted and unweighted (SF-6DHSI) scores was extremely high (Spearman's ρ = 0.971). The correlations of the SF-6DHSI with the Physical Component of the 12-Item Short-Form Health Survey (SF-12) and the Health Assessment Questionnaire was moderate to strong. The intraclass correlation coefficient obtained (0.917) also suggested that the concordance between the weighted and unweighted score distributions was prominent.CONCLUSIONS:A nonweighted approach to score the SF-6D provides a reliable global measure of health status. The SF-6D health classification system is useful for assessing quality of life in a large and representative sample of the Brazilian population.

OBJECTIVE:To analyze the value judgments behind cost-benefit tradeoffs made by health stakeholders in deciding whether or not to incorporate new health technologies and how they should be financed and allocated in limited-resource settings in Brazil.METHOD:From June 2009 to January 2010, a sample of stakeholders in the public and private health sector was identified and invited to complete an online survey consisting of two questionnaires: one collecting socio-demographic/professional information and one capturing resource allocation preferences in four hypothetical scenarios for the incorporation of new health technologies.RESULTS:A total of 193 respondents completed the survey; more than half were male (53.9%) and the most common age group was 31-40 years (36.8%). Scenario 1 (incorporation of a new drug treatment for chronic disease, by reducing/eliminating resources for existing programs) was rejected by 49.2% of the survey sample, who preferred to maintain the status quo for existing programs. Scenario 2 (incorporation of the same new treatment, but financed by a new tax) was rejected by 58.0%. Scenario 3 (incorporation of a new treatment for a highly lethal disease, by age group-20-75 years versus 75+ years-by reducing/eliminating resources for existing programs), was rejected by 42.0%, while 20.7% supported allocations for both groups, 34.2% supported allocations exclusively for the 20-75-year age group, and 3.1% supported allocations exclusively for the 75+ year age group. For Scenario 4, which consisted of five different resource allocations for prevention and treatment programs for another highly lethal disease, the most preferred option (chosen by 50.8% of respondents) was 75%:25% (prevention versus treatment).CONCLUSIONS:When incorporating a new health technology requires reducing/eliminating other health programs, financing it through a tax, or having to choose certain age groups (e.g., younger, working people versus older people), respondents are likely to reject it. When offered the choice of limiting the scope of the program (e.g., prevention versus treatment), respondents are likely to favor prevention. This was the first study in Brazil to capture value judgments that affect stakeholder decision-making on various resource allocations for different scenarios for health technology introduction in limited-resource settings. Future research should investigate the perspective of society as a whole to determine the best approach for decision-making based on common values and consensus within a particular health care system.

Objective: This study describes the summary scores of the Short Form-12 (SF-12) questionnaire, according to socio-demographic factors obtained in a probabilistic and representative sample of the Brazilian urban population. Method: Five thousand (5,000) individuals, over the age of 15, were assessed in 16 capital cities, in the five regions of the country. The selection of households was random. Face-to-face approach was applied in the household interviews. The SF-12 questionnaire was used to assess quality of life. Demographic and socioeconomic characteristics were also evaluated: gender, age, marital status, skin color, region of the country and use of the public health service. Results: The mean value (SD) of the SF-12 for the entire population was 49.3 (8.7) for the physical component (PCS-12) and 52.7 (9.7) for the mental component (MCS-12). Statistical differences were found for gender (PCS-12 and MCS-12), age (PCS-12) and working status (PCS-12 and MCS-12). Women, elderly, widowed and unemployed individuals, those with lower income and with complaints in the last seven days showed lower mean values (PCS-12 and MCS-12). Conclusion: From this point forward, we can provide the basis for comparisons with future research that use the SF-12 for quality of life assessment in Brazil. The Brazilian population has a lower degree of quality of life related do the physical component, and the SF-12 is a useful and discriminative instrument for assessing quality of life in different socio-demographic groups.

Objectives. To describe, analyze, and compare the opinions of decision makers involved in the health technology assessment (HTA) process in Brazil in 2011.Methods. A cross-sectional study was conducted using a structured questionnaire to evaluate the opinions of a convenience sample of health care professionals from both the public and private health care systems (HCS). The survey collected demographic data for each respondent along with their input on national regulations. Data analysis included descriptive statistics, including chi-square tests to compare groups.Results. Of the 200 completed questionnaires, 65% of the respondents were 31-50 years of age; 36% were HCS managers, 49.3% from the public and 50.7% from the private system. The majority of respondents (85%) considered the time permitted for submission of new technology to be inadequate; 88% also stated that the composition of the evaluation committee needed improvement. Respondents from the private health system more frequently stated that submission times were inappropriate (P = 0.019) and that the deadline for a decision by the committee should be defined (P = 0.021), with a maximum of no more than 180 days / 6 months (P < 0.001).Conclusions. Respondents indicated that the HTA process should be improved to meet their expectations. Given that new legislation has been enacted to continuously accept submissions, to make decisions within 180 days, and to expand the committee to represent more stakeholders, most of the respondents concerns have been addressed. This study is valuable as an historical analysis of HTA process improvement. Further surveys are needed to track the new HTA process, its application, and its contribution to health care needs in Brazil.

BACKGROUND Schizophrenia is a debilitating disorder that often requires the affected individual to receive care from a caregiver. Willingness to Pay (WTP) technique allows a valuation of the health state preferences by assessing the impact of the disease and translating it into monetary terms. AIMS OF THE STUDY The objective was to determine the WTP of schizophrenic patients' caregivers on a hypothetical recovery scenario and correlate it to socio-demographic and clinical characteristics, Knowledge of Disease, Quality of life and Burden of Disease. METHODS A convenience sample consecutively assessed 189 outpatients' caregivers from Schizophrenia Program of Federal University of Sao Paulo. A single caregiver was considered for each patient, taking into consideration their close relationship and their direct involvement in the treatment. Open WTP questionnaire for a hypothetical schizophrenia recovery scenario, KAST (Knowledge of Disease), SF-6D (Quality of life) and ZBI-22 (Burden of Disease) scales were applied. RESULTS A monthly WTP mean value (SD) of US\USD 63.63 (111.88) was found. The average value (SD) found was 12.96 (2.45) on KAST, 0.78 (0.08) on SF6D and 29.91 (16.10) on ZARIT. Income, education, social class, knowledge of disease and burden of caregiver were positively correlated to the WTP value. By linear regression model, income and education remained significant. CONCLUSION Willingness to Pay (WTP) is a method that can be used to determine the strength of preference of patients and caregivers for a recovery in schizophrenia. The higher the income and education, the higher the willingness to pay. No clinical characteristics of patients had a statistically significant relation to the value the caregiver would pay. IMPLICATIONS FOR HEALTH POLICIES WTP is a potentially useful tool to determine values and health care preferences, and can be used for the development of mental health policies. IMPLICATIONS FOR FURTHER RESEARCH Future research should be used to enhance WTP tool in mental health studies on the impact of diseases, including schizophrenia.

One more year has elapsed since our last issue of VIHRI focused on Latin America (LA). It has been a very active year in our field in LA. Though in even years there is no regional ISPOR meeting, and we wait for the one to be held in Brazil in 2017, there has been considerable activity in Pharmacoeconomics, Outcomes Research, Health Technology Assessment, Comparative Effectiveness, Patient Centered Outcomes Research and other overlapping descriptors our broad field adopts. We will briefly review some LA highlights in our field, and then go over some specific aspects on VIHRI in general, and on this LA issue in particular. At the macro and international policy level, Universal Health Coverage is gaining momentum in our region, with many international collaborations very active in LA. Another hot topic is the creation and implementation of mechanisms to gain access to high cost drugs (The Fondo Nacional de Recursos of Uruguay is the classic example in LA; and the Ricarte Soto Law in Chile, which was recently updated [[1]María Catalina Batarce. Conoce las tres patologías que se incluirán a la Ley Ricarte Soto. Available from: http://www.latercera.com/noticia/conoce-las-tres-patologias-se-incluiran-la-ley-ricarte-soto/ [Accessed October 3 2016]Google Scholar], a more recent one). Some key players in the regions working closely with governments are REDETSA (the Latin American HTA network with 25 members from 14 countries in the region) which has recently held its annual meeting for the first time in El Salvador; the Criteria Network (an Inter-American Development Bank [IADB] initiative that supports and disseminates evidence to strengthen health spending policies and benefit plans in LA countries); the DIME platform [[2]DIME. Available from: http://www.omaif.org [Accessed October 3 2016]Google Scholar] (a regional initiative, "Informed decisions about high cost drugs", also funded by the IADB and now in its second phase including 5 additional countries that contribute to the observatory of high cost drugs, OMAIF). Additionally, in April 2016, the first Health Technology Assessment International (HTAi) policy forum was held, with the participation of government, representatives of 10 LA countries, and 17 representatives from the Pharmaceutical and Device industries). It has also been an active year for many of our regional LA chapters. Some examples include 1) several activities undertaken by the Argentinean ISPOR chapter related to real world evidence or health technology assessment (HTA) and devices; 2) Conferences organized by the Peru ISPOR chapter on HTA and economic evaluations; 3) The IV ISPOR Colombia meeting with more than 200 attendees and more than 20 research studies presented; and 4) The II Central America and the Caribbean ISPOR Chapter meeting on HTA and Economic Evaluations. We are proud of VIHRI history in these initial years. Since our beginnings in 2012, we have published the work of authors from around the world, including the United States, Brazil, Mexico, Thailand, Columbia, Argentina, Malaysia, Australia, Japan, South Korea, China, United Kingdom, Chile, Taiwan, Singapore, Israel, Hungary, India, Canada and Russia. These authors have contributed over 250 articles that enrich our understanding of pharmacoeconomics and outcomes research and better inform the scientific community. In 2015, Value in Health Regional Issues published content received over 50,000 page views and downloads on Elsevier's electronic platforms. VIHRI readers from the United States, China, United Kingdom, Colombia and Thailand represent the Top 5 countries accessing articles. Due to the growth as a Journal, we have made applications to be indexed by the National Library of Medicine on PubMed and Medline, and to be recognized by Thomson Reuter's Journal Citation Report. As soon as those decisions are made known to us, we will keep you rightly informed. Regarding VIHRI, this is the 11th Volume (and the 5th yearly issue devoted to Latin America). Though with some delay, we are still in the queue for National Library of Medicine PubMed/Medline listing, and hope to be reviewed and indexed in the near future. We think this milestone will bring a new stage regarding the relevance and impact of our Journal. This was the first year the Value in Health Regional Issues Award for Excellent Article was awarded in our region, to a paper from Viegas et al. reporting the social values from EQ-5D in a Brazilian Southern State. The papers of this issue provide a flavor of the depth and width that the field is attaining in LA. There are four studies from researchers in Colombia, three from Argentina, and one each from Brazil, Chile, Mexico and Trinidad & Tobago. Several of the papers deal with infectious or vaccine-preventable diseases [3Vargas Parada C. Lenner Veerman J. Cost-Effectiveness study of HPV vaccination as a primary prevention strategy for Anal Cancer in HIV positive Men in Chile.Value in Health Regional. 2016; 11: 17-23Abstract Full Text Full Text PDF Scopus (2) Google Scholar, 4Keaei M. Kuhlmann J. Conde R. et al.Health Related Quality of Life of Patients with HIV/AIDS in Bogotá, Colombia.Value in Health Regional. 2016; 11: 68-72Abstract Full Text Full Text PDF Scopus (13) Google Scholar, 5Gómez J.A. Villaseñor-Sierra A. Martínez Aguilar A. et al.Estimación de la relación costo-efectividad de las vacunas neumocócicas conjugadas Prevenar-13 y Synflorix®, utilizadas en los programas de vacunación de población infantil Mexicana.Value in Health Regional. 2016; 11 (76–84)Abstract Full Text Full Text PDF Scopus (5) Google Scholar, 6Ciapponi A. Lee A. Bardach A. Glujovsky D. Rey-Ares L. et al.Interchangeability between Pneumococcal Conjugate Vaccines: a systematic review and meta-analysis.Value in Health Regional. 2016; 11: 24-34Abstract Full Text Full Text PDF Scopus (6) Google Scholar]. Others deal with rare disease (the case of type II mucopolysacharidosis in Colombia), or with diagnostic imaging technologies [[7]Aparecido Nunes A. Barbosa Coelho E. Pereira de Souza J. et al.Análise de Custo-Efetividade do uso do Sistema de Comunicação e Arquivamento de Imagens (PACS) em mamografias digitais.Value in Health Regional. 2016; 11: 49-56Abstract Full Text Full Text PDF Scopus (2) Google Scholar] (PACS in Brazil). Economic evaluations constitute the bulk of the issue [3Vargas Parada C. Lenner Veerman J. Cost-Effectiveness study of HPV vaccination as a primary prevention strategy for Anal Cancer in HIV positive Men in Chile.Value in Health Regional. 2016; 11: 17-23Abstract Full Text Full Text PDF Scopus (2) Google Scholar, 4Keaei M. Kuhlmann J. Conde R. et al.Health Related Quality of Life of Patients with HIV/AIDS in Bogotá, Colombia.Value in Health Regional. 2016; 11: 68-72Abstract Full Text Full Text PDF Scopus (13) Google Scholar, 5Gómez J.A. Villaseñor-Sierra A. Martínez Aguilar A. et al.Estimación de la relación costo-efectividad de las vacunas neumocócicas conjugadas Prevenar-13 y Synflorix®, utilizadas en los programas de vacunación de población infantil Mexicana.Value in Health Regional. 2016; 11 (76–84)Abstract Full Text Full Text PDF Scopus (5) Google Scholar, 7Aparecido Nunes A. Barbosa Coelho E. Pereira de Souza J. et al.Análise de Custo-Efetividade do uso do Sistema de Comunicação e Arquivamento de Imagens (PACS) em mamografias digitais.Value in Health Regional. 2016; 11: 49-56Abstract Full Text Full Text PDF Scopus (2) Google Scholar, 8Salvador Parisi C.A. Ritchie C. Petriz N. et al.Medical Direct Costs of Chronic Urticaria in a Private Health Organization of Buenos Aires, Argentina.Value in Health Regional. 2016; 11: 57-59Abstract Full Text Full Text PDF Scopus (8) Google Scholar, 9Casadiego Rincón E.J. Díaz Rojas J.A. Bermúdez C.D. et al.Costo-Efectividad del Uso Profiláctico del Factor Estimulante de Colonias de Granulocitos en Adultos con Leucemia Linfoblástica Aguda en Colombia.Value in Health Regional. 2016; 11: 9-16Abstract Full Text Full Text PDF Scopus (1) Google Scholar, 10Parody E. Guevara C.A. Aguirre Hoyos A. et al.Cost-effectiveness of the quantification of enzymatic activity in leukocytes in comparison to its non-realization for a rare disease in Latin-America: the case of mucopolysaccharidosis type II in Colombia.Value in Health Regional. 2016; 11: 42-48Abstract Full Text Full Text PDF Scopus (2) Google Scholar], but there is also a study evaluating novel methods to derive social preferences in Trinidad & Tobago [[11]Bailey H, Stolk E, Kind P, Towards explicit prioritization for the Caribbean: An EQ-5D value set for Trinidad and Tobago. Value in Health Regional 11:60–7Google Scholar], a descriptive study depicting health-related quality of life in HIV patients [[4]Keaei M. Kuhlmann J. Conde R. et al.Health Related Quality of Life of Patients with HIV/AIDS in Bogotá, Colombia.Value in Health Regional. 2016; 11: 68-72Abstract Full Text Full Text PDF Scopus (13) Google Scholar], and a study evaluating the productivity and microeconomic impact of cardiovascular patients in Argentina [[12]Calcagno J.I. Iribarren S.J. Caporale J.E. et al.Cardiovascular Disease and Healthcare System Impact on Functionality and Productivity in Argentina: A Secondary Analysis.Value in Health Regional. 2016; 11: 35-41Abstract Full Text Full Text PDF Scopus (1) Google Scholar]. We hope that you enjoy this issue and come to know a bit of the lively and increasingly rigorous activity of our field in Latin America. Hopefully, we will continue to advance, each time further, in the use of sound principles for societal decision making and towards the best possible Universal Health Coverage in each and every one of the countries in Latin America. To Maria Cook, VIHRI regional manager, Terry Materese from Elsevier; Steve Priori, the ISPOR senior staff for its publications; and Felicia Davis Alvin, from ISPOR Latin America Development.

The objective of this study was to assess the perceptions of opinion-leaders, patients and their accompanying family members or carers about generic drugs. Three groups of participants were surveyed: (i) 50 customers while they were visiting commercial pharmacies located in São Paulo city, Brazil, (ii) 25 patients and 25 companions while they were waiting at the university outpatient clinic, and (iii) 50 healthcare opinion-leaders from government, hospitals, health plans, academia, and pharmaceutical companies. The questions explored socio-demographic characteristics and perceptions regarding value attributes of generic drugs compared to brand name drugs. Respondents had an average age of 52 years and 53% were women. Respondents believed generic drugs to be cheaper than brand name drugs (97%), and 31% thought generic drugs to be less effective than brand name drugs. Also, generic drugs were perceived by 54% of respondents to be as safe as brand name drugs and 74% would prefer brand name drugs if there was no price difference. In conclusion, multiple factors may contribute to the decision to buy generic drugs; among these, perceived effectiveness, safety and price appear to be the most important factors.

The objective of this study is to describe the prevalence of musculoskeletal symptoms (MSK-S) in the five urban geographical regions of Brazil using the Portuguese version of the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) core questionnaire (CQ)—BRAZCO study. From April to May 2013, a population-based survey was conducted by applying the CQ for 5000 individuals aged over 15 years in 16 capitals of the Brazilian regions. Trained teams assessed the MSK-S and socioeconomic status. The sample consisted of representative quotas of the Brazilian population, proportional to the capitals’ population density. It respected the groups’ quotas of gender and age and included all socioeconomic classes, educational levels, and occupations. There were 1342 (26.9 %) participants who presented MSK-S unrelated to trauma in 7 days preceding the interview. A higher prevalence of these complaints were in females (65.2 %), elderly people, in the north region of the country (30.7 %), and a lower prevalence was found in single individuals (41.7 %) and in the south (23.3 %). The most frequent pain sites were the spine (76.7 %) and knees (49.6 %), and the mean pain intensity was 6.8 (VAS). The BRAZCO study shows that Brazilian population presents a higher rate of MSK-S unrelated to trauma than many Asian countries. These results can be applied to guide the assessment of prevalence of rheumatic diseases. Additionally, it can help in the design of policies for health care workforce organization and its accessibility, as well as to reduce the risk of rheumatic diseases at the community level.

This study appraised the health professionals and managers’ value judgments in Brazilian HTA process, through a new method of research that addresses clinical scenarios to simulate real world dilemmas and support budget allocation. The decisions should be made under clinical and epidemiological aspects, and, also, economic, social, ethical and cultural factors. The main objective was to evaluate how these factors have influenced the decision makers in HTA resources allocation. We agreed to call this model by Decision Making Clinical Scenarios (DMCS). This study was conducted through a decision making questionnaire with four clinical scenarios involving HTA. These scenarios introduced issues involving value judgments, preferences and structuring choices, considering a severe budget restraint. The presented trade-offs were related to health policies, such as budget impact, sources of funding, eligible patients, technology characteristics and disease epidemiology. The results showed a conservative trend. In all three scenarios involving some form of technological incorporation, the most chosen option was to avoid incorporation. Alternatives of funding, as reduction/extinction of current healthcare programs and creation of a new tax, were not accepted as solutions. In budget allocation between prevention and treatment programs, respondents were suited to a preventive long-term strategy. The scenarios have been shown understandable. The absolute scarcity of resources clearly influenced the results. In search of a paradigm for decision making, most of respondents prioritized to save resources, instead of incorporating the technologies. We concluded that managers are not guided only by clinical benefit of a decision. They valorized the importance of funding mechanisms and budget control that enable incorporation, considering economic, social, ethical, and structural aspects. This study model seems to be useful to evaluate the trends of conduct of decision makers. This model can be used in further researches, bringing different factors and criteria into discussion, through clinical real world situations.

Background: Generic drugs (GDs) offer a way to reduce health spending without sacrificing quality. Despite this, there are doubts as to their acceptance by the population. This work aims to assess perceptions of GDs among the Brazilian population.Methods: We conducted a national household survey face-to-face between April and May 2013, with 5000 individuals aged over 15 years. The questions explored socioeconomic and demographic characteristics, the use of GDs, and perceptions about GDs as compared to brand drugs (BDs). The chi-square test was used to examine the associations between the perceptions and the characteristics of the population.Results: Of the 5000 participants, 51.3% were women, 40.2% were white, 48.6% were between 15 and 34 years of age, and 52.3% had income of less than two minimum wages (US$627.78). In terms of the use of GDs, 44.6% of the participants were taking or had taken GDs in the past three months, with the highest figures among the elderly (61.1%) and female (49.2%) populations. Regarding perceptions, 30.4% of the respondents considered GDs less effective than BDs; provided the same price, 59% would prefer BD, and 45.8% agreed that physicians prefer to prescribe GDs. The most negative perceptions about GDs were observed among lower income, elderly and nonwhite populations.Conclusion: The findings provide a better understanding of Brazilians' perceptions regarding GDs. This should be considered when formulating healthcare policies aiming at improving access to effective and quality drugs, and reduction of health costs.