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Background and Objective: Managed entry agreements (MEAs) consist of a set of instruments to reduce the uncertainty and the budget impact of new high-priced medicines; however, there are concerns. There is a need to critically appraise MEAs with their planned introduction in Brazil. Accordingly, the objective of this article is to identify and appraise key attributes and concerns with MEAs among payers and their advisers, with the findings providing critical considerations for Brazil and other high- and middle-income countries. Methods: An integrative review approach was adopted. This involved a review of MEAs across countries. The review question was 'What are the health technology MEAs that have been applied around the world?' This review was supplemented with studies not retrieved in the search known to the senior-level co-authors including key South American markets. It also involved senior-level decision makers and advisers providing guidance on the potential advantages and disadvantages of MEAs and ways forward. Results: Twenty-five studies were included in the review. Most MEAs included medicines (96.8%), focused on financial arrangements (43%) and included mostly antineoplastic medicines. Most countries kept key information confidential including discounts or had not published such data. Few details were found in the literature regarding South America. Our findings and inputs resulted in both advantages including reimbursement and disadvantages including concerns with data collection for outcome-based schemes. Conclusions: We are likely to see a growth in MEAs with the continual launch of new high-priced and often complex treatments, coupled with increasing demands on resources. Whilst outcome-based MEAs could be an important tool to improve access to new innovative medicines, there are critical issues to address. Comparing knowledge, experiences, and practices across countries is crucial to guide high- and middle-income countries when designing their future MEAs. [ABSTRACT FROM AUTHOR]

• The Technology Readiness Levels (TRL) approach is employed for estimating the maturity of CCS System. • A Technology Readiness Assessment (TRA) for a new Carbon Capture and Storage (CCS) concept using offshore salt caverns. • A concept system that allows the monetization of the separated natural gas. • A salt cavern for the storage of 1 billion Sm3 (Standard cubic meter) of a natural gas stream with high CO 2 content. This article presents a Technology Readiness Assessment (TRA) of a new concept called the Salt Cavern Hybrid Subsea Carbon Capture and Storage (CCS) System, which performs all the offshore natural gas and CO 2 separation process with subsequent storage in offshore underground salt caverns. Currently there is a demand for CCS of large quantities of CO 2 associated with CH 4 in the pre-salt offshore oil fields in Brazil. The pre-salt reservoirs have as caprock 2000 m of continuous rock salt. This hybrid system is expected to perform, at the same time, the separation between the natural gas and CO 2 , and Carbon Capture and Storage of CO 2 , allowing the monetization of the separated natural gas. The Technology Readiness Levels (TRL) approach is discussed in this paper for estimating the maturity of the CCS System. The TRL analysis concluded that no technological gaps were identified that would made the project unfeasible and the TRL level enables the project to advance to the field test stage within a reasonably short time horizon. Once implemented it could be one of the largest CCS projects in the world. Also, this paper describes the conceptual design of this hybrid system and presents the results of a TRA showing the methodology that was employed in the process, the technology critical items that were analyzed and the results obtained for each of them and the design of a salt cavern for the storage of 1 billion Sm3 (Standard cubic meter) of a natural gas stream with high CO 2 content. [ABSTRACT FROM AUTHOR]

This article describes a new concept to reduce carbon dioxide emissions of offshore oil production of high gas-to-oil ratio reservoirs and high content of CO2, denominated Offshore Salt Cavern Ultra-deep Water CCS (Carbon Capture and Storage) System. This hybrid system is intended for natural gas storage, the gravitational separation between CO 2 /CH 4 , and CO 2 confinement for final destination. This development emerged from a current demand of some Brazilian pre-salt reservoirs to destinate a gas stream with high CO 2 contamination, produced during the oil extraction. These reservoirs have a continuous salt rock layer of 2000 m as caprock making the construction possible of salt caverns by leaching using seawater. In the first stage of technology development, the system will only store a gas stream contaminated with a high concentration of CO 2. In the second stage of its development, it will allow not only the separation of natural gas from the CO 2 but also its storage and the monetization of CH 4. This paper presents the conceptual design of this technology, showing the steps from the parametric study to select the best relation between flowrate, leaching time, structural stability, and the volume of gas with the high content of CO 2 storage, up to the final geomechanical design using the set of parameters selected. [ABSTRACT FROM AUTHOR]

The article discusses a study which examines the link between brain-derived neurotrophic factor (BDNF) Val66Met polymorphism and obsessive compulsive disorder (OCD). For the study, researchers analyzed 127 Caucasian patients suffering from OCD born in Brazil and 127 matched controlled subjects. They did not observe a difference in the BDNF genotype distribution between OCD patients and controlled subjects. They found that the BDNF Met allele may potentially influence OCD patients.

To describe the Brazilian experience of holding an international workshop to inform the development of a national guideline for the implementation of managed entry agreements (MEA) for health technologies (HT) in National Health System (NHS). Workshop participants were then invited to discuss a hypothetical case of a high-cost HT assessment for a rare disease in groups and to identify key considerations needed to enable MEA implementation in Brazil. [Extracted from the article]