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Carlos Alberto da Silva Magliano,1 Andrea Libório Monteiro,2 Amanda Rebeca de Oliveira Rebelo,1 Claudia Cristina de Aguiar Pereira31Instituto Nacional de Cardiologia, INC, Rio de Janeiro, Brazil; 2Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Illinois, USA; 3Escola Nacional de Saúde Pública, ENSP, FIOCRUZ, Rio de Janeiro, BrazilAims: Guidelines current recommendations regarding the best treatment option for coronary revascularization are usually based on composite outcomes that were not selected or weighed with patients thence they may fail in representing patients’ preferences adequately. This systematic review aimed to appraise existing literature surrounding stated preference (SP) regarding coronary revascularization.Methods and results: Studies related to SP regarding coronary revascularization were searched on Medline, Embase and Lilacs databases. Two reviewers screened all titles independently, and consensus resolved any disagreements. Of 735 total citations, six studies were included and qualitatively synthesized. Notably, the attributes most often cited in these studies coincided with those already used in clinical trials (death, myocardial infarction, stroke and redo revascularization). Half of the studies analyzed the use of composite endpoints and showed the necessity to review this practice since the attributes are weighed differently, and there is a disagreement between patients and physicians. Also, a large variety of methods were used to elicitate and value the attributes such as rating, ranking, standard gamble, willingness to pay, and discrete choice experiments.Conclusion: Despite a large number of studies comparing revascularization treatment efficacy, there are just a few focusing on patients’ preferences. The selection of outcomes to be considered in the trade-off between treatment options and how to weigh them properly, taking into consideration patients’ preferences, need to be explored in future trials.Keywords: review, systematic, preference, patient, angioplasty, transluminal, percutaneous coronary, bypass surgery, coronary revascularization

Carlos Alberto da Silva Magliano,1 Andrea Liborio Monteiro,2 Bernardo Rangel Tura,1 Claudia Silvia Rocha Oliveira,1 Amanda Rebeca de Oliveira Rebelo,1 Claudia Cristina de Aguiar Pereira3 1NATS, Instituto Nacional de Cardiologia, INC, Rio de Janeiro, Rio de Janeiro, Brazil; 2Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA; 3Escola Nacional de Saúde Pública, ENSP, FIOCRUZ, Rio de Janeiro, Brazil Purpose: Communicating information about risk and probability to patients is considered a difficult task. In this study, we aim to evaluate the use of visual aids representing perioperative mortality and long-term survival in the communication process for patients diagnosed with coronary artery disease at the National Institute of Cardiology, a Brazilian public hospital specializing in cardiology. Patients and methods: One-on-one interviews were conducted between August 1 and November 20, 2017. Patients were asked to imagine that their doctor was seeking their input in the decision regarding which treatment represented the best option for them. Patients were required to choose between alternatives by considering only the different benefits and risks shown in each scenario, described as the proportion of patients who had died during the perioperative period and within 5 years. Each participant evaluated the same eight scenarios. We evaluated their answers in a qualitative and quantitative analysis. Results: The main findings were that all patients verbally expressed concern about perioperative mortality and that 25% did not express concern about long-term mortality. Twelve percent considered the probabilities irrelevant on the grounds that their prognosis would depend on “God’s will.” Ten percent of the patients disregarded the reported likelihood of perioperative mortality, deciding to focus solely on the “chance of being cured.” In the quantitative analysis, the vast majority of respondents chose the “correct” alternatives, meaning that they made consistent and rational choices. Conclusion: The use of visual aids to present risk attributes appeared feasible in our sample. The impact of heuristics and religious beliefs on shared health decision making needs to be explored better in future studies. Keywords: patients’ preferences, coronary revascularization, angina, cardiology, coronary artery bypass grafting, percutaneous coronary intervention

Carlos Alberto da Silva Magliano,1 Andrea Liborio Monteiro,2 Bernardo Rangel Tura,1 Claudia Silvia Rocha Oliveira,1 Amanda Rebeca de Oliveira Rebelo,1 Claudia Cristina de Aguiar Pereira3 1HTA Department, National Institute of Cardiology, Rio de Janeiro, Brazil; 2Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA; 3The National School of Public Health Sergio Arouca ENSP/Fiocruz, Rio de Janeiro, Brazil Background: Patients with a diagnosis of coronary artery disease (CAD) may face important decisions regarding treatment options, with the “right choice” depending on the relative weights of risks and benefits. Studies performed as discrete choice experiments are used to estimate these weights, and attribute selection is an essential step in the design of these studies. Attributes not included in the design cannot be analyzed. In this study, we aimed to elicit, rank, and rate attributes that may be considered important to patients and physicians who must choose between angioplasty and surgery for coronary revascularization. Methods: The elicitation process involved performing a systematic review to search for attributes cited in declared preference studies in addition to face-to-face interviews with cardiologists and experts. The interviews were audio-recorded in digital format, and the collected data were transcribed and searched to identify new attributes. The criterion used to finish the data collection process was sampling saturation. Results: A systematic review resulted in the selection of the following 14 attributes: atrial fibrillation, heart failure, incision scar, length of stay, long-term survival, myocardial infarction, periprocedural death, postoperative infection, postprocedural angina, pseudoaneurysm, renal failure, repeat coronary artery bypass grafting, repeat percutaneous coronary intervention, and stroke. The interviews added no new attributes. After rating, we identified significant differences in the values that patients and cardiologists placed on renal insufficiency (p

Background: Men who have sex with men (MSM) and transgender women (TGW) are disproportionally affected by HIV infection in Latin America. This study aims to assess pre-exposure prophylaxis (PrEP) preferences among sexual and gender minorities (SGM) and identify attributes and levels that are related to PrEP uptake and adherence, both crucial for PrEP success., Methods: We conducted a discrete choice experiment (DCE) among SGM from all Brazilian regions (September-December/2020). The survey was administered face-to-face (five Brazilian capitals) and online (entire country). We used a D-efficient zero-prior blocked experimental design to select 60 paired-profile DCE choice tasks., Findings: The total sample size was 3924 (90.5% MSM; 7.2% TGW and 2.3% non-binary or gender diverse persons). In random-effects logit models, highest levels of protection and "no side effects" were the most important attribute levels. For "presentation", injectable and implant were preferred over oral. Participants were willing to accept a 4.1% protection reduction to receive injectable PrEP or a 4.2% reduction if PrEP were taken monthly. The largest class in the latent class models was defined predominantly by the preference for the highest HIV protection level (p < 0.005). Respondents in this class also preferred no side effects, injectable and implant presentations., Interpretation: Higher HIV protection, no side effects, and presentation, whether injectable or implant, were the most important attributes in PrEP preferences. Protection against HIV was the most important attribute. PrEP programs should make available technologies such as long-acting presentations that could reunite the most desired attributes, thus maximizing acceptability and user-appropriateness., Funding: Unitaid., Competing Interests: The authors have no conflicts of interest to report., (© 2023 The Authors.)

Objective: The article seeks to assess the Brazilian health system ability to respond to the challenges imposed by the coronavirus disease 2019 (COVID-19) pandemic by measuring the capacity of Brazilian hospitals to care for COVID-19 cases in the 450 Health Regions of the country during the year 2020. Hospital capacity refers to the availability of hospital beds, equipment, and human resources., Methods: We used longitudinal data from the National Register of Health Facilities (CNES) regarding the availability of resources necessary to care for patients with COVID-19 in inpatient facilities (public or private) from January to December 2020. Among the assessed resources are health professionals (certified nursing assistants, nurses, physical therapists, and doctors), hospital beds (clinical, intermediate care, and intensive care units), and medical equipment (computed tomography scanners, defibrillators, electrocardiograph monitors, ventilators, and resuscitators). In addition to conducting a descriptive analysis of absolute and relative data (per 10,000 users), a synthetic indicator named Installed Capacity Index (ICI) was calculated using the multivariate principal component analysis technique to assess hospital capacity. The indicator was further stratified into value ranges to understand its evolution., Results: There was an increase in all selected indicators between January and December 2020. It was possible to observe differences between the Northeast and North regions and the other regions of the country; most Health Regions presented low ICI. The ICI increased between the beginning and the end of 2020, but this evolution differed among Health Regions. The average increase in the ICI was more evident in the groups that already had considerably high baseline capacity in January 2020., Conclusions: It was possible to identify inequalities in the hospital capacity to care for patients affected by COVID -19 in the Health Regions of Brazil, with a concentration of low index values in the Northeast and North of the country. As the indicator increased throughout the year 2020, inequalities were also observed. The information here provided may be used by health authorities, providers, and managers in planning and adjusting for future COVID-19 care and in dimensioning the adequate supply of hospital beds, health-care professionals, and devices in Health Regions to reduce associated morbidity and mortality. We recommend that the ICI continue to be calculated in the coming months of the pandemic to monitor the capacity in the country's Health Regions.

Objective: To analyze the geographical variation in the provision of health services, namely in demand, patterns of utilization, and effectiveness in the Brazilian Health Regions in four different periods of the COVID-19 pandemic, from February 2020 to March 2021., Methods: Descriptive serial cross-sectional study based on secondary data on COVID-19 hospitalizations from SIVEP-Gripe, a public and open-access database of Severe Acute Respiratory Illness records collected by the Brazilian Ministry of Health, and COVID-19 case notification data from Brasil.io, a repository of public data. Fifty-six epidemiological weeks were split into four periods. The following variables were considered for each Brazilian Health Region, per period: number of hospitalizations, hospitalizations per 100,000 inhabitants, hospitalizations per 100 new cases notified in the Health Region, percentage of hospitalizations with ICU use, percentages of hospitalizations with invasive and non-invasive ventilatory support, percentage of hospitalizations resulting in death and percentage of hospitalizations with ICU use resulting in death. Descriptive statistics of the variables were obtained across all 450 Health Regions in Brazil over the four defined pandemic periods. Maps were generated to capture the spatiotemporal variation and trends during the first year of the COVID-19 pandemic in Brazil., Results: There was great variation in how COVID-19 hospitalizations grew and spread among Health Regions, with higher numbers between June and August 2020, and, especially, from mid-December 2020 to March 2021. The variation pattern in the proportion of ICU use in the hospitalizations across the Health Regions was broad, with no intensive care provision in large areas in the North, Northeast, and Midwest. The proportions of hospitalizations and hospitalizations with ICU use resulting in deaths were remarkably high, reaching medians of 34.0% and 62.0% across Health Regions, respectively., Conclusion: The Heath Regions in Brazil are highly diverse, showing broad disparities in the capacity to respond to the demands imposed by COVID-19, services provided, use and outcomes., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Pre-exposure prophylaxis (PrEP) is an important and well-established prevention strategy for sexual acquisition of HIV. In Brazil, transgender women (TGW) and men who have sex with men (MSM) bear the largest burden among key populations. Little is known about preferences for PrEP characteristics in these vulnerable populations in Latin America. The goal of this study is to investigate preferences of TGW and MSM with respect to PrEP characteristics, whether current user or not, and to assess any attributes and levels that may improve the decision to start using PrEP (uptake) and optimal continuity of use (adherence), which are important dimensions for PrEP success., Methods and Analysis: We hereby outline the protocol of a discrete choice experiment (DCE) to be conducted among TGW and MSM in Brazil. The study will be carried out in two phases. The first phase involves literature review and qualitative approaches including in-depth interviews to inform the development of the DCE (attributes and levels). The second phase entails the DCE survey and supporting questions pertaining to sociodemographic and risk behaviour information. The survey is aimed at current PrEP users and non-users, consisting of two modes of administration: face to face in five Brazilian capitals (Rio de Janeiro, Brasília, Manaus, Porto Alegre and Salvador) and online targeting the entire country. A D-efficient zero-prior blocked experimental design will be used to select 60 paired-profile DCE choice tasks, in which participants will be randomly assigned to one of four groups and presented with a set of 15 choice tasks. The planned sample size is 1000 volunteers., Ethics, Timeline and Dissemination: The study was approved by Comitê de Ética em Pesquisa-Instituto Nacional de Infectologia Evandro Chagas-INI/FIOCRUZ, CEP/INI, CAAE 28416220.2.1001.5262, approval number 3.979.759 in accordance with the Comissão Nacional de Ética em Pesquisa (CONEP-Brazilian National Board of Research Ethics). The study will be conducted between 2020 and 2021. The results will be disseminated to the scientific community and to the public in general through publications in published in peer-reviewed journals and in scientific conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Common bean (Phaseolus vulgaris L.) is a legume whose grain can be stored for months, a common practice among Brazilian growers. Over time, seed coats become darker and harder to cook, traits that are undesirable to consumers, who associate darker-colored beans with greater age. Like commercial pinto and cranberry bean varieties, carioca beans that have darker seeds at harvest time and after storage are subject to decreased market values., Results: The goal of our study was to identify the genetic control associated with lightness of seed coat color at harvest (HL) and with tolerance to post-harvest seed coat darkening (PHD) by a genome-wide association study. For that purpose, a carioca diversity panel previously validated for association mapping studies was used with 138 genotypes and 1,516 high-quality SNPs. The panel was evaluated in two environments using a colorimeter and the CIELAB scale. Shelf storage for 30 days had the most expressive results and the L* (luminosity) parameter led to the greatest discrimination of genotypes. Three QTL were identified for HL, two on chromosome Pv04 and one on Pv10. Regarding PHD, results showed that genetic control differs for L* after 30 days and for the ΔL* (final L*-initial L*); only ΔL* was able to properly express the PHD trait. Four phenotypic classes were proposed, and five QTL were identified through six significant SNPs., Conclusions: Lightness of seed coat color at harvest showed an oligogenic inheritance corroborated by moderate broad-sense heritability and high genotypic correlation among the experiments. Only three QTL were significant for this trait - two were mapped on Pv04 and one on Pv10. Considering the ΔL, six QTL were mapped on four different chromosomes for PHD. The same HL QTL at the beginning of Pv10 was also associated with ΔL* and could be used as a tool in marker-assisted selection. Several candidate genes were identified and may be useful to accelerate the genetic breeding process., (© 2021. The Author(s).)

Background: Almost 200,000 deaths from COVID-19 were reported in Brazil in 2020. The case fatality rate of a new infectious disease can vary by different risk factors and over time. We analysed the trends and associated factors of COVID-19 case fatality rates in Brazilian public hospital admissions during the first wave of the pandemic., Methods: A retrospective cohort of all COVID-19-related admissions between epidemiological weeks 10-40 in the Brazilian Public Health System (SUS) was delimited from available reimbursement records. Smoothing time series and survival analyses were conducted to evaluate the trends of hospital case fatality rates (CFR) and the probability of death according to factors such as sex, age, ethnicity, comorbidities, length of stay and ICU use., Results: With 398,063 admissions and 86,452 (21.7%) deaths, the overall age-standardized hospital CFR trend decreased throughout the period, varying from 31.8% (95%CI: 31.2 to 32.5%) in week 10 to 18.2% (95%CI: 17.6 to 18.8%) in week 40. This decreasing trend was observed in all sex, age, ethnic groups, length of stay and ICU admissions. Consistently, later admission (from July to September) was an independent protective factor. Patients 80+ year old had a hazard ratio of 8.18 (95% CI: 7.51 to 8.91). Ethnicity, comorbidities, and ICU need were also associated with the death risk. Although also decreasing, the CFR was always around 40-50% in people who needed an ICU admission., Conclusions: The overall hospital CFR of COVID-19 has decreased in Brazilian public hospitals during the first wave of the pandemic in 2020. Nevertheless, during the entire period, the CFR was still very high, suggesting the need for improving COVID-19 hospital care in Brazil., Competing Interests: The authors have declared that no competing interests exist.

Objective: To study the profile of hospitalizations due to COVID-19 in the Unified Health System (SUS) in Brazil and to identify factors associated with in-hospital mortality related to the disease., Methods: Cross-sectional study, based on secondary data on COVID-19 hospitalizations that occurred in the SUS between late February through June. Patients aged 18 years or older with primary or secondary diagnoses indicative of COVID-19 were included. Bivariate analyses were performed and generalized linear mixed models (GLMM) were estimated with random effects intercept. The modeling followed three steps, including: attributes of the patients; elements of the care process; and characteristics of the hospital and place of hospitalization., Results: 89,405 hospitalizations were observed, of which 24.4% resulted in death. COVID-19 patients hospitalized in the SUS were predominantly male (56.5%) with a mean age of 58.9 years. The length of stay ranged from less than 24 hours to 114 days, with a mean of 6.9 (±6.5) days. Of the total number of hospitalizations, 22.6% reported ICU use. The odds on in-hospital death were 16.8% higher among men than among women and increased with age. Black individuals had a higher likelihood of death. The behavior of the Charlson and Elixhauser indices was consistent with the hypothesis of a higher risk of death among patients with comorbidities, and obesity had an independent effect on increasing this risk. Some states, such as Amazonas and Rio de Janeiro, had a higher risk of in-hospital death from COVID-19. The odds on in-hospital death were 72.1% higher in municipalities with at least 100,000 inhabitants, though being hospitalized in the municipality of residence was a protective factor., Conclusion: There was broad variation in COVID-19 in-hospital mortality in the SUS, associated with demographic and clinical factors, social inequality, and differences in the structure of services and quality of health care., Competing Interests: The authors have declared that no competing interests exist.

Background: Selecting the optimal treatment strategy for coronary revascularization is challenging. A crucial endpoint to be considered when making this choice is the necessity to repeat revascularization since it is much more frequent after percutaneous coronary intervention (PCI) than after coronary artery bypass grafting (CABG)., Objective: This study intends to provide insights on patients' preferences for revascularization, strategies in the perspective of patients who had to repeat revascularization., Methods: We selected a sample of patients who had undergone PCI and were hospitalized to repeat coronary revascularization and elicited their preferences for a new PCI or CABG. Perioperative death, long-term death, myocardial infarction, and repeat revascularization were used to design scenarios describing hypothetical treatments that were labeled as PCI or CABG. PCI was always presented as the option with lower perioperative death risk and a higher necessity to repeat procedure. A conditional logit model was used to analyze patients' choices using R software. A p value < 0.05 was considered statistically significant., Results: A total of 144 patients participated, most of them (73.7%) preferred CABG over PCI (p < 0.001). The regression coefficients were statistically significant for PCI label, PCI long-term death, CABG perioperative death, CABG long-term death and repeat CABG. The PCI label was the most important parameter (p < 0.05)., Conclusion: Most patients who face the necessity to repeat coronary revascularization reject a new PCI, considering realistic levels of risks and benefits. Incorporating patients' preferences into benefit-risk calculation and treatment recommendations could enhance patient-centered care.

The COVID-19 pandemic poses difficulties for long-term care institutions for the elderly, with increased mortality rates for the residents. This study aims to estimate the impact of COVID-19 on mortality of institutionalized elderly in Brazil. Estimates of the percentage of elderly deaths occurring in care homes were calculated for Brazil, States and Regions using estimates for the total number of deaths. The estimation was based upon information available for other countries. The weighted percentage was 44.7% and 107,538 COVID-19 deaths were estimated for the elderly in these institutions in Brazil in 2020. Higher numbers of deaths were expected in the Southeast Region (48,779 deaths), followed by the Northeast Region (28,451 deaths); São Paulo was the most affected State (24,500 deaths). The strong impact of COVID-19 on the elderly population living in long-term care facilities is clear. Estimates for the country exceeded 100,000 elderly people, potentially the most fragile and vulnerable, and are based upon a conservative number of total deaths, in view of other estimates and the alarming situation of death growth in Brazil from COVID-19.

Background & Aims: Roux-en-Y gastric bypass (RYGB) limits food ingestion and may alter the intestinal expression of genes involved in the endogenous synthesis of polyunsaturated fatty acids (PUFAs). These changes may decrease the systemic availability of bioactive PUFAs after RYGB. To study the impact of RYGB on the dietary ingestion and plasma concentration of PUFAs and on the intestinal expression of genes involved in their endogenous biosynthesis in severely obese women with type 2 diabetes., Methods: Before, and 3 and 12 months after RYGB, obese women (n = 20) self-reported a seven-day dietary record, answered a food frequency query and provided plasma samples for alpha-linolenic (ALA), eicosapentaenoic (EPA), docosahexaenoic (DHA) and arachidonic (ARA) acid assessment by gas chromatography. Intestinal biopsies (duodenum, jejunum and ileum) were collected through double-balloon endoscopy before and 3 months after RYGB for gene expression analysis by microarray (Human GeneChip 1.0 ST array) and RT-qPCR validation., Results: Compared to the preoperative period, patients had decreased intakes of PUFAs, fish and soybean oil (p < 0.05) and lower plasma concentrations of ALA and EPA (p < 0.001) 3 and 12 months after RYGB. FADS1 gene expression was lower in duodenum (RT-qPCR fold change = -1.620, p < 0.05) and jejunum (RT-qPCR fold change = -1.549, p < 0.05) 3 months following RYGB, compared to before surgery., Conclusion: RYGB decreased PUFA ingestion, plasma ALA and EPA levels, and intestinal expression of FADS1 gene. The latter encodes a key enzyme involved in endogenous biosynthesis of PUFAs. These data suggest that supplementation of omega-3 PUFAs may be required for obese patients undergoing RYGB. Clinical Trial Registry number and website: www.clinicaltrials.gov - NCT01251016; Plataforma Brasil - 19339913.0.0000.0068., (Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Quality of life has become a key outcome in assessing the effectiveness of treatments and interventions in health., Methods: Accordingly, this research study aimed to measure quality of life using the EQ-5D-3L instrument for patients from the Jamil Haddad National Institute of Traumatology and Orthopedics (Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad - INTO) with femoral fractures, hospitalized between 11/2015 and 10/2016., Results: A total of 165 orthopedic trauma patients with femoral fractures, aged 18 years or older, who were hospitalized and operated upon in the INTO were assessed. The assessment instruments were applied at admission and in the first and second follow-up visits to the outpatient clinic. Most study subjects were women and older than 60 years. Proximal femoral fracture was the most commonly found fracture. The Visual Analog Scale (VAS) assessments over the study period showed an increasing gain in self-assessed quality of life. Similarly, the EQ-5D-3L showed significant improvements in quality of life assessed in the five dimensions of the instrument: mobility, self-care, usual activities, pain/discomfort and anxiety/depression., Conclusion: This type of assessment may help in decision-making and cost-utility assessments related to orthopedic trauma.

Objective: To estimate the direct medical costs of advanced non-small cell lung cancer care., Methods: We assessed a cohort of 277 patients treated in the Brazilian National Cancer Institute in 2011. The costs were estimated from the perspective of the hospital as a service provider of reference for the Brazilian Unified Health System. The materials and procedures used were identified and quantified, per patient, and we assigned to them monetary values, consolidated in phases of the assistance defined. The analyses had a descriptive character with costs in Real (R$)., Results: Overall, the cohort represented a cost of R$2,473,559.91, being 71.5% related to outpatient care and 28.5% to hospitalizations. In the outpatient care, costs with radiotherapy (34%) and chemotherapy (22%) predominated. The results pointed to lower costs in the initial phase of treatment (7.2%) and very high costs in the maintenance phase (61.6%). Finally, we identified statistically significant differences of average cost by age groups, education levels, physical performance, and histological type., Conclusions: This study provides a current, useful, and relevant picture of the costs of patients with non-small cell lung cancer treated in a public hospital of reference and it provides information on the magnitude of the problem of cancer in the context of public health. The results confirm the importance of radiation treatment and hospitalizations as the main components of the cost of treatment. Despite some losses of follow-up, we assess that, for approximately 80% of the patients included in the study, the estimates presented herein are satisfactory for the care of the disease, from the perspective of a service provider of reference of the Brazilian Unified Health System, as it provides elements for the management of the service, as well as for studies that result in more rational forms of resource allocation., Objetivo: Estimar os custos médicos diretos da assistência ao câncer de pulmão não pequenas células avançado., Métodos: Foi avaliada uma coorte de 277 pacientes matriculados no Instituto Nacional do Câncer em 2011. Os custos foram estimados sob a perspectiva do hospital como prestador de serviços de referência para o SUS. Insumos e procedimentos utilizados foram identificados e quantificados, por paciente, sendo a eles atribuídos valores monetários, consolidados por fases da assistência definidas. As análises tiveram caráter descritivo com custos em reais (R$)., Resultados: Em termos globais, a coorte representou um custo de R$2.473.559,91, sendo 71,5% relacionados à atenção ambulatorial e 28,5% as internações. Na atenção ambulatorial, predominaram os custos com radioterapia (34%) e quimioterapia (22%). Os resultados apontaram para custos menores na fase inicial de tratamento (7,2%) e custos muito elevados na fase de manutenção (61,6%). Por fim, identificaram-se diferenças estatisticamente significativas das médias dos custos por faixas etárias, níveis de escolaridade, desempenho físico e tipo histológico., Conclusões: Este estudo fornece um retrato atual, útil e relevante sobre os custos de pacientes com câncer de pulmão não pequenas células assistidos em um hospital público de referência e provê elementos sobre a magnitude do problema do câncer no âmbito da saúde pública. Os resultados ratificam a importância do tratamento radioterápico e das internações como principais componentes de custo do tratamento. Apesar de algumas perdas de seguimento avalia-se que, para cerca de 80% dos pacientes incluídos no estudo, as estimativas aqui apresentadas sejam satisfatoriamente fidedignas ao cuidado da doença, sob a perspectiva de um prestador de referência do SUS, fornecendo elementos para a gestão do serviço, bem como para estudos que redundem em formas mais racionais de alocação de recursos.

Objectives: Hospital-based health technology assessment (HTA) has become increasingly important in Brazil due to its strategic importance to promote adoption, incorporation, dissemination, and disinvestment of technologies. A strategy to foster hospital-based HTA was implemented in 2009 by creating hospital-based HTA nuclei (NATS) at university hospitals and other strategic hospitals., Methods: Between 2011 and 2012, we interviewed board members in twenty-three NATS located in all geographic regions of Brazil to assess their general characteristics, scientific output, and challenges., Results: Of the total, 65 percent of the NATS belonged to teaching institutions, with 44 percent associated with federal universities. The bulk of their output was in the form of mini-HTA reports. Centers in the Southeast and South of Brazil had the highest production compared with other regions. Lack of expertise and low levels of advanced training were identified as limiting factors in the majority of centers., Conclusions: The experience of the initial twenty-three NATS could be considered positive and has led to the creation of new ones around Brazil. Regional disparities in workload, production, and technical training should be targeted by new policies toward hospital-based HTA in Brazil. The limits and possibilities for intensifying the strategy relate to continuous investment in priority studies, which simultaneously, allow professionals who work in hospitals to receive continued education and produce relevant HTA work in a timely manner.