ORCID Profile
0000-0002-9033-9440
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Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.REPC.2016.09.021
Abstract: We aimed to compare access to new health technologies to treat coronary heart disease (CHD) in the health systems of Portugal and the US, characterizing the needs of the populations and the resources available. We reviewed data for 2000 and 2010 on epidemiologic profiles of CHD and on health care available to patients. Thirty health technologies (16 medical devices and 14 drugs) introduced during the period 1980-2015 were identified by interventional cardiologists. Approval and marketing dates were compared between countries. Relative to the US, Portugal has lower risk profiles and less than half the hospitalizations per capita, but fewer centers per capita provide catheterization and cardiothoracic surgery services. More than 70% of drugs were available sooner in the US, whereas 12 out of 16 medical devices were approved earlier in Portugal. Nevertheless, at least five of these devices were adopted first or diffused faster in the US. Mortality due to CHD and myocardial infarction (MI) was lower in Portugal (CHD: 72.8 vs. 168 and MI: 48.7 vs. 54.1 in Portugal and the US, respectively age- and gender-adjusted deaths per 100000 population, 2010) but only CHD deaths exhibited a statistically significant difference between the countries. Differences in regulatory mechanisms and price regulations have a significant impact on the types of health technologies available in the two countries. However, other factors may influence their adoption and diffusion, and this appears to have a greater impact on mortality, due to acute conditions.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-05-2017
DOI: 10.1200/JCO.2017.35.15_SUPPL.6616
Abstract: 6616 Background: Willingness to pay (WTP) studies assess societal valuation of healthcare interventions. Prostate cancer (PC) is the most common cancer diagnosis in men. We explore factors that may bias valuation of health care benefits through contingent valuation of WTP for therapeutic innovation in metastatic castration-resistant PC. Methods: Cross-sectional study of Portuguese Society (SOC) and Healthcare Providers (HCP). Monthly WTP assessed through biding and open-ended questions by standardized survey with 2 baseline scenarios: ScA 12-month median survival, ScB 30-month median survival. Respondents considered own financial resources and expenses and for each therapeutic scenario reported WTP, out-of-pocket, and expected National Healthcare System (NHCS) WTP. Impact of demographic, personal medical history and household income assessed by tweedie generalized linear model. Results: 1000 subjects on societal cohort and 100 physicians provided valid responses. Subjects reported higher WTP values when NHCS was to provide treatment compared to out-of-pocket cost. For NHCS perspective median WTP for ScA was 2,133€ for HCP vs 5,510€ for SOC and ScB 1 963€ for HCP vs 5,479€ for SOC. Overall, societal cohort’s NHCS mean WTP was 2.6 (ScA) and 2.8 (ScB) times higher (p .001) than healthcare providers, but with no difference for out-of-pocket WTP. This difference remained significant when adjusted for all other factors. Additionally, subjects with prior personal or familial history of cancer and subjects with higher household income provided higher WTP estimates. In HCP cohort, urologists reported higher WTP compared to Medical Oncologists. Conclusions: This study provides critical insight into differing valuation of cancer treatments between physicians and society and potential biases in in idual valuation of healthcare benefits. Improvement of societal’s perception and understanding of cost-benefit assessments is critical to designing an equitable healthcare system.
Publisher: BMJ
Date: 2012
Publisher: Oxford University Press (OUP)
Date: 28-07-2017
Abstract: To compare healthcare in acute myocardial infarction (AMI) treatment between contrasting health systems using comparable representative data from Europe and USA. Repeated cross-sectional retrospective cohort study. Acute care hospitals in Portugal and USA during 2000-2010. Adults discharged with AMI. Coronary revascularizations procedures (percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery). In-hospital mortality and length of stay. We identified 1 566 601 AMI hospitalizations. Relative to the USA, more hospitalizations in Portugal presented with elevated ST-segment, and fewer had documented comorbidities. Age-sex-adjusted AMI hospitalization rates decreased in USA but increased in Portugal. Crude procedure rates were generally lower in Portugal (PCI: 44% vs. 47% CABG: 2% vs. 9%, 2010) but only CABG rates differed significantly after standardization. PCI use increased annually in both countries but CABG decreased only in the USA (USA: 0.95 [0.94, 0.95], Portugal: 1.04 [1.02, 1.07], odds ratios). Both countries observed annual decreases in risk-adjusted mortality (USA: 0.97 [0.965, 0.969] Portugal: 0.99 [0.979, 0.991], hazard ratios). While between-hospital variability in procedure use was larger in USA, the risk of dying in a high relative to a low mortality hospital (hospitals in percentiles 95 and 5) was 2.65 in Portugal when in USA was only 1.03. Although in-hospital mortality due to an AMI improved in both countries, patient management in USA seems more effective and alarming disparities in quality of care across hospitals are more likely to exist in Portugal.
No related grants have been discovered for Francisco Nuno Rocha Gonçalves.