The aim of this study is to identify and characterize the health economic evaluations (HEEs) of diagnostic tests conducted in Brazil, in terms of their adherence to international guidelines for reporting economic studies and specific questions in test accuracy reports. We systematically searched multiple databases, selecting partial and full HEEs of diagnostic tests, published between 1980 and 2013. Two independent reviewers screened articles for relevance and extracted the data. We performed a qualitative narrative synthesis. Forty-three articles were reviewed. The most frequently studied diagnostic tests were laboratory tests (37.2%) and imaging tests (32.6%). Most were non-invasive tests (51.2%) and were performed in the adult population (48.8%). The intended purposes of the technologies evaluated were mostly diagnostic (69.8%), but diagnosis and treatment and screening, diagnosis, and treatment accounted for 25.6% and 4.7%, respectively. Of the reviewed studies, 12.5% described the methods used to estimate the quantities of resources, 33.3% reported the discount rate applied, and 29.2% listed the type of sensitivity analysis performed. Among the 12 cost-effectiveness analyses, only two studies (17%) referred to the application of formal methods to check the quality of the accuracy studies that provided support for the economic model. The existing Brazilian literature on the HEEs of diagnostic tests exhibited reasonably good performance. However, the following points still require improvement: 1) the methods used to estimate resource quantities and unit costs, 2) the discount rate, 3) descriptions of sensitivity analysis methods, 4) reporting of conflicts of interest, 5) evaluations of the quality of the accuracy studies considered in the cost-effectiveness models, and 6) the incorporation of accuracy measures into sensitivity analyses.

No início dos anos 90, observou-se aumento da resistência do Mycobacterium tuberculosis às drogas antituberculose, com alta prevalência entre pacientes HIV+. Neste estudo, foram avaliados a freqüência de resistência, o perfil de sensibilidade do M. tuberculosis às drogas e os fatores predisponentes à resistência entre indivíduos HIV+ nos municípios de Santos, São Vicente, Cubatão, Praia Grande e Guarujá, Estado de São Paulo, Brasil. Foram pesquisados os prontuários de 301 pacientes com resultado de cultura positivo entre 1993 e 2003. A resistência ocorreu em 57 (18,9%) pacientes com a seguinte distribuição: 32 (10,6%) apresentaram tuberculose multirresistente (resistência ao menos à Rifampicina e Isoniazida); 4 (1,3%) casos apresentaram resistência a duas ou mais drogas e 21 (7%) à monorresistência. Observou-se resistência secundária em 70,2% dos casos. Estatisticamente associadas à tuberculose resistente foram: tratamento anterior com drogas antituberculose, tempo de diagnóstico de HIV e hospitalização prévia. Em análise multivariada, apenas tratamento anterior, ajustado por faixa etária, mostrou-se associado (OR = 5,49; IC95%: 2,60-11,60). A ocorrência de resistência em 18,9% dos casos e multirresistência em aproximadamente 10% confirmam a relevância deste problema entre pacientes HIV+ na Baixada Santista.

Since the early 1990s, an increase in Mycobacterium tuberculosis drug resistance has been reported, with high prevalence among HIV+ patients. We evaluated the sensitivity patterns of M. tuberculosis, resistance rate, and predisposing factors among HIV+ patients in Santos, São Vicente, Cubatão, Praia Grande, and Guarujá, São Paulo State, Brazil. The medical charts of 301 patients with positive cultures for M. tuberculosis from 1993 to 2003 were reviewed. Resistance occurred in 57 patients (18.9%), as follows: 32 (10.6%) displayed multidrug-resistant tuberculosis (resistant to at least Rifampicin and Isoniazid); 4 (1.3%) were resistant to two or more drugs; and 21 (7%) were resistant to a single drug. Acquired resistance was observed in 70.1% of cases. Drug resistance was significantly associated with previous tuberculosis treatment, duration of HIV diagnosis, and previous hospitalization. In logistic regression analysis, only previous tuberculosis treatment adjusted by age remained as an independent risk factor (OR = 5.49; 95%CI: 2.60-11.60). Drug resistance to at least one drug in 18.9% and multidrug resistance in 10.6% of cases highlight the relevance of this problem in HIV patients in the Baixada Santista.

No início dos anos 90, observou-se aumento da resistência do Mycobacterium tuberculosis às drogas antituberculose, com alta prevalência entre pacientes HIV+. Neste estudo, foram avaliados a freqüência de resistência, o perfil de sensibilidade do M. tuberculosis às drogas e os fatores predisponentes à resistência entre indivíduos HIV+ nos municípios de Santos, São Vicente, Cubatão, Praia Grande e Guarujá, Estado de São Paulo, Brasil. Foram pesquisados os prontuários de 301 pacientes com resultado de cultura positivo entre 1993 e 2003. A resistência ocorreu em 57 (18,9%) pacientes com a seguinte distribuição: 32 (10,6%) apresentaram tuberculose multirresistente (resistência ao menos à Rifampicina e Isoniazida); 4 (1,3%) casos apresentaram resistência a duas ou mais drogas e 21 (7%) à monorresistência. Observou-se resistência secundária em 70,2% dos casos. Estatisticamente associadas à tuberculose resistente foram: tratamento anterior com drogas antituberculose, tempo de diagnóstico de HIV e hospitalização prévia. Em análise multivariada, apenas tratamento anterior, ajustado por faixa etária, mostrou-se associado (OR = 5,49; IC95%: 2,60-11,60). A ocorrência de resistência em 18,9% dos casos e multirresistência em aproximadamente 10% confirmam a relevância deste problema entre pacientes HIV+ na Baixada Santista.

Since the early 1990s, an increase in Mycobacterium tuberculosis drug resistance has been reported, with high prevalence among HIV+ patients. We evaluated the sensitivity patterns of M. tuberculosis, resistance rate, and predisposing factors among HIV+ patients in Santos, São Vicente, Cubatão, Praia Grande, and Guarujá, São Paulo State, Brazil. The medical charts of 301 patients with positive cultures for M. tuberculosis from 1993 to 2003 were reviewed. Resistance occurred in 57 patients (18.9%), as follows: 32 (10.6%) displayed multidrug-resistant tuberculosis (resistant to at least Rifampicin and Isoniazid); 4 (1.3%) were resistant to two or more drugs; and 21 (7%) were resistant to a single drug. Acquired resistance was observed in 70.1% of cases. Drug resistance was significantly associated with previous tuberculosis treatment, duration of HIV diagnosis, and previous hospitalization. In logistic regression analysis, only previous tuberculosis treatment adjusted by age remained as an independent risk factor (OR = 5.49; 95%CI: 2.60-11.60). Drug resistance to at least one drug in 18.9% and multidrug resistance in 10.6% of cases highlight the relevance of this problem in HIV patients in the Baixada Santista.