Papers by Maurílio Cazarim
Brazilian Journal of Pharmaceutical Sciences
The incorrect disposal of medicines and their environmental impact has been related to the health... more The incorrect disposal of medicines and their environmental impact has been related to the health medicalization and the improper use of medication by society. In this sense, it is very important to know the profile of drug disposal for foster health policies. The aim was to identify the profile of disposal of medicines by the population, including the cost perspective. This is an inquiry descriptive study that began in September 2019. Medicine disposal health education program was carried out over six months in two University pharmacies. A questionnaire for sociodemographic and discarded medicines data collection was applied. Logistic regression analysis for variables association of correct disposal and the chi-square and t-student analysis for comparison between disposal programs were performed for a level of 5% and test power of 80%. Medicines weighed 23.3 kg and 28.5 kg, with the cost variation from US$ 13.5 to US$ 16.1 until the final treatment. The correct disposal was strongly associated with the disposal reason (p=0.013), source of information (p=0.006), prescription (p=0.03), form of use (p=0.01), acquisition source (p=0.001), cost with medication (p=0.0001), education (p=0.028) and age (p=0.05). The correct medicine disposal was associated with important features of the community related to education health.
Medicina (Ribeirão Preto), 2020
Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribut... more Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições, desde que o trabalho original seja corretamente citado.
Brazilian Journal of Health Review
COVID-19 has evolved into a serious clinical condition, especially in patients with comorbidities... more COVID-19 has evolved into a serious clinical condition, especially in patients with comorbidities. However, the literature has diverged in relation to the main characteristics of patients prone to severe evolution. Objective: This study aimed to understand different variables that may be associated with the clinical management of COVID-19 for a better clinical response and prognosis. Methods: This is a systematic review in which the search in PubMed, Cochrane, EMBASE and LILACS databases. A manual and gray literature search on Google Scholar was also conducted. There was no country or region restriction and only studies in Portuguese, English and Spanish were included. Results: Of the 21 studies included in Primary Health Care (PHC) for eligibility, five studies from five countries involving 27,754 patients were analysed and, of the four eligible studies, one study was included for secondary care. Overall, the mean age of the COVID-19 population in PHC was around 41 years old, the n...
CAZARIM, M. S. Long-term economic evaluation of Pharmaceutical Care for patients with systemic ar... more CAZARIM, M. S. Long-term economic evaluation of Pharmaceutical Care for patients with systemic arterial hypertension. 2016. 122f. Dissertation (Master).
Universidade Federal de Juiz de Fora (UFJF), 2008
Maria Silvana Alves (Co-Orientador) Orlando Vieira De Sousa (Co-Orientador) Resumo: O conheciment... more Maria Silvana Alves (Co-Orientador) Orlando Vieira De Sousa (Co-Orientador) Resumo: O conhecimento sobre o sistema de medicação hospitalar constitui uma ferramenta importante aos profissionais da saúde para garantir uma assistência responsável e segura ao paciente. Por isto, o presente estudo teve como objetivo analisar o sistema de medicação do Hospital
Brazilian Journal of Health and Pharmacy, 2021
Journal of Health & Biological Sciences
Objetivos: contribuir para a geração de dados de avaliação econômica de estratégias de empoderame... more Objetivos: contribuir para a geração de dados de avaliação econômica de estratégias de empoderamento farmacoterapêutico para pacientes com Diabetes Mellitus tipo 2 (DM tipo 2). Métodos: este estudo farmacoeconômico é aninhado a um ensaio clínico com controle não randomizado que incluiu pacientes ≥18 anos de idade, cadastrados no HIPERDIA. Os pacientes foram alocados em um modelo de Markov conforme valores de hemoglobina glicada do acompanhamento. As probabilidades do surgimento de complicações relativas ao DM, incluindo-se óbito, foram estimadas por dez anos. Cada complicação do DM tipo 2 teve seu custo estabelecido para determinação do custo anual. Resultados: entre os participantes da intervenção, não ocorrem óbitos ocasionados por DM tipo 2, e a progressão de complicações mantém-se estável durante os anos simulados, enquanto, no grupo controle, 60% dos pacientes podem evoluir para óbito nos dez anos, e a probabilidade de serem acometidos por complicações relacionadas ao DM tipo 2...
Abstract: Cost-effectiveness analysis is essential in health decision making. Several countries u... more Abstract: Cost-effectiveness analysis is essential in health decision making. Several countries use it as synthesis of evidence to incorporate health technologies. The protease inhibitors (PI) boceprevir (BOC) and telaprevir (TVR) are indicated for chronic hepatitis C treatment and were incorporated in guidelines worldwide. Pre-marketing clinical trials showed higher sustained virological response rates in relation to previous therapies, but the incorporation of PIs generated a significant financial impact. The aim of this study was to discuss the relevance of cost-effectiveness analysis through a study that involved the inclusion of PIs in a clinical protocol. The analysis was part of a real-life study that included patients infected with hepatitis C virus genotype 1 treated in a tertiary university hospital in Brazil. Triple therapies (TT) with ribavirin (RBV), peginterferon α-2a (Peg-INF α-2a) and BOC or TVR were compared to dual therapy with RBV and Peg-INF α-2a. Sensitivity ana...
Os idosos constituem a parcela da populacao que mais cresce em todo o mundo. No Brasil, o envelhe... more Os idosos constituem a parcela da populacao que mais cresce em todo o mundo. No Brasil, o envelhecimento populacional tem ocorrido de forma rapida e acentuada. Os pacientes acima de 60 anos chegam a somar 50% dos multiusuarios do SUS. Com o objetivo de descrever e analisar os antibacterianos prescritos a pacientes idosos no âmbito hospitalar, foi realizado um estudo descritivo retrospectivo e tranversal. Em um universo de 1.148 prescricoes, 360 (31,36%) eram destinadas a pacientes idosos e 129 (11,24%) continham ao menos um antibacteriano prescrito a esses pacientes, o que totalizou 188 antibacterianos prescritos a idosos (5,70% do total de medicamentos). O antibacteriano representa uma parcela importante dentre os medicamentos prescritos a idosos.
Revista de Ciências Farmacêuticas Básica e Aplicada, 2012
Os idosos constituem a parcela da populacao que mais vem aumentando em todo o mundo. No Brasil, o... more Os idosos constituem a parcela da populacao que mais vem aumentando em todo o mundo. No Brasil, o envelhecimento populacional tem ocorrido de forma rapida e acentuada. Os pacientes acima de 60 anos chegam a somar 50% dos multiusuarios do SUS, representando um grande consumo de medicamentos de modo a ser o destinatario de uma fracao significativa dos recursos empregados. Contudo, destacam-se os antimicrobianos como os medicamentos prescritos com maior frequencia a essa populacao. Palavras-chave: Saude do idoso. Prescricao de medicamentos. Agentes antibacterianos. ABSTRACT Elderly patients from the aspect of use of antimicrobial: repercussion in the Brazilian Public Health System (SUS) The elderly constitute the population that is increasing most in the world. In Brazil, the aging of the population has been happening fast and accentuated. The patients who are over 60 years of age correspond to 50% of the government medical care (SUS) clients, which represents a high consumption of med...
Pharmaceutics, 2021
Atopic dermatitis (AD) is a chronic inflammatory skin disease that is difficult to treat. Traditi... more Atopic dermatitis (AD) is a chronic inflammatory skin disease that is difficult to treat. Traditional cold cream, a water-in-oil emulsion made from beeswax, is used to alleviate AD symptoms in clinical practice, although its effectiveness has not been scientifically proven. The addition of propolis has the potential to impart anti-inflammatory properties to cold cream. However, in high concentrations, propolis can trigger allergic reactions. Thus, the objective of this work was to develop a cold cream formulation based on purified beeswax containing the same amount of green propolis present in raw beeswax. The impact of adding this low propolis concentration to cold cream on AD control was evaluated in patients compared to cold cream without added propolis (CBlank). Raw beeswax was chemically characterized to define the propolis concentration added to the propolis-loaded cold cream (CPropolis). The creams were characterized as to their physicochemical, mechanical, and rheological ch...
Cadernos de Saúde Pública, 2020
Cost-effectiveness analysis is essential in health decision making. Several countries use it as s... more Cost-effectiveness analysis is essential in health decision making. Several countries use it as synthesis of evidence to incorporate health technologies. The protease inhibitors (PI) boceprevir (BOC) and telaprevir (TVR) are indicated for chronic hepatitis C treatment and were incorporated in guidelines worldwide. Pre-marketing clinical trials showed higher sustained virological response rates in relation to previous therapies, but the incorporation of PIs generated a significant financial impact. The aim of this study was to discuss the relevance of cost-effectiveness analysis through a study that involved the inclusion of PIs in a clinical protocol. The analysis was part of a real-life study that included patients infected with hepatitis C virus genotype 1 treated in a tertiary university hospital in Brazil. Triple therapies (TT) with ribavirin (RBV), peginterferon α-2a (Peg-INF α-2a) and BOC or TVR were compared to dual therapy with RBV and Peg-INF α-2a. Sensitivity analysis of the costeffectiveness ratio indicated an 88.2% chance of TTs presenting a higher cost per cure. The incremental cost-effectiveness ratios (ICER) exceeded the Brazilian gross domestic product (GDP) per capita by three times in all proposed scenarios. The sensitivity of ICER showed an 88.4% chance of TT not being cost-effective. The impact of PI incorporation was negative and the conduct about this could have been different if a previous cost-effectiveness analysis had been conducted.
Procedia Computer Science, 2017
Systemic Arterial Hypertension (SAH) is a risk factor for 9.4 million deaths worldwide. In Brazil... more Systemic Arterial Hypertension (SAH) is a risk factor for 9.4 million deaths worldwide. In Brazil, the condition attributes an annual cost of approximately USD640,000,000 to the SUS. The epidemiological and economic analysis of Pharmaceutical Care (PC) in the management of hypertensive patients showed an improvement in blood pressure control, a reduction of the risk of SAH complications, and an investment return of over USD1.7 million after ten years. Therefore, this article aims to present a pharmacoeconomic tool capable of assisting decision making in the implementation of PC in the SUS. A systematic review is being conducted for the robustness of the estimation of clinical and epidemiological impact of SAH, its results will be tabulated and applied in the improvement of the tool together with the direct medical and non-medical costs, indirect costs and costs of the SAH. In addition, a Markov model will be designed to estimate the incidence of cardiovascular diseases and SAH's associated diseases by studies of proteomics that address the Human Network Disease. We hope to validate this auxiliary tool and thus to improve blood pressure control among hypertensive patients, quality of life, to reduce comorbidities and deaths, as well as optimizing the use of health resources.
European Journal of Pharmaceutics and Biopharmaceutics, 2019
The presence of insulin (INS) receptors on the ocular surface (OS) and lacrimal gland (LG), and t... more The presence of insulin (INS) receptors on the ocular surface (OS) and lacrimal gland (LG), and the high prevalence of dry eye syndrome (DES) and corneal lesions in diabetic patients suggest that INS is relevant for OS homeostasis and wound healing. The study aims at developing delivery systems for the topical administration of INS to the OS in order to improve INS local bioavailability and evaluate the influence of the delivery systems on DES in diabetic rats (DM) (n= 05/group). Chitosan microparticles (MP), chitosan/poloxamer gel (GEL) and MP-loaded GEL (GELMP), with or without INS were developed. Formulations were instilled into the eyes of diabetic rats (DM) for 15 days and the tear fluid volume, corneal cells morphology and cornea thickness were assessed and compared with an aqueous dispersion of INS (DISP-INS). All delivery systems had pH of about 6, osmolality suitable for topical application and positive zeta potential. The MPs with or without INS had sizes close to 4 m, spherical morphology and INS encapsulation efficiency of 77±6%. DISP-INS and GELMP-INS formulations produced tear secretion amounts significantly higher than those receiving formulations containing no INS and similar to healthy animals. Cornea surface impression cytology showed that treatment with INSdelivery systems and not DISP-INS almost normalized cells morphology. Treatment with GELMP-INS increased INS by 2.5 in the LG and eyeball as compared to the groups treated with GEL-INS and MP-INS, while treatment with DISP-INS left no traces of drug in the eye after treatment termination. GEL and GELMP containing INS were also able to normalize the thickness of the corneal epithelia. In conclusion, GELMP-INS normalized tear fluid volume, corneal thickness, protected corneal cells morphology and increased ocular bioavailability of INS, making it a promising treatment strategy for DES and corneal lesions.
Brazilian Journal of Pharmaceutical Sciences, 2017
Human insulin is provided by the Brazilian Public Health System (BPHS) for the treatment of diabe... more Human insulin is provided by the Brazilian Public Health System (BPHS) for the treatment of diabetes, however, legal proceedings to acquire insulin analogs have burdened the BPHS health system. The aim of this study was to perform a cost-effectiveness analysis to compare insulin analogs and human insulins. This is a pharmacoeconomic study of cost-effectiveness. The direct medical cost related to insulin extracted from the Ministry of Health drug price list was considered. The clinical results, i.e. reduction in glycated hemoglobin (HbA1c), were extracted by meta-analysis. Different scenarios were structured to measure the uncertainties regarding the costs and reduction in HbA1c. Decision tree was developed for sensitivity of Incremental Cost Effectiveness Ratio (ICER). A total of fifteen scenarios were structured. Given the best-case scenario for the insulin analogs, the insulins aspart, lispro, glargine and detemir showed an
Value in Health, 2018
OBJECTIVES: To assess the value of implementation of pharmaceutical care (PC) for cardiovascular ... more OBJECTIVES: To assess the value of implementation of pharmaceutical care (PC) for cardiovascular diseases in low-middle-income countries (LMICs). METHODS: This is a health care use and policy study based on health care management, which has evaluated the value of implementation (VOI) of PC from a societal and Brazilian Public Health System (BPHS) perspective. During 2009, a PC program enlisted 104 patients covered by the BPHS. Direct medical and non-medical costs and social costs were considered. Markov modeling projected over 10-years systemic arterial hypertension complications (ischemic heart disease, stroke, peripheral arterial disease, heart failure, chronic kidney disease). The treatment effect was calculated by comparing PC and conventional care and discount rates of 5% and 3% were applied to costs/outcomes, respectively. In a cash flow model, the net present value based on the return on investment (ROI) over 10 years was calculated, which represented a quantitative measure of the pharmaceutical care (PC) acceptance effect, and was converted into a net health benefit (NHB). The systematizing of the epidemiological and NHB impact provided the calculation and sensitivity analysis of VOI according to the variation for 10,000 Monte Carlo's iterations of 38 inputs from the expected value of PC implementation. RESULTS: The ROI was USD $1,712,710 (95%CI 1,146,000-2,216,000), which represented a cost-benefit ratio of 30.03 (95%CI, 26.74e34.28). The social variables presented an important impact on NHB, they were able to change the ROI from USD $1,283,206 to USD $1,962,401. Lambda was estimated as the largest limit of willingness to pay for QALY, usually in LMICs; in Brazil it is three times the GDP, USD $28,000. Thus, the calculated NHB was 2.8 per patient (95%CI 2.67-3.04) and NHB ROI¼5.41%. CONCLUSIONS: The impact of implementation was higher than implementation of net beneficial technology, which presents a great opportunity cost for PC.
Procedia Computer Science, 2018
Is extremely difficult to current methods to know how much intensive is the patient's pharmacothe... more Is extremely difficult to current methods to know how much intensive is the patient's pharmacotherapy and measure it. In this context, we have developed a method that can contribute to advances in clinical practice. The main objective was making this calculation method applicable to clinical practice, becoming it feasible in a computational program/applicative. The calculation method considers the maximum doses to treat a specific disease and the doses in use by the patient to provide a calculation of a specific correction factor. The software development technologies are as follows: Bulma, for responsiveness and style, and Angular Material, for style and searches on the database of disease and medication names. The logical development of the application was set up with Typescript language and Angular 5, a framework for multi-platform development for mobile and desktop. This software, basically, have three different pages. The result page shows a table with 4 columns: patient Identification, equivalence dose (obtained from the calculation quoted above), amount of medicines and, colour's classification of the patients from the highest doses to lowest doses. The software has achieved generate responses for the pharmacological treatment of different patients for a specific disease in different therapeutic levels.
Diabetes & metabolic syndrome, Jan 17, 2017
DM spending in the world is high, and Brazilian studies of public spending caused by DM are scarc... more DM spending in the world is high, and Brazilian studies of public spending caused by DM are scarce. To estimate the annual direct cost for the municipal health sphere, related to DM2 treatment, in patients with and without glycemic control. A cross-sectional study carried out in a city in the interior of Minas Gerais state, with patients with DM2, being municipal PHS users. Data were collected from the computerized system of the municipality and patient records, and analyzed using the IBM SPSS v.19 statistical package. The response variable was categorized into controlled A1c (≤7%) and uncontrolled A1c (>7%). Glycemic control in 56.6% of the patients was unsatisfactory; the mean cost of pharmacotherapy for DM2 was US$ 3.14 per year for patients in the control group and US$ 45.54 per year for uncontrolled patients. Patients with unsatisfactory glycemic control are more expensive for the municipal health system.
Diabetes & metabolic syndrome, Jan 3, 2017
Type 2 diabetes mellitus (T2DM) has burdened health systems in the world to the value of 500 bill... more Type 2 diabetes mellitus (T2DM) has burdened health systems in the world to the value of 500 billion dollars/year. Dipeptidyl peptidase 4 inhibitors (DPP-4 Inhibitors) have been strongly associated with spending on the treatment of T2DM by the courts in Brazil. The aim of this study was to estimate the most cost-effective DPP-4 Inhibitor for T2DM treatment. A pharmacoeconomic study of cost-effectiveness was performed in a medium-sized municipality in Minas Gerais state, Brazil. The data are from legalization in municipal health in 2013. The effectiveness of DPP-4 Inhibitors was measured by the reduction in glycated hemoglobin (A1c). The direct medical costs of drug and adverse drug reactions were identified. With these data, a cost-effectiveness ratio (CER) and construction of the decision tree for sensitivity analysis were performed. The representative of the most effective in reducing A1c gliptins was sitagliptin in combination with metformin, it was able to reduce A1c by 1.16% (1...
Sao Paulo Medical Journal, 2016
CONTEXT AND OBJECTIVE: Dementia is a syndrome characterized by functional and cognitive decline. ... more CONTEXT AND OBJECTIVE: Dementia is a syndrome characterized by functional and cognitive decline. Alzheimer's disease (AD) is one of the most common causes of dementia and has high prevalence among the elderly. It is known that there is no drug capable of interfering with the course of the disease. Research on treatments for AD has been marked by the appearance of new drugs and their abandonment. This study aimed to describe drugs that have been studied with regard to treating AD and which are capable of influencing the course of the disease. DESIGN AND SETTING: Narrative review on original articles published worldwide. METHODS: A systematized search was conducted in the PubMed/MEDLINE, Cochrane Library/Cochrane and SciELO/Bireme databases. The descriptors "Molecular Mechanisms of Pharmacological Action" and "Drug Therapy" were each combined with the descriptor "Alzheimer disease". All of these can be found in MeSH and DeCS. These descriptors were us...
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Papers by Maurílio Cazarim