ABC | Volume 111, Nº1, July 2018

Original Article Stevens et al The Economic Burden of Heart Conditions in Brazil Arq Bras Cardiol. 2018; 111(1):29-36 1. World Heart Federation. The Brazil Declaration. 2016. [Cited in 2017 Dec 12].Available from: http://www.world-heart-federation.org/wcc-2016/ the-Brazil-declaration/UnitedNations. Department of Economic and Social Affairs. World Population Prospects;2015. 2. Salomon JA, Haagsma JA, Davis A, de Noordhout CM, Polinder S, Havelaar AH, et al. Disability weights for the Global Burden of Disease 2013 study. Lancet Glob Health. .2015;3(11):e712-23. 3. WorldHealthOrganization.(WHO). Global burden of disease 2004 update. Washington; 2004. 4. Brasil.Ministério da Saúde. Informações de Saúde [Internet]. DATASUS TecnologiadaInformaçãoaServiçodoSUS.2015[Cited2015Sep5].Available from: http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sih /cnv/niuf.def 5. TheWorldBank.WorldDevelopment Indicators [Internet].2015 [cited2015 Sep 12]. Available from: http://data.worldbank.org/topic 7. WorldHealthOrganization. (WHO). Global Health Expenditures Database [Internet]. 2015 [Cited 2015 Jun 10]. Available from: http://apps.who.int/ nha/database/Select/Indicators/en 8. Vuong TD, Wei F, Beverly CJ. Absenteeism due to functional limitations caused by seven common chronic diseases inUSWorkers. J Occup Environ Med. 2015;57(7):779–84. 9. Dennis C, Houston-Miller N, Schwartz RG, Ahn DK, Kraemer HC, Gossard D, et al. Early return to work after uncomplicated myocardial infarction. Results of a randomized trial. JAMA. 1988;260(2):214-20. 10. Rohrbacker NJ, Kleinman NL, White SA, March JL, Reynolds MR. The burden of atrial fibrillation and other cardiac arrhythmias in an employed population: associated costs, absences, and objective productivity loss. J Occup Environ Med. 2010;52(4):383–91. 11. Kruse M, Sørensen J, Davidsen M, Gyrd-Hansen D. Short and long-term labour market consequences of coronary heart disease: a register-based follow-up study. Eur J Cardiovasc Prev Rehabil.2009;16(3):387-91. 12. OslerM, Mårtensson S, Prescott E, Carlsen K. Impact of gender, co-morbidity and social factors on labour market affiliation after first admission for acute coronary syndrome. A Cohort Study of Danish Patients 2001–2009. PLoS One.2014;9(1):e86758. References Table 6 – Multivariate sensitivity analysis SC TM STS Total costs (reais) 5,832 68 891 58 538 Total QALYs 3.99 5.45 5.30 Incremental costs (reais) 60 059 52 706 Incremental QALYs 1.46 1.31 Incremental cost (reais) per QALY 41 123 40 309 QALY: quality-adjusted life-year; SC: standard care; TM: telemedicine; STS: structured telephone support. Conclusion This study has found that heart conditions impose significant financial and wellbeing impacts across Brazil, with the four conditions costing $56.2 billion reais in 2015 alone. Prevention or better management of heart conditions could result in significant benefits both in improved wellbeing and economic savings. Telemedicine and structured telephone support are cost effective mechanisms for achieving improvements in the management of heart failure. The study was supported by funding from the Novartis Group. The authors are solely responsible for its content. Acknowledgements The authors at Deloitte Access Economics designed the study, collected data, performed analysis and wrote the initial draft of the manuscript. All authors read, commented on, and approved the final manuscript. This research is part of a larger study of the Latin American region, with country specific results also identified for Mexico, Chile, Peru, Venezuela, Colombia, Ecuador, Panama and El Salvador. These results for Brazil were presented at ISPOR Vienna (November 2016) and the World Cardiovascular Congress (June 2016). Author contributions Conception and design of the research: Stevens B, Pezzullo L, Verdian L; Acquisition of data: Stevens B, Tomlinson J; Analysis and interpretation of the data: Stevens B, Pezzullo L, Verdian L, Tomlinson J; Statistical analysis: Stevens B, Tomlinson J; Obtaining financing: Pezzullo L; Writing of the manuscript: Stevens B, Verdian L, Tomlinson J, George A; Critical revision of the manuscript for intellectual content: Stevens B, Pezzullo L, Bacal F. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by Novartis Group. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 35