Bipolar disorder (BD) is one of the leading causes of disability worldwide and has a detrimental impact on health-related quality of life (HRQoL), and personal and social functioning. Despite this, there is insufficient knowledge of the costs, HRQoL implications relevant to BD, and the cost-effectiveness of current treatments for BD in the UK. This thesis aims to inform decisions about local and national service provision by applying a variety of health economic tools to build an economic case for BD. First, economic evaluations of BD management strategies are systematically reviewed. A cost-of-illness study is then conducted to estimate the societal burden of BD in the UK and explore the factors that drive variations in these costs. The appropriateness of applying the EQ-5D-3L outcome measure in BD is assessed, and the feasibility of mapping disease-specific measures to the EQ-5D-3L is explored. Finally, a cost-utility analysis (CUA) is conducted to bring together evidence on the costs and outcomes associated with alternative psychological interventions in BD management. This thesis makes critical contributions to multiple research domains, informing the allocation of scarce healthcare resources in this context. There is a sheer dearth of evidence on cost-effectiveness strategies for the long-term management of BD in the UK, especially the evidence for psychological therapies is limited. The annual societal costs associated with BD in the UK are estimated to be £5.14 billion, demonstrating the significant economic burden associated with this disease. The EQ-5D-3L instrument is found to be useful in measuring HRQoL in BD patients who predominantly experience depressive symptoms but is not sensitive enough to detect changes in individuals with mania. More psychometric evidence is therefore required before this instrument can be widely applied in economic evaluations of BD-related interventions. Finally, the CUA indicates that a novel structured psychoeducation intervention in individuals on remote mood monitoring in the UK is not cost-effective.

Diabetes mellitus (DM) is a significant public health problem that afflicted approximately 29.1 million Americans in 2012 (CDC, 2014). The estimated cost of diabetes in the United States in 2012 was $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity (ADA, 2013a). To reach a diagnosis of DM, a clinician generally relies on fasting plasma glucose (FPG), the oral glucose tolerance test (OGTT), and/or the Hemoglobin A1c (HbA1c) test (ADA, 2013b). Current noninsulin antidiabetic medications include sulfonylureas, GLP-1 analogues, DPP-4 inhibitors, biguanides, thiazolidinediones, and SGLT2 inhibitors (Kaiser & Oetjen, 2014). Insulin therapies include basal (long-acting insulin analogues), biphasic (premixed insulin analogues), prandial (short-acting insulin analogues), and basal bolus (a combination of long-acting and short-acting insulin analogues) (Esposito et al., 2012). The aim of this study is to review the existing literature on the cost effectiveness of diabetes interventions to develop a standardized protocol for early type 2 diabetes care that can be delivered through primary care providers. The substantial cost effectiveness of preventative measures, including ad campaigns and outreach programs, has already been established (Mendis & Chestnov, 2013). Screening for impaired glucose tolerance early and implementing lifestyle and pharmacological changes at an early stage are also considered cost effective approaches for the long-term management of diabetes mellitus (Gillies et al., 2008). This study utilizes six cost effectiveness analyses on both clinical and non-clinical interventions to determine a standardized protocol for screening, diagnosing, and treating DM. Noninsulin antidiabetic drugs accounted for 78.4% of the 154.4 million prescriptions for antidiabetic drugs filled in 2012 (Hampp et al., 2014). Approximately half of the noninsulin antidiabetic drugs filled in 2012 was for metformin, whereas roughly a quarter of the same category was for sulfonylureas (Hampp et al., 2014). In decreasing order, long-acting human analog insulin and fast-acting human analog insulin were the most popular insulin variants in the insulin antidiabetic drug market (Hampp et al., 2014). Of the noninsulin antidiabetic drugs, the highest proportion of diabetic patients who achieved the HbA1C target of <7% were those taking sustained release exenatide (a GLP-1 analog) (63.2%) (Esposito et al., 2012). Of the insulin varieties, the highest proportion of diabetic patients who achieved the HbA1C target of <7% were those using basal bolus insulin (50.2%) (Esposito et al., 2012). While there are some concerns about the ability of diabetic patients with chronic kidney disease to clear metformin via renal excretion, extensive clinical experience supports its use in diabetic patients with mild to moderate renal impairment (Inzucchi et al., 2014). From the cost effectiveness studies, lifestyle modification (i.e., changes in diet and exercise) beginning at any age was determined to be a cost-effective approach in preventing and treating DM and may be cost saving for adults between the age of 25 to 44 (Herman et al., 2005). Screening for DM beginning at age 45 and repeating every three years if negative provides the best balance of effectiveness and cost effectiveness (Kahn et al., 2010). As a first-line clinical intervention, metformin was established to be cost-effective as well in treating DM (but less so compared to lifestyle modification) (Herman et al., 2005). Bariatric surgery for diabetics with a BMI greater than or equal to 35 kg/m2 has also been established as cost effective (Hoerger et al., 2010). Next, in considering the ideal frequency of clinical consultations, diabetics with a stable condition (assessed as HbA1c ≤7.5%, blood pressure ≤145 mmHg, and total cholesterol ≤201 mg/dL) can safely be seen by a primary care provider every six months compared to every three months with no noticeable decline in long-term health outcomes (Wermeling et al., 2014). For cases of T2D that cannot be simply controlled with metformin, sulfonylurea has shown that it is overall more cost-effective and effective as a second-line therapy when compared to DPP-4 inhibitors and GLP-1 analogs (Zhang et al., 2014). Cost effectiveness analysis of the long-acting analogue insulin detemir across different countries reveals substantially different cost effectiveness for the medication in terms of both nominal and purchasing power terms (Home et al., 2014). The results of these studies were parsed to establish a long-term clinical protocol for primary care providers in screening, diagnosing, and treating type 2 diabetes. Future studies should focus on integrating cost effectiveness and comparative effectiveness research in implementing even more nuanced clinical decisions through a structured protocol. The cost effectiveness of existing and new interventions--both clinical and non-clinical in nature--will also need to be continuously assessed to ensure that the measurements incorporate the most accurate set of assumptions on costs and effectiveness.

Infrastructure services are of fundamental importance to a country's economic and social well-being; however, decisions about such investments are complex, involving multiple actors, high levels of uncertainty and creating a multi-decadal lock-in to the choices made. Methodologies to assist with such decisions ('appraisal' methodologies) have developed to consider many of these complexities, yet they remain sector specific, ignoring interdependencies between infrastructure networks. Such methodologies thereby ignore the opportunities or vulnerabilities derived from these inter-relationships, simply assuming that cross-sectoral services will be provided, and ignoring the constraints created for future development. Furthermore, the siloed methodologies make calculation of the total system effects impossible, undermining strategic plans and obscuring any need (or ability to) prioritise across sectors. The work herein aimed to develop and demonstrate a strategic approach, capable of providing a more complete valuation of infrastructure investments by taking the interdependencies between the networks into account. In so doing, it examined the hypothesis that use of such a methodology could help deliver more robust outcomes. The work is founded on development of a common, cross-sector appraisal methodology: fifteen common, monetised infrastructure performance metrics, developed by reviewing the strategic priorities of infrastructure and the existing sectoral cost benefit analyses. This was integrated with best practice from portfolio, pathway and real option approaches to create a longer term, system focused analysis of the decision space. Testing the framework through a case study (the Thames Hub Vision), chosen specifically for its high number of sectors, diversity of impacts and magnitude of its interdependencies, it examines the information gained by the increased methodological complexity. The results demonstrate that current appraisal methods are indeed incomplete, with interdependencies creating additional value and the opportunity for increased robustness. Indeed, ignored system effects are found to be sufficient to reverse the result of the analysis and future effects enabled by the investments are found to be up to an order of magnitude greater than the direct impacts recorded by current appraisals. Furthermore, the response and sensitivity to uncertainty is shown to be affected by consideration of the system effects, both directly, through their application to multiple assets and indirectly, through interaction with the wider investment landscape. The proposed approach captures these values and relationships, allowing more informed decisions to be made. In addition, a decision support tool is developed providing the means to identify which opportunities stakeholders wish to maintain, how these can be created and which variables must be tracked to ensure the opportunities remain valid. The work therefore promotes a more active, strategic approach to infrastructure investment, allowing translation between national targets, regional stakeholder values and sector-specific technical requirements, to create a more holistic plan for a country's infrastructure networks.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / O objetivo deste trabalho é realizar uma avaliação econômica analisando o tratamento com atorvastatina e sinvastatina em comparação ao tratamento com placebo, no cenário do Sistema Único de Saúde (SUS), para subgrupos de pacientes classificados como alto risco de doença cardiovascular; avaliando se o custo adicional das estatinas em comparação ao tratamento placebo é justificado pelo ganho clínico esperado, em termos de redução de evento cardiovascular e redução de mortalidade. Utilizou-se o risco de eventos cardiovascular e a taxa de mortalidade como parâmetros de desfecho. Os dados epidemiológicos da doença e eficácia dos agentes terapêuticos foram obtidos de revisão e análise crítica da literatura. Um modelo analítico de decisão (Markov) foi desenhado para estimar a razão de custo-efetividade incremental da atorvastatina 10mg/dia e sinvastatina 40mg/dia em comparação ao placebo. A população analisada foi uma coorte hipotética composta por homens e mulheres, com idade média de 50 anos e com alto risco de doença cardiovascular. O modelo considera apenas custos médicos diretos, obtidos dos Sistemas de Informações Ambulatoriais e Hospitalares e Banco de Preços do Ministério da Saúde e de estudos de dados primários. A análise de custo-efetividade foi realizada através de planilha Excel, para o horizonte de tempo de 5 e 30 anos. O resultado revela que a atorvastatina 10mg/dia em comparação ao placebo tem maior custo e é mais efetiva, tanto no horizonte de tempo de 5 como no de 30 anos. A sinvastatina 40mg/dia mostrou ser uma estratégia de menor custo e maior efetividade, em comparação ao placebo, em ambos os horizontes de tempo analisados. O resultado da análise de impacto no orçamento demonstrou que o uso de sinvastatina 40mg/dia, em pacientes de alto risco de evento cardiovascular, representa minimização do custo anual em comparação ao uso de atorvastatina 10mg/dia. Observa-se que o tratamento com sinvastatina proporciona uma economia de, aproximadamente, 1,1 bilhão de reais em comparação ao tratamento com placebo. Em contrapartida, o tratamento dos pacientes com atorvastatina leva a um gasto adicional de cerca de 118,6 bilhões de reais em comparação ao tratamento com placebo. / The objective of this study is to perform an economic evaluation analyzing the treatment with atorvastatin and sinvastatin in comparison to placebo treatment, within the Brazilian Public Healthcare System (SUS) scenario, for patients with high risk of cardiovascular disease; analyzing if the additional cost related to statin treatment is justified by the clinical benefits expected, in terms of cardiovascular event and mortality reduction. Cardiovascular event risk and mortality risk were used as outcomes. Statin efficacy at LDL-c and cardiovascular events levels lowering data was obtained from a critical literature review. A decision analytic model was developed to perform a cost-effectiveness analysis comparing atorvastatin 10mg/day and sinvastatin 40mg/day to placebo treatment in patients with dyslipidemia in Brazil. The target population of this study was a hypothetic cohort of men and women with a mean age of 50 years old and high risk of cardiovascular disease. The model includes only direct costs obtained from Ambulatory and Hospital Information System and Price Database of Brazilian Ministry of Health. The comparative cost-effectiveness analysis itself was done through Excel spreadsheets covering a 5 or 30-years time horizon. The result shows that atorvastatin 10mg/day in comparison to placebo has higher cost with higher effectiveness in the time horizon of 5 and 30 years. The sinvastatin 40mg/day appears to be a strategy with lower cost and higher effectiveness in comparison to placebo, in both times horizon analyzed. The budget impact analysis shows that the use of sinvastatin 40mg/day, in patients with high risk of cardiovascular disease, leads to a cost minimization in comparison to the use of atorvastatin 10mg/day. The treatment with sinvastatin is responsible for an economy of, approximately, BRL1.1 billion in comparison to treatment with placebo. Otherwise, the treatment with atorvastatin leads to an additional cost of, approximately, BRL118.6 billions in comparison to the treatment with placebo.

No mundo, as hepatites decorrentes de infecções virais têm sido uma das grandes preocupações em saúde pública devido a seu caráter crônico, curso assintomático e pela sua capacidade de determinar a perda da função hepática. Com o uso em larga escala de medicamentos antirretrovirais, a doença hepática relacionada à infecção pelo vírus da hepatite C (VHC) contribuiu para uma mudança radical na história natural da infecção pelo vírus da imunodeficiência humana (HIV). Não se sabe ao certo o peso da coinfecção VHC/HIV no Brasil, mas evidências apontam que independentemente da região geográfica, esses indivíduos apresentam maiores dificuldades em eliminar o VHC após o tratamento farmacológico, quando comparados a monoinfectados. No âmbito do SUS, o tratamento antiviral padrão para portadores do genótipo 1 do VHC e do HIV é a administração de peguinterferon associado à Ribavirina. Quanto ao período de tratamento e aos indivíduos que devem ser incluídos, os dois protocolos terapêuticos mais recentes possuem divergências. A diretriz mais atual preconiza o tratamento de indivíduos respondedores precoces somados a respondedores virológicos lentos, enquanto a diretriz imediatamente anterior exclui na 12 semana indivíduos que não respondem completamente. Com base nessa divergência, esse estudo objetivou avaliar o custo-efetividade do tratamento contra o VHC em indivíduos portadores do genótipo 1, coinfectados com o HIV, virgens de tratamento antiviral, não cirróticos e imunologicamente estabilizados, submetidos às regras de tratamento antiviral estabelecidos pelas duas mais recentes diretrizes terapêuticas direcionadas ao atendimento pelo SUS. Para tal, foi elaborado um modelo matemático de decisão, baseado em cadeias de Markov, que simulou a progressão da doença hepática mediante o tratamento e não tratamento. Foi acompanhada uma coorte hipotética de mil indivíduos homens, maiores de 40 anos. Adotou-se a perspectiva do Sistema Único de Saúde, horizonte temporal de 30 anos e taxa de desconto de 5% para os custos e consequências clínicas. A extensão do tratamento para respondedores lentos proporcionou incremento de 0,28 anos de vida ajustados por qualidade (QALY), de 7% de sobrevida e aumento de 60% no número de indivíduos que eliminaram o VHC. Além dos esperados benefícios em eficácia, a inclusão de respondedores virológicos lentos mostrou-se uma estratégia custo-efetiva ao alcançar um incremental de custo efetividade de R$ 44.171/QALY, valor abaixo do limiar de aceitabilidade proposto pela Organização Mundial da Saúde OMS - (R$ 63.756,00/QALY). A análise de sensibilidade demonstrou que as possíveis incertezas contidas no modelo são incapazes de alterar o resultado final, evidenciando, assim, a robustez da análise. A inclusão de indivíduos coinfectados VHC/HIV respondedores virológicos lentos no protocolo de tratamento apresenta-se, do ponto de vista fármaco-econômico, como uma estratégia com relação de custoefetividade favorável para o Sistema Único de Saúde. Sua adoção é perfeitamente compatível com a perspectiva do sistema, ao retornar melhores resultados em saúdeassociados a custos abaixo de um teto orçamentário aceitável, e com o da sociedade, ao evitar em maior grau, complicações e internações quando comparado à não inclusão. / Worldwide, hepatitis caused by viral infections has been a major concern for public health because of its chronicity, asymptomatic course and its ability to determine the loss of liver function. With the widespread use of antiretroviral drugs, liver disease related to infection with hepatitis C virus (HCV) contributed to a radical change in the natural history of infection with human immunodeficiency virus (HIV). No one knows for sure the weight of coinfection HCV/HIV in Brazil, but evidence suggests that, regardless of geographic region, these individuals have greater difficulty in eliminating HCV compared to monoinfected. In the Brazilian Unified Health System (SUS), the standard antiviral treatment for patients infected with genotype 1 HCV and HIV is the association of pegylated interferon with ribavirin. Regarding the treatment period and which individuals should treat the two most recent protocols have disagreements. The most current protocol calls for treatment of early responders individuals added to slow responders. Since the guideline immediately preceding the 12th week excludes individuals who do not respond completely. Based on this difference, this study aimed to evaluate the costeffectiveness of HCV treatment in individuals with the genotype 1 coinfected with HIV, antiviral-naïve, non-cirrhotic and immunologically stable, undergoing antiviral treatment rules established by two most recent therapeutic guidelines directed to attend by SUS. To this evaluation, was developed a mathematical model of decision, based on Markov chains, simulating the progression of liver disease under treatment and no treatment. It was accompanied by a hypothetical cohort of thousand men individuals, more than 40 years. Was adopted the perspective of the Brazilian Unified Health System, time horizon of 30 years and a discount rate of 5% for the costs and for clinical consequences. The extension of treatment to slow responders provided an increase of 0.28 years of quality-adjusted life (QALY), 7% survival rate and an increase of 60% in the number of individuals who eliminated HCV. Besides the expected benefits in efficacy, the slow viral responders inclusion proved to be a costeffective strategy to achieve an incremental cost-effectiveness of BRL 44,171.00/QALY, value below of acceptability threshold proposed by the World Health Organization (BRL 63,756.00/QALY). Sensitivity analysis demonstrated that the potentials uncertainties in the model are unable to alter the final result, thus demonstrating the robustness of the analysis. The Inclusion of HCV/HIV co-infected individuals slow virologic responders to treatment protocol, is presented from the point of pharmacoeconomic view, as a strategy to cost-effectiveness favorable for the Brazilian Health System. Its adoption is perfectly compatible with the system perspective, returning better health outcomes with costs below an acceptable budget cap, and the society, to avoid a greater extent, complications and hospitalizations when compared to non-inclusion.

Magister Scientiae - MSc (Pharmacy Administration and Policy Regulation) / The aim of this study is to provide more information in terms of the cost-effectiveness of selecting an enantiopure formulation over a racemic mixture in the context of promoting rational use of medicines. This was done by comparing costs and efficacy of escitalopram versus citalopram and esomeprazole versus omeprazole since they are the most commonly used medicines with both racemate and enantiopure products registered.

Thesis (MTech (Information Technology))--Peninsula Technikon, 2005 / "This study was initiated to determine whether cost estimation is a necessary skill for an Information Technology (IT) consultant. The historic poor record in the software industry for delivering software projects within budget has highlighted a need for IT students to receive adequate preparation for future experiences in the world of work especially if they were to become self-employed. The literature revealed that a variety of employability skills are required when preparing students for entrepreneurship. In IT there is a particular need for project management skills when the entrepreneur is responsible for all aspects of the software project. Cost estimation is a key function of project management.

Thesis (MTech (Business Administration))--Cape Peninsula University of Technology, 2016. / The study, using a selected University of Technology (UoT) as a case study, investigated factors influencing information technology (IT) investments in adopting new technologies in University of Technologies (UoTs). The objective is to determine the benefits of IT investments in UoTs and the impact on UoT operations. Technology is constantly advancing and impacting on organisations’ decisions and how to acquire the right technology for effective administration. IT-investment decisions require unique understanding and management by organisations to properly adapt to changing technology. The research was based on the premise that the purpose of deploying new technologies in any organisation is to reduce the costs of running the organisation and to improve operational effectiveness. This would include Higher Education Institutions (HEIs). However, at most UoTs there is a slow response to adopting new technologies, making them lag behind in the deployment of such technologies.

Thesis (MTech (Construction Management))--Cape Peninsula University of Technology, 2017. / The study investigates the predominant factors responsible for increase in the cost of building materials and the effect of this cost increase on housing delivery in Western Cape, South Africa. Sustainable housing is buildings produced to meet the present housing needs of people without conceding the ability of the future generation to meet their future needs. However, a significant increase in the cost of building materials has been a major constraint to the delivery of sustainable housings, as made evident in the literature, leading to project cost and time overruns or even project abandonment. However, building materials consume up to 65% of the total cost of construction. This factor on cost has, over the years, threatened the ability of the construction industry to deliver projects within budgeted cost, at stipulated time, and at satisfactory quality. This prompted the need to proffer solutions to these factors identified which are causing increases in the cost of building materials towards sustainable housing delivery in Western Cape. Based on this research study, housing is termed to be sustainable when it is available and affordable for the masses timely and at quality expected. The research study adopted a mixed methodological approach, involving the use of semi-structured qualitative interviews and closed-ended quantitative questionnaires administered to construction stakeholders (architects, quantity surveyors, engineers, construction managers, project managers, site supervisors and material suppliers) in the Western Cape Province of South Africa. SPSS version 24 software was used for analysing the quantitative data collected and ‘content analysis’ method was used to analyse the information collected through the qualitative interviews. The findings revealed that the major factors responsible for increasing the cost of building materials are inflation, wastages of building materials by labourers, cost of transportation and distribution of labour, design changes, client contribution to design change and change in government policies and regulation. Moreover, the research showed that fluctuation in the cost of construction and high maintenance costs due to poor workmanship also impact the cost increase of building materials for housing delivery. In addition, research findings affirmed that for optimum materials usage for the enhancement of sustainable construction, the following criteria should be considered in the selection of building materials: maintenance cost, energy consumption and maintainability. The adoption of these findings by construction stakeholders in the South African construction industry would enhance the delivery of affordable housing at reduced cost, at the required time and at the expected quality. Therefore, an adequate implementation of the framework presented in this study will enhance sustainable housing delivery.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / As ações de prevenção, diagnóstico e tratamento da hepatite C crônica integram as agendas das políticas de saúde do Brasil e do mundo, pois se trata de uma doença com grande número de acometidos, com alto custo tratamento e que ocasiona graves desfechos e incapacidade, o que acaba por onerar seu custo social. Os protocolos clínicos e diretrizes terapêuticas demonstram os esforços de inúmeras entidades no combate da hepatite C, pois informam aos profissionais de saúde, pacientes e familiares e cidadãos em geral, qual seria a melhor forma, comprovada cientificamente, de se proceder frente a uma infecção desta natureza. Realizouse uma análise de custoefetividade, sob a perspectiva do SUS, das estratégias: tratamento e retratamento com a terapia dupla, tratamento com a terapia dupla e retratamento com a terapia tripla e tratamento com a terapia tripla. Através de modelo de simulação baseado em cadeias Markov foi criada uma coorte hipotética de 1000 indivíduos adultos, acima de 40 anos, de ambos os sexos, sem distinção declasse socioeconômica, com diagnóstico confirmado para hepatite C crônica, monoinfectados pelo genótipo 1 do VHC e com ausência de comorbidades. A simulação foi iniciada com todos os indivíduos portando a forma mais branda da doença, tida como a classificação histológica F0 ou F1 segundo a escala Metavir. Os resultados demonstram que as duas opções, ou seja, a terapia dupla/tripla e a terapia tripla estão abaixo do limiar de aceitabilidade para incorporação de tecnologia proposto pela OMS (2012) que é de 72.195 (R$/QALY) (IBGE, 2013; WHO, 2012). Ambas são custoefetivas, visto que o ICER da terapia dupla/tripla em relação alinha de base foi de 7.186,3 (R$/QALY) e o da terapia tripla foi de 59.053,8 (R$/QALY). Entretanto o custo incremental de terapia tripla em relação à dupla/tripla foi de 31.029 e a efetividade incremental foi de 0,52. Em geral, quando as intervenções analisadas encontramse abaixo do limiar, sugerese a adoção do esquema de maior efetividade. A terapia tripla, apesar de ter apresentado uma efetividade um pouco acima da terapia dupla/tripla, apresentou custo muito superior. Assim, como seria coerente a adoção de uma ou da outra para utilização no SUS, visto que este sistema apresenta recursos limitados, indicase a realização de um estudo de impacto orçamentário para obterse mais um dado de embasamento da decisão e assim poder apoiar o protocolo brasileiro existente ou sugerir a confecção de novo documento. / The prevention, diagnosis and treatment of chronic hepatitis C integrates health policies in Brazil and worldwide. This disease affect many people, features high cost treatment and cause severe outcomes and disability, increasing social cost. We performed a costeffectiveness analysis under the perspective of SUS, with the following strategies: treatment and retreatment with dual therapy, treatment with dual therapy and retreatment with triple therapy and treatment with triple therapy. A Markov model was developed with a hypothetical cohort of 1000 adults, over 40 years, of both sexes, with confirmed diagnosis for chronic hepatitis C, monoinfected by HCV genotype 1 and absence of comorbidities.The simulation started with all individuals carrying the milder form of the disease, considered F0 or F1, according to Metavir histological classification. The results demonstrate the dual/triple therapy and triple therapy are below the acceptable threshold for embedding technology proposed by the WHO. Both are costeffective. ICER of dual/triple therapy compared with base line was 7186.3 (R$/QALY) and the triple therapy compared with dual/triple therapy was 59053.8 (R$/QALY). However, the incremental cost of triple therapy compared to dual/triple therapy was 31,029 and incremental effectiveness was 0.52. Triple therapy, despite having a little more effectiveness than the dual/triple therapy, showed much highercost. Thus, as would be consistent adopt one or the other for use in the SUS, since this system has limited resources, is better indicate the realization a budget impact analysis to have one more data information to support the decision to continue adopting the Brazilian guideline existing or suggest making another one.