title: Estimating health service utilization for treatment of pneumococcal disease: the case of Brazil.
abstract: BACKGROUND
  Health service utilization (HSU) is an essential component of economic evaluations of health initiatives. Defining HSU for cases of pneumococcal disease (PD) is particularly complex considering the varying clinical manifestations and diverse severity.
  
  
  OBJECTIVE
  We describe the process of developing estimates of HSU for PD as part of an economic evaluation of the introduction of pneumococcal conjugate vaccine in Brazil.
  
  
  METHODS
  Nationwide inpatient and outpatient HSU by children under-5 years with meningitis (PM), sepsis (PS), non-meningitis non-sepsis invasive PD (NMNS), pneumonia, and acute otitis media (AOM) was estimated. We assumed that all cases of invasive PD (PM, PS, and NMNS) required hospitalization. The study perspective was the health system, including both the public and private sectors. Data sources were obtained from national health information systems, including the Hospital Information System (SIH/SUS) and the Notifiable Diseases Information System (SINAN); surveys; and community-based and health care facility-based studies.
  
  
  RESULTS
  We estimated hospitalization rates of 7.69 per 100,000 children under-5 years for PM (21.4 for children <1 years of age and 4.3 for children aged 1-4 years), 5.89 for PS (20.94 and 2.17), and 4.01 for NMNS (5.5 and 3.64) in 2004, with an overall hospitalization rate of 17.59 for all invasive PD (47.27 and 10.11). The estimated incidence rate of all-cause pneumonia was 93.4 per 1000 children under-5 (142.8 for children <1 years of age and 81.2 for children aged 1-4 years), considering both hospital and outpatient care.
  
  
  CONCLUSIONS
  Secondary data derived from health information systems and the available literature enabled the development of national HSU estimates for PD in Brazil. Estimating HSU for noninvasive disease was challenging, particularly in the case of outpatient care, for which secondary data are scarce. Information for the private sector is lacking in Brazil, but estimates were possible with data from the public sector and national population surveys.
authors.affiliation: Clínica de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas, São Paulo, Brazil. ana.sartori@hc.fm.usp.br
authors.forename: A M C
authors.initials: AM
authors.lastname: Sartori
authors.forename: C G
authors.initials: CG
authors.lastname: Novaes
authors.forename: P C
authors.initials: PC
authors.lastname: de Soárez
authors.forename: C M
authors.initials: CM
authors.lastname: Toscano
authors.forename: H M D
authors.initials: HM
authors.lastname: Novaes
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data; D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008586:Meningitis, Pneumococcal / Q000191:economics / Q000453:epidemiology; D010033:Otitis Media / Q000191:economics / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000191:economics* / Q000453:epidemiology; D022242:Pneumococcal Vaccines / Q000191:economics; D011014:Pneumonia / Q000191:economics / Q000453:epidemiology; D018805:Sepsis / Q000191:economics / Q000453:epidemiology; D018074:Vaccines, Conjugate / Q000191:economics
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate