Portuguese Setting Research Articles

Empirical evidence for the validity of the job crafting scale (JCS) in a Portuguese setting

Purpose This study aims to adapt and validate the Job Crafting Scale (JCS), a measure based on the conceptualization of job crafting of the job demands–resources theory, for a sample of Portuguese workers and to test its psychometric properties regarding validity (factor, convergent, discriminant, and criterion) and reliability. Design/methodology/approach Two subsamples (n1 = 315 and n2 = 329) of Portuguese workers aged 18 years old and over participated in this research. Exploratory factor analysis and confirmatory factor analysis were used to assess the factor structure. Findings The results indicated that the Portuguese version of the JCS, with 18 items, has a factor structure composed of four-correlated factors. Furthermore, the results demonstrated the existence of factor, discriminant, and criterion validity, as well as reliability. Originality/value This study provides a job crafting measure adapted to the Portuguese language that can serve as a diagnostic tool for workers and organizations.

Training and attitudes concerning cardiac rehabilitation in Portugal: A national survey of physician members of the Portuguese Society of Cardiology

Introduction and ObjectivesCardiac rehabilitation (CR) is a central component in the management of cardiovascular disease. While its potential benefits have been extensively explored and confirmed, its implementation is still suboptimal, due to various possible barriers. This study aimed to assess training and attitudes concerning CR among physicians in a Portuguese setting. MethodsAn online questionnaire structured in three parts (participant characteristics, training and attitudes concerning CR, and a brief general knowledge assessment) was developed and sent to members of the Portuguese Society of Cardiology. The study population encompassed physicians with a medical specialty or residents from the third year onward of a specialty program. ResultsA total of 97 individuals (57.7% male, 61.9% aged ≤50 years) presented valid answers. CR was available at the workplace of 54.6% of participants. Most of them considered that the time allocated to CR training during residency was inadequate, and thought that more time was needed for this purpose. Most had not dedicated (or intended to dedicate) time for CR training, with lack of time being the most frequently attributed reason. In terms of referral, a substantial proportion of subjects did not refer patients, with lack of CR centers and human resources being the most frequent reasons. ConclusionsThis survey provides contemporary data on CR training and attitudes, highlighting areas of potential improvement, such as time allocated to training in this area. These results could provide a useful pragmatic framework for optimization of training and awareness in this pivotal field of cardiovascular medicine.

EE50 What Is the Economic Impact of an Early Adoption of High Efficacy Treatments in Multiple Sclerosis? A Cost-Consequence Analysis From a Societal Perspective in the Portuguese Setting

EE50 What Is the Economic Impact of an Early Adoption of High Efficacy Treatments in Multiple Sclerosis? A Cost-Consequence Analysis From a Societal Perspective in the Portuguese Setting

“A proof of life” through transition from hospital to home after a stroke in a Portuguese setting - a multi-perspective, longitudinal qualitative study

ABSTRACT Purpose The impact of a stroke is particularly evident during the transition home, with reported unmet needs. However, little is known about post-stroke adaptation in Portugal. This study aimed to understand how Portuguese people with stroke and their informal carers/family adapt over time, and how health professionals support their adaptation. Methods A multi-perspective, longitudinal qualitative study was conducted using in-depth semi-structured interviews one and six months after inpatient discharge. A purposive sample of 24 participants (8 triads) participated. Thematic and narrative analysis strategies were used. Results Three themes were identified: Managing change over time; Balancing support over time; Changing priorities. These suggest the importance of time and gradual adjustment of health professionals’ approach throughout the rehabilitation process tailored to people with stroke’ and carers’ needs. Both valued positive thoughts and support from others to adjust life goals and find a balance between a mutual/bidirectional support and time for themselves. Conclusions Findings show that the manner in which changes after a stroke are approached may be positively transformed to provide strength. As a result of the deeper understanding gained from this study, health professionals may be better placed to acknowledge the needs of people with stroke and carers and find effective ways of supporting them.

Estimation of 10-year risk of fatal and non-fatal cardiovascular disease in a portuguese population

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular disease (CVD) is the most common noncommunicable disease and actually the leading cause of death globally. Hence, it is important to identify individuals who may benefit from CVD preventive strategies. The European Society of Cardiology (ESC) has recently updated the European Systematic Coronary Risk Evaluation (SCORE) to SCORE2 and SCORE2-OP risk prediction algorithms. Those tools were recalibrated to four groups of countries (low, moderate, high and very high CVD risk) based on national CVD mortality rates published by the WHO, with Portugal being now considered a moderate risk country. Purpose To evaluate the application of SCORE2 and SCORE2-OP in a Portuguese population sample. Methods We conducted a cross-sectional study, including individuals aged 40-90 years, without known established Atherosclerotic Cardiovascular Disease, Diabetes mellitus, Chronic Kidney Disease or Familial Hypercholesterolemia. The sample was recruited at a local cardiovascular screening event in Portugal that took place in May 2022. The 10-year fatal and non-fatal CVD risk was calculated using SCORE2 (for individuals aged < 70 years) and SCORE2-OP (for individuals aged ≥ 70 years) tools. Based on CVD risk category, patients were stratified into 3 categories: low to moderate, high and very high risk according to new SCORE algorithms. Primary outcome was the assessment of 10-year risk of fatal and non-fatal CVD with SCORE2 e SCORE2-OP in a local Portuguese population. According to the data distribution, appropriate statistical tests were conducted to compare independent samples. Multivariable linear regression was used to analyze 10-year CVD risk. Results This cohort included 431 individuals. Median age was 71 years (Q1-Q3: 65-75) and 66.8% of individuals were women. Regarding baseline characteristics of the included individuals, 48.1% had hypertension, 38.3% had dyslipidemia, 25.5% were obese and 6.6% were smokers. Based on the SCORE2 model 92 (26.1%) individuals were classified into low to moderate risk, 162 (46.0%) into high risk and 98 (27.8%) into very high-risk category. SCORE2 median was 3.43 % (Q1-Q3: 5.5-8.0 p< 0.01) and SCORE2-OP median was 12.70 % (Q1-Q3: 9.7-12.7). Active smoking was the only independent predictor of 10-years CVD risk both in SCORE2 (RR 3.28, 95% CI: 1.93-4.66, p=0.001) and SCORE2-OP (RR 6.31, 95% CI: 2.67-9.52, p<0.001). Conclusions Most individuals in this sample were stratified into high or very high risk of developing 10-year fatal and non-fatal cardiovascular events. This data is in accordance with the updated risk category of Portugal based on World Health Organization cardiovascular mortality rates. These results not only validate the application of SCORE to the Portuguese setting, but also reinforce how this easily applicable tool can help to identify patients who will benefit from CVD preventive strategies.

Peripheral Nerve Block Practice in Portugal: A National Survey.

Regional anesthesia (RA) has several benefits and its use has increased with the advent of ultrasound-guided techniques. Opioid-sparing anesthesia and reduced use of general anesthesia are some of the mainstay advantages of RA. Although anesthetic practices differ deeply between countries, RA has assumed a crucial role in the daily practice of anesthesiologists, particularly during the COVID-19 pandemic period. This cross-sectional study provides an overview of peripheral nerve block (PNB) techniques performed in Portuguese hospitals. An online survey was reviewed by members of Clube de Anestesia Regional (CAR/ESRA Portugal) and then sent to a national mailing list of anesthesiologists. The survey focused on specific topics related to RA techniquessuch as the importance of training and experience, and the relevance of logistical limitations during the execution of RA. All data were collected anonymously and included in a Microsoft Excel (Microsoft Corp., Redmond, WA, USA) database, for further analysis. A total of 335 valid answers were obtained. All participants considered RA as a key competence in their daily practice. Half of those inquired performed PNB techniques once to twice per week. The main limitations identified for performing RA in Portuguese hospitals were the absence of block rooms and insufficiently trained personnel for the appropriate and safe execution of these techniques. This survey provides a comprehensive overview of RA in the Portuguese setting and could serve as a baseline for further studies.

Cultural Adaptation and Validity Testing of the Portuguese Version of the Health Literacy Questionnaire (HLQ).

Background: Health literacy is considered a determinant of self-management behaviors and health outcomes among people with diabetes. The assessment of health literacy is central to understanding the health needs of a population. This study aimed to adapt the Health Literacy Questionnaire (HLQ) to the Portuguese context and to examine the psychometric properties of a population of people with diabetes. Methods: Data were collected using a self-administrated questionnaire from 453 people with diabetes in a specialized diabetes care unit. Analysis included item difficulty level, composite scale reliability, and confirmatory factor analysis (CFA). Results: The HLQ showed that the items were easily understood by participants. Composite reliability ranged from 0.74 to 0.83. A nine-factor CFA model was fitted to the 44 items. Given the very restricted model, the fit was quite satisfactory [χ2wlsmv = 2147.3 (df = 866), p = 0.001; CFI = 0.931, TLI = 0.925, RMSEA = 0.057 (90% C.I. 0.054–0.060), and WRMR = 1.528]. Conclusion: The Portuguese version of the HLQ has shown satisfactory psychometric properties across its nine separate scales in people with diabetes. Given the strong observed properties of the HLQ across cultures, languages, and diseases, the HLQ is likely to be a useful tool in a range of Portuguese settings.

“Mix of Races, Bad Uterus”: Obstetric Violence in the Experiences of Afro-Brazilian Migrants in Portugal

In this article, I address the issues of obstetric violence and racism in the Portuguese setting of obstetric care. Based on data collected through interviews and participatory artistic creation, I analyze the perception of three Afro-Brazilian migrants about their perinatal experiences of obstetric care in the Portuguese public sector between 2013 and 2019. These women’s experiences have much in common with experiences of obstetric violence as narrated by Portuguese, non-racialized women. Despite this, certain aspects of their experience are related to their particular identification as Brazilian, migrant, and Black, such as xenophobic discrimination and their placement in systems of stratified reproduction, including a supposed tendency for birth by caesarean section, as well as self-policing behaviors because of the stereotype of Brazilian women as flirty. I consider a range of manifestations of obstetric violence and racism, from more overt forms to more covert ones, to analyze how, in a country where racism and obstetric violence are only slowly beginning to be recognized as the norm, multiple discriminations intersect and have an impact on the experiences of women of their bodies in pregnancy, birth, and postpartum, including breastfeeding.

Confirmatory Evaluation of the Modified Medical Research Council Questionnaire for Assessment of Dyspnea in Patients with Chronic Obstructive Pulmonary Disease in Portugal.

The Modified British Medical Research Council Questionnaire is considered an adequate and simple measure of breathlessness in chronic obstructive pulmonary disease. It is widely used in clinical practice in Portugal, but it still lacks confirmatory evaluation for the Portuguese setting. The aim of this study was to perform a cultural adaptation and validation of the Modified British Medical Research Council Questionnaire so that its most suitable version can be made available to researchers and clinicians in Portugal. We performed a cross-sectional descriptive study involving patients with chronic obstructive pulmonary diseaseaged 40 years or older. We applied the Modified British Medical Research Council Questionnaire and the previously validated Portuguese-language version of the clinical questionnaire for chronic obstructive pulmonary disease between January and June 2019.We determined the agreement between the two questionnaires with kappa agreement, with a 95% confidence interval, and we used Spearman correlation to find a correlation between two scores. The study included 65 patients managed in a hospital pulmonology clinic (aged 68 ± 7 years; with predicted FEV1 of 49.86%± 16.5%). The Modified British Medical Research Council scale correlated significantly with all the domains and the overall score of the clinical questionnaire for chronic obstructive pulmonary disease (0.46 < r < 0.68; p < 0.001). In bilingual patients, interclass correlation coefficient was 0.912 (p < 0.001). Our study showed that the Portuguese-language version of the Modified British Medical Research Council Questionnaire is feasible and externally valid when compared with a traditional and previously validated instrument. The Portuguese version of the Modified British Medical Research Council Questionnaire is a valid instrument for measurement of breathlessness in chronic obstructive pulmonary disease.

POSB50 A Cost-Effectiveness Analysis of Rivaroxaban in Combination with Acetylsalicylic Acid (ASA) in Adult Patients with Coronary Artery Disease (CAD) or Symptomatic Peripheral Artery Disease (PAD) at High Risk of Ischaemic Events

To assess the cost-effectiveness of rivaroxaban plus acetylsalicylic acid (ASA) compared to ASA alone in the treatment of patients with coronary artery disease (CAD) or peripheral artery disease (PAD), in the Portuguese setting.

POSA56 A Cost-Effectiveness Analysis of Polatuzumab in Combination with Bendamustine and Rituximab in Patients with Relapsed/Refractory Diffuse Large B-Cell Lymphoma in Portugal

To assess the cost-effectiveness of polatuzumab in combination with bendamustine and rituximab (BR) compared to BR in the treatment of patients with relapsed/ refractory (R/R) diffuse large B-cell lymphoma (DLBC), in the Portuguese setting.

POSB151 Brigatinib As a Leading Option to Manage Previously Not Treated Patients with Anaplastic Lymphoma Kinase-Positive Advanced Non-Small Cell Lung Cancer (ALK+ NSCLC) in Portugal

ALK+ NSCLC is an aggressive subtype of lung cancer with high rates of Central Nervous System (CNS) metastasis, with 15-35% of patients presenting brain metastases at diagnosis, leading to a major clinical burden and a high economic impact on national healthcare systems (NHS). Crizotinib, a first-generation tyrosine kinase inhibitor (TKI), currently used in the Portuguese setting as first-line (1L) treatment, has shown limited CNS efficacy – 70% of patients experience CNS disease progression during treatment with crizotinib.

POSB51 A Cost-Effectivess Analysis of Trastuzumab Emtansine Versus Trastuzumab for the Adjuvant Treatment of Patients with Residual Invasive HER2-Positive Breast Cancer in Portugal

To assess the cost-effectiveness of trastuzumab emtansine (T-DM1) versus trastuzumab for the adjuvant treatment of patients with residual invasive HER2-positive breast cancer (BC) after completion of preoperative systemic treatment in the Portuguese setting.

Portuguese translation and cultural adaptation of the Music in Dementia Assessment Scales (MiDAS)

ABSTRACT Introduction Music in Dementia Assessment Scales (MiDAS) is an observational, dementia-specific, visual analogue scale, developed to measure musical experiences of patients with dementia (PwD). It was derived from qualitative data from focus groups and interviews with PwD, carers, care home staff, and music therapists. Since its publication, there has been great interest in using MiDAS in several European countries, including Portugal. However, no adaptation to Portuguese language and culture is yet available. In this manuscript, we aim to describe the process of translation and cultural adaptation of MiDAS to European Portuguese, presenting the final MiDAS-PT version. Method We have followed a rigorous 10-step approach, consisting of: a preparation stage; elaboration of two forward translations; synthesis of the latter versions; back-translation by a bilingual professional translator; revision of that version by the original author of MiDAS; harmonization with other versions of MiDAS in different languages; testing and debriefing of the final version with volunteer health professionals; consensus meetings; proofreading; and, finally, the reporting of the process. Results No major changes have been made to the actual content text of MiDAS. Some minor adjustments were made to the wording, and additional instruction details were added in order to increase clarity and adequacy in the Portuguese setting. Discussion Overall, Portuguese health professionals considered the instrument to be user-friendly and intuitive in terms of content, structure and layout. To allow the use of MiDAS-PT for research and clinical purposes, the next step will be a study of its psychometric properties.

PCN68 An Incremental Effectiveness Analysis of Lorlatinib for the Treatment of ALK-Positive Advanced Non-Small Cell Lung Cancer that has Progressed after Another ALK Tyrosine Kinase Inhibitor in Portugal

To evaluate the incremental effectiveness of anaplastic lymphoma kinase (ALK) inhibitor lorlatinib compared to platinum-based chemotherapy (PBC) for adult patients with ALK-positive advanced non-small cell lung cancer (NSCLC) whose disease progressed after alectinib or ceritinib as the first ALK tyrosine kinase inhibitor (TKI) therapy or after crizotinib and at least one other ALK TKI in the Portuguese setting. A partitioned-survival model was developed, with progression-free survival (PFS), overall survival (OS), and time on treatment (ToT) for lorlatinib obtained through parametric survival models fit to data from the single-arm phase I/II trial B7461001. For PBC, PFS was modelled using a hazard ratio (HR) estimated from a matching-adjusted indirect comparison based on the B7461001 trial for lorlatinib and a retrospective chart review study for PBC. No OS data were available for PBC in the relevant populations, hence the PFS HR was used as a proxy for the OS HR. PBC ToT was assumed to be equal to PFS. Utility weights for pre-progression and post-progression on lorlatinib were based on the B7461001 trial, and the utility weight for post-progression after PBC or lorlatinib was found in the literature. A lifetime horizon was used. Deterministic and probabilistic sensitivity analyses were conducted. Treatment with lorlatinib allowed for a gain of 1.87 life years (LYs) or 1.40 quality-adjusted life years (QALYs) in patients whose disease progressed after alectinib or ceritinib and a gain of 1.57 LYs or 1.04 QALYs in patients whose disease progressed after crizotinib and another ALK TKI. Sensitivity analyses showed that the model was robust to parameter variation, except for the extrapolations of OS and ToT for lorlatinib. Lorlatinib results in increased life expectancy and quality-adjusted life expectancy compared with PBC in previously treated adult patients with ALK-positive NSCLC in the Portuguese setting.

PCN89 A Cost-Effectiveness Analysis of Atezolizumab in Combination with Carboplatin and Etoposide in Patients with Untreated Extensive-Stage Small Cell Lung Cancer

To assess the cost-effectiveness of atezolizumab in combination with carboplatin and etoposide (CE) compared to CE in the treatment of patients with untreated extensive-stage small cell lung cancer (ES-SCLC), in the Portuguese setting. A partitioned survival model including progression-free survival, post-progression survival and death health states was used to estimate the cost-effectiveness of atezolizumab in combination with CE, using data from the IMpower133, a phase III, randomized, double-blind, placebo-controlled trial. Utility weights were estimated using the proximity to death approach separately for on/off treatment and applying the EQ-5D-5L Portuguese value set to the patient reported outcomes from the IMpower133 trial. Portuguese-specific disease management resource use was based on a panel of clinical experts and on Portuguese diagnosis-related group microdata. The main sources for unit costs were national legislation and official drug cost databases. The analysis was conducted from NHS’s perspective, assuming a lifetime horizon and a 5% discount rate for both costs and effects. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of results. Atezolizumab increases average life expectancy by 0.24 undiscounted life years (LY) or 0.22 undiscounted quality adjusted life years (QALY), enabling a discounted gain of 0.22 LY or 0.20 QALY. Economic analysis shows that the higher cost of the atezolizumab option is mainly due to higher treatment costs. The estimated incremental cost-effectiveness ratios are 124,218€/LY and 138.494€/QALY. Deterministic sensitivity analyses show that results are robust to most scenarios but sensitive to the parametric extrapolation options of the treatment duration and overall survival. Treatment with atezolizumab in combination with CE showed an incremental effectiveness both in terms of LY and QALY compared to CE alone. The cost-effectiveness model of atezolizumab in combination with CE in patients with untreated ES-SCLC was considered valid to support a reimbursement decision in the Portuguese setting.

PCN136 Cost-Effectiveness Analysis of Dacomitinib Versus Gefitinib for the First-line Treatment of Locally Advanced or Metastatic Non-Small Cell Lung Cancer with Epidermal Growth Factor Receptor (EGFR)-Activating Mutations in Portugal

To evaluate the cost-effectiveness of dacomitinib versus gefitinib for the first-line treatment of locally advanced or metastatic non-small cell lung cancer with epidermal growth factor receptor (EGFR)-activating mutations in Portugal. The cost-effectiveness analysis was based on a partitioned survival model using data from ARCHER 1050 trial, a head-to-head phase III randomized controlled trial of dacomitinib versus gefitinib. The model estimated patients’ pathway through progression free survival, post-progression and death health states. Utility weights varied by treatment line and were derived from ARCHER 1050 using EQ-5D-3L for first line treatment and based on the literature for the remaining treatment lines and best supportive care. Portuguese-specific resource use was based on a panel of clinical experts and on Portuguese diagnosis-related group microdata. National legislation and official drug cost databases were the main sources for unit costs. The analysis was conducted from a payers’ perspective, assuming a lifetime horizon, and a 5% annual discount rate for both costs and effects. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the model and its results. Dacomitinib increased average life expectancy enabling a discounted gain of 0.45 life years (LY) or 0.29 quality adjusted life years (QALY). Economic analysis showed overall higher costs with gefitinib (10,912€), mainly due to drug costs in both first and subsequent treatment lines. Dacomitinib was a dominant option when compared to gefitinib. Deterministic sensitivity analyses showed that results were robust in most evaluated scenarios. Despite slightly sensitive to parametric extrapolation of progression-free survival, the dominance relationship was still observed. The cost-effectiveness analysis of dacomitinib for the first-line treatment of locally advanced or metastatic non-small cell lung cancer with EGFR-activating mutations showed that dacomitinib was a dominant option when compared to gefitinib in the Portuguese setting.

Portuguese Experience With IFRS Adoption As Perceived By Auditors

Purpose: Drawing on the experience of adoption of a model based on the International Financial Reporting Standards (IFRS) by Portuguese non-financial unlisted companies in 2010, called Sistema de Normalizacao Contabilistica (SNC), this paper explores auditors’ perceptions regarding dimensions of relevance and suitability of the new accounting model to the Portuguese setting, major problems encountered, and the main engendered benefits.

Cost-effectiveness of cladribine tablets versus fingolimod in patients with highly active relapsing multiple sclerosis in Portugal

Aims: To assess the cost-utility of cladribine tablets versus fingolimod in patients with highly active relapsing-remitting multiple sclerosis (RRMS) in Portugal.Methods: A 1-year cycle cohort-based Markov state transition model was developed to simulate disease progression, measured by Kurtzke Expanded Disability Status Scale (EDSS), relapses, and conversion to secondary-progressive MS (SPMS). Patients were assumed to remain on treatment until progression to EDSS level 7, conversion to SPMS, or complete loss of efficacy due to waning effect. Natural history was based on British Columbia Multiple Sclerosis registry, London Ontario database, UK MS Trust, and cladribine tablets clinical trial (CLARITY). Portuguese all-cause mortality was adjusted for the MS associated increased mortality. Clinical inputs for active treatments (disability progression and relapse rate) were estimated on a network meta-analysis. Utility weights were derived from UK-MS Survey and published literature. Resource consumption by EDSS and due to relapses was based on published literature, National DRG microdata and expert opinion. Unit costs were obtained from official sources. The analysis was conducted from payers’ perspective, time horizon of 50 years and discount rate of 5%, for both costs and benefits. Uncertainty was assessed via probabilistic and deterministic sensitivity analyses.Results: Compared to fingolimod, cladribine tablets were associated with a delay in progression, resulting in a gain of 0.85 quality adjusted life years (QALYs) and a cost decrease of 25,935 €. Probabilistic sensitivity analysis resulted in a mean ICER of −31,781 € per QALY and was dominant in 98.7% of the simulations. Cladribine tablets were dominant across the scenario analyses tested.Conclusions: Treatment of highly active RRMS with cladribine tablets was less costly and more effective than treatment with fingolimod. Hence, it is a dominant strategy in the Portuguese setting. No conclusions can be drawn from the present study regarding other treatment options, in particular natalizumab and alemtuzumab.

PDG88 COST-UTILITY ANALYSIS OF ABIRATERONE VERSUS ENZALUTAMIDE IN THE TREATMENT OF METASTATIC CASTRATION-RESISTANT PROSTATE CANCER AFTER FAILURE OF ANDROGEN DEPRIVATION THERAPY

To assess the cost-utility of abiraterone versus enzalutamide in the treatment of metastatic castration-resistant prostate cancer (mCRPC) in asymptomatic or mildly symptomatic patients, after failure of androgen deprivation therapy (ADT) in Portugal. A lifetime individual-patient simulation model was used to predict time in each health state, according to survival functions that include as explanatory variables the baseline profile and the history of each patient. In each health state, patients face competing risks of death and transition to the next state. Health states are defined by the therapeutic algorithm (pre-docetaxel, docetaxel and post-docetaxel), including periods without any active treatment or on best supportive care. Survival functions were based in the reference clinical trial of abiraterone in the treatment of mCRPC after ADT failure (COU-AA-302), with the treatment coefficient for enzalutamide’s survival functions being adjusted according to median time on treatment from PREVAIL trial. Health state utilities were obtained from the COU-AA-302 trial, the literature and an Oxford Outcomes’ study that assessed quality of life on this population. Resource consumption was based on an expert panel with six specialists on mCRPC treatment in Portugal. Unit costs were based on official sources. The payer’s perspective was considered and costs and consequences were discounted at a 5% annual rate. Compared to enzalutamide, abiraterone was associated to an average saving of €12,564 per patient, with incremental 0.102 life years or 0.003 quality adjusted life years (QALY). Cost differences are mainly due to the lower time on treatment (1.784 years) when compared to enzalutamide (2.118 years). Abiraterone in the treatment of metastatic castration-resistant prostate cancer in asymptomatic or mildly symptomatic patients is a less expensive and more effective option than enzalutamide, being considered a dominant alternative in the Portuguese setting.