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Análise dos custos do procedimento PET-TC com 18 F-FDG na perspectiva do SUS provedor: estudo em uma unidade pública de saúde do Rio de Janeiro, Brasil

Positron emission tomography (PET) has been introduced recently in Brazil and requires costs analysis to support economic evaluation studies on its use. The current study analyzed the use of 18 F-FDG PET-CT and estimated its costs from the perspective of a public healthcare provider. The micro-costing technique was used, identifying, quantifying, and valuing all the inputs used to perform the procedure. Cost estimates considered 85 tests performed at the Brazilian National Cancer Institute from March to June 2012. Reference cases were defined as adult cancer patients, output of five tests per day, and one dose of 18 F-FDG per patient. Unit cost for the procedure was BRL 3,150.30 based on career wages under the Ministry of Science and Technology and BRL 2,927.19 based on Ministry of Health career wages. The factor with the heaviest cost impact was daily output of tests. Other factors that could impact the tests cost in public healthcare institutions were also examined.A tomografia de emissao de positrons (PET) e de uso recente no Brasil e ha necessidade de se estimar os custos do procedimento, de forma a subsidiar estudos de avaliacao economica sobre a tecnologia. O trabalho analisou o processo de producao da PET-TC utilizando 18 F-FDG e estimou seus custos na perspectiva de um provedor publico de servicos de saude. Utilizou- se a tecnica de microcustos, com identificacao, quantificacao e valoracao de todos os insumos consumidos na producao do procedimento. As estimativas de custo consideraram a observacao de 85 exames realizados no Instituto Nacional de Câncer, de marco/julho de 2012. O caso de referencia considerou pacientes oncologicos adultos, volume de producao de 5 exames/dia e uso de uma dose de 18 F-FDG por paciente. Os custos unitarios do procedimento foram de R

Incorporação de novos medicamentos pela Comissão Nacional de Incorporação de Tecnologias do SUS, 2012 a junho de 2016

3.150,30, na perspectiva salarial da carreira de Ciencia & Tecnologia, e de R

Budget impact from the incorporation of positron emission tomography – computed tomography for staging lung cancers

2.927,19 na do Ministerio da Saude. O elemento de maior impacto nos custos correspondeu ao volume diario de producao dos exames. Foram explorados elementos que podem impactar no custo do exame nas instituicoes publicas de saude.

Custo-efetividade do uso da tomografia de emissão de pósitrons na detecção de recorrência do câncer diferenciado de tireoide

The National Commission for incorporation of Health Technologies (CONITEC), established in 2011, advises the Ministry of Health in decisions related to the incorporation, exclusion or change of medicines, products and procedures in the Unified Health System (SUS).The study investigated the decision-making process, profile of demands and incorporation of new medicines in the SUS from January/2012 to June/2016, based on data available on the CONITEC website. All submissions were evaluated and characterized by technology and applicant type. The incorporations were analyzed according to the Anatomical-Therapeutic-Chemical classification, International Classification of Disease of the clinical indication and active record in the National Health Surveillance Agency. In the period, 485 submissions were received, 92.2% concerning requests for incorporation and 62.1% for medicines, of which 93 (30.1%) received a favorable recommendation for incorporation. Domestic demands were more successful than externally originated ones. Six unregistered drugs were incorporated. Infectious and parasitic diseases and musculoskeletal diseases constituted the main clinical indications. The recommendation of incorporation occurred mainly based on the additional clinical benefits and low budget impact.

Cost analysis of 18 F-FDG PET-CT from the perspective of the Brazilian Unified National Health System as healthcare provider: a study in a public healthcare center in Rio de Janeiro, Brazil

OBJECTIVE To estimate the budget impact from the incorporation of positron emission tomography (PET) in mediastinal and distant staging of non-small cell lung cancer. METHODS The estimates were calculated by the epidemiological method for years 2014 to 2018. Nation-wide data were used about the incidence; data on distribution of the disease´s prevalence and on the technologies’ accuracy were from the literature; data regarding involved costs were taken from a micro-costing study and from Brazilian Unified Health System (SUS) database. Two strategies for using PET were analyzed: the offer to all newly-diagnosed patients, and the restricted offer to the ones who had negative results in previous computed tomography (CT) exams. Univariate and extreme scenarios sensitivity analyses were conducted to evaluate the influence from sources of uncertainties in the parameters used. RESULTS The incorporation of PET-CT in SUS would imply the need for additional resources of 158.1 BRL (98.2 USD) million for the restricted offer and 202.7 BRL (125.9 USD) million for the inclusive offer in five years, with a difference of 44.6 BRL (27.7 USD) million between the two offer strategies within that period. In absolute terms, the total budget impact from its incorporation in SUS, in five years, would be 555 BRL (345 USD) and 600 BRL (372.8 USD) million, respectively. The costs from the PET-CT procedure were the most influential parameter in the results. In the most optimistic scenario, the additional budget impact would be reduced to 86.9 BRL (54 USD) and 103.8 BRL (64.5 USD) million, considering PET-CT for negative CT and PET-CT for all, respectively. CONCLUSIONS The incorporation of PET in the clinical staging of non-small cell lung cancer seems to be financially feasible considering the high budget of the Brazilian Ministry of Health. The potential reduction in the number of unnecessary surgeries may cause the available resources to be more efficiently allocated.

Análisis de costes del procedimiento PET-TC con 18 F-FDG desde la perspectiva del SUS proveedor: estudio en una unidad pública de salud de Río de Janeiro, Brasil

The positron emission tomography (18FDG-PET/CT) was recently introduced in Brazilian health care for many oncology indications but accompanied by higher costs. In our study we performed a cost-effectiveness analysis of the addition of PET/CT to the conventional diagnostic work-up to detect recurrent differentiated thyroid cancers. The analytical decision model represented a hypothetical cohort of adults, thyroid cancer patients with high risk by initial stratification, submitted to total thyroidectomy and ablation with I131. The addition of PET/CT was applied to subjects with negative results on I131scintigraphy. The model was designed from the perspective of the Brazilian public health care system, with a time horizon of 10 years. Effectiveness was measured by the additional recurrent cases detected. Only direct medical costs were considered. Costs and benefits were discounted by 5%. Univariate deterministic and probabilistic sensitivity analyzes were performed to explore the uncertainties. The PET/CT diagnosed 13 additional cases compared to conventional strategy (1,888 vs 1,875) by a cost of R

INCORPORATION OF NEW MEDICINES BY THE BRAZILIAN HEALTHCARE SYSTEM´S NATIONAL COMMITTEE FOR HEALTH TECHNOLOGY INCORPORATION, 2012 TO JUNE/2016

477,633.05 per case detected. The parameters of greatest impact in the sensitivity analysis were the accuracy of conventional tests, cost of PET/CT and the discount rate. The costs of adding PET/CT seems significant and its introduction is not cost-effective on the Brazilian perspective.

Disinvestment of Health Technologies by the National Commission for Technology Incorporation from 2012-2016

Positron emission tomography (PET) has been introduced recently in Brazil and requires costs analysis to support economic evaluation studies on its use. The current study analyzed the use of 18 F-FDG PET-CT and estimated its costs from the perspective of a public healthcare provider. The micro-costing technique was used, identifying, quantifying, and valuing all the inputs used to perform the procedure. Cost estimates considered 85 tests performed at the Brazilian National Cancer Institute from March to June 2012. Reference cases were defined as adult cancer patients, output of five tests per day, and one dose of 18 F-FDG per patient. Unit cost for the procedure was BRL 3,150.30 based on career wages under the Ministry of Science and Technology and BRL 2,927.19 based on Ministry of Health career wages. The factor with the heaviest cost impact was daily output of tests. Other factors that could impact the tests cost in public healthcare institutions were also examined.A tomografia de emissao de positrons (PET) e de uso recente no Brasil e ha necessidade de se estimar os custos do procedimento, de forma a subsidiar estudos de avaliacao economica sobre a tecnologia. O trabalho analisou o processo de producao da PET-TC utilizando 18 F-FDG e estimou seus custos na perspectiva de um provedor publico de servicos de saude. Utilizou- se a tecnica de microcustos, com identificacao, quantificacao e valoracao de todos os insumos consumidos na producao do procedimento. As estimativas de custo consideraram a observacao de 85 exames realizados no Instituto Nacional de Câncer, de marco/julho de 2012. O caso de referencia considerou pacientes oncologicos adultos, volume de producao de 5 exames/dia e uso de uma dose de 18 F-FDG por paciente. Os custos unitarios do procedimento foram de R

Cost-Effectiveness of The Use of 18fdg-Pet/Ct In The Detection of Recurrent Differentiated Thyroid Cancer

3.150,30, na perspectiva salarial da carreira de Ciencia & Tecnologia, e de R

Análise dos custos do procedimento PET-TC com 18F-FDG na perspectiva do SUS provedor: estudo em uma unidade pública de saúde do Rio de Janeiro, Brasil Cost analysis of 18F-FDG PET-CT from the perspective of the Brazilian Unified National Health System as healthcare provider: a study in a public healthcare center in Rio de Janeiro, Brazil

2.927,19 na do Ministerio da Saude. O elemento de maior impacto nos custos correspondeu ao volume diario de producao dos exames. Foram explorados elementos que podem impactar no custo do exame nas instituicoes publicas de saude.