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Abstract Background Disability insurance represents a significant economic burden within Brazil’s social security system, yet long-term cost trends across disease groups remain understudied, hindering informed prevention and management strategies. Hospital costs, which account for approximately 40% of direct healthcare expenses, were selected as a comparative reference to contextualize the economic burden of disability insurance. Objective This study analyzes long-term cost trends of newly granted disability insurance by disease groups in Brazil, comparing them to public health system hospitalization expenses. Method This ecological time series study applied the inflection point regression model and Annual Average Percentage Change (AAPC) analysis, utilizing open-access federal government datasets. Annual rates and costs of disability insurance and hospitalizations were examined, categorized by International Classification of Diseases, 10th Revision (ICD-10) groups, and standardized per insured individuals and the general population. Results Between 2010 and 2019, the rate of temporary disability insurance granted (406 per 10,000 insureds) was 94% higher than permanent disability insurance (24 per 10,000), with women showing slightly higher rates but men incurring higher costs. The overall annual average rate of granted disability insurance (430 per 10,000 insureds) and its costs (BRL 5,084 per 100 insureds) were lower than those of hospitalizations (525 per 10,000 and BRL 5,870 per 100 Brazilians, respectively). Disabilities due to injuries, musculoskeletal disorders, and mental health problems had the highest rates (126, 89, and 40 per 10,000 insureds, respectively) and costs (BRL 1,455, 1,076, and 533 per 100 insureds, respectively). Neoplasms showed the only increasing trend in granted rates (AAPC 2.5%). The cost growth of granted disability insurance (AAPC 6.2%) was twice that of hospitalization costs (AAPC 2.9%), with disability insurance costs surpassing hospitalization expenses by 2018. Although most disease groups exhibited stable or declining trends in granted rates, costs increased across nearly all conditions. Conclusion The rising costs of disability insurance in Brazil highlight the growing economic burden of non-medical expenses and the need for evidence-based policies focused on prevention, management, and the sustainability of the social security system.

Abstract Background The impact of the COVID-19 pandemic on breast cancer care across Brazilian regions with varying Human Development Index (HDI) levels remains unclear. This study evaluates the pandemic’s effects on screening mammograms, tumor staging at diagnosis, and treatment initiation in the Brazilian Public Health System between 2017 and 2022, focusing on regions with different HDI levels. Methods This ecological time series study uses an inflection point regression model and monthly percentage change (MPC) to analyze an open-access Brazilian Public Healthcare System dataset. The study focuses on trends and variations in these variables among women aged 50–69 in three state groups classified by HDI: Group A (very high), Group B (medium), and Group C (high). Results The average monthly rate of screening mammograms was highest in Group A (10.70) and lowest in Group B (8.38). At the onset of the COVID-19 pandemic, screening rates dropped significantly, with the most significant decline in Group B (58.6% decrease) and the smallest in Group A (45.7% decrease), lasting for three months. Subsequently, this variable recovered until December 2022 but was insufficient to restore the total series MPC to pre-pandemic levels. Group B had the lowest average rate of early-stage (0-II) diagnoses (2.88), while Group C had the highest (3.68). Early-stage diagnoses declined in the first three months of the pandemic, followed by a partial recovery that was insufficient to restore the pre-pandemic MPC levels. The proportion of advanced-stage diagnoses was highest in Group B (49.02%) and lowest in Group A (45.97%). The pandemic maintained the upward trend of advanced-stage (III-IV) diagnoses across all groups in the total time series. The average proportion of treatments initiated after 60 days of diagnosis was above 60% across all groups, with Group B at 64.50%. This variable began to rise 3 to 4 months after the pandemic and continued increasing until December 2022, with a greater intensity than the pre-pandemic period across all groups. Conclusion The COVID-19 pandemic reduced breast cancer screening and early diagnosis in Brazil, leading to more advanced cases and treatment delays across all regions, with varying impacts according to regional HDI levels.

Abstract Background The COVID-19 pandemic has overloaded the healthcare systems of many countries and reduced the population’s access to treatment and prevention of other diseases. This study aims to assess whether the COVID-19 pandemic has negatively interfered with the trend and the direct costs of screening and chemotherapy treatment of breast cancer in a public and universal healthcare system. Method This was an ecological time series study using an open database of a public and universal health system from 2017 to 2021. Results In 2020, there was a 41% reduction in the coverage rate of breast cancer screening in women aged 50 to 69 years (about 1 million mammograms missed). The total direct cost of breast cancer screening reduced proportionally to the number of tests (BRL 67 million). On the other hand, the cost of chemotherapy treatment was higher in 2020, both in advanced (BRL 465 million) and localized (BRL 113 million) diseases. In the time series, mammograms’ trend and direct costs changed from stationary to decreasing after the COVID-19 pandemic. The trend of direct costs with chemotherapy treatment for the advanced disease has been increasing and has not changed after the COVID-19 pandemic. On the other hand, in the case of localized disease, there was a trend toward reducing direct costs after the pandemic. Conclusion After COVID-19, there was a downward trend in breast cancer screening and its direct costs, an upward trend in chemotherapy costs for advanced disease, and a downward trend in chemotherapy costs for localized disease.