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Introduction: Biological medicines have increased the cost of cancer treatments, which also raises concerns about sustainability. In Brazil, three monoclonal antibodies (mAbs)—bevacizumab, cetuximab, and panitumumab—are indicated for the treatment of metastatic colorectal cancer (mCRC) but not currently funded by the Unified Health System (SUS). However, successful litigation has led to funding in some cases. Objective: Our objective was to evaluate the budgetary impact of including the mAbs bevacizumab, cetuximab, and panitumumab in standard chemotherapy for the treatment of mCRC within the SUS of Minas Gerais (MG), Brazil. Method: A budget impact analysis of incorporating mAbs as first-line treatment of mCRC in MG was explored. The perspective taken was that of the Brazilian SUS, and a 5-year time horizon was applied. Data were collected from lawsuits undertaken between January 2009 and December 2016, and the model was populated with data from national databases and published sources. Costs are expressed in $US. Results: In total, 351 lawsuits resulted in funding for first-line treatment with mAbs for mCRC. The three alternative scenarios analyzed resulted in cost increases of 348–395% compared with the reference scenario. The use of panitumumab had a budgetary impact of $US103,360,980 compared with the reference scenario over a 5-year time horizon, and bevacizumab and cetuximab had budgetary impacts of $US111,334,890 and 113,772,870, respectively. The use of the anti-epidermal growth factor receptor (EGFR) mAbs (cetuximab and panitumumab) is restricted to the approximately 41% of patients with KRAS mutations, so the best cost alternative for incorporation would be the combination of panitumumab and bevacizumab, with a cost of approximately $US106 million. Conclusion: These results highlight the appreciable costs for incorporating bevacizumab, cetuximab, and panitumumab into the SUS. Appreciable discounts are likely to be necessary before incorporation of these mAbs is approved.

Objectives The aim of this study was to evaluate the federal government expenditures with oncological care, for the most incident cancer types among the Brazilian population, using registries of all patients treated by the Brazilian National Health Service (SUS) between 2001 and 2015. We adopted the formal healthcare sector perspective in this study, with the costs per patient estimated by the reimbursement price paid by the Ministry of Health to service providers. Methods The costs were adjusted by the follow-up time for each patient. We performed multivariate regression analysis using ordinary least squares. We analyzed 952 960 patients aged ≥19 years who underwent cancer treatment, between 2001 and 2015, for breast, prostate, colorectal, cervix, lung, and stomach cancers. Results The annual mean costs per patient (in USD purchasing power parity) was $9572.30, varying from $5782.10 for breast cancer to $16 656 for cervical cancer. Several variables predicted higher costs of cancer treatment, namely: to be male (+14%), with younger age ranges at treatment initiation, resident in the Northeast region (+26%), treated for colorectal cancer (+482%), with treatment initiation from 2010 to 2014, tumor stages III and IV (III: +182%; IV: +165%), hospitalization for other reasons besides the cancer treatment, and suffering from some a comorbidity. Conclusions Given the forthcoming Brazilian demographic changes, which strongly suggest that the economic burden of cancer is about to increase in the near future, our estimates provide relevant information to produce useful projections about future cancer-related costs.

OBJECTIVE To identify demographic and clinical characteristics of adult patients hospitalized in the Brazilian Unified Health System (SUS) due to viral pneumonia and investigate the association between some comorbidities and death during hospitalization. METHODS This retrospective cohort study was conducted with secondary data of adults admitted to SUS due to viral pneumonia between 2002 and 2015. Patient profile was characterized based on demographic and clinical variables. The association between the ten Elixhauser comorbidities and in-hospital death was investigated using Poisson regression models with robust standard errors. Results were quantified as incidence rate ratio (IRR) with 95% confidence intervals (CI), and we built five models using successive inclusion of variables blocks. RESULTS Hospital admissions for viral pneumonias decreased throughout the study period, and it was observed that 5.8% of hospitalized patients had an in-hospital death. We observed significant differences in demographic and clinical characteristics by comparing individuals who died during hospitalization with those who did not, with the occurrence of one or more comorbidities being more expressive among patients who died. Although not considered risk factors for in-hospital death, chronic pulmonary disease and congestive heart failure were the most common comorbidities. Conversely, IRR for in-hospital death increased with other neurological disorders, diabetes, cancer, obesity, and especially with HIV/AIDS. CONCLUSIONS Individuals presenting with pulmonary and cardiovascular diseases require proper attention during hospitalization, as well as those with other neurological diseases, diabetes, cancer, obesity, and especially HIV/AIDS. Understanding the influence of chronic diseases on viral infections may support the healthcare system in achieving better outcomes.

The hospitalizations are part of cancer care and has been studied by researchers worldwide. A better understanding about their associated factors may help to achieve improvements on this area. The aims of this study were to investigate the association between demographic and clinical characteristics and hospitalizations, as well as between these characteristics and the length of stay (LOS), within the first year of outpatient treatment, for the most incident cancers in the Brazilian population. In this cohort study, we investigated 417,477 patients aged 19 years or more, who started outpatient cancer treatment, from 2010–2014, for breast, prostate, colorectal, cervix, lung and stomach cancers. The outcomes evaluated were: i) Hospitalizations within the first year of outpatient cancer treatment; and ii) LOS of the hospitalized patients. It was performed a binary logistic regression to evaluate the association between the explanatory variables and the hospitalizations and a negative binomial regression to evaluate their influence on the length of hospital stay. The hospitalizations occurred for 34% of patients, with a median of LOS of 6 days (IQR: 2–15). Female patients were 16% less likely to be hospitalized (OR: 0.84; 95% CI: 0.82–0.86), with lower average of LOS (AR: 0.98; 95% CI: 0.97–0.99), each additional year of age reduced in 2% the hospitalization odds (OR: 0.98; 95% CI: 0.98–0.99) and in 1% the average of LOS (AR: 0.99; 95% CI: 0.98–0.99), patients from South region had twice more chances of hospitalization than from North region (OR: 2.01; 95% CI: 1.93–2.10) and patients with colorectal cancer had greater probability of hospitalization (OR: 4.42; 95% CI: 4.27–4.48), with the highest average of LOS (AR: 1.37; 95% CI: 1.35–1.40). In view of our results, we consider that the government must expand the policies with potential to reduce the number of hospitalizations.

Os gastos em saúde podem representar uma importante parcela dos investimentos governamentais, principalmente nos países em que o sistema de saúde é universal. Tendo em vista a ampliação dos gastos nos últimos anos, sobretudo na assistência oncológica, cresce a necessidade de avaliações econômicas para orientar a tomada de decisão e formulação de políticas públicas. O objetivo do estudo foi avaliar os custos diretos da assistência oncológica no âmbito do Sistema Único de Saúde, entre 2001 e 2014. Trata-se de um estudo de custo da doença, realizado a partir da Base Nacional em Oncologia, coorte histórica de pacientes oncológicos obtida por pareamento determinístico-probabilístico de dados provenientes do DataSUS. A população foi composta por pacientes diagnosticados com câncer de próstata, mama, estômago, cólon e reto, colo do útero e pulmão, submetidos a tratamento oncológico por quimioterapia e/ou radioterapia, podendo inclusive ter realizado cirurgia em conjunto às demais formas de tratamento. Foram incluídos todos os custos diretos relacionados a diagnóstico, quimioterapia, radioterapia, cirurgia e internações. A correção dos valores obtidos ocorreu pelo IPCA registrado em dez/2015. Para avaliar a evolução dos custos diretos no período, foram elaboradas séries históricas de acordo com variáveis de interesse. Como resultados da pesquisa, foram incluídos no estudo 954.091 pacientes, distribuídos entre câncer de mama (40,1%), próstata (22,3%), cólon e reto (13,2%), colo do útero (11,5%), pulmão (7,9%) e estômago (5%). Ao longo de 14 anos, os custos diretos totalizaram R$14,9 bilhões, onde a maior mediana de custo direto foi atribuída ao paciente de câncer cólon e reto (R$15.467,9), seguido do câncer de mama (R$11.398,9) e colo do útero (R$10.572,4). Em relação aos tipos de procedimentos, a maior parcela dos custos diretos no período destinou-se à quimioterapia (R$9,5 bilhões), radioterapia (R$2,5 bilhões) e cirurgia (R$1,3 bilhões). Por sua vez, o gasto estimado com exames diagnósticos foi de R$0,6 bilhões, valor que representou 4% do custo direto total gerado pela assistência oncológica da população em estudo. Verificou-se que, entre 2001 e 2014, os custos diretos da assistência oncológica cresceram cerca de 419%. Entretanto, no mesmo período, o número de pacientes tratados anualmente subiu em proporção mais elevada (503%). Avaliando o custo médio anual por paciente no período, observou-se uma redução considerável dos valores até o ano de 2008, retomando o crescimento até o ano de 2014, mas que não atingiu a média estimada no início do período, sugerindo que os recursos investidos na assistência oncológica não tenham sido efetivamente ampliados, mas apenas reagido ao aumento da incidência do câncer. Considerando que parte da assistência oncológica é realizada por meio do Fundo de Ações Estratégicas e Compensação, cujos valores não constam nas estimativas deste estudo, deve-se avaliar, em outras perspectivas, se houve realmente uma redução dos valores investidos por paciente oncológico no âmbito do SUS. Por fim, apesar de suas limitações, este estudo se mostra capaz de balizar a elaboração de pesquisas mais aprofundadas sobre o tema, não esgotando em si futuras investigações acerca do impacto econômico gerado pelo câncer no Brasil. Health expenditures can represent an important part of public investment, especially in countries where the health system is universal. As a result of the increasing expenses in recent years, especially in cancer care, grows the need of economic evaluations to guide decisionmaking and definition of public policy. The aim of this study was to evaluate the direct costs of cancer care in the Sistema Único de Saúde (SUS), between 2001 and 2014. This is a cost-ofillness study, based on the National Oncology Database, a historical cohort of oncological patients, constructed by deterministic-probabilistic linkage of healthcare system data from DataSUS. This study was composed of patients diagnosed with breast cancer, prostate cancer, stomach cancer, colorectal cancer, cervix cancer and lung cancer, who underwent oncological treatment by chemotherapy and/or radiotherapy, and who also could be treated by surgery together with those treatment forms. All direct costs related to diagnosis, chemotherapy, radiotherapy, surgery and inpatient care were included. The correction of the values occurred by IPCA index referred on December/2015. To evaluate the increase of direct costs in the study, were constructed historical series according to the interest variables. Results: 954,091 patients were included in the study, ranging from breast cancer (40.1%), prostate cancer (22.3%), colorectal cancer (13.2%), cervix cancer (11.5%), lung cancer (7.9%) and stomach cancer (5.0%). Over 14 years, the total of direct costs was R$14.9 billion, from which the highest median direct cost was attributed to the patient with colorectal cancer (R$15,467.9), followed by breast cancer (R$11,398.9) and cervix cancer (R$10,572.4). Referring to the types of procedures, the largest share of the direct costs in the period was allocated to chemotherapy (R$9.5 billion), radiotherapy (R$2.5 billion) and surgery (R$1.3 billion). On the other hand, the estimated direct cost for diagnostic exams was R$ 0.6 billion, which represented 4% of the total direct cost resulted by oncological care of the study's population. We observed that, between 2001 and 2014, the direct costs of cancer care increased about 419%. However, in the same period, the number of patients treated annually grew up by a higher proportion (503%). Evaluating the average annual cost per patient in the period, it was observed a considerable reduction of the values until 2008, resuming the growth until the year 2014, but not equal as registered at the beginning of the follow-up, suggesting that invested resources may not have been increased in fact, only reacted the cancer incidence growth. Considering that part of the cancer care financing occurred by the Strategic Actions and Compensation Fund, whose values were not included in the estimates of this study, it should be evaluated, in other perspectives, whether there was in fact a reduction of the amounts directed per person to cancer care in the scope of SUS. Finally, despite its limitations, this study can be able to guide the construction of more detailed research on this subject, not exhausting future investigations about the economic burden of cancer in Brazil.