Abstract：
OBJECTIVE: Lung cancer is the leading cause of cancer-related death worldwide, and most patients are diagnosed of advanced disease. Molecular-targeted therapy and immunotherapy increase survival among these patients. In this study, we compared the cost of the best treatments available with the amount reimbursed by the Brazilian public healthcare system (Sistema Único de Saúde [SUS]) to treat advanced lung cancer.
METHODS: The authors divided lung cancer into 10 subtypes according to histology and molecular profile. A panel of experts defined the best treatment sequencing for each subtype. The authors considered only drug costs retrieved from the Brazilian Health Regulatory Agency official data. The progression-free survival of each regimen was considered as treatment duration. The cost estimate included all postprogression therapies weighted by each subtype proportional frequency. The amount reimbursed by SUS was the sum of the monthly budget accumulated during the estimated treatment duration and then for the proportional frequency of each subtype.
RESULTS: The budget reimbursed by SUS for treating each advanced lung cancer case in Brazil is R$8000.00 in average whereas the cost estimate for the best treatment available is R$729 454.00 per case, which represents a difference of 9118%. The budget impact to ensure the reimbursement needed to acquire the best treatments available was estimated in near R$13 billion annually.
CONCLUSIONS: The cost estimate of the best treatment available for advanced lung cancer in Brazil is much higher than the amount reimbursed by SUS. This budgetary gap leads to a major access barrier that may compromise the survival outcomes of SUS users.
METHODS: The authors divided lung cancer into 10 subtypes according to histology and molecular profile. A panel of experts defined the best treatment sequencing for each subtype. The authors considered only drug costs retrieved from the Brazilian Health Regulatory Agency official data. The progression-free survival of each regimen was considered as treatment duration. The cost estimate included all postprogression therapies weighted by each subtype proportional frequency. The amount reimbursed by SUS was the sum of the monthly budget accumulated during the estimated treatment duration and then for the proportional frequency of each subtype.
RESULTS: The budget reimbursed by SUS for treating each advanced lung cancer case in Brazil is R$8000.00 in average whereas the cost estimate for the best treatment available is R$729 454.00 per case, which represents a difference of 9118%. The budget impact to ensure the reimbursement needed to acquire the best treatments available was estimated in near R$13 billion annually.
CONCLUSIONS: The cost estimate of the best treatment available for advanced lung cancer in Brazil is much higher than the amount reimbursed by SUS. This budgetary gap leads to a major access barrier that may compromise the survival outcomes of SUS users.
摘要：
目的：肺癌是全球癌症相关死亡的主要原因，大多数患者被诊断为晚期疾病。分子靶向治疗和免疫治疗可提高这些患者的生存率。在这项研究中,我们比较了现有最佳治疗方法的费用与巴西公共医疗系统(SistemaúnicodeSaúde[SUS])用于治疗晚期肺癌的报销金额.
方法：作者根据组织学和分子谱将肺癌分为10种亚型。一组专家确定了每种亚型的最佳治疗顺序。作者仅考虑了从巴西卫生监管机构官方数据中检索到的药物成本。每个方案的无进展生存期被认为是治疗持续时间。成本估算包括所有进展后治疗，按每种亚型比例频率加权。SUS偿还的金额是在估计的治疗持续时间内累积的每月预算的总和，然后是每个亚型的比例频率。
结果：SUS在巴西治疗每例晚期肺癌的预算平均为8000.00雷亚尔，而现有最佳治疗的费用估计为每例729454.00雷亚尔，这代表了9118%的差异。确保获得最佳治疗所需的报销费用的预算影响估计每年接近130亿雷亚尔。
结论：巴西晚期肺癌最佳治疗方案的费用估计远高于SUS的报销金额。这种预算差距导致了一个主要的访问障碍，可能会损害SUS用户的生存结果。
方法：作者根据组织学和分子谱将肺癌分为10种亚型。一组专家确定了每种亚型的最佳治疗顺序。作者仅考虑了从巴西卫生监管机构官方数据中检索到的药物成本。每个方案的无进展生存期被认为是治疗持续时间。成本估算包括所有进展后治疗，按每种亚型比例频率加权。SUS偿还的金额是在估计的治疗持续时间内累积的每月预算的总和，然后是每个亚型的比例频率。
结果：SUS在巴西治疗每例晚期肺癌的预算平均为8000.00雷亚尔，而现有最佳治疗的费用估计为每例729454.00雷亚尔，这代表了9118%的差异。确保获得最佳治疗所需的报销费用的预算影响估计每年接近130亿雷亚尔。
结论：巴西晚期肺癌最佳治疗方案的费用估计远高于SUS的报销金额。这种预算差距导致了一个主要的访问障碍，可能会损害SUS用户的生存结果。
