Impacto orçamentário da incorporação da tomografia de emissão de pósitrons (PET scan) no estadiamento do câncer de pulmão na perspectiva do Sistema Único de Saúde

• Autor(a) principal: Biz, Aline Navega
• Data de Publicação: 2014
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/4274
• topic: Positron-Emission Tomography; Carcinoma; Non-Small-Cell Lung; Unified Health System; Health Care Costs; Budget Impact; Tomografia por Emissão de Pósitrons; Carcinoma Pulmonar de Células não Pequenas; Sistema Único de Saúde (Brasil); Custos de Cuidados de Saúde; Impacto orçamentário; CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA

The exponential increase in health spending requires economic studies, in order to support decisions of public or private agents related to the incorporation of new technologies to health systems. Positron emission tomography (PET) is an imaging technology in the field of nuclear medicine, of high cost and still recent in the country. Scientific evidence accumulated in relation to its use in non-small cell lung cancer (NSCLC) is significant, and technology proves to be of higher accuracy than conventional imaging techniques in mediastinal and distance staging. Economic evaluation conducted in 2013 indicates its cost-effectiveness in NSCLC staging compared to current management strategy based on the use of computed tomography (CT) in the perspective of the Brazilian Health System (SUS). It was incorporated to the list of procedures available through SUS by Ministry of Health (MoH) in April, 2014; however, the economic and financial impacts of this decision are still unknown. This study aimed to estimate the budgetary impact (BI) of the incorporation of PET in NSCLC staging for 2014 to 2018 from the perspective of SUS as the financier of health care. Estimates were calculated by the epidemiological method, and used as basis decision model from previous cost-effectiveness study. National data on incidence of the disease; distribution of prevalence of the disease and technologies accuracy from literature; and costs from microcosting study and SUS database were used. Two strategies of use of the new technology were analyzed: offer (a) to all patients, and (b) restricted to those with negative result of CT. Additionally, univariate and extreme scenarios sensitivity analysis were performed to assess the influence on the results of possible sources of uncertainty in the parameters used. The incorporation of PET-CT to SUS implies the need of additional resources from R$ 158.1 (limited offer) to 202.7 million (comprehensive offer) in five years, and the difference between the two strategies is R$ 44.6 million in the period. In absolute terms, the total BI would be of R$ 555 million (PET-CT for negative CT) and R$ 600 million (PET-CT for all) in the period. The cost of the procedure PET-CT was the most influential parameter on the expenditures estimates related to new technology, followed by the proportion of patients undergoing mediastinoscopy. In the most optimistic extreme scenario, incremental BI would drop to R$ 86.9 (PET-CT for negative CT) and R$ 103.9 million (PET-CT for all), while in the most pessimistic scenario it would increase to R$ 194.0 and R$ 242.2 million, respectively. Results of BI, combined with evidence of cost-effectiveness of the technology gives greater rationality to the final decisions of policymakers. The incorporation of PET in NSCLC staging seems financially feasible when faced to the magnitude of the MoH budget, and potential reduction in the number of unnecessary surgeries can lead to more efficient allocation of resources and better outcomes for patients with better indicated therapeutic strategies.