Brazilian Private Health Care Research Articles

PCV86 - COST-EFFECTIVENESS OF SACUBITRIL/VALSARTAN IN THE TREATMENT OF HEART FAILURE UNDER THE BRAZILIAN PRIVATE HEALTHCARE SYSTEM PERSPECTIVE

To estimate the cost-effectiveness of sacubitril/valsartan versus enalapril in the treatment of heart failure with reduced ejection fraction (HFrEF) New York Heart Association (NYHA) Class II-IV, under the Brazilian Private Healthcare System perspective. A previously developed cost-effectiveness model based on PARADIGM-HF trial was adapted to Brazil using Latin-American trial subgroup (N=1,433) and Brazil-specific epidemiologic and economic data. A two-state regression-based (Markov) cost-utility model with one-month cycling was utilized to examine a hypothetical cohort of HFrEF patients, predicting events and outcomes (mortality, all-cause hospitalization, adverse events and health-related quality of life), adjusted according to baseline characteristics and time from randomization, for each treatment arm. Quality-adjusted-life years (QALY) were derived from PARADIGM-HF. Costs (BRL) include drug, hospitalization and medical resources estimated for private health sector from 2017. Primary outcome was cost-utility (cost/QALY gained) over a 30-year time horizon. Univariate and probabilistic sensitivity analyses were performed. Base-case results suggest that compared with enalapril, sacubitril/valsartan is associated with incremental costs of BRL17,352 and 0.50 QALYs gained, with an incremental cost-effectiveness ratio of BRL34,729 per QALY gained. Increased costs of pharmacological therapy were offset by reductions in hospitalization costs. All-cause– and cardiovascular mortality estimates were reduced at all time points. Expected survival estimates were greater among patients receiving sacubitril/valsartan versus those receiving enalapril (6.24 vs. 5.67 years). Overall, results were not sensitive to variation in model parameters; results were most sensitive to cardiovascular mortality estimates and treatment-effect duration. The Brazil-adapted model estimates suggest that sacubitril/valsartan represents a cost-effective intervention in the treatment of HFrEF (NYHA Class II-IV) versus enalapril, assuming a willingness-to-pay threshold of 3 times the GDP per capita (1 x GDP 2017: BRL 31,587) per QALY gained. Consequently, sacubitril/valsartan represents a good value for money compared with enalapril under the Private Healthcare System in Brazil.

Envelhecimento populacional e gastos com saúde: uma análise das transferências intergeracionais e intrageracionais na saúde suplementar brasileira

O modelo de precificação de planos de saúde no Brasil prevê a imposição de limites de variação das mensalidades por faixa etária, possibilitando a transferência de recursos dos mais jovens, que têm menor risco de utilização, para aqueles em idades mais avançadas. O aumento da proporção de idosos nas carteiras dos planos de saúde poderá inviabilizar as transferências intergeracionais e a atual estrutura de precificação. O objetivo deste artigo é estimar a magnitude das transferências intergeracionais (entre diferentes grupos de idade) e intrageracionais (em um mesmo grupo de idade) na saúde suplementar brasileira, por meio da análise de dados de uma amostra representativa de operadoras de planos de saúde. Segundo os resultados encontrados, os saldos das transferências intergeracionais foram positivos e ocorrem dos mais jovens para beneficiários de 66 anos ou mais. Os resultados mostram ainda a ocorrência de transferências intrageracionais em duas das faixas etárias definidas pela legislação vigente: 0 a 18 anos e 59 anos ou mais. Finalmente, o exercício de retroprojeção demonstrou que nos últimos 15 anos a sinistralidade nos planos individuais apresentou constante aumento, indicando risco crescente de insuficiência das mensalidades para fins de custeio das despesas no médio prazo, em razão do envelhecimento populacional.

Outcome of Patients With Breast Cancer Treated in a Private Health Care Institution in Brazil.

PurposeMiddle-income countries like Brazil often have a dichotomous health care system in which patients may be treated in either public or private institutions that differ substantially in terms of level of access to diagnostic and therapeutic procedures.Patients and MethodsThis was a prospective, observational study to assess real-world data in 1,230 female patients with breast cancer who were treated in a private health care institution between 2012 and 2016 in Brazil.ResultsBreast cancer in these patients mostly was diagnosed at early (79.0% stages I or II) or locally advanced (16.1% stage III) stages. The primary tumor was resected in 89.0% of cases, most often through breast-conserving surgery (55.1%). Patients with locally advanced disease received more aggressive therapy (eg, higher rates of mastectomy, axillary dissection and chemotherapy use) than patients with early-stage disease. The estimated 2-year overall survival (OS) was 95.3%. Survival was significantly longer among patients with stage I or II disease (2-year OS, 97.9% and 97.5%, respectively) than those with stage III or IV disease (89.4% and 69.5%, respectively; P < .01). Tumor grade was also correlated with OS in the overall cohort (P = .05); triple-negative status was only prognostic for patients with stage III disease (P < .01).ConclusionThe data provided aid understanding of the current scenario of breast cancer presentation and treatment in the Brazilian private health care system and may serve as a foundation to guide resource allocation. Our results reinforce the need to pursue adequate access to cancer care in low- and middle-income countries to optimize patient outcome.

PHS38 - What is the Cost of a Breast Cancer Therapy Infusion? Real World Data on Brazilian Private Healthcare Perspective

PHS38 - What is the Cost of a Breast Cancer Therapy Infusion? Real World Data on Brazilian Private Healthcare Perspective

PCV24 - New Coronary Procedures After Coronary Intervention (PCI ABD CABG) In Brazilian Private Healthcare System: A Rwd Secondary Analysis

PCV24 - New Coronary Procedures After Coronary Intervention (PCI ABD CABG) In Brazilian Private Healthcare System: A Rwd Secondary Analysis

PCV79 - Number of Procedures for Peripheral Arterial Disease in Brazilian Private Healthcare System: A RWD Secondary Analysis

Use first time in Brazil, data from healthcare private system collected from National Agency for Private Healthcare (ANS) for Peripheral Arterial Disease (PAD) and calculate number cases and repeated ones in same patient in a period 18 months as a surrogate for possible target lesion revascularization (TLR). Retrospective analysis of published data collected from claims by ANS. Period: Jul/2015 to Dec/2016. From 12 million admissions, 3,000 providers and 908 payers, was selected the codes from the unified Brazilian table that corresponds to procedures related to PAD. These codes were used as a indicator for the disease. ICD is not mandatory in Brazil. Determined: number of cases, sex, age, state and municipality of providers, and the repeated procedures in a new admission as a surrogate to complications (TLR). Finally, the results were compared to the estimated prevalence. From 12 million admissions, found 11,678 patients that performed 34,195 procedures, average age 64.76 y. Gender: men were 73.3% and with average age of 64.16y. The number of patients that did a new procedure in different admission was 881 with a gap in days between admissions of 35 days. Private system had 48 million people, 12 million over 50 years. Procedures were performed in 26 Brazilian states, but 5 states perform 77,89% cases (SP, RJ, MG, PR and RS). According Brazilian medical society in Brazil the prevalence for PAD is 20% over 55y. The rate of procedures was 0.097%. The patients under new procedures in 18 months is 7.54%. Although we found high heterogeneity in coding reports, the data shows a low number of procedures in private system. The root cause for the low number of procedures needs a deeper understanding of patient flow and maybe explain the high number of no traumatic amputations of foot in Brazil (13.9/100,000 inhabitants).

PMD17 - Burden Disease of Aortic Stenosis Associated in Patients Undergoing Transcatheter Aortic Valve Replacement

To estimate the cost and length of stay (LOS) of aortic stenosis (AS) with transcatheter aortic valve replacement (TAVR) An administrative claims database containing over 18 million lives (ORIZON, Brazilian Private Health Care, Fee-for-service) was assessed (from jan/2015 until dec/2016), of patients who underwent a transcatheter aortic valve replacement (n=84) . Records showed expenditure with material, tax, procedures, medication and diagnostics. The average and median with confidence interval of 95% was adopted. 84 patients made use of TAVI and had complete index hospital bills available (the treatment in Brazil are approval only for inoperable and high-risk patients) . The averange cost per patient was BRL 231,972 (include the valve and complications), the cost per day was BRL 9,896 (IC95% 5,579 -14,213), and the median LOS was 16 days. Almost 55% of cost was related with other expenses (tax, procedure, others materials and medications. Most of the treatment cost were not related with Device for this reason the avoidance clinical complications should improve the LOS and cost treatment of TAVR for high-risk and inoperable patients.

PCN60 - Newest Target Therapy And Immunotherapy for the Treatment of Advanced Melanoma: Patterns of Adoption By the Private Health Care Sector in Brazil

We aimed to assess which new treatments for advanced melanoma (AM) are adopted by the Brazilian Private Health Care Sector (PHCS) and describe the profile of patients receiving those therapies. Anonymized, clinical data were retrieved on patients treated for AM during 2016, from a proprietary database of claims (Auditron® - Evidências-Kantar Health) encompassing 20% of people covered by PHCS in Brazil. Evaluated drugs had at least ten months of registry in the National Agency of Sanitary Vigilance (ANVISA): vemurafenib, nivolumab, ipilimumab, dabrafenib, trametinib and cobimetinib. Volume of disease was defined as high (visceral or bone lesions, > one site) or low (single visceral lesion or soft tissue lesions only). Eighty-four patients were included for analysis. Ipilimumab was prescribed for 62% of cases (35% in 1st line; 54% 2nd line and 11% 3rd plus lines). Half these patients had high volume of disease (HVD) and 9.5% had controlled lesions in central nervous system (CNS). Ipilimumab was preceded by 1st line chemotherapy in 92% of cases. Vemurafenib was the second most prescribed new drug (24%) with 50% in 1st line; 35% in 2nd line and 15% in 3rd plus lines. Among these patients, 65% had HVD and 10% had controlled CNS lesions. BRAF status was informed for only 50% of cases. Finally, 13% of patients received nivolumab (73% in 1st line and 27% 2nd line); all had HVD. We retrieved one prescription of cobimetinib for 2nd line in a BRAF+ patient progressing after vemurafenib. No prescriptions for dabrafenib or trametinib were retrieved. Older therapies, like ipilimumab and vemurafenib are already adopted to treat advanced melanoma in clinical practice in Brazil. Prescriptions for more recently approved therapies remain scarce maybe because some are oral medications still unlisted in the regulatory organs’ directory or because they have very specific indications.

PMD23 - Cost-Effectiveness Analysis of Continuous Versus Intermittent Renal Replacement Therapy for Critically ILL Acute Kidney Injury Patients Under the Perspective of the Brazilian Private Healthcare System

PMD23 - Cost-Effectiveness Analysis of Continuous Versus Intermittent Renal Replacement Therapy for Critically ILL Acute Kidney Injury Patients Under the Perspective of the Brazilian Private Healthcare System

PCV7 - An Observational Cross-Sectional Database Study To Estimate Hospitalization Costs Related To Cardiovascular Disease In Brazilian Private Healthcare System

Cardiovascular disease (CVD) is the main cause of morbidity and mortality in Brazil, with around 300,000 deaths/year. This study aims to estimate costs related to hospitalizations associated to CVD in the Brazilian private healthcare system. We conducted an observational research in the Orizon database, which comprehends approximately 27% of the Brazilian private healthcare system population. In order to identify events related to CVD leading to hospitalizations and medical procedures in 2014, we used the medical billing database and sought for primary ICD-10 codes related to hypercholesterolemia, acute coronary syndrome (ACS), including unstable angina and myocardial infarction, coronary artery disease (CAD), cardiac arrest, stroke, atherosclerosis and peripheral arterial disease. Identified events were summarized by ICD and analyzed by days of hospitalization, total direct costs, average cost per day of hospitalization and distribution of cost by categories, including medication, materials and others. In 2014, there were 21,519 CVD related hospitalizations registered in the database, responsible for a total expense of around R$600 million. The average cost of a single CV event leading to hospitalization was R$27.8 thousand, while the average event cost by ICD ranged from R$19.8 thousand (angina pectoris) to R$76.1 thousand (cardiac arrest). The average length of hospitalizations per ICD ranged from 4.2 (stricture of artery) to 16.4 days (cardiac arrest), and the average cost per day of hospitalization varied from R$2.9 thousand (stroke) to R$9.4 thousand (CAD). These costs may still be underestimated, as study limitations include the lack of a standardized reporting process and ICD not being a mandatory information at the medical billing. Hospitalizations and procedures due to CVD heavily affect the private healthcare system, both economically and in occupation of hospital beds, tending to increase due to population ageing in Brazil. There is a significant unmet need for reducing risk factors and consequently CV events.

PCV3 - Budget Impact Analysis Of Adopting Evolocumab In The Brazilian Private Healthcare System For Patients With Uncontrolled LDL-C And High Cardiovascular Risk

PCV3 - Budget Impact Analysis Of Adopting Evolocumab In The Brazilian Private Healthcare System For Patients With Uncontrolled LDL-C And High Cardiovascular Risk

Comparison between real costs and patient's perceptions of the chemotherapy in a Brazilian cancer care facility.

e18343 Background: Cancer is growing very fast and is responsible for roughly 7 million deaths annually. Cancer patients throughout the world suffer from both psychosocial and financial distress early in the time they are diagnosed with the disease. While anti-cancer therapy can magnify such effects by consuming extra intellectual energy from the patient and their family, further burden derived from the economic implications of cancer treatment have been ranked by many as an urgent issue. Methods: 46 patients with diagnosis of prostate, breast, lung or gastrintestinal cancer were asked to fill out a form while receiving chemotherapy. It contained 14 questions. Nurses were responsible for data collection. Wilcoxon test was used to test for interaction. Results: The mean age of patients was 62.2 (±13) and 58% of them were women. Aproximately half of them declared having completed higher education or more. The majority of patients had breast cancer (40%) followed by colorectal (38%), prostate (16%) and lung (5%). Most of the patients believed to be treating a localized disease and thought cure was their treatment goal. 31% of patients said they spent more than expected with their treatment and nearly half thought cost to be a concern. When reviewing patient's expectations and real treatment goals we noticed that the majority of patients had stage IV disease (56%) and that 60% were under palliative care. The median actual cost declared by patients was R$3,000 while the real cost median was R$7,055 which accounts for a 40% downstaging of the real cost. At last, 78% of patients estimated the costs to be less than it really is. Conclusions: There is still a large gap between patient's perceptions about chemotherapy goals and disease stage. When it comes to costs of the treatment the majority of patients tend to underestimate it. That may be in part because most brazilian private health care providers do not work with co-participation and therefore all costs are covered.

Custo-efetividade do afatinibe versus pemetrexede associado a cisplatina, erlotinibe e gefitinibe no tratamento de primeira linha de pacientes com câncer de pulmão não pequenas células localmente avançado ou metastático, com mutação do receptor do fa

Objective: To compare costs and effectiveness of afatinib versus pemetrexed plus cisplatin (PEM/ CIS), erlotinib and gefitinib, as first line treatment in patients with locally advanced or metastatic epidermal growth factor receptor mutation (EGFR+) non-small cell lung cancer (NSCLC) in the Brazilian Private Healthcare System. Methods: A Markov model was used to estimate 7 year progression-free life years (PFLY), life years (LY), quality-adjusted life years (QALY) and clinical outcomes of afatinib. Partitioned survival, safety and utility data from the LUX-Lung 1, 3 and 6 and LUCEOR trials were used. Comparative effectiveness versus gefitinib and erlotinib was estimated using Bayesian indirect treatment comparison. Resource use was estimated by an expert panel and direct costs were estimated from official databases. Results: Compared with PEM/CIS, afatinib was associated with increased progression free survival (0.41 PFLY), increased overall survival (0.16 LY) and increased quality of life (0.21 QALY) with incremental cost (BRL 8,549), resulting in an incremental cost-effectiveness ratio (ICER) of BRL 20.639/PFLY. Compared to erlotinib, afatinib was associated with additional 0.46 PFLY, 0.13 LY and 0.20 QALYs with lower cost (-BRL 21,327). When compared to gefitinib, afatinib was asso[1]ciated with incremental 0.53 PFLY, 0.37 LY and 0.34 QALY and increased cost (BRL 24,890), resulting in an ICER of BRL 46,709/PFLY. Considering 3 PIB per capita as a threshold (BRL 86,628), afatinib is a cost-effective technology versus PEM/CIS and gefitinib and dominant when compared to erlotinib. Conclusion: Findings suggest that afatinib is a cost-effective option, when compared to PEM/CIS, erlotinib and gefitinib, as first line treatment in EGFR+ NSCLC patients.

PMD68 - Cost-Effectiveness Analysis of Serum Free Light Chain Assay (FREELITE®) for The Diagnosis of Monoclonal Gammopathy in The Brazilian Public and Private Healthcare Systems

To assess the efficiency of SFLC for the diagnosis of MG in the Brazilian Public Healthcare System (SUS) and Brazilian Private Healthcare System (BPHS) perspectives From a study already published in literature, data of 652 patients under suspect of MG were used to populate the decision tree model. This model is capable to distinguish which diagnosis protocol provides the highest value to each monetary unit invested. Three strategies were tested: standard protocol (SP) that considers serum electrophoresis (SPEP) as screening test, and two comparators, SP plus SFLC (PP1) and SP plus SFLC and Serum Immunofixation Electrophoresis (SIFE) (PP2). Probabilistic sensitivity analysis was carried out to assess model’s parametric uncertainty. Results are interpreted as the amount of currency (BRL) spent for each incremental correct diagnosis of MG (benefit). Probabilistic simulation pointed an average ICER of BRL 1,192 and BRL 1,470 for PP1 and PP2, respectively in SUS. For BPHS, ICERs were BRL 3,620 and 4,193, respectively. Considering a willingness-to-pay over BRL 1,500 (SUS) and BRL 4,000 (BPHS), PP1 is the strategy more likely to be the cost-effective. PP2 is costlier and promotes more sensitivity compared to SP, resulting in similar efficiency with a trend favouring PP1, though. In SUS and BPHS perspective, adding SFLC in the initial diagnostic work up of MG improves efficiency of financial resources allocated to MG diagnosis regardless its concomitancy to SIFE. The strategy considering SFLC+SPEP for screening purposes adds more value for money compared to SFLC+SPEP+SIFE.

PCN50 - Budget Impact Comparison of Abiraterone Acetate Plus Prednisone in the Pre-Chemotherapy Setting Followed by Enzalutamide in the Post-Chemotherapy Setting Versus the Opposite Treatment Sequence in Metastatic Castration-Resistant Prostate Cancer Patients Under the Brazilian Private Health Care System Perspective

PCN50 - Budget Impact Comparison of Abiraterone Acetate Plus Prednisone in the Pre-Chemotherapy Setting Followed by Enzalutamide in the Post-Chemotherapy Setting Versus the Opposite Treatment Sequence in Metastatic Castration-Resistant Prostate Cancer Patients Under the Brazilian Private Health Care System Perspective

PCN85 - Cost Effectiveness of Abiraterone Acetate Plus Prednisone in the Pre-Chemotherapy Setting Followed by Enzalutamide in the Post-Chemotherapy Setting Versus the Opposite Treatment Sequence in Metastatic Castration-Resistant Prostate Cancer Patients Under the Brazilian Private Health Care System Perspective

ABIRATERONE ACETATE PLUS PREDNISO(LO)NE (AA+P) AND ENZALUTAMIDE (ENZ) ARE NOVEL THERAPIES targeting the androgen axis FOR THE TREATMENT OF METASTATIC CASTRATION RESISTANT PROSTATE CANCER (MCRPC)THIS STUDY MODELs THE COST-EFFECTIVENESS WITH TWO TREATMENT SEQUENCES: AA+P FOLLOWED BY DOCETAXEL (DOC) CHEMOTHERAPY AND THEN ENZ (‘AA+P-DOC-ENZ SEQUENCE’) VERSUS ENZ FOLLOWED BY DOC CHEMOTHERAPY AND THEN AA+P (‘ENZ-DOC-AA+P SEQUENCE’) IN MCRPC PATIENTS. A health economic model has been developed to estimate and compare cost consequences of these two treatment sequences in Brazil. Seven health states were considered in the model: prechemotherapy (AA+P or ENZ), active monitoring (before and after chemotherapy separately), DOC chemotherapy, post-chemotherapy (AA+P or ENZ), best supportive care, and death. Clinical data (duration of treatment, time to chemotherapy) for the model were derived from published pivotal trial results. Cost parameters were derived from available literature and cmed’s official price list. For each treatment sequence, the model estimated total costs and total costs per health state. matching adjustment of full trial population was done. discount rate considered 5%. Total costs were estimated to be R$ 262,801 for ‘AA+P-DOC-ENZ sequence’ and R$ 274,165 for ‘ENZ-DOC-AA+P sequence’ resulting in total difference of R$ 11,364. Prechemotherapy costs of AA+P and ENZ treatment were estimated to be R$ 125,560 and R$ 136,086, respectively (difference R$ 10,526). Similar costs were estimated for the two sequences, e.g., post-chemotherapy costs of AA+P and ENZ treatment were predicted to be R$ 26,309 and R$ 24,778, respectively. total life years gained for ‘AA+P-DOC-ENZ sequence’ were 3,37 against 3,28 in ‘ENZ-DOC-AA+P sequence’. total cost / life-year gained was R$ 78.058 for ‘AA+P-DOC-ENZ sequence’ and R$ 83.548 for ‘ENZ-DOC-AA+P sequence’, resulting in cost difference R$ 5.490. ‘AA+P-DOC-ENZ sequence’ was cost-saving from a Brazilian payer perspective compared with ‘ENZ – DOC-AA+ P sequence’. therefore starting treatment with AA+P may result in savings.

PHS114 - The Economic Cost of a Death Event in the Brazilian Private Health Care System

PHS114 - The Economic Cost of a Death Event in the Brazilian Private Health Care System

PCN52 - Budget Impact Analysis of the Incorporation of Ibrutinib for the Treatment of Relapsed/Refractory Chronic Lymphocytic Leukemia in the Brazilian Private Health Care System

PCN52 - Budget Impact Analysis of the Incorporation of Ibrutinib for the Treatment of Relapsed/Refractory Chronic Lymphocytic Leukemia in the Brazilian Private Health Care System

PRS18 - Budget Impact Of Pneumococcal Disease: Brazilian Private Health Care Database Analysis

Streptococcus pneumoniae is the most significant causal agent of invasive bacterial infections among children and adults1,2. Pneumococcal infections are responsible for severe clinical manifestations such as bacteremia, meningitis and pneumonia, being associated with a high economic burden to healthcare systems1,3,4. Our study aimed to evaluate the impact of the main pneumococcal diseases on Brazilian Private Healthcare System (PHS) and how this may affect Brazilian population. The average number of hospital admissions, as well as the average hospitalization cost for pneumococcal diseases (pneumonia, meningitis and sepsis [PDs]) cases, were analyzed in all age groups, between October 2010 and December 2013, using a PHS database containing over 18 million lives5. The economic impact of absenteeism due to PD was also analyzed, considering the average number of hospital admissions in the PHS and Brazilian average cost of absenteeism per day of BRL 254 (Brazilian data on economically active population [EAP]6 and Brazilian gross national product [GNP]). From 70,850 PD episodes identified in all age groups, 68,717 (96.99%) were pneumonia episodes, 1,745 (2.46%) were bacteremia episodes and 388 (0.55%) were meningitis episodes. The average length of stay was 7 days for pneumonia and meningitis, and 14 days for bacteremia. The average hospitalization cost in the age groups of 0-6 years, 7-49 years and > 50 years was BRL 4,554, BRL 7,110 and BRL 20,079 for meningitis, BRL 1,479, BRL 1,569 and BRL 18,800 for pneumonia and BRL 17,456, BRL 11,868 and BRL 53,524 for bacteremia, respectively. The average cost due to EAP absenteeism was BRL 1,778 for meningitis and pneumonia, and BRL 3,556 for bacteremia. Hospitalizations for PD were associated with a high economic impact on PHS. EAP absenteeism for pneumonia may impact 25% on monthly work. Therefore, developing and promoting PD preventive strategies could reduce the costs associated with these diseases.

PCN75 - Direct Medical Costs of Treating Chronic Lymphocytic Leukemia Patients in the Private Healthcare System in Brazil: Results From A 24-Month Retrospective Analysis of an Administrative Database

The aim of this study is to determine 2-year direct medical costs of treating patients with Chronic Lymphocytic Leukemia (CLL) based on the Brazilian Private Healthcare System. The Orizon database, an administrative database containing inpatient and outpatient claims from a pool of 102 HMOs representing 34% of the total Private Health System, was reviewed from Jan/2009 to Dec/2014. Eligibility criteria were patients starting CLL (ICD-10 code C911) treatment from Jan/2011 to Dec/2012. Direct medical costs (DMC) per patient-year were calculated as the sum of medical claims for each patient included in the analysis, for a maximum period of 24-months or death or loss of follow-up, whichever came first. DMC was categorized in chemotherapy, hospitalizations, and other outpatient costs. Further analysis was conducted for chemotherapy and hospitalizations. From 535 patients with CLL identified in the database, 175 met eligibility criteria and were included in this analysis, representing a total of 212 patients-years. Total DMC in this population was R$25,597,927 (mean cost of R$120,744 per patient-year), from which R$15,778,157 (62%) were related to chemotherapy, R$5,689,887 (22%) to hospitalizations and R$4,129,883 (16%) to other outpatient costs. Outpatient laboratory exams accounted for only a small fraction (R$989,990, 4%) of DMC. A total of 265 hospitalizations were identified in 53 (30%) patients, with an average cost of R$21,471 ± 55,938 per hospitalization. Chemotherapy drugs accounted for 68% of the total costs within chemotherapy treatment, the rest divided between other drugs (12%), disposable devices (6%), hospital facility fees (5%) and other costs (6%). Patients with CLL represent a significant economic burden to private payers. Chemotherapy and hospitalization costs account for about 80% of total costs. Further research will elucidate the cost-effectiveness of novel targeted agents such as ibrutinib, which is administered orally and does not incur costs associated with in-clinic infusions.