Brazilian Private Health Care System Research Articles

EE198 Cost-Utility of Belimumab in Treating Lupus Nephritis: A Brazilian Private Healthcare System Perspective

EE198 Cost-Utility of Belimumab in Treating Lupus Nephritis: A Brazilian Private Healthcare System Perspective

Healthcare in Brazil: An Overview

This study examines the present comprehension of healthcare in Brazil, which accounts for 9.3% of GDP and is not viable in the long term. The research enhances the caliber and triumph of private healthcare initiatives in Brazil, as well as the entire Brazilian healthcare system. Our findings indicate that there are consistent concerns about the public healthcare system deteriorating due to the pandemic while the private healthcare system is seen as costly and a "necessary evil." Professionals in the Brazilian private healthcare system is encountering widespread discontent due to inadequate resources to meet the needs of the people. This research offers recommendations for future investigations.

Etonogestrel-releasing subdermal contraceptive implant: Budget impact analysis based on the Brazilian private healthcare system.

High rates of unplanned pregnancies persist despite pharmacological developments and advancements in contraceptive methods. Here, we demonstrate that the etonogestrel-releasing subdermal contraceptive implant (IMP-ETN) may be an appropriate and cost-effective alternative to levonorgestrel-releasing intrauterine systems (LNG-IUSs) for women in Brazil. For our pharmacoeconomic analysis, we reviewed the literature on IMP-ETN regarding its acceptance, eligibility criteria, choice, relations with age, adverse events and, finally, the unmet need in the fee-for-service private healthcare sector. We considered qualitative observations in combination with quantitative analysis and performed a deterministic sensitivity analysis to investigate whether this technology can be self-sustainable over a period of five years. The target population for this analysis comprised 158,696 women. Compared with the continued use of LNG-IUSs, adopting the IMP-ETN can result in a cost avoidance of $ 7.640.804,02 in the first year and $ 82,455,254.43 in five years. Disseminating information among physicians will promote this change and strengthen the potential cost avoided by private health system payers. These savings can be used to improve other healthcare programs and strategies. Moreover, the principles of care can be promoted by improving and adapting healthcare systems and expanding treatment and follow-up strategies. This would also provide support to women's reproductive rights and improve their quality of life. Our results suggest that the IMP-ETN has a favorable cost-effectiveness profile. Given all its advantages and negative incremental cost impact over a period of five years, the IMP-ETN may be a more favorable alternative to LNG-IUSs. Therefore, it should be offered to beneficiaries with a private healthcare plan. This analysis overcomes previous barriers to the use of cost-benefit models, and our results may help balance decision-making by policymakers, technical consultants, and researchers.

The Impact of Transformational Leadership on Project Management Success in the Brazilian Private Healthcare System

The Impact of Transformational Leadership on Project Management Success in the Brazilian Private Healthcare System

Impact of COVID-19 pandemic on surgical activity in the Brazilian private healthcare system

Introduction Surgical volume was drastically reduced in many countries due to challenges imposed by the COVID-19 pandemic. Objectives We sought to estimate the number of cancelled surgical and diagnostic procedures within the Brazilian private healthcare system between 2020 and 2021 over the course of the COVID-19 pandemic, and to project the procedural backlog generated for specific elective and time-sensitive surgeries, and diagnostic procedures. Methods Data were systematically extracted from the Brazilian national regulatory agency for the private healthcare system and included (i) quarterly and annual surgical and diagnostic volume, and (ii) the number of private health insurance beneficiaries between January 2016 and June 2021. Based on pre-pandemic data we estimated the expected number of surgical and diagnostic procedures that failed to be performed between 2020 and 2021. Results The average quarterly surgical and diagnostic procedures declined by 29.5% in 2020 and by 21.5% in 2021 compared to 2019. In 2020, such reduction reflected a lower number of diagnostic procedures under anesthesia (-35.1%), as well as elective (-14.7%), time-sensitive (-18.8%), and urgent (-4.6%) surgeries. In the first half of 2021, though the surgical and diagnostic procedures increased compared to 2020, they remained significantly below their historical average. The estimated backlogs were 134.385,64 for total surgical procedures, 2.634,64 for bariatric surgery and arthroplasty revision (elective surgeries), 2.845,61 for oncologic (time-sensitive) surgeries, and 304.193,99 for diagnostic procedures, requiring 1.7, 15.9, and 6.8 years, respectively, to make up for such backlogs. Conclusion There was a major decline on the number of surgical and diagnostic procedures due to the COVID-19 pandemic. Despite a slight recovery of elective surgeries throughout the pandemic, many time-sensitive surgeries and diagnostic procedures were cancelled, with potential medium- to long-term consequences to patients and the system as a whole.

CO103 Modelled Impact of Nirsevimab for All Infants in Preventing Respiratory Syncytial Virus (RSV): Related Hospitalizations and Costs in the Brazilian Private Healthcare System

CO103 Modelled Impact of Nirsevimab for All Infants in Preventing Respiratory Syncytial Virus (RSV): Related Hospitalizations and Costs in the Brazilian Private Healthcare System

EE386 Budget Impact of Durvalumab for the Treatment of Patients with Unresectable Stage III Non-Small Cell Lung Cancer in the Brazilian Private Healthcare System

EE386 Budget Impact of Durvalumab for the Treatment of Patients with Unresectable Stage III Non-Small Cell Lung Cancer in the Brazilian Private Healthcare System

The journey of stage III and IV non-small cell lung cancer patients in the Brazilian private healthcare system: a retrospective study.

Non-small cell lung cancer (NSCLC) is still diagnosed at late stages in Brazil. The availability of newer treatment options has changed patient management, however, few real-world data have been published since then. This is a population-based retrospective cohort study that aims to evaluate the characteristics of stage III/IV NSCLC patients and their journey in the Brazilian private healthcare system. Patients aged ≥18 years, residing in Brazil who had their first medical appointment between 2016 and 2018 were included in the study. The sociodemographic and clinical characteristics of the patients and time intervals of interest were described. A total of 10,394 patients were analyzed. The majority of the patients were male (58.5%) with a median age of 64.0 (IQR = 58.0 - 71.0) years. In relation to characteristics of the disease, most of the tumors were characterized as adenocarcinomas (52.3%) and diagnosed at stage IV (72.2%). Most patients arrived at the hospital with an established NSCLC diagnosis, while 45.7% were diagnosed at the first medical appointment in the hospital or later. For patients who were diagnosed at the first medical appointment or later, a median interval of 15.0 (IQR = 6.0 - 33.0) days was observed between the first medical appointment and the diagnosis. The first treatment was given after a median of 25.0 (IQR = 6.0 - 49.0) days after diagnosis for patients without a prior diagnosis, and 57.0 (IQR: 33.0 - 98.0) days for patients with a prior diagnosis. The most common treatments were chemotherapy alone (33.8%), chemotherapy combined with radiotherapy (21.5%), radiotherapy alone (13.1%), adjuvant or neoadjuvant treatment (9.3%), surgery (3.3%), and immunotherapy (0.7%; alone or combined). At the end of follow-up (September, 2020), 52.3% of the patients had died. Despite having more treatment options in the private sector, data show that there is a need to improve access to technologies.

Treatment patterns and healthcare resource utilization for triple negative breast cancer in the Brazilian private healthcare system: a database study

In Brazil, data on the management of triple negative breast cancer (TNBC) as well as the burden of the disease in terms of health care resources utilization (HCRU) are scarce. To characterize the treatment patterns and HCRU associated with the management of Brazilian TNBC patients from the perspective of the private healthcare setting. Patients with at least one claim related to ICD-10 C50 from January 2012 until December 2017, and at least one claim for breast cancer treatment were assessed from a private claims database and classified as early and locally advanced, or metastatic. All patients with hormone and/or targeted therapy were excluded. Three thousand and four patients were identified, of which 82.8% were diagnosed in early and locally advanced stages. For early and locally advanced TNBC patients, 75.3% were treated in an adjuvant setting, mainly with anthracycline regimes. For mTNBC patients, bevacizumab regimens were the main treatment prescribed. More than 48% of mTNBC patients were switched to a second line of treatment. HCRU was higher for mTNBC patients when compared to early and locally advanced patients, with higher costs for metastatic disease management. The treatment setting has little influence on the HCRU pattern or the cost of disease management. The highest burden of disease was observed for metastatic management.

Cost-effectiveness of nivolumab and ipilimumab versus pembrolizumab and axitinib in advanced renal cell carcinoma with intermediate or poor prognostic risk: a Brazilian private healthcare system perspective

ObjectiveNivolumab plus ipilimumab (NIVO + IPI) and pembrolizumab plus axitinib (PEM + AXI) have demonstrated significant clinical benefits as first-line (1 L) treatments for intermediate/poor-risk advanced renal cell carcinoma (aRCC) patients. This study aimed to assess the cost-effectiveness of NIVO + IPI versus PEM + AXI from a Brazilian private healthcare system perspective, utilizing a novel approach to estimate comparative efficacy between the treatments.MethodsA three-state partitioned survival model (progression-free, progressed, and death) was developed to estimate costs, life-years (LYs), quality-adjusted LYs (QALYs), and the incremental cost-utility ratio (ICUR) over a 40-year time horizon. In the absence of head-to-head comparisons between NIVO + IPI and PEM + AXI, clinical data for NIVO + IPI was obtained from CheckMate 214 (NCT02231749) and for PEM + AXI from KEYNOTE-426 (NCT02853331). A matching-adjusted indirect comparison was conducted to account for the imbalance of treatment effect modifiers between the trials. Patient characteristics, resource use, health state utilities, and costs were based on Brazilian-specific sources. Costs and health outcomes were both discounted by 5% annually in line with Brazilian guidelines. The robustness of the results was evaluated through extensive sensitivity analysis and scenario analyses.ResultsWhen comparing the matched versus unmatched OS, PFS, and TTD curves there was no noteworthy difference. NIVO + IPI was associated with cost savings (R$ 350,232), higher LYs (5.54 vs. 4.61), and QALYs (4.74 vs. 3.76) versus PEM + AXI, resulting in NIVO + IPI dominating PEM + AXI. Key model drivers were the treatment duration for PEM, NIVO, and AXI. NIVO + IPI remained dominant in all scenario analyses, which indicated that model results were robust to alternative modelling inputs or assumptions.ConclusionsThis analysis shows that NIVO + IPI is estimated to be a life-extending and potentially cost-saving 1 L treatment option when compared with PEM + AXI for intermediate/poor-risk a RCC patients in the Brazilian private healthcare system.

HTA42 Summary of Recent Health Technology Assessments for New Cancer Pharmacological Technologies in the Brazilian Private Healthcare System

Since October 2021, a continuous submission flow was instituted for the health technology assessment to the mandatory minimum list of technologies covered in the Brazilian Private Healthcare System. This research aims to describe the recent coverage decisions and public consultation participation for cancer pharmacological interventions in the Brazilian Private Healthcare System.

HTA84 Cost-Utility Analysis of Talazoparib Versus Chemotherapy for Patients with Breast Cancer HER2- with Mutation in the BRCA1/2 Gene from the Brazilian Private Healthcare System

Breast cancer is the most common form of neoplasm in women in Brazil, being the main cause of death from cancer in this population. The aim of this analysis is to compare effectiveness and incremental costs between talazoparib and standard chemotherapy the treatment of metastatic breast cancer HER2- with mutation in the BRCA1/2 gene, from the perspective of the Brazilian private healthcare system.

HTA60 Potential Decision Drivers for Positive Recommendations of New Cancer Therapies in the Brazilian Private Healthcare System: Analysis of Recent HTA Submissions

This research aims to analyze potential drivers of coverage decisions for cancer pharmacological interventions submitted to the Brazilian Private Healthcare System under the new submission process, established in October 2021.

EE151 Cost-Minimization of Lorlatinib Versus Alectinib for First Line Treatment for Treatment of Alk-Positive Non–Small-Cell Lung Cancer from the Brazilian Private Healthcare System Perspective

Lung cancer is one of the most prevalent cancers in men and women and has the highest mortality rate of all cancers except non-melanoma skin cancer. Approximately 85% of the cases are non-small cell lung cancer (NSCLC) and, among these, about 3% present the ALK+ translocation. The aim of this analysis is to compare costs between lorlatinib and alectinib in the ALK+ NSCLC in first line treatment from the Brazilian private healthcare system perspective.

The impact of depression in the Brazilian private healthcare system: patient journey and economic burden study associating claim database and expert’s opinion approach

Objective: The study aimed to describe the profile and economic burden of patients with depression from the perspective of the Brazilian Private Healthcare System (PHS). Methods: A two-step methodological quantitative-qualitative research design was performed: retrospective descriptive analysis of the Orizon database of patients with at least one claim of depression (F33, F38, or F39) in PHS (2013-2019) and experienced physicians perspective from an expert meeting. Results: 1,802 patients fulfilling the eligibility criteria counted BRL 74,978 million across the 4-year period. Over this period, nearly 60% of patients had a medical appointment (6.6 appointments per patient, on average), 61% had a psychologist, 9.8% had a psychiatrist appointment, and an average of 115.2 exams and 8.7 emergency visits per patient were performed. According to the experts, the economic impact of depression is more significant when considering the indirect costs related to productivity loss and impairment in occupational and interpersonal functioning. Conclusion: Identifying and diagnosing patients with depression and their real burden is challenging; even with significant costs identified in the claim database analyses in the Brazilian PHS, the real impact must be higher if indirect costs are considered. The depressive disorder should be prioritized in the Brazilian PHS to establish more adequate health policies.

The impact of COPD on the private healthcare system in Brazil: an economic analysis

Objective: To assess healthcare resource utilization and hospitalization costs of patients with chronic obstructive pulmonary disease (COPD) exacerbations in the Brazilian private healthcare system. Methods: A retrospective cohort study, considering data from an administrative database of a private company (Orizon). Patients aged ≥40 years old and with at least one COPD-related claim identified by the ICD-10 code (J40 to J44) at any time during the eligibility period (January/2010 to December/2013) were included in the analysis. Follow-up was performed until December/2014, death or inactivation of a health plan. Sociodemographic characteristics, number of emergency visits, hospital admissions (number and length of stay), length of hospital stay in an intensive care unit (ICU), number of severe COPD exacerbations, therapeutic approach, and hospitalization costs were assessed. Results: The analysis included 8,254 COPD patients. Emergency visits, hospital admission, and exacerbation rates were 0.4, 0.2, and 0.1 per person-year, respectively. The mean length of hospital stays and the length of stay of patients requiring or not ICU stay were 16.6 (SD = 77.0), 8.7 (SD = 36.9), and 27.6 (SD = 109.7), respectively. Mean costs associated to emergency department visits and hospitalizations were 258.2 BRL (SD = 383.1) and 38,165.4 BRL (SD = 124,683.5), respectively. Hospitalizations costs without ICU stay were 11,810.1 BRL (SD = 31,144.1) and 74,585.3 BRL (SD = 182,808.1) for those with ICU utilization. Conclusion: Costs for COPD management during disease exacerbation are very high and may reach almost 75 thousand BRL per hospitalization. The prevention of COPD exacerbations and better disease control may reduce the economic burden on the private healthcare system in Brazil.

The impact of patients with generalized anxiety disorder in the Brazilian Private Healthcare System: a claim database study with expert’s perspective

This study describes the healthcare resource use and costs associated with anxiety assessing claim database outcomes and expert opinion from the perspective of the Brazilian Private Healthcare System. A retrospective analysis of the Orizon database was conducted, containing claims data of anxiety patients reported in Private Healthcare Systems (2015-2017) according to the ICD-10 code (F40 or F41 and their subtypes). Further, a 3-hour online meeting brought together five anxiety and Health Insurance Companies experts to discuss their perspectives. The total cost of the 18,069 patients identified in the database was BRL 490 million: related to medical appointments (2%), exams (16%), emergency room (5%), and others (77%). The mean number of appointments was 5.1 in a 4-year period, performed by 61% of the patients. Approximately 2,595 visits were made to psychiatrists by 923 patients, and 95% underwent at least one examination (100.6 examinations per patient, on average). The identification of anxiety patients and their corresponding burden is challenging to estimate. The higher impact is related to the frequency of healthcare use before the diagnosis than the treatment itself. These outcomes may help plan and implement adequate healthcare programs for patients with anxiety.

ICU Admission, Invasive Mechanical Ventilation, and Mortality among Children and Adolescents Hospitalized for COVID-19 in a Private Healthcare System.

The COVID-19 pandemic devastated healthcare around the world. Data about the COVID-19 outcomes among young people are still scarce. We aim to identify factors associated with the composite outcome among children and adolescents hospitalized due to COVID-19. We performed a search in the database of a large Brazilian private healthcare system. Insured people aged 21 years or younger who were hospitalized due to COVID-19 from Feb/28th/2020 to Nov/1st/2021 were included. The primary endpoint was the composite outcome consisting of ICU admission, need for invasive mechanical ventilation, or death. We evaluated 199 patients who had an index hospitalization due to COVID-19. The median monthly rate of index hospitalization was 2.7 (interquartile range [IQR], 1.6-3.9) per 100,000 clients aged 21 years or less. The median age of the patients was 4.5 years (IQR, 1.4-14.1). At the index hospitalization, the composite outcome rate was 26.6%. The composite outcome was associated with all the previous coexisting morbidities evaluated. The median follow-up was 249.0 days (IQR, 152.0-438.5). There were 27 readmissions (16 patients) within 30 days after the discharge. In conclusion, hospitalized children and adolescents had a composite outcome rate of 26.6% at the index hospitalization. Having previous chronic morbidity was associated with the composite.

Evaluation of biologic therapies for the treatment of moderate-to-severe plaque psoriasis in the brazilian private healthcare system: a Cost Per Responder (CPR) and Treatment Cost Analysis

Introduction: Psoriasis is a chronic, immune-mediated inflammatory skin disease presenting with localized or generalized erythematous, sharply demarcated plaques covered with whitish or silvery scales in a symmetrical distribution. Moderate-to-severe plaque psoriasis in Brazil are usually treated with synthetic systemic drugs, and only patients who do not respond to these therapies or are intolerant to them may be eligible for treatment with biologic agents. These agents are significantly more costly than most synthetic alternatives and, therefore rational resource allocation is necessary to guarantee coverage across the country. Comparative efficacy assessments are usually obtained from network meta-analyses (NMA) and are useful in clinical decision-making. These NMA allow the calculation of the number needed to treat (NNT) which is an easier-to-understand concept for clinicians and decision makers and is the number of patients needed to be treated with a specific therapy to achieve one particular outcome. Objectives: The objective of this study is to determine the efficacy of different biological therapies available in Brazil for the treatment of moderate-to-severe plaque psoriasis in terms of cost per responder (CPR) for the different levels of Psoriasis Area Severity Index (PASI) response. The treatment cost for 1 and 2 years of therapy were also calculated. Methods: A NMA by Núnez et al (2018) presented the data that was used to estimate the CPR of adalimumab, etanercept, infliximab, ixekizumab, secukinumab and ustekinumab. NNT was calculated relative to the placebo response for the outcomes of PASI score reduction of ≥75%, ≥90% or 100% (Table 1). In order to estimate treatment costs for year 1 and 2, the number of doses and unit prices were considered. Since the time horizon of this analysis was 1 year, only treatment costs in the first year (R$, Brazilian currency) were considered for CPR estimation (Table 2), using as reference the Brasíndice pharmaceutical guide (wholesale prices plus 18% taxes (Table 3)). The number of doses used in the analyses for each of the products was based on the current product labels in Brazil. Results: Ixekizumab had the lowest NNT (1.18 for PASI-75, 1.41 for PASI-90 and 2.46 for PASI100) and the lowest CPR for PASI-90 and PASI-100 (R$ 126.364 and R$ 220.464, respectively). Conclusion: For PASI-90 and PASI-100 responses, ixekizumab is the most cost-efficient therapy for moderate-to-severe plaque psoriasis in the first year in the Brazilian private healthcare system, presenting the lowest NNT and CPR.

EE92 Economic Evaluation of Isavuconazole Versus Voriconazole for the Treatment of Patients With Possible Invasive Aspergillosis in the Brazilian Private Healthcare System

In 2019, isavuconazole was approved in Brazil by ANVISA for the treatment of invasive aspergillosis (IA) and invasive mucormycosis (IM). The primary objective was to assess the cost-effectiveness of isavuconazole compared to reference voriconazole for suspected IA in the Brazilian Private Healthcare System (PHS). The secondary objective was to assess the price impact in an economic evaluation of generic voriconazole versus isavuconazole without discount on list price, and generic and reference voriconazole with a 60% discount.