Brazilian Public Healthcare System Research Articles

Abstract PO5-09-12: Unraveling the Intricacies of Racial Disparities in Breast Cancer in Brazil

Abstract Abstract Background: Over the past three decades, numerous countries have experienced a substantial decrease in breast cancer (BC) fatality, attributed to heightened consciousness, widened and earlier screening, and enhanced therapeutic interventions. However, these advancements have not eradicated the disparity in BC treatment across different racial and ethnic groups. In Brazil, the causes of these disparities are diverse and intricate, resembling health inequalities among ethnic communities observed in other countries. This study aimed to investigate the trends in BC incidence and mortality rates in Brazil, considering clinicopathological and sociodemographic variations, and placing particular emphasis on the severity of racial disparity concerning race/skin color. Patients and methods: Incidence trends for women with BC were analyzed using data from 13 Brazilian Population-Based Cancer Registries covering the period 2010-2015. Crude incidence ratios (CIRs) and the annual average percent change (AAPC) were calculated. Clinical and sociodemographic information from 348 Hospital-Based Cancer Registries spanning from 2000 to 2019 was also utilized. Meanwhile, mortality data for the years 2000-2020 were obtained from the National Mortality Information System. Racial and skin color data were collected through a self-declaration process, following the classification proposed by the Brazilian Institute of Geography and Statistics, which included categories such as white, black, and brown/mixed race. In the analysis, black and brown/mixed race categories were combined as black. Yellow and indigenous categories were excluded. Statistical significance was defined as a p-value less than 0.05. To determine clinically relevant differences, a threshold of more than 5% disparity in proportional values was used as an arbitrary criterion. Results: Between 2010 and 2015, a total of 70,896 newly diagnosed cases of BC were recorded. Mean CIRs were 83.9/100,000 for the overall population, 101.3/100,000 for white women, and 59.7/100,000 for black women. Neither the group of white women (AAPC -1.7; 95% CI: -7.9 to 4.9; p = 0.506) nor the group of black women (AAPC -0.4; 95% CI: -5.0 to 4.5; p = 0.831) exhibited any significant changes in the incidence rate. Black women predominantly originated from underdeveloped regions (56.4%, p < 0.001), were referred by the public healthcare system in Brazil (79.0%, p < 0.001), had ≤ 8 years of schooling (68.7%, p < 0.001), were unmarried (50.9%, p< 0.001), reported alcohol consumption (20.9%, p < 0.001), and were diagnosed with advanced stage disease (60.1%, p < 0.001). The escalation in mortality rates among black women exhibited a notable difference, amounting to 3.8 times the increase observed among white women (AAPC + 2.3; 95% CI: 2.1 to 2.5; p < 0.001) (AAPC + 0.6; 95% CI: 0.5 to 0.7; p < 0.001). Conclusion: Despite the lower incidence of BC in black women compared to their white counterparts, there is a concerning rise in BC-related mortality rates among black women. This group exhibits a significantly unfavorable sociodemographic and clinicopathological profile. These results highlight the pressing need to address the multifaceted factors contributing to these disparities, encompassing socioeconomic disparities and unequal healthcare access. Keywords: Breast cancer; racial disparities; incidence; mortality. Citation Format: Jesse Lopes da Silva, Andreia Cristina De Melo, Mariana Espirito Santo Rodrigues, Lucas Zanetti de Albuquerque, Luiz Claudio Santos Thuler. Unraveling the Intricacies of Racial Disparities in Breast Cancer in Brazil [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-09-12.

Humanized Childbirth: An Experience Report of the Assistance Offered by the Unified Health System in a City in the SouthEast of Brazil

Background: Childbirth is a crucial event in a woman’s life and her baby’s, with significant implications for the health and well-being of both. In Brazil, the predominant approach has been medicalized childbirth, with frequent medical interventions during the birthing process. However, growing evidence highlights the benefits of humanized childbirth for the physical and emotional health of the mother and baby. In this context, this study analyzes the transition towards more humanized childbirth practices in Brazil, its impacts, and associated challenges. Objectives: This study aims to analyze the implementation of humanized childbirth practices in Brazil, focusing on the stages of pregnant women reception, preparing the environment for the child’s arrival, and the symbolism of childbirth through Placenta Printing. Specific objectives include evaluating pregnant women’s satisfaction with the childbirth experience, analyzing the reduction of unnecessary medical interventions, and assessing neonatal outcomes associated with these practices. Methods: The study is an experience report that occurred in a municipal hospital in Minas Gerais, Brazil, during the year 2024. Humanized childbirths were followed through the Brazilian public healthcare system, which offers free and universal assistance to pregnant women during childbirth. The stages of pregnant women reception, preparing the environment for the child’s arrival, and the symbolism of childbirth through Placenta Printing were detailed and implemented according to established protocols. Pregnant women’s satisfaction was assessed through postpartum interviews, while data related to the rate of medical interventions and neonatal outcomes were collected and analyzed. Results: The results demonstrated high satisfaction among pregnant women with the humanized childbirth experience, highlighting empathetic reception, clear and respectful communication, and consideration of their preferences in preparing the environment and practicing Placenta Printing. Additionally, there was a significant reduction in unnecessary medical interventions, reflected in a decrease in the cesarean section rate, episiotomies, and other medical procedures during childbirth. Neonatal outcomes were also positive, with favorable neonatal adaptation indicators. Conclusion: The experience of humanized childbirth in Brazil represents a significant advancement in promoting maternal and neonatal health. Despite the challenges faced, the benefits associated with this comprehensive approach to childbirth are undeniable. It is crucial for health authorities, healthcare professionals, and society to continue supporting and promoting humanized childbirth practices as part of a broader effort to improve maternal and neonatal health outcomes in Brazil

Affective relatedness, temporalities, and the politics of care in a medical South-South partnership

Abstract For more than 50 years, Cuba has been one of the most important players in the field of international medical care in the Global South. Between 2013 and 2018, Cuba sent nearly 18,000 Cuban health professionals to Brazil within the framework of the More Doctors Program to assist during the Brazilian public health care system's state of emergency. This article focuses on local encounters and emergent socialities between Cuban physicians and Brazilian patients and medical staff. Their sensitive moments of interaction—with their embodied, emplaced, and political dimensions of past and present—hold the possibility of a fragile intersubjectivity that creates its own temporal and affective dynamics, undermining, for a moment, the prevalent care regimes.

Time-driven activity-based costing (TDABC) of current clinical practice for mucopolysaccharidosis type II patients assisted at one institution of the Brazilian Public Healthcare System: Data from JAV-RARAS Study

Time-driven activity-based costing (TDABC) of current clinical practice for mucopolysaccharidosis type II patients assisted at one institution of the Brazilian Public Healthcare System: Data from JAV-RARAS Study

Analysis of the costs of teleconsultation for the treatment of diabetes mellitus in the SUS.

To present the results of a cost analysis of remote consultations (teleconsultations) compared to in-person consultations for patients with type 2 diabetes, in the Brazilian public healthcare system (SUS) in the city of Joinville, Santa Catarina (SC). In addition to the costs from the local manager's perspective, the article also presents estimates from the patient's perspective, based on the transportation costs associated with each type of consultation. Data were collected from 246 consultations, both remote and in-person, between 2021 and 2023, in the context of a randomized clinical trial on the impact of teleconsultation carried out in the city of Joinville, SC. Teleconsultations were carried out at Primary Health Units (PHU) and in-person consultations at the Specialized Health Center. The consultation costs were calculate by the method time and activity-based costing (TDABC), and for the estimate of transportation costs data was collected directly from the research participants . The mean costs and time required to carry out each type of consultation in different scenarios and perspectives were analyzed and compared descriptively. Considering only the local SUS manager's perspective, the costs for carrying out a teleconsultation were 4.5% higher than for an in-person consultation. However, when considering the transportation costs associated with each patient, the estimated value of the in-person consultation becomes 7.7% higher and, in the case of consultations in other municipalities, 15% higher than the teleconsultation. The results demonstrate that the incorporation of teleconsultation within the SUS can bring economic advantages depending on the perspective and scenario considered, in addition to being a strategy with the potential to increase access to specialized care in the public network.

EE544 The Impact of Pulmonary Arterial Hypertension in the Brazilian Public Healthcare System: A Microcosting Approach Based on Expert's Opinion

EE544 The Impact of Pulmonary Arterial Hypertension in the Brazilian Public Healthcare System: A Microcosting Approach Based on Expert's Opinion

EPH20 Muscular Dystrophy-Related Hospitalizations and Outpatient Procedures in the Brazilian Public Healthcare System: A Real World Data Analysis

EPH20 Muscular Dystrophy-Related Hospitalizations and Outpatient Procedures in the Brazilian Public Healthcare System: A Real World Data Analysis

EPH246 Landscape of Diffuse Large B-Cell Lymphoma (DLBCL) in Brazilian Public Healthcare System (SUS)

EPH246 Landscape of Diffuse Large B-Cell Lymphoma (DLBCL) in Brazilian Public Healthcare System (SUS)

Cost-effectiveness of continuous glucose monitoring with FreeStyle Libre® in Brazilian insulin-treated patients with types 1 and 2 diabetes mellitus

BackgroundHypoglycemia is a barrier to optimal glucose control in the treatment of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Blood glucose monitoring is essential in diabetes management. Inappropriate glucose management is associated with high mortality and morbidity. FreeStyle Libre® (FSL) is a continuous glucose monitoring (CGM) system that provides effective, safe, and convenient glucose monitoring, without routine finger pricking. This study aims to estimate the incremental cost-effectiveness ratio (ICER) of the FSL system in comparison to conventional Self-monitoring of blood glucose (SMBG) in T1DM and T2DM patients that require intensive insulin therapy.MethodsA decision-tree model was developed to compare the cost-effectiveness ratio between FSL and conventional SMBG from the perspective of the Brazilian Public Healthcare System (SUS). The model captures the cumulative rates of acute complications such as severe hypoglicemia and diabetic ketoacidosis, per-event costs, and quality-adjusted life-years (QALYs) gained over a 1-year time horizon in adult and pediatric patients (≥ 4 years old) with T1DM or T2DM. Inputs from the Brazilian health databases, clinical trials, and real-world data were used in the study.ResultsThe results demonstrated that, regarding solely severe hypoglicemia and diabetic ketoacidosis events, T1DM have a QALY difference of 0.276, a cost difference of R$ 7.255, and an ICER of R$ 26,267.69 per QALY gained for CGM with FSL, when compared to conventional SMBG. T2DM results demonstrated equally a QALY difference of 0.184, a cost difference of R$ 7290, and an ICER of R$ 39,692.67 per QALY gained, in favour of CGM with FSL.ConclusionOur findings demonstrated that FSL is cost-effective in T1DM and T2DM for acute diabetic complications, from a SUS perspective. CGM with FSL can promote safe, convenient, and cost-effective glucose monitoring, therefore contributing to the improvement of the incidence of complications and quality of life.

Epidemiological analysis of patients with psoriatic arthritis in follow-up at the brazilian Unified Health System

Introduction/ObjectivesPsoriatic arthritis (PsA) is a chronic multisystem osteoarticular disease that requires specialized care. Most Brazilians depend on the public healthcare provided by the Unified Health System (Sistema Único de Saúde, SUS). This study aimed to describe the epidemiological characteristics of patients with PsA in follow-up in SUS, focusing on the incidence and prevalence of the disease, comorbidities, and hospitalizations.MethodsWe collected data from the Outpatient Data System of SUS (Sistema de Informações Ambulatoriais do SUS, SIA/SUS) regarding outpatient visits and hospitalizations in the Brazilian public healthcare system from January 2008 to March 2021 using the Techtrials Disease Explorer® platform and the medical code related to PsA were selected.ResultsWe evaluated 40,009 patients and found a prevalence of 24.4 cases of visits due to PsA per 100,000 patients in follow-up in SUS. Female patients were predominant (54.38%). The incidence of visits due to PsA has been increasing in recent years and we observed an incidence of 8,982 new visits in 2020. The main comorbidities of these patients were osteoarthritis, lower back pain, shoulder injuries, oncological diseases, crystal arthropathies, and osteoporosis. Hospitalizations were mainly due to treating clinical or cardiovascular conditions and performing orthopedic procedures.ConclusionThe number of visits due to PsA in SUS has increased in recent years, mainly on account of new diagnoses of the disease, although the prevalence found in this study’s population was lower than that observed in the general population.

Characteristics of paroxysmal nocturnal hemoglobinuria patients in Brazil: A retrospective administrative claims database analysis of PNH patients in Brazilian public healthcare system.

Few studies have reported the profile of patients with paroxysmal nocturnal hemoglobinuria (PNH) and their care in the Brazilian health system. To describe clinical and epidemiological characteristics of patients with PNH in the Brazilian public health system including procedures performed, associated comorbidities and visits to health care professionals. In a real-world observational, retrospective, population-based cohort study, anonymized secondary data provided by the Department of Informatics of the Brazilian Unified Health System (DATASUS) were analyzed. Patients were considered eligible if they had at least one procedure coded with the ICD-10 code D59.5 from January 1, 2008 to December 30, 2018. In total, 675 individual PNH patients were identified (52.4% female; prevalence of 1:237,000 people). Around 15.8% of the patients included had myelodysplastic syndrome and about half of the sample had other aplastic anemias and/or other bone marrow failure syndromes. Portal vein thrombosis (I82 ICD code) was reported in 4.3% of patients. Regarding hospitalizations, 263 individual PNH patients had 416 inpatient admissions with the ICD code for PNH (D59.5) on admission. Twelve deaths occurred during the study period, of which two had the PNH ICD code related with the cause of death, while another three deaths were associated with acquired hemolytic anemia (D59.9), unspecified aplastic anemia (D61.9) and acute respiratory failure (J96.0), respectively. Despite its limitations, this statistical analysis of data extracted from DATASUS reasonably describes PNH patients in Brazil and its variations across different regions of the country. Comorbidities frequently associated with PNH such as portal vein thrombosis were not as common in our study, but it is assumed that several thrombotic events at specific sites were coded under the broader I82 ICD code. The frequency of visits to different health professionals, including hematologists, increased after the diagnosis of PNH. Among hospitalized PNH patients, the mortality rate was 4.5%.

EE53 Cost-Minimization and Budget Impact Analysis of Venetoclax Versus Acalabrutinib for 1L and R/R Chronic Lymphocytic Leukemia in the Brazilian Public Healthcare System

To demonstrate the economic advantages of using venetoclax (plus obinutuzumab [VenO] or rituximab [VenR]) vs acalabrutinib monotherapy (Acala) in the first line (1L) and relapse or refractory (R/R) chronic lymphocytic leukemia (CLL) treatment under the Brazilian public healthcare system (SUS).

RWD33 Cardiac Implantable Electronic Device Centers’ Landscape in the Brazilian Public Healthcare: A 12-Year Real World Data Analysis

Cardiac implantable electronic devices (CIED) implantation procedures, available in the Brazilian Public Health System (SUS) for more than 30 years, are performed only in tertiary care centers. This research aims to explore CIED implantation centers' landscape in the Brazilian Public Healthcare System.

P065 A Brazilian experience of elexacaftor/tezacaftor/ivacaftor in people with cystic fibrosis carrying at least one copy of F508del-CFTR

Background/objectives: Despite various reports from different countries demonstrating the safety and efficacy of elexacaftor-tezacaftor-ivacaftor (ETI) therapy in people with CF (PwCF) carrying at least one copy of F508del-CFTR, it is still not available for PwCF by the Brazilian Public Healthcare System. Here, we reported the clinical outcomes of 22 Brazilians with CF who earned the right to receive ETI therapy through court rulings.

EE99 Cost-Utility Analysis of 13-Valent Pneumococcal Conjugate Vaccine in the Immunization of Children Under Five Years for the Prevention of Invasive Pneumococcal Disease and Pneumonia in the Brazilian Public Healthcare System

Streptococcus pneumoniae (or pneumococcus) infections are still important causes of morbidity and mortality. In 2015, despite the decrease in the burden of pneumococcal disease due to the use of conjugate vaccines, an estimated 393,000 deaths worldwide in children under 5 years old were due to pneumonia. The aim of this analysis is to compare utility and costs between 13-valent pneumococcal conjugate vaccine versus the 10-valent for children under five years old.

EE187 Umeclidinium/Vilanterol Versus Tiotropium/Olodaterol in the Treatment of Severe to Very Severe Chronic Obstructive Pulmonary Disease (COPD) from the Brazilian Public Healthcare System Perspective: A Budget Impact Analysis

Umeclidinium/vilanterol (UMEC/VIL) and tiotropium/olodaterol (TIO/OLO), both combinations of long-acting muscarinic antagonist and long-acting beta2-adrenergic (LAMA/LABA) with similar efficacy and safety, are reimbursed for COPD treatment in Brazilian Public Healthcare System (SUS) since 2020. In 2021/2022, according to the Brazilian Government Price Panel (PP), TIO/OLO public sales volume were four times higher compared to UMEC/VIL. Our aim was to estimate the budget impact analysis (BIA) of switching TIO/OLO to UMEC/VIL for severe to very severe COPD treatment in SUS.

EE526 Cost-Effectiveness Analysis of Transthyretin-Associated Amyloid Cardiomyopathy from the Brazilian Public Healthcare System Perspective

Transthyretin-associated amyloid cardiomyopathy (ATTR-CM) is a rare condition, caused by cardiac infiltration of amyloid fibrils, leading to organ dysfunction and, consequently, progressive heart failure. The hereditary form of the disease usually manifests itself after 47 years of age, with a median survival of 2.5 years after diagnosis for patients without treatment. The wild form affects almost exclusively older people, with a mean age at diagnosis of 74 years and a median survival from diagnosis in untreated patients of approximately 3.5 years (depending on the stage of the disease). The aim of this analysis is to compare utility and incremental costs between tafamidis and symptomatic treatment.

EE52 Cost-Effectiveness Analysis of Crizotinib Versus Chemoterapy for First Line Treatment of Non-Small Cell Lung Cancer Alk+, from the Brazilian Public 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 effectiveness and incremental costs between crizotinib and standard chemotherapy in the ALK+ NSCLC treatment from the Brazilian public healthcare system perspective.

A machine learning model to assess potential misdiagnosed dengue hospitalization

Dengue, like other arboviruses with broad clinical spectra, can easily be misdiagnosed as other infectious diseases due to the overlap of signs and symptoms. During large outbreaks, severe dengue cases have the potential to overwhelm the health care system and understanding the burden of dengue hospitalizations is therefore important to better allocate medical care and public health resources. A machine learning model that used data from the Brazilian public healthcare system database and the National Institute of Meteorology (INMET) was developed to estimate potential misdiagnosed dengue hospitalizations in Brazil. The data was modeled into a hospitalization level linked dataset. Then, Random Forest, Logistic Regression and Support Vector Machine algorithms were assessed. The algorithms were trained by dividing the dataset in training/test set and performing a cross validation to select the best hyperparameters in each algorithm tested. The evaluation was done based on accuracy, precision, recall, F1 score, sensitivity, and specificity.The best model developed was Random Forest with an accuracy of 85% on the final reviewed test. This model shows that 3.4% (13,608) of all hospitalizations in the public healthcare system from 2014 to 2020 could have been dengue misdiagnosed as other diseases. The model was helpful in finding potentially misdiagnosed dengue and might be a useful tool to help public health decision makers in planning resource allocation.

Intestinal complications in patients with Crohn’s disease in the Brazilian public healthcare system between 2011 and 2020

This is a secondary database study using the Brazilian public healthcare system database. To describe intestinal complications (ICs) of patients in the Brazilian public healthcare system with Crohn's disease (CD) who initiated and either only received conventional therapy (CVT) or also initiated anti-tumor necrosis factor (anti-TNF) therapy between 2011 and 2020. This study included patients with CD [international classification of diseases - 10th revision (ICD-10): K50.0, K50.1, or K50.8] (age: ≥ 18 years) with at least one claim of CVT (sulfasalazine, azathioprine, mesalazine, or methotrexate). IC was defined as a CD-related hospitalization, pre-defined procedure codes (from rectum or intestinal surgery groups), and/or associated disease (pre-defined ICD-10 codes), and overall (one or more type of ICs). In the 16809 patients with CD that met the inclusion criteria, the mean follow-up duration was 4.44 (2.37) years. In total, 14697 claims of ICs were found from 4633 patients. Over the 1- and 5-year of follow-up, 8.3% and 8.2% of the patients with CD, respectively, presented at least one IC, of which fistula (31%) and fistulotomy (48%) were the most commonly reported. The overall incidence rate (95%CI) of ICs was 6.8 (6.5-7.04) per 100 patient years for patients using only-CVT, and 9.2 (8.8-9.6) for patients with evidence of anti-TNF therapy. The outcomes highlighted an important and constant rate of ICs over time in all the CD populations assessed, especially in patients exposed to anti-TNF therapy. This outcome revealed insights into the real-world treatment and complications relevant to patients with CD and highlights that this disease remains a concern that may require additional treatment strategies in the Brazilian public healthcare system.