Vol. 21 No. 1 (2022)
Original Articles

Expenditures on the treatment of encephalon malignant neoplasia by the Brazilian public health system (2008-2017)

Published 2022-07-04

Keywords

  • Encephalon malignant neoplasia,
  • Cancer treatment costs,
  • SUS

How to Cite

1.
G. Garcia C, Nespoli J. Expenditures on the treatment of encephalon malignant neoplasia by the Brazilian public health system (2008-2017). BJHBS [Internet]. 2022 Jul. 4 [cited 2024 Oct. 11];21(1):39-46. Available from: https://bjhbs.hupe.uerj.br/bjhbs/article/view/24

Abstract

Introduction: Encephalon malignant neoplasia (EMN) is a harmful type of cancer and its most aggressive phenotypes lead to the demise of patients in 12-18 months despite the use of state-of-the-art therapies, which remain inefficient and expensive for patients, families and health systems. The aim of this work was to analyze the expenditures of the Brazilian Sistema Único de Saúde (SUS), the national public health system, on EMN patients compared to all neoplasia patients over a span of ten years (2008 to 2017). Methodology and resources: Monthly data were collected from the SUS data base DATASUS from 2008 to 2017 and analyzed with regard to EMN and general neoplasia for the following categories: value of total expenditures; number of hospitalizations; mean value of hospitalizations; mean of monthly permanence time and death rate. Results: More than 0.3% of SUS costs were directed to EMN patients, although they represented 0.1% of total hospitalizations. The mean value of hospitalization of EMN patients was almost 80% that of general neoplasia patients and hospitalization time was twice that of general neoplasia patients. Moreover, EMN patients had a death rate almost four times higher than that of general neoplasia patients. Discussion and conclusion: EMN therapies remained expensive and lacked efficacy in the time period under analysis, with a disproportionate share of SUS expenditure being dedicated to these patients. Improving the effectiveness of treatment requires drug repurposing and adjuvant chemotherapy—in addition to radiotherapy and the use of monoclonal antibodies.

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References

  1. McKinney PA. Brain tumours: incidence, survival, and aetiology. J Neurol Neurosurg & Psychiatry [Internet]. 2004 Jun 1;75(suppl 2):ii12 LP-ii17. Available from: https://doi.org/10.1136/jnnp.2004.040741
  2. Omuro A, DeAngelis LM. Glioblastoma and other malignant gliomas: a clinical review. JAMA [Internet]. 2013;310:1842–50. Available from: https://doi.org/10.1001/jama.2013.280319
  3. Ostrom QT, Patil N, Cioffi G, et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2013–2017. Neuro Oncol [Internet]. 2020 Oct 30 [cited 2021 April 14]; 22(1):iv1–iv96. Available from: https://doi.org/10.1093/neuonc/noaa200
  4. Undabeitia J, Torres-Bayona S, Samprón N, et al. Indirect costs associated with glioblastoma: Experience at one hospital. Neurol (English Ed.) [Internet]. 2018 July 20 [cited 2021 April 14];33(2):85–91. Available from: https://doi.org/10.1016/j.nrl.2016.05.003
  5. Chen DY, Chen CC, Crawford Jr WSG. Tumor-related epilepsy: epidemiology, pathogenesis and management. J Neurooncol [Internet]. 2018 May 24 [cited 2021 April 14];139(1)13-21. Available from: https://doi.org/10.1007/s11060-018-2862-0
  6. Schreck KC, Grossman S. Role of Temozolomide in the Treatment of Cancers Involving the Central Nervous System. Oncol (willist Park) [Internet]. 2018 November 15 [cited 2021 April 15];32(11):555–60. Available from: Available from: https://doi.org/10.1007/s11060-018-2862-0
  7. Kaibara T, Tyson RL, Sutherland G. Human cerebral neoplasms studied using MR spectroscopy: a review. Biochem Cell Biol [Internet]. 1998 May 30 [cited 2021 April 13];76(2–3):477–86. Available from: https://doi.org//10.1139/o98-048
  8. Davis ME. Epidemiology and Overview of Gliomas. Semin Oncol Nurs [Internet]. 2018 Dec 1 [cited 2021 April 17];34(5):420–9. Available from: https://doi.org/10.1016/j.soncn.2018.10.001
  9. Werneck de Carvalho LE, Sarraf JS, Semblano AAP, et al. Central nervous system tumours profile at a referral center in the Brazilian Amazon region, 1997–2014. PLoS One [Internet]. 2017 Apr 3 [cited 2021 Apr 6];12(4):e0174439. Available from: https://doi.org/10.1371/journal.pone.0174439
  10. Stoyanov GS, Sarraf JS, Matev BK, et al. A Comparative Review of Demographics, Incidence, and Epidemiology of Histologically Confirmed Intracranial Tumors in Brazil and Bulgaria. Cureus [Internet]. 2018 Feb 19 [cited 2021 April 21];10(2):e2203–e2203. Available from: https://doi.org/10.7759/cureus.2203
  11. Garcia CG, Kahn SA, Geraldo LHM, et al. Combination Therapy with Sulfasalazine and Valproic Acid Promotes Human Glioblastoma Cell Death Through Imbalance of the Intracellular Oxidative Response. Mol Neurobiol [Internet]. 2018 Jan 19 [cited 2021 April 24]; 55: 6816-6833. Available from: https://doi.org/10.1007/s12035-018-0895-1
  12. Lukas RV, Wainwright DA, Ladomersky E, et al. Newly Diagnosed Glioblastoma: A Review on Clinical Management. Oncology (Williston Park) [Internet]. 2019 Mar 13 [cited 2021 April 23];33(3):91–100. Available from: https://doi.org/10.1080/10463356.2018.1462031
  13. Balça-Silva J, Matias D, Carmo A, et al. Cellular and molecular mechanisms of glioblastoma malignancy: Implications in resistance and therapeutic strategies. Semin Cancer Biol [Internet]. 2019 Sep 25 [cited 2021 April 29];58:130–41. Available from: https://doi.org/10.1016/j.semcancer.2018.09.007
  14. Wen PY, Weller M, Lee EQ, et al. Glioblastoma in adults: a Society for Neuro-Oncology (SNO) and European Society of Neuro-Oncology (EANO) consensus review on current management and future directions. Neuro Oncol [Internet]. 2020 Aug 17 [cited 2022 March 20]; 22(8): 1073-1113. Available from: https://doi.org/10.1093/neuonc/noaa106
  15. Zanders ED, Svensson F, Bailey DS. Therapy for glioblastoma: is it working? Drug Discov Today [Internet]. 2019 Marcj 13 [cited 2021 May 4];24(5):1193–201. Available from: https://doi.org/10.1016/j.drudis.2019.03.008
  16. Cagney DN, Alexander BM. The cost and value of glioblastoma therapy. Expert Rev Anticancer Ther [Internet]. 2017 Aug 3 [cited 2021 May 7];17(8):657–9. Available from: https://doi.org/10.1080/14737140.2017.1351355
  17. Zuccarini M, Giuliani P, Ziberi S, et al. The Role of Wnt Signal in Glioblastoma Development and Progression: A Possible New Pharmacological Target for the Therapy of This Tumor. Genes (Basel) [Internet]. 2018 Feb 17 [cited 2022 March 20]; 9(2):105. Available from: https://doi.org/10.3390/genes9020105
  18. Becker J, Wilting J. WNT signalling in neuroblastoma. Cancers (Basel) [Internet]. 2019 Jul 19 [cited 2022 March 20]; 11(7): 1013. Available from: https://doi.org/10.3390/cancers11071013
  19. Zafar A, Wang W, Liu G, et al. Molecular targeting therapies for neuroblastoma: Progress and challenges. Med Res Rev [Internet]. 2021 March [cited 2022 March 20]; 41(2):961-1021. Available from: https://doi.org/10.1002/med.21750
  20. Ney GM, McKay L, Koschmann C, et al. The emerging role of Ras pathway signaling in pediatric cancer. Cancer Res [Internet]. 2020 Dec 1 [cited 2020 March 20]; 80(23):5155-5163. Available from: https://doi.org/10.1158/0008-5472.CAN-20-0916
  21. Mariotto AB, Yabroff KR, Shao Y, et al. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst [Internet]. 2011 December 1 [cited 2021 May 9]19;103(2):117–28. Available from: https://doi.org/ 10.1093/jnci/djq495
  22. Monteiro GTR, Koifman S. Mortalidade por tumores de cérebro no Brasil, 1980-1998 . Cadernos de Saúde Pública [Internet]. 2003 Sept 5 [cited 2021 May 4]; 19(4): 1139–51. Available from: https://doi.org/10.1590/S0102-311X2003000400035
  23. Blomqvist P, Lycke J, Strang P, et al. Brain tumours in Sweden 1996: care and costs. J Neurol Neurosurg Psychiatry [Internet]. 2000 Jun 20 [cited 2021 May 13];69(6):792–8. Available from: https://doi.org/10.1136/jnnp.69.6.792
  24. Raizer JJ, Fitzner KA, Jacobs DI, et al. Economics of Malignant Gliomas: A Critical Review. J Oncol Pract [Internet]. 2014 Dec 2 [cited 2021 May 21];11(1):59–65. Available from: https://doi.org/10.1200/JOP.2012.000560
  25. Tykocki T, Eltayeb M. Ten-year survival in glioblastoma. A systematic review. J Clin Neurosci [Internet]. 2018 Aug 1 [cited 2021 May 12];54:7–13. Available from: https://doi.org/10.1016/j.jocn.2018.05.002
  26. Silverstein MD, Cascino TL, Harmsen WS. High-Grade Astrocytomas: Resource Use, Clinical Outcomes, and Cost of Care. Mayo Clin Proc [Internet]. 1996 Oct 1 [cited 2021 May 11];71(10):936–44. Available from: https://doi.org/10.4065/71.10.936
  27. Wasserfallen J-B, Ostermann S, Leyvraz S, et al. Cost of temozolomide therapy and global care for recurrent malignant gliomas followed until death. Neuro Oncol [Internet]. 2005 Apr 1 [cited 2021 May 11];7(2):189–95. Available from: https://doi.org/10.1215/S1152851704000687
  28. Abbruzzese C, Matteoni S, Signore M, et al. Drug repurposing for the treatment of glioblastoma multiforme. J Exp Clin Cancer Res [Internet]. 2017 Nov 28 [cited 2021 May 13];36(1):169. Available from: https://doi.org/10.1186/s13046-017-0642-x
  29. Bernard-Arnoux F , Lamure M, Ducray F, et al. The cost-effectiveness of tumor-treating fields therapy in patients with newly diagnosed glioblastoma. Neuro-Oncology [Internet]. 2016 Aug 1 [cited 2021 May 12];18(8):1129–36. Available from: https://doi.org/10.1093/neuonc/now102
  30. Chung WJ, Lyons SA, Nelson GM, et al. Inhibition of cystine uptake disrupts the growth of primary brain tumors. J Neurosci [Internet]. 2005 Aug 3 [cited 2022 March 20]; 25(31):7101-10. Available from: https://doi.org/10.1523/jneurosci.5258-04.2005
  31. Lewerenz J, Hewett SJ, Huang Y, et al. The cystine/glutamate antiporter system xC- in health and disease: from molecular mechanisms to novel therapeutic opportunities. Antioxid Redox Signal [Internet]. 2013 Feb 10 [cited 2022 March 20]; 18(5):522-55. Available from: https://doi.org/10.1089/ars.2011.4391
  32. Garcia J, Hurwitz HI, Sandler AB, et al. Bevacizumab (Avastin®) in cancer treatment: A review of 15 years of clinical experience and future outlook. Cancer Treat Rev [Internet]. 2020 June 01 [cited 2022 March 20]; 86: 1-18. Available from: https://doi.org/10.1016/j.ctrv.2020.102017
  33. Sousa F, Moura RP, Moreira E, et al. Therapeutic monoclonal antibodies delivery for the glioblastoma treatment. Adv Protein Cher Struct Biol [Internet]. 2018 March 30 [cited 2022 March 20]; 112:61-80. Available from: https://doi.org/10.1016/bs.apcsb.2018.03.001
  34. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. JAMA [Internet]. 2005 March 10 [cited 2022 March 20]; 352:987-96. Available from: https://doi.org/10.1056/NEJMoa043330
  35. Wick W, Platten M, Meisner C, et al. Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Onc [Internet]. 2012 May 10 [cited 2022 March 20]; 13:707-15. Available from: https://doi.org/10.1016/S1470-2045(12)70164-X
  36. Braun K, Ahluwalia MS. Treatment of glioblastoma in older adults. Curr Oncol Rep [Internet]. 2017 Oct 26 [cited 2022 March 20]; 19:81. Available from: https://doi.org/10.1007/s11912-017-0644-z
  37. Di Nunno V, Franceschi E, Tosoni A, et al. Treatment of recurrent glioblastoma: state-of-the-art and future perspectives. Exp Rev Antican Ther [Internet]. 2020 Sep 03 [cited 2020 March 20]; 20(9): 785-95. Available from: https://doi.org/10.1080/14737140.2020.1807949
  38. Collins H, Calvo S, Greenberg K, et al. Information needs in the precision medicine era: how genetics home reference can help. Interact J Med Res [Internet]. 2016 Apr 27 [cited 2022 March 20]; 5(2):e13. Available from: https://doi.org/10.2196/ijmr.5199
  39. Zhou Y, Wu W, Bi H, et al. Glioblastoma precision therapy: from the bench to the clinic. Cancer Lett [Internet]. 2020 Apr 10 [cited 2022 March 20]; 475: 79-91. Available from: https://doi.org/10.1016/j.canlet.2020.01.027
  40. White K, Connor K, Clerkin J, et al. New hints towards a precision medicine strategy for IDH wild-type glioblastoma. Ann Oncol [Internet]. 2020 December [cited 2022 March 20]; 31(12):1679-92. Available from: https://doi.org./ 10.1016/j.annonc.2020.08.2336
  41. Liu D, Yang T, Ma W, et al. Clinical strategies to manage adult glioblastoma patients without MGMT hypermethylation. J Cancer [Internet]. 2022 Jan 1 [cited 2022 March 20]; 13(1):354-363. Available from: https//doi.org/10.7150/jca.63595
  42. Fritz L, Dirven L, Reijneveld JC, et al. Advance care planning in glioblastoma patients. Cancers (Basel) [Internet]. 2016 Nov 8 [cited 2022 March 20]; 8(11):102. Available from: https://doi.org/10.3390/cancers8110102