Dados do Trabalho

Título

FINANCIAL IMPACT OF JAVELIN 100 AND EV-302 PROTOCOLS IN BLADDER CANCER TREATMENT IN THE SISTEMA UNICO DE SAUDE (SUS)

Resumo

Introduction: Bladder cancer is the ninth most common cancer worldwide. In Brazil, there are 11,370 new cases every year. Given the high cost of treating this neoplasm and the large number of Brazilians dependent on Brazilian public healthcare, bladder cancer accounts for a significant portion of public health spending. These expenditures become much higher when evaluating the use of newer treatment protocols such as JAVELIN 100, which utilizes AVELUMAB, and EV-302, which utilizes ENFORTUMAB VEDOTIN and PEMBROLIZUMAB. In this context, this work aimed to estimate the financial impact of implementing the JAVELIN 100 and EV-302 Protocols in the treatment of bladder cancer patients in the Sistema Único de Saúde. Methods: Data were collected from DATASUS, Radar do Câncer, INCA, and GLOBOCAN databases regarding the number of stage IV bladder cancer cases in Brazil, the State of São Paulo, the City of São Paulo, and the Greater ABC region. Previous studies from our group were used to estimate the costs of treatment following the NCCN model. Total costs were estimated in each area considering one year of treatment with the JAVELIN 100 and EV-302 protocols. Results: In Brazil, 2047 new bladder cancer patients in stage IV arise each year. Of these, 655 are in the state of São Paulo, 220 in the city of São Paulo, and 32 in the Greater ABC Region. These case numbers would represent a cost of 1,595,653,653.86 if 100% of stage IV patients were treated following the JAVELIN-100 protocol. The total cost at the national level would be 2,237,249,346.79 if 100% of patients were treated following the EV-302 protocol. Estimates considering increasing litigation lawsuits allow us to predict that with fewer than 10% of patients litigating their treatments, the application of the JAVELIN-100 protocol would already represent a higher cost than treating 90% of patients following the NCCN model. Projections with the EV-302 protocol show that treating only 6% of patients would already cost the equivalent of treating 94% of patients in the NCCN model. Conclusion: Bladder cancer treatment is extremely costly for the public health system. The growing wave of judicialization lawsuits aimed at ensuring treatment according to the latest protocols seriously compromises resources allocated to the treatment of oncological diseases. This scenario can potentially compromise the provision of care, limiting the number of bladder cancer patient treatments.