Gestão do cuidado ao paciente com doença hemato-oncológica sob a perspectiva do SUS: análise de hospitalizações e avaliação econômica do daratumumabe no tratamento do mieloma múltiplo

Abstract

Aiming to contribute to the management of the Brazilian Public Health System (SUS) regarding hematologic malignances (NH), this work presents the development of two studies: (a) cost analysis per hospitalization for NH, and (b) cost-effectiveness evaluation of adding daratumumab to the treatment scheme for Multiple Myeloma (MM) in patients not eligible for autologous hematopoietic stem cell transplantation (TCTH). By extracting data from the SUS hospital admissions system, we developed a retrospective descriptive analysis of frequencies and costs of NH admissions according to their temporal, spatial distribution (by states and regions), and by pathology, in the decade between the years 2010 and 2019. Average cost per procedure and access rate were also estimated. It was observed that there was a stable growth trend in frequencies and costs over the analyzed period. Furthermore, a significant discrepancy in the procedure frequency was found between the North and Southeast regions, which recorded the lowest and highest number of procedures, respectively. It was also observed that the frequency of hospitalizations per pathology did not reflect the incidence estimated by the literature in the country for each of the pathologies evaluated. For the cost-effectiveness study, a partitioned survival simulation model was developed for the inclusion of daratumumab in the treatment scheme consisting of bortezomib, melphalan, and prednisone (VMP). A 30-year time horizon and the perspective of the SUS were used for the analysis. Based on literature data, it was possible to observe that the inclusion of this drug to VMP in the treatment of these patients can increase overall survival and progression-free survival. Considering the costs related to this technology and patient management in the Brazilian scenario, however, the inclusion of daratumumab is seemingly above the threshold of acceptability adopted by SUS. For this strategy to be cost-effective in the observed scenario, the technology would require a cost reduction of almost 50%. The study, therefore, does not recommend the inclusion of daratumumab to VMP in the treatment of MM in patients not eligible for TCTH.