Câncer pediátrico: avaliação econômica de tecnologias que evitam efeitos colaterais ao tratamento.

Abstract

With the objective of contributing to the decision making of the technology management process within SUS, a cost effectiveness evaluation was developed to compare the use of dexrazoxane in different populations and the use of the proton beam therapy to treat children with medulloblastoma. The model was built with a lifetime horizon under Brazilian health system perspective in both studies. A budget impact analysis for each technology was also built. After a search in the literature, a Markov model was developed able to compare the use of dexrazoxane in 6 patients risk profiles of developing cardiotoxicity. Using the drug in children under 5 years of age was the most cost-effective alternative (ICER of R $ 6,156.96), followed by use in all patients (ICER of R$ 58,968.7). If the price decreases to less than R$250 per bottle, the alternative to use in all children becomes more cost-effective. The budget impact at the end of 5 years was R$ 30,622,404.81 for use only in children under 5 years. Using technology in all children would produce an incremental impact of R$ 94,352,898.77. To evaluate the cost-effectiveness of the proton beam therapy, a microssimulation model was developed comparing scenarios of equipment lifespan and number of patients treated. The baseline parameters was 50 patients with 20 years of lifespan. The QALY gain was 2.71 and the average ICER was R$ 171,012.51/ QALY. For the willingness to pay threshold of 1 GDP per capita it was observed that incorporation of the technology would be cost-effective if were treated more than 150 patients. The equipment lifespan and other variables, had limited weight when varied in the sensitivity analysis, without significantly changing the model responses. At the end of 20 years, the budget impact was R$ 345,598,440.91. The study recommends the incorporation of dexrazoxane in children under 5 years of age and does not recommend the incorporation of the proton accelerator in the treatment of medulloblastoma in children.