PMID- 37480058
OWN - NLM
STAT- MEDLINE
DCOM- 20230724
LR  - 20230724
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 23
IP  - 1
DP  - 2023 Jul 21
TI  - Does it fit in your pocket? economic burden of PD-1 inhibitors' toxicity in the 
      supplementary health system: evidence from Brazil.
PG  - 781
LID - 10.1186/s12913-023-09736-6 [doi]
LID - 781
AB  - BACKGROUND: A full understanding of the economic burden associated with 
      treatment-related adverse events (AEs) can aid estimates of the incremental costs 
      associated with incorporating new technologies and support cost-effective 
      economic modeling in Brazil. In this context, the main objective of this work was 
      to evaluate in a real-life database: (i) the direct medical cost of monitoring 
      the occurrence of AEs (CMO); (ii) the direct medical cost of managing an 
      identified AE (CMN); and (iii) the total direct medical cost of monitoring and 
      managing AEs (TMC), in quarterly periods from 0 to 24 months of the monitoring of 
      cancer patients who used a PD-1 inhibitor from the perspective of the 
      supplementary health system in Brazil. METHODS: This study was conducted from the 
      supplementary health system (SSS) perspective and followed the methodological 
      guidelines related to cost-of-illness studies. A bottom-up (person-based) 
      approach was used to assess the use of health resources to monitor and manage AEs 
      during the use of PD-1 inhibitors, which made it possible to capture differences 
      in the mean frequency of the use of health services with stratification results 
      for different subgroups. As the Brazilian SSS is complex, asymmetric, and 
      fragmented, this study used information from different sources. The methodology 
      was divided into three parts: (i) Data Source: clinical management of AEs; (ii) 
      Microcosting: management of the economic burden of AEs; (iii) Statistical 
      analysis: stratification of results for different subgroups. RESULTS: Analysis of 
      the economic burden of toxicity showed higher CMO costs than CMN in all the 
      periods analyzed. In general, for every BRL 100 on average invested in the TMC of 
      AEs, BRL 95 are used to monitor the occurrence of the AE and only BRL 5 to manage 
      an identified AE. This work also showed that the sociodemographic characteristics 
      of patients, the journey of oncological treatment, and the toxicity profile 
      affect the economic burden related to AE. CONCLUSION: This study provided 
      real-world evidence of the economic burden of AEs associated with the use of PD-1 
      inhibitors in Brazil. This work also made methodological contributions by 
      evaluating the economic burden of AE of PD-1 inhibitors considering the kinetics 
      of toxicity occurrence and categorizing the costs in terms of CMO, CMN and TMC.
CI  - (c) 2023. The Author(s).
FAU - Duarte, Hugo Santos
AU  - Duarte HS
AD  - Faculdade de Ciencias Medicas de Minas Gerais, Alameda Ezequiel Dias, 275, Belo 
      Horizonte, MG, 30130-110, Brazil.
FAU - da Veiga, Cassia Rita Pereira
AU  - da Veiga CRP
AD  - Departamento de Gestao de Servicos de Saude, Escola de Enfermagem, Universidade 
      Federal de Minas Gerais, Av. Alfredo Balena, 190, Belo Horizonte-MG, 30130-100, 
      Brazil.
FAU - da Veiga, Claudimar Pereira
AU  - da Veiga CP
AD  - FDC Business School, Fundacao Dom Cabral, , Av. Princesa Diana, 760,Alphaville 
      Lagoa Dos Ingleses, Nova Lima, MG, 34018-006, Brazil.
FAU - Wainstein, Alberto Julius Alves
AU  - Wainstein AJA
AD  - Faculdade de Ciencias Medicas de Minas Gerais, Alameda Ezequiel Dias, 275, Belo 
      Horizonte, MG, 30130-110, Brazil.
FAU - da Silva, Wesley Vieira
AU  - da Silva WV
AD  - Universidade Federal de Alagoas - UFAL, Av. Lourival Melo Mota, S/N, Tabuleiro Do 
      Martins, Maceio, Alagoas, 57072-900, Brazil.
FAU - Drummond-Lage, Ana Paula
AU  - Drummond-Lage AP
AD  - Faculdade de Ciencias Medicas de Minas Gerais, Alameda Ezequiel Dias, 275, Belo 
      Horizonte, MG, 30130-110, Brazil. apdrummond@gmail.com.
LA  - eng
GR  - 312023/2022-7/Conselho Nacional de Desenvolvimento Cientifico e Tecnologico/
PT  - Journal Article
DEP - 20230721
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
RN  - 0 (Immune Checkpoint Inhibitors)
SB  - IM
MH  - Humans
MH  - Brazil
MH  - *Financial Stress
MH  - *Immune Checkpoint Inhibitors
MH  - Government Programs
MH  - Health Resources
PMC - PMC10360250
OTO - NOTNLM
OT  - Burden of toxicity
OT  - Cost
OT  - Health management
OT  - Oncology
OT  - PD-1/PD-L1 inhibitor
COIS- Claudimar Pereira da Veiga is an Editorial Board member for the BMC Health 
      Services Research. No other authors report a conflict of interest.
EDAT- 2023/07/22 10:41
MHDA- 2023/07/24 06:42
PMCR- 2023/07/21
CRDT- 2023/07/21 23:38
PHST- 2022/12/26 00:00 [received]
PHST- 2023/06/22 00:00 [accepted]
PHST- 2023/07/24 06:42 [medline]
PHST- 2023/07/22 10:41 [pubmed]
PHST- 2023/07/21 23:38 [entrez]
PHST- 2023/07/21 00:00 [pmc-release]
AID - 10.1186/s12913-023-09736-6 [pii]
AID - 9736 [pii]
AID - 10.1186/s12913-023-09736-6 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2023 Jul 21;23(1):781. doi: 10.1186/s12913-023-09736-6.