RESUMEN
Importance: It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most frequent cancer in Brazil, but the country does not have an LC screening (LCS) policy. Objective: To compare the number of individuals eligible for screening, 5-year preventable LC deaths, and years of life gained (YLG) if LC death is averted by LCS, considering 3 eligibility strategies by sociodemographic characteristics. Design, Setting, and Participants: This comparative effectiveness research study assessed 3 LCS criteria by applying a modified version of the LC-Death Risk Assessment Tool (LCDRAT) and the LC-Risk Assessment Tool (LCRAT). Data are from the 2019 Brazilian National Household Survey. Participants included ever-smokers aged 50 to 80 years. Data analysis was performed from February to May 2023. Exposures: Exposures included ever-smokers aged 50 to 80 years, US Preventive Services Task Force (USPSTF) 2013 guidelines (ever-smokers aged 55 to 80 years with ≥30 pack-years and <15 years since cessation), and USPSTF 2021 guidelines (ever-smokers aged 50 to 80 years with 20 pack-years and <15 years since cessation). Main Outcomes and Measures: The primary outcomes were the numbers of individuals eligible for LCS, the 5-year preventable deaths attributable to LC, and the number of YLGs if death due to LC was averted by LCS. Results: In Brazil, the eligible population for LCS was 27â¯280â¯920 ever-smokers aged 50 to 80 years (13â¯387â¯552 female [49.1%]; 13â¯249â¯531 [48.6%] aged 50-60 years; 394â¯994 Asian or Indigenous [1.4%]; 3â¯111â¯676 Black [11.4%]; 10â¯942â¯640 Pardo [40.1%]; 12â¯830â¯904 White [47.0%]; 12â¯428â¯536 [45.6%] with an incomplete middle school education; and 12â¯860â¯132 [47.1%] living in the Southeast region); 5â¯144â¯322 individuals met the USPSTF 2013 criteria for LCS (2â¯090â¯636 female [40.6%]; 2â¯290â¯219 [44.5%] aged 61-70 years; 66â¯430 Asian or Indigenous [1.3%]; 491â¯527 Black [9.6%]; 2â¯073â¯836 Pardo [40.3%]; 2â¯512â¯529 [48.8%] White; 2â¯436â¯221 [47.4%] with an incomplete middle school education; and 2â¯577â¯300 [50.1%] living in the Southeast region), and 8â¯380â¯279 individuals met the USPSTF 2021 LCS criteria (3â¯507â¯760 female [41.9%]; 4â¯352â¯740 [51.9%] aged 50-60 years; 119â¯925 Asian or Indigenous [1.4%]; 839â¯171 Black [10.0%]; 3â¯330â¯497 Pardo [39.7%]; 4â¯090â¯687 [48.8%] White; 4â¯022â¯784 [48.0%] with an incomplete middle school education; and 4â¯162â¯070 [49.7%] living in the Southeast region). The number needed to screen to prevent 1 death was 177 individuals according to the USPSTF 2013 criteria and 242 individuals according to the USPSTF 2021 criteria. The YLG was 23 for all ever-smokers, 19 for the USPSTF 2013 criteria, and 21 for the USPSTF 2021 criteria. Being Black, having less than a high school education, and living in the North and Northeast regions were associated with increased 5-year risk of LC death. Conclusions and Relevance: In this comparative effectiveness study, USPSTF 2021 criteria were better than USPSTF 2013 in reducing disparities in LC death rates. Nonetheless, the risk of LC death remained unequal, and these results underscore the importance of identifying an appropriate approach for high-risk populations for LCS, considering the local epidemiological context.
Asunto(s)
Neoplasias Pulmonares , Humanos , Femenino , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiología , Brasil/epidemiología , Detección Precoz del Cáncer , Factores de Riesgo , FumadoresRESUMEN
BACKGROUND: To guarantee the right to health, the health system must also ensure access to medicines. Several financial arrangements to provide these technologies are implemented and range from the direct (either total or partial) to indirect payment by the patient, being necessary to evaluate its effect on access to medicines. However, to ensure access to medicines is not just about ensuring its availability, as this only materializes in its use. Thus, evaluation studies of interventions in access to medicines have been using indicators related to the health results and use of health services as its outcomes. Furthermore, as this relationship is not direct, it is important to critically assess the adequacy of these tools to measure this phenomenon and, additionally, the ability to use it in the Brazilian scenario. Therefore, this study sought to identify, describe, and analyze the use of these indicators as medicine access outcomes, through a review of the scientific literature. METHODS: An extensive literature review was done using a bibliographic database for a systematic review. The references were selected based on inclusion and exclusion criteria, and the indicators from the papers retained were analyzed using the parameters of validity, measurability, reliability, and relevance. RESULTS: We have analyzed over 12,000 references of which 30 references were included, describing the use of 49 health outcomes and health service use indicators. The majority reported the use of health service utilization measures. In our evaluation, the best indicators for assessing the effects of co-payment intervention on access are the ones aimed at specific populations or symptomatic health conditions in which the response to the therapeutic treatment is known and occurs in a short period of time. It was evident the lack of information on the indicators analyzed as well as the limitation of the Brazilian secondary databases for its calculation. CONCLUSIONS: This research showed the variety and heterogeneity of the indicators used in scientific studies. The best indicators for access to medicines are sought to measure the use of health services for symptomatic health conditions that are quickly responsive to pharmacological treatment, while the indicators related to worker productivity loss was the most suitable for health outcomes.