Association between socioeconomic factors and origin of hospital referrals among patients with oral cancer

Background: The Brazilian Unified Health System (SUS) is responsible for offering free assistance to more than100 million Brazilians, including treatment of oral cancer lesions. Considering that the Brazilian public systemaids the most vulnerable population, this study analyzed whether the origin of hospital referrals of patients withoral cancer is associated with socioeconomic factors.Material and Methods: A cross-sectional study was carried out from cancer hospital records of the National Cancer Institute (RHC-INCA), considering the primary locations (C00 to C06) diagnosed between 2016 and 2019.Data on gender, skin color (white and non-white), education (no schooling, incomplete or complete elementaryeducation; high school; incomplete and complete higher education) and origin of referral (SUS and non-SUS) wereanalyzed by multiple logistic regression (p<0.05).Results: Higher referral rates by the SUS were observed in 2017 (OR=1.27; 95% CI=1.098-1.480) and 2018(OR=1.28; 95% CI=1.101-1.490); no differences were found between the years 2016 and 2019. Regarding gender,men were 40% more likely to have the SUS as the source of referral (OR=1.40; 95% CI=1.233-1.600). Non-whiteindividuals were 34% more likely to have the SUS as the source of the referral (OR=1.34; 95% CI=1.190-1.512). Illiterate individuals or individuals who only attended elementary school were 6.38 times more likely to be referredby the SUS than individuals with higher education (OR=6.38; 95% CI=5.228-7.796).Conclusions: It is concluded that the origin of hospital referrals via SUS of patients with oral cancer is associatedwith socioeconomic factors. (AU)

Trend of hospitalized cases of oral cancer in Brazil and its relationship with oral health coverage in public health system between 2009 and 2017

BACKGROUND: This study aimed to analyze the trend in the number of hospitalized cases of oral cancer in Brazil, according to the coverage of oral health services in public health system, and also investigate the influence of healthcare and clinical characteristics on the severity of oral cancer cases. MATERIAL AND METHODS: This retrospective study considered the period between 2009 and 2017. Data from the Hospital Registry of Cancer from the National Cancer Institute were used, considering the primary locations C00 to C06. Detailed information including sex, age, alcohol and tobacco use, year of first consultation, and the clinical stage of the cases were also collected. The frequency of hospitalized cases was correlated with the coverage of Primary Care Oral Health Teams (ESB) and the number of Dental Specialty Centers (CEO). It was also estimated the chance of advanced oral cancer cases, according to healthcare and clinical characteristics. Data were analyzed using Tweedie's multiple regression and multiple binary logistic regression (Alpha < 0.05). RESULTS: There was an increasing trend in the number of hospitalized cases of oral cancer in Brazil between 2009 and 2017 (B = 0.043, p < 0.001, PR = 1.044). The increase in ESB coverage was associated with small increase in the number of hospitalized cases of oral cancer (B = 0.001, p = 0.003, PR = 1.001). The increase in the number of CEO was associated with decrease in the number of hospitalized cases of oral cancer (B = -0.085, p < 0.001, PR = 0.918). The increase of ESB (OR = 0.998) and CEO (OR = 0.974) contributed for reducing the number of stage IV cases, whilst the history of alcohol and tobacco use (OR = 1.574) was associated with an increase in the number of stage IV cases. CONCLUSIONS: Although an increasing trend was detected, the expansion of the public health system reduced the number of hospitalized cases and the frequency of advanced oral cancer cases in Brazil

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Cost-Effectiveness Analysis of Rehabilitation Interventions for Teeth With Extensive Coronary Destruction.

OBJECTIVE: To perform a cost-effectiveness analysis of rehabilitation interventions for management of posterior teeth (molar) with extensive coronary destruction. METHODOLOGY: An economic model by Markov simulated a hypothetical 10-year cohort with 1,000 patients requiring treatment for a molar tooth with pulp necrosis and extensive coronary destruction. This study adopted the perspective of a local manager from Specialized Center in Dentistry, based on the transfer from the Ministry of Health. Treatments were proposed: Tooth Extraction + Removable Partial Denture (TE+RPD); Root Canal Treatment + Intra-Radicular Restoration + Single Crown (RCT+RIR+SC); and Tooth Extraction + Dental Implant + Single Crown (TE+DI+SC). The costs were obtained from the SUS Integrated System of Procedures, Medicines and orthoses; prostheses and special materials table management (SIGTAP). Failure and survival rates were obtained from systematic reviews. The variable "years of survival" was an outcome of effectiveness. The probabilistic simulation considered the confidence interval of 95%, variation of parameters by 5% and annual discount rate of 5%. RESULTS: TE+RPD intervention presented lower cost and effectiveness. The incremental cost-effectiveness ratio (ICER) of RCT+IRR+SC and TE+DI+SC interventions compared to TE+RPD were $13.06 and $9.92 per year of survival. Compared to RCT+IRR+SC, the TE+DI+SC intervention had an ICER=$26.90 per year of survival. The acceptability curve indicates that the choice of intervention depends on the willingness to pay. CONCLUSION: The RCT+IRR+SC intervention presented a balance of cost-effectiveness. Rehabilitation with implants can be considered in view of the higher expectation of longevity and, especially, greater willingness to pay.