RESUMO
Positron emission tomography (PET) has been introduced recently in Brazil and requires costs analysis to support economic evaluation studies on its use. The current study analyzed the use of 18 F-FDG PET-CT and estimated its costs from the perspective of a public healthcare provider. The micro-costing technique was used, identifying, quantifying, and valuing all the inputs used to perform the procedure. Cost estimates considered 85 tests performed at the Brazilian National Cancer Institute from March to June 2012. Reference cases were defined as adult cancer patients, output of five tests per day, and one dose of 18 F-FDG per patient. Unit cost for the procedure was BRL 3,150.30 based on career wages under the Ministry of Science and Technology and BRL 2,927.19 based on Ministry of Health career wages. The factor with the heaviest cost impact was daily output of tests. Other factors that could impact the test's cost in public healthcare institutions were also examined.
Assuntos
Fluordesoxiglucose F18 , Imagem Multimodal/economia , Tomografia por Emissão de Pósitrons/economia , Tomografia Computadorizada por Raios X/economia , Brasil , Análise Custo-Benefício , Humanos , Imagem Multimodal/métodos , Programas Nacionais de Saúde , Tomografia por Emissão de Pósitrons/métodos , Sensibilidade e EspecificidadeRESUMO
A tomografia de emissão de pósitrons (PET) é de uso recente no Brasil e há necessidade de se estimar os custos do procedimento, de forma a subsidiar estudos de avaliação econômica sobre a tecnologia. O trabalho analisou o processo de produção da PET-TC utilizando 18 F-FDG e estimou seus custos na perspectiva de um provedor público de serviços de saúde. Utilizou- se a técnica de microcustos, com identificação, quantificação e valoração de todos os insumos consumidos na produção do procedimento. As estimativas de custo consideraram a observação de 85 exames realizados no Instituto Nacional de Câncer, de março/julho de 2012. O caso de referência considerou pacientes oncológicos adultos, volume de produção de 5 exames/dia e uso de uma dose de 18 F-FDG por paciente. Os custos unitários do procedimento foram de R$ 3.150,30, na perspectiva salarial da carreira de Ciência & Tecnologia, e de R$ 2.927,19 na do Ministério da Saúde. O elemento de maior impacto nos custos correspondeu ao volume diário de produção dos exames. Foram explorados elementos que podem impactar no custo do exame nas instituições públicas de saúde.
Positron emission tomography (PET) has been introduced recently in Brazil and requires costs analysis to support economic evaluation studies on its use. The current study analyzed the use of 18 F-FDG PET-CT and estimated its costs from the perspective of a public healthcare provider. The micro-costing technique was used, identifying, quantifying, and valuing all the inputs used to perform the procedure. Cost estimates considered 85 tests performed at the Brazilian National Cancer Institute from March to June 2012. Reference cases were defined as adult cancer patients, output of five tests per day, and one dose of 18 F-FDG per patient. Unit cost for the procedure was BRL 3,150.30 based on career wages under the Ministry of Science and Technology and BRL 2,927.19 based on Ministry of Health career wages. The factor with the heaviest cost impact was daily output of tests. Other factors that could impact the test’s cost in public healthcare institutions were also examined.
La tomografía por emisión de positrones (PET) es de uso reciente en Brasil y es necesario estimar sus costes, con el fin de subsidiar estudios de evaluación económica sobre esta tecnología. El trabajo examina el proceso de producción de PET-TC con 18F-FDG y se estimaron sus costes desde la perspectiva de un prestador público de servicios de salud. Se empleó la técnica de microcostes, con la identificación, cuantificación y valoración de los insumos consumidos en la producción del procedimiento. Las estimaciones consideran la observación de 85 exámenes entre marzo y julio de 2012. El “caso base” considera pacientes adultos de cáncer, con una producción de 5 exámenes/día y el uso de una dosis de 18F-FDG por paciente. Los costes unitarios del procedimiento fueron, respectivamente, R$ 3.150.30 y R$ 2.927.19, desde la perspectiva del Ministerio de Ciencia y Tecnología y del Ministerio de Salud. El volumen diario de producción fue el elemento de mayor impacto en los costes. Además, se analizaron los factores que pueden repercutir en el coste del examen en instituciones de salud pública.
Assuntos
Humanos , Imagem Multimodal/economia , Tomografia por Emissão de Pósitrons/economia , Tomografia Computadorizada por Raios X/economia , Brasil , Análise Custo-Benefício , Imagem Multimodal/métodos , Programas Nacionais de Saúde , Tomografia por Emissão de Pósitrons/métodos , Sensibilidade e EspecificidadeRESUMO
Background: Axillary nodal status remains the best survival predictor for patients with earlystage breast cancer. Accurate identification of sentinel lymph node (SLN) is the first step for biopsy. Purpose: To evaluate the lymph flow to SLN with Computerized Tomography using small volume of low molecular iodinated contrast medium. Material and Methods: Thin section and 3D CT images of the breast and axilla were acquired from 20 patients with early stage breast cancer. Images were acquired before subcutaneous injection of a small volume of water soluble iodinated contrast medium in the periareolar region and 1-7 minutes latter. Location of SLN and CT density were assessed at CT lymphography and the positive group was compared with negative one. Results: In all patients, CT lymphography allowed localization of SLN and its afferent lymphatic vessel, as well as measuring the contrast medium uptake and washout from SLN. The negative group presented grater and faster contrast medium uptake and washout compared to the positive one. Conclusion: CT lymphography provides good anatomical localization of SLN.
