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1.
Cad Saude Publica ; 35(8): e00108218, 2019 Aug 22.
Artigo em Português | MEDLINE | ID: mdl-31460611

RESUMO

Renal cancer is the 13th most frequent neoplasm in the world. From 2010 to 2014, renal cancer accounted for 1.43% of cancer deaths in Brazil. The treatment of choice for metastatic renal cancer is tyrosine kinase inhibitors (TKI) sunitinib and pazopanib. This article assesses cost-effectiveness between pazopanib and sunitinib in the treatment of metastatic renal cancer. A cost-effectiveness study was performed from the perspective of a federal hospital under the Brazilian Unified National Health System (SUS). TKI effectiveness and safety outcomes were applied to the decision tree model. Clinical data were extracted from patient charts, and direct costs were consulted from official Ministry of Health sources. The cost of 10 months of treatment, including the costs of the TKI, procedures and management of adverse events, was BRL 98,677.19 for pazopanib and BRL 155,227.11 for sunitinib. The drugs displayed statistically equivalent effectiveness and statistically different safety outcomes, with pazopanib displaying better results. In this setting, pazopanib is the dominant technology when the treatment costs are analyzed together with the costs of managing adverse events.

2.
Cad. Saúde Pública (Online) ; 35(8): e00108218, 2019. tab, graf
Artigo em Português | LILACS-Express | ID: biblio-1019622

RESUMO

Resumo: O câncer renal é a 13ª neoplasia mais frequente no mundo. Entre 2012 e 2016, representou 1,48% das mortes por câncer no Brasil. A terapia de escolha para o tratamento de câncer renal metastático são os inibidores de tirosina quinase (ITK), sunitinibe e pazopanibe. Este artigo avalia o custo-efetividade do pazopanibe comparado ao sunitinibe no tratamento de câncer renal metastático. Foi realizada uma análise de custo-efetividade sob a perspectiva de um hospital federal do Sistema Único de Saúde. No modelo de árvore de decisão foram aplicados os desfechos de efetividade e segurança dos ITK. Os dados clínicos foram extraídos de prontuários e os custos diretos consultados em fontes oficiais do Ministério da Saúde. O custo de 10 meses de tratamento, englobando o valor dos ITK, procedimentos e manejo de eventos adversos, foi de R$ 98.677,19 para o pazopanibe e R$ 155.227,11 para o sunitinibe. Os medicamentos apresentaram efetividade estatisticamente equivalente e diferença estatisticamente significativa para o desfecho de segurança, no qual o pazopanibe obteve o melhor resultado. O pazopanibe, nesse contexto, é a tecnologia dominante quando os custos de tratamento são associados aos de manejo de eventos adversos.


Abstract: Renal cancer is the 13th most frequent neoplasm in the world. From 2010 to 2014, renal cancer accounted for 1.43% of cancer deaths in Brazil. The treatment of choice for metastatic renal cancer is tyrosine kinase inhibitors (TKI) sunitinib and pazopanib. This article assesses cost-effectiveness between pazopanib and sunitinib in the treatment of metastatic renal cancer. A cost-effectiveness study was performed from the perspective of a federal hospital under the Brazilian Unified National Health System (SUS). TKI effectiveness and safety outcomes were applied to the decision tree model. Clinical data were extracted from patient charts, and direct costs were consulted from official Ministry of Health sources. The cost of 10 months of treatment, including the costs of the TKI, procedures and management of adverse events, was BRL 98,677.19 for pazopanib and BRL 155,227.11 for sunitinib. The drugs displayed statistically equivalent effectiveness and statistically different safety outcomes, with pazopanib displaying better results. In this setting, pazopanib is the dominant technology when the treatment costs are analyzed together with the costs of managing adverse events.


Resumen: El cáncer renal es la 13ª neoplasia más frecuente en el mundo. Entre 2010 y 2014, representó un 1,43% de las muertes por cáncer en Brasil. La terapia de elección para el tratamiento de cáncer renal metastásico son los inhibidores de tirosina quinasa (ITK), sunitinib y pazopanib. Este artículo evalúa el costo-efectividad entre pazopanib y sunitinib en el tratamiento de cáncer renal metastásico. Se realizó un análisis de costo-efectividad desde la perspectiva de un hospital federal del Sistema Único de Salud. En el modelo de árbol de decisión se aplicaron los desenlaces de efectividad y seguridad de los ITK. Los datos clínicos se extrajeron de registros médicos, y los costos directos consultados en fuentes oficiales del Ministerio de Salud. El costo de 10 meses de tratamiento, englobando el valor de los ITK, procedimientos y gestión de eventos adversos, fue de BRL 98.677,19 con el pazopanib y BRL 155.227,11 con el sunitinib. Los medicamentos presentaron efectividad estadísticamente equivalente y diferencia estadísticamente significativa para el desenlace de seguridad, en el que el pazopanib obtuvo el mejor resultado. El pazopanib, en este contexto, es la tecnología dominante cuando los costes de tratamiento están asociados a los de la gestión de eventos adversos.

3.
Rio de Janeiro; s.n; 2008. xiii, 127 p. tab.
Tese em Português, Português | LILACS, Inca | ID: biblio-934229

RESUMO

...Muitos pacientes com doenças que ameaçam a vida, como o câncer, não selimitam ao tratamento prescrito pelo médico assistente e, na esperança da cura, buscam tratamentos alternativos cujos resultados são de difícil avaliação (Beijnen e Schellens, 2004). No anseio da cura ou mesmo do alívio de sintomas, se automedicam por repetição de prescrições anteriores ou por indicação de parentes ou amigos (Arrais et al., 1997) e usam substâncias de efeito indeterminado como fitoterápicos e produtos naturais (Turolla e nascimento, 2006). Esse cenário, apesarde presumido, não pode ser avaliado precisamente, uma vez que freqüentemente não é relatado pelo paciente ao seu médico assistente (Rockwell et al., 2005).Assim, pouco se sabe sobre a prevalência de uso de produtos alternativos e do risco da ocorrência de reações adversas decorrentes de interações medicamentosas (Elmer et al., 2007). Na vigência da quimioterapia antineoplásica, devido à estreitamargem terapêutica, a possibilidade dessas associações cria um quadro maior de incertezas, pela possibilidade de potencialização de toxicidades, elevando-as a graus inaceitáveis (Oates, 2006; Rockwell et al., 2005).Dentro desse contexto, a intervenção do farmacêutico pode representarrecurso poderoso na identificação dessas interações (Weideman,1999; Batlle, 2002; ASPH, 1995; Ikeda et al., 2005, Chumney e Robinson, 2006), as quais pioram a qualidade de vida do paciente, interferem no tratamento e podem ser fatais (Mcleod, 1998). Em nosso estudo, o farmacêutico se colocou em contato direto com o paciente em tratamento quimioterápico antineoplásico, para identificação do uso de medicamentos prescritos e não prescritos, incluindo medicamentos alopáticos e fitoterápicos e de produtos naturais e para caracterização da ocorrência de reações adversas clinicamente significativas, buscando a proposição de uma prática quecontribua para melhoria da assistência ao paciente, com relação a prevenção emanejo das reações adversas.


Patients with lung cancer demand special care not only because of the symptoms and complications due to the progression of the disease, but also because of agerelated comorbidities, continuous use of drugs and use of non-authorized products for intended therapeutical purposes. Because of the narrow safety range of chemotherapy agents, these drug associations may lead to increased toxicities. The main objective of our study was to evaluate the safety of the chemotherapy treatment used for patients with lung cancer in HCI/INCA, in order to improve the quality of the oncologic care. We developed a methodology of pharmacotherapeutic follow-up in order to characterize the frequency and the severity of clinically significant adverse events and to identify the use of prescribed and non-prescribed products, including conventional drugs, phytotherapy and non-authorized therapeutical products. The strategy of pharmacotherapeutic follow-up was based on patient interviews, consults to the patient’s clinical records and laboratory exams and consults to the clinical staff, with no intervention on the definition of clinical conducts. We evaluated 62 patients who were treated exclusively with chemotherapy protocols combining cisplatin or carboplatin to etoposide. The patients had median age of 61years-old (95%CI 59-64), with previous history of tobbacco use (85%) and presence of comorbidities (61%), hypertension being the most frequent (40%). Most patients had advanced disease, with non-small cell lung cancer being predominant (84%) and adenocarcinoma the most frequent hystologic type (56%). Comparing the protocols with carboplatin or cisplatin, we found significant difference on the frequency of emesis, which was more frequent in the group treated with cisplatin, and thrombocitopenia, which was more frequent in the group treated with carboplatin. However, the protocols did not differ on the risk of severe toxicities (grades III or IV). Therefore, we evaluated the global risk of the chemotherapy treatment, regardless of the platinum agent used. We found increased relative risk of hematological toxicities (neutropenia, febrile neutropenia, anemia and thrombocitopenia), gastrointestinal toxicities (constipation, nausea, emesis, mucositis, abdominal pain and diarrhea) and dermatological toxicities (alopecia, itching e desquamation). There was also increased risk of severe toxicities (grades III or IV) for neutropenia (68%), febrile neutropenia (27%) and constipation (34%). The drugs used previously to the chemotherapy treatment included: analgesics (42%), opioid analgesics (40%), anti-hypertensives (40%), antiulcer e antacids (39%). Non-prescribed drugs were reported by 24% of the patients, laxatives being the most frequently used (14%). During the chemotherapy treatment, there was a significant increase in the use of the following agents: antiemetic (100%), propellant (64%), anti-ulcer and antacid drugs (43.5%), antimicrobial agents (39%), axatives (37%), opioid analgesics (21%) and anxyolitics (21%). We also found increase on the use of non-prescribed drugs (24%), laxatives presenting the higher increase (17%). Taken together, these results suggest that the pharmacological support to adverse events should be improved, particularly with relation to the revention of febrile neutropenia and to the prevention and treatment of constipation. The methodology developed here may contribute for implantation of the practice of pharmaceutical care in HCI/INCA.


Assuntos
Masculino , Feminino , Humanos , Tratamento Farmacológico , Neoplasias Pulmonares , Farmacologia
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