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1.
Lancet Oncol ; 22(3): 341-350, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33662286

RESUMO

BACKGROUND: In addition to increased availability of treatment modalities, advanced imaging modalities are increasingly recommended to improve global cancer care. However, estimates of the costs and benefits of investments to improve cancer survival are scarce, especially for low-income and middle-income countries (LMICs). In this analysis, we aimed to estimate the costs and lifetime health and economic benefits of scaling up imaging and treatment modality packages on cancer survival, both globally and by country income group. METHODS: Using a previously developed model of global cancer survival, we estimated stage-specific cancer survival and life-years gained (accounting for competing mortality) in 200 countries and territories for patients diagnosed with one of 11 cancers (oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, breast, cervix uteri, and prostate) representing 60% of all cancer diagnoses between 2020 and 2030 (inclusive of full years). We evaluated the costs and health and economic benefits of scaling up packages of treatment (chemotherapy, surgery, radiotherapy, and targeted therapy), imaging modalities (ultrasound, x-ray, CT, MRI, PET, single-photon emission CT), and quality of care to the mean level of high-income countries, separately and in combination, compared with no scale-up. Costs and benefits are presented in 2018 US$ and discounted at 3% annually. FINDINGS: For the 11 cancers studied, we estimated that without scale-up (ie, with current availability of treatment, imaging, and quality of care) there will be 76·0 million cancer deaths (95% UI 73·9-78·6) globally for patients diagnosed between 2020 and 2030, with more than 70% of these deaths occurring in LMICs. Comprehensive scale-up of treatment, imaging, and quality of care could avert 12·5% (95% UI 9·0-16·3) of these deaths globally, ranging from 2·8% (1·8-4·3) in high-income countries to 38·2% (32·6-44·5) in low-income countries. Globally, we estimate that comprehensive scale-up would cost an additional $232·9 billion (95% UI 85·9-422·0) between 2020 and 2030 (representing a 6·9% increase in cancer treatment costs), but produce $2·9 trillion (1·8-4·0) in lifetime economic benefits, yielding a return of $12·43 (6·47-33·23) per dollar invested. Scaling up treatment and quality of care without imaging would yield a return of $6·15 (2·66-16·71) per dollar invested and avert 7·0% (3·9-10·3) of cancer deaths worldwide. INTERPRETATION: Simultaneous investment in cancer treatment, imaging, and quality of care could yield substantial health and economic benefits, especially in LMICs. These results provide a compelling rationale for the value of investing in the global scale-up of cancer care. FUNDING: Harvard TH Chan School of Public Health and National Cancer Institute.


Assuntos
Simulação por Computador , Assistência à Saúde , Saúde Global , Custos de Cuidados de Saúde/tendências , Serviços de Saúde/estatística & dados numéricos , Imagem Multimodal/métodos , Neoplasias/mortalidade , Adolescente , Adulto , Idoso , Terapia Combinada , Países em Desenvolvimento , Feminino , Seguimentos , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Neoplasias/economia , Neoplasias/patologia , Neoplasias/terapia , Prognóstico , Taxa de Sobrevida , Adulto Jovem
6.
Lancet Oncol ; 22(2): 182-189, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33485458

RESUMO

BACKGROUND: The growing demand for cancer surgery has placed a global strain on health systems. In-depth analyses of the global demand for cancer surgery and optimal workforce requirements are needed to plan service provision. We estimated the global demand for cancer surgery and the requirements for an optimal surgical and anaesthesia workforce, using benchmarks based on clinical guidelines. METHODS: Using models of benchmark surgical use based on clinical guidelines, we estimated the proportion of cancer cases with an indication for surgery across 183 countries, stratified by income group. These proportions were multiplied by age-adjusted national estimates of new cancer cases using GLOBOCAN 2018 data and then aggregated to obtain the estimated number of surgical procedures required globally. The numbers of cancer surgical procedures in 44 high-income countries were divided by the actual number of surgeons and anaesthetists in the respective countries to calculate cancer procedures per surgeon and anaesthetist ratios. Using the median (IQR) of these ratios as benchmarks, we developed a three-tiered optimal surgical and anaesthesia workforce matrix, and the predictions were extrapolated up to 2040. FINDINGS: Our model estimates that the number of cancer cases globally with an indication for surgery will increase by 5 million procedures (52%) between 2018 (9 065 000) and 2040 (13 821 000). The greatest relative increase in surgical demand will occur in 34 low-income countries, where we also observed the largest gaps in workforce requirements. To match the median benchmark for high-income countries, the surgical workforce in these countries would need to increase by almost four times and the anaesthesia workforce by nearly 5·5 times. The greatest increase in optimal workforce requirements from 2018 to 2040 will occur in low-income countries (from 28 000 surgeons to 58 000 surgeons; 107% increase), followed by lower-middle-income countries (from 166 000 surgeons to 277 000 surgeons; 67% increase). INTERPRETATION: The global demand for cancer surgery and the optimal workforce are predicted to increase over the next two decades and disproportionately affect low-income countries. These estimates provide an appropriate framework for planning the provision of surgical services for cancer worldwide. FUNDING: University of New South Wales Scientia Scholarship and UK Research and Innovation Global Challenges Research Fund.


Assuntos
Anestesia/tendências , Planos de Sistemas de Saúde/tendências , Mão de Obra em Saúde/tendências , Neoplasias/cirurgia , Anestesia/economia , Assistência à Saúde/economia , Assistência à Saúde/tendências , Saúde Global/economia , Planos de Sistemas de Saúde/economia , Mão de Obra em Saúde/economia , Humanos , Renda , Neoplasias/economia , Neoplasias/epidemiologia , Cirurgiões/economia
7.
Lancet Oncol ; 22(2): 173-181, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33485459

RESUMO

BACKGROUND: Estimating a population-level benchmark rate for use of surgery in the management of cancer helps to identify treatment gaps, estimate the survival impact of such gaps, and benchmark the workforce and other resources, including budgets, required to meet service needs. A population-based benchmark for use of surgery in high-income settings to inform policy makers and service provision has not been developed but was recommended by the Lancet Oncology Commission on Global Cancer Surgery. We aimed to develop and validate a cancer surgery benchmarking model. METHODS: We examined the latest clinical guidelines from high-income countries (Australia, the UK, the EU, the USA, and Canada) and mapped surgical treatment pathways for 30 malignant cancer sites (19 individual sites and 11 grouped as other cancers) that were notifiable in Australia in 2014, broadly reflecting contemporary high-income models of care. The optimal use of surgery was considered as an indication for surgery where surgery is the treatment of choice for a given clinical scenario. Population-based epidemiological data, such as cancer stage, tumour characteristics, and fitness for surgery, were derived from Australia and other similar high-income settings for 2017. The probabilities across the clinical pathways of each cancer were multiplied and added together to estimate the population-level benchmark rates of cancer surgery, and further validated with the comparisons of observed rates of cancer surgery in the South Western Sydney Local Health District in 2006-12. Univariable and multivariable sensitivity analyses were done to explore uncertainty around model inputs, with mean (95% CI) benchmark surgery rates estimated on the basis of 10 000 Monte Carlo simulations. FINDINGS: Surgical treatment was indicated in 58% (95% CI 57-59) of newly diagnosed patients with cancer in Australia in 2014 at least once during the course of their treatment, but varied by site from 23% (17-27) for prostate cancer to 99% (96-99) for testicular cancer. Observed cancer surgery rates in South Western Sydney were comparable to the benchmarks for most cancers, but were higher for some cancers, such as prostate (absolute increase of 29%) and lower for others, such as lung (-14%). INTERPRETATION: The model provides a new template for high-income and emerging economies to rationally plan and assess their cancer surgery provision. There are differences in modelled versus observed surgery rates for some cancers, requiring more in-depth analysis of the observed differences. FUNDING: University of New South Wales Scientia Scholarship, UK Research and Innovation-Global Challenges Research Fund.


Assuntos
Países Desenvolvidos/economia , Neoplasias Embrionárias de Células Germinativas/economia , Neoplasias/economia , Neoplasias Testiculares/economia , Austrália/epidemiologia , Benchmarking/economia , Canadá/epidemiologia , Gerenciamento de Dados , Guias como Assunto/normas , Humanos , Neoplasias/epidemiologia , Neoplasias/cirurgia , Neoplasias Embrionárias de Células Germinativas/epidemiologia , Neoplasias Testiculares/epidemiologia , Reino Unido/epidemiologia
9.
Cancer Discov ; 11(3): 524, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33483379

RESUMO

The federal spending bill enacted by the U.S. Congress in December for fiscal year 2021 totals $1.4 trillion, plus another $900 billion in emergency COVID-19 relief funding. The $1.4 trillion includes budget increases for the NIH, NCI, and FDA that help the agencies keep pace with inflation. Research advocates say more than $10 billion in emergency supplemental funds for the NIH is urgently needed to support medical research affected by the COVID-19 pandemic.


Assuntos
Pesquisa Biomédica/legislação & jurisprudência , Governo Federal , Política de Saúde , Neoplasias/terapia , Apoio à Pesquisa como Assunto , Pesquisa Biomédica/economia , /economia , Humanos , Oncologia/organização & administração , National Cancer Institute (U.S.)/economia , National Institutes of Health (U.S.)/economia , Neoplasias/economia , Sociedades Médicas , Estados Unidos , United States Food and Drug Administration/economia
10.
Support Care Cancer ; 29(1): 349-358, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32361832

RESUMO

PURPOSE: Fighting cancer is a costly battle, and understanding the relationship between patient-reported financial toxicity (FT) and health outcomes can help inform interventions for post-treatment cancer survivors. METHODS: Stages I-III solid tumor, insured US cancer survivors (N = 103) completed a survey addressing FT (as measured by the standardized COST measure) and clinically relevant health outcomes (including health-related quality of life [HRQOL] and adherence to recommended survivorship health behaviors). Univariate and multivariate analyses were used to assess demographic and disease-specific correlates of FT, and to assess the predictive value of FT on HRQOL and adherence to survivorship health behaviors. RESULTS: Approximately 18% of respondents noted FT levels associated with significant financial burden. In univariate analyses, after correcting for multiple comparisons, greater FT was associated with unpartnered status, non-retirement, and lower level of educational attainment. Greater FT was also significantly associated with HRQOL components of anxiety, fatigue, pain, physical functioning, and social functioning. FT was not significantly associated with any measured survivorship health behaviors. In multivariate analyses, FT was found to be a meaningful predictor of patient-reported anxiety, fatigue, physical functioning, and social functioning above and beyond theoretically and statistically relevant demographic characteristics. CONCLUSIONS: Although overall levels of FT were lower among cancer survivors in this sample, as compared with active treatment patients assessed in previous studies, financial burden continued to be a concern for a significant minority of cancer survivors and was associated with components of reduced HRQOL. Further research is needed to understand FT among underinsured survivors and those treated in community oncology settings. IMPLICATIONS FOR CANCER SURVIVORS: Incorporation of FT assessment into survivorship care planning could enhance clinical assessment of survivors' FT vulnerability, help address the dynamic and persistent challenges of survivorship, and help identify those most in need of intervention across the cancer care continuum.


Assuntos
Sobreviventes de Câncer/psicologia , Efeitos Psicossociais da Doença , Gastos em Saúde , Neoplasias/economia , Qualidade de Vida/psicologia , Adulto , Ansiedade/psicologia , Fadiga/psicologia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Neoplasias/terapia , Medidas de Resultados Relatados pelo Paciente , Inquéritos e Questionários , Sobrevivência
11.
Support Care Cancer ; 29(1): 485-490, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32405963

RESUMO

AIM: To assess financial distress (FD) and its impact on symptom expression and other quality of life issues PATIENTS AND METHODS: Advanced cancer patients admitted to inpatient and outpatient clinics were selected. Standard epidemiological data including age, gender, primary cancer diagnosis, and Karnofsky level were recorded. Data regarding marital status, number of cohabitants, religious belief, educational level, and family income (< 1000, 1000-3.000, > 3000 euros), as well as extra costs not covered by health care system, were collected. Symptom burden including FD was measured by Edmonton Symptom Assessment Scale (ESAS), FACT-G (Functional Assessment of Cancer Therapy-General), and HADS (Hospital Anxiety Depression scale) were measured. RESULTS: Two hundred thirty-six patients were evaluated. The mean FD was 3.55 (SD 3.1). One hundred patients (42%) had a FD of ≥ 4. There was an inverse correlation between FD and income (P = 0.032). Most patients incurred in extra-costs, the most frequent being for drugs (n, 114). FD was inversely associated with age (P = 0.024), marital status (divorced or separated, P = 0.005), ESAS anxiety (P = 0.006), total ESAS (P = 0.019), physical well-being (P = 0.033), poor social family well-being (P = 0.004), emotional well-being (P = 0.045), poor functional well-being (P = 0.019), HADS-A (P = 0.003), and global HADS (P = 0.034). Family income was inversely related to age (P = 0.023), education level (P < 0.0005), less number of hospital admissions in the last month (P = 0.020), physical well-being (P = 0.039), social/family well-being (P = 0.020), and total well-being (P = 0.001). CONCLUSION: FD is very common in advanced cancer patients. FD was associated with anxiety, depression, and poor quality of life. The screening of FD may allow to develop effective interventions of social support.


Assuntos
Neoplasias/economia , Qualidade de Vida/psicologia , Avaliação de Sintomas/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Neoplasias/psicologia
12.
Bull Cancer ; 107(11): 1129-1137, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33036742

RESUMO

PURPOSE: Human, material, and financial resources being limited, the organization of the care system must allow an efficient allocation of resources. The management of cancers leads to specific and repetitive care for which the reimbursement of transport costs represents a high cost. We carried out an analysis of the additional transport costs, linked to the care of patients in Île-de-France, in a center other than the radiotherapy center closest to their home. MATERIALS AND METHODS: Using data from the Île-de-France Regional Health Agency, we have created a model evaluating the additional cost linked to transport generated by the care of a radiotherapy patient far from his home. In order to take into account the uncertainties linked to the hypotheses made in the development of the model, we carried out deterministic and probabilistic sensitivity analyzes. RESULTS: In the base case, the additional annual cost related to transport was 841,176 euros in Île-de-France. The probabilistic sensitivity analysis reports a total annual additional cost of 2,817,481 euros. CONCLUSION: Our results are similar to a report from the General Inspectorate of Social Affairs published in July 2011, which then pointed to an additional cost of between 4 and 6 million euros annually. The long-term care of cancer patients from their homes contributes to a deterioration in the quality of life linked to travel times, a delay in the care of potential treatment complications, and the spread of infectious diseases, such as COVID-19, and bacteria resistant to antibiotics.


Assuntos
Ambulâncias/economia , Institutos de Câncer/provisão & distribução , Acesso aos Serviços de Saúde/economia , Neoplasias/radioterapia , Transporte de Pacientes/economia , Ambulâncias/estatística & dados numéricos , Custos e Análise de Custo , França , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Modelos Estatísticos , Neoplasias/economia , Paris , Qualidade de Vida , Alocação de Recursos , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricos , Incerteza
14.
Support Care Cancer ; 28(10): 4645-4665, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32653957

RESUMO

PURPOSE: Financial toxicity related to cancer diagnosis and treatment is a common issue in developed countries. We seek to systematically summarize the extent of the issue in very high development index countries with publicly funded healthcare. METHODS: We identified articles published Jan 1, 2005, to March 7, 2019, describing financial burden/toxicity experienced by cancer patients and/or informal caregivers using OVID Medline Embase and PsychInfo, CINAHL, Business Source Complete, and EconLit databases. Only English language peer-reviewed full papers describing studies conducted in very high development index countries with predominantly publicly funded healthcare were eligible (excluded the USA). All stages of the review were evaluated in teams of two researchers excepting the final data extraction (CJL only). RESULTS: The searches identified 7117 unique articles, 32 of which were eligible. Studies were undertaken in Canada, Australia, Ireland, UK, Germany, Denmark, Malaysia, Finland, France, South Korea, and the Netherlands. Eighteen studies reported patient/caregiver out-of-pocket costs (range US$17-US$506/month), 18 studies reported patient/caregiver lost income (range 17.6-67.3%), 14 studies reported patient/caregiver travel and accommodation costs (range US$8-US$393/month), and 6 studies reported financial stress (range 41-48%), strain (range 7-39%), or financial burden/distress/toxicity among patients/caregivers (range 22-27%). The majority of studies focused on patients, with some including caregivers. Financial toxicity was greater in those with early disease and/or more severe cancers. CONCLUSIONS: Despite government-funded universal public healthcare, financial toxicity is an issue for cancer patients and their families. Although levels of toxicity vary between countries, the findings suggest financial protection appears to be inadequate in many countries.


Assuntos
Neoplasias/economia , Feminino , Humanos , Masculino , Neoplasias/epidemiologia
15.
Public Health ; 185: 306-311, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32717672

RESUMO

OBJECTIVES: The global patterns of cancer incidences and mortality rates are slowly shifting towards low- and middle-income countries. Through our article, we highlight the societal cost associated with premature mortality and morbidity of cancer in Nepal. The monetary loss is indicative of the severity of the issue and it serves to motivate the policymakers realize the urgency in devising appropriate cancer control strategies. STUDY DESIGN: The study design is a cross-sectional study using the GLOBOCAN 2012 data. METHODS: Using the human capital approach, we measure the number of years of life lost (YLL) and the number of years of productive life lost (YPLL) due to cancer in Nepal. RESULTS: We found that following diagnosis, a Nepali patient with cancer is likely to lose out on 19.64 years of their life; the average number of YLL is higher for females (22.2 years vs 16.8 years in males). After adjusting for labor force participation rate and predicted growth rate of the economy, we found that cancer led to a total productivity loss of $149 million (males) and $121 million (females) in 2012. The burden of the top five cancers accounted for almost half of the total productivity loss in both the genders. Cervical and lung cancer incur the maximum cost to society, respectively, for females and males. CONCLUSIONS: The article highlighted the severity of the cancer issue and emphasized the urgency needed in devising cancer control policies in Nepal.


Assuntos
Expectativa de Vida , Mortalidade Prematura , Neoplasias/economia , Neoplasias/epidemiologia , Adolescente , Adulto , Idoso , Efeitos Psicossociais da Doença , Estudos Transversais , Emprego , Feminino , Humanos , Incidência , Renda , Neoplasias Pulmonares/economia , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Neoplasias/prevenção & controle , Nepal/epidemiologia , Neoplasias do Colo do Útero/economia , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-32630745

RESUMO

In view of an efficient use of the Italian National Health Service-funded healthcare resources, a novel data-processing strategy combining information from multiple sources was developed in a regional cancer network of northern Italy. The goal was to calculate the annual overall cost of care pathways of six disease groups in 10,486 patients. The evaluation was conceived as a population-based cost description from the perspective of the Italian National Health Service. Costs occurred during a defined time period for a cross-section of patients at varying stages of their disease were measured. The total cancer care cost was €81,170,121 (11.1% of total local health expenditure), with a cost per patient of €7741.17 and a cost per capita of €204.62. Surgical, inpatient and day-hospital medical admissions, radiotherapy, drugs, outpatient care, emergency admissions, and home and hospice care accounted for 21.2%, 24.1%, 6.2%, 28.2%, 14.0%, 0.9%, and 5.4% of the total cost, respectively. The highest cost items included drugs (cost per capita, €22.95; 11.2% of total cost) and medical admissions (€14.51; 7.1%) for blood cancer, and surgical (€14.56; 7.1%) and medical admissions (€13.60; 6.6%) for gastrointestinal cancer. The information extracted allows multidisciplinary cancer care teams to be more aware of the costs of their clinical decisions.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Neoplasias/economia , Medicina Estatal , Assistência Ambulatorial , Gastos em Saúde , Hospitalização , Humanos , Itália/epidemiologia , Neoplasias/epidemiologia , Neoplasias/terapia
18.
Public Health ; 185: 130-138, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32622220

RESUMO

OBJECTIVES: Health insurance availability and affordability are vital elements in diagnosis and treatment of patients with cancer and thus constitute clinical significance as well. Although past studies have explored the disparity in mortality figures for patients with different insurance statuses, this population-based study is pioneering in analyzing the changes in cancer mortality risks over time amid macroeconomic shifts. STUDY DESIGN: The study uses Surveillance Epidemiology and End Results (SEER) data of 424,889 non-elderly patients with breast, cervical, ovarian, and uterine cancer diagnosed during 2007-2010 and 2011-2015. METHODS: In addition to discussing incidence figures and insurance patterns, the study uses Kaplan-Meier and Cox's proportional hazard models to examine the changes in survival probability and mortality risks for insurance-stratified patients with female-specific cancer across the two time periods. RESULTS: Patients without insurance have an increased risk of mortality over time relative to insured patients. Moreover, uninsured patients face this heightened risk more than Medicaid patients. DISCUSSION: Despite public policy measures as well as advancements in diagnostic facilities and treatment technology, the increased relative mortality of patients without insurance limits the long-term affordability of cancer treatment for economically vulnerable patients in comparison with insured patients.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Neoplasias/mortalidade , Adolescente , Adulto , Neoplasias da Mama/mortalidade , Feminino , Humanos , Incidência , Cobertura do Seguro/economia , Seguro Saúde/economia , Medicaid/economia , Pessoas sem Cobertura de Seguro de Saúde , Pessoa de Meia-Idade , Neoplasias/economia , Neoplasias/epidemiologia , Neoplasias Ovarianas/mortalidade , Fatores de Risco , Programa de SEER , Estados Unidos , Neoplasias do Colo do Útero/mortalidade , Neoplasias Uterinas/mortalidade , Adulto Jovem
19.
Gan To Kagaku Ryoho ; 47(7): 1007-1011, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32668840

RESUMO

The Japanese government set the target to "reduce health inequalities" in the second version of "Healthy Japan 21". However, it is not enough to monitor the socioeconomic inequalities in cancer. In England, National Health Service(NHS) targeted to "tackle the inequalities in cancer" since 2000. In this review, I introduced some researches for the socioeconomic inequalities in cancer in Japan. We monitored the area-level socioeconomic inequalities in mortality using vital statistics data in Japan using the areal-based deprivation index. Among total inequalities in all cause of death, inequalities in cancer death is the most contributed. Inequalities in lung cancer mortality were widest for both sexes, which is related to the inequalities in smoking rate. We also monitored socioeconomic inequalities in stage-specific incidence using population-based cancer registry. For most of cancer sites, higher late-stage incidence were observed in the more deprived area, which might be due to poor access to the cancer screening in those area. Socioeconomic inequalities in cancer survival were also observed, especially for the cancer sites which has favor prognosis. Although stage at diagnosis plays an important role in these socioeconomic inequalities, other factors such as co-morbidities are likely play a part. We need further study to understand the mechanism of inequalities in cancer using more clinically detail database in near future.


Assuntos
Neoplasias , Medicina Estatal , Feminino , Humanos , Incidência , Japão , Masculino , Neoplasias/economia , Neoplasias/terapia , Fatores Sexuais , Fatores Socioeconômicos
20.
Cancer Immunol Immunother ; 69(10): 1947-1958, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32676716

RESUMO

OBJECTIVES: Scientific advances in the last decade have highlighted the use of immunotherapy, especially immune checkpoint inhibitors, to be an effective strategy in cancer therapy. However, these immunotherapeutic agents are expensive, and their use must take into account economic criteria. Thus, the objective of the present study was to systematically identify and review published EE related to the use of ipilimumab, nivolumab or pembrolizumab in melanoma, lung cancer, head and neck cancer or renal cell carcinoma, and to assess their quality. METHODS: The systematic literature research was conducted on Medline via PubMed and the Cochrane Central Register of Controlled Trials to identify economic evaluations published before July 2018. The quality of each selected economic evaluation was assessed by two independent reviewers using the Drummond checklist. RESULTS: Our systematic review was based on 32 economic evaluations using different methodological approaches, different perspectives and different time horizons. Three-quarters of the economic evaluations are full (n = 24) with a Drummond score ≥ 7, synonymous of "high quality". Among them, 66% reported a strategy that was cost-effective. The most assessed immunotherapeutic agent was nivolumab. In patients with renal cell carcinoma or head and neck cancer, it was less likely to be cost-effective than in patients with melanoma or lung cancer. CONCLUSIONS: Whether or not these findings will be confirmed remains to be seen when market approval to cover more indications is extended and new effective immunotherapeutic agents become available.


Assuntos
Antineoplásicos Imunológicos/economia , Análise Custo-Benefício , Imunoterapia/economia , Neoplasias/tratamento farmacológico , Neoplasias/economia , Antineoplásicos Imunológicos/uso terapêutico , Humanos , Neoplasias/imunologia , Neoplasias/patologia , Prognóstico
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