• Análise de custo-efetividade comparando a aplicação ou não de irradiação cerebral total antes da radiocirurgia estereotáxica para o tratamento de uma a quatro metástases cerebrais, de acordo com a perspectiva de pagadores privados terceiros brasileiros

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Título

Análise de custo-efetividade comparando a aplicação ou não de irradiação cerebral total antes da radiocirurgia estereotáxica para o tratamento de uma a quatro metástases cerebrais, de acordo com a perspectiva de pagadores privados terceiros brasileiros

Tipo de documento

Apresentação

Descrição

Resumo apresentado na The Professional Society for Health Economics and Outcomes Research (ISPOR)

Fonte

ISPOR

Ano de publicação

2012

Referência (Vancouver)

Santos M, Stefani SD, Dias R, Palma A, Neto JPR, Campos ESD. Cost-efectiveness analysis comparing the application or not of whole brain irradiation before stereotectic radiosurgery for the treatment of one to four brain metastases, according to Brazilians third-party private payer's perspective' [Internet]. In: ISPOR Europe 2012; Berlin, Germany. Disponível em: https\://www\.ispor.org/heor-resources/presentations-database/presentation/ispor-15th-annual-european-congress/cost-efectiveness-analysis-comparing-the-application-or-not-of-whole-brain-irradiation-before-stereotectic-radiosurgery-for-the-treatment-of-one-to-four-brain-metastases-according-to-brazilians-third-party-private-payers-perspective

URL

https://www.ispor.org/heor-resources/presentations-database/presentation/ispor-15th-annual-european-congress/cost-efectiveness-analysis-comparing-the-application-or-not-of-whole-brain-irradiation-before-stereotectic-radiosurgery-for-the-treatment-of-one-to-four-brain-metastases-according-to-brazilians-third-party-private-payers-perspective

Identificador

2012ISPOR037

Title

Cost-efectiveness Analysis Comparing the Application Or Not of Whole Brain Irradiation Before Stereotectic Radiosurgery For the Treatment of One to Four Brain Metastases, According to Brazilians Third-party Private Payer's Perspective'.

Document type

Presentation

Description

Abstract presented at The Professional Society for Health Economics and Outcomes Research (ISPOR)

Source

ISPOR

Publication year

2012

Reference (Vancouver)

Santos M, Stefani SD, Dias R, Palma A, Neto JPR, Campos ESD. Cost-efectiveness analysis comparing the application or not of whole brain irradiation before stereotectic radiosurgery for the treatment of one to four brain metastases, according to Brazilians third-party private payer's perspective' [Internet]. In: ISPOR Europe 2012; Berlin, Germany. Available from: https\://www\.ispor.org/heor-resources/presentations-database/presentation/ispor-15th-annual-european-congress/cost-efectiveness-analysis-comparing-the-application-or-not-of-whole-brain-irradiation-before-stereotectic-radiosurgery-for-the-treatment-of-one-to-four-brain-metastases-according-to-brazilians-third-party-private-payers-perspective

URL

https://www.ispor.org/heor-resources/presentations-database/presentation/ispor-15th-annual-european-congress/cost-efectiveness-analysis-comparing-the-application-or-not-of-whole-brain-irradiation-before-stereotectic-radiosurgery-for-the-treatment-of-one-to-four-brain-metastases-according-to-brazilians-third-party-private-payers-perspective

Identifier

2012ISPOR037

Resumo

Objetivos: Em pacientes com uma a quatro metástases cerebrais, se o diâmetro for < 4 cm, o tratamento padrão é a irradiacão cerebral total (WBI) seguida de radiocirurgia estereotáxica (SRS). Há um interesse crescente na entrega isolada de SRS, visando reduzir os efeitos colaterais da WBI, apesar de um maior risco de recorrências intracerebrais. O objetivo deste estudo foi comparar a relação custo-efetividade dessas duas estratégias, sob a perspectiva de pagadores terceiros Brasileiros. Métodos: Foi realizada uma meta-análise de dados sumários, incluindo todos os ensaios clínicos prospectivos de fase III que compararam SRS versus WBI+SRS. Dados sobre manejo de recorrência, dependendo do tamanho da lesão e do tratamento previamente administrado, também foram extraídos. Os custos foram estimados com base nas tarifas de reembolso do sistema de saúde Brasileiro para o sistema privado (CBHPM). Apenas custos diretos foram considerados e expressos em Reais Brasileiros (BRL). Uma análise de sensibilidade probabilística foi conduzida para avaliar a robustez dos resultados. A perspectiva adotada foi a dos pagadores terceiros Brasileiros. Resultados: Três ensaios clínicos prospectivos de fase III foram selecionados, incluindo 467 pacientes. Como não houve diferença na sobrevida geral, a efetividade foi avaliada de acordo com o controle local. Após dois anos de acompanhamento, 78% [64,2-87,4%] dos pacientes tratados com SRS e 53% [47-57%] dos pacientes tratados com WBI+SRS apresentaram recorrência. A razão de custo-efetividade incremental (ICER) comparando WBI+SRS com SRS foi de 7.489,60 BRL/ano sem recorrências cerebrais. Análises de sensibilidade mostraram que o ICER permanece aceitável sob uma ampla gama de pressupostos. Conclusões: Os resultados sugerem que WBI+SRS pode ser considerada uma estratégia custo-efetiva em pacientes com até 4 metástases cerebrais. Uma vez que nenhum efeito prejudicial na sobrevida foi demonstrado, SRS pode ser economicamente vantajosa para pagadores terceiros Brasileiros, mas os pacientes precisam estar cientes dos riscos envolvidos na não entrega de WBI.

Notas

O registro foi originalmente publicado em inglês. A versão em português foi traduzida com o apoio de inteligência artificial.

Abstract

Objetives: In patients with one to four brain metastasis, if diameter < 4 cm, the standard treatment is whole brain irradiation (WBI) followed by stereotactic radiosurgery (SRS). There is growing interest on the delivery of isolated SRS, aiming to reduce side effects of WBI, despite a higher risk of intra-cerebral recurrences. The Objetive of this study was to compare the cost-effectiveness of those two strategies, under Brazilians third-part payers’ perspective. Methods: A meta-analysis of summary data, including all phase III prospective trails that compared SRS to WBI+SRS, was performed. Data about recurrence management, dependant of on the lesion size, as well as of previous delivered treatment, were also extracted. Costs were estimated based on charges accordingly to Brazilian Health Care reimbursement rates for the private system (CBHPM). Only directs costs were considered, and were expressed in Brazilian Reais (BRL). A probabilistic sensitivity analysis was conducted to evaluate the robustness of the Results. The perspective was that from the Brazilian Third Party payer. Results: Three phase III prospective trials have been selected, including 467 patients. Once there was no difference in overall survival, effectiveness was evaluated according to local control. After two years of follow up, 78% [64.2-87.4%] of the SRS patients and 53% [47-57%] of the WBI+SRS patients have recurred. The incremental cost-effectiveness ratio (ICER) comparing WBI+SRS to SRS was of 7.489,60 BRL/year without cerebral recurrences. Sensitivity analysis showed that ICER remains acceptable under a wide range of assumptions . Conclusions: Results suggested that WBI+SRS might be considered as a cost-effective strategy in patients with up to 4 brain metastases. Once no detrimental survival effect have been shown, SRS can be cost-savings for Brazilians third-party payers, but patients need to be aware of the risks involved in not delivering WBI.

Notes

The record was originally published in English. The Portuguese version was translated with the aid of artificial intelligence.

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