Article type
Year
Abstract
Background: The costs of oncology are among the highest in most health systems. The use of therapies based in low quality studies is not uncommon and have a high economic impact. In Brazil, the health plans (HP) are, by law, not required to cover experimental therapies.
Objective: To evaluate the chemotherapy use in three health plans in Brazil, aiming to determine if experimental treatments were in use, the costs of these treatments and to propose strategies for cost-savings.
Methods: We retrospectively evaluated all chemotherapy treatments performed during three months in three HP, which insures 800.000 people. For each treatment we extracted data regarding the patients, disease and stage, drugs and doses and their costs. Then, a search in MEDLINE and in the internet was conducted looking for guidelines, systematic reviews, randomized studies or approval by regulatory agencies (such as FDA and EMEA), aiming to determine if that treatment should be considered experimental or standard. To consider a treatment as experimental, it had to have no approval by regulatory agencies, no clinical benefit established by clinical trials and no recommendation to its use in guidelines. Our belief is that, as shown in the literature, the use of guidelines would improve the outcomes. We also calculated the estimate cost savings by eliminating the use of experimental therapies and by the adoption of generic instead of brand name drugs.
Results: We evaluated approximately 2400 treatments in the three months period. Total costs of these treatments was R$ 4,100,000.00, corresponding to US$ 1,460,000.00. The use of experimental therapies varied from 10% to 25% of the cases, corresponding to 25% to 41% of the total costs of all chemotherapies prescribed. The implementation of evidence based guidelines and auditing was able to reduce the costs in 25% in one of the HP, after one year. The substitution of brand names by generic medicines would drop total costs by an additional 22%.
Conclusion: The use of evidence based audit in oncology is potentially cost-saving in HP, and possibly improves the quality of care. The substitution of brand names by generic drugs can also offer additional cost savings.
Objective: To evaluate the chemotherapy use in three health plans in Brazil, aiming to determine if experimental treatments were in use, the costs of these treatments and to propose strategies for cost-savings.
Methods: We retrospectively evaluated all chemotherapy treatments performed during three months in three HP, which insures 800.000 people. For each treatment we extracted data regarding the patients, disease and stage, drugs and doses and their costs. Then, a search in MEDLINE and in the internet was conducted looking for guidelines, systematic reviews, randomized studies or approval by regulatory agencies (such as FDA and EMEA), aiming to determine if that treatment should be considered experimental or standard. To consider a treatment as experimental, it had to have no approval by regulatory agencies, no clinical benefit established by clinical trials and no recommendation to its use in guidelines. Our belief is that, as shown in the literature, the use of guidelines would improve the outcomes. We also calculated the estimate cost savings by eliminating the use of experimental therapies and by the adoption of generic instead of brand name drugs.
Results: We evaluated approximately 2400 treatments in the three months period. Total costs of these treatments was R$ 4,100,000.00, corresponding to US$ 1,460,000.00. The use of experimental therapies varied from 10% to 25% of the cases, corresponding to 25% to 41% of the total costs of all chemotherapies prescribed. The implementation of evidence based guidelines and auditing was able to reduce the costs in 25% in one of the HP, after one year. The substitution of brand names by generic medicines would drop total costs by an additional 22%.
Conclusion: The use of evidence based audit in oncology is potentially cost-saving in HP, and possibly improves the quality of care. The substitution of brand names by generic drugs can also offer additional cost savings.