Real-world molecular testing and treatment patterns in brazilian patients with newly diagnosed locally advanced or metastatic NSCLC

OBJECTIVES: To evaluate the molecular testing and treatment patterns in a retrospective cohort of newly diagnosed treatment-naïve patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC). METHODS: This is an observational retrospective cohort study conducted across 10 cancer centers in Brazil. Treatment-naïve patients with locally advanced or metastatic NSCLC were enrolled from January to December 2014. The following data were collected from the medical records of patients from diagnosis until the last record (death, loss to follow-up, or the end of the maximum follow-up period): demographics; medical history; smoking status; disease characteristics; previous treatments; and molecular testing patterns and results. The overall survival (OS) was also estimated. Results: A total of 391 patients from 8 different Brazilian states were included, with a median age of 64.1 years (23.7-98.7), with most patients being males (60.1%). The smoking status of 74.2% of patients was a 'former' or 'current smoker'. Stage IV NSCLC at diagnosis was observed in 82.4% of patients, with 269 of them (68.8%) presenting adenocarcinoma (ADC). Among the stage IV ADC patients, 54.0% were referred for molecular testing. Among the patients with an available epidermal growth factor receptor (EGFR) mutation status, 31 (24.0%) were EGFR-positive. The first-line treatment was a platinum-based chemotherapy for 98 patients (25.1%), while non-platinum-based regimens were used in 54 patients (13.8%). OS data were available for 370 patients, with a median OS of 10.8 months. Never smokers had a significantly higher median OS versus current or former smokers (14.6 versus 9.1 months; log-rank p=0.003). Among the patients for whom molecular testing data were available, those with EGFR-positive results had a longer median OS (34.6 versus 12.8 months; log-rank p=0.003). Conclusion: Our findings provide relevant information for prescribers and policy decision-makers by highlighting the unmet needs of patients and the importance of molecular testing in newly diagnosed locally advanced or metastatic lung adenocarcinoma. We also highlight the respective EGFR-tyrosine kinase inhibitor treatment when the result is positive and the areas in which further efforts are required to grant access to effective treatment.

Programas de benefício farmacêutico privados no Brasil e Estados Unidos: uma análise comparativa / Private pharmaceutical benefit programs in Brazil and the United States: a comparative analysis

Esta tese analisa os programas de benefício farmacêutico (PDF's) pelas operadoras de saúde suplementar no Brasil e nos planos de saúde privados americanos. O estudo se desenvolveu a partir de 3 capítulos principais. No primeiro capítulo foi elaborado um modelo que permitisse a comparação entre os diversos PBF's praticados no Brasil e nos Estados Unidos. Para tal foram analisadas as seguintes variáveis: características operacionais dos PBF's; o Sistema de Informação, como uma ferramenta importante para gerenciamento do programa; a adesão ao tratamento e as ferramentas destinadas ao controle se custo e fraude. No segundo capítulo foram analisadas as mudanças recentes ocorridas no mercado americano e as implicações sobre os PBF's e sobre o mercado farmacêutico. Foram avaliadas as formas de disponibilização de medicamentos, com destaque para o surgimento e consolidação das empresas de gerenciamento dos PBF's (PBM's). As ferramentas de controle de custo e farude aplicadas, bem como o impacto da não adesão e as iniciativas no gerenciamento de doentes crônicos. No terceiro capítulo foram analisadas as mudanças pelas quais vem passando o sistema de saúde suplementar no Brasil, foram obtidas informações acerca das iniciativas que vêm sendo praticadas no setor. No final do trabalho foi observado que os PBF's, apesar de recentemente consolidados no mercado americano, são praticados pela grande maioria dos planos privados deste país, com grande impacto sobre o mercado farmacêutico, que viu seu faturamento quase que dobrar em uma década. No Brasil, as iniciativas ainda são esparsas e fragmentadas, sobretudo pela transição que ainda passa o nosso sistema de saúde suplementar. Entretanto, ainda que os PBF's fossem uma prática usual, acreditamos que eles teriam pouco impacto sobre mercado e/ou acesso ao consumo de medicamentos.