The use of micro-costing in an economic analysis of allogeneic HSCT in Brazil / O uso do microcusteio na análise econômica do TCTH alogênico no Brasil

Objetivo: O objetivo deste estudo foi estimar os custos do tratamento do transplante de células--tronco hematopoéticas (TCTH) em um centro de referência no Brasil. Métodos: A população do estudo foi composta por pacientes provenientes da lista de TCTH do Sistema Único de Saúde submetidos ao TCTH em um hospital do sul do Brasil, entre 2016 e 2019. A avaliação de custos foi realizada por meio de um estudo de microcusteio, baseado no Time-Driven Activity-based Costing (TDABC) adaptado para estudos econômicos em saúde e incluiu as seguintes etapas: definição da questão de pesquisa, coleta de dados estruturada e análise estatística dos resultados. Resultados: O custo total do TCTH foi de $ 155.110 ($ 92.794 ­ $ 249.146 USD). O TCTH de doador não aparentado compatível foi mais caro do que o TCTH de doador aparentado compatível. Os principais fatores de custo envolvem complicações pós-transplante, principalmente a ocorrência de infecções. Em relação à composição dos custos, exames e procedimentos representam o maior custo em TCTH (45%). Conclusão: Essas estimativas podem ser aplicáveis a novas avaliações de custo-efetividade do TCTH e ajudar os gestores na tomada de decisão em saúde, especialmente em países de média renda

Objective: The objective of this study was to estimate treatment costs of Hematopoietic stem cell transplantation (HSCT) at a reference center in Brazil. Methods: The study population consisted of patients from the Unified Health System HSCT who underwent HSCT in southern Brazil between 2016 and 2019. Costs were measured using a micro-costing approach, based on Time-Driven Activity-based Costing (TDABC) adapted for economic studies in health and included the following steps: definition of the research question, structured data collection, and statistical analysis of results. Results: The total cost of HSCT was $155,110 ($92,794 ­ $249,146 USD). Matched unrelated donor HSCT was more expensive than matched related donor HSCT. The major cost factors involve post- -transplant complications, mainly the occurrence of infections. Concerning cost composition, exams and procedures represent the largest expense in HSCT (45%). Conclusion: These estimates could be applicable to further evaluations for HSCT cost-effectiveness and help healthcare decision-makers in middle-income countries

Donor characteristics and hematopoietic stem cell transplantation outcome: experience of a single center in Southern Brazil

ABSTRACT Background: Hematopoietic stem cell transplantation is a curative treatment for many patients with hematological disorders. Donor-recipient genetic disparity, especially involving the human leukocyte antigen system is a critical factor for transplant outcome. Objective: To evaluate retrospectively donor characteristics and correlations with the occurrence of acute and chronic graft-versus-host disease, disease-free survival and overall survival in a Brazilian population submitted to allogeneic hematopoietic stem cell transplantation between 1994 and 2012 in a single center. Results: Three hundred and forty-seven consecutive transplantations were included. Related transplants (81.2%) were significantly more common than unrelated transplants (18.7%); donor and recipient median ages were 34 (range: 1-61) and 33 (range: 3-65) years respectively with donor HLAs being matched for 333 (95.9%) patients. Donor gender, cytomegalovirus status and ABO incompatibility did not influence the five-year overall survival. In univariate analyses, overall survival was negatively influenced by the presence of acute graft-versus-host disease (33% vs. 47%, respectively; p-value = 0.04), unrelated transplant (41.5% vs. 50.9%, respectively; p-value = 0.045) and donors aged over 40 years (41% vs. 52%, respectively; p-value = 0.03). Older donors were associated with a higher rate of acute (52% vs. 65.8%; p-value = 0.03) and chronic graft-versus-host disease (60% vs. 43%, respectively; p-value = 0.015). In multivariate analyses, acute graft-versus-host disease [relative risk (RR): 1.8; 95% confidence interval (CI): 1.1-29; p-value = 0.008] and older donors (RR: 1.6; 95% CI 1.11-2.24; p-value = 0.013) were associated with higher transplant-related mortality. Conclusions: In transplant patients, to have a donor older than 40 years of age seems to significantly increase the incidence of acute and chronic graft-versus-host disease and transplant-related mortality with no impact on disease-free survival and overall survival. In spite of the rather small cohort of patients, these findings are similar to what is described in the literature suggesting that a younger donor should be chosen whenever possible.

Fibrobroncoscopia no diagnóstico e decisão terapêutica de infecções respiratórias em pacientes neutropênicos febris hematológicos / Fiberoptic bronchoscopy in the diagnosis and therapeutic decision for respiratory infections in hematological febrile neutropenic patients

INTRODUÇÃO: A neutropenia febril é uma complicação frequente dos pacientes submetidos ao tratamento quimioterápico ou Transplante de Célula Tronco Hematopoiética (TCTH). A fibrobroncoscopia (FBC) flexível tem sido utilizada para auxiliar no diagnóstico de doenças pulmonares. No entanto, não há consenso em relação ao benefício do exame para estabelecer diagnóstico e alterar o tratamento das doenças pulmonares nesse contexto. Estudos prévios, retrospectivos e bastante heterogêneos, com pacientes imunocomprometidos não-HIV mostraram que o rendimento da fibrobroncoscopia para estabelecer diagnóstico etiológico varia de 13 a 81% e gera alteração de terapêutica em 5 e 51%. O objetivo deste estudo foi avaliar o rendimento da Fibrobroncoscopia, o risco ao procedimento em pacientes hematológicos e neutropênicos. MÉTODOS: Estudo transversal retrospectivo que avaliou pacientes com neoplasia hematológica e neutropenia febril e que tenham sido submetidos à fibrobroncoscopia diagnóstica entre janeiro de 2011 e dezembro de 2012 internados no Hospital de Clínicas de Porto Alegre. RESULTADOS: Foram incluídos 45 pacientes: 18 (36%) tiveram resultado positivo no Lavado Broncoalveolar (LAB), sendo que houve mudança na conduta terapêutica em 95% dos pacientes que apresentaram positividade no LAB. Com relação ao risco do procedimento tivemos uma taxa de 2,2% de complicação, com um paciente que apresentou dessaturação imediatamente após o procedimento. CONCLUSÃO: Apesar do número limitado de pacientes, nossos achados indicam que a realização da fibrobroncoscopia com LAB em pacientes neutropênicos é segura e com um rendimento semelhante aos descritos na literatura

INTRODUCTION: Febrile neutropenia is a common complication in patients undergoing chemotherapy or hematopoietic Stem Cell Transplantation (HSCT). Flexible fiberoptic bronchoscopy has been used to aid in the diagnosis of pulmonary diseases. However, there is no consensus regarding the benefit of the exam in establishing diagnosis and in changing the treatment of lung disease in this context. Previous retrospective studies, quite heterogeneous and with non-HIV immunocompromised patients, showed that the yield of fiberoptic bronchoscopy in establishing etiology ranges from 13% to 81%, and in changing therapy, from 5% to 51%. To evaluate the efficiency of Fiberoptic bronchoscopy and the procedure-related risk for neutropenic patients with hematologic malignancy. METHODS: This retrospective cross-sectional study analyzed the medical records of patients with hematologic malignancy with febrile neutropenia who had undergone diagnostic fiberoptic bronchoscopy between January 2011 and December 2012 at the Hospital de Clínicas de Porto Alegre. RESULTS: A total of 45 patients were included: 18 (36%) tested positive for bronchoalveolar lavage, with change in therapeutic management occurring for 95% of them. The procedure-related risk was 2.2%, with one patient showing desaturation immediately after the procedure. CONCLUSION: Despite the limited number of patients, our findings indicate that fiberoptic bronchoscopy in neutropenic patients is safe, and the results are similar to those previously reported