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De Camargo Cancela M, Monteiro Dos Santos JE, Lopes de Souza LB, Martins LFL, Bezerra de Souza DL, Barchuk A, Hanly P, Sharp L, Soerjomataram I, Pearce A. The economic impact of cancer mortality among working-age individuals in Brazil from 2001 to 2030. Cancer Epidemiol 2023; 86:102438. [PMID: 37579673 PMCID: PMC10577440 DOI: 10.1016/j.canep.2023.102438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND About half of cancer deaths in Brazil occur among individuals of working-age (under 65 years for men, under 60 for women), resulting in a substantial economic impact for the country. We aimed to estimate the years of potential productive life lost (YPPLL) and value the productivity lost due to premature deaths from cancer between 2001 and 2015 and the projected to 2030. METHODS We used the Human Capital Approach to estimate the productivity losses corresponding to YPPLL for cancer deaths in working age people (15-64 years). Mortality data were obtained from the Mortality Information System from 2001 to 2015 and projected between 2016 and 2030. Economic data were obtained from the Continuous National Household Sample Survey and forecasted to 2030. Productivity lost was calculated as the monetary value arising from YPPLL in Int$(2016). RESULTS Between 2001 and 2030, a total of 2.3 million premature deaths from all cancers combined were observed and forecasted in Brazil (57% men, 43% women), corresponding to 32 million YPPLL and Int$141.3 billion in productivity losses (men: Int$102.5 billion, women: Int$38.8 billion). Between 2001 and 2030, among men, lung (Int$ 12.6 billion), stomach (Int$ 10.6 billion) and colorectal (Int$ 9.4 billion) cancers were expected to contribute to the greatest productivity losses; and among women, it will be for breast (Int$ 10.0 billion), cervical (Int$ 6.4 billion) and colorectal (Int$ 3.2 billion) cancers. CONCLUSIONS Many preventable cancers result in high lost productivity, suggesting measure to reduce smoking prevalence, alcohol consumption, physical inactivity and inadequate diet, improving screening programs and increasing vaccination coverage for human papillomavirus and hepatitis B would have a positive impact on the economy, as well as reducing morbidity and mortality from cancer.
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Affiliation(s)
- Marianna De Camargo Cancela
- Division of Surveillance and Data Analysis, Coordination of Prevention and Surveillance, Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil.
| | - Jonas Eduardo Monteiro Dos Santos
- Division of Surveillance and Data Analysis, Coordination of Prevention and Surveillance, Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil
| | - Leonardo Borges Lopes de Souza
- Division of Surveillance and Data Analysis, Coordination of Prevention and Surveillance, Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil
| | - Luís Felipe Leite Martins
- Division of Surveillance and Data Analysis, Coordination of Prevention and Surveillance, Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil
| | | | - Anton Barchuk
- Faculty of Social Sciences, Health Sciences, Tampere University, Finland
| | - Paul Hanly
- School of Business, National College of Ireland, Dublin, Ireland
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, University of Newcastle, Newcastle Upon Tyne, United Kingdom
| | | | - Alison Pearce
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Ramos MC, Passone JADL, Lopes ACDF, Safatle-Ribeiro AV, Ribeiro Júnior U, de Soárez PC. Economic evaluations of colorectal cancer screening: A systematic review and quality assessment. Clinics (Sao Paulo) 2023; 78:100203. [PMID: 37099816 PMCID: PMC10182269 DOI: 10.1016/j.clinsp.2023.100203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/09/2023] [Accepted: 04/05/2023] [Indexed: 04/28/2023] Open
Abstract
Colorectal Cancer (CRC) is the third most common type of cancer worldwide and ranks second in mortality. Screening programs for early detection and treatment have been implemented in several countries. Economic evaluations are an important tool to support decision-making about reimbursement and coverage decisions in health systems and, therefore, to support efficient resource allocation. The article aims to review the up-to-date evidence on economic evaluations of CRC screening strategies. MEDLINE, EMBASE, Web of Science, SCOPUS, SciELO, Lilacs, CRD databases, and lists of references were reviewed to identify relevant literature regarding full economic evaluations of CRC screening in asymptomatic average-risk individuals over 40 years old. Searches were conducted with no restriction to language, setting, or date. Qualitative syntheses described CRC screening strategies and comparators (baseline context), study designs, key parameter inputs and incremental cost-effectiveness ratios. Seventy-nine articles were included. Most of the studies were from high-income countries and a third-party payer perspective. Markov models were predominantly used, although microsimulation has been increasingly adopted in the last 15 years. The authors found 88 different screening strategies for CRC, which differed in the type of technique, the interval of screening, and the strategy, i.e., isolated or combined. The annual fecal immunochemical test was the most predominant screening strategy. All studies reported cost-effective results in their scenarios compared to no screening scenarios. One-quarter of the publications reported cost-saving results. It is still necessary to develop future economic evaluations in Low- and Middle-Income Countries (LMICs), which account for the high burden of disease.
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Affiliation(s)
- Marcela Castro Ramos
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | | | - Ana Carolina de Freitas Lopes
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Adriana Vaz Safatle-Ribeiro
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Ulysses Ribeiro Júnior
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Patrícia Coelho de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
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Economic burden of cancer attributable to overweight in the Brazilian Unified Health System. J Cancer Policy 2022; 33:100345. [PMID: 35724958 DOI: 10.1016/j.jcpo.2022.100345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/19/2022] [Accepted: 06/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Alongside the rising prevalence of overweight and obesity in Brazil, there is expected to be increased direct healthcare costs of cancers. Herein, we estimated the economic costs of cancer attributable to overweight in the Brazilian Unified Health System (SUS), according to sex, type of cancer and geographic location (Federative Units). METHODS The population attributable fraction (PAF) of fifteen types of cancer were estimated using body mass index (BMI) data of 85,715 adults (≥ 20 years) involved in the 2019 National Health Survey and relative risks of cancers from a meta-analysis. Inpatients and outpatient procedures and costs of cancer treatment were obtained from the SUS systems. RESULTS Costs of cancers included in this study were Int$ 1 billion in 2019, of which 9 % or Int$ 95 million were attributable to overweight and obesity. PAFs were higher in men (11 %) than in women (8 %), while the attributable cancer costs were higher in women (Int$ 55 million) than in men (Int$ 40 million). Cancers with the highest PAFs were endometrial cancer (40 %) and esophageal cancer (26 %), whereas cancers with the highest attributable costs were colorectal cancer (Int$ 25 million) and breast cancer (Int$ 24 million). CONCLUSION Overweight was responsible for approximately Int$ 95 million (9 %) cancer direct healthcare cost in Brazil. Public policies and programs aimed at encouraging healthy diets and physical activity may decrease the economic burden of cancer in Brazil.
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Torres GF, Amaya JA, Buitrago G. Attributable Costs of Lung Cancer for the Colombian Health System: A Cost-of-Illness Study. Value Health Reg Issues 2022; 30:120-126. [PMID: 35344754 DOI: 10.1016/j.vhri.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/29/2021] [Accepted: 02/18/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Lung cancer imposes a significant economic burden on most countries. Nevertheless, there is scarce information about this burden on health systems in low- and middle-income countries. This study aims to estimate the economic burden of lung cancer on the Colombian health system, a middle-income country with universal health coverage in Latin America. METHODS We conducted a cost-of-illness study that included all direct costs generated by prevalent cases of lung cancer in Colombia during 2017. We used administrative databases containing patient-level information on consumption of healthcare services and reports on healthcare spending published by the Colombian Ministry of Health. To decrease the probability of misallocation of costs, we used propensity score matching to estimate the marginal costs of delivering healthcare services to patients with lung cancer. Additionally, ordinary least squares and variations in case definitions were used to assess the robustness of all estimates. RESULTS Total costs attributable to lung cancer in 2017 ranged from $50 039 588 to $74 468 111, with important differences across insurance regimes (from $4 629 938 for the subsidized regime to $55 342 357 for the contributory regime). Notably, 43% of all costs ($27 081 348) were caused by the consumption of services not included in the health benefit package. There were no significant differences between inpatient and outpatient costs. CONCLUSIONS Lung cancer imposes a significant economic burden on the Colombian health system. Although all affiliates are entitled to a unique health benefit package, there were important differences in costs across insurance regimes. Further research is needed to identify the main mechanisms underlying these differences.
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Affiliation(s)
- Gabriel F Torres
- Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Javier A Amaya
- Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Giancarlo Buitrago
- Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Bogotá, Colombia
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Rezende LFM, Ferrari G, Bahia LR, Rosa RDS, da Rosa MQM, de Souza RC, Lee DH, Giovannucci E, Eluf-Neto J. Economic burden of colorectal and breast cancers attributable to lack of physical activity in Brazil. BMC Public Health 2021; 21:1190. [PMID: 34158014 PMCID: PMC8220697 DOI: 10.1186/s12889-021-11221-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/07/2021] [Indexed: 12/14/2022] Open
Abstract
Background The increasing number of cancer patients has an escalating economic impact to public health systems (approximately, International dollars- Int$ 60 billion annually in Brazil). Physical activity is widely recognized as one important modifiable risk factor for cancer. Herein, we estimated the economic costs of colon and post-menopausal breast cancers in the Brazilian Unified Health System (SUS) attributable to lack of physical activity. Methods Population attributable fractions were calculated using prevalence data from 57,962 adults who answered a physical activity questionnaire in the Brazilian National Health Survey, and relative risks of colon and breast cancer from a meta-analysis. Annual costs (1 Int$ = 2.1 reais) with hospitalization, chemotherapy and radiotherapy were obtained from the Hospital and Ambulatory Information Systems of the Brazilian SUS. Two counterfactual scenarios were considered: theoretical minimum risk exposure level (≥8000 MET-min/week) and physical activity guidelines (≥600 MET-min/week). Results Annually, the Brazilian SUS expended Int$ 4.5 billion in direct costs related to cancer treatment, of which Int$ 553 million due to colon and breast cancers. Direct costs related to colon and breast cancers attributable to lack of physical activity were Int$ 23.4 million and Int$ 26.9 million, respectively. Achieving at least the physical activity guidelines would save Int$ 10.3 mi (colon, Int$ 6.4 mi; breast, Int$ 3.9 mi). Conclusions Lack of physical activity accounts for Int$ 50.3 million annually in direct costs related to colon and post-menopausal breast cancers. Population-wide interventions aiming to promote physical activity are needed to reduce the economic burden of cancer in Brazil.
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Affiliation(s)
- Leandro F M Rezende
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Medicina Preventiva, Rua Botucatu, 740 -Vila Clementino, Sao Paulo, SP, 04023-062, Brazil.
| | - Gerson Ferrari
- Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile
| | - Luciana Ribeiro Bahia
- National Institute of Science and Technology for Health Technology Assessment (IATS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Roger Dos Santos Rosa
- National Institute of Science and Technology for Health Technology Assessment (IATS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,National Institute of Science and Technology for Health Technology Assessment (IATS), Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Michelle Quarti Machado da Rosa
- National Institute of Science and Technology for Health Technology Assessment (IATS), Departamento de Medicina Social, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Romulo Cristovão de Souza
- Departamento de Tecnologias da Informação e Educação em Saúde, Faculdade de Ciências Médicas - UERJ, Rio de Janeiro, Brazil
| | - Dong Hoon Lee
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edward Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - José Eluf-Neto
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Palacios A, Rojas-Roque C, González L, Bardach A, Ciapponi A, Peckaitis C, Pichon-Riviere A, Augustovski F. Direct Medical Costs, Productivity Loss Costs and Out-Of-Pocket Expenditures in Women with Breast Cancer in Latin America and the Caribbean: A Systematic Review. PHARMACOECONOMICS 2021; 39:485-502. [PMID: 33782865 DOI: 10.1007/s40273-021-01014-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Our objective was to conduct a systematic review of the literature to identify, categorise, assess, and synthesise the healthcare costs of patients with breast cancer (BC) and their relatives in Latin America and the Caribbean (LAC). METHODS In December 2020, we searched for published data in PubMed, LILACS, EMBASE, and other sources, including the grey literature. Studies were eligible if they were conducted in LAC and reported the direct medical costs, productivity loss costs, out-of-pocket expenditure, and other costs to patients with BC and their relatives. No restrictions were imposed on the type of BC population (metastatic BC or human epidermal growth factor receptor 2-positive/negative BC, among others). We summarised the characteristics and methodological approach of each study and the healthcare costs by cancer stage. We also developed and applied an original ad hoc instrument to assess the quality of the cost estimation studies. RESULTS We identified 2725 references and 63 included studies. In total, 79.3% of the studies solely reported direct medical costs and five solely reported costs to patients and their relatives. Only 14.3% of the studies were classified as of high quality. The pooled weighted average direct medical cost per patient-year (year 2020 international dollars [I$]) by BC stage was I$13,179 for stage I, I$15,556 for stage II, I$23,444 for stage III, and I$28,910 for stage IV. CONCLUSION This review provides the first synthesis of BC costs in LAC. Our findings show few high-quality costing studies in BC and a gap in the literature measuring costs to patients and their relatives. The high costs associated with the advanced stages of BC call into question the affordability of treatments and their accessibility for patients. Registered in PROSPERO (CRD42018106835).
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Affiliation(s)
- Alfredo Palacios
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina.
- Facultad de Ciencias Económicas, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Carlos Rojas-Roque
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Lucas González
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Ariel Bardach
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Claudia Peckaitis
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
| | - Andres Pichon-Riviere
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Federico Augustovski
- Health Technology Assessment and Health Economics Department, Institute for Clinical Effectiveness and Health Policy (IECS), Doctor Emilio Ravignani 2024, Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health, National Scientific and Technical Research Council, Buenos Aires, Argentina
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