A825oncologic products within Latin America (LA) in comparison to a developed market (Canada). Methods: A panel of opinion leaders and policy-makers from Brazil, Colombia, Argentina, Mexico, and Canada was convened to understand current challenges in health care, patient access, and reimbursement of high-cost oncologic products with a focus on NSCLC. Results: In LA, patient access to biomarker testing in all cancers is limited, except for common biomarkers like HER2 in breast cancer. In Canada, there is no uniform coverage across provinces for diagnostic testing. In LA, there is an inconsistent and varied level of prioritization in public and private markets amongst various cancers (e.g. breast) for which access to highcost oncologic agents is more likely. Specifically, NSCLC is not prioritized because of its perceived association with smoking and "poor prognosis". It is unlikely in LA for expensive medications to be included in the standard benefit packages, and the review process can be lengthy for those that are included. Some patients may get access to some medications through filing a judicial claim against the government for individual drug cost reimbursement. Although various LA countries are witnessing evolution in some form, unlike in Canada, HTA does not have a substantial influence on payer decision-making on drug coverage. There was a consensus for enrolling more patients in clinical trials, development of regional/local clinical guidelines, and generating real-world and cost-effectiveness evidence to potentially improve reimbursement and shorten time to access to medications. ConClusions: Access to high-cost oncologic medications could be potentially improved through increased patient participation in clinical trials, generation of relevant guidelines and robust cost-effectiveness and evidence-based analyses, and implementation of risk-sharing agreements requiring innovative cancer care models.
OBJETIVO: Analisar a resposta e toxicidade da braquiterapia de alta taxa de dose (BATD) intersticial para carcinoma do colo do útero com recidiva pélvica pós-radioterapia. MATERIAIS E MÉTODOS: Entre 1998 e 2001, 11 pacientes com carcinoma de colo de útero e que tiveram recidiva pélvica pós-radioterapia receberam BATD intersticial. Idade: 41 a 71 anos (média: 56,5 anos); estádios (FIGO): IIA, IIB, IIIB e IVA. Nove (82%) pacientes tinham carcinoma de células escamosas e duas (18%), adenocarcinoma. Dose total de BATD: 20-30 Gy, em frações de 4-5 Gy. O seguimento variou de dois a 54 meses (média: 22,5 meses), através de exame físico periódico (três meses). Uma paciente faleceu sem avaliação de resposta. RESULTADOS: Dez pacientes (91%) tiveram resposta clínica completa, com duração de três a 46 meses (média: 18,9 meses). Três pacientes estão livres de doença (27%), duas estão vivas com doença (18%), três morreram (27%) e de três se perdeu o seguimento após nova recidiva (27%). A toxicidade para o trato urinário foi de 9% (uma paciente - grau III). CONCLUSÃO: A BATD intersticial é uma abordagem alternativa e viável para pacientes selecionadas que tiveram recidiva pós-radioterapia. Foi possível obter altas taxas de resposta com baixa toxicidade, considerando-se o grupo estudado, o tempo de seguimento e a re-irradiação.
Objectives: To quantify the number and costs of relapses avoided over 2 years in the first-line treatment of RRMS based on the findings of the Cochrane report. MethOds: An Excel-based financial model estimated the relapses and costs incurred by a hypothetical cohort of 1000 RRMS patients treated with first-line disease-modifying drugs (DMDs). The modelled cohort evaluated the consequences of treatment with subcutaneous (SC) interferon beta-1a versus intramuscular (IM) interferon beta-1a, as this was the only comparison whose data quality was assessed as 'high' by the Cochrane Review (Filippini et al., 2013). Risk of relapse was based on the 2-year data from the Cochrane Review network meta-analysis. The analysis was performed from a US payer perspective. The cost of a relapse was sourced from Panitch et al., 2005, and adjusted to 2012 US dollars. Net annual cost of therapy was based on wholesale acquisition cost. Given the model's short time horizon, disability-related costs were not included as these tend to be an important economic driver only over the long-term progression of the disease. In order to test how variability in the model's inputs might impact the analysis' results, two-way sensitivity analyses were performed based on the reported 95% risk of relapse credible intervals for SC interferon beta-1a and IM interferon beta-1a. Results: In a hypothetical cohort of 1000 RRMS patients, treatment with SC interferon beta-1a is expected to result in the avoidance of 173 (sensitivity analysis range:-20 to 399) relapses versus IM interferon beta-1a over 2 years. Assuming a direct cost of relapse of $5141, this represents a savings of $890,212 (sensitivity analysis range:-$102,138 to $2,052,934) versus IM interferon beta-1a. cOnclusiOns: Subcutaneous interferon beta-1a is likely to result in fewer relapses and lower direct costs of relapse versus IM interferon beta-1a over a 2-year period treatment.
0 1 7 ) A 8 5 3 -A 9 4 3 A881 had HVD and 10% had controlled CNS lesions. BRAF status was informed for only 50% of cases. Finally, 13% of patients received nivolumab (73% in 1st line and 27% 2nd line); all had HVD. We retrieved one prescription of cobimetinib for 2nd line in a BRAF+ patient progressing after vemurafenib. No prescriptions for dabrafenib or trametinib were retrieved. ConClusions: Older therapies, like ipilimumab and vemurafenib are already adopted to treat advanced melanoma in clinical practice in Brazil. Prescriptions for more recently approved therapies remain scarce maybe because some are oral medications still unlisted in the regulatory organs' directory or because they have very specific indications.
A881 had HVD and 10% had controlled CNS lesions. BRAF status was informed for only 50% of cases. Finally, 13% of patients received nivolumab (73% in 1st line and 27% 2nd line); all had HVD. We retrieved one prescription of cobimetinib for 2nd line in a BRAF+ patient progressing after vemurafenib. No prescriptions for dabrafenib or trametinib were retrieved. ConClusions: Older therapies, like ipilimumab and vemurafenib are already adopted to treat advanced melanoma in clinical practice in Brazil. Prescriptions for more recently approved therapies remain scarce maybe because some are oral medications still unlisted in the regulatory organs' directory or because they have very specific indications.
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