Introduction: Managed Entry Agreements (MEAs) consist of a set of instruments to reduce the uncertainty and the budget impact of new high priced medicines; however, there are concerns. There is a need to critically appraise MEAs with their planned introduction in Brazil. Accordingly, the objective is to identify and appraise key attributes and concerns with MEAs among payers and their advisers, with the findings providing critical considerations for Brazil and other high-and middle-income countries. Methods: An integrative review approach was adopted. This involved a review of MEAs across countries. The review question was 'What are the health technology MEAs that have been applied around the world?' This review was supplemented with studies not retrieved in the search known to the senior level co-authors including key South American markets. Afterall, involved senior level decision makers and advisers providing guidance on potential advantages and disadvantages of MEAs and ways forward. Results: 25 studies were included in the review. Most MEAs included medicines (96.8%), focused on financial arrangements (43%), and included mostly antineoplastic medicines. Most countries kept key information confidential including discounts or had not published such data. Few details were found in the literature regarding South America. Our findings and inputs resulted in both advantages including reimbursement and disadvantages including concerns with data collection for outcome-based schemes. Conclusion: We are likely to see a growth in MEAs with the continual launch of new high priced and often complex treatments, coupled with increasing demands on resources. Whilst outcome based MEAs could be an important tool to improve access to new innovative medicines there are critical issues to address. Comparing knowledge, experiences and practices across countries is crucial to guide high-and middle-income countries when designing their future MEAs.

Introduction: Lung cancer is the most frequently diagnosed type of cancer and the main cause of death from malignant neoplasms worldwide. One of the most recent discoveries in the context of non-small cell lung cancer (NSCLC) was the mutation of the anaplastic lymphoma kinase receptor (ALK). This genetic alteration is found in approximately 2-5% of NSCLC patients, and crizotinib was the first targeted therapy discovered for its first-line treatment.Objective: To conduct a systematic review and meta-analysis to estimate the magnitude of the overall survival (OS) and progression-free survival (PFS) from using crizotinib as treatment compared to traditional chemotherapy to guide future decision making. Methods: PRISMA and Cochrane recommendations were followed using the findings based on studies published in the main international electronic databases. Selection criteria included the following: randomized clinical trials (RCT) or cohort studies that had assessed the efficacy and effectiveness of crizotinib as monotherapy in patients with NSCLC with ALK fusions. Results: From 2504 publications identified in the literature, only eight publications referring to seven studies met the selection criteria, with high heterogeneity identified between the studies. Overall, there was a significant gain in PFS (HR 0.38; 95% CI 0.30-0.49; p \ 0.00001); however, there was no significant gain in OS (HR 0.68; 95% CI 0.43-1.08; p = 0.10). Conclusion:The study highlighted and confirmed that treatment with crizotinib led to clinical improvement in PFS among patients with advanced NSCLC with ALK fusion, as previously reported. However, there was no increase in overall survival in patients with NSCLC with genetic alterations of ALK. This must be considered when reviewing and funding treatments for NSCLC patients with this

England and the Netherlands, which have 0.12 and 0.23 beds per head of population over the age of 80 years respectively (6).

Background: There are many health benefits since 31 years after the foundation of the National Health Service (NHS) in Brazil, especially the increase in life expectancy. However, family-income inequalities, insufficient funding, and suboptimal private sectorpublic sector collaboration are still areas for improvement. The efforts of Brazil to achieve universal health coverage (UHC) for medicines have resulted in increased public financing of medicines and their availability, reducing avoidable hospitalization and mortality. However, lack of access to medicines still remains. Due to historical reasons, pharmaceutical service organization in developing countries may have important differences from high-income countries. In some cases, developing countries finance and promote medicine access by using the public infrastructure of health care/medical units as dispensing sites and cover all costs of medicines dispensed. In contrast, many high-income countries use private community pharmacies and cover the costs of medicines dispensed plus a fee, which includes all logistic costs. In this study, we will undertake an economic evaluation to understand the funding needs of the Brazilian NHS to reduce inequalities in access to medicines through adopting a pharmaceutical service organization similar to that seen in many high-income countries with hiring/accrediting private pharmacies. Methods: We performed an economic evaluation of a model to provide access to medicines within public funds based on a decision tree model with two alternative scenarios public pharmacies (NHS, state-owned facilities) versus private pharmacies

Aims: Cost-minimization analysis (CMA) comparing the teledermatology service of the State of Santa Catarina, Brazil with the provision of conventional care, from the societal perspective. Patients & methods: All costs related to direct patient care were considered in calculation of outpatient costs. The evaluation was performed using the parameters avoided referrals and profile of hospitalizations. The economic analysis was developed through a decision tree. Results: Totally, 40% of 79,411 tests performed could be managed in primary care, avoiding commuting and expanding the patients’ access. The CMA showed the teledermatology service had a cost per patient of US$196.04, and the conventional care of US$245.66. Conclusion: In this scenario, teledermatology proved to be a cost-saving alternative to conventional care, reducing commuting costs.

No abstract

COVID-19 has evolved into a serious clinical condition, especially in patients with comorbidities. However, the literature has diverged in relation to the main characteristics of patients prone to severe evolution. Objective: This study aimed to understand different variables that may be associated with the clinical management of COVID-19 for a better clinical response and prognosis. Methods: This is a systematic review in which the search in PubMed, Cochrane, EMBASE and LILACS databases. A manual and gray literature search on Google Scholar was also conducted. There was no country or region restriction and only studies in Portuguese, English and Spanish were included. Results: Of the 21 studies included in Primary Health Care (PHC) for eligibility, five studies from five countries involving 27,754 patients were analysed and, of the four eligible studies, one study was included for secondary care. Overall, the mean age of the COVID-19 population in PHC was around 41 years old, the number of cases was higher for females and, there was no difference between the groups without and with exposure, sex (ρ=0.322) and age (ρ=0.395). More than half of the patients had symptoms and, 47% had comorbidities. Heart diseases were the most prevalent among them. Approximately 79% of those infected had non-essential occupation. There was evidence that non-essential occupation was associated with infected individuals (ρ=0.002). Conclusions: This review identified that there may be greater vulnerability to contamination and aggravation of COVID-19 in female individuals, with adult age in non-essential activity, presence of chronic non-communicable diseases.

Background: Brazil has a well-established public health system (SUS), but the approval process and incorporation of new drugs can be complex and bureaucratic. More than 75% of the Brazilian population depends on SUS for oncology treatment. Considering that Lung Cancer (LC) is the major cause of cancer mortality in the country, and its huge impact on social burden an estimation of Years of Potential Life Lost (YPLL) due to the lack of Crizotinib, an anaplastic lymphoma kinase (ALK) inhibitor, in SUS was made necessary. For this study was considered the time frame from the approval by the National Health Surveillance Agency (ANVISA) in 2016 to 2019.Methods: The Number of Eligible Patients (NEP) with NSCLC ALK+ was taken from our National Cancer Institute (INCA). Pts with life insurance and other histologies, not NSCLC, were disregarded. For the YPLL calculation purpose the NEP between the years 2016 & 2019 was multiply by the difference of the documented improvement in the overall survival of the therapeutic regimen, according PROFILE 1014; 59,8 months and 19,2 months for crizotinib and chemotherapy regime respectively. For a conservative calculation, we assume that all eligible pts would have had access at the time of first approval in the country.