How much more does the SUS spend for late cancer detection – 07/18/2023 – Health

The Unified Health System (SUS) spent more than BRL 3.8 billion on cancer treatment in 2022 —and, according to researchers, a significant part of that money could be saved if the tumors had been diagnosed at an early stage, when treatment is more effective and cheaper.

These are some of the findings of a recent survey by the Oncology Observatory, which is part of the civil society group All Together Against Cancer (TJCC), based on last year’s data available on Datasus.

The analysis revealed, for example, that a single chemotherapy session against stage 1 breast cancer (the earliest) costs BRL 134.17 to the public coffers. In phase 4 of the disease (the most advanced), this same modality of treatment is BRL 809.56 – a value six times higher.

The treatment tends to be more expensive, according to specialists, because it involves specific drugs, developed to combat advanced tumors. These therapeutic options usually have a higher price. In addition, the patient in an advanced stage may need extra treatment sessions and closer follow-up.

Still according to available statistics, a considerable number of tumors are detected late. In breast cancer, 57% of cases are caught in stages 1 and 2, compared to 43% that have already evolved to 3 and 4.

In the case of the lung, 88% of patients only discover the disease when it is more severe, in stages 3 and 4.

The researchers calculated these estimates of possible savings by stage and type of cancer, but note that it is not possible to accurately determine a total savings due to the lack of more detailed oncology data, such as the severity of all (or most) of the cancers. tumors diagnosed in the country.

What do the numbers say

According to the National Cancer Institute (Inca), 704,000 new cases and 235,000 deaths from this disease are expected in Brazil each year.

This makes tumors the third leading cause of death in the country, behind only heart attacks and strokes.

According to a survey by the Oncology Observatory, of the 3.8 billion spent on cancer treatment in the SUS alone, 77% of that amount (R$ 3 billion) goes to outpatient treatment, which involves chemotherapy and radiotherapy sessions, for example.

The remaining sums are used for surgeries (R$519 million, or 13% of the total) and hospitalizations (R$374 million, or 10%).

By dividing this total cost by the number of interventions performed last year, the researchers found that each outpatient procedure in oncology costs, on average, BRL 758.93, while a hospital stay costs BRL 1,082.22 and surgery represents BRL 3,406 ,07.

Epidemiologist Ana Beatriz Almeida, one of the authors of the work, points out that these values ​​refer exclusively to treatment —including expenses with medicines, inputs and equipment.

“Cancer does not only involve therapies. There are other expenses from the point of view of public health, such as prevention campaigns and diagnostic tests, which were not included in this account”, he clarifies.

Those responsible for the survey also show concern about the effects of the Covid-19 pandemic on this budget. After all, during the period that the coronavirus circulated with great intensity, in the years 2020 and 2021, a large part of the population did not leave their homes and failed to undergo tests capable of detecting cancer in its early stages.

“We are talking about a system that already has limited resources, so any new budget overload represents an alert”, says Nina Melo, coordinator of the Oncology Observatory.

“And we just want patients to be diagnosed early. This represents a better clinical outcome, more quality of life and, of course, a reduction in costs for the SUS”, she adds.

cost per tumor

The differences are even more visible when these values ​​are divided according to the type of cancer and the stage at which they are diagnosed.

To make these calculations, experts selected four common tumors in the population: breast, prostate, colorectal and lung.

This group of diseases consumes a considerable share of the budget for oncological therapies in the public network: together, tumor problems that affect any of these four parts of the body represent 57% of total expenditure on chemotherapy, 54% on radiotherapy, 25% of hospitalizations and 31 % of surgeries.

But what about the individual costs of each treatment? To answer this question, the Oncology Observatory estimated the price of a single chemotherapy session according to the stage of the disease.

To summarize, a stage 1 tumor is one that was caught very early and has not yet compromised nearby lymphatic tissues; the 2 has spread a little more in its place of origin; 3 is locally advanced but has not affected other organs; and 4 was diagnosed with metastasis (when the disease already appears in places that go beyond its original position).

And the numbers obtained by the researchers reveal important differences, as you can see in the graph below.

In addition to the six-fold difference in the price of chemo against breast cancer, the cost of this treatment is almost R$ 150 for stage 1 or 4 prostate tumors and more than R$ 300 for colorectal tumors.

“We already expected that there would be a price increase in more advanced staging, but the difference in values ​​went far beyond what we imagined”, says Melo.

“When the disease is discovered in an advanced stage, therapeutic protocols include high-cost medications in most cases”, explains physician Catherine Moura, CEO of the Brazilian Association of Lymphoma and Leukemia (Abrale), who was not directly involved with the search.

“And that all comes at a price,” he adds.

Difficulties in statistics

It is worth emphasizing that these values ​​presented above refer only to a single chemo session. Generally, patients need to take several cycles of this therapy, spaced every few weeks between cycles.

That is, if these values ​​are multiplied by the number of chemotherapies performed and the number of patients diagnosed with cancer every year, the savings with treatment could reach millions of reais if more tumors were diagnosed in early stages, researchers believe.

And here comes a major difficulty in completing this analysis: the lack of more detailed national registries on the severity of cancer at the time of detection.

The BBC News Brazil report asked the Oncology Observatory to survey how many cases of the disease are diagnosed in Brazil according to staging.

The statistics found by the researchers showed a rather nebulous scenario. A large proportion of reported tumors are staged as “ignored”.

“This is very harmful for the epidemiology of cancer, and leads to limitations in the analyzes that we could do”, laments Almeida.

These numbers can be seen in the graph below:

It is worth mentioning that these specific statistics only come from reference hospitals in oncology that carry out this work of transmitting data to public banks, and do not represent the entire reality of cancer diagnosis and treatment in the country.

If we exclude the high proportion of tumors with unknown staging and take into account only those that received the appropriate severity classification, it is possible to have an idea of ​​how the diagnosis of the disease often occurs at a late stage, especially when it affects the lung and the colorectal region:

According to the researchers, this provides an idea —even if vague— of how early detection of tumors would save public funds (not counting, of course, the greater chances of survival related to a treatment given when the disease has not yet evolved). .

Almeida recalls that the financial impact of cancer goes far beyond the price of one medicine or another.

“We cannot forget the indirect costs. A patient often stops working, in addition to premature deaths also representing a loss to the economy”, highlights the author of the research.

Moura, from Abrale, understands that it is necessary to focus more and more on campaigns for the prevention and early detection of cancer.

“All this investment is effective”, she believes.

“It is important that the population across the country is aware of the different types of cancer, the most prevalent ones and how to minimize the risk factors for them.”

“And only with awareness campaigns, carried out through different channels, so that the reach is equal, will we be able to achieve this result”, she concludes.

This text was originally published here.