Impacto financeiro e organizacional do rastreamento do câncer de mama no Sistema Único de Saúde
Impacto financeiro e organizacional do rastreamento do câncer de mama no Sistema Único de Saúde
Data
2018
Autores
Miyamoto, Hellen Harumi
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
O câncer de mama é a neoplasia maligna mais frequente entre as mulheres e a causa mais frequente de mortes por câncer em mulheres no país e a primeira causa no mundo. O Instituto Nacional do Câncer estimou 54.960 casos de câncer de mama para o biênio 2016/2017 no Brasil. Intensa é a discussão dos efeitos nocivos (falso positivo, sobrediagnóstico e falso negativos) no rastreamento do câncer de mama com mamografia além da efetividade do rastreamento na redução da mortalidade. Este estudo tem por objetivo apresentar os impactos do rastreamento do câncer de mama por mamografia na perspectiva do Sistema Único de Saúde. Foi criada uma coorte hipotética de pacientes e construído um modelo de fluxograma com os procedimentos a serem realizados para confirmação diagnostica e para o tratamento. A avaliação do sobredianóstico foi realizada em três cenários diferentes. Calculou-se o impacto financeiro dos efeitos nocivos do rastreamento bem como o impacto na utilização do sistema de saúde. Observou-se a partir do modelo na coorte hipotética de 19.594.342 mulheres, 44.977 mulheres identificadas inicialmente com câncer de mama pelo rastreamento com mamografia. Foram encontrados ainda 234.437 casos falso positivos e 12.983 falsos negativos. O custo estimado para o rastreamento com mamografia em toda a população alvo foi de R$ 898.008.693,86. Para confirmação diagnóstica foram realizados no braço com câncer 73.762 exames complementares e no braço sem câncer 351.655 exames com os custos estimados de R$ 6.282.957,48 e R$ 33.995.649,05 respectivamente. Do total de mulheres com resultado falso positivo, foram encaminhadas à cirurgia 7033 mulheres. Com base nas estimativas, foram identificadas 11.346 mulheres com sobrediagnóstico ao custo de R$ 33.883.371,43 anualmente. O resultado da avaliação demonstrou a necessidade de revisão do planejamento das ações de controle do câncer de mama com melhor destinação dos recursos inicialmente para a organização da oferta de exame confirmatórios e unidades de tratamento do câncer e a implementação do rastreamento organizado no pais além da necessidade de ampla divulgação da recomendação atual da população alvo.
Breast cancer is the most frequent in women and the leading cause of death in women with cancer in Brazil and the first worldwide. The Brazilian National Institute of Cancer (INCA) has estimated 54.960 new cases per year of breast cancer in Brazil for the years 2016-2017. There is a lot of discussion about harms (false positive, false negative and overdiagnosis) and benefits of mammography screening for breast cancer for reduce the mortality. This study aim to examine the impacts of breast cancer screening with mammography in the Brazilian Unified National Health System (SUS). It was designed a diagram with the pathway should a woman follow for diagnostic confirmation and treatment. The evaluation of overdiagnosis was performed in 3 different scenarios The financial impact of harms in consequence of the mammography screening as well as the impact of this in the utilization of the health care system were calculated. The findings showed from a hypothetical cohort of 19.594.342 women mammography was able to find 44.977 women with breast cancer. It was also found 234.437 false positive cases and 12.983 false negatives. The amount dedicated to screening the target population was R$ 898.008.693,86. Additional tests were performed to confirm breast lesion. In the cancer branch were performed 73.732 tests and for the non cancer branch 351.655 tests, estimated costs R$ 6.282.957,48 and R$ 33.995.649,05 respectively. 7033 false positive women, were indicated surgical procedure. Based in the estimative for overdiagnosis were possible to identify 11.346 women with estimated costs R$ 33.883.371,43 every year. This result indicated the need of the review of National Plan and recommendations for Breast Cancer control with a most effective destination of the resources. Initially for the improvement of coverage to diagnostic procedures and for new units of cancer treatment and the implementation of an organized screening in Brazil besides training patient and health care professionals about the recommendations in the target public for breast screening in Brazil.
Breast cancer is the most frequent in women and the leading cause of death in women with cancer in Brazil and the first worldwide. The Brazilian National Institute of Cancer (INCA) has estimated 54.960 new cases per year of breast cancer in Brazil for the years 2016-2017. There is a lot of discussion about harms (false positive, false negative and overdiagnosis) and benefits of mammography screening for breast cancer for reduce the mortality. This study aim to examine the impacts of breast cancer screening with mammography in the Brazilian Unified National Health System (SUS). It was designed a diagram with the pathway should a woman follow for diagnostic confirmation and treatment. The evaluation of overdiagnosis was performed in 3 different scenarios The financial impact of harms in consequence of the mammography screening as well as the impact of this in the utilization of the health care system were calculated. The findings showed from a hypothetical cohort of 19.594.342 women mammography was able to find 44.977 women with breast cancer. It was also found 234.437 false positive cases and 12.983 false negatives. The amount dedicated to screening the target population was R$ 898.008.693,86. Additional tests were performed to confirm breast lesion. In the cancer branch were performed 73.732 tests and for the non cancer branch 351.655 tests, estimated costs R$ 6.282.957,48 and R$ 33.995.649,05 respectively. 7033 false positive women, were indicated surgical procedure. Based in the estimative for overdiagnosis were possible to identify 11.346 women with estimated costs R$ 33.883.371,43 every year. This result indicated the need of the review of National Plan and recommendations for Breast Cancer control with a most effective destination of the resources. Initially for the improvement of coverage to diagnostic procedures and for new units of cancer treatment and the implementation of an organized screening in Brazil besides training patient and health care professionals about the recommendations in the target public for breast screening in Brazil.
Description
Palavras-chave
Breast cancer, Screening, Mammography, Overdiagnosis, Câncer de mama, Rastreamento, Mamografia, Sobrediagnóstico
Citação
Miyamoto HH. Impacto financeiro e organizacional do rastreamento do câncer de mama no Sistema Único de Saúde. Rio de Janeiro. Dissertação [Mestrado Profissional em Avaliação de Tecnologias em Saúde] - Instituto Nacional de Cardiologia; 2018.