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VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 8 5 3 – A 9 4 3 I2: 0.9%; p= 0.388). However, metabolic outcomes were poorly described, preventing a meta-analysis. A mixed treatment comparison corroborated the direct metaanalysis. Conclusions: Considering the high level of risk of bias and the absence
of important published outcomes for anti-obesity therapy assessments, this study
found that the evaluated drugs showed poor evidence of efficacy in the treatment
of overweight and obese patients. Robust safety data were not identified to suggest
changes in their regulatory status.
Medical Treatments for Acromegaly: Systematic Review and
Network Meta-Analysis
Leonart LP, Ferreira VL, Tonin FS, Pontarolo R
Universidade Federal do Paraná, Curitiba, Brazil
Objectives: To evaluate the safety and efficacy of medical treatments used in acromegaly. Methods: A systematic search was conducted in the electronic databases
PubMed, Scopus, Web of Science, and Scielo. Head-to-head or against placebo randomized controlled trials (RCT) in acromegaly patients were included. Data regarding
baseline characteristics, the outcomes insulin-like growth factor 1 (IGF-1) and/or
growth hormone (GH) control and adverse events were extracted. The meta-analyses were performed using the software Addis 1.16.8. Results: 10 studies were
included in this review. The records involved the drugs Pegvisomant, Lanreotide
Autogel, Lanreotide SR, Octreotide, Octreotide LAR, Pasireotide, Bromocriptine, and
placebo. A network meta-analysis was performed for the outcome patients with
IGF-1 control. Pegvisomant and Lanrotide Autogel showed statistically significant
superiority compared to placebo (Odds Ratio with 95% credible interval of 0.06
[0.00-0.55] and 0.09 [0.01-0.88], respectively). No other statistical differences were
observed. The probability rank suggested that Pegvisomant and Pasireotide have
similar probabilities of being the best drug to control IGF-1 circulating levels (33%
and 34%, respectively). It was not possible to build a network for GH outcome
because the definition of GH control was not standardized among the studies.
Considering adverse events, most of trials reported complaints related to the
gastrointestinal tract (e.g., diarrhea and nausea). Conclusions: This was the
first meta-analysis to compare high quality evidence (RCT) of medical treatments
used in acromegaly. Despite the low number of trials, it was possible to compare
the interventions though an indirect analysis. Considering that acromegaly is a
rare disease, the publication of interventional studies is not frequent. Thus, we
recommend the addition of a control group using a different drug when trials are
performed, making the comparison of efficacy between drugs feasible. Pasireotide,
newer and cheaper than Pegvisomant, seems to be a promising drug that should
be more investigated.
ASSOCIATION Between Second-Line Therapy (2LT) Regimen Type,
Duration of Therapy (DOT), and Time To Next Treatment (TTNT) In A
United States (US) Relapsed/Refractory Multiple Myeloma (RRMM)
Cohort: An Electronic Medical Records (EMR)-Based Study
Romanus D1, Raju A2, Yong C1, Farrelly E2, Luptakova K1, Labotka R1, Noga SJ1, Blazer M2,
Hari P3
1Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical
Company Limited, Cambridge, MA, USA, 2Xcenda, LLC, Palm Harbor, FL, USA, 3Medical College of
Wisconsin, Division of Hematology Oncology, Milwaukee, WI, USA
Objectives: Extended DOT in MM trials may improve outcomes, but data in
RRMM patients treated in routine care are limited. We evaluated DOT and TTNT
(a surrogate for progression-free survival) by 2LT regimen type in a US cohort of
RRMM patients. Methods: In this retrospective EMR-database study, adult RRMM
patients diagnosed between 1/1/2007—6/30/2015 initiating bortezomib-, carfilzomib-, or lenalidomide-based (Bort-, Carf-, or Len-based) 2LT were grouped into
mutually exclusive categories: Bort- (+/-Len); Carf- (+/-Len); Len-based (-Carf/Bort).
DOT was defined as the time from first to last administration of all 2LT drugs or
death and TTNT as the time from 2LT initiation to 3LT initiation or death. KaplanMeier method was used for 2LT DOT and TTNT descriptive analyses and Cox
proportional-hazards regression for multivariate analyses. Results: Among 492
RRMM patients, median age in the Len-based [n= 227]; Bort-based [n= 213], and
Carf-based [n= 52]) groups was 69, 72, and 67 years. Overall, unadjusted median
2LT DOT: 7.7 months (95% CI: 6.6, 9.2) and TTNT: 14.7 months (95% CI: 12.9, 17.7).
Len-based patients had the longest unadjusted median (months) DOT and TTNT vs
other groups; 2LT DOT: Len- (10.1 [95% CI: 7.9, 11.9]); Bort- (6.6 [95% CI: 5.1, 8.2]); Carfbased (4.6 [95%CI: 3.0, 7.5]), and 2LT TTNT: Len- (20.1 [95% CI: 17.7, 29.2]); Bort- (11.9
[95%CI: 9.5, 13.7]); Carf-based (5.7 [95%CI: 3.7, 8.2]), (P< 0.01 for both). In adjusted
analysis, 2LT regimen type was significantly associated with DOT (adjusted HRBort
for treatment discontinuation: 1.41 [95% CI: 1.11, 1.79] and HRCarf: 1.93 [95% CI:
1.25, 2.96] vs Len-based), and with. TTNT (adjusted HRBort: 1.91 [95% CI: 1.45, 2.52]
and HRCarf: 3.21 [95% CI: 2.00, 5.17] vs Len-based). Conclusions: In this RRMM
cohort, 2LT TTNT was ~2-fold longer than DOT, Lenalidomide-based regimens were
associated with the longest unadjusted and adjusted 2LT DOT and TTNT. Future
research is needed for confirmation.
Use of Thalidomide In Erythematosus Lupus Treatment
Teixeira DR1, Galdino-Pitta MR1, Nunes TR2, Viana DC3, Araujo BC2, Zanghelini F4,
Pereira MC2, Rego MJ4, Oliveira MD5, PittaId 4, Pitta MG2, Andrade CA2
1Federal University of Pernambuco, Recife, Brazil, 2Universidade Federal de Pernambuco, Recife,
Brazil, 3Avenida Professor Moraes Rego, Recife, Brazil, 4UFPE, Recife, Brazil, 5University Federal de
Pernambuco, Recife, Brazil
Objectives: Thalidomide is listed in the National List of Essential Medicines in
Brazil (RENAME 2014) for the treatment of Hansen’s disease, multiple myeloma
and systemic erythematosus lupus (LES). This study aimed to evaluate the therapeutic indication of thalidomide in the treatment of systemic erythematosus
lupus patients. Methods: The research was carried out on March 16, 2015
on the literature on Best Practice (BMJ), Dynamed and UpToDate, being used
the DeCS and MeSH indexed terms: “Lupus Erythematosus, Cutaneous” and
“Thalidomide”. Results: According to the evidence on the BMJ, Thalidomide is
indicated as a third-line treatment in systemic erythematosus lupus (LES) patients
in the following situations: all patients for cutaneous erythematosus lupus (LEC)
who do not respond to other treatments; including discoid erythematosus lupus
(LED) lesions indicated in once a day doses of oral 50-200mg. On Dynamed, a update
(2013) indicates the use of thalidomide in improving the recurrent (refractory) LEC
but it was found high neurotoxicity. The UpToDate evidence synthesis reports that
when one or more of first line agents is not successful, more aggressive therapy to
reduce remission of the disease should be considered. Still, thalidomide is highly
efficacious for LEC, but has potential for serious adverse effects, including teratogenicity and a relatively high risk of peripheral neuropathy. Thalidomide has a
rapid onset of action, usually with response within the first month of treatment.
This should be initiated at 50mg to 100mg daily doses, and reduced to the minimal effective dose after clinical improvement. Conclusions: Thalidomide can
be used for the treatment of patients with LES, especially refractory and who did
not respond to first-line treatments. Potential adverse effects of thalidomide make
it more useful as short-term remission inducing agent and as maintenance treatment, concurrently with conventional medications or other systemic medicinal
products for the refractory LEC.
Treatment Patterns and Impact of Not Achieving Skin Clearance
for Psoriasis Patients In Latin America
Papadimitropoulos M1, Romiti R2, Garcia EG3, Lobosco S4, Leonardi Reyes F5, Wang X6,
Haynes G7
1Eli Lilly and Company, Canada, Toronto, ON, Canada, 2Hospital das Clínicas University of
São Paulo (USP), São Paulo, Brazil, 3Elil Lilly and Co, Mexico City, Mexico, 4Adelphi Real World,
Macclesfield, UK, 5Eli Lilly, Bogota, Colombia, 6University of Toronto, Toronto, ON, Canada,
7Eli Lilly and Company, Indianapolis, IN, USA
Objectives: To describe psoriasis treatments in Latin America and the impact
of failing to achieve high psoriasis skin clearance. Methods: One hundred and
forty-four dermatologists and 941 of their psoriasis patients from Brazil, Colombia,
Argentina and Mexico participated in the Adelphi Latin America Disease Specific
Programme, answering questions about current disease severity, treatment, satisfaction and treatment history. The Physician’s Global Assessment (PGA) identified
patients with clear skin or substantial coverage remaining; EQ-5D (5L) questionnaire
captured quality of life (QoL); Work Productivity and Activity Impairment (WPAI)
questionnaire assessed work productivity. Results: Current psoriasis treatments
for the 941 patients were biologic agents (38.4%), conventional systemic treatment
(45.4%) or combination of both (13.9%); 38% patients were receiving a steroid and
11% phototherapy. Of those treated with biologics, conventional systemic treatment
or combination of both, 42.7%, 63.2% and 45.8% respectively were not considered by
the dermatologist to be in remission. Among patients with clear to nearly clear skin
(PGA 0-1; n= 343) 86.3% patients currently treated with a biologic were in remission
compared with 79.1% treated with a conventional systemic treatment. Compared
to patients with substantial skin coverage (PGA 2-5; n= 597), patients in the clear or
nearly clear skin group had fewer areas of the body affected in difficult to treat areas
such as scalp (19.2% vs 51.9%), groin/genitals (0.6% vs 17.7%) and palmar-plantar
regions (11.4% vs 26.6%); had lower incidence of flares (5.2% vs 37%), greater satisfaction (96.5% vs 53.7%); better mean (SD) EQ-5D (5L) (0.87 [0.2] vs 0.77 [0.2]) and mean
total WPAI (6.5 [13.7] vs 18.0 [26.5]). Conclusions: Many Latin American patients
had substantial skin coverage, even when treated with biologics. More biologictreated patients were in remission than conventional systemic-treated patients.
Better skin clearance was associated with improved QoL and work productivity,
reflecting the need of treatments providing higher skin clearance.
Characteristics of Latin American Patients With Rheumatoid
Arthritis Receiving Advanced Therapy
Brnabic A1, Xavier R2, Goncalves L3, Lucas J4, Hernandez P5, Gaich CL6,
Papadimitropoulos M7
1Eli Lilly and Company, Sydney, Australia, 2Universidade Federal do Rio Grande do Sul, Porto
Alegre, Brazil, 3Eli Lilly and Company, São Paulo, Brazil, 4Adelphi Real World, Bollington, UK,
5Compañía Farmacéutica Eli Lilly de Centroamérica, S.A, Este San José, Costa Rica, 6Eli Lilly and
Company, Indianapolis, IN, USA, 7Eli Lilly and Company, Canada, Toronto, ON, Canada
Objectives: To present demographics and characteristics of Latin American
patients with rheumatoid arthritis (RA). Methods: Data was collected in 2015 for
the Adelphi RA Latin America Disease Specific Programme, a cross-sectional survey
of rheumatologists and their RA patients. Rheumatologists (N= 188) from Brazil
(n= 47), Argentina (n= 42), Colombia (n= 33), Mexico (n= 41) and Venezuela (n= 25)
provided demographics and clinical characteristics for patients > 18 years currently
prescribed a biologic DMARD (bDMARD) or JAK inhibitor with/without a conventional DMARD. Results: Approximately 54.8% rheumatologists were female and on
average, saw 107 patients/5-day week. The analysis included 801 patients from Brazil
(n= 246), Argentina (n= 239), Colombia (n= 137), Mexico (n= 82) and Venezuela (n= 97).
Majority of patients (82.8%) were female, aged mean (SD) 51.9 (13.3) years with mean
(SD) disease duration 11.1 (9.4) years. At the time of survey 31.8% patients were classified as moderate-severe based on rheumatologist’s judgement despite 98.5% currently receiving a bDMARD or JAK inhibitor. Mean (SD) DAS-28 disease activity was
3.8 (1.4). Many patients (38.4%) reported via a VAS scale moderate-high levels of pain
and were currently experiencing mean (SD) of 3.2 (3.0) symptoms, including joint
tenderness (47.3%), swollen joints (46.3%) and morning stiffness (42.2%). The mean
(SD) number of joints affected was 4.5 (2.2); wrists (89.1%), MCP joints (85.4%) and
knees (62.7%) were most prevalent. According to the rheumatologist, 14.1% patients
were flaring at time of survey (defined as temporary worsening of symptoms), and
79.4% were not in remission (defined as DAS-28 < 2.6) irrespective of treatment. The mean (n, SD) EQ-5D 5L utility and EQ-5D VAS scores were 0.7 (509, 0.2) and 70.7
VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 8 5 3 – A 9 4 3 (535, 21.5), respectively. Conclusions: Among the Latin American RA patients surveyed, many receiving a bDMARD or JAK inhibitor experience moderate-high levels
of pain, have moderate-severe disease activity and remain clinically uncontrolled
across a range of patient reported outcomes and clinical measures.
Characteristics of Psoriasis Patients In Latin America
Burge R1, Galimberti R2, Goncalves L3, Lucas J4, Wang X5, Botello BS6, Brnabic A7
1Eli Lilly and Company, Indianapolis, USA; Division of Pharmaceutical Sciences, University of
Cincinnati, Cincinnati, OH, USA, 2Universidad de Buenos Aires, Hospital Italiano de Buenos
Aires, Buenos Aires, Argentina, 3Eli Lilly and Company, São Paulo, Brazil, 4Adelphi Real World,
Bollington, UK, 5University of Toronto, Toronto, ON, Canada, 6Eli Lilly and Company, Mexico City,
Mexico, 7Eli Lilly and Company, Sydney, Australia
Objectives: To present demographics and characteristics of Latin American psoriasis patients. Methods: Data was obtained from the Adelphi Psoriasis Latin
America Disease Specific Programme. Dermatologists completed patient record
forms related to treatment practice, demographics and clinical characteristics for
patients > 18 years old diagnosed with moderate-severe psoriasis for over 1 year
who had received at least one systemic treatment. Patients provided consent prior
to completing forms related to their symptoms. Results: Dermatologists (n= 144)
from Brazil (n= 40), Colombia (n= 30), Argentina (n= 35) and Mexico (n= 39) had a mean
(SD) of 17.6 (9.6) practice years and on average saw 118.5 patients/5-day week. The
analysis included 941 patients from Brazil (n= 320), Colombia (n= 179), Argentina
(n= 209) and Mexico (n= 233); 56.4% were male, with mean (SD) age 49.5 (13.8) years,
mean (SD) BMI 27.4 (4.9), and mean (SD) disease duration 12.2 (10.8) years. At the
time of survey 44.1% of patients were classified as moderate-severe, 63.4% had PGA
score 2-5, 31.9% had BSA > 10% and 31% were experiencing flare. Patients diagnosed
as moderate-severe were undergoing treatment with biologic (32.7%), conventional
systemic (53.4%) and combination therapy (12.6%); 48% moderate-severe patients
were receiving a steroid and 13% phototherapy. Difficult to treat areas included scalp
(40.0%), groin/genitals (11.5%) and palmar-plantar areas (20.8%). Most bothersome
areas were scalp (29.2%), groin/genitals (9.9%), toes (8.1%) and soles of the feet (7.7%).
Most common symptoms in patients regardless of severity were scaling (72.2%),
inflamed skin (52.5%) and itching (44.5%). Comorbidities included hypertension
(33.2%), hyperlipidemia (23.9%), anxiety (23.7%), depression (14.0%) and diabetes
(18.1%). Approximately 60% were currently employed; of those unemployed or
retired, 9% were unable to work due to psoriasis. Conclusions: Psoriasis is a
burdensome disease in Latin American patients due to its symptoms, impact on
appearance, high incidence of comorbidities and presence of lesions in difficult to
treat areas of the skin.
Burden of Disease for Psoriasis In Argentina, Brazil, Colombia and
Papadimitropoulos M1, Romiti R2, Guerra MA3, Vorstenbosch E4, Brnabic A5, Haynes G6,
Goncalves L7, Leonardi Reyes F8, Garcia EG9, Burge R10
1Eli Lilly and Company, Canada; University of Toronto, Toronto, ON, Canada, 2Hospital das
Clínicas University of São Paulo (USP), São Paulo, Brazil, 3Monterrey, Nuevo Leon, Mexico,
4Parc Sanitari Sant Joan de Deu, Barcelona, Spain, 5Eli Lilly and Company, Sydney, Australia, 6Eli
Lilly and Company, Indianapolis, IN, USA, 7Eli Lilly and Company, São Paulo, Brazil, 8Eli Lilly,
Bogota, Colombia, 9Elil Lilly and Co, Mexico City, Mexico, 10Eli Lilly and Company, Indianapolis,
USA; Division of Pharmaceutical Sciences, University of Cincinnati, Cincinnati, OH, USA
Objectives: Psoriasis is a common, chronic skin disease, affecting approximately
2% of the population. There is much variability in prevalence and impact studies
across the world, and few numbers are known from Latin-America. The objective
of this study is to conduct a systematic review on disease burden for psoriasis
(PS) and psoriatic arthritis (PsA) in the four most populated Latin-American
countries, namely Argentina, Brazil, Colombia and Mexico. Methods: PubMed/
Medline, Web of Science and grey literature databases (BASE, MediGraphic and PDF
Search Engine) were searched for publications in English, Spanish or Portuguese
at January 21st 2016. Additionally, regional journals and professional and patient
association web pages were consulted. The AMSTAR quality criteria were taken into
account. Results: Out of 565 records, 317 unique records met the predetermined
inclusion criteria. The estimated age-standardized prevalence of psoriasis for these
countries ranged from 1.27% to 1.56%. Concerning the prevalence of moderate/
severe psoriasis, no epidemiology studies were identified. Prevalence estimations
came from single-centre studies with heterogeneity in study samples and severity
classifications, data varied between 19% (Mexico) and 90% (Argentina). Treatment
forms varied per country and institution being most prevalent topical therapy (22%100%) and conventional systemic therapy (32%-62%) whereas few used biological
therapy (2%-12%). The most frequent co-morbid disorders were obesity, metabolic
and cardiovascular problems, and anxiety and depression. Impact in terms of health
related quality of life was higher than in other dermatological diseases. Most cost
analyses focused on the cost-effectiveness of treatment interventions. A cost-ofillness study from Colombia found that total annual cost per patient was $12,595
for private practice and $10,895 for the public sector. Conclusions: The burden
of psoriasis in Latin America is large. However, evidence is still scarce and more
studies are needed to evaluate the full cost and impact of the disorder in Latin
American countries.
Treatment Patterns and Satisfaction For Rheumatoid Arthritis
Patients In Latin America Undergoing Advanced Therapy
Papadimitropoulos M1, Mysler E2, Garcia EG3, Lobosco S4, Botello BS5, Leonardi Reyes F6,
Haynes G7
Lilly and Company, Canada; University of Toronto, Toronto, ON, Canada, 2Reumatología,
Organización Médica de Investigación, Buenos Aires, Argentina, 3Elil Lilly and Co, Mexico City,
Mexico, 4Adelphi Real World, Macclesfield, UK, 5Eli Lilly and Company, Mexico City, Mexico,
6Eli Lilly, Bogota, Colombia, 7Eli Lilly and Company, Indianapolis, IN, USA
Objectives: To describe treatment use, switching and satisfaction in Latin
American rheumatoid arthritis (RA) patients currently prescribed advanced
therapy. Methods: Data was obtained from the Adelphi Rheumatoid Arthritis
Latin America Disease Specific Programme, a cross-sectional survey of rheumatologists and their RA patients. Rheumatologists (n= 188) from Brazil, Argentina,
Colombia, Mexico and Venezuela completed patient record forms related to
treatment for 801 patients currently receiving a biologic disease modifying antirheumatic drug (bDMARD) or JAK inhibitor. Self-reported data was collected from
patients. Results: Of the 789 patients currently receiving advanced therapy;
97.0% were receiving bDMARDs and 3.0% JAK inhibitors. Their physicians planned
to continue the current treatment for nearly all (94.4%) patients. Of the patients
on bDMARDs, 72.7 % were currently treated with an anti-TNF biologic compared
to 27.3% with a non-TNF biologic. On average, patients had been treated with
their current therapy for mean (SD) of 20.6 (20.4) months; patients were treated
longer with anti-TNFs than non-anti-TNFs (mean [SD] months of 21.5 (21.5) and
18.4 (17.2), respectively). Most patients (87.6%) were being treated with a conventional disease modifying antirheumatic drug (cDMARD) in combination with the
bDMARD or JAK inhibitor. Approximately 73.2% of patients had been treated with
two or more cDMARDs prior to initiation of biologic treatment. Most patients
(79.2%) were currently receiving a first-line biologic, 18.1% were receiving a secondline and 2.7% receiving their third or more biologic. Most (77.4%) rheumatologists and patients (77.1%) were satisfied with the control achieved for the current
treatment. The main reason rheumatologists switched treatment was a loss of
response (51.9%). Conclusions: This data suggests that most of the bDMARD
or JAK inhibitor RA patients surveyed from Latin America also received a cDMARD
and were satisfied with treatment. The majority of patients received multiple
cDMARDs prior to current treatment.
Budget Impact of Introducing Secukinumab In The Treatment
of Moderate-To-Severe Plaque Psoriasis From The Private Payer
Perspective In Brazil
Suzuki C, Lopes N
Novartis Biociências SA, Sao Paulo, Brazil
Objectives: To evaluate the budget impact of including secukinumab for the
treatment of moderate-to-severe plaque psoriasis patients from the perspective
of the Brazilian private healthcare system over five years. Methods: Excelbased model was developed to estimate investment required for inclusion of
secukinumab, as an additional biologic alternative by comparing two scenarios:
“without-secukinumab” versus “with-secukinumab”. Number of patients eligible for biologic therapy was calculated considering: (1)hypothetical population
of 1,000,000; (2)prevalence of psoriasis patients about 1%; (3)85% of these are
plaque psoriasis patients; (4)20% presenting moderate-to-severe disease; (5)50%
are eligible for systemic therapy; (6)40% of these are eligible for biologic therapy;
(7)annual discontinuation rate of biologic therapy: around 10%; and (8)from the
second year on, an annual incidence of 59.9/100,000 was considered to calculate
new psoriasis patients entrance. 25% and 20% of market share for each biologic
was considered in the “without-secukinumab” and “with-secukinumab” scenarios,
respectively. Drug annual costs were based on the respective ex-factory prices and
the recommended dosages. Infliximab cost was based on an average body weight
of 70kg. Results: The number of patients eligible for treatment with biologic
agents was estimated to be around 340 in the first year with an incidence of 20. The
annual costs of maintenance therapy with biologic agents were estimated to be:
BRL46,614 (ustekinumab 45mg); BRL74,778 (secukinumab); BRL87,748 (etanercept);
BRL93,227 (ustekinumab 90mg); BRL96,533 (adalimumab); BRL96,607 (infliximab
100mg). The total budget impact was negative around: -BRL4 million in 5 years
(average: -BRL838K per year) [1BRL= 0,32USD; 30/Jan/2017]. Conclusions: The
annual maintenance therapy cost with secukinumab is the second lowest cost
among all biologic agents. The introduction of secukinumab could generate savings from the perspective of private healthcare system according to this model.
To evaluate the budget impact of including secukinumab for the treatment of
moderate-to-severe plaque psoriasis patients from the perspective of the Brazilian
private healthcare system over five years.
Budget Impact of The Inclusion of Oxycodone In The Brazilian
Public Healthcare Setting For The Treatment of Cancer Pain
Souza DA1, Aguiar EC1, Miguel AK2, Rosim RP2, Ballalai Ferraz AF2
Paulo, Brazil, 2QuintilesIMS, São Paulo, Brazil
1Mundipharma, São
Objectives: Oxycodone is a strong opioid absent from Brazilian federal guidelines
(PCDT) for cancer pain treatment. According to literature, it is an effective option
for opioid rotation for the control of pain in oncologic patients. The goal of this
study is to calculate the budget-impact of the inclusion of oxycodone for cancer
pain to the PCDT. Methods: SUS claim databases (DataSUS) reports the number
of patients using each of the opioids available in Brazil, however it does not report
dispensed opioids for all Brazilian states. To estimate the total number of patients
with cancer pain using strong opioids, we selected patients using opioids during
cancer treatment and extrapolated the number of patients based on the proportion
of the population present in the states that report opioid consumption. Also based
on DataSUS databases, mean treatment period was assumed to be 4.5 months. We
assumed that the population growth would be the same as that of cancer incidence
and that oxycodone’s market share at peak would be 25%, since in the literature
1/4 of the patients may not respond to morphine, reached within four years after
protocol inclusion. Only drug costs were considered and time horizon is five years.
One-way sensitivity analysis was performed in order to test which parameters most
affect the result of the analysis. Results: The estimated number of patients using
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