• Pedro Aguiar Júnior, Carmelia Maria Noia Barreto, Felipe Roitberg, Gilberto Lopes Júnior, and GiglioAuro DelAD0000-0002-2009-824XMD, PhD. Physician and Professor, Centro de Estudos em Hematologia e Oncologia, Faculdade de Medicina do ABC, Santo André (SP), Brazil..
• MD, MSc. Physician and Consultant, Department of Oncology, Faculdade de Medicina do ABC (FMABC), Santo André (SP), and Physician and Consultant, Américas Centro de Oncologia Integrado, São Paulo (SP), Brazil.
• Sao Paulo Med J. 2019 Nov 1; 137 (6): 505511505-511.

BackgroundLung cancer is the fourth most common cancer in Brazil. In the 2000s, better understanding of molecular pathways led to development of epidermal growth factor receptor (EGFR)-targeted treatments that have improved outcomes. However, these treatments are unavailable in most Brazilian public healthcare services (Sistema Único de Saúde, SUS).ObjectiveTo assess the potential number of years of life not saved, the budget impact of the treatment and strategies to improve access.Design And SettingPharmacoeconomic study assessing the potential societal and economic impact of adopting EGFR-targeted therapy within SUS.MethodsWe estimated the number of cases eligible for treatment, using epidemiological data from the National Cancer Institute. We used data from a single meta-analysis and from the Lung Cancer Mutation Consortium (LCMC) study as the basis for assessing differences in patients' survival between use of targeted therapy and use of chemotherapy. The costs of targeted treatment were based on the national reference and were compared with the amount reimbursed for chemotherapy through SUS.ResultsThere was no life-year gain with EGFR-targeted therapy in the single meta-analysis (hazard ratio, HR, 1.01). The LCMC showed that 1,556 potential life-years were not saved annually. We estimated that the annual budget impact was 125 million Brazilian reais (BRL) with erlotinib, 48 million BRL with gefitinib and 52 million BRL with afatinib. Their incremental costs over chemotherapy per life-year saved were 80,329 BRL, 31,011 BRL and 33,225 BRL, respectively. A drug acquisition discount may decrease the budget impact by 30% (with a 20% discount). A fixed cost of 1,000 BRL may decrease the budget impact by 95%.ConclusionReducing drug acquisition costs may improve access to EGFR-targeted therapy for lung cancer.

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