Health Economic Evaluations of Cancer in Brazil: A Systematic Review

Background: A large number of health economic evaluation (HEE) studies have been published in developed countries. However, Brazilian HEE literature in oncology has not been studied. Objective: To investigate whether the scientific literature has provided a set of HEE in oncology capable of supporting decision making in the Brazilian context.Methods: A systematic review was conducted to identify and characterize studies in this field. We searched multiple databases selecting partial and full HEE studies in oncology (1998-2013).Results: Fifty-five articles were reviewed, of these, 33 (60%) were full health economic evaluations. Type of cancers most frequently studied were: breast (38.2%), cervical (14.6%), lung (10.9%) and colorectal (9.1%). Procedures (47.3%) were the technologies most frequently evaluated. In terms of the intended purposes of the technologies, most (63.6%) were treatments. The majority of the incremental cost-effectiveness ratios (ICERs) reported have been below the cost-effectiveness threshold suggested by the World Health Organization (WHO).Conclusions: There has been an increase in the number of HEEs related to cancer in Brazil. These studies may support decision-making processes regarding the coverage of and reimbursement of healthcare technologies for cancer treatment in Brazil

Clinical research in ovarian cancer: consensus recommendations from the Gynecologic Cancer InterGroup

The Gynecologic Cancer InterGroup (GCIG) sixth Ovarian Cancer Conference on Clinical Research was held virtually in October, 2021, following published consensus guidelines. The goal of the consensus meeting was to achieve harmonisation on the design elements of upcoming trials in ovarian cancer, to select important questions for future study, and to identify unmet needs. All 33 GCIG member groups participated in the development, refinement, and adoption of 20 statements within four topic groups on clinical research in ovarian cancer including first line treatment, recurrent disease, disease subgroups, and future trials. Unanimous consensus was obtained for 14 of 20 statements, with greater than 90% concordance in the remaining six statements. The high acceptance rate following active deliberation among the GCIG groups confirmed that a consensus process could be applied in a virtual setting. Together with detailed categorisation of unmet needs, these consensus statements will promote the harmonisation of international clinical research in ovarian cancer

AIM2CERV: a randomized phase III study of adjuvant AXAL immunotherapy following chemoradiation in patients who have high-risk locally advanced cervical cancer (HRLACC)

Background Patients with HRLACC experience a 50% chance of disease recurrence/death following cisplatin-based chemoradiation (CCRT) plus brachytherapy, and represent a group with a significant unmet need for new treatments. Persistent infection with oncogenic strains of human papillomavirus (HPV) is the most common cause of CC, and provides rationale for therapeutic targeting of HPV. Axalimogene filolisbac (AXAL/ADXS11-001) is an irreversibly attenuated Listeria monocytogenes-listeriolysin O immunotherapy that secretes a HPV E7 fusion protein that induces HPV-specific cytotoxic T cell generation and reduces immune tolerance in the tumor microenvironment. Previous studies demonstrated AXAL was well tolerated and associated with objective tumor response and survival benefits in patients with recurrent/metastatic CC. AXAL has received FDA Fast Track Designation for the treatment of HRLACC

Table_1_Health Economic Evaluations of Cancer in Brazil: A Systematic Review.DOCX

<p>Background: A large number of health economic evaluation (HEE) studies have been published in developed countries. However, Brazilian HEE literature in oncology has not been studied. Objective: To investigate whether the scientific literature has provided a set of HEE in oncology capable of supporting decision making in the Brazilian context.</p><p>Methods: A systematic review was conducted to identify and characterize studies in this field. We searched multiple databases selecting partial and full HEE studies in oncology (1998-2013).</p><p>Results: Fifty-five articles were reviewed, of these, 33 (60%) were full health economic evaluations. Type of cancers most frequently studied were: breast (38.2%), cervical (14.6%), lung (10.9%) and colorectal (9.1%). Procedures (47.3%) were the technologies most frequently evaluated. In terms of the intended purposes of the technologies, most (63.6%) were treatments. The majority of the incremental cost-effectiveness ratios (ICERs) reported have been below the cost-effectiveness threshold suggested by the World Health Organization (WHO).</p><p>Conclusions: There has been an increase in the number of HEEs related to cancer in Brazil. These studies may support decision-making processes regarding the coverage of and reimbursement of healthcare technologies for cancer treatment in Brazil.</p

Transfusion requirements in surgical oncology patients: A prospective, randomized controlled trial

Background: Several studies have indicated that a restrictive erythrocyte transfusion strategy is as safe as a liberal one in critically ill patients, but there is no clear evidence to support the superiority of any perioperative transfusion strategy in patients with cancer. Methods: In a randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial in the intensive care unit of a tertiary oncology hospital, the authors evaluated whether a restrictive strategy of erythrocyte transfusion (transfusion when hemoglobin concentration <7 g/dl) was superior to a liberal one (transfusion when hemoglobin concentration <9 g/dl) for reducing mortality and severe clinical complications among patients having major cancer surgery. All adult patients with cancer having major abdominal surgery who required postoperative intensive care were included and randomly allocated to treatment with the liberal or the restrictive erythrocyte transfusion strategy. The primary outcome was a composite endpoint of mortality and morbidity. Results: A total of 198 patients were included as follows: 101 in the restrictive group and 97 in the liberal group. The primary composite endpoint occurred in 19.6% (95% CI, 12.9 to 28.6%) of patients in the liberal-strategy group and in 35.6% (27.0 to 45.4%) of patients in the restrictive-strategy group (P = 0.012). Compared with the restrictive strategy, the liberal transfusion strategy was associated with an absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5). Conclusion: A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

I Diretriz Brasileira de Cardio-Oncologia da Sociedade Brasileira de Cardiologia

Inst Canc Estado Sao Paulo, BR-01246 Sao Paulo, BrazilUniv Sao Paulo, Hosp Clin, Fac Med, Inst Coracao, BR-05508 Sao Paulo, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Inst Cardiol, Sao Paulo, BrazilUniv Fed Rio Grande do Sul, Hosp Clin Porto Alegre, Serv Cardiol, BR-90046900 Porto Alegre, RS, BrazilUniv Hosp, Brasilia, DF, BrazilHosp Procardiaco, Ctr Insuficiencia Cardiaca, Rio De Janeiro, BrazilUniv Pernambuco, Recife, PE, BrazilUniv Fed Amazonas, Fdn Ctr Oncol Amazonas, Manaus, Amazonas, BrazilMonte Tabor Hosp Sao Rafael, Salvador, BA, BrazilFdn Beneficencia Hosp & Cirurgia, Clin Coracao, Aracaju, SE, BrazilHosp Socor, Ecoctr, Belo Horizonte, MG, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Inst Cardiol, Sao Paulo, BrazilWeb of Scienc

Clinical research in ovarian cancer: consensus recommendations from the Gynecologic Cancer InterGroup

10.1016/s1470-2045(22)00139-5The Lancet Oncology238e374-e38