Cancer treatment advances, but access is hampered by funding, say experts

Oncology advances with the emergence of innovative treatments, such as immunotherapy and gene therapies, but access to high-cost technologies is crossed by problems of management, funding and insufficient investment in research in Brazil, which still does not guarantee basic care for patients. with cancer.

The pricing and the attribution of value to cancer therapies were discussed this Thursday (29), during one of the panels of the 9th Todos Juntos Contra o Câncer, event promoted by Abrale (Brazilian Association of Lymphoma and Leukemia). The panel was mediated by economist Ivo Bucaresky, consultant in the areas of health regulation and health economics at Orplavi Consultoria.

The development of an innovative drug in oncology starts with research and clinical studies. Then, the technology is submitted to Anvisa (National Health Surveillance Agency) for evaluation and registration and, if approved, goes to the CMED (Medicine Market Regulation Chamber), an inter-ministerial body that discusses and establishes maximum prices. of medicines in the country, explains Romilson de Almeida Volotão, executive secretary of CMED.

In the next steps, the incorporation of the drug into the SUS (Unified Health System) through Conitec (National Commission for the Incorporation of Technologies in the SUS) is evaluated and, through the ANS (National Supplementary Health Agency), the inclusion in the private system.

It is precisely at this stage that underfunding prevents therapies from actually reaching patients, even when they are approved by Conitec, says Sandro Martins, an oncology consultant at Hospital Universitário de Brasília and Rede D’Or.

He states that the favorable position of the body for a drug imposes a new cost on the health budget without adding money — when there is, the contribution is insufficient and does not correspond to the cost of the technology.

For Antonio Britto Filho, executive director of Anahp (National Association of Private Hospitals), health management suffers from a structural breakdown, in which the budget is insufficient, there is a lack of integration between public and private and there is no discussion about ways of financing the expensive cancer treatments.

In this scenario, it is not possible to use all the possibilities of therapy to guarantee the quality of life of cancer patients, he says.

An alternative would be to discuss increasing the public health budget and reducing drug prices, says João Carapinha, a doctor in law and public policy and a professor at Northeastern University (USA).

During the presentation, the expert outlined an overview of health system models in Europe, with emphasis on social health insurance financed by employers and employees and on universal access formats similar to the SUS, such as the NHS (the United Kingdom’s public health system). United).

He considers it necessary to analyze which elements of international models, both decentralized and concentrated in regulatory agencies, are best suited to the Brazilian reality, since importing an external solution would not be effective, even if it works in his country of origin.

Even if an increase in the budget for the SUS were made, it would be necessary to plan the application of resources considering that the country still fails in the initial steps of cancer treatment, such as early diagnosis and intervention, emphasizes Paulo Hoff, president of SBOC (Brazilian Society of Clinical Oncology).

When it comes to discussing the prices of innovative treatments, Hoff believes that Brazil, as it represents a small share of the world market for oncological products, would hardly influence the decrease in values, despite the efforts of agencies such as CMED. The United States, for example, buys most of the supplies for cancer. For him, the system would need to be reviewed globally.

Another way to improve access would be to invest in clinical research in Brazil, says Fernando de Rezende Francisco, executive manager of Abracro (Brazilian Association of Representative Organizations for Clinical Research). According to him, the country currently participates in only 2% of global clinical research studies in all therapeutic areas, a percentage that is even lower in oncology (1%), which represents 20% of research in the world.

If it could increase participation in clinical trials to 5%, the country would guarantee access to innovative medications for 50,000 patients a year and generate 50,000 health jobs, says Francisco. But, even though it is strategic, the sector lacks actions that value it, adds the specialist.