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Inclusion of molecular monitoring (BCR-ABL1) in the treatment of chronic myeloid leukemia in the Brazilian Public Health System (SUS): an urgent need for treatment management
Boquimpani, Carla Maria; Abdo, André Neder Ramires; Martins, Denise Pires; Lima, Luciana Britto de Abreu; Torriani, Mayde Seadi; Bendit, Israel.
Afiliação
  • Boquimpani, Carla Maria; HEMORIO. Rio de Janeiro. BR
  • Abdo, André Neder Ramires; Hospital Alemão Oswaldo Cruz. São Paulo. BR
  • Martins, Denise Pires; Associação Brasileira de Linfoma e Leucemia. São Paulo. BR
  • Lima, Luciana Britto de Abreu; Instituto Nacional de Câncer - INCA. Rio de Janeiro. BR
  • Torriani, Mayde Seadi; Sociedade Brasileira de Farmacêuticos em Oncologia. São Paulo. BR
  • Bendit, Israel; Universidade de São Paulo - USP. Hospital das Clínicas. Departamento de Hematologia. São Paulo. BR
Hematol., Transfus. Cell Ther. (Impr.) ; 43(1): 50-57, Jan.-Mar. 2021. tab, graf
Article em En | LILACS | ID: biblio-1154292
Biblioteca responsável: BR408.1
Localização: BR408.1
ABSTRACT
ABSTRACT

Introduction:

Chronic Myeloid Leukemia (CML) is a myeloproliferative disease that affects mainly adults between 50 and 55 years. In Brazil, information from the Sistema Único de Saúde (SUS) Outpatient Information System indicates that 12,531 patients had the Autorização de Procedimento Ambulatorial (APAC) approved for the CML treatment in 2017. Disease monitoring through molecular response evaluation is critical to the care of CML patients. The quantitative PCR test (real-time polymerase chain reaction) provides adequate evaluation parameters that allow the health professional to intervene at the right moments in order to reduce the chance of progression of the disease, providing the best outcome to the patient, including the possibility of treatment discontinuation for eligible patients. Although the test is included in the Clinical Protocol and Therapeutic Guidelines (PCDT) of CML, it is not possible to monitor the molecular response within SUS since there is no reimbursement for this test.

Objective:

Obtain expert recommendations on the importance, financing, and reimbursement of molecular monitoring in SUS.

Methods:

Six CML experts with different perspectives participated in the panel. The discussion was based in the main publications about the quantitative PCR test in CML monitoring.

Results:

Experts'

recommendations:

Molecular monitoring should be part of the integral treatment of patients with CML to reduce the chances of disease progression and costs to the health system; The government should put into practice what is provided in the PCDT of Chronic Myeloid Leukemia in Brazil performing the monitoring of the molecular response via quantitative PCR; The government should create a code with adequate nomenclature and reimbursement value in SIGTAP, so that the test is carried out and covered by the public health network, as it is contained in the PCDT of the disease and the existing APAC does not cover the operational costs for its performance; Patients with chronic phase CML should perform a quantitative PCR every 3 months and, after reaching the MMR, should perform the examination every 6 months, as recommended by international guidelines; Patients should be monitored in reference laboratories that are standardized according to the international scale; The laboratories that are within the reference public centers could absorb all the test demand in Brazil, and other centers could be qualified through an ABHH accreditation; Adequate molecular monitoring may allow some patients to stop taking drugs and selffinancing the molecular test for all SUS patients

Conclusion:

A solution for the molecular test (BCR-ABL1) funding is urgent to ensure the monitoring of CML patients in SUS. The savings that might be generated with patients that stop taking the medication when adequately monitored may finance the test.
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Texto completo: 1 Coleções: 01-internacional Base de dados: LILACS Assunto principal: Leucemia Mielogênica Crônica BCR-ABL Positiva / Reação em Cadeia da Polimerase em Tempo Real Tipo de estudo: Guideline / Qualitative_research Limite: Humans País/Região como assunto: America do sul / Brasil Idioma: En Revista: Hematol., Transfus. Cell Ther. (Impr.) Assunto da revista: Hematologia / TransfusÆo de Sangue Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Brasil País de publicação: Brasil

Texto completo: 1 Coleções: 01-internacional Base de dados: LILACS Assunto principal: Leucemia Mielogênica Crônica BCR-ABL Positiva / Reação em Cadeia da Polimerase em Tempo Real Tipo de estudo: Guideline / Qualitative_research Limite: Humans País/Região como assunto: America do sul / Brasil Idioma: En Revista: Hematol., Transfus. Cell Ther. (Impr.) Assunto da revista: Hematologia / TransfusÆo de Sangue Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Brasil País de publicação: Brasil