Kantar Health (Brazil)

Introduction: Obesity is a chronic relapsing disease characterized by abnormal or excessive adiposity with health risks. Any nutritional intervention in patients who are candidates for or have already undergone bariatric surgery must be based on a detailed nutritional assessment, including an assessment of personal values, preferences, and social determinants of eating habits. Objective: It was to carry out a systematic review to explore and present nutritional importance before, during, and after bariatric surgery. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from September to October 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 122 articles were found. A total of 43 articles were evaluated in full and 34 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 22 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=64.5%>50%. It was concluded that enteral nutrition strategies could represent a possible alternative to other methodologies, especially when it is recommended to improve patient adherence to the diet prescribed before bariatric surgery. Weight loss induced by the ketogenic diet before bariatric surgery has beneficial effects in reducing liver volume, metabolic profile, and intra- and postoperative complications. Knowledge of the type of bariatric surgery performed and an understanding of its anatomy and physiology help provide optimal care to patients, especially nutritional complications. Nutritional deficiencies and metabolic disorders result from “malabsorption” procedures, such as RYGB. It is essential to immediately administer thiamine. Dextrose should be avoided in intravenous hydration until thiamine is adequately replaced. For all bariatric patients, a protein intake of 60-70 g/d and multivitamin with iron and vitamin B12 supplementation is recommended. Daily calcium and vitamin D supplementation is also encouraged. Additionally, serum micronutrient levels should be monitored regularly and additional supplemental measures prescribed as indicated.

PurposeWe describe patterns of care and treatment outcomes for non-metastatic PCa (nmPCA), either hormone-sensitive or castration-resistant, in the United States of America (USA) in 2018.MethodsA survey (CancerMPact®) recruited physicians nationwide to answer an online questionnaire about how they treated patients with nmPCA. Questions covered aspects of treatment at all disease stages. Board-certified urologists and oncologists with at least five years of clinical practice and who treated at least 30 PCa patients monthly were included.ResultsThe survey included responses from ninety-four physicians with an average of 17.5 years of clinical practice, who had treated a combined average of 4415 patients with nmPCA per month in 2018. Approximately 40% of patients in stage I were managed with either active surveillance or observation/no therapy, decreasing to 20%, 8% and 6% in stages II, III and IV(M0), respectively. Intensity-modulated radiotherapy was favored over other radiotherapy modalities, with rates of use ranging between 60% and 69% depending on disease stage. Leuprolide as monotherapy or in combination with enzalutamide, abiraterone or bicalutamide were the most common systemic treatment options for non-metastatic hormone-sensitive PCa (nmHSPC) patients with the first or second recurrence. Only 16.5% of non-metastatic castration-resistant PCa (nmCRPC) patients did not relapse within five years of initial therapy for nmCRPC.ConclusionWhile PCa treatment recommendations are rapidly changing due to advances in treatment, we observed great concordance between their most current versions and real-world data treatment patterns reported by US physicians.

Objetivo: Este trabalho teve por objetivo determinar o custo-efetividade e o impacto orçamentário do cabozantinibe para o sistema de saúde suplementar no Brasil, no tratamento de carcinoma de células renais (RCC) avançado ou metastático, após falha de tratamento com inibidor do fator de crescimento endotelial vascular (VEGF), quando comparado ao atual tratamento aprovado: nivolumabe. Métodos: Foram utilizados custos referentes ao uso de recursos, tratamento médico, eventos adversos e qualidade de vida, calculados por estado de saúde. Foi considerado o tempo horizonte de 20 anos para análise de custo-efetividade e 5 anos para impacto orçamentário, e foi realizado um cenário alternativo comparando o cabozantinibe ao nivolumabe e axitinibe. Resultados: O cabozantinibe apresentou eficácia superior quando comparado ao nivolumabe e ao axitinibe e representa uma redução de custos comparado ao nivolumabe. Em relação aos eventos adversos, o cabozantinibe apresenta redução dos gastos quando comparado ao nivolumabe. Conclusão: Esses resultados mostram um potencial de economia ao sistema de saúde suplementar com a adoção do cabozantinibe no tratamento para RCC avançado ou metastático em segunda linha no Brasil.

ABSTRACT Objective: Pharmacovigilance revolves around the maintenance and understanding of drug safety through detection and evaluation of spontaneous adverse events (AE) reporting. However, underreported phenomenon occurs often due inefficient spontaneous reporting by patients, physicians, healthcare professionals and caregivers. Therefore, the aim of this survey was to evaluate the knowledge and perception related to pharmacovigilance in Brazil. Methods: From February to March 2015, 260 respondents answered an internet-based survey related to knowledge on pharmacovigilance from Oncoguia Institute, an independent non-profit cancer patient advocacy group. Descriptive analyses were performed according to answers frequency. Results: Among the respondents, 40.7% were diagnosed with breast cancer, followed by hematological malignancies (6.5%). Reported treatment included chemotherapy (35.9%), surgery (28.7%), and radiotherapy (16.4%). Most of the respondents were not aware of the importance of a pharmacovigilance AE report (51.7%). In fact, 21.3% of the respondents were not aware of what AEs are. In 65% of the cases, physicians have described the main AE expected to the prescribed treatment. Respondents reported nausea (23.6%), hair loss (22.8%), weight gain (14.5%) and vomiting (13.2%) as the most common AEs. Only 7.2% and 4.2% of the respondents were aware that AEs could be reported to pharmaceutical industry and ANVISA, respectively. Conclusions: This survey demonstrates that knowledge and perception regarding AEs and pharmacovigilance activities are very poor among overall population, including cancer patients. Therefore, there is an enormous demand for educational awareness of AEs reporting importance in overall population, patients, and physicians, especially in oncology.

Objetivo: Estimar o impacto orçamentário da introdução de rituximabe subcutâneo, comparado ao intravenoso, no sistema de saúde suplementar brasileiro, para o tratamento de linfoma não Hodgkin (LNH) difuso de grandes células B CD-20 positivo. Métodos: As perspectivas foram o sistema de saúde suplementar e operadoras de saúde de grande, médio e pequeno portes. Dados da Agência Nacional de Saúde Suplementar (ANS) foram utilizados para obter o número médio de pacientes por porte das operadoras e cruzados com dados epidemiológicos de LNH para estimar a população elegível. Uma pesquisa com 28 operadoras mapeou taxas, preços e tabelas de referência usadas para o reembolso de medicamentos, materiais e procedimentos. Uma equipe multidisciplinar estimou o uso de recursos. Os custos médicos diretos foram incluídos e os preços foram obtidos de fontes públicas. O horizonte temporal foi de cinco anos e considerou-se a incorporação progressiva de rituximabe subcutâneo com 20% no primeiro ano até atingir 100%. Resultados: Em cinco anos, 3.846 pacientes com LNH difuso foram estimados para o sistema de saúde suplementar, 35 para uma operadora de grande porte, 5 para uma de médio porte e 5 para uma de pequeno porte. Demonstrou-se que a incorporação de rituximabe subcutâneo pode economizar até R$ 15,8 milhões para todo o sistema, R$ 144,3 mil para uma operadora de grande porte e R$ 20,4 mil tanto para uma operadora de médio quanto para uma de pequeno porte. Conclusão: A incorporação de rituximabe subcutâneo no sistema de saúde suplementar brasileiro pode economizar até R$ 15,8 milhões no tratamento de LNH.

PurposeThis survey investigated patients’ and nurses’ preferences among four different autoinjectors used for subcutaneous delivery of medication for rheumatoid arthritis (RA).MethodsIn a multinational survey in five countries, 200 patients with RA and 100 nurses training patients on the use of autoinjectors participated in face-to-face interviews. Respondents were asked to rate the importance of eleven autoinjector attributes and to compare the autoinjectors for etanercept (Enbrel®, MyClic® autoinjector), adalimumab (Humira®, Humira pen), and an etanercept biosimilar (Benepali®, Molly® autoinjector) with a demonstration autoinjector for a new etanercept biosimilar – Erelzi® (SensoReady® autoinjector).ResultsEasy grip and ease of performing self-injection were the most important attributes identified by both groups. Overall, 79% of the patients rated the SensoReady autoinjector easier to use than their currently used injection device (86% of MyClic users, 84% of Humira pen users, and 63% of Molly users). In the patient survey, the SensoReady performed better than the other autoinjectors on the attributes visual feedback after completion of injection, easy to grip, and convenient shape. Nurses also rated the SensoReady easier to use than the MyClic (95%), Humira pen (97%), or Molly (91%). When asked which autoinjector they would recommend to a patient with RA who had not used an autoinjector before, 81% of patients and 90% of nurses selected the SensoReady.ConclusionBoth patients and nurses perceived the SensoReady to be easier to use compared with other available injection devices. The main reasons for this preference were the buttonless injection, 360° viewing window for feedback (visual confirmation of dose injection), and convenient triangular shape making the injection device easy to grip. Patients and nurses were most likely to recommend the SensoReady autoinjector over other autoinjectors to patients with RA.

Background: In 2016, Hodgkin’s Lymphoma (HL) was responsible for 2,470 new cases in Brazil and, despite recent scientific advances, there are unmet medical needs that affects patients’ outcome. Therefore, we aimed to explore the unmet medical needs in the management of HL patients in Brazil, based on experts’ perspective. Methods: A questionnaire was developed to address the unmet medical needs including barriers for the diagnosis and treatment of HL in Brazil. The questionnaire results were presented in a panel discussion to validate participants’ responses and to collect additional data. Main results: Eight experts participated in the panel. On both healthcare systems, public and private, a slight majority of patients was women and most of them were under 60 yearsold. In addition, the majority of patients were referred from another specialty on both systems. The time from onco-hematologist appointment to diagnosis was different between public and private sector (median of 30 and 12.5 days, respectively). Most patients in the public sector were on stage III (33%) and IV (33%); in the private sector, most patients were on stages II (36%) and III (24%). The most common barriers were the delayed diagnosis and the unavailability of diagnostic procedures and treatment options. Conclusion: According to participants, issues related to infrastructure and healthcare resource allocation affects the management of HL. Improvements in the infrastructure and educational measures for physicians and patients may contribute to minimize the barriers.