PP49 Financing The Line Of Care In The First Biochemical Relapse Of Prostate Cancer After [⁶⁸Ga] PSMA PET- CT

Abstract

Introduction

It is estimated that prostate cancer will reach 66 thousand by the triennium 2020-2022 according to the National Cancer Institute (INCA). After initial diagnosis and staging the patient may undergo radical prostatectomy and/or curative radiotherapy. In patients with biochemical relapse (PSA >0.2 ng/ml) initially treated with radical prostatectomy, salvage external radiotherapy is indicated. The [⁶⁸Ga] Prostate Specific Membrane Antigen Positron Emission Tomography-Computed Tomography (PSMA PET-CT) scan is mainly used for localization of prostate cancer in the setting of first biochemical recurrence and can significantly influence the clinical management of the patient.

Methods

The overall objective of this work is to perform a treatment cost analysis for patients in first biochemical recurrence of prostate cancer after curative radical prostatectomy and after performing [⁶⁸Ga] PSMA PET-CT from the perspective of the Brazilian Health System (SUS). A decision tree was constructed through consultation with experts to outline the patient’s entire treatment. Values per modelled therapeutic procedure were surveyed in two different scenarios, with and without [⁶⁸Ga] PSMA PET-CT. The average treatment in scenario 1 was stereotaxic radiation therapy (SBRT), and rescue radiotherapy and androgen deprivation therapy (ADT). In scenario 2, it was salvage radiotherapy and ADT. The reimbursement table was prepared from data collected by SUS system. Variations were analyzed using a sensitivity study. Total average values included: individual procedure, according to medical management (up to 3 years) and population percentage with and without [⁶⁸Ga] PSMA PET-CT.

Results

Values were calculated in Brazilian currency (BRL) for each procedure. The total amount calculated for scenario 1 was BRL 264,965,465.00 (USD 55,642,747.65) and for scenario 2 was BRL 123,585,612.72 (USD 26,162,978.67).

Conclusions

The reimbursement of line of care adopted after [⁶⁸Ga] PSMA PET-CT is an important information to expand access to the Brazilian population. It shows an increased cost with [⁶⁸Ga] PSMA PET-CT adoption. A prospective study should be considered with high follow up.