radiotherapy in brazil - alatro 2017...2017/08/11  · eduardo weltman sociedade brasileira de...

Eduardo Weltman Sociedade Brasileira de Radioterapia

Faculdade de Medicina da Universidade de São Paulo

Hospital Israelita Albert Einstein

Radiotherapy in Brazil

• Demand and supply

• Radiotherapy Remuneration

• Conclusions

Brazilian Radiotherapy Challenge

• Demand and supply

• Radiotherapy Remuneration

• Conclusions

Brazilian Radiotherapy Challenge

Radiotherapy Availability in Brazil – 2017

The Economist 2017

Rinfussa M et al. Rep Pract Oncol Radiother 18:159-172, 2013

Radiotherapy Population Demand

“ The World Heath Organization (WHO)

recommends a standard from 250,000 to 300,000

inhabitants per megavoltage machine.”

Maria Helena Marechal – CNEN – Congresso Brasileiro de Radioterapia 2015

Megavoltage Machines in Brazil – 2015

Total: 357 Megavoltage

Availability / 300.000

inhabitants:

• North: 0.23

• Northeast: 0.28

• Midwest: 0.41

• Southeast: 0.75

• South: 0.66

• Brazil: 0.54

www.ibge.gov.br – Population Estimate 2014

Radiation Therapy Facilities in Brazil – 2017

Total: 259

Alessandro Facure – CNEN – Personal Communication 2017

Megavoltage Machines in Brazil – 2017

Total: 406 (371 Linacs / 35 Cobalt)

Alessandro Facure – CNEN – Personal Communication 2017

Public Health System – Equipment Availability

*Health Ministry Estimate – Forum Oncoguia in 28/04/16

80% of the Brazilian patients are treated with governmental

support (SUS)*

SAS/MS: 03/Oct/17**

Available

Governmental

Megavoltage

Machines

Megavoltage Machines

300.000 inhabitants

SUS

(80% of the demand)

North 9 0.19

Northeast 57 0.36

Midwest 14 0.35

Southeast 135 0.61

South 55 0.71

Brazil

269

0.50 www.ibge.gov.br – Population Estimate 2014

DATASUS: 27/May/15*

2015*

2017**

286 Machines

Public Health System – Equipment Availability

New cancer cases prediction / year 540,000*

Patients to be treated with radiotherapy (60% of the incidence) 324,000

Recommended number of MM (600 patients / year / MM*) 540

Public MM needed (80% of the cases*) 432

Available Public MM 269 (62%)

Brazilian Radiotherapy Demand and supply

Megavoltage Machines per Incidence – 2015

*Health Ministry Estimate – Forum Oncoguia in 28/04/16

Cancer cases prediction / 2015 540,000*

Patients to be treated with radiotherapy (60% of the

incidence) 324,000

Public health system patients (80% of the cases*) 259,200

Number of patients treated by government in 2015 145,180** (56%)

Brazilian Radiotherapy Demand and Supply

Patients per Incidence Prediction – 2015

*Health Ministry Estimate* and Information** – Forum Oncoguia in 28/04/16

Operational LINACs 4

Construction in progress 8

Construction paralyzed 2

Waiting authorization 3

Projects in elaboration 18

Tenders under review 22

Suspended tenders 11

Excluded tenders 13

Total 81

80 LINACs Brazilian Program

Ordinance no 931 – 10/May/2012

Project State – August 2017

http://portalsaude.saude.gov.br/index.php/o-ministerio/principal/leia-mais-o-ministerio/582-sctie-

raiz/deciis/l3-deciis/12438-plano-de-expansao-da-radioterapia-no-sus Accessed in 02/10/17

High Technology in Brazil

• 116/234 (50%): Facilities answered

• 55 (47%): Reported using IMRT

• 60 (52%): Use some kind of IGRT

Ethos & Scientia 2016

Departments with Radiosurgery in Brazil

Arno Lotar Cordova Junior – Congresso Brasileiro de Radiocirurgia 2016

• Demand and supply

• Radiotherapy Remuneration

• Conclusions

Brazilian Radiotherapy Challenge

August/10 May/17 Variation

Minimum Wage R$ 510.00 R$ 937.00 + 83.7%

IPCA / INPC - - + 55%

Dollar R$ 1.76 R$ 3.27 + 86%

SBRT Index - - + 98%*

Readjustment of Remuneration by SUS: 0%

Costs Range: August 2010 – May 2017

Underfunding of Public Health

*Calculated adjustment necessary to cover the costs

• Demand and supply

• Radiotherapy Remuneration

• Conclusions

Brazilian Radiotherapy Challenge

Conclusions

• 40% of the public health patients with

indication of radiotherapy do not receive

this treatment

• There is a shortage of 200 machines

• The government adjustment necessary

to cover the costs is at least 60%

eweltman@einstein.br

Thank you!