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