OBJECTIVES: Reimbursement of oncology treatments by Brazilian Public Health System (SUS) is controlled by the Authorization for High Complexity Procedures (APAC) system. Each treatment line has an APAC code associated with a specific reimbursement value that should cover all drug expenses in one month. However, with innovation and more expensive drugs that have been launched, these fixed values may not be enough to cover drug expenses. In this context, our objective was to compare costs of recommended treatments with values reimbursed by the APAC system.     METHODS: We reviewed NCCN (National Comprehensive Cancer Network) guidelines for mNSCLC and analyzed recommended chemotherapy regimens. Regimens costs were calculated and compared to the APAC value for metastatic NSCLC which reimburses only 1,100.00BRL (~343.75USD) per month. Drugs maximum sales price for government without taxes were used.  For the drugs that already have generics, calculations were made in two different ways:  mean price or the lowest price. The following parameters were used to calculate regimens costs by milligrams approach:  age 65, weight 70kg, and body surface 1,70mRESULTS:

Ten different regimens are recommended for metastatic NSCLC, two target therapies, four bevacizumab and two pemetrexed based regimens, and other 3 older regimens. By considering mean costs of drugs whose patents expired, the APAC value does nt cover any regimen. Costs ranged from 574BRL (~179,30USD) to 14,204BRL (~4,439USD). With the approach of the cheapest drug in the market, only three regimens are covered by the APAC: cisplatin+docetaxel (574BRL~179USD), carboplatin+docetaxel (1,002BRL~313USD) and carboplatin+paclitaxel (984BRL~307USD). In addition, with the exception of target therapies, all regimens are recommended for 21 days, being two months of APAC correspondent to 3 cycles. Considering this time mismatch, only cisplatin+docetaxel fits the APAC.

CONCLUSIONS:

Our analysis indicated that patients may not have access to recommended treatment because the reimbursement system is not updated to the advent of new technologies.