Banca de DEFESA: Aurélio Matos Andrade

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : Aurélio Matos Andrade
DATE: 26/03/2024
TIME: 09:00
LOCAL: Online - Plataforma TEAMS
TITLE:

Temporal analysis of mortality from Acute Lymphoblastic Leukemia in the Federal District - Brazil and global assessment of the cost-effectiveness of Tisagenlecleucel.

KEY WORDS:

Acute Lymphocytic Leukemia; Mortality Records; Tisagenlecleucel; Advanced Therapy; Cost-Effectiveness Assessment

PAGES: 159
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUMMARY:

Acute Lymphoblastic Leukemia (ALL) is an aggressive hematological
neoplasm characterized by the uncontrolled proliferation of lymphocyte precursor cells. The
disorder promotes the accumulation of immature cells in the blood, substantially
compromising hematopoiesis and potentially leading to death. Although this pathology is more
prevalent in children, its incidence also extends to the adult population group. Currently, there
are efficient therapeutic options for some patients. However, refractory and recurrent cases of
this neoplasm impose a clinical, economic and social dilemma, requiring innovative and costly
therapeutic approaches. With this in mind, this thesis was structured with the objective of first
analyzing mortality from acute lymphoblastic leukemia in the Federal District - Brazil.
Subsequently, the objective was to determine the global cost-effectiveness ratio of the first
advanced therapy product approved by ANVISA for the treatment of acute lymphoblastic
leukemia Tisagenlecleucel compared to conventional therapies available for refractory or
relapsed cases in B cells in children and young adults. The methodological path was outlined in
two methods: the first was an ecological time series study using data from the Mortality
Information System classified by code C91.0 of the International Classification of Diseases. The
results showed a predominantly male profile (51.70%), single (60.41%), white race/color
(52.16%), with four to seven years of education (27.37%). The mortality trend due to ALL was
increasing for the age groups of 0-4 years and 50-59 years, with increasing rates of 9.0% and
8.7%. It is concluded that it was possible to determine the profile of people who die most from
ALL in the DF, in addition to understanding the temporal changes over the course of 20 years
in different age groups, warning that scientific discussions and reallocation of resources must
be prioritized in the direction and applicability of public policies highlighting gaps in diagnosis
and treatment for children up to 4 years of age and for adults who are aging. In the second
article, the method consisted of a systematic review that followed the parameters of the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The
systematic review highlighted the Incremental Cost-Effectiveness Ratio with discount per
Quality-Adjusted Life Year (QALY) gained after the use of Tisagenlecleucel compared to the
analysis of the averages for Combined Clofarabine (Clo-C) was US$38,837.00 and the
Blinatumomab (Blina) US$25,569.00. Regarding the cost of the medicine, the average for
Tisagenlecleucel was around 4.3 times; 10.8 times; 4.7 times respectively higher than the
average Monotherapeutic Clofarabine (Clo-M); Clo-C; and Blina. The global cost-effectiveness
assessment played a crucial role in this thesis for children and young adults with R/R-B ALL,
considering Tisagenlecleucel is a cost-effective option. Therefore, it should be considered and
financed by public policy makers and by the Unified Health System (SUS) as an alternative for
treating patients in the Federal District, Brazil and around the world.

COMMITTEE MEMBERS:
Externa à Instituição - FLÁVIA TAVARES SILVA ELIAS - FIOCRUZ
Interno - ***.876.431-** - MAURICIO GOMES PEREIRA - UnB
Externo à Instituição - JORGE VAZ PINTO NETO - ABHH-TC
Presidente - 3088161 - JULIANA LOTT DE CARVALHO
Externa ao Programa - ***.356.791-** - MARIA SUELI SOARES FELIPE - USP