RESUMO
Objective: To compare costs between treatment strategies employed prior to and after prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) via the Brazilian Unified Health Care System and their impact on the therapeutic management of biochemical recurrence of prostate cancer. Materials and Methods: The referring physicians were surveyed on their treatment intentions (strategies) at two different time points: prior to and after PSMA PET/CT. Cost comparison results are presented as median (IQR) for each of the two strategies. The shift in therapeutic management after PSMA PET/CT was also analyzed. Results: The study sample included 59 patients (mean age: 65.9 years). The PSMA PET/CT result was considered positive in 38 patients (64.4%) and was found to have an impact on the treatment strategy in for 36 patients (61.0%). Prior to PSMA PET/CT, salvage therapy (i.e., treatment with curative intent) was the intended treatment for most patients, and that was significantly less so after the examination (76.3% vs. 45.8%; p < 0.001). Conversely, a strategy involving systemic (i.e., palliative) therapy became more common after PSMA PET/CT (23.7% vs. 54.2%; p < 0.001). The after-PSMA PET/CT strategy presented higher overall costs than did the before-PSMA PET/CT strategy, in all scenarios evaluated. In all scenarios, nearly half of this cost difference was related to the cost of the PSMA PET/CT itself, the remainder being related to the new treatment choices that stemmed from knowledge of the PSMA PET/CT findings. Conclusion: For patients treated within the Brazilian Unified Health Care System, PSMA PET/CT presented higher costs in comparison with conventional imaging methods. Adding PSMA PET/CT to the workflow had an impact on therapeutic management, mainly representing a shift from futile curative treatments to systemic palliative ones. The amount of funds that could potentially be saved by not providing such futile treatments would suffice to evaluate roughly two patients with PSMA PET/CT scans for each futile treatment strategy avoided.
Objetivo: Comparar custos entre estratégias antes e após o exame de PET/CT-PSMA da perspectiva do Sistema Único de Saúde e seu impacto no manejo terapêutico para pacientes com recidiva bioquímica de câncer de próstata. Materiais e Métodos: Os médicos solicitantes informaram a intenção terapêutica em dois momentos: antes e após o exame. Os resultados de comparação de custo estão apresentados como medianas de custo (p25; p75). A mudança na intenção terapêutica também foi analisada. Resultados: O estudo envolveu 59 pacientes (idade média: 65,9 anos). A PET/CT-PSMA foi considerada positiva em 38 dos 59 pacientes (64.4%). O exame impactou a estratégia de tratamento para 36 pacientes (61%). Antes da obtenção das informações da PET/CT-PSMA, a terapia de resgate (i.e., com intenção curativa) era o tratamento sugerido para a maioria dos pacientes, e após o exame, reduziu significativamente (76,3% vs 45,8%; p < 0,001). Em contrapartida, a terapia sistêmica (i.e., paliativa) aumentou como intenção de tratamento após o exame (23,7% vs 54,2%; p < 0,001). A estratégia "após PET/CT-PSMA" apresentou maiores custos em relação à estratégia "antes da PET/CT-PSMA" nos cenários comparados. Cerca de metade da diferença de custos entre as duas estratégias foi relacionada aos custos do exame propriamente ditos, enquanto a outra metade foi relacionada às novas escolhas de tratamento a partir do exame. Conclusão: Oferecer a PET/CT-PSMA no Sistema Único de Saúde apresentou maiores custos em relação à estratégia com métodos de imagem convencionais e impactou o manejo terapêutico, pelo favorecimento de tratamentos sistêmicos paliativos no lugar de tratamentos curativos fúteis. A quantidade de recursos que poderiam ser poupados ao evitar tratamentos fúteis seria suficiente para avaliar aproximadamente dois pacientes com exames de PET/CT-PSMA para cada estratégia de tratamento fútil evitada.
RESUMO
MicroRNAs (miRNAs) are a class of non-coding small RNAs representing one of the most exciting areas of modern medical science. miRNAs modulate a large and complex regulatory network of gene expression of the majority of the protein-coding genes. Currently, evidences suggest that miRNAs play a crucial role in the pathogenesis of heart failure. Some miRNAs as miR-1, miR-133 and miR-208a are highly expressed in the heart and strongly associated with the development of cardiac hypertrophy. Recent data indicate that these miRNAs as well as miR-206 change their expression quickly in response to physical activity. The differential regulation of miRNAs in response to exercise suggests a potential value of circulating miRNAs (c-miRNAs) as biomarkers of physiological mediators of the cardiovascular adaptation induced by exercise. Likewise, serum levels of c-miRNAs such as miR-423-5p have been evaluated as potential biomarkers in the diagnosis and prognosis of heart failure. On the other hand, the manipulation of miRNAs levels using techniques such as 'miR mimics' and 'antagomiRs' is becoming evident the enormous potential of miRNAs as promising therapeutic strategies in heart failure.