Thyroid cancer burden and economic impact on the Brazilian public health system

• Main Authors: Carolina Castro Porto Silva Janovsky, Marcio Sommer Bittencourt, Maykon Anderson Pires de Novais, Rui M. B. Maciel, Rosa Paula M. Biscolla, Paola Zucchi
• Format: Article
• Language: English
• Published: Brazilian Society of Endocrinology and Metabolism
• Series: Archives of Endocrinology and Metabolism
• Subjects: Thyroid cancer; economic impact; Brazilian public health system; costs; overdiagnosis
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972018000500537&lng=en&tlng=en

ABSTRACT Objective: Recent data indicates an increasing incidence of thyroid cancer not accompanied by a proportional increase in mortality, suggesting overdiagnosis, which may represent a big public health problem, particularly where resources are scarce. This article aims to describe and evaluate the procedures related to investigation of thyroid nodules and treatment and follow-up of thyroid cancer and the costs for the Brazilian public health system between 2008 and 2015. Materials and methods: Data on procedures related to investigation of thyroid nodules and treatment/follow-up of thyroid cancer between 2008 and 2015 in Brazil were collected from the Department of Informatics of the Brazilian Unified Health System (Datasus) website. Results: A statistically significant increase in the use of procedures related to thyroid nodules investigation and thyroid cancer treatment and follow-up was observed in Brazil, though a reduction was noted for procedures related to the treatment of more aggressive thyroid cancer, such as total thyroidectomy with neck dissection and higher radioiodine activities such as 200 and 250 milicuries (mCi). The procedures related to thyroid nodules investigation costs increased by 91% for thyroid ultrasound (p = 0.0003) and 128% in thyroid nodule biopsy (p < 0.001). Costs related to treatment and follow-up related-procedures increased by 120%. Conclusion: The increase in the incidence of thyroid cancer in Brazil is directly associated with an increased use of diagnostic tools for thyroid nodules, which leads to an upsurge in thyroid cancer treatment and followup-related procedures. These data suggest that substantial resources are being used for diagnosis, treatment and follow-up of a potentially indolent condition.