Breaking Barriers: Reducing Costs and Overcoming Challenges in <i>BCR::ABL-1</i> Monitoring for Chronic Myeloid Leukemia in Brazil.

Abstract

Tyrosine kinase inhibitors are available in the Brazilian public health care system. However, reimbursement challenges limit access to molecular testing of <i>BCR::ABL-1</i>, which is essential for diagnosing and monitoring measurable residual disease in chronic myeloid leukemia (CML). This study estimated the costs associated with delivering the <i>BCR::ABL-1</i> test in a tertiary academic reference care center in Brazil and simulated alternatives to increase patient access to the test. This is an economic analysis that estimates the costs based on resource consumption from a hospital to deliver a specific health care service, following the steps of the time-driven activity-based costing method at an academic reference center in Brazil. With the costs per test calculated, a scenario analysis estimated the budget impact resulting from an increase in test volume and a decrease in kit purchase cost, considering the local incidence of the disease. The cost per test was R$717, and if only laboratory reagents and personnel were considered, delivering the test to one patient accounted for R$556, whereas the current reimbursement fee is R$144. The simulated scenarios indicate that by increasing the volume of tests delivered by 60% and renegotiating the acquisition cost with the supplier in the same proportion, it is possible to cover 63% of the regional demand without increasing the budget impact. The financial and access challenges explored in this study underscore the importance of accelerating more effective and sustainable health policies in the CML field, which include access to the <i>BCR::ABL-1</i> test with financial accountability.