Câncer de próstata: epidemiologia, distribuição geográfica de gastos e fatores associados com tratamento cirúrgico na década de 2013 a 2022 no Brasil

Abstract

Introduction: Prostate neoplasia is increasing worldwide, in line with the aging of the population. Neoplasms are common among men, along with cardiac and respiratory conditions, as well as diseases caused by external factors. Due to sociocultural and economic factors, prostate cancer is often diagnosed at an advanced stage and with complications, particularly in Brazil. Moreover, socioeconomic conditions directly influence the prognosis of the disease and men's quality of life, resulting in higher costs for the healthcare system, as curative treatments are more expensive than prevention and health promotion. Objective: To analyze the epidemiology of prostate cancer surgical procedures and medical costs over ten years, under the perspective of Brazilian health system. Methods: Observational, retrospective and descriptive ecological study, considering prostate neoplasm’s surgical treatment public data available from 2013 to 2022. The inclusion criteria was male individuals, aged 20 years and above, diagnosed with prostate neoplasms and carcinoma in situ, and underwent surgical intervention. The relative number of surgeries performed, and the hospitalization expenses are the dependent variables, while the explanatory variables include socioeconomic factors and healthcare structure related to cancer. The economic analysis used was the cost-of-illness approach. Data Sources: SIH/SUS, IBGE, IPEA e INCA. Results: In 2019, a total of 13,753 surgical procedures were performed for prostate neoplasia, with a corresponding cost of R$ 62,591,914.16. The most frequently performed surgeries are also the costliest and are typically indicated for high risk prostate cancer. There was substantial variability across the macro-regions regarding Gross Domestic Product per capita and rates of surgery, expenses, and oncology referral centers, with a notable variability in average expenses (Coefficient of Variation 113.5%). Over the 2013–2022 timeline, rates of surgeries, expenses, and certain socioeconomic and healthcare structure indicators remained stable, except for the reduction of the number of SUS hospital beds and increase of Gross Domestic Product per capita. The COVID-19 pandemic had a significant impact on all variables in 2020 and 2021. Choropleth maps enabled visualization of the concentration of interest variable rates, Oncology Referral Centers, and per capita Income in the South, Southeast, and Midwest regions, as well as the scarcity in the North and Northeast. The Spearman test showed correlations between dependent and explanatory variables both in macro-regions and in the Federal Units and Federal District, except for male proportion, urologist rate, and Primary Care teams. GDP per capita demonstrated a significant correlation at the macro-region level but not among the Federal Units. Conclusion: The results indicated that prostate cancer surgery rates differ significantly across macro-regions, states, and the Federal District, highlighting the substantial discrepancies in socioeconomic conditions and healthcare resources available among territorial units. The relationship between the variables suggests that favorable socioeconomic conditions, better income distribution, and population well-being contribute positively to healthcare development within regions. Conversely, greater social vulnerability is associated with a lower number of surgical treatments, indicating a potential inadequacy in healthcare services. A continuous reduction in SUS hospital beds was observed over the studied decade, along with the negative impact of the COVID-19 pandemic on prostate surgery treatment. In summary, the results reinforce the well-known issue of low healthcare funding and the inefficiency of the current method of allocating resources to primary care compared to secondary and tertiary levels of healthcare. This compromises the sustainability of the Unified Health System (SUS) and keeps socioeconomically disadvantaged populations from accessing timely and effective medical care.