Original Title: Cirurgia de citorredução com hipertermoquimioterapia em pacientes com mesotelioma peritoneal maligno

Authors' objectives: Is treatment with cytoreductive surgery with hyperthermic chemotherapy more effective and cost-effective than systemic chemotherapy for patients with diffuse malignant peritoneal mesothelioma?

Authors' results and conclusions: The Conitec’s members present at the 86th Ordinary Meeting, on March 4th and 5th, 2020, unanimously decided to recommend the incorporation of cytoreductive surgery with HIPEC for the treatment of peritoneal mesothelioma, in the scope of SUS, in accordance with a protocol to be developed by the Ministry of Health.

Authors' recommendations: Scientific evidence: Clinical trials on cytoreductive surgery with HIPEC specifically for patients with MPM were not found. As HIPEC was the intervention of interest, studies on normothermic intraperitoneal chemotherapy were not considered. Eleven observational studies were selected, which had used a database of patients from one or more health centres. The number of patients evaluated in these studies ranged from 11 to 401, and the data collection period ranged from 3 to 26 years. The HIPEC techniques used were: in 4 studies, open abdomen (or Coliseum technique); in another 4 studies, closed abdomen; in 2 multicentre studies, the (open or closed) surgical procedures varied among the participating centres; and in one study, details of the technique were not reported. The temperature of HIPEC ranged from 40 to 43 ºC, and the duration ranged from 60 to 120 minutes, and mitomycin C alone or in combination with a platinum-based drug was used in most studies. Most studies reported an overall 5-year survival rate ranging from 27% to 80.8%. Budget impact analysis: The incremental value per health centre was assessed considering it would perform 24 procedures per year. A dynamic microsimulation model was developed, over a five-year time horizon. According to the Brazilian Society of Surgical Oncology (SBCO in Portuguese), 120-200 cases per year of pseudomyxoma peritonei and peritoneal mesothelioma would be eligible for the procedure. The average annual budget impact for the 24 patients was estimated to be BRL 1,692,864.36. For the entire population, the values per year ranged from BRL 8,661,117.15 to BRL 14,657,044.06.

Project Status: Completed

URL for project: http://conitec.gov.br/images/Consultas/Relatorios/EN2020/20201119_Report517_CytoreductiveSurgery_MalignantPeritonealMesothelioma.pdf

Year Published: 2020

URL for published report: http://conitec.gov.br/images/Relatorios/2020/Relatorio_HIPEC_Mesotelioma_FINAL_517_2020.pdf

URL for additional information: http://conitec.gov.br/recomendation-reports

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Brazil

Organisation Name: National Committee for Technology Incorporation (CONITEC)

Contact Address: Esplanada dos Ministérios, Bl. G, Ed. Sede, 8º andar, CEP: 70058-900

Contact Name: Clarice Moreira Portugal

Contact Email: clarice.portugal@saude.gov.br