Health litigation and cancer survival in patients treated in the public health system in a large Brazilian city, 2014-2019
Litigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health services. The study aimed to evaluate whether cancer patients in Belo Horizonte, Minas Gerais, Brazil, increased their overall survival by increasing acc...
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| Published in: | BMC public health Vol. 23; no. 1; pp. 534 - 17 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
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BioMed Central Ltd
21-03-2023
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| Abstract | Litigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health services. The study aimed to evaluate whether cancer patients in Belo Horizonte, Minas Gerais, Brazil, increased their overall survival by increasing access to certain drugs or treatments through litigation, controlling for the effect of demographic and disease-related variables.
A retrospective cohort study was conducted. Patients with breast, prostate, brain, lung, or colon cancers from 2014 to 2019 were included. Survival analysis was performed using the Cox proportional hazards model.
In the multivariate analysis, litigation was significantly associated with increased survival in cancers of breast (HR = 0.51, 95%CI 0.33-0.80), prostate (HR = 0.50, 95%CI 0.30-0.85), colon (HR = 0.59, 95%CI 0.38-0.93), and lung (HR = 0.36, 95%CI 0.22-0.60). Five-year survival rates of patients who sued for treatment were 97.8%, 88.7%, 59.3%, and 26.0%, compared to median survival of 95.7%, 78.7%, 41.2%, and 2.4%, respectively, among patient that did not resort to court action. The study suggests that litigation for access to cancer treatment may represent a step forward in obtaining more effective treatment. This study´s main limitations are the lack of patients´ clinical information for use as control variables and the lack of variables to assess patients´ quality of life. The study also found that many cases involved claims that could have been solved by administrative rather than legal action. Some claims thus reflect the lack of adequate administrative procedures.
When based on scientific evidence, access to new therapies, combined with other technologies already available, can favor patient survival. Access to new therapies through litigation may increase health inequalities since low-income patients have limited access to legal recourse against the State to meet their needs. The timely approval of new effective therapies can mitigate the judicialization of cancer treatment. |
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| AbstractList | Abstract Background Litigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health services. The study aimed to evaluate whether cancer patients in Belo Horizonte, Minas Gerais, Brazil, increased their overall survival by increasing access to certain drugs or treatments through litigation, controlling for the effect of demographic and disease-related variables. Methods A retrospective cohort study was conducted. Patients with breast, prostate, brain, lung, or colon cancers from 2014 to 2019 were included. Survival analysis was performed using the Cox proportional hazards model. Results In the multivariate analysis, litigation was significantly associated with increased survival in cancers of breast (HR = 0.51, 95%CI 0.33–0.80), prostate (HR = 0.50, 95%CI 0.30–0.85), colon (HR = 0.59, 95%CI 0.38–0.93), and lung (HR = 0.36, 95%CI 0.22–0.60). Five-year survival rates of patients who sued for treatment were 97.8%, 88.7%, 59.3%, and 26.0%, compared to median survival of 95.7%, 78.7%, 41.2%, and 2.4%, respectively, among patient that did not resort to court action. The study suggests that litigation for access to cancer treatment may represent a step forward in obtaining more effective treatment. This study´s main limitations are the lack of patients´ clinical information for use as control variables and the lack of variables to assess patients´ quality of life. The study also found that many cases involved claims that could have been solved by administrative rather than legal action. Some claims thus reflect the lack of adequate administrative procedures. Conclusion When based on scientific evidence, access to new therapies, combined with other technologies already available, can favor patient survival. Access to new therapies through litigation may increase health inequalities since low-income patients have limited access to legal recourse against the State to meet their needs. The timely approval of new effective therapies can mitigate the judicialization of cancer treatment. Background Litigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health services. The study aimed to evaluate whether cancer patients in Belo Horizonte, Minas Gerais, Brazil, increased their overall survival by increasing access to certain drugs or treatments through litigation, controlling for the effect of demographic and disease-related variables. Methods A retrospective cohort study was conducted. Patients with breast, prostate, brain, lung, or colon cancers from 2014 to 2019 were included. Survival analysis was performed using the Cox proportional hazards model. Results In the multivariate analysis, litigation was significantly associated with increased survival in cancers of breast (HR = 0.51, 95%CI 0.33-0.80), prostate (HR = 0.50, 95%CI 0.30-0.85), colon (HR = 0.59, 95%CI 0.38-0.93), and lung (HR = 0.36, 95%CI 0.22-0.60). Five-year survival rates of patients who sued for treatment were 97.8%, 88.7%, 59.3%, and 26.0%, compared to median survival of 95.7%, 78.7%, 41.2%, and 2.4%, respectively, among patient that did not resort to court action. The study suggests that litigation for access to cancer treatment may represent a step forward in obtaining more effective treatment. This study´s main limitations are the lack of patients´ clinical information for use as control variables and the lack of variables to assess patients´ quality of life. The study also found that many cases involved claims that could have been solved by administrative rather than legal action. Some claims thus reflect the lack of adequate administrative procedures. Conclusion When based on scientific evidence, access to new therapies, combined with other technologies already available, can favor patient survival. Access to new therapies through litigation may increase health inequalities since low-income patients have limited access to legal recourse against the State to meet their needs. The timely approval of new effective therapies can mitigate the judicialization of cancer treatment. Keywords: Judicial actions, Public health, Brazil, Cancer drugs, Survival analyses, Cancer Litigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health services. The study aimed to evaluate whether cancer patients in Belo Horizonte, Minas Gerais, Brazil, increased their overall survival by increasing access to certain drugs or treatments through litigation, controlling for the effect of demographic and disease-related variables. A retrospective cohort study was conducted. Patients with breast, prostate, brain, lung, or colon cancers from 2014 to 2019 were included. Survival analysis was performed using the Cox proportional hazards model. In the multivariate analysis, litigation was significantly associated with increased survival in cancers of breast (HR = 0.51, 95%CI 0.33-0.80), prostate (HR = 0.50, 95%CI 0.30-0.85), colon (HR = 0.59, 95%CI 0.38-0.93), and lung (HR = 0.36, 95%CI 0.22-0.60). Five-year survival rates of patients who sued for treatment were 97.8%, 88.7%, 59.3%, and 26.0%, compared to median survival of 95.7%, 78.7%, 41.2%, and 2.4%, respectively, among patient that did not resort to court action. The study suggests that litigation for access to cancer treatment may represent a step forward in obtaining more effective treatment. This study´s main limitations are the lack of patients´ clinical information for use as control variables and the lack of variables to assess patients´ quality of life. The study also found that many cases involved claims that could have been solved by administrative rather than legal action. Some claims thus reflect the lack of adequate administrative procedures. When based on scientific evidence, access to new therapies, combined with other technologies already available, can favor patient survival. Access to new therapies through litigation may increase health inequalities since low-income patients have limited access to legal recourse against the State to meet their needs. The timely approval of new effective therapies can mitigate the judicialization of cancer treatment. Litigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health services. The study aimed to evaluate whether cancer patients in Belo Horizonte, Minas Gerais, Brazil, increased their overall survival by increasing access to certain drugs or treatments through litigation, controlling for the effect of demographic and disease-related variables.BACKGROUNDLitigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health services. The study aimed to evaluate whether cancer patients in Belo Horizonte, Minas Gerais, Brazil, increased their overall survival by increasing access to certain drugs or treatments through litigation, controlling for the effect of demographic and disease-related variables.A retrospective cohort study was conducted. Patients with breast, prostate, brain, lung, or colon cancers from 2014 to 2019 were included. Survival analysis was performed using the Cox proportional hazards model.METHODSA retrospective cohort study was conducted. Patients with breast, prostate, brain, lung, or colon cancers from 2014 to 2019 were included. Survival analysis was performed using the Cox proportional hazards model.In the multivariate analysis, litigation was significantly associated with increased survival in cancers of breast (HR = 0.51, 95%CI 0.33-0.80), prostate (HR = 0.50, 95%CI 0.30-0.85), colon (HR = 0.59, 95%CI 0.38-0.93), and lung (HR = 0.36, 95%CI 0.22-0.60). Five-year survival rates of patients who sued for treatment were 97.8%, 88.7%, 59.3%, and 26.0%, compared to median survival of 95.7%, 78.7%, 41.2%, and 2.4%, respectively, among patient that did not resort to court action. The study suggests that litigation for access to cancer treatment may represent a step forward in obtaining more effective treatment. This study´s main limitations are the lack of patients´ clinical information for use as control variables and the lack of variables to assess patients´ quality of life. The study also found that many cases involved claims that could have been solved by administrative rather than legal action. Some claims thus reflect the lack of adequate administrative procedures.RESULTSIn the multivariate analysis, litigation was significantly associated with increased survival in cancers of breast (HR = 0.51, 95%CI 0.33-0.80), prostate (HR = 0.50, 95%CI 0.30-0.85), colon (HR = 0.59, 95%CI 0.38-0.93), and lung (HR = 0.36, 95%CI 0.22-0.60). Five-year survival rates of patients who sued for treatment were 97.8%, 88.7%, 59.3%, and 26.0%, compared to median survival of 95.7%, 78.7%, 41.2%, and 2.4%, respectively, among patient that did not resort to court action. The study suggests that litigation for access to cancer treatment may represent a step forward in obtaining more effective treatment. This study´s main limitations are the lack of patients´ clinical information for use as control variables and the lack of variables to assess patients´ quality of life. The study also found that many cases involved claims that could have been solved by administrative rather than legal action. Some claims thus reflect the lack of adequate administrative procedures.When based on scientific evidence, access to new therapies, combined with other technologies already available, can favor patient survival. Access to new therapies through litigation may increase health inequalities since low-income patients have limited access to legal recourse against the State to meet their needs. The timely approval of new effective therapies can mitigate the judicialization of cancer treatment.CONCLUSIONWhen based on scientific evidence, access to new therapies, combined with other technologies already available, can favor patient survival. Access to new therapies through litigation may increase health inequalities since low-income patients have limited access to legal recourse against the State to meet their needs. The timely approval of new effective therapies can mitigate the judicialization of cancer treatment. BackgroundLitigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health services. The study aimed to evaluate whether cancer patients in Belo Horizonte, Minas Gerais, Brazil, increased their overall survival by increasing access to certain drugs or treatments through litigation, controlling for the effect of demographic and disease-related variables.MethodsA retrospective cohort study was conducted. Patients with breast, prostate, brain, lung, or colon cancers from 2014 to 2019 were included. Survival analysis was performed using the Cox proportional hazards model.ResultsIn the multivariate analysis, litigation was significantly associated with increased survival in cancers of breast (HR = 0.51, 95%CI 0.33–0.80), prostate (HR = 0.50, 95%CI 0.30–0.85), colon (HR = 0.59, 95%CI 0.38–0.93), and lung (HR = 0.36, 95%CI 0.22–0.60). Five-year survival rates of patients who sued for treatment were 97.8%, 88.7%, 59.3%, and 26.0%, compared to median survival of 95.7%, 78.7%, 41.2%, and 2.4%, respectively, among patient that did not resort to court action. The study suggests that litigation for access to cancer treatment may represent a step forward in obtaining more effective treatment. This study´s main limitations are the lack of patients´ clinical information for use as control variables and the lack of variables to assess patients´ quality of life. The study also found that many cases involved claims that could have been solved by administrative rather than legal action. Some claims thus reflect the lack of adequate administrative procedures.ConclusionWhen based on scientific evidence, access to new therapies, combined with other technologies already available, can favor patient survival. Access to new therapies through litigation may increase health inequalities since low-income patients have limited access to legal recourse against the State to meet their needs. The timely approval of new effective therapies can mitigate the judicialization of cancer treatment. Litigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health services. The study aimed to evaluate whether cancer patients in Belo Horizonte, Minas Gerais, Brazil, increased their overall survival by increasing access to certain drugs or treatments through litigation, controlling for the effect of demographic and disease-related variables. A retrospective cohort study was conducted. Patients with breast, prostate, brain, lung, or colon cancers from 2014 to 2019 were included. Survival analysis was performed using the Cox proportional hazards model. In the multivariate analysis, litigation was significantly associated with increased survival in cancers of breast (HR = 0.51, 95%CI 0.33-0.80), prostate (HR = 0.50, 95%CI 0.30-0.85), colon (HR = 0.59, 95%CI 0.38-0.93), and lung (HR = 0.36, 95%CI 0.22-0.60). Five-year survival rates of patients who sued for treatment were 97.8%, 88.7%, 59.3%, and 26.0%, compared to median survival of 95.7%, 78.7%, 41.2%, and 2.4%, respectively, among patient that did not resort to court action. The study suggests that litigation for access to cancer treatment may represent a step forward in obtaining more effective treatment. This study´s main limitations are the lack of patients´ clinical information for use as control variables and the lack of variables to assess patients´ quality of life. The study also found that many cases involved claims that could have been solved by administrative rather than legal action. Some claims thus reflect the lack of adequate administrative procedures. When based on scientific evidence, access to new therapies, combined with other technologies already available, can favor patient survival. Access to new therapies through litigation may increase health inequalities since low-income patients have limited access to legal recourse against the State to meet their needs. The timely approval of new effective therapies can mitigate the judicialization of cancer treatment. |
| ArticleNumber | 534 |
| Audience | Academic |
| Author | de Castro, Mônica Silva Monteiro Magalhães Júnior, Helvécio Miranda Dos Santos, Fausto Pereira da Silva, Gabriela Drummond Marques Figueiredo, Iara Veloso Oliveira de Miranda, Wanessa Debôrtoli de Sousa, Rômulo Paes |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36944943$$D View this record in MEDLINE/PubMed |
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| Keywords | Brazil Cancer drugs Judicial actions Survival analyses Public health Cancer |
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| References | ATM Araújo (15415_CR26) 2021; 10 15415_CR40 VO Chagas (15415_CR24) 2020; 20 15415_CR43 15415_CR49 R Riera (15415_CR21) 2021; 7 15415_CR47 15415_CR46 FJ Rodrigues Filho (15415_CR29) 2021; 45 V Gauri (15415_CR1) 2008; 10 15415_CR39 LU Santana (15415_CR22) 2021; 31 L Santos (15415_CR48) 2021; 45 HC Capucho (15415_CR32) 2022; 27 15415_CR50 15415_CR3 15415_CR4 15415_CR5 15415_CR6 15415_CR15 15415_CR14 15415_CR9 P Sedgwick (15415_CR44) 2012; 345 WD Miranda (15415_CR13) 2021; 10 IT Teixeira (15415_CR7) 2022; 4 LA Salha (15415_CR54) 2022; 21 15415_CR23 15415_CR27 RM O’Brien (15415_CR42) 2007; 41 CM Ribeiro (15415_CR52) 2021; 72 15415_CR19 15415_CR17 MC Castro (15415_CR2) 2019; 394 LC Lopes (15415_CR18) 2010; 44 TS Andia (15415_CR10) 2019; 18 BSF Braga (15415_CR25) 2021; 21 K Tay-Teo (15415_CR28) 2019; 2 CM Vargas-Pelaez (15415_CR11) 2019; 18 D Schoenfeld (15415_CR41) 1982; 69 15415_CR30 15415_CR34 15415_CR31 15415_CR38 15415_CR37 15415_CR36 15415_CR35 R Lisbôa (15415_CR20) 2021; 44 R Core Team (15415_CR45) 2022 SGG Lima (15415_CR33) 2019; 24 AL Chieffi (15415_CR16) 2017; 17 HV Hogerzeil (15415_CR12) 2006; 368 ML Sampaio (15415_CR8) 2021; 21 MN Shafaee (15415_CR51) 2022; 27 C Allemani (15415_CR53) 2018; 391 |
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10125 year: 2018 ident: 15415_CR53 publication-title: Lancet doi: 10.1016/S0140-6736(17)33326-3 contributor: fullname: C Allemani – volume: 18 start-page: 68 issue: 1 year: 2019 ident: 15415_CR11 publication-title: Int J Equity Health doi: 10.1186/s12939-019-0960-z contributor: fullname: CM Vargas-Pelaez – ident: 15415_CR35 – ident: 15415_CR38 – volume: 45 start-page: 807 issue: 130 year: 2021 ident: 15415_CR48 publication-title: Saúde em Debate doi: 10.1590/0103-1104202113018 contributor: fullname: L Santos – ident: 15415_CR43 doi: 10.2307/2347550 – volume: 72 start-page: 101 year: 2021 ident: 15415_CR52 publication-title: Cancer Epidemiol contributor: fullname: CM Ribeiro – volume: 20 start-page: 80 issue: 1 year: 2020 ident: 15415_CR24 publication-title: BMC Health Serv Res doi: 10.1186/s12913-020-4929-9 contributor: fullname: VO Chagas – volume: 45 start-page: 707 year: 2021 ident: 15415_CR29 publication-title: Saúde em Debate doi: 10.1590/0103-1104202113011 contributor: fullname: FJ Rodrigues Filho – volume: 4 start-page: 2082 issue: 4 year: 2022 ident: 15415_CR7 publication-title: Brazilian J Bus doi: 10.34140/bjbv4n4-034 contributor: fullname: IT Teixeira – volume: 44 start-page: 620 issue: 4 year: 2010 ident: 15415_CR18 publication-title: Rev Saúde Pública agosto de doi: 10.1590/S0034-89102010000400005 contributor: fullname: LC Lopes – volume: 44 start-page: 1255 year: 2021 ident: 15415_CR20 publication-title: Saúde Debate contributor: fullname: R Lisbôa – volume: 7 start-page: 311 year: 2021 ident: 15415_CR21 publication-title: JCO Global Oncology doi: 10.1200/GO.20.00639 contributor: fullname: R Riera – volume: 368 start-page: 305 issue: 9532 year: 2006 ident: 15415_CR12 publication-title: Lancet doi: 10.1016/S0140-6736(06)69076-4 contributor: fullname: HV Hogerzeil – volume: 21 start-page: 1 issue: 1 year: 2021 ident: 15415_CR8 publication-title: BMC Public Health doi: 10.1186/s12889-021-11397-1 contributor: fullname: ML Sampaio – volume: 31 start-page: 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| Snippet | Litigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health services.... Background Litigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health... BackgroundLitigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access health... Abstract Background Litigation for health care, also known as health judicialization, is frequent in Brazil. It involves recourse to the court system to access... |
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| Title | Health litigation and cancer survival in patients treated in the public health system in a large Brazilian city, 2014-2019 |
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