Lawsuits against the Brazilian Unified Health System regarding Bladder/Ureteral Cancer

Abstract

Abstract Objective To evaluate the technical notes (TNs) issued by the Center for Technical Support of the Judiciary (Núcleo de Apoio Técnico do Poder Judiciário, NAT-Jus, in Portuguese) of the Brazilian Ministry of Justice regarding lawsuits against the Brazilian Unified Health System (Sistema Único de Saúde, SUS, in Portuguese) concerning bladder/ureteral cancer, in order to better advise the formulation of public policies regarding oncologic care. Materials and Methods A cross-sectional study on the TNs issued by NAT-Jus regarding lawsuits from patients against SUS from 2019 to 2023 concerning bladder or ureteral cancer. Results A total of 137 TNs were issued. Most plaintiffs were male patients (70.8%), with a mean age of 69.1 ± 17.6 years. The lawsuits were filed in an attempt to obtain medications (67%), medical care or procedures (26%), or other health products (7%).The most common medications requested were immuno-oncology (IO) therapeutic agents, in 66 cases (pembrolizumab, avelumab, nivolumab, and atezolizumab), followed by the Bacillus Calmette-Guerin (BCG) vaccine (n = 13), chemotherapeutic agents in 5 cases, erdafitinib in 2 cases, and enfortumab vedotin in 1 case.Pembrolizumab was the medication most frequently requested by patients undergoing treatment for bladder or ureteral cancer. Out of more than 50 thousand TNs, there were 1,349 requests for this medication. Bladder or ureteral cancer was responsible for 3.4% of all the demands for pembrolizumab.It is also notable that lawsuits were more common in the Southern (n = 47), followed by the Southeastern (n = 26), Northeastern (n = 20), and Midwestern (n = 6) regions. The lawsuits in the South were more often related to expensive medications. In the Northeast and Midwest, there were proportionally more lawsuits demanding medical procedures. The Brazilian Federal Government lost the lawsuits, representing expenses of BRL 42.1 million with these novel medications within the period evaluated. Conclusion Bladder cancer treatment within SUS faces obstacles and shortages of essential medications. Moreover, advanced and costly therapies are not widely available, straining the public healthcare system and resulting in increasing legal costs. Collaboration among the government, the scientific community, and patient advocacy organizations is crucial to ensure the sustainability of SUS in the face of these challenges.