P-142: Clinical – epidemiologic features and disparities in access to diagnostic tools and novel therapies for MM Patients in Public and Private Health Care – A Comparative Analysis of 2 Hospitals in Brazil.

Introduction: The diagnosis and treatment of Multiple Myeloma have rapidly advanced in recent years, resulting in increased survival rates and improved quality of life. However, inequities in access quality of care remain a known issue, especially amongst public and private healthcare services in Brazil, where more than 70% of the population depend on public healthcare system – Sistema Unico de Saude (SUS). This study aims to evaluate the discrepancies in diagnostic and therapeutic resources among patients treated at two different healthcare scenarios in São Paulo, Brazil between 2017 and 2023.

Methods: This is a cross-sectional study of clinical, diagnostic, and therapeutic data from 247 patients with Multiple Myeloma, identified in eletronical records using the ICD-10 code C90. Data were collected from a private hospital (Hospital Israelita Albert Einstein - HIAE) and a public hospital (Hospital Municipal Vila Santa Catarina Dr. Gilson de C. Marques de Carvalho - HMVSC). The chi-square test was used for a univariate association between variables.

Results: When divided between the private HIAE (185 patients) end the public hospital HMVSC (62 patients), the epidemiologic features showed an average age at diagnosis of 72 and 66 y/o respectively, with male predominance in both institutions (57% in HIAE and 58% in HMVSC). Only 9 patients (13%) at HMVSC had cytogenetic study results compared to 85% at HIAE, making it difficult to classify most of this population according to new prognostic scores as R-ISS and R2-ISS, reflecting the first challenge in adequate risk stratification in patients treated in public healthcare. Regarding ISS staging, there was no significant difference between patients from the two hospitals.

Patients at HIAE had access to all approved novel therapies by Agencia Nacional de Vigilancia Sanitaria (ANVISA) whereas patients at HMVSC only had access to Bortezomib, Cyclophosphamide, Melphalan, Thalidomide, and Dexamethasone. The public service patients also had higher mortality rates compared to those in the private hospital (33% vs. 22%, respectively), not statistically significant (p= 0.3402).



Conclusions: Previous studies have demonstrated differences in the quality of care for Multiple Myeloma patients due to socioeconomic disparities. Our study enlightens the inequity in access to diagnostic tests for better prognostic stratification and novel therapies between these 2 private and public hospitals, what reflects the macro scenario in Brazil, highlighting