Introduction: Although it has been said that 'health is priceless', it certainly has its costs. In the last decades, the growing expenditure on health has raised concerns about better management of resources destined for this purpose. Among the factors related to the increase in health costs, changes in morbidity and mortality patterns in contemporary societies are evident, which can be explained by the reduction in infectious and contagious diseases and the increase in chronic degenerative ones. Hereditary Angioedema is a chronic disease that requires regular medical follow-up and treatment. The aim of this study was to evaluate the direct and indirect costs of Hereditary Angioedema with C1 inhibitor deficiency (C1-INH-HAE) treatment in specialized centers in Brazil. Methods: The present study is part of the National Network for Rare Diseases. It has a prospective and retrospective design that aims to understand and measure the Care Value Journey (CVJ) of patients with C1-INH-HAE in Brazil. It was carried out in 116 patients of 7 reference centers. Questionnaires were applied to patients/caregivers, one retrospective and one prospective (v1), containing general data about the patient; diagnosis, treatment, productivity, costs and evolution of the disease. In addition, interviews were conducted with nurses, doctors and administrators allocated in the centers to understand the reality of the resources used within the protocols used for management of C1-INH-HAE in each institution. Results: The most frequently used drug for long-term prophylaxis was oxandrolone [25/116; 21,5%], followed by danazol [14/116; 12.6%] and tranexamic acid [14/116; 12.06%]. The average monthly cost of oxandrolone was US$ 19.94; danazol, US$ 24.05 and tranexamic acid, US$ 8.61. Icatibant Acetate was the most commonly used medication for on demand treatment [14/116; 12.06%], with a mean use of 3 shots every 4 months for each patient. This drug was obtained through lawsuit and the cost per application was US$ 1,416.26. The total cost of this patient's care journey, including medical appointments, exams and medications was US$ 23,391.31 per year. Loss of productivity at work, which is an indirect cost, must also be taken into account in a pharmacoeconomic study. The time spent in a 1-year follow-up of a patient with C1-INH-HAE, taking into account medical appointments and exams, was 372.5 minutes. This time can reflect on absenteeism at work and school. The assessment of productivity loss, assessed using the Work Productivity and Activity Impairment - General Health (WPAI-GH) questionnaire, was answered by 7 caregivers and 87 patients. Of these, 46 patients and 4 caregivers answered that they were employed. The percentage of commitment during work (presenteeism) was 32.4% and the absenteeism (time lost from work) was 17.2%. Conclusion: The direct and indirect costs that patients with C1-INH-HAE have with the treatment of the disease are excessively high considering the socioeconomic level of Brazilian population. More investments in pharmacoeconomic studies are needed to think of strategies that minimize these costs

BACKGROUND: Inborn errors of metabolism (IEM) present significant challenges in diagnosis and management. The Brazilian Rare Diseases Network (BRDN) is a consortium of 40 healthcare centers from all five regions of Brazil established in 2020, designed to perform an epidemiological survey on rare diseases (RD). This study aims to present comprehensive data on patients with IEM assisted in the centers of BRDN, including their clinical profiles, diagnosis, and treatments applied. METHODS: We conducted a comprehensive review of all cases with confirmed or suspected IEM in BRDN. Selection criteria were established using the Rare IEM classification from Orphadata (v. Dec 4, 2023, https: //www.orphadata.com/classifications/), incorporating ICD-10, OMIM, and Orpha diagnostic codes. A retrospective (2018-2019) and prospective (2022-2024) data collection was conducted using a RedCap standard form. RESULTS: Of 19,307 total records at BRDN, 2,667 (13.8%) IEM cases were registered (retrospective phase: 1,798/12,285; prospective phase: 870/7022). Most participants (32.4%) lived in the Southeast region of Brazil. The mean age at inclusion was 18.0 years (±15.5), and 1,402 (52.6%) were female. Diagnosis of IEM was confirmed in 88.3% and suspected in 11.7%. For RD coding, Orpha was mostly (71.4%) used. The most frequent diagnoses were Phenylketonuria (PKU, n=762), Mucopolysaccharidosis (MPS) type 2 (n=102), Fabry disease (n=95), MPS type 6 (n=89) and Gaucher disease (n=86). Biochemical diagnosis was performed in 66.6% of cases, molecular diagnosis was conducted in 25.7%, and the remaining cases were categorized as Others. Only 26.2% were diagnosed through newborn screening. The most recorded Human Phenotype Ontology were: Reduced phenylalanine hydroxylase level, Seizure, and Hyperphenylalaninemia. Positive family history was registered in 27.1% and 16.5% reported consanguinity. In the retrospective phase, specific treatment for IEM was reported in 71.6% of cases. Within the overall cohort, 41.2% received diet therapy. Previous hospitalizations were documented in 88.3%. The mortality rate was 1.8% during the retrospective phase. CONCLUSIONS: This study shows the first Brazilian nationwide data on IEM, demonstrating the importance of networking between specialized RD centers. PKU is included in the Brazilian Newborn Screening Program, leading to higher diagnostic prevalence. This data may contribute to improving the assistance of IEM in Brazil.

INTRODUCTION: The newborn screening (NBS) enables early diagnosis and treatment of several rare diseases (RD). Besides red reflex, hearing and pulse oximetry screening, the Brazilian NBS Program involves a blood spot test, including Phenylketonuria; Congenital hypothyroidism; Cystic fibrosis (CF); Congenital adrenal hyperplasia; Biotinidase deficiency and Sickle cell anemia. Given the limited epidemiological data on RD in Brazil, the Brazilian Rare Diseases Network (RARAS) was established aiming to perform a national survey on RD. OBJECTIVES: To analyze the epidemiological data of RD diagnosed through NBS in Brazil using data from the RARAS network. MATERIALS AND METHODS: Retrospective data of cases with confirmed or suspected RD diagnosis in the RARAS' centers between 2018-2019 were collected using RedCap. All cases diagnosed through NBS were included. RESULTS: Out of 12,530 RARAS records, 900 (7.18%) were diagnosed through NBS. Most were born in the Southeast region (42.38%), were female (66.56%) and admixed (50.59%). The mean age at data collection was 12.97 years (±10.54). Diagnosis was confirmed in 97.71% cases; 2.29% were under investigation. The Brazilian Unified Health System funded most diagnoses (98.27%). The most frequent diagnoses were Phenylketonuria (n=454); Congenital hypothyroidism (n=145) and CF (n=117). When excluding the pathologies from the public NBS Program, the most prevalent disorders were Maple syrup urine disease (n=15), Glucose-6-phosphate dehydrogenase deficiency and Galactosemia (n=5). Familial recurrence rate was 12.20% and consanguinity rate was 11.46%. Hospitalization was reported by 201 (22.89%), with a mean of 2.37 hospitalizations/participant, mainly due to CF. The mortality rate was 0.34%, with aminoacidopathies as the leading cause of death. CONCLUSIONS: The low mortality rate of this population compared to the Brazilian infant mortality rate in 2019 (1.33%), and the reduced hospitalization rate compared to the general RARAS' rate (4.12), underline the importance of early diagnosis through NBS for better outcomes. Furthermore, the higher consanguinity rate compared to the Brazilian (1.60%) and RARAS' rate (6.40%), may be due to the autosomal recessive inheritance of most screened diseases. Data show the importance of early diagnosis of life-threatening disorders that were not diagnosed in the public NBS, highlighting the necessity of expansion of screened disorders in this program.