Expenditure of biological drugs for rheumatoid arthritis treatment in the Brazilian public health system

OBJECTIVE: This work aims to analyze the quantity and expenses related to biological drugs used for the treatment of rheumatoid arthritis (RA) in outpatient public care within the Brazilian Unified Health System (SUS). METHODS: It is a cross-sectional descriptive study based on secondary data from a historical series, referring to the purchase, volume, and the number of patients treated with different biological drugs (infliximabe, etanercept, adalimumab, rituximab, abatacept, tocilizumab, golimumab, and certolizumab pegol) for RA treatment in outpatient care from 2012 to 2017. The data were extracted from the SUS Outpatient Information System database-SIA/SUS and included ten drugs used for RA treatment. The study assessed the quantity and expenditure of these drugs, the number of RA patients treated, and the expenditure by RA subtypes. The National Broad Consumer Price Index was used to adjust the expenditures for December 2017. RESULTS: Th e M inistry o f H ealth a llocated approximately $ 500 m illion t o provide a bout 2 million units of biological drugs for RA patients from 2012 to 2017. The supply of adalimumab 40 mg and etanercept 50 mg accounted for 68.3% of the total expenditure. The subtypes “other rheumatoid arthritis with rheumatoid factor” (ICD-10 M05.8), “rheumatoid arthritis without rheumatoid factor” (ICD-10 M06.0), and “Felty’s syndrome” (M05. 0) represented 84.5% of the total expenditures. The proportion of patients treated with biological drugs increased by 33.0%. There was a significant 83.0% increase in the number of patients using biological drugs compared to the overall number of RA patients treated during the study period. CONCLUSIONS: The results obtained allow us to draw a more recent profile of expenditure on RA treatment and indicate trends in the use of biological drugs for this condition, generating data that can support management decisions in public health policies

Costs of Public Pharmaceutical Services in Rio de Janeiro Compared to Farmácia Popular Program

OBJETIVO Analisar custos da assistência farmacêutica pública frente ao Programa Farmácia Popular. MÉTODOS Comparação entre os valores pagos pelo Programa Aqui Tem Farmácia Popular com os custos integrais relativos à provisão de medicamentos pela Secretaria Municipal de Saúde do Rio de Janeiro. A comparação compreendeu 25 medicamentos, comuns tanto à provisão pela assistência farmacêutica pública municipal quanto pelo Programa Aqui Tem Farmácia Popular. O cálculo do custo unitário por unidade farmacotécnica de cada medicamento envolveu os gastos da Secretaria Municipal de Saúde com custos de aquisição (preço), logísticos e com a dispensação em nível local. O valor de referência dos medicamentos pago pelo Aqui Tem Farmácia Popular foi extraído da norma ministerial em vigor em 2012. As comparações envolveram o valor de referência pleno; valor de referência com desconto dos 10,0% pagos de contrapartida pelos usuários; e valor de referência máximo pago pelo Ministério da Saúde (descontados contrapartida e sem impostos).Foram realizadas simulações das diferenças entre os gastos da Secretaria Municipal de Saúde do Rio de Janeiro com os medicamentos do elenco comum e os que seriam incorridos se esses tivessem sido executados com base no valor de referência do Aqui Tem Farmácia Popular. RESULTADOS A Secretaria Municipal de Saúde do Rio de Janeiro gastou R$28.526.526,57 com 25 medicamentos do rol comum em 2012; 58,7$124.170.777,76 considerando a melhor situação de pagamento pelo Ministério da Saúde (90,0% do valor de referência, com impostos descontados). CONCLUSÕES A diferença de custos entre a provisão pública pela Secretaria Municipal de Saúde do Rio de Janeiro e o Programa Aqui Tem Farmácia Popular sinaliza que alguns valores de referência poderiam ser objetos de exame para sua redução.OBJECTIVE To analyze the costs of public pharmaceutical services compared to Farmácia Popular Program (Popular Pharmacy Program). METHODS Comparison between prices paid by Aqui Tem Farmácia Popular Program (Farmácia Popular is available here) with the full costs of medicine provision by the Municipal Health Department of Rio de Janeiro. The comparison comprised 25 medicines supplied by both the municipal pharmaceutical service and Aqui Tem Farmácia Popular Program. Calculating the cost per pharmaceutical unit of each medicine included expenditure by Municipal Health Department of Rio de Janeiro with procurement (price), logistics, and local dispensation. The reference price of medicines paid by Aqui Tem Farmácia Popular was taken from the Brazilian Ministry of Health standard in force in 2012. Comparisons included full reference price; reference price minus 10.0% copayment by users; and maximum reference paid by the Ministry of Health (minus copayment and taxes). Simulations were carried out of the differences between the costs of Municipal Health Department of Rio de Janeiro with the common medicines and those potentially incurred based on the reference price of Aqui Tem Farmácia Popular. RESULTS The Municipal Health Department of Rio de Janeiro spent R$28,526,526.57 with 25 medicines of the common list in 2012; 58.7$124,170,777.76, considering the best scenario of payment by the Brazilian Ministry of Health (90.0% of the reference price, minus taxes). CONCLUSIONS The difference in costs between public provision by Municipal Health Department of Rio de Janeiro and Farmácia Popular Program indicates that some reference prices could be reviewed aiming at their reduction

Hypertension and diabetes treatment affordability and government expenditures following changes in patient cost sharing in the Farmacia popular program in Brazil: an interrupted time series study

BACKGROUND: Increasing medicines availability and affordability is a key goal of Brazilian health policies. Farmacia Popular (FP) Program is one of the government\u27s key strategies to achieve this goal. Under FP, antihypertension (HTN) and antiglycemic (DM) medicines have been provided at subsidized prices in private retail settings since 2006, and free of charge since 2011. We aim to assess the impact of sequential changes in FP benefits on patient affordability and government expenditures for HTN and DM treatment under the FP, and examine their implications for public financing mechanisms and program sustainability. METHODS: Longitudinal, retrospective study using interrupted time series to analyze: HTN and DM treatment coverage; total and per capita expenditure; percentage paid by MoH; and patient cost sharing. Analyzes were conducted in the dispensing database of the FP program (from 2006 to 2012). RESULTS: FP has increased its coverage over time; by December 2012 FP covered on average 13% of DM and 11.5% of HTN utilization, a growth of over 600 and 1500%, respectively. The overall cost per treatment to the MoH declined from R$36.43 (R$ = reais, the Brazilian currency) to 18.74 for HTN and from R$33.07to R$15.05 for DM over the period analyzed, representing a reduction in per capita cost greater than 50%. The amount paid by patients for the medicines covered increased over time until 2011, but then declined to zero. We estimate that to treat all patients in need for HTN and DM in 2012 under FP, the Government would need to expend 97% of the total medicines budget. CONCLUSIONS: FP rapidly increased its coverage in terms of both program reach and proportion of cost subsidized during the period analyzed. Costs of individual HTN and DM treatments in FP were reduced after 2011 for both patients (free) and government (better negotiated prices). However, overall FP expenditures by MoH increased due to markedly increased utilization. The FP is sustainable as a complementary policy but cannot feasibly substitute for the distribution of medicines by the SUS

Brazilian generics market change after Farmácia Popular program

OBJECTIVE: To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS: This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP – Health has no price). RESULTS: Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS: Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies

Perfil e financiamento da pesquisa em saúde desencadeada pela pandemia da COVID-19 no Brasil

Introduction: Facing COVID-19 pandemic challenges Brazil on taking actions to deal with the installed health crisis, and to choose which interventions are more efficient and effective with the problems arising from the new disease. This picture of uncertainties has led to health research financing actions, which aim at scientific and technological improvement, supporting evidence-based decision making. Objective: To map the health research funding opportunities to face the COVID-19 in Brazil, in terms of priority areas, funding sources and financial volumes. Methods: We search public sources to map documents related to the promotion of research and innovation in health, with public and private sectors. We conducted a survey directly on the websites of public research institutions and an unsystematic search to identify private financing, and categorized objects of the financing notice and calls identified in large areas and specific topics. Results: We found 23 financing opportunities focusing on the combat of COVID-19 pandemic, covering 20 different financing agents in a total amount of BRL 337,460,612.00. Five public institutions finance 75.0% of the resources. Conclusions: Despite the small amount of resources, there was an effort to promote health R&D in a timely manner, mainly by federal public agencies, with emphasis on CAPES and CNPq. The most contemplated areas were the inputs needed to face COVID-19 (diagnostic tests, medical equipment and devices, medicines, vaccines and biological products) and telecommunication and information technologies. However, the contributions covered practically all the important areas for knowledge, prevention and treatment of the disease. It is noteworthy that health R&D in Brazil has had its resources significantly reduced since 2015.Introdução: O enfrentamento da pandemia COVID-19 desafia o Brasil sobre as medidas a tomar com a crise sanitária instalada e quais intervenções são mais eficientes e efetivas frente aos problemas decorrentes da nova doença. Esse quadro de incertezas tem levado a ações de financiamento de pesquisa em saúde, que visam o aprimoramento científico e tecnológico, subsidiando a tomada de decisões baseada em evidências. Objetivo: Mapear as oportunidades de financiamento de pesquisa em saúde para o enfrentamento da COVID-19 no Brasil, em termos das áreas priorizadas, fontes financiadoras e volumes financeiros. Método: Fontes públicas foram utilizadas para mapear documentos relativos ao fomento à pesquisa e à inovação em saúde, junto às instâncias públicas e privadas. Realizou-se levantamento diretamente nos sítios eletrônicos das instituições públicas de pesquisa e busca assistemática para identificar financiamentos privados. Os objetos de financiamentos dos editais e chamadas identificados foram categorizados segundo grandes áreas e temáticas específicas. Resultados: Foram identificadas 23 oportunidades de financiamento para o enfrentamento à COVID-19, cobrindo 20 diferentes agentes de financiamento, totalizando R$ 337.460.612,00. Cinco instâncias públicas responderam aproximadamente por 75,0% dos recursos. Conclusões: Apesar do pequeno montante de recursos, houve esforço de fomento à P&D/S em tempo oportuno, principalmente por parte de órgãos públicos federais, com destaque para CAPES e CNPq. As áreas mais contempladas foram os insumos necessários ao enfrentamento da COVID-19 (testes diagnósticos, equipamentos e dispositivos médicos, medicamentos, vacinas e produtos biológicos) e a tecnologias de telecomunicação e informação. Entretanto, os aportes atenderam praticamente todas as áreas importantes para o conhecimento, prevenção e tratamento da doença. Destaca-se que a P&D/S no Brasil tem tido seus recursos significativamente reduzidos desde 2015

Educação e informação em saúde: iniciativas dos núcleos de telessaúde para o enfrentamento da COVID-19

Objetivo: Identificar as iniciativas de teleducação e informações em saúde direcionadas ao enfrentamento da pandemia da COVID-19 oferecidas pelos Núcleos Estaduais de Telessaúde vinculados ao Programa Telessaúde Brasil Redes. Método: Estudo exploratório, transversal, de abordagem quali-quantitativa, na forma de casos múltiplos, usando informações disponíveis nos sítios eletrônicos e mídias sociais. Resultados: Informações e iniciativas de tele-educação voltadas à COVID-19 estavam presentes em 15 dos 23 Núcleos existentes. Verificouse produção de amplo leque de materiais diversos, que incluem cursos a distância, webpalestras, webaulas, cartilhas, infográficos e outros materiais informativos. Destaca-se a existência de forte tendência das ações de teleducação com foco nas redes sociais (YouTube, Facebook, Twitter e Instagram), como coadjuvantes na divulgação de produtos e serviços para a população, fortalecendo a democratização e o acesso a informações úteis para usuários, enfermeiros e profissionais dos serviços de saúde. Conclusão: Acesso à informação de forma ágil e transparente, durante o isolamento social é crítico no enfrentamento da pandemia. A web revela-se como importante ferramenta para obter informações sobre a COVID nos Núcleos de Telessaúde. Os resultados mostram papel relevante a ser exercido pelos serviços de telessaúde, considerando a necessidade de qualificação profissional e de acesso à informação de qualidade demandada pela pandemia