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Medicine manipulation: An alternative to mitigate therapeutic gaps in the Brazilian Unified Health System? PLoS One 2022; 17:e0276785. [DOI: 10.1371/journal.pone.0276785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022] Open
Abstract
Despite the various initiatives carried out in Brazil and in the world, the challenge of offering essential medicines in adequate presentations remains, especially to the public affected by diseases considered neglected and the pediatric population, for whom the therapeutic options remain limited. The main objective of this study was to evaluate the production of manipulated medicines as a strategy to mitigate therapeutic and access gaps to essential medicines within the Brazilian public health system, called the Unified Health System (SUS). The evaluation, carried out between 2020 and 2021, identified, among the medicines considered essential to the Brazilian health context, those unavailable, for which strategies were evaluated to mitigate the identified unavailability, which is conventionally called therapeutic gaps. For 57% (n = 235) of pharmaceutical presentations identified as therapeutic gaps in SUS, manipulation was identified as the best strategy to promote access. Of these presentations, 30% (n = 70) were identified as priorities in the context of patient care and were mainly related to the demands of the pediatric public and those affected by poverty-related diseases. Concerning poverty-related diseases, the absence of evidence on the development of a standard formula for drugs with indication for such diseases was demonstrated. The need for an annual investment of approximately US$74.75 per capita was estimated to offer treatments in adequate presentations to SUS users, which should reflect in the improvement of the quality of life of about 26 thousand people. It was observed that this investment amount corresponds to only 3% of the budget for the purchase of medicines financed exclusively by the Ministry of Health thorugh the Strategic Component of Pharmaceutical Assistance (CESAF) approved for 2021.
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Tamachiro ST, Gonçalves FAR, Simone ALM, Aguiar PM. [Does the pharmaceutical industry interfere in the sustainability of the public health system in Brazil? A reflection on the pressure for the incorporation of medicines]. CAD SAUDE PUBLICA 2022; 38:e00233321. [PMID: 35894368 DOI: 10.1590/0102-311xpt233321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/17/2022] [Indexed: 11/22/2022] Open
Abstract
The objective is to analyze the contribution of the pharmaceutical industry to the sustainability of the Brazilian Unified National Health System (SUS), based on the pressure for the incorporation of medicines. For this purpose, a descriptive study was conducted on requests for the incorporation of medicines sent to Commission for Incorporation of Technologies in the SUS (CONITEC) from 2012 to 2020. Characteristics such as technology indication, economic evaluation, financing component, public consultation, and CONITEC decision were analyzed. The results were compared according to the type of solicitor using statistical tests. 514 requests were analyzed, of which 438 related to incorporation. The pharmaceutical industry accounted for 37% of the requests and 33.5% of the incorporations. Differences were observed between the solicitors regarding the type of economic evaluation and incremental cost-utility ratio value, with half of the industry's demands above the threshold of 3 PIB per capita/QALY. The pharmaceutical industry obtained more contributions in public consultations of its requests and presented concentration of requests for antineoplastic and immunomodulatory agents and for anti-infectious, especially for hepatitis C and HIV. There was also a lower number of demands from the pharmaceutical industry in the Basic and Strategic Components of Pharmaceutical Assistance. Our findings point to the tension between the significant participation of the industry as an applicant, the high mobilization of public consultations, the emphasis on Specialized Component drugs, and CONITEC's resistance to this pressure, with a tendency of greater refusal and greater participation of other solicitors in requests for expansion of use, exclusion, and incorporation of drugs that are less requested by the pharmaceutical industry.
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Affiliation(s)
| | | | | | - Patricia Melo Aguiar
- Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brasil
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Labis da Costa MJ, Nascimento GC, Athie TS, Sales Silva JD, Reis EA, Martin AP, Godman B, Dias Godói IP. Willingness to pay for a hypothetical malaria vaccine in Brazil: a cross-sectional study and the implications. J Comp Eff Res 2022; 11:263-274. [PMID: 35029122 DOI: 10.2217/cer-2021-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Malaria is an infection caused by protozoa of genus Plasmodium, considered the one associated with increasingly large outbreaks. Methods: A cross-sectional study was conducted with residents in the northern region of Brazil on the willingness to pay (WTP) for a hypothetical vaccine against malaria (effective protection of 80%). Results: Of 616 people interviewed, most interviewees were female (61%) and were employed (97%). The median individual maximum WTP for a hypothetical malaria vaccine was US$11.90 (BRL 50). Conclusion: The northern region of Brazil is one of the largest markets for a malaria vaccine due to its epidemiological relevance. Consequently, economic studies will be important to assist in the assessment of the potential price and value of new vaccines.
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Affiliation(s)
- Maria José Labis da Costa
- Instute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará 68.500-000, Brazil
| | - Gesiane Cavalcante Nascimento
- Instute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará 68.500-000, Brazil
| | - Thannuse Silva Athie
- Instute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará 68.500-000, Brazil
| | - Juliana de Sales Silva
- Institute of Studies in Agricultural & Regional Development - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará 68.500-000, Brazil
| | - Edna Afonso Reis
- Departament of Stascs, Exact Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 31270-901, Brazil.,Researcher of the Group (CNPq) for Epidemiological, Economic & Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal do Sul e Sudeste do Pará; Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Antony Paul Martin
- Faculty of Health & Life Sciences, Brownlow Hill, Liverpool L69 3BX, UK.,QC Medica, York, North Yorkshire, UK
| | - Brian Godman
- Department of Pharmacoepidemiology, Institute of Pharmacy & Biomedical Sciences, 161 Cathedral Street, Glasgow G4 0RE, UK.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Isabella Piassi Dias Godói
- Instute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará 68.500-000, Brazil.,Researcher of the Group (CNPq) for Epidemiological, Economic & Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal do Sul e Sudeste do Pará; Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
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de Jesus SM, Santana RS, Leite SN. The organization, weaknesses, and challenges of the control of thalidomide in Brazil: A review. PLoS Negl Trop Dis 2020; 14:e0008329. [PMID: 32760161 PMCID: PMC7410199 DOI: 10.1371/journal.pntd.0008329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The drug thalidomide has resurged in the world market under restrictive conditions for marketing and use. In Brazil, there are still cases of pregnant women using thalidomide even after the implementation of laws that regulate the control of use (Law No. 10.651/2003 and Collegiate Board Resolution No. 11/2011). The objective of this study was to discuss the control of thalidomide use in Brazil, based on a scoping review of the scientific literature, documents, and data from the Ministry of Health. A total of 51 studies and documents related to the following subthemes were selected: (1) organization of access and use of thalidomide in the health system; (2) epidemiological and population characteristics of people affected by leprosy; and (3) occurrence of pregnancy and cases of embryopathy with the use of thalidomide. The results showed that Brazil has no unified information database about thalidomide patients. Furthermore, there is inconsistency in the accreditation of public health centers that dispense this medicine, in a country that has a high consumption of thalidomide in the Unified Health System. A large part of this amount of dispensed medicine is intended for the treatment of erythema nodosum leprosum, mainly in the North, Northeast, and Central-West regions of the country, which are endemic for leprosy. This disease is the only one among the clinical indications of the medicine approved in Brazil that does not have a Clinical Protocol and Therapeutic Guidelines. The control of thalidomide use in Brazil presents historical regulatory failures. These are currently linked to the organization and structure of primary healthcare in the country, as well as to the lack of leadership of the Ministry of Health and National Health Surveillance Agency when it comes to managing the process of control of this use.
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Affiliation(s)
- Soraya Machado de Jesus
- Postgraduate Program in Pharmaceutical Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
| | | | - Silvana Nair Leite
- Postgraduate Program in Pharmaceutical Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Szpak R, Strapasson GC, Böger B, Rattmann YD, Gomes EC. Legal demands of the tiotropium bromide for treatment of chronic obstructive pulmonary disease and their financial impact for the State of Paraná, Brazil. EINSTEIN-SAO PAULO 2019; 18:eGS4442. [PMID: 31576910 PMCID: PMC6905164 DOI: 10.31744/einstein_journal/2020gs4442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022] Open
Abstract
Objective To analyze the legal demands of tiotropium bromide to treat chronic obstructive pulmonary disease. Methods We included secondary data from the pharmaceutical care management systems made available by the Paraná State Drug Center. Results Public interest civil action and ordinary procedures, among others, were the most common used by the patients to obtain the medicine. Two Health Centers in Paraná (Londrina and Umuarama) concentrated more than 50% of the actions. The most common specialty of physicians who prescribed (33.8%) was pulmonology. There is a small financial impact of tiotropium bromide on general costs with medicines of the Paraná State Drug Center. However, a significant individual financial impact was observed because one unit of the medicine represents 38% of the Brazilian minimum wage. Conclusion Our study highlights the need of incorporating this medicine in the class of long-acting anticholinergic bronchodilator in the Brazilian public health system.
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Affiliation(s)
- Renata Szpak
- Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Beatriz Böger
- Universidade Federal do Paraná, Curitiba, PR, Brazil
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Santana RS, de Oliveira Lupatini E, Zanghelini F, de March Ronsoni R, Rech N, Leite SN. The different clinical guideline standards in Brazil: High cost treatment diseases versus poverty-related diseases. PLoS One 2018; 13:e0204723. [PMID: 30332422 PMCID: PMC6192575 DOI: 10.1371/journal.pone.0204723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/13/2018] [Indexed: 01/09/2023] Open
Abstract
Each year, evidence-based clinical guidelines gain more space in the health professionals' practice and in services organization. Due to the scarcity of scientific publications focused on diseases of poverty, the development of well-founded clinical guidelines becomes more and more important. In view of that, this paper aims to evaluate the quality of Brazilian guidelines for those diseases. The AGREE II method was used to evaluate 16 guidelines for poverty-related diseases (PRD) and 16 guidelines for global diseases whose treatment require high-cost technologies (HCD), with the ultimate aim of comparing the results. It was found that, in general, the guideline development quality standard is higher for the HCD guidelines than for the PRD guidelines, with emphasis on the "rigour of development" (48% and 7%) and "editorial independence" (43% and 1%) domains, respectively, which had the greatest discrepancies. The HCD guidelines showed results close to or above international averages, whereas the PRD guidelines showed lower results in the 6 domains evaluated. It can be concluded that clinical protocol development priorities need some redirecting in order to qualify the guidelines that define the healthcare organization and the care of vulnerable populations.
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Affiliation(s)
| | | | - Fernando Zanghelini
- Postgraduate Program in Therapeutic Innovation, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Norberto Rech
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Silvana Nair Leite
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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