O Regimento dos preços dos medicamentos... na farmácia brasileira oitocentista / Regulation of drug prices in nineteenth-century Bazilian pharmacy

Resumo Em 5 de novembro de 1808, dom João de Bragança promulgou um alvará sobre o exercício dos boticários e o preço das drogas e ordenou a criação de um regulamento para taxar o custo dos medicamentos comercializados no Brasil. Publicado pela primeira vez em 1809, o Regimento dos preços dos medicamentos... ganhou novas edições nos anos subsequentes e tornou-se um indispensável instrumento de trabalho para os envolvidos com a feitura e o comércio dos remédios. Este texto situa historicamente e destaca esse documento brevemente explorado pelos pesquisadores da história da farmácia brasileira, visto ter sido uma das primeiras iniciativas do governo luso-brasileiro condizentes com a atividade farmacêutica no Brasil no século XIX.

Abstract On November 5th, 1808, D. João de Bragança issued a license about the practice of druggists and the price of drugs and ordered the creation of a regulation to tax the cost of medicines marketed in Brazil. First published on 1809, the Regimento dos preços dos medicamentos... gained new editions in the following years and became an indispensable working tool for those involved in the making and trading of drugs at this time. This paper situates historically and sheds light on a document briefly explored by the researchers of the history of the Brazilian pharmacy, taking into account that it was one of the first initiatives of the Luso-Brazilian government in line with the pharmaceutical activity in Brazil in the nineteenth century.

Gastos das famílias brasileiras com medicamentos segundo a renda familiar: análise da Pesquisa de Orçamentos Familiares de 2002-2003 e de 2008-2009 / Brazilian family spending on medicines: an analysis of data from the Family Budget Surveys, 2002-2003 and 2008-2009 / Gasto de las familias brasileñas con medicamentos: análisis de encuestas de presupuestos familiares 2002-2003 y 2008-2009

O estudo teve como objetivos investigar os gastos das famílias brasileiras com medicamentos e as desigualdades de renda nestes gastos, segundo categorias de medicamentos. Trata-se de estudo transversal realizado com dados das Pesquisas de Orçamentos Familiares (POF) realizadas em 2002-2003 e 2008-2009. Os valores foram corrigidos pelo Índice Nacional de Preços ao Consumidor Amplo (IPCA). O Índice de Concentração (IC) foi calculado como medida de desigualdade. O gasto médio com medicamentos para o total das famílias correspondeu a R$ 53,54 na POF 20022003 e R$ 59,02 na POF 2008-2009. Os IC revelaram concentração dos gastos entre as famílias de maior renda. A composição destes gastos é diferente conforme a renda das famílias. Entre as de menor renda predominam os gastos com analgésicos, antigripais e anti-inflamatórios. Entre as de maior renda predominam os gastos com medicamentos para diabetes, hipertensão e doenças do coração. Para as famílias de menor renda, apesar da redução do peso do gasto com medicamentos sobre sua renda, este ainda é o principal componente dos gastos com saúde.

This study aimed to investigate spending on medicines by Brazilian families and related income inequalities, according to types of medicines. A cross-sectional study used data from the Family Budget Surveys conducted in 2002-2003 and 2008-2009. Expenditures were corrected according to the Extended National Consumer Price Index (IPCA). The Concentration Index (CI) was calculated as a measure of inequality. Average monthly spending on medicines was BRL 53.54 in the 2002-2003 survey and BRL 59.02 in 2008-2009. CI showed spending concentration in higher-income families. Spending composition varied according to family income. Lower-income families spent predominantly on analgesics, cold medicines, and anti-inflammatory drugs. Higher-income families concentrated their spending on medicines for diabetes and hypertension (and other cardiovascular diseases). From one survey to the next, even though lower-income households reduced the percentage of their budget spent on medicines, the latter still consume a large proportion of their health spending.

El estudio investigó el gasto en medicamentos entre las familias brasileñas y las desigualdades relacionadas con sus ingresos, en relación con los tipos de medicamentos. Se realizó un estudio transversal, con datos de la Encuesta de Presupuestos Familiares (POF), llevada a cabo en 2002-2003 y 2008-2009. Los valores de gasto se ajustaron según el Índice de Precios al Consumo (IPCA). El índice de concentración (IC) se calculó como una medida de la desigualdad. El gasto promedio en medicamentos fue de R$53,54 en la POF 2002-2003 y R$59,02 en la POF 2008-2009. Los IC mostraron una concentración del gasto en las familias de mayores ingresos. La composición del gasto varía según los ingresos familiares. Las familias de menores ingresos gastan sobre todo en analgésicos, medicamentos para el resfriado y antiinflamatorios. Las familias de mayores ingresos concentran su gasto en medicamentos para la diabetes, la hipertensión y otras enfermedades del corazón. Los hogares de menores ingresos redujeron el porcentaje de su presupuesto gastado en medicamentos, pese a que este conserva una parte importante de su gasto en salud.

Desigualdades socioeconômicas nos gastos e comprometimento da renda com medicamentos no Sul do Brasil / Socioeconomic inequalities in expenditures and income committed to the purchase of medicines in Southern Brazil / Desigualdades socioeconómicas en los gastos y comprometimiento de la renta con medicamentos en el Sur de Brasil

OBJETIVO: Descrever as desigualdades socioeconômicas referentes ao uso, gastos e comprometimento de renda com a compra de medicamentos. MÉTODOS: Estudo transversal de base populacional com 1.720 adultos de área urbana de Florianópolis, SC, em 2009. Realizou-se a seleção da amostra por conglomerados e as unidades primárias foram os setores censitários. Investigou-se o uso de medicamentos e os gastos com sua compra nos 30 dias anteriores, por meio de entrevista. Uso, gasto e comprometimento de renda devido a medicamentos foram analisados segundo a renda familiar per capita, a cor da pele auto-referida, idade e o sexo dos indivíduos, ajustado para amostra complexa. RESULTADOS: A prevalência de uso de medicamentos foi de 76,5 por cento (IC95 por cento: 73,8;79,3), maior entre as mulheres e naqueles com maior idade. A média de gastos com medicamentos foi igual a R$ 46,70, com valores mais elevados entre as mulheres, os brancos, os com idade mais elevada e entre os mais ricos. Enquanto 3,1 por cento dos mais ricos comprometeram mais de 15 por cento de seus rendimentos na compra de medicamentos, esse valor chegou a 9,6 por cento nos mais pobres. A proporção de pessoas que tiveram de comprar medicamentos após tentativa fracassada de obtenção pelo Sistema Único de Saúde foi maior entre os mais pobres (11,0 por cento), mulheres (10,2 por cento) e naqueles com maior idade (11,1 por cento). Grande parte dos adultos comprou medicamentos contidos na Relação Nacional de Medicamentos Essenciais (19,9 por cento) ou na Relação Municipal de Medicamentos Essenciais (28,6 por cento), com diferenças significativas segundo sexo, idade e renda. CONCLUSÕES: Existe desigualdade socioeconômica, de idade e de gênero no comprometimento de renda com a compra de medicamentos, com piores condições para os mais pobres, os de maior idade e para as mulheres.

OBJECTIVE: To describe socioeconomic inequalities regarding the use, expenditures and the income committed to the purchase of medicines. METHODS: A cross-sectional population-based study was carried out with 1,720 adults living in the urban area of Florianópolis, Southern Brazil, in 2009. Cluster sampling was adopted and census tracts were the primary sampling units. Use of medicines and the expenditures incurred in their purchase in the past 30 days were investigated through interviews. Use, expenditures and the income committed concerning medicines were analyzed according to per capita family income, self-reported skin color, age and sex, adjusting for the complex sample. RESULTS: The prevalence of medicine use was 76.5 percent (95 percentCI: 73.8; 79.3), higher among women and in older individuals. The mean expenditure on medicine was R$ 46.70, with higher values among women, whites, older individuals and among richer people. While 3.1 percent of the richest committed more than 15 percent of their income to purchasing medicine, that figure reached 9.6 percent in the poorest group. The proportion of people that had to buy medicines after an unsuccessful attempt to obtain them in the public health system was higher among the poor (11.0 percent), women (10.2 percent) and the elderly (11.1 percent). A large part of the adults bought medicines contained in the National List of Essential Medicines (19.9 percent) or in the Municipal List of Essential Medicines (28.6 percent), with significant differences according to gender, age and income. CONCLUSIONS: There is socioeconomic, age and gender inequality in the income committed to the purchase of medicines, with worse conditions for the poor, older individuals and women.

OBJETIVO: Describir las desigualdades socioeconómicas relacionadas con el uso, gastos y comprometimiento de la renta con la compra de medicamentos. MÉTODOS: Estudio transversal de base poblacional con 1.720 adultos de área urbana de Florianópolis, Sur de Brasil en 2009. Se realizó la selección de la muestra por conglomerados y las unidades primarias fueron los sectores censitarios. Se investigó el uso de medicamentos y los gastos con su compra en los 30 días anteriores, por medio de entrevista. Uso, gasto y comprometimiento de renta debido a medicamentos fueron analizados según la renta familiar per capita, el color de la piel auto-referida, edad y el sexo de los individuos, ajustado para muestra compleja. RESULTADOS: La prevalencia del uso de medicamentos fue de 76,5 por ciento (IC95 por ciento:73,8;79,3), mayor entre las mujeres y en aquellos con edad avanzada. El promedio de gastos con medicamentos fue igual a R$ 46,70, con valores más elevados entre las mujeres, los blancos, los de edad más elevada y entre los más ricos. Mientras que 3,1 por ciento de los más ricos comprometieron más de 15 por ciento de sus rendimientos en la compra de medicamentos, ese valor llegó a 9,6 por ciento en los más pobres. La proporción de personas que tuvieron que comprar medicamentos posterior al intento fracasado de obtenerlos por el Sistema Único de Salud fue mayor entre los más pobres (11,0 por ciento), mujeres (10,2 por ciento) y en aquellos con edad avanzada (11,1 por ciento). Gran parte de los adultos compró medicamentos ubicados en la Relación Nacional de Medicamentos Esenciales (19,9 por ciento) o en la Relación Municipal de Medicamentos Esenciales (28,6 por ciento), con diferencias significativas según sexo, edad y renta. CONCLUSIONES: Existe desigualdad socioeconómica, de edad y de género en el comprometimiento de renta con la compra de medicamentos, con peores condiciones para los más pobres, los de edad avanzada y para las mujeres.

Impacto de las medidas de inafectación tributaria en los precios de los medicamentos para el tratamiento de la diabetes / Impact of tax measures inafectación in prices of drugs for the treatment of diabetes

La presente publicación evalúa el impacto de medidas tributarias en los precios de venta de los medicamentos utilizados en el tratamiento de la diabetes, así el monitoreo del comportamiento de los precios de venta de estos medicamentos en el mercado público y privado a nivel nacional.

Measuring medicine prices in Peru: validation of key aspects of WHO/HAI survey methodology / Determinación de los precios de los medicamentos en Perú: validación de aspectos fundamentales del método de encuesta de la OMS/HAI

Objectives: To assess the possibility of bias due to the limited target list and geographic sampling of the World Health Organization (WHO)/Health Action International (HAI) Medicine Prices and Availability survey used in more than 70 rapid sample surveys since 2001. Methods: A survey was conducted in Peru in 2005 using an expanded sample of medicine outlets, including remote areas. Comprehensive data were gathered on medicines in three therapeutic classes to assess the adequacy of WHO/HAI's target medicines list and the focus on only two product versions. WHO/HAI median retail prices were compared with average wholesale prices from global pharmaceutical sales data supplier IMS Health. Results: No significant differences were found in overall availability or prices of target list medicines by retail location. The comprehensive survey of angiotensin-converting enzyme inhibitor, anti-diabetic, and anti-ulcer products revealed that some treatments not on the target list were costlier for patients and more likely to be unavailable, particularly in remote areas. WHO/HAI retail prices and IMS wholesale prices were strongly correlated for higher priced products, and weakly correlated for lower priced products (which had higher estimated retailer markups). Conclusions: The WHO/HAI survey approach strikes an appropriate balance between modest research costs and optimal information for policy. Focusing on commonly used medicines yields sufficient and valid results. Surveyors elsewhere should consider the limits of the survey data as well as any local circumstances, such as scarcity, that may call for extra field efforts.

Objetivos: Evaluar la posibilidad de sesgo debido a la limitación de la lista de referencia y del muestreo geográfico de la encuesta de precios y disponibilidad de medicamentos de la Organización Mundial de la Salud/Health Action International (OMS/HAI) usada en más de 70 muestras de encuestas rápidas desde el 2001. Métodos: En el año 2005, se realizó una encuesta en Perú, con una muestra ampliada de puntos de venta de medicamento, incluso en zonas remotas. Se recogieron datos integrales acerca de los medicamentos de tres clases terapéuticas, con el fin de evaluar la idoneidad de la lista de referencia de medicamentos de la OMS/HAI y el énfasis únicamente en dos versiones del producto. Las medianas de los precios al por menor de la OMS/HAI se compararon con el promedio de precios al por mayor del proveedor de datos mundiales de ventas farmacéuticas IMS Health. Resultados: No se observó ninguna diferencia significativa en la disponibilidad general ni en los precios de los medicamentos de la lista de referencia por localización de venta al por menor. La encuesta integral de los inhibidores de la enzima convertidora de la angiotensina, los antidiabéticos y los productos antiulcerosos reveló que algunos tratamientos que no están en la lista destinataria eran más caros para los pacientes y era más probable que no estuvieran a la venta, sobre todo en las regiones remotas. Los precios al por menor de la OMS/HAI y los precios al por mayor de IMS presentaron una correlación intensa en el caso de los productos de precio más alto, y la correlación fue débil en el caso de los productos de precio más bajo (que tuvieron márgenes de beneficio calculados más altos para el minorista). Conclusiones: El método de la encuesta de la OMS/HAI logra un equilibrio adecuado entre los costos de investigación moderados y la información óptima para la política. El énfasis en los medicamentos de uso frecuente produce unos resultados válidos y suficientes. Los encuestadores de otros...

Disponibilidade no setor público e preços no setor privado: um perfil de medicamentos genéricos em diferentes regiões do Brasil / Availability of generic drugs in the public sector and prices in the private sector in different regions of Brazil

Foi realizado estudo para identificar perfil de preços e disponibilidade de medicamentos segundo tipo de provedor, nas cinco regiões do país, para uma lista de medicamentos utilizados no tratamento de doenças prevalentes na população. Utilizou-se a metodologia de avaliação de preços proposta pela Organização Mundial da Saúde (OMS) pela Ação Internacional para a Saúde (AIS), adaptada para o cenário brasileiro. A análise evidenciou que no setor público há mais medicamentos similares do que genéricos em todas as regiões. Para a maioria dos medicamentos (71,4 por cento) a disponibilidade de genéricos foi menor que 10 por cento. No setor privado, a média do número de diferentes de versões genéricas encontradas nos pontos de venda foi muito inferior ao número de versões existentes no mercado. A análise mostrou correlação positiva entre o número de genéricos comercializados, ou encontrados no ponto de venda, e variação de preços em relação ao preço máximo ao consumidor. Estima-se que medicamentos genéricos estejam competindo em preço entre si e com similares, mas não com medicamentos de referência.

A study to identify availability and prices of medicines, according to type of provider, was conducted in the five regions of Brazil. A list of medicines to treat prevalent diseases was investigated, using the medicines price methodology developed by the World Health Organization and Health Action International, adapted for Brazil. In the public sector, bioequivalent (vis-à-vis reference brand) generics are less available than multisource products. For most medicines (71.4 percent), the availability of bioequivalent generics was less than 10 percent. In the private sector, the average number of different bioequivalent generic versions in the outlets was far smaller than the number of versions on the market. There was a positive correlation between the number of generics on the market, or those found at outlets, and the price variation in bioequivalent generic products, in relation to the maximum consumer price. It is estimated that price competition is occurring among bioequivalent generic drugs and between them and multisource products for the same substance, but not with reference brands.

Dos enfoques sobre los medicamentos y la industria farmacéutica / Two approaches on drugs and the drug industry

Se comparan dos enfoques sobre los medicamentos a partir de la posición que ocupan en la sociedad, la industria farmacéutica mundial y la cubana. Se analizan cinco componentes relacionados con la “cadena del medicamento” y el ambiente en que esta se desarrolla. Los componentes hacen referencia a los siguientes temas: papel de esta industria en el mercado, como espacio de compra-venta de productos y movilización de recursos financieros. Influencia sobre el poder político para generar decisiones que logren mantener e incrementar el mercado. Tratamiento del prescriptor como un “cliente” que es necesario atraer para aumentar las ventas de medicamentos. Atención a los pacientes reales o potenciales como consumidores actuales o futuros, que puede incluso actuar sobre los prescriptores para ampliar el mercado. Estos componentes se analizan en el marco de la actual sociedad mundial globalizada. En contraposición se analizan los propósitos de la industria farmacéutica cubana en la cadena del medicamento en el contexto de una sociedad socialista

Transferring the financial risks of pharmaceutical benefits from a large health care provider in Argentina to a consortium of pharmaceutical companies

OBJECTIVE: The National Institute of Social Services for Retirees and Pensioners (NISSRP) is a nationwide health care financing agency and service provider in Argentina. Among its services, the NISSRP provides outpatient drug coverage to more than 3.3 million beneficiaries, mainly senior citizens and disabled persons. In 1997, to help cope with its rising costs, the NISSRP agreed to transfer the risk for the cost of outpatient medications and cancer-treatment drugs to a consortium of pharmaceutical companies in exchange for a fixed monthly payment. The objective of this study was to determine the impact that this new approach had on three things: (1) the level of expenditures for the medicines that were included in the agreement, (2) the pattern of nonrational prescribing for NISSRP beneficiaries, and (3) this pattern's relationship with macroeconomic variables and the pattern of prescribing for Argentina as a whole. METHODS: We compared outpatient-medicine consumption in 1999 with consumption before the agreement went into effect. RESULTS: The actual amount that NISSRP beneficiaries spent out-of-pocket climbed from US$ 336.13 million in 1996 to US$ 473.36 million in 1999, an increase of almost 41 percent. The nominal amount "spent" by the NISSRP in 1999 was US$ 601.11 million, versus a real amount of US$ 374.75 million in 1996, an "increase" of 60 percent (that increase for the NISSRP was only theoretical since the agreement specified the fixed monthly amount that the NISSRP would have to pay to the pharmaceutical consortium). In contrast with the increased real spending by NISSRP beneficiaries, Argentina's economy remained stable over the assessed period, with the consumer price index even falling by 0.8 percent. We found high levels of nonrational drug use in the NISSRP system in both 1996 and 1999, indicating a serious ongoing problem. CONCLUSIONS: An agreement with pharmaceutical companies, like the one we have described, might add an element of financial predictability for institutions such as the NISSRP. However, such an agreement can easily result in an increased economic burden for health care beneficiaries, and without any improvement in the services that they receive. This type of agreement requires extensive mechanisms for control, follow-up, and updating, and it also risks making nonrational drug prescribing the accepted rule. While perhaps feasible, the requirements for this kind of agreement are actually very difficult to put into...

Atención médica ambulatoria en México: el costo para los usuarios / Ambulatory medical care in Mexico: the cost for users

Objetivo. Analizar los resultados de la Encuesta Nacional de Salud II (ENSA-II), en lo relativo a los costos del proceso de búsqueda y obtención de la atención médica ambulatoria en diferentes instituciones del sector público y privado. Material y métodos. La información se obtuvo a partir de los indicadores de costos de la atención médica que notificó la población de estudio de la ENSA-II. Los costos para el bolsillo del consumidor fueron la variable dependientes, y las independientes, la condición de aseguramiento y el ingreso económico. Las significancia de los niveles de variación se identificó aplicando la prueba de Duncan. Resultados. Los costos en todo el país, en dólares estadunidenses, fueron: transporte, $ 2.20; consulta general, $7,90; medicamentos, $ 9.60, y estudios de diagnóstico, $13.6. El costo promedio total de la atención ambulatoria fue de $22.70. Los hallazgos empíricos permiten sugerir una nueva propuesta de análisis de los costos en salud, tanto directos como indirectos, en que incurren los consumidores de servicios de salud, dichos costos representan una carga importante en relación con el ingreso familiar, situación que se agudiza en el caso de la población no asegurada. Conclusiones. La incorporación de la perspectiva económica en el análisis de los problemas de los sistemas de salud, no debe limitarse a los costos de producción de servicios en que incurren los proveedores, sobre todo si lo que se busca es resolver los problemas de equidad y accesibilidad que actualmente caracterizan a la oferta de servicios médicos en México

Pharmacoeconomics of intravenous antibiotic use in serious infections

A pharmacoeconomic study of 15 antibiotics available in Barbados was performed. The antibiotics studied were amoxycillin/clavulanate, ampicillin/sulbactam, cefazolin, cefotaxime, ceftazidime, ceftriaxone, clindamycin, cloxacillin, cotrimoxazole, gentamicin, imipenem, metronidazole, piperacillin/tazobactam, and vancomycin. The costs of use of these compound were calculated for a five-day course using a formula comprising eight categories: antibiotic purchase cost, maintenance of intravenous access, drug delivery cost, drug monitoring cost, dose readjustment, general monitoring cost, 'sharps' disposal cost and adverse effects. The cost of adverse effects were not included in this study due to lack of accurate data. The total cost of antibiotic use (in U.S. dollars) ranged from $42.52 to $463.73 per five-day course. Generic compound were less expensive ($45.52-$98.23) than brand-name compounds ($106.18 - $463.73). Antibiotic purchase costs accounted for proportions of total costs ranging from 7 to 93 percent. Non-drug costs represented a much greater proportion of total costs of generic compounds. For most compound the non-drug costs were related to the frequency of dosing, but for gentamicin the non-drug costs were relatively higher because of the need for monitoring of serum gentamicin levels. Efficacy and freedom from side-effects will remain the most important determinants in the choice of antibiotic therapy. However, pharmacoeconomic analyses can provide prescribers with the information required to make cost-effective choices for treatment of their patients

Drug supply system, and over all pattern and extent of drug usage in public health care system of state of Bahrain

During the last decade, there has been much concern about the expenditure incurred on pharmaceuticals in public health care system as usually it constitutes for onethird of total expenditure on material purchase of health care system. The present study analyses current status of drug supply system and drug usage pattern in public health care system, ministry of health, state of Bahrain. These analyses revealed some interesting facts such as overall increasing trend on drug expenditure, more use of newly introduced anti-bacterial,anti-ulcer agents, etc'inspite of the many activities already diverted to economize on drug expenditure, it is believed that formation of National Drug Supply System based on policies discussed in this study,can further help to economize on pharmaceutical supply and enhance the overall development process in public health care system of state of Bahrain