Gastos com pagamentos no Programa Aqui Tem Farmácia Popular: evolução entre 2006-2014 / Expenditures with payments in the "Aqui Tem Farmacia Popular" Program: evolution between 2006-2014

Resumo A partir de 2004, o Governo Federal anunciou o "Programa Farmácia Popular do Brasil", para melhorar o acesso da população brasileira aos medicamentos. A vertente "Aqui Tem Farmácia Popular" (ATFP), iniciada em 2006, tem sido a principal responsável pela expansão dessa forma de provisão. Este artigo examinou os dispêndios do Ministério da Saúde com pagamentos de medicamentos aos estabelecimentos credenciados ao Programa ATFP, no período 2006 a 2014. Foram utilizados dados de fontes secundárias, como o Fundo Nacional de Saúde e a Sala de Apoio à Gestão Estratégica e contato direto com o sistema e-SIC. Gastos do ATFP foram mapeados segundo a indicação de uso dos medicamentos, pelas empresas credenciadas, e também comparados ao repasse ministerial dedicado ao financiamento do Componente Básico da Assistência Farmacêutica. No período, foram gastos R$ 7,9 bilhões com o ATFP, com forte padrão de crescimento após a entrada, em 2011, da isenção de copagamento. Medicamentos para tratamento da hipertensão arterial somaram 60% dos gastos, seguido dos antidiabéticos (19%) e dislipidemia (14%). Losartana potássica e sinvastatina obtiveram destaque nos gastos. Os aumentos expressivos nos gastos federais devem ser objeto de monitoramento cuidadoso, já que sustentabilidade financeira é questão fundamental na viabilidade dos sistemas de financiamento de medicamentos.

Abstract In 2004, the federal government has announced a new mechanism to improve the access of the Brazilian population to medicines, called "Programa Farmácia Popular do Brasil". The model named "Aqui Tem Farmácia Popular" (ATFP), started in 2006 with the participation of the private retail pharmacies, has been the main responsible for the expansion of this form of provision. This article examined the expenditures of the Ministry of Health with payments of medicines to accredited private sector pharmacies to the ATFP Program in 2006 to 2014. We used data from secondary sources, such as the National Health Fund, SAGE database and direct contact with the e-SIC system. Were spent BRL 7.9 billion with the ATFP, with strong growth pattern after exemption of copayment, since 2011. Medicines for treatment of hypertension totaled 60% of expenditures, followed by the antidiabetic (19%) and dyslipidemia (14%). Losartan potassium and simvastatin were the major drugs in spending. The significant increases in federal expenditures should be the object of careful monitoring, since financial sustainability is a fundamental question on the viability of the financing systems of medicines.

Gastos da Secretaria Municipal de Saúde do Rio de Janeiro, Brasil, com medicamentos: uma análise do período 2002-2011 / Expenditures on medicines by the Rio de Janeiro Municipal Health Department, Brazil, 2002-2011 / Gastos en medicamentos del Departamento de Salud Municipal de Río de Janeiro, Brasil: un análisis del período 2002-2011

O estudo analisou o comportamento histórico das compras de medicamentos da Secretaria Municipal do Rio de Janeiro, Brasil, entre 2002-2011. Utilizaram-se dados financeiros sobre quantidade anual total adquirida e preço unitário. Calcularam-se o gasto anual por habitante e a proporção das despesas com medicamentos frente aos gastos municipais em saúde. Os gastos foram ajustados pelo Índice de Preços ao Consumidor Amplo para compará-los a 2011. Os medicamentos foram classificados, segundo ambiente de predomínio de uso, em hospitalar ou atenção primária e pelas classes do sistema anatômico-terapêutico-químico da Organização Mundial da Saúde. Os gastos totais ajustados foram de cerca de R$ 575 milhões, com redução ao longo do intervalo analisado. Medicamentos anti-infecciosos e vinculados aos sistemas cardiovascular e nervoso responderam por 55% dos gastos totais. Houve transição dos gastos com medicamentos do ambiente hospitalar para aqueles de uso predominante na atenção primária em saúde. A análise pode potencializar a gestão e sinaliza para necessidade de correção de rumos na política municipal de medicamentos.

This study analyzed time trends in the purchase of medicines by the Rio de Janeiro Municipal Health Department, Brazil, from 2002 to 2011, analyzing data on total annual amounts and unit prices. Annual expenditure per inhabitant and expenditures on medicines as a proportion of total municipal health spending were calculated. Expenditures were adjusted according to the Expanded Consumer Price Index to compare them to 2011. Medicines were classified according to the predominant place of use (in-hospital or primary care) and the WHO Anatomical Therapeutic Chemical classification. Adjusted total expenditures totaled some BRL 575 million, with a decline over the period. Antimicrobials and medicines for the cardiovascular and nervous systems accounted for 55% of total expenditures. There was a shift from in-hospital spending on medicines to those used predominantly in primary care. The analysis can contribute to healthcare management and emphasizes the need to reorient the municipality’s policy for medicines.

El estudio analizó los datos de adquisición de medicamentos del Departamento Municipal de Salud de Río de Janeiro, Brasil, entre 2002-2011. Hemos utilizado los datos financieros que contienen información sobre la cantidad total comprada y el precio por unidad. Se calculó el gasto anual per cápita y la proporción porcentual de los costos de medicamentos, frente a los gastos de salud municipal. Los gastos se han ajustado por el Índice de Precio al Consumidor en su concepto Amplio, para compararlos con 2011. Los medicamentos se clasifican de acuerdo con el uso predominante, entorno hospitalario, o de atención primaria en salud y el sistema de la Organización Mundial de la Salud anatómico-terapéutico-químico. Los gastos totales fueron aproximadamente R$ 575 millones, con una reducción de gastos durante el período analizado. Antiinfecciosos y medicamentos para los sistemas cardiovascular y nervioso representaron el 55% del gasto total, con una transición del hospital a la atención farmacéutica, vinculada a la atención primaria de salud. En este análisis el uso de datos sobre el gasto permitido mejora la gestión y dirección para la corrección de la política municipal.

Cost of medicines & their affordability in private pharmacies in Delhi (India).

Background & objectives: Medicines can account for up to 90 per cent of health care spending by poor people. High costs of medicines contribute to decreased access to healthcare. This study was conducted to assess the cost of medicines and their affordability in the private pharmacies in Delhi, India. Methods: A survey was conducted to assess the costs of prescribed medicines and treatment of community acquired pneumonia (CAP), with medicines purchased from 27 private pharmacies, in Delhi. Affordability of medicines was assessed by comparing the costs of treatment (medicines) to the monthly per capita expenditure (MPCE) on food, minimum monthly and daily wages for different classes of workers. Results: A large variability in the costs of prescriptions was observed (129.37+ 217.99) The cost of treatment of CAP varied from 34.50- 244.75 with azithromycin and 72.20- 277.30 with levofloxacin. The percentage of MPCE on food spent for a prescription was 17.64 per cent for urban and 23.4 per cent for rural population. The percentage of MPCE on food spent for treatment of CAP ranged from 10.11 to 13.42 per cent with azithromycin and 13.28 to 17.61 per cent with levofloxacin. The number of days a worker on minimum daily wages would have to work to enable him to purchase his prescription medicines ranged from 1-17 days, depending on the problem. The cost of treatment of CAP required 1-3 days of work by a daily wage earner, depending on the brand of medicine prescribed. Interpretation & conclusions: The findings of our study show that the costs of medicines are highly variable and not affordable for the economically poor in India. Modifications in National Pharmaceutical Policy need to be done urgently.

Análise dos custos de medicamentos no tratamento das dislipidemias em Ribeirão Preto, SP, Brasil / Analysis of dyslipidemia treatment drug costs in Ribeirão Preto, São Paulo State, Brasil

Fundamentos: As dislipidemias representam importante fator de risco para o desenvolvimento de doençascardiovasculares, comprovado por meio de grandes estudos observacionais.Objetivo: Analisar os custos de utilização de atorvastatina, sinvastatina, bezafibrato e ciprofibrato por indivíduospertencentes ao Programa de Medicamentos Excepcionais do Ministério da Saúde, distribuídos pelo Hospital das Clínicas de Ribeirão Preto, SP, Brasil, em 2007. Métodos: Estudo observacional, descritivo e de carátertransversal. Casuística composta por 332 (31,11%) indivíduos sorteados aleatoriamente dentre 1067 pacientes, de ambos os sexos, encaminhados pelo Sistema Único de Saúde (SUS) e consultórios particulares. Os indivíduos foram entrevistados e seus prontuáriosmédicos analisados. Resultados: Dos 312 pacientes entrevistados, 157 (51%) eram do sexo masculino. A faixa etária variou de 15-63 anos (62,0±12,23 anos). Fizeram uso de estatinas 227 (73,22%) pacientes; 54 (17,42%) de fibratos e 31 (10%)pacientes formavam o grupo-controle. O tratamento do grupo atorvastatina apresentou o maior custo (R$994,69paciente/ano), já no grupo da sinvastatina (R$337,61 paciente/ano) houve maiores gastos com exameslaboratoriais e complementares. No grupo dos fibratos, a categoria de medicamentos foi a que gerou maiorgasto em ambos os grupos. Os pacientes do grupo ciprofibrato apresentaram mais necessidade de exameslaboratoriais e complementares em relação ao grupo bezafibrato.Conclusões: O tratamento com atorvastatina foi o mais oneroso, entretanto, os pacientes apresentaram menor ocorrência de eventos e procedimentos cardiovasculares, além do menor custo com exames laboratoriais.

Generic drug prescribing in central Saudi Arabia: perceptions and attitudes of physicians

Physicians play a key role in generic drug prescribing, but their behavior is affected by many determinants. We examined physician practices and attitudes and other factors influencing the prescription of generic drugs. A self-administered questionnaire was used to collect information from a random sample of physiccians from different settings in central Saudi Arabia. Data were analyzed to describe all variables and test any significant difference between groups of physicians. The study included 772 physicians from different affiliations. The majority of physicians [n=741, 96%] reported that they knew enough about the therapeutic value of generic drugs. The majority [75%] reported that they knew the price differences, and this knowledge helped 72% of them to switch to generic prescription medication. Most physicians [79%] support generic substitution, but they indicated that there are certain cliniccal situations where they prefer to use brand name drugs. Physicians reported receiving visits and samples more frequently from representatives of brand name companies. Physicians did not report a significant difference in pressure from patients to prescribe either generic or brand drugs. Most physicians had a positive attitude towards the government role in assuring the quality of local drug products [80%] and in enforcing physicians to prescribe generic drugs [85%]. Physicians face competing forces to prescribe either brand name or generic drugs. The majority support generic drug substitution. There are multiple factors that support prescription of generic drugs

The economic implications of the use of anti-vascular endothelial growth factor drugs in age-related macular degeneration.

Age-related macular degeneration (ARMD) is the most common cause for visual impairment in the elderly in western countries. Recently several anti-vascular endothelial growth factor (VEGF) drugs like pegaptanib sodium (Macugen), ranibizumab (Lucentis) and bevacizumab (Avastin) are available for use in the management of wet ARMD. A major limitation of these drugs is that they require multiple intravitreal injections, every 4 to 6 weeks interval for a period of 2 years. Moreover, most of these drugs are too expensive for the general masses to afford in developing nations. Avastin, though used "off-label", offers a comparable result at affordable cost, however, long term results are awaited. The drug industry should review the entire pricing policy of these drugs in developing countries like India, and develop affordable alternative compounds. The article reviews the economic burden and affordability issues of these Anti-VEGF drugs in ARMD.

Evolución de la farmacoterapéutica hacia la aplicación racional (Parte 1) / Pharmacotherapy evolution towards rational drug use (Part 1)

base para los medicamentos del futuro. Paralelamente a la síntesis de productos innovadores, la industria farmacéutica, desarrollacopias de aquellos fármacos para los que caduca la protección de sus patentes.El mercado de genéricos, garantiza a los pacientes, un rendimiento clínico de los medicamentos que compiten con el innovador,que no se aparte mas de lo razonable, en cuanto a riesgos y beneficios, del fármaco líder, generando la competencia, una disminuciónde los costos directos de los medicamentos.La OMS recomienda como estrategias para la implementación de Políticas Nacionales de Medicamentos, la promoción de medicamentosgenéricos y esenciales, entendiendo por estos últimos, aquellos que cumplen las características de ser: útiles, eficaces,disponibles y accesibles.El concepto de “Uso Racional de los Medicamentos”,define un proceso que involucra una prescripción, conservación y administraciónadecuada así como disponibilidad oportuna y una adhesión del paciente al tratamiento farmacológico.El uso irracional de los medicamentos es la principal causa de las llamadas “patologías farmacológicas”.La farmacovigilancia, es el sistema de control de calidad de los fármacos por parte de los profesionales, el desarrollo responsablede la misma conlleva a una mejora en la calidad de la prescripción a los pacientes.La formación continua de los profesionales de la salud y el acceso a la información independiente y de rigurosidad académica,son fundamentales para aplicar con éxito los adelantos científicos.

Pharmacology underwent a significant evolution as from the XX century. At present, biotechnology development constitutes thebasis of drugs in the future. In parallel to the synthesis of innovative products,copies of drugs for which patent protection expiresare developed.The generic market guarantees the patient a clinical efficiency of the drug competing with the innovator, which will not differmore than reasonably with the brand-name medication as regards to risks and benefits, encouraging competition and keepingdirect cost down.The WHO recommends the promotion of generic and essential drugs, id est those that prove to be useful, efficient, available, andaccessible, as a strategy for the implementation of Drugs National Policies.The concept of ‘Rational Drug Use’, is defined as a process involving the prescription, preservation and adequate administration,as well as a timely availability and adherence of the patient to the pharmacological treatment.The Irrational use of medication is the main cause of ‘Pharmacological Pathologies’.Pharmacovigilance, is a system of drugs controlcarried out by professionals once the product has been marketed. A responsibledevelopment of this control entails the improvement on the quality of prescription to the patient.A permanent education to health professionals, the access to unbiased information and academic accuracy are crucial elementsfor the successful application of scientific breakthroughs.

Economic evaluation of snake antivenom production in the public system

Snake antivenom, an expensive animal product, is presently the only effective treatment for the consequences of snakebite. In Latin America, antivenoms are mainly produced by public institutions with frequent shortages of the necessary supply. Here, we present an economical analysis of the factors affecting production cost, assuming a basic processing batch of 100 L hyperimmune plasma. Three annual production volumes were considered for two typical production technologies. The components of cost were classified as fixed, variable and semi-variable. We found that in all stages of production, fixed cost represents the major contribution to total cost, and is given essentially by manpower cost, particularly for low production volumes. Our estimation shows that antivenom cost can vary from US$ 2.4 to US$ 25 per 10 mL vial, depending on the production volume, the plasma processing technology used and the titer achieved during the immunization stage. We conclude that interested laboratories and authorities of countries with population at risk should consider the possibility of a joint production to improve the process efficiency, lower the product unitary cost and obtain the necessary supply for their own demand or that of other countries in need

Farmacoeconomía: su importancia / Importance of the studies of pharmacoeconomy

Dada la necesidad de reducir los costos en los servicios de salud, cada vez cobra mayor importancia la farmacoeconomía, la cual es definida como la descripción y análisis de los costos de la terapia con medicamentos, aplicada a los sistemas de salud. La investigación en este aspecto incluye la identificación, cálculo y comparación de costos, riesgos y beneficios de programas, servicios y terapias, y la determinación de opciones que produzcan el mejor resultado de salud acorde con los recursos invertidos. En otras palabras, implica comprar a un costo adecuado, el medicamento que mejor resultado producirá en el paciente y en los servicios de salud. En el presente estudio se define la terminología derivada de esta novedosa disciplina: costo/efectividad, costo/beneficio, costo/utilidad, costo de la enfermedad, minimización de costos. Se abordan algunos aspectos que es necesario no soslayar: la magnitud del costo de una enfermedad varía dependiendo desde el punto de vista de quien efectúa el análisis económico; la falta de relación fija entre los costos médicos y lo que se cobra por ellos; la dificultad para cuantificar beneficios y costos (principalmente los primeros); la especial susceptibilidad a sesgos particulares (además de los inherentes a todo estudio clínico). También se describen 10 pasos básicos para la conducción de un análisis de farmacoeconomía

Impacto económico de la infeción por VIH-SIDA en Venezuela / Economic impact of the HIV-AIDS infection in Venezuela

La terapia antiretroviral altamente eficaz de los pacientes infectados con VIH-1 ha demostrado ser más beneficiosa y menos costosa que el tratamineto de las complicaciones infecciosas y neoplásticas asociadas, especialmente cuando se utiliza precozmente. La accesibilidad al tratamiento para todos los infectados constituye por lo tanto un objetivo primario en la lucha contra ésta epidemia

Los medicamentos antineoplásicos y sus perspectivas en los países del tercer mundo / The antineoplastic drugs and their perspectives in the Third World countries

El cáncer es la segunda causa de muerte de la población en la mayoría de los países del mundo, incluyendo en éstos a algunos países subdesarrollados. Sin embargo, los países desarrollados tienen acceso a la mayoría de los medicamentos antineoplásicos en comparación con el que tienen los países del Tercer Mundo; donde existe una gran diferencia en el nivel de consumo por enfermo. Para que se tenga una magnitud de esta problemática, se realiza una evaluación económica estimada de los casos de cáncer en el Tercer Mundo y los costos promedio de los tratamientos quimioterapéuticos; también se realizan una comparación entre los niveles estimados del consumo actual y el consumo necesario para satisfacer las necesidades prioritarias de los países pobres en materia de medicamentos antineoplásicos. Sobre la base de este panorama, los países subdesarrollados sólo tienen una alternativa que es el autoabastecimiento de sus necesidades a partir de la producción nacional de fármacos para el cáncer. Esto no es más, que la adquisición de una planta productora de formas terminadas de medicamentos a partir de la materia prima importada

Limitacion del costo farmaceutico: Perspectiva del consumidor / The pharmaceutical cost and its limitation: consumer's view

Existe una larga historia de medicamentos y de compromiso de parte de la OMS en este tema; pero se ha visto poco ipacto en la practica que el concepto ha sido asimilado por los individuos. Con los problemas economicos, el interes por los ME (Medicamentos Esenciales) re-nacio incluyendo los paises desarrollados. la industria farmaceutica empieza a entender que sus propios interese, hasta ahora frecuentemente en oposicion con los de los servicios de salud, no son diferentes a largo plazo. Todas las resoluciones de la Asamblea de la Organizacion Mundial de la Salud pueden resumirse en una declaracion general: que los paises tienen que elaborar y implementar una politica nacional de medicamentos esenciales. Planificar es elegir y en el contexto economico preente se debe hacer elecciones y contener la escalada de los presupuestos farmaceuticos por la industria