Consequências da judicialização das políticas de saúde: custos de medicamentos para as mucopolissacaridoses

Abstract

O estudo analisa os gastos da judicialização de medicamentos para a mucopolissacaridose (MPS), uma doença rara, de alto custo, fora da política de assistência farmacêutica e com benefício clínico. O levantamento de dados foi realizado nos arquivos de 196 dossiês que determinou que o Ministério da Saúde fornecesse medicamentos no período entre 2006 e 2010, e nos registros administrativos e contábeis do Ministério da Saúde. A análise identifica sujeição do governo brasileiro a monopólios de distribuição de medicamentos e, consequentemente, perda de sua capacidade de administrar compras. Também identifica que a imposição da aquisição imediata e individualizada impede a obtenção de economias de escala com a compra planejada de maiores quantidades de medicamento, e impõe dificuldades logísticas para o controle das quantidades consumidas e estocadas. Conclui-se que a judicialização decorre da ausência de uma política clara do sistema de saúde para doenças raras em geral, e tem como consequência gastos acima do necessário para o tratamento.

Studies published in indexed journals on lawsuits for medicines in Brazil: a systematic review

“…The data refer to studies done in the states of Pernambuco 5 , Rio Grande do Sul 2,6 , Minas Gerais 7,8 , Rio de Janeiro 9,10,11,12 , and São Paulo 13,14,15,16,17 , besides one article that collected data directly from the Ministry of Health in Brasilia 18 . The studies that examined the most lawsuits (between 2,000 and 2,927 cases) were done in the states of São Paulo, Rio de Janeiro, and Santa Catarina 7,12,14,16,19 .…”

“…Two articles dealt specifically with lawsuits for rare diseases 6,18 , and one focused on claims filed by cancer patients 17 . Of the five studies that examined more than 2,000 lawsuits, only one verified whether the origin of the supply was from the public or private sector, and whether the drugs were registered with the Brazilian National Health Surveillance Agency (ANVISA) 14 , and three studies analyzed whether the drugs claimed through lawsuits were part of official government lists 12,14,19 .…”

“…In these same studies with the most lawsuits, one studied a period of more than ten years 7 and the others covered from one to three years 12,14,16,19 . Two of these studies were by the same research group and published analyses from the same sample in different time periods and with different analyses 14,16 .…”

“…• On page 5, second column, first paragraph, line 10, where the text reads: ...and three studies analyzed whether the drugs claimed through lawsuits were part of official government lists 12,14,19 ... it should read: ...three studies 12,14,18 analyzed whether the drugs claimed through lawsuits were part of official government lists... ...In eleven studies 2,6,7,8,9,10,11,15,17,19,20 , the authors avalyzed the most frequent therapeutic indications.…”

“…...In eleven studies 2,6,7,8,9,10,11,15,17,19,20 , the authors avalyzed the most frequent therapeutic indications. Diabetes mellitus and hypertension led the list (n = 6 and 4, respectively), followed by chronic obstructive pulmonary disease (COPD), chronic hepatitis C, cancer (n = 3), rheumatoid arthritis and kidney disease (n = 2)...…”