Sustentabilidade da política de acesso a medicamentos anti-retrovirais no Brasil

Abstract

OBJECTIVE:The expense of acquiring antiretroviral drugs in Brazil has given rise to debate about the sustainability of the policy of universal access to AIDS medications, despite the evident benefits. The objective of this study was to analyze the evolution of the Ministry of Health's spending on acquiring antiretroviral drugs from 1998 to 2005, the determining factors and the medium-term sustainability of this policy (2006)(2007)(2008). METHODS:The study on the evolution of spending on antiretrovirals included analysis of their prices, the year-by-year expenditure, the number of patients utilizing the medication, the mean expenditure per patient and the strategies for reducing the prices maintained during this period. To analyze the sustainability of the policy for access to antiretrovirals, the cost of acquiring the drugs over the period from 2006 to 2008 was estimated, along with the proportion of gross domestic product and federal health expenditure represented by this spending. The data were collected from the Ministry of Health, the Brazilian Institute for Geography and Statistics (IBGE) and the Ministry of Planning. RESULTS:The expenditure on antiretrovirals increased by 66% in 2005, breaking the declining trend observed over the period from 2000 to 2004. The main factors associated with this increase were the weakening of the national generics industry and the unsatisfactory results from the process of negotiating with pharmaceutical companies. CONCLUSIONS:The Brazilian policy for universal access is unsustainable at the present growth rates of the gross domestic product, unless the country compromises its investments in other fields.

Food insecurity of HIV/AIDS patients at a unit of outpatient healthcare system in Brasilia, Federal District, Brazil

“…In that same year, the spending on antiretrovirals in the budget of the HIV/AIDS Program reached 68.4%, representing 2.7% of the total amount spent on health 13 . Considering that in the Federal District the monthly cost of an essential food basket is R$45.00, and the annual spending on food per patient with food insecurity would be R$540.00, which represents less than 10% of the spending on antiretroviral therapy.…”

Antiretroviral manufacturers and the challenge of universal access to drugs through the Brazilian National STD/AIDS Program

“…These changes have been confirmed by Brazilian agenda-setters and official government documents 3,4,5 . Other trends have emerged, and the government's supply of ARVs and the various stakeholders have increasingly appeared in the debates in light of this new institutional context.…”

“…Among the basket provided by the National STD/AIDS Program, eight drugs were manufactured domestically. The need to purchase new imported ARVs is due to the emergence of viral resistance, which requires that patients be treated with the so-called second or third-line products, protected by patents 3 , in addition to the incorporation of drugs with lower toxicity, used in the initial regimens. Imported ARVs now account for 81.6% of total expenditure 1 .…”

Indução de endividamento hospitalar na compra de medicamento em situação de monopólio: o caso do mesilato de imatinibe

“…De forma análoga, no enfrentamento da epidemia de AIDS no Brasil, a incorporação de medicamentos ARV patenteados significou um aumento do gasto público, levantou questionamentos sobre a sustentabilidade da política de acesso universal a medicamentos e requereu respostas governamentais para redução de preços, tais como negociação de preços com as empresas detentoras das patentes, ameaça e uso da licença compulsória, entre outros 21,22 . O dilema da incorporação de tecnologia e da situação de monopólio requer melhor planejamento sobre como assegurar o acesso, não só do ponto de vista da disponibilidade, mas também da sustentabilidade financeira, que é assegurada quando os preços são acessíveis.…”