Smoking, mortality, access to diagnosis, and treatment of lung cancer in Brazil.

INTRODUCTION: Lung cancer (LC) is a relevant public health problem in Brazil and worldwide, given its high incidence and mortality. Thus, the objective of this study is to analyze the distribution of smoking and smoking status according to sociodemographic characteristics and disparities in access, treatment, and mortality due to LC in Brazil in 2013 and 2019. METHOD: Retrospective study of triangulation of national data sources: a) analysis of the distribution of smoking, based on the National Survey of Health (PNS); b) investigation of LC records via Hospital-based Cancer Registry (HCR); and c) distribution of mortality due to LC in the Mortality Information System (SIM). RESULTS: There was a decrease in the percentage of people who had never smoked from 2013 (68.5%) to 2019 (60.2%) and in smoking history (pack-years). This was observed to be greater in men, people of older age groups, and those with less education. Concerning patients registered in the HCR, entry into the healthcare service occurs at the age of 50, and only 19% have never smoked. While smokers in the population are mainly Mixed-race, patients in the HCR are primarily White. As for the initial stage (I and II), it is more common in White people and people who have never smoked. The mortality rate varied from 1.00 for people with higher education to 3.36 for people without education. Furthermore, White people have a mortality rate three times higher than that of Black and mixed-race people. CONCLUSION: This article highlighted relevant sociodemographic disparities in access to LC diagnosis, treatment, and mortality. Therefore, the recommendation is to strengthen the Population-Based Cancer Registry and develop and implement a nationwide LC screening strategy in Brazil since combined prevention and early diagnosis strategies work better in controlling mortality from the disease and continued investment in tobacco prevention and control policies.

Impact of the National Lung Screening Trial (NLST) publication and Medicare Lung cancer screening payment on lung cancer incidence rates: An interrupted time series analysis.

INTRODUCTION: Explore the impact of the Lung Cancer Screening Trial (NLST-September-2011) and the Medicare approval for CT-screening (CT-LCS-AP-February-2015) on lung cancer incidence rates, mortality, and the percentage of early-stage lung cancer diagnosis (ESLCD-T1-T2N0M0). METHODS: Retrospective interrupted time series analysis using SEER-18 database. All individuals with lung cancer (LC) diagnosis from 2006 to 2016 were included. The effect of NLST and CT-AP-2015 on the monthly percentage of early-stage ESLCD was the primary outcome, additionally LC incidence and mortality rates were calculated. The analysis was performed by age, sex, race, marital status, insurance status, and household income. Bivariate and multivariate models were used to identify predictors of ESLCD. RESULTS: The study cohort was composed by 388,207 individuals, 69 years old in average, 46.6 % female, and 81.1 % white. LC incidence and mortality rates declined from 2006 to 2016 without association with NLST-September-2011 and CT-LCS-AP-February-2015. The percentage of ESLCD increased over time for all groups. Overall rates of ESLCD started at 18 % in January-2006 and increased to 25 % by December-2016. The intervention NLST-2011 did not show an impact in the ESLCD while the CT-AP-2015 showed a significant impact in the ESLCD trend (p < 0.001). ESLCD was associated with female, white, insurance, and household incomes above median. Medicare expansion was a significant factor for insured group, married patients and those from households under the median income level. CONCLUSION: Medicare approval for CT screening was found to have a statistically significant effect on the diagnosis of early-stage lung cancer and neither NLST-September-2011 nor CT-AP-2015-February-2015 impacted the incidence nor mortality rates. POLICY SUMMARY: To improve early-stage lung cancer diagnosis, it is vital to invest in health policies to increase Lung Cancer Screening implementation and to reduce disparities in access to diagnosis. Furthermore, policies that facilitate access to diagnosis and treatment are crucial to reduce lung cancer mortality.

Longevity and cost of care: the challenge of a self-managed health plan. / Longevidade e custo da assistência: o desafio de um plano de saúde de autogestão.

This paper aims to analyze the relationship between the cost of health care and the aging of the population assisted by a self-managed plan, reflecting on the ways to address the challenge arising from this conjunction of population demographic changes. This is a descriptive study of the 1997-2016 period based on secondary data from the management operator of the health plan under study and from another administrative database of a self-managing provider with broad nationwide coverage. Older adults (over 60 years) increased 55% during the study period. On the other hand, the so-called "very old" (over 80 years) grew 332.8%. The population above 60 years corresponds to 25.7% of the total, and accounts for 68.8% of expenses. Most of the population covered (84,6%) is located in the State of Rio de Janeiro, which has the highest per capita health care cost in Brazil. We found a relationship between aging of the beneficiary population and increased expenditure. It is imperative to invest in health promotion and disease prevention initiatives as a way of improving the quality of life and financial sustainability of the plan, and define a subsystem that delimits and regulates access to the network and is accepted by the beneficiaries.

O objetivo deste artigo é analisar a relação entre o custo da assistência e o envelhecimento da população assistida por um plano de autogestão, refletindo sobre possibilidades de enfrentamento do desafio advindo dessa conjunção de fatores. Trata-se de um estudo descritivo do período 1997 a 2016, efetivado a partir de dados secundários provenientes da operadora do plano de saúde em estudo, e outro banco administrativo de operadora de autogestão de grande abrangência nacional. Os idosos (mais de 60 anos) aumentaram no período do estudo 55,5%. Já os chamados "muito idosos" (acima de 80 anos) cresceram em quantidade 332,8%. A população acima de 60 anos corresponde a 25,7% do total sendo responsável por 68,8% das despesas. A grande maioria da população atendida (84,6%) está localizada no Estado no Rio de Janeiro, o qual tem o mais alto custo per capita em saúde no País. Foi encontrada relação entre o envelhecimento da população beneficiária e o aumento das despesas. É imperioso investir em iniciativas de promoção da saúde e prevenção de doenças como forma de melhora da qualidade de vida e viabilidade financeira do plano, além de definir um sub-sistema que delimite e discipline o acesso à rede e seja aceito pelos beneficiários.

Hypertension and diabetes treatment affordability and government expenditures following changes in patient cost sharing in the "Farmácia popular" program in Brazil: an interrupted time series study.

BACKGROUND: Increasing medicines availability and affordability is a key goal of Brazilian health policies. "Farmácia Popular" (FP) Program is one of the government's key strategies to achieve this goal. Under FP, antihypertension (HTN) and antiglycemic (DM) medicines have been provided at subsidized prices in private retail settings since 2006, and free of charge since 2011. We aim to assess the impact of sequential changes in FP benefits on patient affordability and government expenditures for HTN and DM treatment under the FP, and examine their implications for public financing mechanisms and program sustainability. METHODS: Longitudinal, retrospective study using interrupted time series to analyze: HTN and DM treatment coverage; total and per capita expenditure; percentage paid by MoH; and patient cost sharing. Analyzes were conducted in the dispensing database of the FP program (from 2006 to 2012). RESULTS: FP has increased its coverage over time; by December 2012 FP covered on average 13% of DM and 11.5% of HTN utilization, a growth of over 600 and 1500%, respectively. The overall cost per treatment to the MoH declined from R$36.43 (R$ = reais, the Brazilian currency) to 18.74 for HTN and from R$33.07to R$15.05 for DM over the period analyzed, representing a reduction in per capita cost greater than 50%. The amount paid by patients for the medicines covered increased over time until 2011, but then declined to zero. We estimate that to treat all patients in need for HTN and DM in 2012 under FP, the Government would need to expend 97% of the total medicines budget. CONCLUSIONS: FP rapidly increased its coverage in terms of both program reach and proportion of cost subsidized during the period analyzed. Costs of individual HTN and DM treatments in FP were reduced after 2011 for both patients (free) and government (better negotiated prices). However, overall FP expenditures by MoH increased due to markedly increased utilization. The FP is sustainable as a complementary policy but cannot feasibly substitute for the distribution of medicines by the SUS.

Retrospective interrupted time series examining hypertension and diabetes medicines usage following changes in patient cost sharing in the 'Farmácia Popular' programme in Brazil.

OBJECTIVES: 'Farmácia Popular' (FP) programme was launched in 2004, expanded in 2006 and changed the cost sharing for oral hypoglycaemic (OH) and antihypertensive (AH) medicines in 2009 and in 2011. This paper describes patterns of usage and continuity of coverage for OH and AH medicines following changes in patient cost sharing in the FP. STUDY DESIGN: Interrupted time series study using retrospective administrative data. METHODS: Monthly programme participation (PP) and proportion of days covered (PDC) were the two outcome measures. The open cohort included all patients with two or more dispensings for a given study medicine in 2008-2012. The interventions were an increase in patient cost sharing in 2009 and zero patient cost sharing for key medicines in 2011. RESULTS: A total of 3.6 and 9.5 million patients receiving treatment for diabetes and hypertension, respectively, qualified for the study. Before the interventions, PP was growing by 7.3% per month; median PDC varied by medicine from 50% to 75%. After patient cost sharing increased in 2009, PP reduced by 56.5% and PDC decreased for most medicines (median 60.3%). After the 2011 free medicine programme, PP surged by 121 000 new dispensings per month and PDC increased for all covered medicines (80.7%). CONCLUSION: Cost sharing was found to be a barrier to continuity of treatment in Brazil's private sector FP programme. Making essential medicines free to patients appear to increase participation and continuity of treatment to clinically beneficial levels (PDC >80%).

Farmácia Popular Program: pharmaceutical market analysis of antihypertensive acting on the renin-angiotensin system medicines.

This paper aims to analyse changes in the retail pharmaceutical market following policy changes in the Farmácia Popular Program (FP), a medicines subsidy program in Brazil. The retrospective longitudinal analyses focus on therapeutic class of agents acting on the renin-angiotensin system. Data obtained from QuintilesIMS (formerly IMS Health) included private retail pharmacy sales volume (pharmaceutical units) and sales values from 2002 to 2013. Analyses evaluated changes in market share following key FP policy changes. The therapeutic class was selected due to its relevance to hypertension treatment. Market share was analysed by therapeutic sub-classes and by individual company. Losartan as a single product accounted for the highest market share among angiotensin II antagonists. National companies had higher sales volume during the study period, while multinational companies had higher sales value. Changes in pharmaceutical market share coincided with the inclusion of specific products in the list of medicines covered by FP and with increases in or exemption from patient copayment.

Farmácia Popular Program: pharmaceutical market analysis of antihypertensive acting on the renin-angiotensin system medicines / Programa Farmácia Popular: análise do mercado farmacêutico de anti-hipertensivos do sistema renina-angiotensina

Abstract This paper aims to analyse changes in the retail pharmaceutical market following policy changes in the Farmácia Popular Program (FP), a medicines subsidy program in Brazil. The retrospective longitudinal analyses focus on therapeutic class of agents acting on the renin-angiotensin system. Data obtained from QuintilesIMS (formerly IMS Health) included private retail pharmacy sales volume (pharmaceutical units) and sales values from 2002 to 2013. Analyses evaluated changes in market share following key FP policy changes. The therapeutic class was selected due to its relevance to hypertension treatment. Market share was analysed by therapeutic sub-classes and by individual company. Losartan as a single product accounted for the highest market share among angiotensin II antagonists. National companies had higher sales volume during the study period, while multinational companies had higher sales value. Changes in pharmaceutical market share coincided with the inclusion of specific products in the list of medicines covered by FP and with increases in or exemption from patient copayment.

Resumo Este artigo visa analisar as mudanças no mercado de varejo farmacêutico, seguindo as alterações de diretiva no Programa Farmácia Popular (FP), que realiza subvenção de medicamentos no Brasil, em parceria pública privada. Foi realizada análise longitudinal retrospectiva dos medicamentos da classe terapêutica dos agentes que atuam sobre o sistema renina-angiotensina. Os dados obtidos do QuintilesIMS incluíram o varejo farmacêutico em termos do volume e valores de vendas de 2002 a 2013. Análises realizadas consideraram intervenções e reformas ocorridas no FP e seu impacto no mercado farmacêutico da classe terapêutica selecionada, devido a sua relevância para o tratamento da hipertensão. Também se examinou o comportamento do mercado tomando por base as empresas farmacêuticas produtoras. Losartan monodroga representou a maior fatia de mercado entre os antagonistas de angiotensina II. Empresas nacionais obtiveram maior volume de vendas durante o período de estudo, enquanto as empresas multinacionais exibiram maior valor de vendas. Mudanças no mercado farmacêutico coincidiram com a inclusão de produtos específicos na lista de medicamentos abrangidos pelo FP e com aumentos ou isenção de copagamento pelos pacientes.

Barriers in household access to medicines for chronic conditions in three Latin American countries.

BACKGROUND: Access to medicines is one of the major challenges in health policy. The high out-of-pocket expenditures on medicines in the Latin American and Caribbean (LAC) region represents important barrier to affordable access to care for NCDs. This paper aim to identify key barriers in access to medicines for household members with a diagnosed chronic condition in three Central America countries. METHODS: This was a cross-sectional analytic study, based on data from three household surveys using a common methodology. We examined associated factors to: (1) seeking care for chronic illness from a trained clinician in the formal health system, and (2) obtaining all medicines sought for the chronic conditions reported. RESULTS: A chronic condition was reported in 29.8 % (827) of 2761 households - 47.0, 30.7 and 11.8 % in Nicaragua, Honduras and Guatemala, respectively. The three main chronic conditions reported were hypertension, arthritis, and diabetes. Seeking care in the formal health system ranged from 73.4 % in Nicaragua to 83.1 % in Honduras, while full access to medicines varied from 71.6 % in Guatemala to 88.0 % in Honduras. The main associated factors of seeking care in the formal health system were geographic location, household head gender, Spanish literacy, patient age, perceived health status, perceived quality of public sector care, household economic level, and having health insurance. Seeking care in the formal health system was the main bivariate associated factor of obtaining full access to medicines (OR: 4.3 95 % CI 2.6 - 7.0). The odds of full access to medicines were significantly higher when the household head was older than 65 years, medicines were obtained for free, households had higher socioeconomic status, and health care was sought in the private sector. CONCLUSIONS: The nature of the health system plays an important role in access to medicines. Access is better when public facilities are available and function effectively, or when private sector care is affordable. Thus, understanding how people seek care in a given setting and strengthening key health system components will be important strategies to improve access to medicines, especially for populations at high risk of poor access.

Stakeholders' perspectives on access-to-medicines policy and research priorities in Latin America and the Caribbean: face-to-face and web-based interviews.

BACKGROUND: This study aims to rank policy concerns and policy-related research issues in order to identify policy and research gaps on access to medicines (ATM) in low- and middle-income countries in Latin America and the Caribbean (LAC), as perceived by policy makers, researchers, NGO and international organization representatives, as part of a global prioritization exercise. METHODS: Data collection, conducted between January and May 2011, involved face-to-face interviews in El Salvador, Colombia, Dominican Republic, and Suriname, and an e-mail survey with key-stakeholders. Respondents were asked to choose the five most relevant criteria for research prioritization and to score policy/research items according to the degree to which they represented current policies, desired policies, current research topics, and/or desired research topics. Mean scores and summary rankings were obtained. Linear regressions were performed to contrast rankings concerning current and desired policies (policy gaps), and current and desired research (research gaps). RESULTS: Relevance, feasibility, and research utilization were the top ranked criteria for prioritizing research. Technical capacity, research and development for new drugs, and responsiveness, were the main policy gaps. Quality assurance, staff technical capacity, price regulation, out-of-pocket payments, and cost containment policies, were the main research gaps. There was high level of coherence between current and desired policies: coefficients of determination (R2) varied from 0.46 (Health system structure; r = 0.68, P <0.01) to 0.86 (Sustainable financing; r = 0.93, P <0.01). There was also high coherence between current and desired research on Rational selection and use of medicines (r = 0.71, P <0.05, R2 = 0.51), Pricing/affordability (r = 0.82, P <0.01, R2 = 0.67), and Sustainable financing (r = 0.76, P <0.01, R2 = 0.58). Coherence was less for Health system structure (r = 0.61, P <0.01, R2 = 0.38). CONCLUSIONS: This study combines metrics approaches, contributing to priority setting methodology development, with country and regional level stakeholder participation. Stakeholders received feedback with the results, and we hope to have contributed to the discussion and implementation of ATM research and policy priorities in LAC.

[Social determinants of exclusion from health services and medicines in three Central American countries]. / Determinantes sociales de la exclusión a los servicios de salud y a medicamentos en tres países de América Central.

OBJECTIVE: Examine the social determinants that affect population behavior with regard to the search for and acquisition of medicines, and their relationship to exclusion from health services based on aggregate data from three Central American countries: Guatemala, Honduras, and Nicaragua. METHODS: A descriptive, observational cross-sectional study was conducted by administration of a household survey. The study sample was selected in accordance with the conglomerate method. Data was analyzed with the SPSS® V.17 program using descriptive statistics, bivariate, multivariate, and principal components analysis (PCA). RESULTS: Although the majority of the persons could access health care, health exclusion (odds ratio [OR] 4.10; 95% confidence interval [95% CI]) was the main determinant of lack of access to medicines. The characteristics of housing (OR 0.747, 95% CI), formal employment of head of the household (OR 0.707, 95% CI), and socioeconomic status of the household (OR 0.462, 95% CI) were also important determinants of lack of access to medicines. CONCLUSIONS: The phenomena of lack of access to health services and medicines are not independent from one another. It was corroborated that the health system, as an intermediate social determinant of health, is an important factor for improvement of access to medicines. Public policies that aim to achieve universal coverage should consider this relationship in order to be effective.

Determinantes sociales de la exclusión a los servicios de salud y a medicamentos en tres países de América Central / Social determinants of exclusion from health services and medicines in three Central American countries

OBJETIVO: Examinar los determinantes sociales que afectan la conducta de la población en relación con la búsqueda y obtención de medicamentos, y su relación con la exclusión de los servicios de salud para datos agregados de tres países de América Central: Guatemala, Honduras y Nicaragua. MÉTODOS: Estudio observacional descriptivo de corte transversal, mediante la aplicación de una encuesta de hogares. La muestra del estudio se seleccionó de acuerdo al método de conglomerados. Los datos fueron analizados con el programa SPSS® V.17, utilizando estadística descriptiva y análisis bivariado, multivariado y por componentes principales (ACP). RESULTADOS: Aunque la mayoría de las personas pudo acceder a la atención en salud, la exclusión en salud (razón de probabilidades [RP] 4,10; intervalo de confianza de 95% [IC95%]) fue el principal determinante de la falta de acceso a los medicamentos. Las características de la vivienda (RP 0,747, IC95%), la formalidad del empleo del jefe(a) de hogar (RP 0,707, IC95%) y las condiciones socioeconómicas del hogar (RP 0,462, IC95%) fueron también importantes determinantes de la falta de acceso a los medicamentos. CONCLUSIONES: Los fenómenos de la falta de acceso a servicios de salud y a medicamentos no son independientes entre sí. Se corroboró que el sistema de salud, como determinante social intermediario de la salud, es un factor importante para la mejora del acceso a medicamentos. Las políticas públicas orientadas a alcanzar la cobertura universal deben contemplar esta relación para ser eficaces.

OBJECTIVE: Examine the social determinants that affect population behavior with regard to the search for and acquisition of medicines, and their relationship to exclusion from health services based on aggregate data from three Central American countries: Guatemala, Honduras, and Nicaragua. METHODS: A descriptive, observational cross-sectional study was conducted by administration of a household survey. The study sample was selected in accordance with the conglomerate method. Data was analyzed with the SPSS® V.17 program using descriptive statistics, bivariate, multivariate, and principal components analysis (PCA). RESULTS: Although the majority of the persons could access health care, health exclusion (odds ratio [OR] 4.10; 95% confidence interval [95% CI]) was the main determinant of lack of access to medicines. The characteristics of housing (OR 0.747, 95% CI), formal employment of head of the household (OR 0.707, 95% CI), and socioeconomic status of the household (OR 0.462, 95% CI) were also important determinants of lack of access to medicines. CONCLUSIONS: The phenomena of lack of access to health services and medicines are not independent from one another. It was corroborated that the health system, as an intermediate social determinant of health, is an important factor for improvement of access to medicines. Public policies that aim to achieve universal coverage should consider this relationship in order to be effective.

Access to medicines for acute illness in middle income countries in Central America / Acesso a medicamentos para doencas agudas em paises de renda media da America Central / Acceso a medicamentos para enfermedades agudas en paises de renta media de America Central

OBJECTIVE : To analyze the main predictors of access to medicines for persons who experienced acute health conditions. METHODS : This was a cross-sectional analytic study, based on data from household surveys. We examined the predictors of: (1) seeking care for acute illness in the formal health care system and (2) obtaining all medicines sought for the acute condition. RESULTS : The significant predictors of seeking health care for acute illnesses were urban geographic location, head of household with secondary school education or above, age under 15, severity of illness perceived by the respondent, and having health insurance. The most important predictor of obtaining full access to medicines was seeking care in the formal health care system. People who sought care in the formal system were three times more likely to receive all the medicines sought (OR 3.0, 95%CI 2.3;4.0). For those who sought care in the formal health system, the strongest predictors of full access to medicines were seeking care in the private sector, having secondary school education or above, and positive perceptions of quality of health care and medicines in public sector health facilities. For patients who did not seek care in the formal health system, full access to medicines was more likely in Honduras or Nicaragua than in Guatemala. Urban geographic location, higher economic status, and male gender were also significant predictors. CONCLUSIONS : A substantial part of the population in these three countries sought and obtained medicines outside of the formal health care system, which may compromise quality of care and pose a risk to patients. Determinants of full access to medicines inside and outside the formal health care system differ, and thus may require different strategies to improve access to medicines.  .

OBJETIVO : Analisar os principais preditores de acesso a medicamentos em condições agudas de saúde. MÉTODOS : Estudo transversal analítico, baseado em inquérito domiciliar realizado em Nicarágua, Honduras e Guatemala. Foram identificados os preditores de: procurar cuidados para a condição aguda no sistema formal de saúde e obter todos os medicamentos procurados para a condição aguda. Os dados foram analisados com SPSS ® v.17, usando estatísticas descritivas e regressão logística multivariada. RESULTADOS : Houve autorrelato de doença aguda em 48,3% dos 2.761 domicílios pesquisados, sendo 59,0% em Nicarágua, 56,2% em Honduras e 30,9% na Guatemala. Indivíduos com doença aguda e pior percepção da gravidade da doença ou menores de 15 anos com seguro saúde tiveram maior chance de procurar cuidado. O acesso a medicamentos está fortemente correlacionado com a busca de cuidado, e a obtenção de todos os medicamentos necessários foi três vezes maior para aqueles que buscaram o sistema formal de saúde (OR 3,0; IC95% 2,3;4,0). Procurar o setor privado, ter alto nível educacional e percepção positiva sobre a qualidade do cuidado e dos medicamentos aumentam a chance de acesso pleno a medicamentos dentro do sistema de saúde. Para os pacientes que não procuraram o setor formal, o acesso pleno aos medicamentos foi mais provável em Honduras ou Nicarágua. Outros importantes preditores incluem localização urbana, maior status econômico e ser do sexo masculino. CONCLUSÕES : Parte da população nos três países obteve medicamentos fora do sistema formal de saúde, o que pode representar risco aos pacientes. Determinantes do acesso pleno a medicamentos, dentro e fora do sistema formal de saúde, foram distintos e assim ...

OBJETIVO : Analizar los principales predictores de acceso a medicamentos en condiciones agudas de salud. MÉTODOS : Estudio transversal analítico, basado en pesquisa domiciliar realizada en Nicaragua, Honduras y Guatemala. Se identificaron los predictores de: buscar cuidados para la condición aguda en el sistema formal de salud y obtener todos los medicamentos buscados para la condición aguda. Los datos fueron analizados con SPSS ® v.17 usando estadísticas descriptivas y regresión logística multivariada. RESULTADOS : Hubo auto relato de enfermedad aguda en 48,3% de los 2.761 domicilios investigados, siendo 59,0% en Nicaragua, 56,2% en Honduras y 30,9% en Guatemala. Individuos con enfermedad aguda y peor percepción de la gravedad de la enfermedad o menores de 15 años con seguro salud tuvieron mayor chance de buscar cuidado. El acceso a medicamentos está fuertemente correlacionado con la búsqueda de cuidado, y la obtención de todos los medicamentos necesarios fue tres veces mayor en aquellos que buscaron el sistema formal de salud (OR 3,0; IC95% 2,3;4,0). Procurar el sector privado, tener alto nivel educativo y percepción positiva sobre la cualidad de cuidado y de los medicamentos aumentan el chance de acceso pleno a medicamentos dentro del sistema de salud. Para los pacientes que no buscaron el sector formal, el acceso pleno a los medicamentos fue más probable en Honduras o Nicaragua. Otros importantes predictores incluyen localización urbana, mayor estatus económico, y ser del sexo masculino. CONCLUSIONES : parte de la población en los tres países obtuvo medicamentos fuera del sistema formal de salud, lo que puede representar riesgo para los pacientes. Determinantes del acceso pleno a los medicamentos, dentro y fuera del sistema formal de salud, fueron distintos y así podrán exigir diferentes estrategias para mejorar el acceso ...

Dimensões e determinantes do acesso a medicamentos em três países da América Central / Dimensions and determinants of access to drugs in three Central American countries

Se tem feito um grande esforço para estabelecer medidas operacionais, comvistas a permitir a verificação do avanços das políticas de promoção do acesso a medicamentos no mundo. Nesse sentido, a OPS conduziu nas Américas o pesquisa sobre “Estudio del impacto de la Exclusión de la Atención de la Salud sobre el Acceso a los Medicamentos en Honduras, Guatemala y Nicaragua”, aqui denominado estudofonte, foi tomado como base secundária. Após a revisão da literatura científicainternacional acerca da conceituação e mensuração do acesso aos medicamentos, foramanalisados os principais determinantes da busca de cuidado e do acesso aosmedicamentos para problemas agudos de saúde e para doenças crônicas nãotransmissíveis usando o estudo fonte como base secundária de dados. Na primeira etapa, após a revisão evidenciou-se que não há consenso sobre o conceito de acesso a medicamentos, apontando a necessidade de refletir sobre o tema, avançando naelaboração de padrões para a operacionalização do conceito de acesso a medicamentos, visando viabilizar com clareza seu alcance e sua medição. A busca de cuidado foi o principal determinante para o acesso pleno tanto para as condições agudas quanto nasenfermidades crônicas. As variáveis presentes no estudo se mostraram adequadas para descrever o acesso a medicamentos no nível domiciliar, e os modelos pertinentes para aidentificação dos determinantes, tanto para a condição aguda, quanto para a crônica, corroborando os pressupostos do presente estudo. As condições demográficas e socioeconômicas da população foram evidenciadas como determinantes do acesso a medicamentos tanto para as condições crônicas quando nas condições agudas. Os resultados encontrados contribuíram para compreender as barreiras ao acesso a medicamentos tanto na enfermidade crônica quanto nas situações agudas, e o uso destes resultados se fazem úteis para o desenvolvimento de estratégias adequadas para melhorar o acesso aos medicamentos nos países em desenvolvimento.

Preços e disponibilidade de medicamentos no Programa Farmácia Popular do Brasil / Precios y disponibilidad de medicamentos en el Programa Farmacia Popular de Brasil / Medicine prices and availability in the Brazilian Popular Pharmacy Program

OBJETIVO: Analisar o desempenho do Programa Farmácia Popular do Brasil perante os setores público e privado, em relação a: disponibilidade, preço e custo, para o paciente, de medicamentos para hipertensão e diabetes. MÉTODOS: Foi utilizada a metodologia desenvolvida pela Organização Mundial da Saúde em conjunto com a Ação Internacional para Saúde, para comparação de preços e disponibilidade de medicamentos. A pesquisa foi aplicada em maio de 2007, em estabelecimentos de diferentes setores [público, privado e as modalidades própria (FPB-P) e expansão (FPB-E) do Programa], em 30 municípios do Brasil. Os quatro medicamentos analisados foram: captopril 25mg e hidroclorotiazida 25mg, para hipertensão, e metformina 500mg e glibenclamida 5mg, para diabetes. RESULTADOS: O FPB-E apresentou maior disponibilidade de medicamentos e o setor público, a menor. Tanto no setor público quanto na FPB-P o percentual de disponibilidade de similares foi maior que o de genéricos...

OBJECTIVE: To analyze the performance of the Programa Farmácia Popular do Brasil (FPB - Brazilian Popular Pharmacy Program) in the public and private sectors, in terms of availability and cost of medicines for hypertension and diabetes. METHODS: The methodology developed by the World Health Organization, in partnership with the Health Action International, was used to compare medicines prices and availability. This study was performed in May 2007, in different sectors (public, private and the Program's government-managed [FPB-P] and private-sector-managed [FPB-E] categories), in 30 cities in Brazil. A total of four medicines were analyzed: captopril 25mg and hydrochlorothiazide 25mg for hypertension; and metformin 500mg and glibenclamide 5mg for diabetes. RESULTS: FPB-E showed greatest medicine availability, while the public sector the lowest. The percentage of availability of similar medicines was higher than that of generic medicines, both in the public sector and in the FPB-P...

OBJETIVO: Analizar el desempeño del Programa Farmacia Popular de Brasil frente a los sectores público y privado, con relación a: disponibilidad, precio y costo para el paciente, de medicamentos para hipertensión y diabetes. MÉTODOS: Fue utilizada la metodología desarrollada por la Organización Mundial de la Salud en conjunto con la Acción Internacional para Salud, para comparar los precios y la disponibilidad de medicamentos. La investigación fue aplicada en mayo de 2007, en establecimientos de diferentes sectores [público, privado y las modalidades propia (FPB-P) y expansión (FPB-E) del Programa], en 30 municipios de Brasil. Los cuatro medicamentos analizados fueron: captopril 25 mg e hidroclorotiazida 25 mg, para hipertensión, y metformina 500 mg y glibenclamida 5 mg, para diabetes. RESULTADOS: El FPB-E presentó mayor disponibilidad de medicamentos y el sector público, la menor. Tanto en el sector público como en la FPB-P el porcentaje de disponibilidad de similares fue mayor que el de los genéricos...

Medicine prices and availability in the Brazilian Popular Pharmacy Program.

OBJECTIVE: To analyze the performance of the Programa Farmácia Popular do Brasil (FPB - Brazilian Popular Pharmacy Program) in the public and private sectors, in terms of availability and cost of medicines for hypertension and diabetes. METHODS: The methodology developed by the World Health Organization, in partnership with the Health Action International, was used to compare medicines prices and availability. This study was performed in May 2007, in different sectors (public, private and the Program's government-managed [FPB-P] and private-sector-managed [FPB-E] categories), in 30 cities in Brazil. A total of four medicines were analyzed: captopril 25mg and hydrochlorothiazide 25mg for hypertension; and metformin 500mg and glibenclamide 5mg for diabetes. RESULTS: FPB-E showed greatest medicine availability, while the public sector the lowest. The percentage of availability of similar medicines was higher than that of generic medicines, both in the public sector and in the FPB-P. Comparison of prices among sectors showed a lower purchase price in the FPB-E, followed by the FPB-P. The FPB-E charged prices that were over 90% cheaper than those in the private sector. The number of working days required to obtain treatment for hypertension and diabetes were fewer in the FPB-E. CONCLUSIONS: The lower availability found in the public sector could be one of the reasons for the migration of users from the public sector to the FPB. The high prices in the private sector also contribute for this Program to be an alternative of medicine access in Brazil.

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

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%), the availability of bioequivalent generics was less than 10%. 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.

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.