Farmacoeconomia: gastos com análogos de insulina adquiridos por meio de judicialização em um município do estado do Pará, Brasil, no ano de 2016 / Pharmacoeconomics: expenses with analogues of insulin acquired by judicialization in a county from the state of Pará, Brazil, in 2016

Objetivo: Analisar os gastos com insulinas análogas de ação rápida e longa, no município de Belém/PA, no ano de 2016. Métodos: Trata-se de um estudo descritivo, quantitativo de farmacoeconomia, relacionado aos custos de insulinas análogas. A pesquisa foi realizada na Secretária Municipal de Saúde de um município do estado do Pará, por meio da análise das notas de empenho referentes à aquisição de insulinas análogas no ano de 2016. Os dados foram tabulados no Microsoft® Excel 2010, no qual também foram geradas tabelas e gráficos para melhor interpretação das informações coletadas. A presente pesquisa não envolveu a participação de seres humanos e nem a utilização de dados secundários, por isso não houve a necessidade de submissão ao Comitê de Ética em Pesquisa (CEP). Resultados: Durante o ano de 2016, foram disponibilizadas 15 variedades de apresentação de análogos de insulinas. Neste ano, foram realizadas 10 compras de insulinas comprovadas por meio de empenho, resultando num total de 30.450 frascos de insulina, que gerou uma despesa extra de R$ 1.857.778,00 ao município. Em relação à quantidade comprada e ao custo de cada insulina análoga, a insulina Glargina liderou o ranking em ambas as variáveis, obtendo 12.650 frascos comprados e custo total de R$ 967.970,00. Conclusão: Mesmo com a recente inclusão nas listas-padrão de algumas insulinas análogas que devem ser disponibilizadas pelo Sistema único de Saúde (SUS), essa ação ainda não ocorre de maneira efetiva no território brasileiro, evidenciado pelos gastos significativos com a compra de insulinas análogas por meio de judicialização.

Objective: To analyze the costs of fast and long-acting analogues of insulin in Belém/PA, from 2016. Methods: This is a descriptive and quantitative study of pharmacoeconomics, related to the analogues of insulins cost. The research was realized at the Municipal Health Secretary from a county in the state of Pará, through analysis of the commitment notes regarding the acquisition of analogous of insulins from the year of 2016. The data were charted in Microsoft® Excel 2010, which also generated another's tables and graphs for the information collected better interpretation. The present research did not involve the human beings participation or even use of secondary data, so there was no need to submit to the Research Ethics Committee (REC/CEP). Results: During the year 2016, 15 presentation varieties of analogous of insulin were made available. This same year, 10 purchases of proven insulin were performed through a commitment, resulting in a total of 30.450 bottles of insulin, which generated an extra expense of R$ 1,857.778.00 to the county. Regarding the quantity purchased and the cost of each analogous insulin, Glargina insulin led the ranking in both variables, obtaining 12.650 bottles purchased and R$ 967,970.00 of total cost. Conclusion: Despite the recent inclusion at the standard lists of some analogues of insulins that should be made available by the Single Health System (SHS/SUS), this action still does not occur effectively in Brazil, evidenced by the significant expenses with the purchase of analogues of insulins through a judicial process (public civil action).

Cost-effectiveness of insulin analogs from the perspective of the Brazilian public health system

ABSTRACT Human insulin is provided by the Brazilian Public Health System (BPHS) for the treatment of diabetes, however, legal proceedings to acquire insulin analogs have burdened the BPHS health system. The aim of this study was to perform a cost-effectiveness analysis to compare insulin analogs and human insulins. This is a pharmacoeconomic study of cost-effectiveness. The direct medical cost related to insulin extracted from the Ministry of Health drug price list was considered. The clinical results, i.e. reduction in glycated hemoglobin (HbA1c), were extracted by meta-analysis. Different scenarios were structured to measure the uncertainties regarding the costs and reduction in HbA1c. Decision tree was developed for sensitivity of Incremental Cost Effectiveness Ratio (ICER). A total of fifteen scenarios were structured. Given the best-case scenario for the insulin analogs, the insulins aspart, lispro, glargine and detemir showed an ICER of R$ 1,768.59; R$ 3,308.54; R$ 11,718.75 and R$ 2,685.22, respectively. In all scenarios in which the minimum effectiveness was proposed, lispro, glargine and detemir were dominant strategies. Sensitivity analysis showed that the aspart had R$ 3,066.98 [95 % CI: 2339.22; 4418.53] and detemir had R$ 6,163.97 [95% CI: 3919.29; 11401.57] for incremental costs. We concluded there was evidence that the insulin aspart is the most cost-effective.