Bacilloscopy for leprosy in Brazil's public health system between 2013 and 2022

The MONALEESA-7 trial compared ribociclib plus endocrine therapy (ET) with placebo as first-line treatment of advanced luminal/HER2-negative breast cancer (ABC) in premenopausal and perimenopausal women (age <50 years) and showed significant benefits to progression-free survival and overall survival. This study aimed to compare the cost-effectiveness of ribociclib + ET versus ET alone in patients with ABC from the perspective of the Brazilian public national health system. We calculated the incremental cost-effectiveness ratio (ICER) using a Markov model with progression-free survival, post-progression survival, and death states. We expressed ICER as incremental costs per progression-free life-year (PFLY) and quality-adjusted life-year (QALY) gained in a 10-year time horizon. We used parametric survival distributions fit to MONALEESA-7 data to generate survival distributions for progression-free and post-progression survival. The largest British preference study in breast cancer served as the basis to estimate health-state utilities. We estimated direct costs (ABC treatment, follow-up, monitoring, and adverse events) using Brazilian-specific values from public sources. An expert consensus panel determined the resource patterns required. We applied annual discounts of 5% to costs and QALYs. Ribociclib + ET resulted in an incremental gain of 1.03 PFLYs and 0.80 QALYs at a cost of $37,319.31. The ICER of ribociclib + ET versus ET was $36,379.41 per PFLY gained and $46,590.79 per QALY gained. In deterministic sensitivity analysis, results were primarily affected by the annual discount rate, followed by the cost of ribociclib. In probabilistic sensitivity analysis, simulations agreed with the base-case. Ribociclib increased PFLYs and QALYs in patients with HR+/HER2- ABC when added to ET. Because Brazil does not have a formally defined cost-effectiveness threshold, other domains need to be considered for incorporation decisions, such as disease burden and humanistic impact on this young, economically active population. These findings may be useful in discussions for incorporation of ribociclib into the Brazilian public health system.

This study is aligned with other research that critically analyzes the way sickle cell disease has been framed as a global burden to health since the 2000s. To this end, the study investigates Brazilian attempts to establish structural technical cooperation programs in health with Benin, Ghana, and Senegal, based on the comprehensive care model offered to people with sickle cell disease under its public health system, the Unified Health System (Sistema Único de Saúde, SUS). This international initiative is part of a broader drive to disseminate internationally the values of universalism and equality, enshrined in the Brazilian health reform and embodied in SUS.

The BRICS countries are keen to provide health services universally, but given the bewildering choice of new medicines and medical devices, health technology assessment has become an essential tool. South Africa has set itself the goal of providing universal coverage of health-care services by 2025, with its National Health Insurance system that is being rolled out over 14 years. The challenges are familiar in other low and middle-income countries that have set themselves similar ambitious goals. For Malebona Precious Matsoso, the director-general of the South African National Department of Health, the success of the project relies on improving the scope and quality of public services, and on making the most of scarce public resources. will play a major role in improving outcomes and the delivery of services, but can be costly, she writes in the South African Medical Journal in March 2013. A rigorous, independent mechanism to assess the cost-effectiveness of new technology is required, building on experience of other In 2011 WHO Member States committed themselves to developing their health financing systems as the basis for universal health coverage and this goal has been underscored by the BRICS countries --Brazil, the Russian Federation, India, China and South Africa--at their annual health ministers' meetings since 2011. These countries are realizing that without a system to weigh up the benefits and costs of medicines, vaccines, diagnostics and new equipment, costs can soon spiral out of control. That is where health technology assessment comes in. [ILLUSTRATION OMITTED] Health technology assessment is a way of weighing up the benefits and costs of two or more health-care options to see which is the best in the given situation. Health technology has its roots in the wealthy industrialized countries, but in the last two decades the approach has taken root in many emerging and developing economies. The International Network of Agencies for Health Technology Assessment has 57 members in 32 countries. One of these is Brazil--a country struggling to maintain universal provision of healthcare services, since it rolled out its unified health system (SUS) in 1988, given that new health-care options are constantly coming on to the market. Among middle-income countries, Brazil is a pioneer in the field. It established its health technology unit in 2003. The National Commission for the Incorporation of Technologies, known by its acronym Conitec, produces studies comparing technologies as well as guidelines for clinical practice and lists of drugs to be reimbursed, according to Conitec President Dr Clarice Alegre Petramale. Conitec has done hundreds of evaluations, she says. About 65% of them have been of new drugs and the rest of medical devices. As a result, 85 new technologies were adopted by Brazil's public health system over the last two years. India has rolled out its National Health Mission aiming for universal health coverage, while China has set itself the goal of achieving universal coverage of health-care services by 2020. Both countries--the two most populous in the world--regard technology assessment activities as vital to supporting this goal. For the Russian Federation, the challenge has been to maintain the universal access to health services already provided. Dr Svetlana Axelrod, Deputy Director of the Department of International Cooperation and Public Relations at the health ministry in Moscow, says: Our health technology assessment system evaluates a range of new health technologies, including medicines, equipment, quality assurance systems and cell technologies. Rational and efficient use of financial resources are vital for the efficiency of the health system, its organization and management, Axelrod says. Adriana Velazquez Berumen, from the WHO medical devices unit in the Essential Medicines and Health Products Department, agrees: It's about getting the data and evidence on technologies required for better health service delivery. …

O artigo apresenta uma análise retrospectiva dos últimos dez anos de governo federal e da saúde pública no Brasil. Inicialmente trabalha a história da construção do Sistema Único de Saúde (SUS) e seus principais protagonistas. Depois analisa o SUS, seus objetivos, funções, diretrizes e princípios. Finalmente, faz a análise do governo progressista brasileiro dos dez últimos anos em relação à saúde. Conclui pelo descumprimento contumaz da legislação e das diretrizes por que sempre propugnou em relação à saúde.

BackgroundBenign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in aging men, and significantly affects their quality of life and productivity. In Brazil, where most of the population relies on the Public Health System (SUS), transurethral resection of the prostate (TURP) and simple prostatectomy (SP) are the primary surgical modalities. These procedures vary in cost-effectiveness, influencing clinical decisions and healthcare resource allocation. Therefore, we aimed to describe the perioperative outcomes of surgical modalities (TURP and SP) and the financial impact of these treatments in major Brazilian regions in recent years.MethodThis ecological study utilized data from the Brazilian Public Health System database (DATASUS) from 2009 to 2022. The records of patients diagnosed with BPH and undergoing TURP or SP were analyzed across Brazil’s major geographic regions. The key outcomes included annual surgery volumes, patient demographic characteristics, hospitalization characteristics (e.g., length of stay and intensive care unit utilization), intrahospital mortality rates, and government reimbursements to hospitals. Statistical analyses included descriptive statistics, comparisons between the two techniques, and regression models to assess the temporal trends in mortality rates.ResultsOver the 14-year period analyzed, Brazil recorded 204,358 BPH surgeries, with the Southeast region accounting for 46.56% of the procedures. TURP was the predominant procedure nationwide (61.44%), particularly in the higher-income regions. Perioperative outcomes favored TURP, with lower intrahospital mortality rates (0.25% vs. 0.55% for SP) and shorter hospital stays (median, 3 days vs. 5 days for SP). Both procedures resulted in decreasing mortality trends, although the differences were not statistically significant. Government reimbursements for hospitals were lower for TURP than for SP and did not keep pace with inflation during this period.ConclusionThis study underscores the prominent role of the Southeast region in BPH surgeries within Brazil's public health system and highlights TURP’s favorable perioperative outcomes of TURP over SP. It also showed a financial deficit in surgery reimbursements, which may impact the sustainability of the public health system.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13261-z.

Este trabalho teve como objetivo avaliar a utilização de alguns serviços de Atenção Básica pela população infantil no estado do Maranhão, comparando-se a evolução dos indicadores nos últimos dez anos. Realizou-se um estudo descritivo, no período de julho de 2007 a janeiro de 2008, com uma amostra representativa do estado do Maranhão de 1.711 crianças, obtida por amostragem aleatória sistemática por conglomerados. Foi utilizada a pesquisa "Saúde, Nutrição e Mortalidade Infantil no Maranhão", desenvolvida em 1996, como referencial comparativo aos dados do presente estudo. Do total de crianças estudadas, 38,4% realizaram a consulta preventiva no primeiro ano de vida, das quais 92,1% utilizaram o Sistema Único de Saúde (SUS). Observou-se que praticamente todas as variáveis tiveram incremento positivo em relação ao estudo da década passada - as consultas de puericultura no primeiro ano de vida e antes do primeiro mês de vida em média 10%; já o acesso ao serviço público ascendeu em torno de 17%. Conclusões: Com essa análise do comportamento atual e de 10 anos atrás, observou-se a melhoria em alguns indicadores de atenção à saúde da criança no estado do Maranhão, possivelmente relacionada aos processos de implantação e aprimoramento da Estratégia Saúde da Família, determinantes do processo de consolidação do Sistema Público de Saúde no Brasil - evolução que pode parecer lenta aos olhos das pesquisas, mas que tem a dimensão necessária para configurar-se na maior política de inclusão social do país.

Background/Objectives: The Brazilian Constitution defines health as a universal right and a State responsibility, with the Unified Public Health System (SUS) ensuring free access to comprehensive care, including renal replacement therapies (RRTs) such as dialysis and kidney transplantation. This study aimed to analyze trends in peritoneal dialysis (PD) usage within Brazil's public health system over a 10-year period, focusing on geographic, demographic, and clinical changes. Methods: Using data from DATASUS and the Brazilian Society of Nephrology Dialysis Census, we analyzed PD usage and patient characteristics from 2014 to 2023. This methodology enabled an in-depth examination of shifts in RRT trends across regions and patient demographics. Results: PD usage declined from 6.5% in 2014 to 4.3% in 2023, with the steepest reductions observed in the North and Northeast regions. Usage increased in the Central-West region, while the Southeast and South experienced steady declines from 2016 to 2023. The proportion of centers offering PD decreased from 51.6% in 2014 to 37.9% in 2023. Over time, the average age of PD patients increased, as did the proportion of Brown/Black individuals receiving PD. Despite these shifts, patient serum levels of hemoglobin, parathyroid hormone, and phosphorus remained stable. Conclusions: This study highlights a relative decline in PD availability and use within Brazil's public health system, with notable regional disparities. These findings underscore the urgent need for targeted policies to support PD infrastructure, funding, and training to ensure equitable access to RRT across the country.

To analyze time trend patterns in Breast Cancer (BC) surgeries performed at Brazil's Public Health System, known as SUS from 2008 to 2014. Ecological study of time series, based on the database system from SUS. Information on surgical procedures performed for BC treatment was collected. Analysis of the absolute number of surgeries was performed using Poisson Regression through Jointpoint Regression, and the trends were calculated through the annual percentage change (APC), with a confidence interval (CI) of 95%, and statistical significance when P < 0.05. Data analysis from 193.596 breast surgeries revealed a reduced number of simple mastectomies (APC -4.4%; CI -7.4 to -1.4; P < 0.05); stable trends in radical mastectomy with lymphadenectomy (APC -1.0%; CI -2.4 to 0.5; P = 0.1) and breast conserving surgery (APC 0.4%; CI -1.6 to 2.4; P = 0.6). Also, we observed a reduced number of axillary lymphadenectomy dissection (APC -16.8%; CI -26.8 to -5.4; P < 0.05); increased trends in breast reconstruction with implants after 2011 (APC 9.1%; CI 0.1-18.8; P < 0.05) and with flaps after 2012 (APC 61.3%; CI 41.3-84.0; P < 0.05). The overall rate of patients with breast reconstruction increased from 15% in 2008 to 29.2% in 2014. We found a significant increase in breast reconstruction in public health system in Brazil, and also a reduction in simple mastectomy and axillary lymphadenectomy.

Background: Breast cancer is the most common neoplasm in Brazilian women, with high percent of patients diagnosed in advanced stages. Metastatic breast cancer (mBC) is a challenge in the country, where 75% of the population is covered by public health system (Sistema Único de Saúde, SUS). We conducted an on-line survey to describe the journey of human epidermal growth factor receptor 2-negative (HER2-), hormone receptor positive (RH+) mBC patients across public scenario in Brazil. Methods: An on-line survey comprised of 39 to 48 (depending on the kind of some questions, which could open another question in case of affirmative answer) objective questions were sent by e-mail to180 oncologists working in public and private health care system. Questions were focused on assessing wait time for first treatment after admission in the hospital in both systems, availability of oncological drugs within SUS according to essential medicines list by World Health Organization, and presence of palliative and multidisciplinary teams in both systems. Continuous variables were measured by median and mean. The level of statistical significance adopted was 5% with Teste p two-sided. Analyses were performed using SAS statistical software (version 25.0). Results: We had 150 respondents working in SUS and private health system, which fulfilled the inclusion criteria to participate in this survey. The other 30 respondents were excluded from the study because they worked exclusively in SUS or exclusively in the private system, and their answers were not analyzed. Median wait time for surgery was 60 days in the SUS (N=150) and 30 days in the private health system (N=150) e (p &amp;lt; 0,0001). Regardless of chemotherapy provided, median waiting time was 30 and 15 days in the SUS (N=150) and the private health system (N=150), respectively (p &amp;lt; 0,0001). Most oncologists in the SUS (N=125, 83.3%) pointed to endocrine therapy as their first-choice treatment in mBC. Concerning endocrine therapy in the SUS, Gonadotropin-Releasing Hormone Agonist (GnRHa) was available, and it was prescribed by 54 (36.0%) and Fulvestrant for 72 (48.0%) of respondents. Considering chemotherapy, weekly paclitaxel alone or combined with platin were available and they were prescribed by 124 (82.6%) and 109 (72.6%) of oncologists respectively. Vinorelbine was available and it was prescribed according to oncologists’ report by 109 (72.6%) and Pegylated liposomal doxorubicin (PLD) by 38 (25.3%) of oncologists. Oncologists answered agree or strongly agree that they had a multidisciplinary care team in SUS 77,3% (N =116) versus 87,3% (N=131) in the private system (p=0.022). Concerning palliative care 66,09% (N= 99) in the SUS versus 82,0% (N=123) in the private system answered that they agreed or strongly agreed that this service was available (p=0.001). Conclusions: The Brazilian government has continuously improved delivery of services and medicines via the public system (SUS), but there are still significant differences within this system and versus the private sector. Unavailability of endocrine therapy agents as GnRHa and Fulvestrant, and some chemotherapy agents as PLD and Vinorelbine for high percentage of patients, raises the existence of disparities within SUS. Also, longer waiting times for treatment in the SUS, lower availability of support teams such multidisciplinary and palliative care, they point out disparities between SUS and private health systems. The lack of a National Cancer Control Program and low health investment by Brazilian government might explain the difference in cancer patients’ access. Citation Format: Heloísa Resende, Igor Soares, Angélica Renó, Ana Cunha, Vinícius Aguiar, Letícia Tureta, Viviane Pereira. The journey of HR positive, HER2 negative metastatic breast cancer’s patients: heterogeneities and barriers in Brazilian public health system- a national survey [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-09.

Venous thromboembolism is a condition of great interest to public health, as it is potentially preventable and has a high morbidity and mortality potential. Knowing the real-world data in a country of continental dimensions such as Brazil is essential to help define health policies that enable proper diagnosis and treatment of this disease. The objective of this study was to evaluate the incidence and in-hospital mortality rates of venous thromboembolism in public hospitals under Brazil's public health system. This is a population-based, cross-sectional, retrospective analysis of all hospitalizations for venous thromboembolism in the Brazilian public health system between 2008 and 2022. Using a public database, all hospital admissions for thromboembolic events were selected, defining the incidence, in-hospital mortality, and differences between Brazilian macro-regions. A total of 700,315 admissions for venous thromboembolism were documented in the Brazilian public health system between 2008 and 2022, which represents 3.02 admissions per 10,000 inhabitants per year. The Southeast region accounted for more than half (54.5%) of the hospitalizations. The highest incidence of hospitalizations occurred in the wealthiest regions (Southeast and South), while the lowest incidence was observed in the poorest regions (North and Northeast). On the other hand, a higher proportion of in-hospital mortality was observed in the North and Northeast regions. The highest admission rates were registered in wealthier regions, while a higher proportion of deaths was found in the poorer ones. This may reveal the difficulty in accessing healthcare services in the North and Northeast regions, which is reflected in the potential underdiagnosis of thromboembolic events in these regions.

BackgroundThere are high incidence and mortality rates of breast cancer in Brazil. Brazilian’s social and economic disparities, along with complexities of its health system pose challenges to the appropriate implementation of mammography screening as a public policy for the population. In 2015, the Ministry of Health updated the recommendations for the early detection of breast cancer, which had, until then, been based on specialists’ consensus, maintaining biennial screening mammography for women aged 50–69 years. However, the screening coverage did not exceed 25% of the expected number of exams for the Brazilian population who use the public health system. The objective of this study was to analyze barriers and facilitators (determinants) of opportunistic mammography screening in the Brazilian public health system.MethodsWe conducted a scoping review to examine the extent to which guidelines have been implemented from 2015 to 2025, excluding those that (1) did not include the population aged 50 to 69 years, (2) did not discuss mammographic screening in the Brazilian public health system, (3) included populations with cancer or at high risk of cancer. Results were coded into the domains of the Consolidated Framework for Implementation Research (CFIR).ResultsIn the 85 articles selected, we coded 74 determinants, 50 referring to barriers and 24 to facilitators. The barriers were related to the outer setting 18(24.3%), inner setting 11(14.9%), characteristics of individuals 9(12.2%), process 6(8.1%), and intervention characteristics 6(8.1%). The facilitators were related to the outer setting 14(18.9%), inner setting 5(6.8%), intervention characteristics 3(4.1%) and individual characteristics 2(2.7%).ConclusionUsing CFIR helps understand the multiple interrelated factors that affect the implementation of opportunistic mammographic screening in the Brazilian public health system. Our results can provide initial data for further studies that aim to improve and organize the implementation of mammography screening in Brazil.

The study assessed the Global Quality Score (GQS) and informational engagement of users with YouTube videos on the Brazilian public health system (SUS). The YouTube video search tool was used with the Portuguese keywords 'unified health system' and 'SUS'. The first 100 videos returned in the search were studied, using the GQS to measure their educational value, usefulness, and information quality. Users' engagement with the videos was calculated based on their number of likes/reactions and comments. Other data collected were authorship, year of publication, topic approached, target audience, video length, and use of references. Two trained and calibrated researchers collected the data. Multiple analysis was performed with Logistic Regression, using a 95% confidence interval and significance of p<0.05. There were no poor or generally poor GQS scores (scores 1 and 2) and most videos (58%) achieved moderate or good scores (scores 3 and 4). Videos published after the onset of COVID-19 had a 70% lower chance of engagement than those published in pre-pandemic years (OR: 0.30; 95%CI: 0.12-0.74). Videos that targeted healthcare professionals were 72% less likely to achieve higher GQS scores, than those with an unidentified target audience (OR: 0.28; 95%CI: 0.10-0.75). The informational engagement of the videos showed fewer comments than likes/reactions. Most YouTube videos about the SUS had moderate or good global quality, which was associated with their period of publication and choice of target audience.

Hospitalization due to pneumococcal disease in the Unified Health System in Brazil: A retrospective analysis of administrative data

Brazil is an upper middle-income country in South America with the world's sixth largest population. Despite great advances in health-care services and cardiac surgical care in both its public and private health systems, little is known on the volume, outcomes, and trends of coronary artery bypass grafting (CABG) in Brazil's public health system. The aim of this study was to evaluate the outcome of CABG on the public health system from January 2008 to December 2017 through the database DATASUS. This study is based on publicly available material obtained from DATASUS, the Brazilian Ministry of Health's data processing system, on numbers of surgical procedures, death rates, length of stay, and costs. Only isolated CABG procedures were included in our study. We used the TabNet software from the DATASUS website to generate reports. The χ2 test was used to compare death rates. A p < .05 was considered statistically significant. We identified 226,697 CABG procedures performed from January 2008 to December 2017. The overall in-hospital mortality over the 10-year period was 5.7%. We observed statistically significant differences in death rates between the five Brazilian macro-regions. Death rates by state ranged from 2.6% to 13.1%. The national average mortality rate remained stable over the course of time. Over 10 years, a high volume of CABG was performed in the Brazilian Public Health System, with significant differences in mortality, number of procedures, and distribution of surgeries by region. Future databases involving all centers that perform CABG and carry out risk-adjusted analysis will help improve Brazilian resultsand enable policymakers to adopt appropriate health-care policies for greater transparency and accountability.

By rebuilding the history of the facilities that constituted the city of Rio de Janeiro's health system between 1916 and 2015, this article also pieces together one hundred years of the country's public health system. Due to its important role, first as the country's capital, then as a state, and later as the capital city of the State of Rio de Janeiro, this city had a major influence on the multiple events that led to the creation of Brazil's Unified Health System. Periodization was used as a methodological resource to explore how factors that influenced the aims of the technical powers and government were turned into health services stemming from the ideology that underpinned the history of the health system. It is also evident that, despite its constant growth up to the creation of the Unified Health System, the network has always operated in parallel to, and independently from, the hospital and ambulatory network of the social security system and private and philanthropic services. The public health system in Brazil has always been focused at addressing problems related to inequality and social exclusion. The city of Rio de Janeiro's primary care network has always played, and continues to play, an important role in disseminating a new organizational culture in Brazil's national health system.