Abstract
The costs of medicines pose a growing burden on healthcare systems worldwide. A comprehensive understanding of current procurement processes provides strong support for the development of effective policies. This study examined Brazilian Federal Government pharmaceutical procurement data provided by the Integrated System for the Administration of General Services (SIASG) database, from 2006 to 2013. Medicine purchases were aggregated by volume and expenditure for each year. Data on expenditure were adjusted for inflation using the Extended National Consumer Price Index (IPCA) for December 31, 2013. Lorenz distribution curves were used to study the cumulative proportion of purchased therapeutic classes. Expenditure variance analysis was performed to determine the impact of each factor, price and/or volume, on total expenditure variation. Annual expenditure on medicines increased 2.72 times, while the purchased volume of drugs increased 1.99 times. A limited number of therapeutic classes dominated expenditure each year. Drugs for infectious diseases drove the increase in expenditures from 2006 to 2009 but were replaced by antineoplastic and immunomodulating agents beginning in 2010. Immunosuppressants (L04), accounted for one third of purchases since 2010, showing the most substantial growth in expenditures during the period (250-fold increase). The overwhelming price-related increase in expenditures caused by these medicines is bound to have a relevant impact on the sustainability of the pharmaceutical supply system. We observed increasing trends in expenditures, especially in specific therapeutic classes. We propose the development and implementation of better medicine procurement systems, and strategies to allow for monitoring of product price, effectiveness, and safety. This must be done with ongoing assessment of pharmaceutical innovations, therapeutic value and budget impact.
Highlights
Medicines represent one of the largest and fastest growing costs for healthcare systems worldwide
According to data from 161 WHO Member States from 1995 to 2006, per capita spending on pharmaceuticals has increased by approximately 50%, and these increments were more pronounced in middle-income countries, where pharmaceutical expenditure in 2006 was1.76 times greater than in 1995 [1]
The analysis of medicines expenditures must be performed, for each public level to identify potential problems and formulate adequate and cost-effective policies [9]. Such analyses require access to high-quality data on pharmaceutical expenditure, which has generally been lacking for low- and middle-income countries [1]. This study addresses this gap by examining public medicine procurement in Brazil
Summary
Medicines represent one of the largest and fastest growing costs for healthcare systems worldwide. Ensuring and expanding access to quality medicines at affordable prices, with adequate financing require an effective healthcare supply system This system should include the selection of reliable suppliers of assured-quality products and the procurement of safer and more cost-effective medicines in the right quantities at the lowest possible total cost to the system optimal and timely delivery [2]. Should cost-effectiveness analyses for the introduction of all new medicines must be made, but new models for the introduction of expensive medicines are needed, as well as effective management of essential medicines for treating common diseases like hypertension, diabetes, and respiratory, cardiovascular and infectious diseases in general [4] This requires efficient and transparent procurement procedures
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