Brazilian Unified Health System Research Articles

The burden of physical inactivity for the public health care system in Brazil.

To update the estimated cost of physical inactivity for the Brazilian Unified Health System (SUS). The hospitalization costs were accessed via a database of the Ministry of Health - Informatics Department of the Brazilian SUS. Physical inactivity for the year 2017 was accessed via the Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel - Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey). Seven chronic non-communicable diseases (NCD) were selected via the international classification of disease (ICD-10). The population fraction attributable to physical inactivity was calculated based on relative risk reported in previous studies and the prevalence of physical inactivity. In 2017, the seven NCD considered in the analysis were responsible for 154,017 hospital admissions in adults older than 40 years old, residing in the state capitals and the Federal District, which corresponded to 6.5% of hospitalizations and 10.6% of SUS costs at an estimated US$ 112,524,914.47. Considering the group of individuals with insufficient physical activity in their leisure time, the percentage cost attributed to physical inactivity reached 17.4% of the estimated costs with NCD. At a national level, NCD were responsible for approximately 740 thousand hospitalizations, costing US$ 482 million, from which 17.4%, US$ 83 million were attributed to physical inactivity. This study provides evidence to conclude that physical inactivity exerts an economic impact on the SUS due to NCD hospitalization. Physical inactivity is a modifiable lifestyle and compelling evidence, including that of this article, supports the promotion of a more active community as one of the major targets of public health care policies.

The impact of implementing the 10-valent pneumococcal conjugate vaccine on hospitalizations for pneumonia among children

Pneumonia is a major cause of morbidity and mortality in children, with pneumococcus as the main etiologic agent. In Brazil, the 10-valent pneumococcal conjugate vaccine (PCV-10) was introduced into the childhood immunization schedule in 2010. The aim of this study was to assess the impact caused by implementing PCV-10 on the hospitalizations of children with pneumonia, between 2005 and 2015, in the state of Pernambuco, Brazil. An ecological time series study and a forecasting analysis were conducted. A comparison was made between the hospitalizations of children aged between seven months and four years due to pneumonia in the Brazilian Unified Health System, in the 5 years before (2005–2009) and after (2011–2015) implementation of PCV-10. Descriptive analysis included absolute and relative values, means and rates of hospitalization. The chi-square test was used to compare the annual incidence of hospitalizations and the t-Student test to compare the five-year mean values. For the temporal modeling of hospitalizations, an autoregressive integrated moving average was used, adjusted with seasonal-SARIMA (Box-Jenkins methodology), with a prediction of the monthly number of hospitalizations for 2011–2015. The predicted and observed values for 2011–2015 were then compared. The number of hospitalizations after implementing PCV-10 was reduced by 24.5 %. The monthly average of hospitalizations dropped from 681 (2005–2009) to 514 (2011–2015). The hospitalization rate dropped from 56.1 per thousand live births in the five-year period prior to PCV-10 to 43.4 in the following five-year period (a 22.7% reduction). Comparing the values predicted by the SARIMA model for a scenario without PCV-10 in the second five-year period, with those reported after implementing PCV-10, the estimated number of prevented hospitalizations was 8,682 in the five years following the introduction of the vaccine. In conclusion, in the five years following implementation of PCV-10, hospitalizations of children with pneumonia in Pernambuco decrease by 22%.

What are the implications of the adoption of the new fiscal framework for the Brazilian Unified Health System?

What are the implications of the adoption of the new fiscal framework for the Brazilian Unified Health System?

HTA77 Training and Active Social Participation in the Incorporation of Health Technologies in the Brazilian Unified Health System

To offer training to law people on the process of technology assessment in the Brazilian Unified Health System, including the fundamentals of clinical epidemiology and the decision making process.

Comparison of lung cancer clinical trials treatment options and standard practice in Brazilian national health system over the last decade.

e18678 Background: New cancer drugs for metastatic non-small cell (NSCLC) and small cell lung cancer (SCLC) have been approved worldwide in the past decade, but expensive pricing has led to unequal access. Despite being categorized as an upper-middle income country, Brazil's public health system is underfunded and has faced difficulties in incorporating new cancer treatments, which is concerning as two-thirds of the population depend on the public health system for their cancer-related medical needs. We hypothesized that the disparity between the standard of care (SOC) provided in developed nations and the prevailing practices in Brazil's public healthcare system is widening. Methods: We conducted a search of the ClinicalTrials.gov database from January 1st, 2012 to December 31th, 2021, for all phase III clinical trials on metastatic lung cancer that had at least one clinical site located in Brazil. We collected data on the experimental arm therapies, planned outcomes, and control arm therapies (used as a proxy for the standard of care worldwide). We then compared the control-arm drug therapy at the trial's start date with the standard practice for lung cancer in the Brazilian Unified Health System (SUS) at that time, using available governmental protocols on lung cancer (PCDT) and recent approvals from the technology health assessment committee (CONITEC). Additionally, we assessed the potential eligibility of patients treating in SUS for second-line therapy trials based on prior required treatments to trial enrollment. We analyzed two time periods: 2012-2016 and 2017-2021. Results: Out of 86 screened trials, 64 were included. 86% of them were on NSCLC, and 67% on first-line settings. Almost half had a biomarker inclusion criterion for enrollment. Immunotherapy was studied most frequently (52%), followed by targeted therapies (36%) and antibody-conjugate drugs (ADC) (9.4%). PD(L)1 was the target of 33% of drug therapies. Compared to 2012-2017, in the 2018-2021 period we observed an increase in available clinical trials (24 vs 40) with similar rates of NSCLC (83% vs. 88%, p = 0.7) and first-line therapies (68 vs 67%, p > 0.9). The proportion of trials with control group therapies better than the standard practice available at the time increased from 8.3% to 38% in the recent time-period (p = 0.011). Among second-line therapy trials, the proportion of trials with mandatory previous therapy unavailable in SUS rose numerically from 12% to 54% (p = 0.085). Conclusions: While the number of trials increased over time, there was a rising proportion of control group therapies better than available standard practice in Brazil. The widening difference between drug therapies in clinical trials and standard cancer treatments creates difficult ethical quandaries for oncologists enrolling patients, and also impacts patient eligibility in advanced settings.

Disaster risk reduction, the Sustainable Goals agenda and the principles of the SUS, in the context of the COVID-19 pandemic

The aim of this study was to analyze the connections between the Sendai Framework for Disaster Risk Reduction, the Sustainable Development Goals (SDGs), and the principles of Brazil's Unified Health System (SUS) in the context of the public health emergency caused by the COVID-19 pandemic and its potential implications for population health. This qualitative, cross-sectional, exploratory study collected data from health professionals with experience in emergency and disaster risk management and treatment practices, which were then processed using the Iramuteq software for lexical analysis. The textual corpus was presented through a descending hierarchical classification that resulted in seven classes grouped into three categories: disaster response in the context of SUS; prevention of future disaster risks; and preparedness and recovery actions based on the Sendai Framework and the SDGs. The study highlighted aspects related to the direct and indirect effects of the COVID-19 pandemic and the challenges related to disaster risk reduction as advocated by the Sendai Framework, emphasizing the need to strengthen the culture of safety and sustainability within the SUS, which aligns with the ODS and social determinants of health.

Lack of organization to access cancer treatment in southeast Brazil: Urgent need to change.

e18516 Background: Healthcare access is a fundamental component in achieving universal health coverage, the central commitment of the Brazilian Unified Health System (SUS). In Brazil, primary healthcare centers from the cities refer suspected or confirmed cases of cancer to accredited oncology services in their regions. Methods: This is a qualitative exploratory study aiming to knowing the functioning of the cancer care network in 26 cities of the Southern Region of the State of Espírito Santo/Brazil (686,450 inhabitants) that refer patients to an SUS-accredited oncology center.The information was collected during the year 2022 through semi-structured interviews with cities health departments. Results: Regarding the extent of the Primary Health Care Service (PHCS), the results showed that only 14 cities (54%) have 100% of their territory covered, while the others have coverage ranging from 75% to 98%. With regard to medical work in PHCS units, it was found adequate in 17 (65% )cities and not adequate in the other 9 (35% ); however, their was only 2 licensed physicians in Family Medicine working the cities. The number of patients being treated is known in just 5 (19%) cities and as far as transport to the treatment center, 16 (62%) cities report that meet the demand and 10 (32%) that do not. Finally, no city had a support service to help patients navigate the public health system. Conclusions: The results indicate that Access to basic health services is insufficient in the Southern region of the State of Espirito Santo, and that the organization of the cancer care network needs to be improved with more resources and trained medical professionals.

EE244 Cost-Effectiveness Analysis of Liposomal Amphotericin B Versus Isavuconazole for Treating Mucormycosis in the Consolidation Phase from the Perspective of the Brazilian Unified Health System

Mucormycosis is a rare invasive fungal infection with high lethality, affecting mainly patients with hematological neoplasia, decompensated diabetes, and covid-19 infection. The aim was to perform a cost-effectiveness analysis of liposomal Amphotericin B (standard treatment) versus isavuconazole for treating mucormycosis in the consolidation phase from the perspective of the Brazilian Unified Health System.

Alzheimer's disease: an epidemiological analysis over the number of hospitalizations and deaths in Brazil.

Alzheimer's disease (AD) is a neurodegenerative condition characterized by impaired cognitive function. It results in high morbidity, including a large number of hospitalizations, and mortality, generating high costs to health systems. The present epidemiological analysis evaluated the number of hospitalizations and deaths by AD as the main diagnosis in Brazil between 2010 and 2020. This endeavor should contribute to a better understanding of the disease and its implications. The present analytical, observational, longitudinal, and retrospective study used data extracted from the Department of Informatics of the Brazilian Unified Health System (DATASUS, in the Portuguese acronym). The variables include the number of hospitalizations, the total cost spent, the average cost per hospitalization, the average length of hospital stay, the number of deaths during hospitalization, the mortality rate per hospitalization, sex, age group, region, and race. From 2010 to 2020, there were 188,811 deaths and 13,882 hospitalizations for AD, with a total expenditure of BRL 25,953,019.40 in hospitalizations. The average length of hospital stay was 25 days. Over the considered period, mortality, the number of hospitalizations, and the total cost increased while the average length of stay decreased. From 2010 to 2020, AD represented a large portion of hospital admissions, generating a significant cost to the health system and a large number of deaths. These data are important to undertake joint efforts to prevent hospitalizations of these patients in order to minimize impacts on the health system.

EE36 Cost-Effectiveness Analysis of Taptest and Continuous Lumbar Drainage in Comparison to Standard Care in Suspected Idiopathic Normal Pressure Hydrocephalus from the Perspective of the Brazilian Unified Health System

Three symptoms — impaired gait, cognition, and incontinence — define idiopathic normal pressure hydrocephalus (iNPH). To predict whether iNPH patients will benefit from shunt surgery, the tap test (TT) or continuous lumbar drainage (CLD) may be employed. This study's goal is to evaluate the cost-effectiveness of TT and CLD in comparison to the standard of care, in which all patients with suspected iNPH underwent shunt surgery, from the perspective of the Brazilian Public Health System.

Hospitalizations for oral and oropharyngeal cancer in Brazil by the SUS: impacts of the covid-19 pandemic.

To analyze the impact of the different phases of the covid-19 pandemic on hospitalizations for oral (CaB) and oropharyngeal (CaOR) cancer in Brazil, carried out within the scope of the Brazilian Unified Health System (SUS). We obtained data regarding hospital admissions due to CaB and CaOR between January 2018 and August 2021 from the SUS Hospital Information System, analyzing hospital admissions as rates per 100,000 inhabitants. We divided the pandemic (January 2020 to August 2021) and pre-pandemic (January 2018 to December 2019) periods into four-month periods, comparing the pandemic period rates with analogous rates for the pre-pandemic period - for Brazil, by macro-region and by a group of procedures performed during hospitalization. We also analyzed the impact of the pandemic on the average cost of hospitalizations, expressing the results in percentage change. Rates of hospitalization in the SUS due to CaB and CaOR decreased during the pandemic in Brazil. The most significant reduction occurred in the second four-month period of 2020 (18.42%), followed by decreases in the third four-month period of 2020 (17.76%) and the first and second four-month periods of 2021 (respectively, 14.64% and 17.07%), compared with 2019. The South and Southeast showed the most expressive and constant reductions between the different phases of the pandemic. Hospitalizations for clinical procedures suffered a more significant decrease than for surgical procedures. In Brazil, the average expenditure per hospitalization in the four-month pandemic periods was higher than in the reference periods. After more than a year of the pandemic's beginning in Brazil, the SUS hospital care network for CaB and CaOR had yet to be re-established. The repressed demand for hospitalizations for these diseases, which have fast evolution, will possibly result in delays in treatment, negatively impacting the survival of these patients. Future studies are needed to monitor this situation.

Experiences of women in prenatal, childbirth, and postpartum care during the COVID-19 pandemic in selected cities in Brazil: The resignification of the experience of pregnancy and giving birth.

The COVID-19 pandemic has impacted public and private health systems around the world, impairing good practices in women's health care. However, little is known about the experiences, knowledge, and feelings of Brazilian women in this period. The objective was to analyze the experiences of women, seen at maternity hospitals accredited by the Brazilian Unified Health System (SUS, acronym in Portuguese), regarding health care during pregnancy, childbirth, and postpartum periods, their interpersonal relationships, and perceptions and feelings about the pandemic. This was a qualitative, exploratory research, carried out in three Brazilian municipalities with women hospitalized in 2020, during pregnancy, childbirth, or postpartum period, with COVID-19 or not. For data collection, semi-structured individual interviews (in person, by telephone, or by digital platform) were conducted, recorded and transcribed. The content analysis of thematic modalities was displayed as per the following axes: i) Knowledge about the disease; ii) Search for health care in prenatal, childbirth, and postpartum periods; iii) Experience of suffering from COVID-19; iv) Income and work; and v) Family dynamics and social support network. A total of 46 women were interviewed in São Luís-MA, Pelotas-RS, and Niterói-RJ. Use of media was important to convey information and fight fake news. The pandemic negatively impacted access to health care in the prenatal, childbirth, and postpartum periods, contributing to worsening of the population's social and economic vulnerabilities. Women experienced diverse manifestations of the disease, and psychic disorders were very frequent. Social isolation during the pandemic disrupted the support network of these women, who found social support strategies in communication technologies. Women-centered care-including qualified listening and mental health support-can reduce the severity of COVID-19 cases in pregnant, parturient, and postpartum women. Sustainable employment and income maintenance policies are essential to mitigate social vulnerabilities and reduce risks for these women.

Análise política da ação do Movimento da Reforma Sanitária Brasileira na pandemia da COVID-19: 2020-2021

Abstract The aim of this study is to analyze the political action of the Brazilian Health Care Reform Movement (MRSB, Movimento da Reforma Sanitária Brasileira), particularly Cebes and Abrasco, during the COVID-19 pandemic. The data were obtained through the documental review of publications from the abovementioned entities, which describe their positions on government actions implemented between January 2020 and June 2021. The results show that the performance of these entities included several actions, most of them reactive and critical of the Federal Government’s role in the pandemic. Moreover, they led the creation of “Frente pela Vida”, an organization that brought together several scientific entities and civil society organizations, whose highlight was the preparation and dissemination of the “Frente pela Vida Plan”, a document that contains a comprehensive analysis of the pandemic and its social determinants, as well as a set of proposals to face the pandemic and its effects on the population’s living and health conditions. It is concluded that the performance of the MRSB entities reveals alignment with the original project of the Brazilian Health Care Reform (RSB, Reforma Sanitária Brasileira), emphasizing the relationship between health and democracy, the defense of the universal right to health and the expansion and strengthening of the Brazilian Unified Health System - SUS (Sistema Único de Saúde).

Análise estratégica da atuação do governo federal brasileiro na pandemia de COVID-19: 2020-2021

Abstract The study aim is to analyze the performance of the Brazilian federal government (FG) in the COVID-19 pandemic, seeking to identify tensions and conflicts between actors and institutions of the three branches of the government and the FG with state governors. Data production included a review of articles, publications and documents that analyze the pandemic evolution and record announcements, decisions, actions, debates and controversies between these actors in the period of 2020 to 2021. The results include the characterization of the action style of the central Actor and the analysis of conflicts between the Presidency, the Ministry of Health, ANVISA, state governments, the House of Representatives and the Senate and the Federal Supreme Court, seeking to correlate them with the debate around the political projects for health in dispute under the current circumstances. It is concluded that the central actor largely used a communicative action aimed at his supporters and strategic action characterized by imposition, coercion and confrontation in the relationships he maintained with other institutional actors, especially when they diverged from his viewpoints about how to face the health crisis, consistently with his connection to the ultra-neoliberal and authoritarian political project of the FG, which includes the deconstruction of the Brazilian Unified Health System.

Mobile health can be patient-centered and help solve inequality issues in Brazil's Unified Health System.

Mobile health can be patient-centered and help solve inequality issues in Brazil's Unified Health System.

Institutional support as a device for implementing policies in brazil's unified health system

Institutional support as a device for implementing policies in brazil's unified health system

Eficácia E Custo-Utilidade De Intervenções Para O Tratamento Da Enurese Em Crianças E Adolescentes Sob A Perspectiva Do Sistema Único De Saúde Brasileiro: Effectiveness and Cost-Utility of Interventions for Enuresis Treatment in Children and Adolescents From the Brazilian Single Health System Perspective

ObjectivesThis study aimed to estimate the cost-utility of effective interventions for enuresis treatment in children and adolescents and to calculate the incremental cost-utility ratio from the perspective of the Brazilian Unified Health System in a 1-year time horizon. MethodsThe economic analysis is in 7 stages: (1) survey of evidence of treatments for enuresis, (2) performing the network meta-analysis, (3) estimation of the probability of cure, (4) cost-utility analysis, (5) model sensitivity analysis, (6) analysis of acceptability of interventions by acceptability curve, and (7) monitoring the technological horizon. ResultsThe association between desmopressin and oxybutynin is the therapeutic strategy with the highest probability of success in the treatment of enuresis in children and adolescents compared with placebo (relative risk [RR] 2.88; 95% confidence interval [CI] 1.65-5.04), followed by the combination therapy between desmopressin and tolterodine (RR 2.13; 95% CI 1.13-4.02), alarm (RR 1.59; 95% CI 1.14-2.23), and neurostimulation (RR 1.43; 95% CI 1.04-1.96). Combination therapy between desmopressin and tolterodine was the only 1 considered not to be cost-effective. Neurostimulation, alarm therapy, and therapy had the respective incremental cost-utility ratio values: R$5931.68, R$7982.92, and R$29 050.56/quality-adjusted life-years. ConclusionAmong the therapies that are on the borderline of efficiency, the combined therapy between desmopressin and oxybutynin presents the greatest incremental benefit at an incremental cost that is still feasible, given that it does not exceed the reference value of the cost-effectiveness threshold established in Brazil.

Validation of surgical care quality indicators in the Brazilian Unified Health System.

To validate a set of indicators for monitoring the quality of surgical procedures in the Brazilian Unified Health System (SUS). Validation study developed in 5 stages: 1) literature review; 2) prioritization of indicators; 3) content validation of indicators by RAND/UCLA consensus method; 4) pilot study for reliability analysis; and 5) development of instruction for tabulation of outcome indicators for monitoring via official information systems. From the literature review, 217 indicators of surgical quality were identified. The excluded indicators were: those based on scientific evidence lower than 1A, similar, specific, which corresponded to sentinel events; and those that did not apply to the SUS context. Twenty-six indicators with a high level of scientific evidence were submitted to expert consensus. Twenty-two indicators were validated, of which 14 process indicators and 8 outcome indicators with content validation index ≥80%. Of the validated process indicators, 6 were considered substantially reliable (Kappa coefficient between 0.6 and 0.8; p < 0.05) and 2 had almost perfect reliability (Kappa coefficient > 0.8, p < 0.05), when the inter-rater agreement was analyzed. One could measure and establish tabulation mechanism for TabWin for 7 outcome indicators. The study contributes to the development of a set of potentially effective surgical indicators for monitoring the quality of care and patient safety in SUS hospital services.

Association between Mortality from Chronic Noncommunicable Diseases and Human Development Index in Brazil between 1980 and 2019.

Chronic noncommunicable diseases (CNCDs) caused more than 734,000 deaths (55% of all deaths) in Brazil in 2019, with an important socioeconomic impact. To analyze the mortality rates from CNCDs in Brazil from 1980 to 2019 and their association with socioeconomic indicators. This was a descriptive, time-series study of deaths from CNCDs in Brazil from 1980 to 2019. Data on the annual frequencies of deaths and on population were obtained from the Department of Informatics of the Brazilian Unified Health System. Crude and standardized mortality rates per 100,000 inhabitants were estimated using the direct method (Brazilian population in 2000). The quartiles of each CNCD were calculated, where a quartile change, due to an increase in mortality rate, was represented by a chromatic gradient. The Municipal Human Development Index (MHDI) of each Brazilian federative unit was extracted from the Atlas Brasil website and correlated with the rates of CNCD mortality. There was a reduction in mortality rates due to diseases of the circulatory system during the period, except in the Northeast Region. There was also an increase in mortality from neoplasia and diabetes, while the rates of chronic respiratory diseases showed little variation. There was an inverse correlation between the federative units with greater reduction in CNCD mortality rates and the MHDI. The observed decrease in mortality due to diseases of the circulatory system may reflect an improvement in socioeconomic indicators in Brazil during the period. The increase in mortality rates due to neoplasms is probably related to the aging of the population. The higher mortality rates of diabetes seem to be associated with an increase in the prevalence of obesity in Brazilian women.

Systematic review on health care for transvestites and transsexuals in Brazil.

To synthesize scientific evidence to characterize health care for transvestites and transsexuals in Brazil. This is a systematic review, conducted from July 2020 to January 2021 and updated in September 2021, whose protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) platform, under code CRD42020188719. The survey of evidence was carried out in four databases and eligible articles were evaluated for methodological quality, and those with a low risk of bias were included. Fifteen articles were selected and the findings were grouped into six categories according to their thematic approaches: Possibilities to transform health care; Transvestiphobia and transphobia: violations inside and outside the Brazilian Unified Health System (SUS); Professional unpreparedness to care for transvestites and transsexuals; Search for health care alternatives; Right to health for transvestites and transsexuals: utopia or reality?; The Transsexualization Process: advances and challenges. There is evidence that health care for transvestites and transsexuals in Brazil is still exclusive, fragmented, centered on specialized care and guided by curative actions, resembling the care models that preceded the SUS and which have been heavily criticized since the Brazilian Sanitary Reform.