Health equity and the usage of atypical antipsychotics within the Brazilian national health system: findings and implications

Abstract

Background: There is a need to evaluate the health equity of atypical antipsychotics users who obtain their medicines from the Brazilian National Health System (SUS) through the identification of key factors that influence their health status due to concerns with equity of care. Research design and methods:Cross-sectional study among patients attending state pharmacies in Brazil. Individuals were included if they used atypical antipsychotics, aged ≥18 years, and answered the EQ-5D-3L questionnaire. Sociodemographic, behavioral, and clinical data were collected. The dependent variable was health status. Associations between the independent variables and the dependent variable were analyzed by adjusting a linear regression model. Results: Overall, 388 individuals met the eligibility criteria and were included in the analysis. The final multiple linear regression model demonstrated a statistically significant association between VAS and suicide attempts, private care, current antipsychotics, comorbidities, and perceived family support. Conclusions: The study identified several factors both individual and collective that correlate with the health status of atypical antipsychotic users, and confirmed the importance of providing medicines for treating psychotic disorders. However, other factors are involved including social support. Our results suggest additional activities and policies are necessary including strategies to address the differences in private and public health care.

Real-world effectiveness of olanzapine and risperidone in the treatment of schizophrenia in Brazil over a 16-year follow-up period; findings and implications

“…SUS is the Brazilian public health system nationwide and serves all individuals, without depending on the individual's socio-economic status (SES), covering both complex and simple medical procedures as well as authorized medicines including high cost medicines. These medicines are provided free-of-charge provided that patients meet the agreed prescribing criteria every three months [31][32][33]. However, patients are free to purchase their medicines privately, either by paying out of pocket or through private health plans.…”

“…In Brazil, the public health system [Sistema Único de Saúde (SUS)] provides both typical antipsychotics, i.e. chlorpromazine and haloperidol, in both oral and injectable presentations as well as oral atypical antipsychotics, clozapine, olanzapine, quetiapine, risperidone and ziprasidone, free of charge for patients with schizophrenia [31,32]. Previous studies conducted in Brazil among patients in the SUS reported that atypical antipsychotics were responsible for most of the direct medical expenditures in a cohort of eleven years follow-up.…”

“…Olanzapine and risperidone were the most prescribed antipsychotics, with olanzapine the most used despite being the most expensive with lower costs for risperidone [32]. However, there are concerns with equity of access to atypical antipsychotics in Brazil [31]. Consequently, we wanted to expand our original research in Brazil [32] by assessing the efficacy of olanzapine and risperidone in the real world and assess the risk factors for discontinuation of treatment in patients with schizophrenia to provide future guidance using a nationwide cohort with 16-year follow-up period.…”