The Brazilian Unified National Health System: Proposal of a Cost-effectiveness Evaluation Model

Oliveira, L.; Passador, Cláudia Souza

doi:10.1590/1807-7692bar2016140120

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…In Brazil, since the enactment of the Federal Constitution of 1988, the right to health is universal. Thus, the Brazilian public health system, Sistema Único de Saúde—SUS, provides pharmacological treatment; hospital and outpatient care for each Brazilian citizen [ 8 ], including multiple sclerosis patients diagnosed as relapsing-remitting or secondary progressive multiple sclerosis (RRMS and SPMS). SPMS includes patients with chronic advanced MS.…”

Section: Introductionmentioning

confidence: 99%

The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil

et al. 2018

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BackgroundMultiple Sclerosis (MS) is a disease that appreciably impacts on the quality of life of patients and is associated with high expenditure. MS is a chronic multifactorial disease, characterized by inflammation, demyelination and axonal loss. The Brazilian public health system provides pharmacological treatment as well as hospital and outpatient care for patients with relapsing-remitting and secondary progressive multiple sclerosis. However, we are not aware of any previous publications assessing total direct medical costs in patients with a long follow-up within the Brazilian healthcare system. Consequently, the objective is to analyze public spending on patients with MS to guide stakeholders in future investment and disinvestment decisions.Methods and findingsWe retrospectively analyzed public Brazilian spending on patients with MS between 2000 and 2015 using the patient-centered registry of all patients in the public health system (SUS) obtained through deterministic-probabilistic record linkage of the Outpatient Information System, Hospital Information System and Mortality Information Systems in Brazil. Descriptive data analysis and a multiple linear regression model was performed to evaluate the associations between the mean annual cost per patient and the clinical and demographic variables. The suitability of the model was verified from a residue analysis and the level of significance adopted was 5%.Results28,401 patients were identified and subsequently 23,082 patients were analyzed. The majority of the patients were female (73.3%), lived in the southeast region (58.9%), had a mean age of 36.8 (± 12.2) years and started treatment using one of the interferons beta (78.9%). The total direct medical cost spending in the sixteen years of the follow-up was US $ 2,308,393,465.60, and the mean annual expenditure per patient was US $ 13,544.40 (± 4,607.05). In the best fit model (p <0.001), approximately 40% of the variability of the mean annual cost per patient was explained by the region of residence; medication used (intention to treat); if the patient was a non-exclusive user of medicines, i.e., used SUS for other procedures other than high-cost medicines; year of treatment start; and presence of events (death; Relapse; change of treatment and/or comorbidity).ConclusionsIn the public health system of Brazil, disease modifying therapies currently represent almost all of the total direct costs of multiple sclerosis treatment. Around the world, new and emerging health technologies to treat of MS impose a challenge to health budgets, highlighting the need for cost-effectiveness studies comparing these technologies to those already available. Our regression model may help in this process, and calls attention to the need to access the real world performance of new therapies available in SUS, with the potential for disinvestment and/ or price reductions if needed.

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Section: Introductionmentioning

confidence: 99%

The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil

et al. 2018

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“…Considering that Brazilian socioeconomic characteristics affect the municipality assessment, the index considers homogeneous groups of municipalities grouped according to the demographic pro le, population health condition, and health system structure [49], since Brazilian municipalities have different socioeconomic and structural conditions [47][48][49][50].…”

Section: Socioeconomic Indexesmentioning

confidence: 99%

Pharmaceutical Services Management Capacity and the Municipal Socioeconomic Scenario: Persistent Inequalities

Faraco

Rover

Cunha

et al. 2023

Preprint

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Background Although access to essential medicines means resolution for most health conditions in primary health care, ensuring it is still a complex challenge for all health systems. Recent studies show that fair access to medicines must be determined by health care needs, considering the variables in the socioeconomic environment. In this context, despite advances, weaknesses in the development of pharmaceutical services persist, strongly related to management capacity. The study investigates the relationship between the management capacity of Pharmaceutical Services and socioeconomic indices in Brazilian municipalities, analysing which contextual factors are involved in its development.Methods Data from a cross-sectional exploratory study at national scale and indicators developed by Faraco et al. were used to define the capacity of Pharmaceutical Services management. Pearson’s chi-square test and multivariate analysis were performed to associate Pharmaceutical Services management capacity with socioeconomic indices of each municipality. These socioeconomic indices were collected from public database platforms.Results The results prove significant relationships between management and socioeconomic indicators, suggesting that Pharmaceutical Services management capacity is influenced by the environment in which it operates. This study shows municipalities with better management capacity results were those with better socioeconomic indices, better health system conditions and structure, reflecting a greater number of professionals, greater participation of popular social control and use public resources. It is also highlighted that municipalities with a smaller population size and lower socio-economic indices have less ability to manage pharmaceutical services, revealing worsening inequalities for its citizens.Conclusions The existence of an adequate minimum structure, a qualified workforce, service organization, and opportunities for political articulation are essential, as well as conditions for these municipalities to develop and improve their management capacity and for financing based on socioeconomic indicators to become an effective access and adequate use of medicines for the population.

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“…In Brazil, one of the tools used by the Brazilian government to assess the Unified Health System (SUS) is the Index of Unified Health System Performance (IDSUS), which measures access to health services and the effectiveness of these systems; that is, it functions as a representation of the country’s health system [ 18 ]. The IDSUS considers 24 performance indicators, of which 14 are related to healthcare access and 10 are related to the effectiveness of the service [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

A Multi-Criteria Approach to Assess the Performance of the Brazilian Unified Health System

Aires

Salgado

2022

IJERPH

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Brazil’s Unified Health System (SUS) provides universal free access to health services and is considered a model for the rest of the world. One of the tools used by the Brazilian government to assess this system is the Index of Unified Health System Performance (IDSUS). However, this method has a number of limitations, such as disregarding the opinion of healthcare decision makers. Thus, the aim of the present study was to propose a model based on the R-TOPSIS in order to assess the performance of the SUS. Methodologically, the main steps for proposing multi-criteria models were followed, and to validate the model, a real case study with a set of six cities (alternatives) of the state of São Paulo was used. The results provide a clearer picture of the differences in terms of potential and obtained access, as well as the effectiveness of health services in the cities analyzed. Likewise, the proposal of integrating multiple criteria as well as considering healthcare decision makers proved to be decisive for the results obtained, even in comparison with the other approaches. It was concluded that the proposed method provides a robust and adequate analysis of health systems performance.

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The Brazilian Unified National Health System: Proposal of a Cost-effectiveness Evaluation Model

Cited by 4 publications

References 20 publications

The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil

The long-term costs for treating multiple sclerosis in a 16-year retrospective cohort study in Brazil

Pharmaceutical Services Management Capacity and the Municipal Socioeconomic Scenario: Persistent Inequalities

A Multi-Criteria Approach to Assess the Performance of the Brazilian Unified Health System

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