Chaves Gabriela Costa, Castro Claudia Garcia Serpa Osorio de, Oliveira Maria Auxiliadora
Departamento de Politica de Medicamentos e Assistência Farmacêutica, Escola Nacional de Saúde Publica Sergio Arouca, Fiocruz.R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil. gabicostachaves@ ensp.fiocruz.br.
Cien Saude Colet. 2017 Aug;22(8):2527-2538. doi: 10.1590/1413-81232017228.05602017.
This paper analyzes the Minister of Health's (MoH) procurement of medicines for hepatitis C from 2005 to 2015. Data sources were the Integrated General Services Administration (SIASG), to estimate annual expenditure for selected medicines of the MoH Clinical Protocols and Therapeutic Guidelines (PCDT) for Hepatitis C. All presentations and strengths recorded on SIASG were included. The unit prices were estimated based on the purchase with the highest volume each year. There was a 159.5 fold increase in expenditure of the selected medicines from 2005 to 2006, because procurement of those medicines became centralized. In 2007 there was 730% increase in spending due to the incorporation of pegainterferons alfa 2a and 2b. In 2012 the purchase of only two new direct-acting antivirals (DAA) accounted for 99% of total annual expenditure. In 2015 the adoption of a new DAA led to an increase of 230% (R$945 million) in MoH spending. The significant increase of MoH expenditure on medicines for hepatitis C from 2005 to 2015 was due to the increase of volumes purchased as well as the incorporation of alfapeginterferon and new DAAs. Ensuring universal access to treatment for hepatitis C will depend on the implementation of strategies that strengthen the MoH's bargaining power in price reduction negotiations with the manufacturers of monopoly medicines.
本文分析了2005年至2015年卫生部（MoH）采购丙型肝炎药物的情况。数据来源为综合总务管理局（SIASG），用于估算卫生部丙型肝炎临床方案与治疗指南（PCDT）中选定药物的年度支出。SIASG记录的所有剂型和规格均包括在内。单价根据每年采购量最大的那次采购进行估算。2005年至2006年，选定药物的支出增长了159.5倍，原因是这些药物的采购实现了集中化。2007年，由于纳入了聚乙二醇干扰素α-2a和α-2b，支出增长了730%。2012年，仅两种新型直接抗病毒药物（DAA）的采购就占年度总支出的99%。2015年，采用一种新型DAA导致卫生部支出增加了230%（9.45亿雷亚尔）。2005年至2015年卫生部丙型肝炎药物支出的显著增加，是由于采购量的增加以及纳入了聚乙二醇干扰素和新型DAA。确保丙型肝炎治疗的普遍可及性将取决于实施相关策略，以增强卫生部在与专利药品制造商进行降价谈判时的议价能力。
