Date Published: April 7, 2017
Publisher: Public Library of Science
Author(s): Tatiana Chama Borges Luz, Claudia Garcia Serpa Osorio-de-Castro, Rachel Magarinos-Torres, Bjorn Wettermark, Eduard J Beck.
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.
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 .
From 2006 to 2013, the Brazilian Federal Government purchased, nearly 23 billion drug packaging units (Table 1) belonging to 15 different anatomical main groups (ATC 1st level) and 90 different therapeutic groups (ATC 2nd level). The total medicine expenditure, adjusted for inflation, was USD 14.7 billion (BRL 34.6 billion) during the period (Table 1). Annual expenditure increased 2.72 times (172%) from 2006 to 2013, while volume increased 1.99 times (100%). The top twenty therapeutic groups accounted for more than 90% of total expenditure and volume each year (Table 1).
Our findings suggest a significant increase in pharmaceutical expenditure by the Brazilian Federal Government from 2006 to 2013. Total expenditure practically tripled, while the quantities purchased only doubled during this eight-year period. This tendency of growth in pharmaceutical spending is being observed worldwide, but at different rates [15–19]. In Canada, from 2006 to 2011, government medicines expenditures increased at an average annual rate of 4.5% , while in Brazil the rate was 13.3% per year. In China, a similar (14.9%) yet non-deflated annual growth rate for total drug expenditure was observed for the period 1990–2009 .