Risk or Benefit? Expenditures with Medicines Demanded by Judicial Decisions against Brazilian National Public Health System (SUS) and the Risk of Damage to Patients by Medicines Interactions

Posted: 15 Jun 2007

See all articles by Daniel Faleiros

Daniel Faleiros

Federal University of Minas Gerais

Augusto A. Guerra

Federal University of Minas Gerais (UFMG)

Grazielle D. Silva

affiliation not provided to SSRN

Eli Iola G. Andrade

Federal University of Minas Gerais (UFMG)

Daniele A.C. Szuster

Ministério da Saúde

Elias A. Jorge

Ministério da Saúde

Vania L. Macedo

Ministério da Saúde

Francisco A. Acurcio

Federal University of Minas Gerais

Mariângela L. Cherchiglia

Federal University of Minas Gerais (UFMG)

Date Written: June 12, 2007

Abstract

Rationale: The policy of free and universal access to healthcare in Brazil, that assures the principle of equity based on the Federal Constitution of 1988, has caused repercussions as citizens become more aware of their rights. This has been achieved via lawsuits based on the statement: health is everyone's right and a duty of the State. The number of lawsuits to obtain access to medicines has taken legal and financial proportions, causing a great impact on public expenditure with health.

Objectives: To investigate the efficiency of judicial decisions against the federal manager of the Unified Health System (SUS) regarding the benefits and the costs of denied treatments.

Methods: This study is based on data from procedural records that obligates distribution of drugs by the federal level of management of the Unified Health System (SUS), between of January of 2000 the August of 2005. Data were collected using a questionnaire that matches information of procedural records from the Legal Advisory Board of the Office of Sciences, Technology and Strategic Inputs of the Ministry of Health. Possible interactions were verified, according to the TATRO DS 2004 method, in lawsuits that requested five or more different medicines. The value of medicines was calculated according to information obtained from the National Bank for Health Prices, a service offered by the Department of Health Economy of the Ministry of Health in Brazil.

Results: We analyzed 425 lawsuits from individual patients requesting 1 to 30 different drugs. The possibility of drug interactions occurred in 52% actions, in 46 (11%) lawsuits asking for 5 or more drugs were found, in which in 8 (2%) they had admitted the prescription of 9 to 30 drugs. In 63% of these lawsuits, 78 drug interactions were found, with a level of significance index from 1 (serious) to 5 (less serious). Serious levels of significance occurred (1 and 2) in 47% of the interactions, adding up to 7 and 30 lawsuits, respectively. One of the lawsuits had 10 drug interactions, in which 3 of them had level of significance of 1 (risk of death of the patient). 86 lawsuits asked for 19 different active principles with a purchase record in the Price Bank and with a detailed description of the amount of medicine needed for a one-month treatment. When grouped by amount of medicines and its market value (unitary mean above of USD 50,00 for one year) reached the sum of USD 1,76 millions.

Conclusions: The results suggest a potential high risk of drug interactions in patients receiving drugs through lawsuits against the Unified Health System. Patients on a higher number of drugs were associated with different levels of drug interactions. Six of these patients were classified within the most serious levels of significance (risk of death). Complex healthcare needs and new expenses for the Unified Health System (SUS) can be pointed out as consequences of irrational drug use by patients, and therefore, the possibility of new lawsuits against the health system can't be discarded. The estimated expenditure shows that judicial action is not enough to provide fundamental rights to all citizens, does not guarantee effectiveness in lawsuits and is also still a deficiency of the Unified Health System (SUS).

Keywords: Drug interactions, Lawsuits, Unified Health System (Brazil)

JEL Classification: H51, I18, I31, K32

Suggested Citation

Faleiros, Daniel R. and Guerra, Augusto A. and Silva, Grazielle D. and Andrade, Eli Iola G. and Szuster, Daniele A.C. and Jorge, Elias A. and Macedo, Vania L. and Acurcio, Francisco A. and Cherchiglia, Mariângela L., Risk or Benefit? Expenditures with Medicines Demanded by Judicial Decisions against Brazilian National Public Health System (SUS) and the Risk of Damage to Patients by Medicines Interactions (June 12, 2007). iHEA 2007 6th World Congress: Explorations in Health Economics Paper, Available at SSRN: https://ssrn.com/abstract=993225

Daniel R. Faleiros (Contact Author)

Federal University of Minas Gerais ( email )

Av. Antonio Carlos, 6627
MG30170-120 Belo Horizonte, 31270-901
Brazil

Augusto A. Guerra

Federal University of Minas Gerais (UFMG) ( email )

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

Grazielle D. Silva

affiliation not provided to SSRN ( email )

No Address Available

Eli Iola G. Andrade

Federal University of Minas Gerais (UFMG) ( email )

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

Daniele A.C. Szuster

Ministério da Saúde ( email )

Rio de Janeiro, 20031-142
Brazil

Elias A. Jorge

Ministério da Saúde ( email )

Rio de Janeiro, 20031-142
Brazil

Vania L. Macedo

Ministério da Saúde ( email )

Rio de Janeiro, 20031-142
Brazil

Francisco A. Acurcio

Federal University of Minas Gerais ( email )

Av. Antonio Carlos, 6627
FAFAR Sala 1048B2
Belo Horizonte, Minas Gerais 31270901
Brazil
553134996855 (Phone)
553134996852 (Fax)

Mariângela L. Cherchiglia

Federal University of Minas Gerais (UFMG) ( email )

Av. Antonio Carlos, 6627
Belo Horizonte, Minas Gerais 31270-901
Brazil

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