Drivers of federal spending in pharmaceuticals of the Specialized Component: measurement and analysis

Vieira, Fabiola Sulpino

doi:10.11606/s1518-8787.2021055003097

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055003097 copy

Drivers of federal spending in pharmaceuticals of the Specialized Component: measurement and analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVES:

Quantify and analyze the contribution of the main drivers of federal spending in pharmaceuticals purchase from the Specialized Component of Pharmaceutical Care (CEAF) in the period from 2010 to 2019.

METHODS:

An analysis of the annual expenditure's decomposition of the Brazilian Ministry of Health (MS) in pharmaceuticals from group 1A of the CEAF was carried out in order to isolate the contribution of its main drivers, price, quantity and residual, which involves therapeutic choices. This contribution's quantification was made with the support of the RStudio software version 1.3.1056 and the IndexNumR statistical package.

RESULTS:

The main driver of increased expenditure between 2011 and 2018 was the quantity of overlapping pharmaceuticals, 55% and 34%. In turn, the main driver in 2013 and 2015 was the residual, 33.2% and 57.9%. However, the expenditure in 2019 decreased by 30.4% compared with 2010. There was a decrease in the prices of daily treatments throughout the period. Among the years in which there was a reduction in expenditure, the residual was the main driver of the decrease in 2012 (-19.6%) and 2019 (-11.9%), while prices had the greatest impact on the decrease in expenditure in 2014 (-12%). There was also a reduction in the quantity of overlapping pharmaceuticals in three consecutive years, being -11% in 2015, -4% in 2016 and -11% in 2017. Lastly, in 2019 the reduction was -4%.

CONCLUSIONS:

The contribution of drivers to MS expenditure in the CEAF's 1A group fluctuated between 2010 and 2019. However, the expenditure decrease in recent years was induced by the three main drivers: price, quantity and residual. The decrease in the quantity purchased may have reduced the availability of some pharmaceuticals in the Brazilian Unified Health System (SUS).

DESCRIPTORS:
Drugs from the Specialized Component of Pharmaceutical Care; Drug Costs; Health Expenditures; Pharmaceutical Services; Unified Health System

Year	Drugs			Expenditure (in R$ of 2019)
Year	Purchased in the year (A)	Purchased in the current year and the previous year (overlapping) (B)	Frequency in % (C) = (B)/(A)	Total in the year (D)	In drugs purchased in the current year and in the previous year (overlapping) (E)	Frequency in % (F) = (E)/(D)
2010	13	–	–	3,111,101,607	–	–
2011	17	12	70.6	3,964,405,181	3,565,115,413	89.9
2012	13	9	69.2	2,730,880,595	2,224,139,542	81.4
2013	20	9	45.0	3,421,253,546	2,203,442,115	64.4
2014	26	16	61.5	3,374,752,748	2,403,345,441	71.2
2015	30	20	66.7	4,457,392,520	2,143,408,273	48.1
2016	27	23	85.2	3,114,255,832	2,834,934,548	91.0
2017	30	21	70.0	2,253,005,743	1,848,589,843	82.0
2018	36	21	58.3	2,721,660,204	1,866,013,403	68.6
2019	41	25	61.0	2,164,179,182	1,509,499,956	69.7

Year	Expenditure on the year in R$ of 2019 (A)	Expenditure on overlapping pharmaceuticals		Expenditure on non-overlapping pharmaceuticals
Year	Expenditure on the year in R$ of 2019 (A)	Value in R$ of 2019 (B)	Frequency in % (C) = (B)/(A)	Value in R$ of 2019 (D)	Frequency in % (E) = (D)/(A)
2010	3,111,101,607	–	–	–	–
2011	3,964,405,181	3,565,115,413	89.9	399,289,768	10.1
2012	2,730,880,595	2,224,139,542	81.4	506,741,053	18.6
2013	3,421,253,546	2,203,442,115	64.4	1,217,811,431	35.6
2014	3,374,752,748	2,403,345,441	71.2	971,407,307	28.8
2015	4,457,392,520	2,143,408,273	48.1	2,313,984,247	51.9
2016	3,114,255,832	2,834,934,548	91.0	279,321,284	9.0
2017	2,253,005,743	1,848,589,843	82.0	404,415,900	18.0
2018	2,721,660,204	1,866,013,403	68.6	855,646,801	31.4
2019	2,164,179,182	1,509,499,956	69.7	654,679,226	30.3

Year	Expenditure in the year (A)	Overlapping pharmaceuticals^b b It is not possible to separate the residual's contribution arising from any changes in the pattern of use of overlapping pharmaceuticals between two years in this analysis, as the expenditure (E) refers to the expenditure with the overlapping list in the two compared periods, this list being different in the analyzed series, as can be seen in the column of the number of overlapping drugs in Table 1 of this article. (purchased in the current year and in the previous year)				Expenditure on non-overlapping pharmaceuticals (F) = (A) - (E)
Year	Expenditure in the year (A)	Price (B)	Quantity (C)	Change (D) = (B) + (C)	Expenditure (E)
2010	3,111,101,607	–	–	–	–	–
2011	3,964,405,181	−942,747,326	1,482,949,631	540,202,305	3,565,115,413	399,289,768
2012	2,730,880,595	−429,401,035	55,202,768	−374,198,267	2,224,139,542	506,741,053
2013	3,421,253,546	−409,206,701	262,862,794	−146,343,906	2,203,442,115	1,217,811,431
2014	3,374,752,748	−319,312,207	157,940,963	−161,371,244	2,403,345,441	971,407,307
2015	4,457,392,520	−152,411,230	−270,527,006	−422,938,236	2,143,408,273	2,313,984,247
2016	3,114,255,832	−1,065,511,265	−139,082,756	−1,204,594,021	2,834,934,548	279,321,284
2017	2,253,005,743	−317,851,837	−240,357,431	−558,209,268	1,848,589,843	404,415,900
2018	2,721,660,204	−214,323,069	503,440,831	289,117,762	1,866,013,403	855,646,801
2019	2,164,179,182	−104,657,061	−62,468,364	−167,125,425	1,509,499,956	654,679,226

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence: Fabiola Sulpino Vieira, SBS, Quadra 1, Bloco J, Ed. BNDES, 16° andar, Sala 1.620 70076-900 Brasília, DF, Brasil. Email: fabiola.vieira@ipea.gov.br