Background: Biological therapies have a significant economic and clinical burden but, in general, lose their effectiveness over time. This study evaluated the medication persistence and costs associated to use of anti-TNF agents for psoriatic arthritis (PsA) treatment. Methods: A historical cohort composed of individuals in Brazil with PsA diagnosis was developed during the period between 2010 and 2015. The difference among the anti-TNF agents was verified by the log-rank test. The predictors of medication non-persistence were identified by Cox regression. The costs were compared by variance analysis with Bonferroni correction. Results: 11,008 patients were analyzed. Adalimumab (51%) was the most used anti-TNF agent. Individuals using adalimumab presented higher medication persistence as compared to etanercept and infliximab. The costs with anti-TNF agents corresponded to 90% of the total costs and were similar among anti-TNF agents. The non-persistence predictors were female sex, younger patients, to live in the Northeastern and Northern regions of Brazil, to use infliximab and etanercept, and have more comorbidities. Conclusion: The direct costs with anti-TNF agents were the main component of total costs. Outpatient and inpatient costs increase when medication persistence decreases. A considerable price reduction of anti-TNF agents has been observed over the years.

Biological therapy in the treatment of psoriatic arthritis: economic and epidemiological considerations.

Resumo O objetivo deste artigo e investigar como os consorcios publicos intermunicipais de saude atuam no Brasil. Para isso, realizou-se uma pesquisa qualitativa do tipo analise documental sobre o conteudo dos convenios celebrados entre os consorcios com a Uniao, disponiveis no Portal da Transparencia da Uniao, no periodo de 1996 a 2016. Os resultados abordam duas categorias: descricao geral dos convenios celebrados no Brasil e o conteudo dos convenios celebrados pelos consorcios publicos intermunicipais (CIS). Os convenios celebrados, concentrados principalmente nas regioes Sul e Sudeste, tiveram como objetivo realizar acoes de âmbito regional, contribuindo, assim, para o processo de regionalizacao da saude. Contudo, desafios relativos ao processo de cooperacao e coordenacao entre as instâncias gestoras de saude ainda persistem, sobretudo vinculados a melhoria dos vinculos entre os consorcios com as coordenadorias regionais de saude e um aprofundamento em relacao ao controle social dessas organizacoes.

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Regionalização da saúde e cooperação federativa no Brasil: o papel dos consórcios intermunicipais

Aim: To evaluate the persistence of biological (TNF inhibitor [anti-TNF]) and synthetic (conventional synthetic disease-modifying antirheumatic drugs [csDMARDs]) antirheumatic agents for psoriatic ...

https://www.future-science.com/doi/pdf/10.4155/fsoa-2018-0101

Medication persistence for psoriatic arthritis in a Brazilian real-world setting.

The COVID-19 pandemic has the potential to affect all individuals, however in a heterogeneous way. In this sense, identifying specificities of each location is essential to minimize the damage caused by the disease. Therefore, the aim of this research was to assess the vulnerability of the 853 municipalities in the second most populous state in Brazil, Minas Gerais (MG), in order to direct public policies. Then, an epidemiological study was carried out based on Multi-Criteria Decision Analysis (MCDA) using indicators with some relation to the process of illness and death caused by COVID-19. The indicators were selected by a literature review and categorized into: demographic, social, economic, health infrastructure, population at risk and epidemiological. The variables were collected in Brazilian government databases at the municipal level and evaluated according to MCDA, through the Program to Support Decision Making based on indicators (PRADIN). Based on this approach, the study performed simulations by category of indicators and a general simulation that allowed to divide the municipalities into groups of 1 to 5, with 1 being the least vulnerable and 5 being the most vulnerable. The groupings of municipalities were exposed in their respective mesoregions of MG in a thematic map, using the software Tabwin 32. The results revealed that the mesoregion of Norte de Minas stands out with more than 40% of its municipalities belonging to group 5, according to economic, social and health infrastructure indicators. Similarly, the Jequitinhonha mesoregion exhibited almost 60% of the municipalities in this group for economic and health infrastructure indicators. For demographic and epidemiological criteria, the Metropolitana de Belo Horizonte mesoregion is the most vulnerable, with 42.9% and 26.7% of the municipalities in group 5, respectively. Considering the presence of a population at risk, Zona da Mata reported 42.3% of the municipalities in the most vulnerable group. In the joint analysis of data, the Jequitinhonha, Vale do Mucuri and Vale do Rio Doce mesoregions were the most vulnerable in the state of MG. Thus, through the outlined profile, the present study proved how socioeconomic diversity affects the vulnerability of the municipalities to face COVID-19 outbreak, highlighting the need for interventions directed to each reality.

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A vulnerability analysis for the management of and response to the COVID-19 epidemic in the second most populous state in Brazil

Pharmaceutical Assistance (PA) is a dynamic and multidisciplinary process that aims to supply health systems, programs or services with quality medicines, enabling access and health care, in an efficient and timely manner. The objective of the study was to evaluate the profile of administrative processes for the treatment of PsA, identify the time elapsed in the flow of processes and its associated factors. A cross-sectional study of medication requests for the treatment of PsA was carried out between November 2014 and December 2016. Linear regression was used to verify the factors associated with time to delivery. A total of 218 cases containing 250 drugs were analyzed. The median time between the medical appointment and the first dispensation was 66 days (interquartile range, 44–90). The State proceedings, which includes requesting the drug until the authorization of treatment, was the stage that most contributed to the total time spent. The factors associated with the longer time to delivery of medications were prescriptions coming from clinics and specialty centers, from dermatologists, non-authorized processes and non-persistent patients in the treatment in 12 months. The median time to receive medicines for the PsA treatment in Belo Horizonte health region after a medical prescription was higher than 2 months. The time between the solicitation of the medicines and the authorization of the treatment in the SUS (State administrative procedure) was the main component of the total time spent.

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Access to high-cost medications for psoriatic arthritis in the National Health System in Brazil: the long path up to dispensation

The study aimed to describe the specialized health services and to identify areas of greater difficulty of access to specialized consultations offered by SUS in small cities in the 18th Regional Health Area of Parana State, Brazil, using case study methodology. The data were collected between January and April 2015. Managers, management teams and the board of directors of the CIS (Consorcio Intermunicipal de Saude) were interviewed. The 21 studied specialist areas were rated like Sufficient Quota, Insufficient Quota, Inexistent Supply, and Assistance Gap. The services with more difficulty of access were Vascular Surgery, Proctology, Geriatrics, Endocrinology, and Neurology, considered Inexistent Supply/Assistance Gap, and Orthopedics, Neuro-pediatrics, Urology, Rheumatology, Ophthalmology, and Otorhinolaryngology, were considered Insufficient Share. Contribute to the magnitude of the problem: lack of specialist doctors, private sector dependence and de decrease of the Federal and State Governments in financing the Health Sistem. Therefore, the gap in specialized healthcare is complex and difficult to solve in the short-terms, proving that this services have become a "bottleneck" in the SUS.

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Difficulties in accessing services that are of medium complexity in small municipalities: a case study

Resumo O processo de descentralizacao exerce forte impacto nas financas dos Municipios de Pequeno Porte (MPP) e estes sao o ente mais vulneravel da federacao. Objetivou-se analisar os principais problemas e as estrategias de gestao utilizadas pelos MPP para enfrentar as desigualdades decorrentes do processo de descentralizacao. Pesquisa qualitativa desenvolvida por meio de grupos operativos com 55 trabalhadores das equipes gestoras de MPP da macrorregiao norte do Parana. Foi realizada analise compreensiva e interpretativa utilizando a Teoria do Jogo Social como referencial teorico. Dentre os problemas, estao a insuficiente capacidade para fazer a gestao dos municipios e para ofertar atencao integral a saude aos municipes. A constituicao de Consorcios Intermunicipais de Saude, a compra de servicos por contratos paralelos com prestadores privados e a adesao a programas do estado e da Uniao sao estrategias para o enfrentamento dos problemas, porem estas desencadeiam um intercâmbio de problemas. Para minimizar a vulnerabilidade dos MPP, e preciso fomentar o empoderamento do gestor municipal, implantar processos de escuta dos MPP e de uma cultura de enfrentamento dos problemas de forma coletiva e compartilhada entre os entes federados, para que haja uma gestao interfederativa.

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Camila Ribeiro Silva

Papers

Difficulties in accessing services that are of medium complexity in small municipalities: a case study

Problemas e estratégias de gestão do SUS: a vulnerabilidade dos municípios de pequeno porte