Public financing of human insulins in Brazil: 2009-2017

ABSTRACT: Background: From 2006 to 2017, the Brazilian federal government provided free of charge traditional insulins for diabetes treatment. This involved public tendering by the Department of Health Logistics of the Ministry of Health (DLOG-MOH) and the reimbursement after direct contracting for supply with commercial private retailers (Brazilian Popular Pharmacy Program - PFPB). Objective: We aim to describe the budget of the Brazilian federal government committed to for the acquisition of insulin, as well as corresponding prices and treatment availability from 2009 to 2017. Methods: Insulin volume and expenditure data were obtained in official administrative databases and in the Electronic System of the Information Service to Citizens. Data were analyzed according to the total provision by the federal government, DLOG-MOH and PFPB. Moreover, data were presented according to insulin type. Volumes were calculated in number of defined daily doses (DDD)/1,000 inhabitants/day. Results: Budgetary commitments due to insulin over nine years amounted to U$1,027 billion in 2017, with an approximate average of U$114.1 million per year. DLOG-MOH was the main insulin provider, despite the increase in PFPB provision along period. DLOG-MOH and PFBP together provided an average of 6.08 DDD/1000 inhabitants/day for nine years. Average prices in PFPB were higher than those in the DLOG series, with a downward trend over the years, narrowing to 2.7 times in 2017, when compared to 2009. Conclusions: Brazil evidenced a moderately sustainable and effective, albeit imperfect, policy for public provision of traditional insulins in the period preceding mandatory free supply of insulin analogues. Future studies must address treatment availability and financial sustainability in the new scenario.

摘要：
背景：2006年至2017年间，巴西联邦政府为糖尿病治疗免费提供传统胰岛素。该项目由卫生部物流司（Department of Health Logistics of the Ministry of Health, DLOG-MOH）通过公开招标实施，并通过与商业私营零售商直接签订供货合同后予以报销，即巴西大众药房计划（Brazilian Popular Pharmacy Program, PFPB）。
目的：本研究旨在描述2009年至2017年间，巴西联邦政府用于胰岛素采购的承诺预算金额，以及对应采购价格与治疗可及性情况。
方法：胰岛素使用量与支出数据来源于官方行政数据库以及公民信息服务电子系统（Electronic System of the Information Service to Citizens）。数据分析按照联邦政府、卫生部物流司及巴西大众药房计划的总供给量展开，同时按胰岛素类型进行数据呈现。使用量以每千居民每日规定日剂量（defined daily doses, DDD）为单位计算。
结果：九年间胰岛素相关预算承诺总额在2017年达10270亿美元，年均约1.141亿美元。卫生部物流司是胰岛素的主要供应方，尽管同期巴西大众药房计划的供给量有所增长。卫生部物流司与巴西大众药房计划的总平均供给量在九年间达每千居民每日6.08个规定日剂量。巴西大众药房计划的平均采购价格高于卫生部物流司采购序列，且呈逐年下降趋势，2017年该差价较2009年缩小至2.7倍。
结论：本研究显示，在强制免费供应胰岛素类似物之前的这段时期内，巴西的传统胰岛素公共供给政策虽存在不完善之处，但具备适度的可持续性与有效性。未来的研究需针对新场景下的治疗可及性与财政可持续性展开探讨。