RESUMO

Resumo Objetivo: Analisar o perfil das compras realizadas por órgãos federais brasileiros dos antineoplásicos mesilato de imatinibe, trastuzumabe e L-asparaginase, entre janeiro/2004 e dezembro/2013. Métodos: Dados de compras foram extraídos do Sistema Integrado de Administração de Serviços Gerais-SIASG. Foram analisados: quantidade, preço unitário, data e tipo de compra e órgão comprador. Para permitir comparação de preços, os valores correntes foram corrigidos para dezembro/2013, pelo IPCA. Resultados: As quantidades adquiridas do imatinibe e trastuzumabe aumentaram progressivamente, sendo o Ministério da Saúde (MS) o principal comprador. Seus preços médios ponderados (PMP) apresentaram tendência de queda. Observou-se redução nos PMP do imatinibe, mesmo antes da centralização da compra pelo MS. O PMP do transtuzumabe foi reduzido em 57% após a incorporação pela CONITEC e a centralização de compras. As quantidades e preços da L-asparaginase variaram entre os órgãos. Diferentemente dos outros medicamentos, verificou-se significativa elevação de 117% no PMP da L-asparaginase, refletindo o desabastecimento no mercado mundial. Conclusões: A inclusão em Parcerias de Desenvolvimento Produtivo e a centralização das compras pelo MS parecem justificar as reduções de preço do imatinibe e trastuzumabe, reforçando a tese do uso do poder de compra do Estado. Estas reduções podem contribuir na ampliação de seu acesso no SUS.

Abstract Objective: To analyze the Brazilian federal procurement profile for imatinib mesylate, trastuzumab and L-asparaginase from January 2004 to December 2013. Methods: Information was extracted from the Brazilian Federal Government procurement database and included volume, unit price, date and type of purchase, government agency buyer. Prices were deflated to December 2013 by the Brazilian Pricing Index. Results: Purchase volumes of imatinib and trastuzumab increased progressively. The Ministry of Health was the main buyer. Weighted average prices (WAP) for these medicines showed a downward trend. A WAP reduction for imatinibe occurred before centralized purchases by the Ministry of Health began. After incorporation by CONITEC and centralized purchases in 2012, trastuzumab WAP was reduced by 57%. For L-asparaginase volumes and prices varied among different government agencies, but contrary to the two other medicines, L-asparaginase presented a 117% WAP increase, possibly reflecting stockouts in the international market. Conclusions: The setting of Productive Development Partnerships (PDPs) and centralized purchasing by the Brazilian Ministry of Health suggest a decrease in prices for imatinib and trastuzumab, underlining the government´s purchasing power. These reductions may contribute to availability of these medicines in the Brazilian Public Health System.

Assuntos

RESUMO

OBJECTIVES: This article reviews clinical experiences in the treatment of chronic myeloid leukemia (CML) in an environment of limited resources. METHODS: We reviewed recent publications on Pub med and abstracts from mayor congresses relevant to the disease. RESULTS: CML is a hematological neoplasm observed more frequently in adults, regardless of their socioeconomic status. Until recently, available treatments improved patients' quality of life but did not modify survival. It was not until interferon appeared that patients received a drug that reduced and even eliminated Philadelphia chromosome-positive (Ph+) cells. DISCUSSION: With the start of the new millennium, the International Randomized Study of Interferon-α plus cytarabine versus STI571 (IRIS) trial demonstrated a dramatic improvement in survival by comparing imatinib versus interferon alpha plus cytarabine. The Food and Drug Administration (FDA) approved imatinib as first-line treatment for newly diagnosed CML in 2001 due to its outstanding effectiveness. Years later, three second-generation (dasatinib, nilotinib, bosutinib) and one third-generation (ponatinib) tyrosine-kinase inhibitors (TKIs) were developed and approved. These highly effective treatment options, however, are not affordable for many low-income patients. Additionally, the use of drugs that effectively treat but do not cure the disease has resulted in an important economic impact for patients and health care systems worldwide, especially those in developing countries. Imatinib is the least expensive and a very effective TKI in many low-income countries. Early allogeneic stem cell transplantation must be considered in the management of selected patients before CML transformation.

Assuntos