Economic evaluation of the Programs Rede Farmácia de Minas do SUS versus Farmácia Popular do Brasil

Garcia, Marina Morgado; Guerra, Augusto Afonso; Acúrcio, Francisco de Assis

doi:10.1590/1413-81232017221.15912015

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Free Themes • Ciênc. saúde colet. 22 (1) • Jan 2017 • https://doi.org/10.1590/1413-81232017221.15912015 copy

Economic evaluation of the Programs Rede Farmácia de Minas do SUS versus Farmácia Popular do Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

We conducted an economic assessment of the Pharmaceutical Assistance - Rede Farmácia de Minas Gerais-RFMG and Farmácia Popular do Brasil-FPB to ascertain which of the two models stands out as the most efficient. To do this, a model, which consisted of a study of incurred costs in both programs, up to the dispensing of medicine to citizens, was developed. The uncertainties of the proposed model were tested using the Monte Carlo method. If the entire population initially estimated in the RFMG were attended in the FPB, there would be an additional cost of R$ 139,324,050.19. The sensitivity analysis appeared to be favorable to the RFMG. A total of 10000 simulations were carried out, resulting in a median value of R$ 114,053,709.99 for the RFMG and R$ 254,106,120.65 for the FPB. The current National Drug Policy emphasizes the need to strengthen pharmaceutical services beyond the mere acquisition and delivery of pharmaceutical products. The public healthcare service model, consistent with the principles and guidelines of the SUS, seems to be more appropriate in ensuring complete and universal quality healthcare services to the citizens. The economic study conducted reinforces this fact, as it appears to be a more efficient alternative of the direct use of resources in the public health network.

Key words
Public Health; Health economics; Access to medicines; Pharmaceutical care

Use indication	Medicines	DDD (mg)
Asthma	Beclomethasone; Dipropionate 250 mcg oral aerosol	0.8
	Beclomethasone; Dipropionate 50 mcg nasal suspension	0.8
	Salbutamol; Sulfate 100 mcg aerosol	0.8
Contraceptives	Levonorgestrel + Ethinylestradiol; 0.15mg + 0.03 mg tablet	–
	Medroxyprogesterone; Acetate 150 mg/ml suspension for injection	1.67
	Norethisterone; 0.35 mg tablet	–
	Norethisterone enanthate + estradiol valerate; 50mg/ml + 5mg/ml injection	–
Diabetes
Oral hypoglycemiant	Glibenclamide; 5 mg tablet	10
Oral hypoglycemiant	Metformin; Hydrochloride 850 mg tablet	2000
Insulins ^* * DDD in U. For items. Levonorgestrel + Ethinyl estradiol; 0.15 mg + 0.03 mg, Norethisterone; 0.35 mg, Norethisterone enanthate + Valerate Estradiol; 50mg / ml + 5mg / ml inj and Timolol; maleate 5 mg / ml Ophthalmic sol because it isn't available in DDD ATC / DDD, was used to calculate the information of the maximum daily dose of each medication, available in package insert.	NPH Human Insulin; 100 UI/ml 3 mL	40
	Regular Human Insulin; 100 UI/ml 10 mL	40
Cardiovascular Diseases
Antihypertensives	Enalapril; maleate 10 mg tablet	10
	Propranolol; hydrochloride 40 mg tablet	160
	Hydrochlorothiazide; 25 mg tablet	25
	Losartan; potassium 50 mg coated tablet	50
	Captopril; 25 mg tablet	50
Hypolipemiant	Simvastatin: 10mg tablet	30
Hypolipemiant	Simvastatin; 40mg tablet	30
Parkinson's Disease	Levodopa; Benserazide; hydrochloride 100 mg +25mg tablet	600
Parkinson's Disease	Levodopa+Carbidopa; 250mg + 25 mg tablet	600
Glaucoma	Timolol; maleate 5 mg/ml ophthalmic solution	–
Osteoporosis	Alendronate; sodium 70 mg tablet	10

Item	Parameter	Quantity (a)	Monthly Unit Cost (R$) (b)	Monthly Total Cost (R$) (a*b)	% of item	% of total
Human Resources (HR)	Pharmacist^* * Source: RAIS – Elaboration: Research Station of Market Signals – EPSM/NESCON/FM/UFMG	2	3,455.90	6,911.80	36.8%	17.6%
	Assistant - Pharmacy Technician^* * Source: RAIS – Elaboration: Research Station of Market Signals – EPSM/NESCON/FM/UFMG	6	1,832.48	10,994.88	58.6%	27.9%
	Training	8	106.62	852.96	4.5%	2.2%
Human Resources Subtotal				18,759.64	100.0%	47.6%
Social charges	13th salary (9.75%)	1	1,388.57	1,388.57	11.4%	4.4%
	Vacations (+1/3 of vacations) (13.00%)	1	1,851.42	1,851.42	15.2%	5.9%
	INSS, FGTS and food (57.00%)	1	8,117.78	8,117.78	66.8%	25.9%
	Transportation Vouchers^ Pass value: Round trip by bus to the city of Belo Horizonte	8	116.60	932.80	6.1%	2.4%
	Benefits (uniforms)	8	100.00	66.67	0.4%	0.2%
Subtotal social charges HR				15,280.04	100.0%	38.8%
Consumables	General services, hygiene and cleaning materials	1	500.00	500.00	62.5%	1.3%
Consumables	Consumables	1	300.00	300.00	37.5%	0.8%
Subtotal consumables				800.00	100.0%	2.0%
Services	Telecommunications (internet/phone)	1	150.00	150.00	15.3%	0.4%
	Corrective and evolutive software maintenance^* ***** Value calculated from SES-MG contract for maintenance and development of SIGAF;	1	70.00	70.00	7.1%	0.2%
	Water and electricity	1	250.00	250.00	25.4%	0.6%
	Waste disposal^** ****** Source: Bidding process carried out by FHEMIG and Contracts Report of the Secretariat of Comptroller General of the State of Pernambuco		512.95	512.95	52.2%	1.3%
Subtotal services				982.95	100.0%	2.5%
Property	Commercial Building^*** *** Source: Regional Council of Realtors – CRECI-MG	1	2,222.40	2,222.40	77.0%	5.6%
Property	Building maintenance (4%)		665.00	665.00	23.0%	1.7%
Subtotal Property				2,887.40	100.0%	7.3%
Furniture and equipment	Equipment maintenance (5%)		250.00	250.00	37.5%	0.6%
Furniture and equipment	Depreciation of furniture and equipment	1	416.67	416.67	62.5%	1.1%
Subtotal furniture and equipment				666.67	100.0%	1.7%
Total				39,376.70		100%

Medicine	Treatment (year)	RFMG
Medicine	Treatment (year)	Unitary value (a) R$	Cost of monthly treatment per patient R$	Cost of monthly treatment per patient adjusted (b) R$	Total Cost (c) (R$)
NPH Human Insulin; 100 UI/ml 3 mL	655,522	4.5800	13.5073	17.1783	11,260,717.20
Captopril; 25 mg tablet	3,496,121	0.0093	0.4101	3.1511	11,016,614.46
Losartan; potassium 50 mg coated tablet	4,512,958	0.0279	0.6171	3.3728	15,221,440.53
Simvastatin; 40mg tablet	1,212,782	0.0902	1.4964	4.3145	5,232,529.32
Simvastatin; 10mg tablet	1,118,485	0.0378	2.5076	5.3976	6,037,097.18
Enalapril; maleate 10 mg tablet	1,576,560	0.0151	0.3336	3.0691	4,838,669.33
Metformin; hydrochloride 850 mg tablet	1,365,689	0.033	1.7175	4.5513	6,215,673.93
Salbutamol; Sulfate100 mcg aerosol	301,599	0.01	1.7695	4.6071	1,389,482.48
Regular Human Insulin; 100 UI/ml 10 mL	258,259	9	7.9628	11.2401	2,902,857.79
Propranolol; hydrochloride 40 mg tablet	854,170	0.009	0.7981	3.5666	3,046,490.57
Alendronate; sodium 70 mg tablet	358,114	0.2452	0.7749	3.5418	1,268,358.64
Glibenclamide; 5 mg tablet	1,155,875	0.0092	0.4063	3.147	3,637,564.07
Norethisterone + estradiol; 50mg+5/mL inj solution	784,260	3.05	2.2488	5.1203	4,015,663.36
Beclomethasone; 250 mcg oral aerosol	274,185	0.085	6.0164	9.1554	2,510,283.84
Beclomethasone; 50 mcg nasal suspension	51,725	0.095	33.6209	38.7199	2,002,800.72
Levodopa+Carbidopa; 250mg + 25 mg tablet	21,491	0.159	8.4406	11.7518	252,562.24
Timolol; 5 mg/mL ophthalmic solution	98,604	0.196	0.8671	3.6405	358,970.50
Levodopa + Benserazide; 100 mg +25 mg tablet	7,249	0.99	131.3869	143.4272	1,039,660.10
Norethisterone; 0,35 mg tablet	187,963	0.0583	1.2893	4.0928	769,285.30
Levonorgestrel + Ethinylestradiol; 0,15+0,03 mg tablet	1,949,218	0.0191	0.295	3.0278	5,901,827.35
Medroxyprogesterone; 150 mg/ml inj suspension	902,284	7	1.7238	4.5581	4,112,695.39
Hydrochlorothiazide; 25 mg tablet	7,220,275	0.008	0.177	2.9014	20,948,976.68
Total cost					113,980,220.98

Medicine	FPB
Medicine	Unit reference value (d) R$	Cost of monthly treatment per patient R$	Cost of monthly treatment per patient adjusted (e) R$	Total Cost (f) (R$)
NPH Human Insulin; 100 UI/ml 3 mL	26.55	78.3013	79.8673	52,354,742.56
Captopril; 25 mg tablet	0.28	12.3866	12.6344	44,171,293.96
Losartan; potassium 50 mg coated tablet	0.32	7.0781	7.2196	32,581,941.72
Simvastatin; 40mg tablet	0.89	14.7644	15.0597	18,264,155.39
Simvastatin; 10mg tablet	0.23	15.2621	15.5674	17,411,848.20
Enalapril; maleate 10 mg tablet	0.39	8.6264	8.7989	13,872,054.01
Metformin; hydrochloride 850 mg tablet	0.16	8.3272	8.4937	11,599,746.42
Salbutamol; Sulfate100 mcg aerosol	0.1	17.6952	18.0491	5,443,594.73
Regular Human Insulin; 100 UI/ml 10 mL	26.55	23.4904	23.9602	6,187,937.56
Propranolol; hydrochloride 40 mg tablet	0.08	7.0781	7.2196	6,166,800.66
Alendronate; sodium 70 mg tablet	3.37	10.6487	10.8617	3,889,728.65
Glibenclamide; 5 mg tablet	0.12	5.3086	5.4147	6,258,752.43
Norethisterone + estradiol; 50mg+5/mL inj solution	10.17	7.4983	7.6483	5,998,261.89
Beclomethasone; 250 mcg oral aerosol	0.15	10.6171	10.8295	2,969,280.66
Beclomethasone; 50 mcg nasal suspension	0.13	46.0075	46.9277	2,427,353.30
Levodopa+Carbidopa; 250mg + 25 mg tablet	0.58	30.7896	31.4054	674,946.54
Timolol; 5 mg/mL ophthalmic solution	0.86	3.8045	3.8806	382,639.12
Levodopa + Benserazide; 100 mg +25 mg tablet	1.05	139.3497	142.1367	1,030,305.46
Norethisterone; 0,35 mg tablet	0.1274	2.8186	2.875	540,384.04
Levonorgestrel + Ethinylestradiol; 0,15+0,03 mg tablet	0.1795	2.7796	2.8352	5,526,330.54
Medroxyprogesterone; 150 mg/ml inj suspension	11.12	2.7384	2.7932	2,520,223.89
Hydrochlorothiazide; 25 mg tablet	0.08	1.7695	1.8049	13,031,949.44
Total cost				253,304,271.17

Medicine	FPB x RFMG
Medicine	Δ Unitary value Acquisition =(d-a)/d	Δ Cost of monthly treatment per patient adjusted =(e-b)/e	Incremental Cost Δ=(f-c)
NPH Human Insulin; 100 UI/ml 3 mL	82.8%	78.5%	41,094,025.36
Captopril; 25 mg tablet	96.7%	75.1%	33,154,679.50
Losartan; potassium 50 mg coated tablet	91.3%	53.3%	17,360,501.19
Simvastatin; 40mg tablet	89.9%	71.4%	13,031,626.07
Simvastatin; 10mg tablet	83.6%	65.3%	11,374,751.02
Enalapril; maleate 10 mg tablet	96.1%	65.1%	9,033,384.68
Metformin; hydrochloride 850 mg tablet	79.4%	46.4%	5,384,072.49
Salbutamol; Sulfate100 mcg aerosol	90.0%	74.5%	4,054,112.24
Regular Human Insulin; 100 UI/ml 10 mL	66.1%	53.1%	3,285,079.77
Propranolol; hydrochloride 40 mg tablet	88.7%	50.6%	3,120,310.10
Alendronate; sodium 70 mg tablet	92.7%	67.4%	2,621,370.01
Glibenclamide; 5 mg tablet	92.4%	41.9%	2,621,188.36
Norethisterone + estradiol; 50mg+5/mL inj solution	70.0%	33.1%	1,982,598.53
Beclomethasone; 250 mcg oral aerosol	43.3%	15.5%	458,996.82
Beclomethasone; 50 mcg nasal suspension	26.9%	17.5%	424,552.58
Levodopa+Carbidopa; 250mg + 25 mg tablet	72.6%	62.6%	422,384.30
Timolol; 5 mg/mL ophthalmic solution	77.2%	6.2%	23,668.62
Levodopa + Benserazide; 100 mg +25 mg tablet	5.7%	-0.9%	-9,354.64
Norethisterone; 0,35 mg tablet	54.3%	-42.4%	-228,901.26
Levonorgestrel + Ethinylestradiol; 0,15+0,03 mg tablet	89.4%	-6.8%	-375,496.80
Medroxyprogesterone; 150 mg/ml inj suspension	37.1%	-63.2%	-1,592,471,51
Hydrochlorothiazide; 25 mg tablet	90.0%	-60.8%	-7,917,027.24
Total cost			139,324,050.19

Parameter	Base value	Interval	ICER (FPB - RFMG/SUS) R$
Monthly salary per Pharmacist (R$)	3,455.90	(990.00 – 5,921.24)	(156,636,856.12;122,011,263.31)
Amount of Dispensation per month	6,600	(1,100 – 8,800)	(-245,268,232.22; 158,553,674.31)
Amount of Medicines per Patient	2.20	(1.30 – 3.80)	(86,072,819.29; 171,710,779.04)
Variation Coefficient of Unit Cost	1.00	(0.35 – 1.65)	(163,414,165.30; 115,233,954.13)
Logistic Losses Coefficient	1.05	(1.02 – 1.40)	(140,382,965.46; 126,970,159.42)
Losses in Reimbursement Coefficient	1.02	(1.005 – 1.05)	(135,598,997.67; 146,774,183.80)
Tax Burden Coefficient	0.2627	(0.0883 – 0.3314)	(190,473,788.67; 119,175,055.25)

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

MM Garcia and AA Guerra Júnior contributed substantially to the design, planning, analysis and interpretation of the data; preparation and approval of the final version of the manuscript. FA Acúrcio contributed substantially to the design, planning and interpretation of data; critical revision and approval of the final version of the manuscript.