Immunosuppressants in Brazil: underlying drivers of spending trends, 2010–2015

ABSTRACT

Background: Immunosuppressants are recommended for treatment of autoimmune diseases, and in transplant therapy. The high cost of these drugs has been causing an important impact on global pharmaceutical spending.

Objective: Analyzing immunosuppressant expenditure in Brazil, using data from the Federal Procurement System database (SIASG), between 2010 and 2015.

Methods: The pharmaceutical products were classified in accordance with the Anatomical, Therapeutic and Chemical (ATC) classification system recommended by World Health Organization (WHO) and aggregated by volume and by expenditure. The expenditure variation was decomposed into three broad categories: price effects, quantity effects, and drug mix effects.

Results: During the period, annual expenditure increased by 49%, ranging from USD 494.5 million in 2010 to USD 738.7 million in 2015, while purchased quantities increased by 294%, ranging from 49.8 million in 2010 to 196.5 million in 2015. Two factors drove expenditures: the quantity effect and the drug-mix effect.

Conclusion: These findings may contribute to understand immunosuppressant spending trends and the factors that influence them in order to formulate effective cost containment strategies and design optimum drug policy. Rigorous evaluations are recommended to reduce the drug-mix effect, including systems to monitor price, effectiveness, safety, therapeutic value and budget impact of pharmaceutical innovations.

KEYWORDS:

• Drivers
• drug expenditure
• immunosuppressants
• trends

Acknowledgments

The authors wish to thank Mariana C. B. Ramos and Aurelio Maia of the Brazilian Ministry of Health for their support with the data extraction from the SIASG database.

Author Contributions

Alves and Luz contributed equally to the study design, data analysis and interpretation, to the manuscript writing and to final manuscript review. Osorio-de-Castro and Wettermark contributed to data interpretation and to the final manuscript review. All authors read and approved the final manuscript.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethical Statement

The study analyzed publicly available data and did not involve human subjects, specimens or tissue samples, or vertebrate animals, embryos, or tissues. There was no need of prior approval by an Institutional Review Board.

Additional information

Funding

The work was funded in part by the Brazilian Research and Development Council (CNPq), Grant Number [303342/2013-7] (CGSOC, productivity grant).