ABSTRACT

Health technologies have revolutionized medical care and health management. The National Commission for the Incorporation of Technologies in the SUS (Conitec) is the Ministry of Health’s body that advises on the incorporation, exclusion or alteration of new technologies in the Unified Health System (SUS). This study aimed to describe the profile of technologies incorporated in the SUS between January 1, 2012 and September 30, 2019. Data were collected on the Conitec website. Statistical analysis used Pearson’s chi-square test and Fisher’s exact test. The results show that 380 technologies were incorporated, with medication prevailing (46.6%). In relation to the plaintiffs, those of internal origin surpassed the others (82.4%), mainly secretariats of the Ministry of Health (p<0.001). Infectious and Parasitic Diseases (PIDs) were the most benefited (20.3%), with emphasis on HIV (Human Immunodeficiency Virus). Most of the incorporated technologies underwent public consultation (p<0.001). It is concluded that the profile of the incorporated technologies are mainly medicines, by internal demand, with indication for PIDs and, above all, for HIV. Medicines continue to be the focus of requests and internal demands have gained more space in this scenario.

KEYWORDS
Unified Health Systems; Biomedical technology; Technology assessment; biomedical

Introduction

The Brazilian Federal Constitution of 1988 recognized health as a right for all and a duty of the State, forcing it to guarantee universal and equitable access to medicines and other health technologies¹1 Caetano R, Silva RMD, Pedro EM, et al. Incorporação de novos medicamentos pela Comissão Nacional de Incorporação de Tecnologias do SUS, 2012 a junho de 2016. Ciênc. Saúde Colet. 2017; (22):2513-25.. Health technologies are medicines, procedures, products and protocols used in patient care²2 Santos ZMSA, Frota MA, Martins ABT. Tecnologias em saúde: da abordagem teórica a construção e aplicação no cenário do cuidado. Fortaleza: EdUECE; 2016.

The incorporation of technologies in the Unified Health System (SUS) was standardized, for the first time, in 2006, through decrees nº 152 and nº 3,323. At that time, the flow took place through the articulation between the Cabinet of Health Care (SAS), the Cabinet of Science, Technology and Strategic Products (SCTIE), the Cabinet of Health Surveillance (SVS), the National Supplementary Health Agency (ANS) and National Health Surveillance Agency (Anvisa)³3 Comissão Nacional de Incorporação de Tecnologias. Histórico institucional. [acesso em 2019 jul 9]. Disponível em: http://conitec.gov.br/historico-institucional
http://conitec.gov.br/historico-instituc... .

Also according to Conitec³3 Comissão Nacional de Incorporação de Tecnologias. Histórico institucional. [acesso em 2019 jul 9]. Disponível em: http://conitec.gov.br/historico-institucional
http://conitec.gov.br/historico-instituc... , it was up to SAS to manage the process of incorporating technologies and to SCTIE to manage the assessment of technologies of interest to SUS. Under the coordination of the SAS, the Commission for the Incorporation of Technologies of the Ministry of Health (Citec) was created, with the mission of forwarding the process of admissibility of technologies in line with the social needs in health and management of the SUS. In 2008, the coordination of Citec was transferred to SCTIE³3 Comissão Nacional de Incorporação de Tecnologias. Histórico institucional. [acesso em 2019 jul 9]. Disponível em: http://conitec.gov.br/historico-institucional
http://conitec.gov.br/historico-instituc... .

In 2011, Citec was expanded and named the National Commission for the Incorporation of Technologies in the SUS (Conitec), through Law nº 12,401/2011, which amended Law nº 8,080/1990 (Organic Law of the SUS). It is an organ of the regulatory structure of the Ministry of Health, which advises on the incorporation, exclusion or change of new health technologies in the SUS⁴4 Comissão Nacional de Incorporação de Tecnologias. Histórico institucional. [acesso em 2020 jan 12]. Disponível em http://conitec.gov.br/historico-institucional
http://conitec.gov.br/historico-instituc... .

The operating framework of Conitec is based on two forums: the Conitec Plenary and the Executive Secretariat. The Conitec Plenary holds monthly meetings, in which the demands for incorporation, exclusion or alteration of technologies within the scope of the SUS are evaluated, as well as updating of the National List of Essential Medicines (Rename)⁵5 Rabelo RB, Petramale CA, Da Silveira LC, et al. A comissão nacional de incorporação de tecnologias no SUS: um balanço dos primeiros anos de atuação. Revista Eletrônica Gestão e Saúde. 2015; (4): 3225-3240..

The technical and scientific support necessary for the analysis of these demands is exercised by the Executive Secretariat of the commission, which is under the responsibility of the Department of Management and Incorporation of Health Technologies (DGITS) of the Secretariat of Science, Technology and Strategic Inputs of the Ministry of Health, assisted by a network of national institutions (hospitals and universities), partners of Conitec, which carry out studies on demand by DGITS⁵5 Rabelo RB, Petramale CA, Da Silveira LC, et al. A comissão nacional de incorporação de tecnologias no SUS: um balanço dos primeiros anos de atuação. Revista Eletrônica Gestão e Saúde. 2015; (4): 3225-3240..

DGITIS was created by Decree No. 7797, of August 30, 2012, revoked by Decree No. 9,795/2019 and amended by Decree No. 9,816/2019. Its functions are to monitor, subsidize and support Conitec’s activities and demands and contribute to the promotion of access and rational use of safe and efficient technologies, among others. This department is made up of the Coordinations: General Coordination of Health Technology Management (CGGTS); Coordination of Monitoring and Evaluation of Health Technologies (CMATS); Technology Incorporation Coordination (Citec); Coordination of Management of Clinical Protocols and Therapeutic Guidelines (CCPTG) and General Coordination of Technological Innovation in Health (CGITS)⁶6 Comissão Nacional de Incorporação de Tecnologias. [acesso em 2020 jan 12]. Disponível em: http://conitec.gov.br/entenda-a-conitec-2
http://conitec.gov.br/entenda-a-conitec-... .

Changes in the process of incorporating technologies since the creation of Conitec have been significant, changing the dynamics and quality of the entry of new products into the SUS. It is necessary to analyze their profile, as they are still recent technologies, with potential health impacts and that involve public resources needed to make them available to citizens¹1 Caetano R, Silva RMD, Pedro EM, et al. Incorporação de novos medicamentos pela Comissão Nacional de Incorporação de Tecnologias do SUS, 2012 a junho de 2016. Ciênc. Saúde Colet. 2017; (22):2513-25..

The incorporation of technologies has been the main responsible for the increase in the costs of national health systems, especially industrialized products such as medicines. In SUS, the annual expenditure on the purchase of health products and technologies exceeds R$ 20 billion⁷7 Guimarães R, Noronha J, Elias FTS, et al. Política de ciência, tecnologia e inovação em saúde. Ciênc. Saúde Colet. 2019; 24(3):881-886..

The increase in public spending on health products is due, in part, to the formal incorporation of new technologies into the SUS. And this, consequently, can be associated with the phenomenon of the judicialization of health. Between 2010 and 2017, the Ministry of Health disbursed R$ 4.5 billion for the purchase of medicines, equipment, food supplements and coverage of surgeries and hospitalizations based on court orders. In 2016, the Ministry of Health spent R$ 654.9 million on the purchase of just 10 medicines, to serve 1,213 people⁸8 Pierro B. Demandas crescentes: parcerias entre instituições de pesquisa e a esfera pública procuram entender a judicialização da saúde e propor estratégias para lidar com o fenômeno. Rev. Pesquisa Fapesp. 2017; 18(252):18-25..

The supplementary health sector in Brazil differs in its methodology for incorporating technologies. The periodic review of the ANS list has little relation to the guidelines and guidelines followed by Conitec in the process of evaluating technologies for the SUS, thus confirming the existing dichotomy between the two models. The use of a demand entry form, the request for a technical-scientific opinion from the applicants and the holding of public consultations by ANS configure the main similarities between the two processes.

However, the non-disclosure of the Health Technology Assessment reports, the lack of economic evaluations and, mainly, the lack of clarity of the criteria for the Agency’s recommendation, demonstrate some of the differences of the ANS process in relation to Conitec⁹9 Lisbôa R, Caetano R. Avaliação de Tecnologias em Saúde na saúde suplementar brasileira: revisão de escopo e análise documental. Saúde debate. 2021, 44:1255-1276..

It is essential to investigate the profile of technologies incorporated in the SUS in Brazil, since information such as these are of public relevance and serve as a parameter for managers to improve decision-making, remedy deficiencies related to the incorporation of health technologies and make efficient use of resources.

This study aimed to evaluate and describe the profile of technologies incorporated by the SUS, from January 2012 to September 2019, in addition to investigating which is the most significant demandant and which group of diseases is most covered by incorporation.

Material and methods

This is an exploratory, descriptive, retrospective study, presenting a qualiquantitative approach to the demands submitted to Conitec, from January 1, 2012 to September 30, 2019. Data collection was carried out between March and October 2019. They are secondary data, collected through document analysis, mainly in the databases available for consultation on the Conitec website (hiperlink: http://conitec.gov.br/)

The following technologies were considered: (i) medicines (conventional drugs, vaccines, chemotherapy and biologicals), (ii) procedures (surgical procedures, care procedures, imaging, laboratory and other tests), (iii) products (apparatus, equipment and inputs used in health care) and (iv) Clinical Protocols and Therapeutic Guidelines (CPTGs) (clinical protocols and therapeutic guidelines, diagnostic and therapeutic guidelines and usage protocols). The CPTGs were included as technologies due to the fact that several concepts in the international literature and the Ministry of Health consider it so¹1 Caetano R, Silva RMD, Pedro EM, et al. Incorporação de novos medicamentos pela Comissão Nacional de Incorporação de Tecnologias do SUS, 2012 a junho de 2016. Ciênc. Saúde Colet. 2017; (22):2513-25..

For statistical analysis, Pearson’s Chi-square test was used, a priori, in which case the data were randomly selected, all expected frequencies were greater than or equal to 1 and no more than 20% of the expected frequencies were lower to 5¹⁰10 Lima Filho MA. Teste de Independência. [acesso em 2020 jan 12]. Disponível em: http://www.de.ufpb.br/~luiz/AED/Aula10.pdf
http://www.de.ufpb.br/~luiz/AED/Aula10.p... .

In cases where the impossibility of this was verified, the Fisher’s Exact Test was used. It is a test that calculates the exact probability, but it is limited as it cannot be applied in cases where the sample data are very large¹¹11 Campos GM. Estatística prática para docentes e pós-graduandos. São Paulo: Faculdade de Odontologia de Ribeirão Preto; 2001..

The margin of error used in deciding the statistical tests was 5.0%. Data were entered into Excel spreadsheets and the softwere used to obtain statistical calculations was IBM SPSS, version 23.

Results

According to table 1, a total of 380 incorporated technologies were obtained, in a period of 7 years and 9 months, with an average of 49 incorporations per year, with 2018 also being the year with the highest number of incorporated technologies, totaling 76. Among these 380 incorporated technologies, 177 (46.6%) were medicines, 93 (24.5%) were procedures, 90 (23.7%) were CPTGs, and 20 (5.3%) were products.

Regarding the plaintiffs, the internal demand (cabinets, agencies and public institutions of the three spheres of government linked to the Ministry of Health) obtained 313 (82.4%), external (individuals and/or legal entities governed by private law) 58 (15.3%) and internal and external (when the same technology is requested by an internal and external demander) 9 (2.4%) of the total incorporated technologies. For the public consultation, 281 (73.9%) technologies were submitted to this procedure, while 99 (26.1%) did not.

Table 2 analyzes the type of technology according to the applicant. It was found that the three types of demanders were able to incorporate more medicines into the SUS than the other types of technologies. In percentage terms, of all their respective incorporated demands, internal claimants had 37.4%, external 93.1% and internal and external 66.7% for medicines. However, in absolute numbers, internal claimants were higher, with 117 incorporations. The association between variables was significant (p<0.001).

Table 3 explains the applicants with the greatest success in incorporating technologies. It was found that public bodies stood out in number of incorporations, especially the secretariats linked to the Ministry of Health, such as the Secretariat of Sciences, Technologies and Strategic Inputs (128 technologies), the Secretariat of Health Care (124 technologies) and the Secretariat of Health Surveillance (63 technologies).

The National Association of Groups of Rheumatic Patients (Anapar) was the only institution of the group of patients that had its demands incorporated, totaling 06 technologies. All these technologies are biological medicines used in the treatment of rheumatoid arthritis, being four monoclonal antibodies (Rituximab, Tocilizumab, Infliximab and Adalimumab) and two fusion proteins (Abatacept and Etanercept).

Also according to table 3, several companies in the pharmaceutical industry were successful in their demands. Th e three companies that most managed to incorporate requested technologies were Roche®, GlaxoSmithKline® and Novartis®, with 05 technologies each.

The judiciary was also responsible for some embedded technologies. The Porto Alegre’s Federal Court responsible for 02 technologies, Federal Court of the 4th Region - Judicial Section of Rio Grande do Sul for 01 technology and Federal court of the 6th Region - Judicial Section of Sergipe for 01 technology.

It is noteworthy that the sum of technologies exceeds the actual number of technologies incorporated due to the fact that some technologies were requested by more than one applicant.

Table 4 shows that medicines were not only the technologies that most went through public consultation (44.1%), but also those that failed to undergo this procedure the most (53.5%). Public consultation is an important tool to promote democratization and transparency in the choice of technologies for the SUS, as it allows society to participate in this choice process. However, in some cases, such as the extreme need for some medications, for example, these technologies are exempt from public consultation.

According to table 5, the group of ‘some Infectious and Parasitic Diseases (IPDs)’ prevailed, with 77 technologies, followed by ‘endocrine, nutritional and metabolic diseases’, with 42 technologies and, in third, the group ‘others’, with 39 technologies.

Among the most benefited PIDs, HIV (Human Immunodeficiency Virus) had the highest number of incorporations aimed at its treatment, totaling 19 technologies, corresponding to 21.1% of the total incorporated technologies for this group of diseases. It is noteworthy that the totalization of technologies for diagnosis exceeded the amount of technologies for the group ‘Some Infectious and Parasitic Diseases’ because some technologies were indicated for more than one disease framed in this group.

Discussion

According to the data from this study, 2018 was the year with the highest number of incorporations, but nothing was found in the literature to justify this higher number of incorporated technologies. However, the CPTGs (Complementary Material) had a massive incorporation that year, totaling 33, even surpassing the number of incorporated drugs, leveraging the total number of technologies incorporated in that year. These official SUS documents aim to ensure better health care, as they are drawn up based on scientific evidence. These are technologies that need to be updated every two years or when there is inclusion, change or exclusion of technologies, causing the need to update health care practices¹²12 Brasil. Ministério da Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Protocolo Clínico e Diretrizes Terapêuticas do Diabete Melito Tipo 1. 2019. [acesso em 2020 fev 23]. Disponível em: http://conitec.gov.br/images/Relatorios/2019/Relatrio_PCDT-Diabetes-Mellitus-Tipo-1_2019.pdf
http://conitec.gov.br/images/Relatorios/... .

The study showed that drugs were the most incorporated type of technology. In the study by Nunes et al.¹³13 Nunes LMN, Fonteles MMDF, Passos ACB, et al. Evaluation of demands of inclusion, exclusion and alteration of Technologies in the Brazilian Health System submitted to the National Committee on Technology Incorporation. Braz. J. Pharm. Sci. 2017; 53(2):1-12. on the incorporation of medicines by Conitec, between 2012 and 2015, it was found that medicines already had a greater number of incorporations in relation to other types of technologies in that period. According to the same authors, this fact is not surprising, as research and innovation related to this type of technology also dominate the market and the scientific community.

In Brazil, research in this area is still insufficient, making the national scientific community having to resort to research from other countries with greater expertise. This makes local production unfeasible and makes the purchase of health products more expensive, as there is a need to import them. In addition, developed countries usually have a well-developed local pharmaceutical industry, which encourages the production of research and development¹⁴14 Petramale CA. Avaliação e incorporação: do quê precisamos realmente. OPAS/OMS-representação Brasil. Brasília, DF. 2016; 1(8)..

The internal plaintiffs had superiority in relation to the others. The study by Caetano et al.¹1 Caetano R, Silva RMD, Pedro EM, et al. Incorporação de novos medicamentos pela Comissão Nacional de Incorporação de Tecnologias do SUS, 2012 a junho de 2016. Ciênc. Saúde Colet. 2017; (22):2513-25. on the incorporation of new drugs by Conitec, between 2012 and 2016, obtained numbers similar to those in the present study. Domestic demand was 77 (82.8%), while external demand was 16 (17.2%). Despite being a study focused only on medicines, this fact demonstrates the tendency for agencies and institutions linked to the Ministry of Health to be responsible for a significant part of the technologies incorporated in the SUS.

This superiority is due to the new public policy for technology management from Conitec, which gained the credibility of the secretariats linked to the Ministry of Health¹⁵15 Rabelo RB, Petramale CA, Silveira LC, et al. A comissão nacional de incorporação de tecnologias no SUS: um balanço dos primeiros anos de atuação. Rev. Eletr. Gest. Saúde. 2015; (4):3225-40..

All three types of claimants managed to incorporate more medicines than the other types of technologies, reinforcing the importance that demanders attach to this type of technology. In addition, internal claimants outnumbered all other demanders in terms of incorporation, in all types of technologies.

This fact differs from what was found by Lima¹⁶16 Lima SGG. O processo de incorporação de tecnologias em oncologia no SUS: análise da Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde - Conitec. [dissertação]. Rio de Janeiro: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz; 2015., who researched Conitec’s demands between 2012 and 2014. At the time, industry demands prevailed, that is, external demand, in technologies such as medicines and products. Therefore, this period evaluated in this study, with a predominance of internal applicants, represents a positive aspect, considering that there was an attenuation of the influence of the pharmaceutical industries, driven by economic interest, in the face of the public consumption market¹⁶16 Lima SGG. O processo de incorporação de tecnologias em oncologia no SUS: análise da Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde - Conitec. [dissertação]. Rio de Janeiro: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz; 2015..

Several external applicants were successful in their demands. Like Anapar, which was the most successful, with four monoclonal antibodies and two fusion proteins used in the treatment of rheumatoid arthritis.

This is due to the fact that biological drugs, such as monoclonal antibodies and fusion proteins, have caused a real therapeutic revolution in several areas, including rheumatology¹⁷17 IMS Health. Top 20 global products 2014. [acesso em 2019 nov 10]. Disponível em: http://www.imshealth.com/files/web/Corporate/News/TopLine%20Market%20Data/2014/Top_20_Global_Products_2014.pdf.
http://www.imshealth.com/files/web/Corpo... .

Rheumatoid arthritis is a systemic inflammatory disease that affects mainly the joints, but it can also affect the lungs, heart and other organs. It is estimated that this disease affects 0.2 to 1% of the population in Brazil. This represents 2 million people and, despite its low prevalence, it is a disease that requires adequate treatment because it causes physical limitations to patients¹⁸18 Borssatto AGF. Incorporação de medicamentos imunobiológicos para artrite reumatoide no setor suplementar de saúde do Brasil: a percepção de pacientes, médicos e gestores. [dissertação]. São Paulo: Fundação Getúlio Vargas; 2019..

Anapar was founded on April 26, 2006, in the city of Rio de Janeiro (RJ). Its function is to provide the integration of groups and associations of Brazilian Rheumatic Patients already established, support the creation of new groups, fight for the defense of patients’ rights and seek public health policies that allow better living conditions for these patients¹⁹19 Biored Brasil. Associações que apoiam a Biored Brasil. 2016. [acesso em 2020 mar 3]. Disponível em https://www.bioredbrasil.com.br/associacoes-que-apoiam-a-biored-brasil/
https://www.bioredbrasil.com.br/associac... .

Among the external demanders, the pharmaceutical industry was the most prevalent, despite not having so many technologies incorporated individually in relation to other groups. Roche®, GlaxoSmithKline® and Novartis® stood out the most, with 5 technologies each, including medicines, being fusion proteins, monoclonal antibodies, antiretrovirals, antiviral vaccines, vasodilators, immunomodulators and cholinergics.

The three companies are multinationals of foreign origin. According to data from the Evaluate group, which is a leader in market analysis in the biotechnology and pharmaceutical sectors, Roche® will be the leader in the biologicals market by 2022. The analysis highlights that the laboratory has the most valued pipeline, that is, its product portfolio is more acceptable to customers and is estimated to reach the level of R$43 billion in 2022. Roche®’s investments in research and development are likely to exceed Novartis®’s, and that products from that, in 2022, represent 10% of the fifty best-selling products in the world²⁰20 Vidal TJ, Figueiredo TA, Pepe VLE. O mercado brasileiro de anticorpos monoclonais utilizados para o tratamento de câncer. Cad. Saúde Pública. 2018; (34):1-14..

This superiority in the number of applicants from the pharmaceutical industry among external applicants is attributed to the need for infrastructure and technical capacity to develop scientific, technical and economic studies, which are mandatory in the technology submission process with Conitec²¹21 Rego V. Eficiência no SUS como alternativa à judicialização das políticas públicas de saúde: a criação da Conitec e a utilização de triagem administrativa na concessão de medicamentos [monografia]. Ribeirão Preto: Universidade de São Paulo; 2013. [acesso em 2020 mar 3]. Disponível em: http://www.tcc.sc.usp.br/tce/disponiveis/89/890010/tce-20122013-094059/publico/VictorRego.pdf
http://www.tcc.sc.usp.br/tce/disponiveis... .

This study showed that the judiciary, in a smaller number, also requested and had their demands accepted, which suggests that they are looking for solutions to the recurring problem of judicialization of various technologies not available until then by the SUS.

In recent years, the Ministry of Health has spent R$ 4.5 billion on medicines and other health technologies, complying with court orders. The incorporation of new technologies may be motivated by the phenomenon of judicialization as a way to improve the forecast of health expenses²²22 Souza KAO, Souza LEPF, Lisboa ES. Ações judiciais e incorporação de medicamentos ao SUS: a atuação da Conitec. Saúde debate. 2018; (42)837-48..

Judicialization in the health area is not only taking place in Brazil, but also in Latin American countries and several other countries in which the right to health is the legal foundation of their public health systems. With the institution of Conitec, there was an attempt to change this panorama. It disciplined the process of assessment and incorporation of health technologies in the SUS, providing evidence-based decision-making, transparency in the administrative process for the incorporation of health technologies and the establishment of mechanisms for social participation²³23 Brasil. Lei nº 12.401, de 28 de abril de 2011. Altera a Lei 8.080, de 19 de setembro de 1990, para dispor sobre a assistência terapêutica e a incorporação de tecnologia em saúde no âmbito do Sistema Único de Saude - SUS. Diário Oficial da União. 29 Abr 2011. [acesso em 2020 mar 3]. Disponível em: https://www.jusbrasil.com.br/diarios/26364169/pg-1-secao-1-diario-oficial-da-uniao-dou-de-29-04-2011
https://www.jusbrasil.com.br/diarios/263... .

It is routine for the Executive Secretariat of Conitec to send information and technical clarifications regarding the incorporation of technologies in the SUS to various citizens, agencies and institutions, providing interaction with the Public Prosecutors, the Federal Attorney General (AGU) and the Judiciary. This activity translates into a contribution, as: (i) it provides clarification to the Public Prosecutor’s Office on the availability of health technologies by the SUS, thus preventing the filing of new lawsuits; (ii) provides technical support to AGU for the defense of the Union in lawsuits; and (iii) provides technical support to judges so that they can have information that allows them to make decisions in requests for the granting of injunctions in lawsuits²⁴24 Simabuku EMG, Catanheide ID, D’agostino C, et al. Comissão nacional de incorporação de tecnologias no SUS e a judicialização do acesso à saúde. Revista Eletrônica Gestão e Saúde. 2015; (4)3024-3042..

An important fact is that almost 74% of all technologies went through public consultation. This represents an important step to strengthen social participation in the processes of incorporating technologies into the SUS, as it allows society to contribute with criticism, opinions about the aforementioned technology, which can affect its acceptance or not. This procedure became mandatory after the creation of Conitec, in 2011.

The decree No. 7,646/2011, which regulated the processes for evaluating applications for incorporation into the SUS, establishes that all recommendations issued by the Plenary are subject to public consultation. However, article 29 of this Decree provides for the possibility of a simplified administrative process in cases of relevant public interest, without detailing, however, in which situations this applies²⁵25 Brasil. Decreto nº 7.646, de 21 de dezembro de 2011. Dispõem sobre a Comissão Nacional de Incorporação de tecnologias no Sistema Único de Saúde e sobre o processo administrativo para incorporação, exclusão e alteração de tecnologias em saúde pelo Sistema Único de Saúde, e dá outras providências. Diário Oficial da União. 21 Dez 2011.. This justifies the fact that there is no public consultation in all technology assessment processes by Conitec.

This research showed that the category of diseases most benefited from incorporations was ‘Some Infectious and Parasitic Diseases’, with an emphasis on HIV. It seems to be paradoxical when trying to prioritize the most prevalent diseases in Brazil, which are chronic non-communicable ones, such as hypertension, diabetes, chronic obstructive pulmonary disease, asthma and cancer. However, infectious diseases are still a public health problem in Brazil. Although the proportion of total deaths caused by them has fallen from 50% to 5% over the last eighty years, this reduction has been more pronounced in some infectious diseases than in others²⁶26 Barreto ML, Teixeira MG, Bastos FI, et al. Saúde no Brasil. Sucessos e fracassos no controle de doenças infecciosas no Brasil: o contexto social e ambiental, políticas, intervenções e necessidades de pesquisa. Lancet. 2015; 377(9780):47-60..

Brazil faces the persistence of emerging diseases, as exemplified by the most important one, introduced in the 1970s, the HIV, which demands the continuous need for health care and the availability of high potency antiretrovirals²⁷27 Waldman EA, Sato APS. Trajetória das doenças infecciosas no Brasil nos últimos 50 anos: um contínuo desafio. Rev. Saúde Públ. 2016; (50):68.. Therefore, the volume of technologies incorporated into this category is justifiable, since it is necessary not only to ensure the eradication of some diseases, but also to control the number of cases of emerging and re-emerging diseases.

Conclusions

The process of incorporating technologies into the SUS through Conitec brought relevant aspects, especially modernization, transparency and social participation. Such factors positively influence the final result. There was an important advance in the renewal of technologies incorporated in the SUS, mainly medications, through a more transparent process.

In addition, the study allowed to demonstrate the relevance of medicines not only for public health in Brazil, but also for public expenditure, which make up an important portion of expenditure. Understanding these expenses is important to enable decision-making by managers, as well as direct, in a balanced way, the incorporation of technologies in the SUS. In this context, it is suggested that investments in the area of research and development of health products be stimulated to make national production viable and, consequently, reduce acquisition costs by the SUS, and promote access to the greatest possible number of patients.

It is concluded that the profile of the incorporated technologies are mainly medicines, by internal demand, with indication for PIDs and, above all, for HIV. Medications continue to be the focus of requests, however internal demands have gained more space in this scenario, above all demands coming from divisions of the Ministry of Health.

References

Publication Dates

History