Gastos com medicamentos para o tratamento da artrite reumatoide: a importância do acesso mediado pelo Sistema Único de Saúde

Abstract

Rheumatoid arthritis (RA) is an autoimmune disease mainly characterized by destruction of peripheral joints, resulting in progressive functional limitation. Treatment, as determined by the Clinical Protocol and Therapeutic Guidelines (PCDT), includes disease-modifying antirheumatic drugs that are part of the Specialized Component of Pharmaceutical Care. This study aimed to analyze the expenditure on these drugs in the different stages of the disease for public and private acquisitions and to use these values as a basis for discussion about patients' access to treatment. The expenditures for the 673 RA patients in the Ambulatory Care Pharmacy of the Walter Cantídio University Hospital in September 2017 were calculated using the ANVISA Price Bank. It was observed that 62.7% of the patients were in the first stage of treatment and the government procurement for this group represented only 6.3% of the total of R$ 1,016,961.60. Considering the therapeutic regimens used by the largest number of patients in each stage, the highest price in government drug spending were leflunomide with methotrexate in the first (R$ 209.50), methotrexate with etanercept in the second (R$ 4,547.52) , methotrexate with golimumab (R$ 2,441.02) and with tocilizumab (R$ 2,884.92) in the third. The price of these combinations for private purchases was estimated at R$ 480.80, R$ 9,333.76, R$ 5,038.06 and R$ 4,327.80, respectively. Considering the profile of the users served at the study site, it can be inferred that if they were obliged to pay for these drugs, it could become a catastrophic expense, rendering treatment unfeasible and compromising the patients' health.