Solicitações judiciais de medicamentos para tratamento de câncer, Minas Gerais, 1999-2009: estudo descritivo

Abstract

This study aims to analyze the profile of lawsuits by medicine to treat cancer brought against the State Department of Health of Minas Gerais in the years 1999-2009. This is a retrospective descriptive study. The data used were obtained from lawsuits against of State Department of Health of Minas Gerais in which drugs were ordered for use in the treatment of cancer in the period analyzed . Data regarding the lawsuit, the patient beneficiary, the health care that originated the prescription and the drug court defendant were collected. The requested drugs were classified according to the Anatomical Therapeutic Chemical Code - ATC. Possible requests of drugs for use in anticancer indications not included in the product information (off label) approved by the health regulatory agencies in Brazil and the United States were observed. As the results, 8.05% of all lawsuits had claims for medicines for cancer treatment, which mostly were conducted by private attorneys. Most medical care related to the study patients (46.9%) were performed in health facilities located in the macro-region of Minas Gerais Centre, mainly in the city of Belo Horizonte, and in private hospitals (37.0%). The most frequent diseases were reported by the beneficiaries malignant neoplasm of the brain (15.4%) and malignant neoplasm of the breast (12.2%). Among the most requested drugs, highlights the temozolomide (17.23%) and rituximab (11.41%). The drugs belonging to the class of monoclonal antibodies (32.0 %) and protein kinase inhibitors (31.6%) were the most demanded. Among the drugs that do not fall into the category of antineoplastic agents and immunomodulators, 62 % did not belong to any of the public programs of pharmaceutical care at the time of the court order, with the most analgesics. 8.0% of legal requests for drugs off label use were found in accordance with the Brazilian regulation. The same number of off label uses were found when analized the American regulation. There was a predominance of requests for deferrals and injunction in favor of the beneficiary. The study indicates that the judicial requests of drugs for the treatment of cancer contributed to the deepening of the iniquity existing in health care. This, because the judicial actions were used by the private sector to fund treatments of high-cost of your beneficiaries with public funds. On the other hand, showed a deficit of incorporating technologies in Health System, in oncology, that requires the improvement of the model of care provided. The results demonstrate the need for improvements in public health care, in the regulatory mechanisms of supplementary assistance and in the criteria for evaluating judicial processes, in order to promote greater equity in access to health services.