Avaliação econômica dos medicamentos para o tratamento da osteoporose no sistema único de saúde

Abstract

Osteoporosis is a relevant public health problem. It is characterized by low bone mineral density associated with fragility fractures. Generally, fractures involve the hip, vertebrae, forearm and wrist. The disease occurs frequently in aging people and primarily in postmenopausal women, due to the low hormone levels. In order to assist the discussion about the quality use of medicines in the treatment of postmenopausal osteoporosis, we conducted an economic evaluation of the available therapeutic strategies. To compose this major project, we conducted five separate studies. The first study highlights the amount spent by the National Health System on drugs for the treatment of bone metabolic diseases in Brazil. The second one is a review of economic evaluations conducted in Brazil and in other countries, focusing on the theme. The third regards the costs of the drugs used in the treatment of postmenopausal osteoporosis. The fourth study describes the costs of low-energy fractures resulting from simple falls, typical of the osteoporosis. The latter study includes a full cost-effectiveness economic evaluation, of drugs for the treatment of postmenopausal osteoporosis. We identified 611,419 individuals registered in the Exceptional Drug Program in 2000-2004. Musculoskeletal system and connective tissue diseases represented 21.7% of all illnesses included in this Program. The average cost of drugs affecting bone structure and mineralization was R$26.50±60.56. The systematic review of economic evaluations of medicines used in the treatment of osteoporosis in postmenopausal women showed that in general, bisphosphonates have been most often evaluated and were considered the best strategies resulting in the best incremental cost-effectiveness. In the study of the expenditures of the Exceptional Drug Program on the treatment of osteoporosis we identified 72,265 women who received medication during the period 2000-2006. The population consisted predominantly of women aged 60-69 years, who started treatment in 2000 and suffered previous osteoporotic fractures. Alendronate sodium is the most commonly drug used in early treatment. Considering alendronate sodium as reference, the drugs raloxifene and calcitonin were alternatives with greater impact on the increasing average monthly expenses of medicines. The fourth study was a cost analysis of fractures under the perspective of the National Health System. It showed that costs were higher for vertebral fractures, followed by fractures of the hips, forearm and wrists. Costs of vertebral fractures ranged from R$ R$18,299.31 a R$36,970.99; hip fractures from R$3,870.07 a R$20,042.60. Costs for forearm fractures ranged from R$2,467.26 a R$8,074.55. And costs of fractures wrists ranged from R$827.64 a R$7,043.29. Mostly the higher cost of the treatment was due to the purchase of prostheses. The results of the last article on cost-effectiveness of drugs for osteoporosis in postmenopausal women showed that for patients with osteoporosis, initiating treatment in the age of 40-49 and 50 -59 years with alendronate was the cost-effective. To women aged 60-69 years, in addition the alendronate, denosumab and not treat were cost-effective. On women aged 70-79 and 80 or more, alendronate again was the cost-effective option. In this thesis, as a whole, we identified the main aspects of economic evaluation regarding drug expenditures and costs of osteoporosis-related fractures. The economic evaluation identified the therapeutic options that had a good incremental cost effectiveness ratio, i.e., the additional cost spent for each year of additional life gained with the use of medication within the acceptable willingness to pay threshold of the country, which is one to three times the Gross Domestic Product.