Compras de medicamentos pelo Instituto Nacional de Câncer: análise do período 2007-2014.

Abstract

The Brazilian National Cancer Institute (INCA) is a national reference center for cancer care in the country and an important purchaser for treatment and paliative care medicines. It possesses a specific separate annual budget for maintenance of the medicine stocks in the institution. Expenses exceeded R$ 650 million between 2007 and 2014. This study examined drug procurement carried out by INCA between January/2007 and December/2014 in order to (1) identify acquired medicines, their therapeutic classification, type of purchase, suppliers, volumes, prices and expenses contracted in these purchases; (2) analyze off-bid procurement modes of purchase and (3) study the antineoplastic drugs of greater impact for procurement in the institution. This was designed as a descriptive, quantitative and retrospective exploratory study, based on INCA drug procurement registers. Data source was a public domain secondary data base extracted from the federal government procurement system. The analyzed variables were purchase mode, justification of the off-bid purchases, acquired total volume, unit purchase price and contracted suppliers. The medicines were categorized by Anatomical Therapeutic Classification (ATC). Unit prices were deflated to December 2014 using the National Consumer Price Index (IPCA/IBGE). For analysis of the historical behavior of prices and volumes, a trend analysis was performed based on the least squares method. A 50% cut-off point of contracted annual spending identified antineoplastics of greater financial impact. In the eight-year period, INCA performed 4,216 medicine purchases, corresponding to 238,284,897 units of 680 different medicines. The expenses were impressive: R$ 922.171.315, 51. There was a tendency towards reduction of number of purchases and of purchase prices over the period. Main ATC groups involved in purchases were Antineoplastic and Immunomodulating Agents (L), Antiinfectives for Systemic Use (J) and Nervous System Drugs (N). These groups are representative the institutional care profile. About 85% of the acquisitions occurred through bidding by manufacturers. A trend of increase in off-bid purchases was observed, strongly influenced by sole supplier acquisitions. Annual data on contracted expenses permitted identification of antineoplastic drugs causing greater impact on drug procurement: trastuzumab, imatinib mesylate, docetaxel, rituximab and capecitabine. The examination of INCA purchases also brought to light important limitations for the success of medicine purchases in the institution, such as: long procurement process duration, budgetary cuts and difficulties in availability of human resources qualified for better understanding the particularities of medicines and their market environment.