A PARTNERSHIP BETWEEN ACADEMY AND GOVERNMENT FOR
IMPROVING PHARMACEUTICAL CARE
Prof. Augusto Guerra, PhD & Prof. Francisco Acurcio, PhD
Federal University of Minas Gerais
Brazil
Prof. Francisco de Assis Acurcio &Contact:
Prof. Augusto
Afonso Guerra Jr
[email protected]
Coordenação [email protected]
OUR MAIN ACTIVITIES
• evaluate the compliance of the patient treatment request
with the Brazilian or the State Protocols;
• produce Technical Appraisals of judicial requests for
medicines and specific demands about medicines utilization;
• support judicial and administrative decisions.
Sep/2011→ Aug/2013
First 12 months: 75,939 patient treatment requests evaluated
10%-20% increase per year
In two years produced 9,480 individual Technical Appraisals to assist in the
defense of the State with respect to request processes of drugs and/or
procedures filed against him.
Major interests
 Studies to evaluate the performance of new
and incorporated drugs subject of public
finance
Comparative effectiveness research
 Cost/effectiveness - pharmacoeconomics
 Disinvestment protocols and Value Based Price
 Medicines Policies and Access
 Academic detailing for Prescribers
 Judicial demands in Health

Specialized Component
High cost medicines Brazilian National Program

Provides medicines for
patients high cost treatment
due unitary cost or chronic use.

e.g.:
• Cost per patient year USD
300,000.00 Gaucher’s disease
• or USD 2,000.00 Schizophrenia

Drugs are prescribed and
dispensed in accordance with
the established criteria in
Clinical Protocols and
Therapeutic Guidelines.
RECENT TECHNICAL APPRAISALS
1
2
3
4
5
6
7
8
Published
Efficacy and safety of sorefenib in the treatment of
kidney cancer
Efficacy and safety of rituximab in the treatment of
B-cell non-Hodgkin limphoma
Efficacy and safety of ursodeoxycholic acid in the
treatment of primary biliary cirrhosis
Efficacy and safety of trastuzumab in the treatment
of breast cancer
Efficacy and safety of temozolomide in the treatment
of low grade astrocytomas
Efficacy and safety of ranibizumab and bevacizumab
in the treatment of Age-Related Macular
Degeneration
Amphotericin B formulations for the treatment of
fungal infections in patients with HIV/AIDS
Efficacy and safety of sorefenib in the treatment of
liver cancer
1
2
3
4
5
In revision
Efficacy and safety of drug-eluting stents for
coronary artery disease
Effectiveness of drug-eluting stents for coronary
artery disease
Cost-effectiveness of drug-eluting stents for
coronary artery disease
Efficacy and safety of kidney transportation
machines
Efficacy and safety of testosterone treatment for
male sexual disorder
Desenvolvimento de modelos para
tomada de decisão em saúde
Stent Farmacológico
Qual é mais
custo-efetivo?
Stent Convencional
Value Based Price
Preço Baseado no Valor Terapêutico
Relação de custo por ano de vida ganho
R$4.853,99
Academic Detailaing
PROJETO PESQUISA

Estudo de viabilidade de técnicas de visitação
médica para detalhamento acadêmico de
prescritores sobre

medicamentos disponibilizados no SUS:
• Estudo de Caso - A doença de Alzheimer
Record Linkage
Produce an unique
Identifier per Patient
Data Integration
SIM
APAC/SIA
Mortality Information
System
Ambulatory
Information System
AIH/SIH
Hospital
Information System
Databases assembled
Probabilistc Linkage
started in 2003

First version – 60 months follow up


Second Version – 84 months follow up


Jan/2000 until dec/2004
Jan/2000 until dec/2006
Third Version – 132 months follow up

Jan/2000 until dec/2010 (assembling)
» Dec/2013 (mortality) – 164 months
• Links to state bases – Transplants; Other Medicines; Notifiable
Diseases
Medicine use from birth to age two years: the 2004 Pelotas
(Brazil) Birth Cohort study.
Oliveira EA, Bertoldi AD, Domingues MR, Santos IS, Barros AJD.
Rev. Saúde Pública. 2010;44(4):591-600.
Birth cohort differences in the use of medications in a Brazilian population of
older elderly: the Bambuí Cohort Study of Aging (1997 and 2008).
Loyola Filho AI, Firmo JOA, Uchôa E, Lima-Costa MF, Ai LF, Jo F, et al. Cad. Saúde
Pública. 2011;27 Suppl 3:S435-43
Non-afherence among patients initianting antiretroviral therapy: a challenge
for health professionals in Brazil. AIDS. 2005, suppl.4, pp. S5-S13.
BONOLO PF, CESAR CC, ACURCIO FA, CECCATO MGB, PADUA CM, ALVARES
J, CAMPOS LN, CARMO RA, GUIMARÃES MDC.
AIDS
Initial antiretroviral therapy in a 20-year observational cohort of patients
followed at a reference center in the city of São Paulo, Brazil.
Ruiz EAC, Ramalho M, Tancredti MV, Moatti JP, Monteiro ALC, Fonsi M, et al.
Rev bras epidemiol. 2011;14(1):86-97
Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): Objectives and Design.
Aquino EML, Barreto SM, Bensenor IM, Carvalho MS, Chor D, Duncan BB et al. Am J
Epidemiol. 2012;175(4):315-324
Drug Utilization Studies

Studies that addresses the marketing, distribution,
prescription and use of drugs in a society, with
special emphasis on medical, social and economic
use of that (WHO)

They can be quantitative and / or qualitative

It is the initial step of a journey whose goal is to
solve a specific problem related with a drug
Suñé AF, Valsecia M. Promoción de um mejor uso de los medicamentos: El papel de los estudios de utilización de medicamentos. In: Barros JAC
(org.) . Os fármacos na atualidade. Antigos e novos desafios. Brasília: ANVISA, 2008. Cap.7, p. 217-227.
Aspects of self-medication in Brazil.
Arrais PSD, Coelho
HLL, Batista MCDS, Carvalho ML, Righi RE, Arnau JM. Rev. Saúde Pública.
1997;31(1):71-7.
CARVALHO MFC, ROMANO-LIEBERI NS, BERGSTEN-MENDES G, SECOLI SR, RIBEIRO E, LEBRÃO ML et al.
Polypharmacy among the elderly in the city of São Paulo, Brazil – SABE Study. Rev bras epidemiol. 2012;15(4):817-827
ROZENFELD S, FONSECA MJM, ACURCIO FA.. Drug utilization and polypharmacy among the elderly: a survey in
Rio de Janeiro City, Brazil. Rev Panam Salud Publica. 2008, vol.23, n.1, pp. 34-43.
Prescription, dispensing, and regulation of psychoactive anorexigenic
drugs in Belo Horizonte, Minas Gerais, Brazil. Cad. Saúde Pública. 2008,
vol.24, n.8, pp. 1763-1772.
CARNEIRO MFG, GUERRA JUNIOR AA, ACURCIO FA.
Characterization of lawsuits for the supply of “essential” medicines in the State
of Rio de Janeiro, Brazil. Cad. Saúde Pública. 2010, 26 (3): 461-471
PEPE VLE, VENTURA M, SANT’ANA JMB, FIGUEIREDO TA, SOUZA VR, SIMAS L, OSORIODE-CASTRO COS.
Probabilistic Record Linkage
•
Probabilistic Record Linkage is a technique which
allow finding diverse data from a same person or
entity in different databases or in the same.
•
This last case is so-called deduplication
•
The procedure establishes probabilities for each
variable when it matches and when it doesn’t...
•
Probabilities “m” and “u”
Epidemiological profile of high cost medicines users in the
Brazilian Health System. Rev. bras. estud. Popul.. 2009, vol.26, n.2, pp. 263-282.
ACURCIO FA, BRANDÃO CMR, GUERRA JÚNIOR AA, CHERCHIGLIA ML, ANDRADE EIG,
ALMEIDA AM, SILVA GD, QUEIROZ OV, FALEIROS DR.
Cyclosporine versus tacrolimus in immunosuppressive maintenance
regimens in renal transplants in Brazil: Survival Analysis from 2000 to
2004. Ann Pharmacother . 2010, vol.44, n.1, pp. 192-201.
GUERRA JÚNIOR AA, CESAR CC, CHERCHIGLIA ML, ANDRADE EIG, QUEIROZ OV, SILVA GD, ACURCIO FA.
Looking forward

Partnership for research and academic mobility
between researchers, professors and graduate
students.


Towards enhance methods and adopting new
perspectives
Partnership towards collaborative research and
publishing papers.