Waste in public treasuries is harmful to health

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While all eyes are focused on the long and difficult battle against the Covid-19 pandemic, the Ministry of Health has taken a decision, without rational explanation, that could significantly increase the costs of the Unified Health System (SUS) and affect millions of Brazilians.

The plan is to purchase 66.2 million disposable human insulin pens this year, according to a public hearing that opened Feb. 22. This corresponds to the full volume of the property purchased last year. The questions you don’t want to be silenced are: Why pens instead of bottles which are cheaper? And why can it be disposed of?

Insulin pens are more practical for diabetics to use. It is estimated that 15.7 million people have the disease in Brazil, according to the International Diabetes Federation (IDF), and many of them depend on the provision of this drug by the SUS. However, in order to serve more and more – and better – these patients specifically, product cost and system sustainability must be taken into account.

The intent to purchase single-use insulin pens remains inconsistent with the recommendation of the National Committee for the Integration of Technologies at SUS (Conitec). In 2017, the committee defended the federal government’s purchase of reusable (and non-disposable) pens, arguing that it would contribute to increased adherence to the treatments. In Conitec’s calculations, the purchase costs of these devices will gradually decrease from 2018 to 2021.

In practice, the opposite happened. Those who follow the public auctions related to this drug will be able to see that the purchase of disposable human insulin pens planned for this year, if carried out for two years, will cost the public treasury six times what Conitec calculated for three years. However, these pens cost three times more than bottles of the same drug, considering the capacity of both product presentations.

In addition to negatively affecting the accounts of the SUS, which will be reflected in the ability to serve the entire population of Brazil in this critical context of the epidemic, the decision also dampens the competitiveness of the national industry in the supply of these drugs.

The health sector accounts for 10% of Brazil’s gross domestic product (GDP) and moves R$700 billion annually, according to a recent survey coordinated by Fiocruz, so it’s extremely important to remain productive, competitive and create jobs.

Brazil needs to promote the technological development agenda in health, which includes an ecosystem that begins with research and extends to the end of services in health facilities, through production and distribution. Otherwise, we will remain captive to technologies, drugs, vaccines, and supplies produced abroad at a higher cost or more complex supply.

The Ministry of Health’s decision runs counter to the sector’s initiatives to incorporate innovative solutions to reduce costs and improve treatments at the same time. It is necessary to allocate public resources intelligently to ensure that an increasing number of Brazilians have access to diabetes control treatments.

The excess value may also be applied to the purchase of disposable human insulin pens in care services or in the purchase of SUS for medicines indicated for other diseases.

Also of note is the importance of awareness campaigns focused on prevention. After all, the prognosis for the growth of cases of diabetes is alarming. The Israeli military estimates that 700 million people worldwide will be diagnosed with the disease in 2045, compared to 463 million in 2019, when the entity was last surveyed.

Brazil is the country with the largest number of diabetics in Latin America. One in three people in the Latin American region does not know they have the disease, so this large group is at risk of developing serious complications. In addition to the significant damage to health and quality of life in these cases, the result is increased pressure on costs and capacity for care in the health system – both public and private.

It should be noted that diabetes mellitus is one factor related to the comorbidity of covid-19, which requires more attention for proper diagnosis, prevention and treatment.

Preventing the development of diseases and limiting their complications is an effective way to support the sustainability of the health system and enhance the well-being of the population. However, in order to achieve a balanced balance between income and health, it is necessary to have a strategy to prioritize public policies that benefit all, provide universal access and universal health care – without wasting public resources.

In a word, the Federal Audit Bureau and the Public Prosecution Office. There is nothing to expect from the Ministry of Health.

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Health Physician, Professor at USP School of Public Health and EAESP/FGV