Judicialização da saúde: análise técnica baseada em evidência das demandas judiciais de medicamentos em Alagoas, Brasil

Abstract

The Brazilian constitution of 1988 assumes, in its legal bases, integral access to health, including pharmaceutical care. However, due to the inherent bureaucracy in this area, many citizens are unable to access certain drug therapies, and thus need to use the judicial route to exercise their rights. This phenomenon is known as health judicialization. This study evaluated the volume of scientific evidence of the demands for legal drugs, by public defenders of the State of Alagoas, and established a purchase as therapeutic alternatives provided by Health Unic System (SUS). This study adopts a cross-sectional, analytical, quantitative approach, with a secondary source of data, provided through the technical opinions of the Inter-Institutional Nucleus of Health Judicialization (NIJUS) pharmacists. The procedural aspects of the lawsuits were analyzed; The sociodemographic profile of the applicants; Medical specialties and diagnostics; Anatomical Therapeutic Chemical (ATC) classification of medications; Evidence-based technical analysis of the drugs required, according to Thomsom Micromedex-Drugdex System; As well as analyzes of National Commission for the Incorporation of Technologies's (CONITEC) reports and the reasons that led to judicialisations. Of the 297 opinions analyzed, 58.9% of the applicants were represented by women, 54.2% belonged to the adult age group (18-59 years). All the applicants were considered to be legal under the law and 92.9% lived in Maceió. The municipality of Maceió was defendant in 56.3% of the lawsuits, followed by the State of Alagoas in 40.9%. Four medical specialties appeared more frequently: 20,7% nephrologist, 11,6% neurologists, 10,5% cardiologists and 9,5% endocrinologists. 77.4% of the reported conditions were chronic. According to the most frequent International Classifications of Diseases (CID-10) analysis, 24.1% belonged to pathologies related to the genitourinary system and 20% to the circulatory system. The ATC analysis of the 473 judicialized drugs showed that 23.1% were in the class of hormones for systemic use, except sex hormones and insulins and 17.3% in the nervous system class. The evidence-based analysis of 440 drugs showed that 41.8% had strength of IIA recommendation and 73.2% level of evidence B. It was found that 75% of the judicialized drugs had therapeutic alternatives provided by the SUS and that 86 % of the medicines requested were not part of National List of Essential Medicines (RENAME 2013). Thus, we can conclude that the largest portion of the judicialized medicines are for the treatment of degenerative diseases, which are often already covered by the SUS through clinical protocols of the basic or specialized component. These therapeutic alternatives usually have levels of scientific evidence and strength of recommendation equivalent to those requested by judicial means. This may indicate the existence of substantive gaps in the constitutional relationship between the right to health and pharmaceutical care, allowing for a mismatch between the judiciary and the executive powers.