(P-465) Avoidable Public Expenditures with Selected Antineoplastic Drugs for Breast Cancer in Brazil

Background: Breast cancer is the most incident type of among Brazilian women. Among the treatments for breast cancer, chemotherapy is used in 60% of patients. Timely treatment can cure, prevent metastasis and improve quality of life. Scaling up access for oncology drugs depends on effective public procurement.

Objectives: The study analyzes the Brazilian federal procurement profile for selected antineoplastic drugs for breast cancer, and the behavior of acquisitions in relation to the quantities and prices practiced between 2013-2019, pointing out avoidable expenditures with these drugs.

Methods: Antineoplastic agents, category L of the ATC classification system, were selected according to their presence in Breast Carcinoma Brazilian Guidelines either for adjuvant or neoadjuvant chemotherapy. Fixed combined treatment regimens were excluded. Regular purchases registered in the Integrated System for Administration of General Services were analyzed, considering quantity, unit price, date and purchasing agency. These agencies were linked to the three most important buyers in the public sphere: Ministry of Health, the Ministry of Education and the Ministry of Defense. Any other public agencies were added in the “Other” category. Prices were deflated to December 2019 by the Brazilian Pricing Index.

Results: Ten antineoplastics drugs were selected: anastrozole (1mg), docetaxel (40mg), exemestane (25mg), letrozole (2,5mg), paclitaxel (6mg), tamoxifen (20mg), trastuzumab (440mg), vinorelbine (10, 20 and 30mg). The “Other” category presented greatest total expenditure. Trastuzumab and tamoxifen were responsible for the highest expenditure and volume, respectively. The Ministry of Education carried out the largest volume of purchases, except for trastuzumab, which was most purchased by the “Other” category. The Ministry of Defense presented the highest purchase prices, standing out for the highest overspending in the period. The total avoidable overspending, considering all categories and medicines was over BRL 99 million.

Conclusions: The analysis of government purchases can bring essential information for the understanding of availability and access to antineoplastic agents. The differences observed in the performance of different categories of buyers as to amounts purchased and prices practiced for antineoplastics drugs could be reduced by employing strategies to expand the centralization of purchases, resulting in expanded access to breast cancer medicines in the public sector.