Dados do Trabalho

Título

JUDICIALIZATION DEMANDS FOR BLADDER/URETERAL CANCER IN THE PUBLIC HEALTH SYSTEM IN BRAZIL

Resumo

Petitioning for medications via the judiciary system in Brazil represents a legal right, but also a measure that influences national drug policy. Since 2019, the NAT-Jus system has released over 50,000 technical notes (TN) based on individual legal demands. The present study aimed to evaluate lawsuits against the Brazilian Public Health System SUS concerning bladder/ureteral cancer, as it evaluated the technical notes issued by NAT-Jus regarding lawsuits from patients against SUS from 2019-2023, concerning bladder or ureteral cancer. The study found that a total of 137 TN were issued. Most demanders were male patients(70.8%), with a meanSD age of 69.117.6 years. Lawsuits intended to obtain medications(67%), medical care or procedures(26%), or other health products(7%). The most common medications requested were immunotherapeutic agents(n=66) - (pembrolizumab, avelumab, nivolumab, atezolizumab - followed by BCG(n=13), chemotherapeutic agents(n=5), erdafitinib(n=2) and enfortumab vedotin(n=1). Almost all demands granted these medications for unlimited time. Pembrolizumab was the medication more frequently requested by patients treating bladder or ureteral cancer. Of more than 50,000 TN, the drug was requested 1,349 times. Bladder or ureteral cancer was responsible for 3.4% of all the demands for pembrolizumab. The distribution of the legal demands within the Brazilian states and cities are outlined. Legal demands were more common in the South(n=47), followed by the Southeast (n=26), Northeast(n=20), and Central-west(n=6) regions. Lawsuits in the South were more often related to expensive medications. In the Northeast and Central-west, there were proportionally more lawsuits demanding medical procedures. The Federal Government lost the causes representing BRL 42.1 million with these novel medications within the period evaluated. It is clear that there are significant challenges – such as long queues and shortages of essential and/or costly medications - in realizing patient’s right to universal healthcare through the SUS. such. Therefore, collaboration between the government, the scientific community, and patient advocacy organizations is crucial to ensure the sustainability of the Brazilian healthcare system in the face of these challenges. If a rational and cautious evaluation of the incorporation of new technology into the public system is not adopted, the system will soon collapse.