ACCOUNTING THE PROGRESS
The most recent advance related to reproductive health in Brazil came
from the incorporation of the Etonogestrel Subdermal Contraceptive
Implant (IMP-ETN) by the National Commission for the Incorporation of
Technologies in the Unified Health System (CONITEC), through Ordinance
No.13, April 2021. The plenary understood that the evidence is favorable
to the IMP-ETN for the population in general, but when removing the main
outcome – pregnancy – it found a budgetary impact that required
choosing the population that would benefit most from the technology at
first, thus proposed the segment of individuals outlined by the
Secretary of Health Surveillance (SVS) and by the Secretary of Primary
Health Care (SAPS).
Hence, in the case of Brazil, it is important to note that the report
published by CONITEC (599) states that the IMP-ETN was dominant against
most contraceptive methods available in the SUS, except for the Copper
IUD in which there was a reason for positive incremental cost. If we
take into account the number of births in Brazil in 2019 among women
aged 18 to 49 and multiply this value by the percentage of Unplanned
Pregnancies (GNP) in Brazil (55.4%), we find a value of 1,451,469 GNPs
in 2019 , which represented approximately R$ 6.4 billion to the public
coffers, since the cost of a GNP in Brazil is R$ 4,439,009. Now, adding
up the current values of the IMP-ETN in the CMED (Medicine Market
Regulation Chamber) - ICMS of 18% (R$ 685.66) + the cost of the
failure rate (0.01) published by the WHO , we would obtain the
approximate value of R$ 1 billion. In this context, subtracting the
costs related to the IMP-ETN from the costs of GNPs in 2019, a
hypothetical cost-avoidance of approximately R$ 5.4 billion of public
resources is observed, establishing an avoided cost ratio of R$ 6.00
for every BRL 1.00 invested.
The compulsory care coverage to be guaranteed in private health care
plans, established by RN nº 465 of February 24, 2021, includes only
definitive methods and intrauterine devices as a contraceptive option.
The entry of new competitors in the market establishes benefits for the
sustainability of the health system with the simplification of
processes, learning from the experience of competitors, improvement in
products or even by improving the expected outcomes10,
besides adding value to the provider.