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.