[Sustainability of Brazilian policy for access to antiretroviral drugs].
OBJECTIVE
The expense of acquiring antiretroviral drugs in Brazil has given rise to debate about the sustainability of the policy of universal access to AIDS medications, despite the evident benefits. The objective of this study was to analyze the evolution of the Ministry of Health's spending on acquiring antiretroviral drugs from 1998 to 2005, the determining factors and the medium-term sustainability of this policy (2006-2008).


METHODS
The study on the evolution of spending on antiretrovirals included analysis of their prices, the year-by-year expenditure, the number of patients utilizing the medication, the mean expenditure per patient and the strategies for reducing the prices maintained during this period. To analyze the sustainability of the policy for access to antiretrovirals, the cost of acquiring the drugs over the period from 2006 to 2008 was estimated, along with the proportion of gross domestic product and federal health expenditure represented by this spending. The data were collected from the Ministry of Health, the Brazilian Institute for Geography and Statistics (IBGE) and the Ministry of Planning.


RESULTS
The expenditure on antiretrovirals increased by 66% in 2005, breaking the declining trend observed over the period from 2000 to 2004. The main factors associated with this increase were the weakening of the national generics industry and the unsatisfactory results from the process of negotiating with pharmaceutical companies.


CONCLUSIONS
The Brazilian policy for universal access is unsustainable at the present growth rates of the gross domestic product, unless the country compromises its investments in other fields.
Grangeiro
Alexandre
A
Instituto de Saúde, Secretaria de Estado da Saúde, Rua Santo Antonio 590, 01314-000 São Paulo, SP, Brazil. grangeiro@isaude.sp.gov.br
Teixeira
Luciana
L
Bastos
Francisco I
FI
Teixeira
Paulo
P
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics; D019380:Anti-HIV Agents / Q000191:economics / Q000600:supply & distribution* / Q000627:therapeutic use; D001938:Brazil; D016527:Drug Costs; D005376:Financial Management; D006077:Government Agencies / Q000191:economics; D015658:HIV Infections / Q000188:drug therapy*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006291:Health Policy; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D009313:National Health Programs / Q000458:organization & administration*
D019380:Anti-HIV Agents