Multiple sclerosis treatment coverage: an analysis based on inequality indicators
DOI:
https://doi.org/10.11606/s1518-8787.2026060007156Keywords:
Health Equity, Pharmaceutical Services, Multiple SclerosisAbstract
OBJECTIVE: To assess territorial inequalities in the coverage of first-line pharmacological treatment for relapsing-remitting multiple sclerosis in the Brazilian Unified Health System (SUS) in 2024, analyzing the regional distribution of coverage, consumption, and spending, and quantifying socioeconomic inequalities using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) indicators. METHODS: An observational study based on administrative data from the SUS, integrating information from Outpatient Procedure Authorizations and epidemiological estimates to calculate consumption in defined daily doses and per capita expenditure on disease-modifying drugs. The state Human Development Index was used as a socioeconomic proxy to calculate the SII and RII indicators, which quantify absolute and relative inequalities. RESULTS: In 2024, only 35.3% of eligible patients received treatment, with coverage varying between regions (50.9% in the Central-West and 34.3% in the Northeast). The SII (0.2082) and RII (2.58) for PT/PATSUS indicated strong socioeconomic inequality in coverage. For per capita spending, there was no consistent socioeconomic gradient (SII = -99.18; RII = 0.96). Consumption in defined daily doses showed significant inequality (SII = 61.65; RII = 2.50), reflecting greater therapeutic intensity in states with a higher Human Development Index. CONCLUSIONS: The study shows important limitations in the coverage and equity of treatment for relapsing-remitting multiple sclerosis in the SUS, with structural inequalities associated with regional socioeconomic position. The integrated use of administrative indicators and inequality metrics (SII and RII) provides subsidies for policy interventions focused on distributive justice and sustainability of the public health system.
References
1. Walton C, King R, Rechtman L, Kaye W, Leray E, Marrie RA, et al. Rising prevalence of multiple sclerosis worldwide: insights from the atlas of MS, third edition. Mult Scler J. 2020;26(14):1816-21. https://doi.org/10.1177/1352458520970841
2. Korsukewitz C, Wiendl H. Emerging trends and challenges in multiple sclerosis in Europe: rethinking classification and addressing COVID-19 impact. Lancet Reg Health Eur. 2024 Aug;44:101017. https://doi.org/10.1016/j.lanepe.2024.101017
3. Ministério da Saúde (BR). Secretaria de Atenção Especializada à Saúde, Secretaria de Ciênca, Tecnologia e Insumos Estratégicas. Protocolo clínico e diretrizes terapêuticas esclerose múltipla. Brasília, DF: Ministério da Saúde; 2023.
4. Carnero Contentti E, Giachello S, Correale J. Barriers to access and utilization of multiple sclerosis care services in a large cohort of Latin American patients. Mult Scler. 2021 Jan;27(1):117-29. https://doi.org/10.1177/1352458519898590
5. Rivera VM, Macias MA. Access and barriers to MS care in Latin America. Mult Scler J Exp Transl Clin. 2017 Mar;3(1):2055217317700668. https://doi.org/10.1177/2055217317700668
6. Bianco J, Damasceno A, Becker J, Casarin F, Carlos N, Martins T, et al. Prevalência da esclerose múltipla em pacientes tratados com medicamentos modificadores do curso da doença utilizando dados do Sistema Único de Saúde brasileiro. Jornal Brasileiro de Economia da Saúde. 2023;15(1):12-23. https://doi.org/10.21115/JBES.v15.n1.12-23
7. Silva IC, Restrepo-Mendez MC, Costa JC, Ewerling F, Hellwig F, Ferreira LZ, et al. Mensuração de desigualdades sociais em saúde: conceitos e abordagens metodológicas no contexto brasileiro. Epidemiol Serv Saude. 2018 Mar;27(1):e000100017. https://doi.org/10.5123/S1679-49742018000100017
8. Oliveira LCF, Nascimento MAA, Lima IMSO. O acesso a medicamentos em sistemas universais de saúde: perspectivas e desafios. SaUde Debate 2020;43(spe5):286-298; . https://doi.org/10.1590/0103-11042019s523
9. Boing AC, Andrade FB, Bertoldi AD, Peres KGA, Massuda A, Boin AF. Prevalências e desigualdades no acesso aos medicamentos por usuários do Sistema Único de Saúde no Brasil em 2013 e 2019. Cad Saude Publica. 2022;6(38):e00114721. https://doi.org/10.1590/0102-311xpt114721
10. Love-Koh J, Cookson R, Gutacker N, Patton T, Griffin S. Aggregate distributional cost-effectiveness analysis of health technologies. Value Health. 2019 May;22(5):518-26. https://doi.org/10.1016/j.jval.2019.03.006
11. Meunier A, Longworth L, Gomes M, et al. Distributional cost-effectiveness analysis of treatments for non-small cell lung cancer: an illustration of an aggregate analysis and its key drivers Running heading DCEA of treatments for non-small cell lung cancer: an illustration of an aggregate analys. PharmacoEconomics. 2023;55(91):11. https://doi.org/10.11606/s1518-8787.2021055003097
12. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Portaria Conjunta no1, de 7 de maio de 2015. [citado 24 abr 2025]. Estabelece as diretrizes para disponibilização das versões mensais e/ou arquivos de configuração dos sistemas de informação sob a gestão da Coordenação-Geral de Sistemas de Informação (CGSI/ DRAC/SAS/MS), bem como o envio das bases de dados desses sistemas pelos Gestores dos Estados, do Distrito Federal e dos Municípios, à base de dados nacional do Sistema Único de Saúde (SUS). Disponível em: https://bvsms.saude.gov.br/bvs/ saudelegis/sas/2015/poc0001_07_05_2015.html
13. Ministério da Saúde (BR). DATASUS. SIGTAP – Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e OPM do SUS. Brasíla, DF: Ministério da Saúde; 2021 [citado 17 jun 2025]. Disponível em: http://sigtap.datasus.gov.br/tabela-unificada/app/sec/ inicio.jsp
14. Ministério da Saúde (BR). Banco de Preços em Saúde. Brasília, DF; Ministério da Saúde; 2025 citado 26 abr 2025]. Disponível em: https://bps-legado.saude.gov.br/visao/consultaPublica/ relatorios/geral/index.jsf
15. Institute for Health Metrics and Evaluation. Global Burden of Disease Collaborative Network: results. Washinton, DC: Institute for Health Metrics and Evaluation 2025 [citado 6 nov 2025]. Disponível em: https://vizhub.healthdata.org/gbd-results/
16. Atlas BR. Atlas do desenvolvimento humano no Brasil. 2025 [citado 21 jun 2025]. Disponível em: http://www.atlasbrasil.org.br/ranking
17. Norwegian Institute of Public Health. Who Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2025. Oslo: Norwegian Institute of Public Health; 2025.
18. Ministério da Saúde (BR). Biblioteca Virtual em Saúde. 71% dos brasileiros têm os serviços públicos de saúde como referência. 1 jan 1970 [citado 5 ago 2025]. Dispontível em: https:// bvsms.saude.gov.br/71-dos-brasileiros-tem-os-servicos-publicos-de-saude-como-referencia/
19. Freitas EL, Calil-Elias S, Erbisti RS, Grinberg-Weller B, Miranda ES. Consumption of drugs for Alzheimer’s disease on the Brazilian private market. Rev Saude Publica. 2023 Nov;57(1):83. https://doi.org/10.11606/s1518-8787.2023057005128
20. Ministério da Saúde (BR). Conselho Nacional de Saúde. Resolução no 466, de 12 de dezembro de 2012. O Plenário do Conselho Nacional de Saúde em sua Quinquagésima Nona Reunião Ordinária, realizada nos dias 09 e 10 de outubro de 1996, no uso de suas competências regimentais e atribuições conferidas pela Lei nº 8.080, de 19 de setembro de 1990, e pela Lei nº 8.142, de 28 de dezembro de 1990, resolve: Aprovar as seguintes diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diario Oficial Uniao. 13 dez 20212.
21. Moura JA, Teixeira LA, Tanor W, Lacerda AC, Mezzarane RA. Prevalence of multiple sclerosis in Brazil: an updated systematic review with meta-analysis. Clin Neurol Neurosurg. 2025 Feb;249:108741. https://doi.org/10.1016/j.clineuro.2025.108741
22. Harper S, Ruder E, Roman HA, Geggel A, Nweke O, Payne-Sturges D, et al. Using inequality measures to incorporate environmental justice into regulatory analyses. Int J Environ Res Public Health. 2013 Aug;10(9):4039-59. https://doi.org/10.3390/ijerph10094039
23. Albert-Ballestar S, García-Altés A. Measuring health inequalities: a systematic review of widely used indicators and topics. Int J Equity Health. 2021 Mar;20(1):73. https://doi.org/10.1186/s12939-021-01397-3
24. Schlotheuber A, Hosseinpoor AR. Summary measures of health inequality: a review of existing measures and their application. Int J Environ Res Public Health. 2022 Mar;19(6):3697-722. https://doi.org/10.3390/ijerph19063697
25. Brandão CM, Guerra AA Jr, Cherchiglia ML, Andrade EI, Almeida AM, Silva GD, et al. Gastos do Ministério da Saúde do Brasil com medicamentos de alto custo: uma análise centrada no paciente. Value Health. 2011;14(5 Suppl 1):S71-7. https://doi.org/10.1016/j.jval.2011.05.028
26. Vieira FS. Indutores do gasto federal em medicamentos do componente especializado: medição e análise. Rev Saude Publica. 2021;91(55):1. https://doi.org/10.11606/s1518-8787.2021055003097
Published
Issue
Section
License
Copyright (c) 2026 Gabriela Bittencourt Gonzalez Mosegui, Cid Manso de Mello Vianna, Fernando Antoñanzas, Fabiano Saldanha Gomes de Oliveira, Deison Alencar Lucietto, Marcus Paulo da Silva Rodrigues
This work is licensed under a Creative Commons Attribution 4.0 International License.
Funding data
-
Conselho Nacional de Desenvolvimento Científico e Tecnológico
Grant numbers 406465/2024-0
