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Area of Science:

  • Health Services Research
  • Public Health
  • Health Economics

Background:

  • Relapsing-remitting multiple sclerosis (RRMS) treatment access is crucial for patient outcomes.
  • The Brazilian Unified Health System (SUS) aims to provide equitable healthcare access.
  • Territorial and socioeconomic disparities in healthcare are a persistent challenge.

Purpose of the Study:

  • To evaluate territorial inequalities in first-line pharmacological treatment coverage for RRMS within the SUS in 2024.
  • To analyze regional variations in treatment coverage, consumption, and expenditure.
  • To quantify socioeconomic inequalities using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII).

Main Methods:

  • Observational study utilizing administrative SUS data (Outpatient Procedure Authorizations).
  • Calculation of consumption in defined daily doses (DDD) and per capita expenditure for disease-modifying drugs.
  • Socioeconomic analysis using the state Human Development Index (HDI) to compute SII and RII.

Main Results:

  • Only 35.3% of eligible RRMS patients received treatment in 2024, with significant regional variation (e.g., 50.9% Central-West vs. 34.3% Northeast).
  • Strong socioeconomic inequality in coverage was observed (SII=0.2082, RII=2.58).
  • Consumption inequality (SII=61.65, RII=2.50) indicated higher therapeutic intensity in higher HDI states, while spending showed no consistent gradient.

Conclusions:

  • Significant limitations exist in RRMS treatment coverage and equity within the SUS.
  • Structural inequalities linked to regional socioeconomic status impact treatment access.
  • Integrated administrative and inequality metrics (SII, RII) can inform policies for distributive justice and health system sustainability.