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A CASE STUDY - COLLECTIVE VERSUS INDIVIDUAL BASIS FOR THE JUDICIARY DEBATE

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Between January and August 2016, the São Paulo State Department of Health lost 264 lawsuits requiring this insulin glargine for adult patients . Insulin glargine is the drug with the highest number of lawsuits and has already been unfavorably assessed by the CONITEC. Objective: To analyze the profile and main reasons contained in the lawsuits to obtain insulin glargine, including the medical reports and the lawyers‘ claim. Methods: Random analysis of 153 (58%) lawsuits were carried out in digital court records. Data collected from legal proceedings were: type of diabetes (1, 2 or unspecified); age of the patient; origin of the order; specialty of the prescriber and the reason described for the request. Results: The mean age of the 153 patients was 49±17 years. The majority of patients requested insulin glargine to achieve glycemic control (116; 76%): because -“diabetes is uncontrolled and the analogous insulin is essential to get it” (106; 69%); or -“patient claims to have obtained glycemic control with insulin glargine but there are not laboratory tests results in lawsuits” (7; 5%); or -“ask replacement of insulin detemir with glargine for glycemic control” (3; 2%). Only 87 (57%) lawsuits reported the patients’ diabetes type: type 1 (42; 28%) or 2 (45; 29%). Most of this judicialization came from private outpatient clinics (116; 76%) and 99 (65%) were prescribed by endocrinologists. Conclusion: Judicial decisions are still insufficiently underpinned by scientific evidence (only patients’ drug need claim has been recorded to justify supply) and incomplete regarding objective diagnostic variables.