ABSTRACT
In health technology assessment (HTA), decision criteria are considered relevant to support the complex deliberative process that requires simultaneous consideration of multiple factors. The aim was to identify and analyze the decision criteria that have been used by the National Health Technology Assessment Commission (CONITEC) when recommending the incorporation of technologies for the treatment of cancer. Descriptive study, based on reports from CONITEC, between 2012 and 2018, on oncology technologies. The data were collected in a specific extraction form and analyzed using descriptive statistics. 39 reports were analyzed, 15 of them did not present any explicit decision criteria. Medicines were the most frequently evaluated type of technology. The most frequent types of cancers were: breast cancer, head and neck cancer, colorectal cancer, non-Hodgkin's lymphoma and lung cancer. The most frequently considered criteria were: financial impact and effectiveness. The study identified the decision criteria that have been most used in the area of ââoncology, however, the lack of transparency in relation to the weight of these criteria makes it difficult to understand their influence on the result of the decisions taken.
Nos processos de avaliação de tecnologias em saúde (ATS), critérios de decisão são considerados relevantes para apoiar o complexo processo deliberativo que requer consideração simultânea de múltiplos fatores. Objetivou-se identificar e analisar os critérios de decisão que têm sido utilizados pela Comissão Nacional de Avaliação de Tecnologias em Saúde (CONITEC) na recomendação de incorporação de tecnologias para o tratamento do câncer. Trata-se de um estudo descritivo, baseado em relatórios da CONITEC, entre 2012 e 2018, sobre tecnologias em oncologia. Os dados foram coletados em formulário de extração específico e analisados por meio de estatísticas descritivas. Foram analisados 39 relatórios, 15 deles não apresentavam nenhum critério de decisão explícito. Os medicamentos constituíram o tipo de tecnologia mais frequentemente avaliado. Os tipos de cânceres mais frequentes foram: de mama, de cabeça e pescoço, colorretal, linfoma não Hodgkin e de pulmão. Os critérios considerados com mais frequência foram: impacto financeiro e efetividade. O estudo identificou os critérios de decisão que têm sido mais utilizados na área de oncologia, entretanto, a falta de transparência em relação ao peso desses critérios torna difícil compreender a influência deles no resultado das decisões tomadas.
Subject(s)
Decision Making , Technology Assessment, Biomedical , Humans , Resource AllocationABSTRACT
Resumo Nos processos de avaliação de tecnologias em saúde (ATS), critérios de decisão são considerados relevantes para apoiar o complexo processo deliberativo que requer consideração simultânea de múltiplos fatores. Objetivou-se identificar e analisar os critérios de decisão que têm sido utilizados pela Comissão Nacional de Avaliação de Tecnologias em Saúde (CONITEC) na recomendação de incorporação de tecnologias para o tratamento do câncer. Trata-se de um estudo descritivo, baseado em relatórios da CONITEC, entre 2012 e 2018, sobre tecnologias em oncologia. Os dados foram coletados em formulário de extração específico e analisados por meio de estatísticas descritivas. Foram analisados 39 relatórios, 15 deles não apresentavam nenhum critério de decisão explícito. Os medicamentos constituíram o tipo de tecnologia mais frequentemente avaliado. Os tipos de cânceres mais frequentes foram: de mama, de cabeça e pescoço, colorretal, linfoma não Hodgkin e de pulmão. Os critérios considerados com mais frequência foram: impacto financeiro e efetividade. O estudo identificou os critérios de decisão que têm sido mais utilizados na área de oncologia, entretanto, a falta de transparência em relação ao peso desses critérios torna difícil compreender a influência deles no resultado das decisões tomadas.
Abstract In health technology assessment (HTA), decision criteria are considered relevant to support the complex deliberative process that requires simultaneous consideration of multiple factors. The aim was to identify and analyze the decision criteria that have been used by the National Health Technology Assessment Commission (CONITEC) when recommending the incorporation of technologies for the treatment of cancer. Descriptive study, based on reports from CONITEC, between 2012 and 2018, on oncology technologies. The data were collected in a specific extraction form and analyzed using descriptive statistics. 39 reports were analyzed, 15 of them did not present any explicit decision criteria. Medicines were the most frequently evaluated type of technology. The most frequent types of cancers were: breast cancer, head and neck cancer, colorectal cancer, non-Hodgkin's lymphoma and lung cancer. The most frequently considered criteria were: financial impact and effectiveness. The study identified the decision criteria that have been most used in the area of oncology, however, the lack of transparency in relation to the weight of these criteria makes it difficult to understand their influence on the result of the decisions taken.
ABSTRACT
Objetivo: Calcular os custos adicionais da pessoa com deficiência física e investigar o seu impacto na renda familiar. Métodos: Seguindo a Classificação Internacional de Funcionalidade, identificaram-se quatro perfis de deficiência com graus diferentes de severidade quanto à mobilidade dos membros inferiores e superiores. Foi construída uma matriz de necessidades para estimar os custos adicionais, seguindo o Método de Padrão Orçamentário, a partir de grupos focais. Dados foram coletados em 2013. Utilizou-se o salário mínimo nacional de 2015 (R$ 816,52) para estimar os custos. Resultados: Os custos adicionais variaram de 2 a 14 vezes o salário mínimo nacional. O perfil de menor custo adicional foi o 2, seguido do 1, 3 e 4. O perfil 4 foi o de maior custo adicional devido à grande incapacidade das pessoas. Há exigência de alta intensidade de assistência pessoal e de oferta de equipamentos. Na assistência pessoal, calculou-se o trabalho dos cuidadores dividindo-o por um período de 2, 4, 8 e 24 horas, para São Paulo, Rio de Janeiro, Santa Catarina, Paraná e Brasil. Os custos com assistência pessoal são relevantes no total dos custos e variam conforme a região. Conclusões: Demonstrou-se que há um custo adicional para as pessoas com deficiência física em todos os perfis. Há risco de empobrecimento porque esses custos absorvem a renda dessas pessoas e de sua família, a qual não pode gastar em outros serviços. A renda pode ser, assim, insuficiente para as necessidades primordiais, ficando clara a necessidade de políticas públicas para prover serviços necessários ou benefícios financeiros.
Objective: To calculate the additional costs of living for people with physical disabilities and to investigate their impact on family income. Methods: We identified four profiles of deficiency with different grades of severity, according to the International Classification of Functioning, Disability and Health. They were related to the extent of mobility of upper and lower limbs. Additional costs were evaluated through focal groups following the Budgetary Pattern Method. We also set up a matrix to express the additional costs. Data were collected in 2013. The national minimum wage from 2015 (R$ 816,52) was considered to estimate the proportional costs. Results: Additional costs fluctuated between 2 to 14 times the national minimum wage. The profile with the minor additional cost was 2, succeeded by 1, 3 and 4. Profile 4 showed the highest additional cost since people with physical disabilities need huge intensity of personal assistance and equipment supply. In personal assistance, we calculated the work of caregivers by sharing it into 2, 4, 8 and 24 hours/day. Costs with personal assistance diversify amongst São Paulo, Rio de Janeiro, Santa Catarina, Paraná and Brazil due to distinct minimum wage. Conclusions: This research showed the presence of an additional cost for people with physical disabilities in all profiles. There is a risk of impoverishment with sacrifice in family's income since they cannot waste in other domestic services. Thus, it is clear that there is a strong need of public policies to underpin these families with more health services or financial benefit.
Subject(s)
Humans , Cost of Illness , Disabled PersonsABSTRACT
BACKGROUND: The quality of the evidence used in health technology assessment (HTA) agency reports has been considered essential for decision-making processes and their legitimacy. In Brazil, CONITEC is the agency responsible for defining data mandatory for the submission of proposals for the incorporation of new technologies. The objective of this study was to analyse CONITEC recommendation reports, the type of scientific evidence used in them and their compliance with operational procedures. METHODS: This is a descriptive study based on CONITEC official reports from July 2012 through December 2016. Data were collected with a specific extraction form and analysed using descriptive statistics. RESULTS: We evaluated 199 CONITEC recommendation reports. The annual number of reports increased during the study period. The absolute annual number of new technologies incorporated in 2013 (n = 24) was similar to that observed for 2014 (n = 24) and 2015 (n = 22), decreasing in 2016 (n = 13). The type of technology most frequently evaluated was 'drugs' (68.3%), followed by 'procedures' (20.1%). Overall, 117 (58.8%) reports were internal demands, 75 (37.7%) were external demands and 7 (3.5%) were mixed demands. There were differences between internal and external demands in terms of the evidence used in the reports and the decision regarding the recommendation to incorporate the technologies. Among the internal demands, the recommendation to incorporate the new technology was made for 70.9% of the reports, only 9.6% of which included full HTAs. Among the external demands, the incorporation of the new technology was recommended for 17.3% of the reports, 76.9% of which included full HTAs. Of the 101 reports in which incorporation of the new technology was recommended, 88 (87.1%) did not include a full health economic evaluation and ICER calculation. There are compliance difficulties with the recommendations in the CONITEC internal regulations regarding the type and quality of evidence considered in the analysis of recommendation reports. CONCLUSIONS: The characteristics of the evidence used in recommendation reports and those considered to be mandatory were very different, indicating problems in decision-making processes. There is a need to study, with a broader perspective, the factors that influence the type of evidence used in decision-making processes in order to contribute to the development of better practices and policies.
Subject(s)
Advisory Committees , Cost-Benefit Analysis , Decision Making , Evidence-Based Medicine , Guidelines as Topic , Health Policy , Technology Assessment, Biomedical , Brazil , HumansABSTRACT
OBJECTIVE: To describe methods and challenges faced in the health impact assessment of vaccination programs, focusing on the pneumococcal conjugate and rotavirus vaccines in Latin America and the Caribbean. METHODS: For this narrative review, we searched for the terms "rotavirus", "pneumococcal", "conjugate vaccine", "vaccination", "program", and "impact" in the databases Medline and LILACS. The search was extended to the grey literature in Google Scholar. No limits were defined for publication year. Original articles on the health impact assessment of pneumococcal and rotavirus vaccination programs in Latin America and the Caribbean in English, Spanish or Portuguese were included. RESULTS: We identified 207 articles. After removing duplicates and assessing eligibility, we reviewed 33 studies, 25 focusing on rotavirus and eight on pneumococcal vaccination programs. The most frequent studies were ecological, with time series analysis or comparing pre- and post-vaccination periods. The main data sources were: health information systems; population-, sentinel- or laboratory-based surveillance systems; statistics reports; and medical records from one or few health care services. Few studies used primary data. Hospitalization and death were the main outcomes assessed. CONCLUSIONS: Over the last years, a significant number of health impact assessments of pneumococcal and rotavirus vaccination programs have been conducted in Latin America and the Caribbean. These studies were carried out few years after the programs were implemented, meet the basic methodological requirements and suggest positive health impact. Future assessments should consider methodological issues and challenges arisen in these first studies conducted in the region.
Subject(s)
Health Impact Assessment , Immunization Programs , Pneumococcal Vaccines , Rotavirus Vaccines , Vaccination , Caribbean Region , Humans , Latin AmericaABSTRACT
ABSTRACT OBJECTIVE To describe methods and challenges faced in the health impact assessment of vaccination programs, focusing on the pneumococcal conjugate and rotavirus vaccines in Latin America and the Caribbean. METHODS For this narrative review, we searched for the terms "rotavirus", "pneumococcal", "conjugate vaccine", "vaccination", "program", and "impact" in the databases Medline and LILACS. The search was extended to the grey literature in Google Scholar. No limits were defined for publication year. Original articles on the health impact assessment of pneumococcal and rotavirus vaccination programs in Latin America and the Caribbean in English, Spanish or Portuguese were included. RESULTS We identified 207 articles. After removing duplicates and assessing eligibility, we reviewed 33 studies, 25 focusing on rotavirus and eight on pneumococcal vaccination programs. The most frequent studies were ecological, with time series analysis or comparing pre- and post-vaccination periods. The main data sources were: health information systems; population-, sentinel- or laboratory-based surveillance systems; statistics reports; and medical records from one or few health care services. Few studies used primary data. Hospitalization and death were the main outcomes assessed. CONCLUSIONS Over the last years, a significant number of health impact assessments of pneumococcal and rotavirus vaccination programs have been conducted in Latin America and the Caribbean. These studies were carried out few years after the programs were implemented, meet the basic methodological requirements and suggest positive health impact. Future assessments should consider methodological issues and challenges arisen in these first studies conducted in the region.
RESUMO OBJETIVO Descrever métodos e desafios enfrentados na avaliação do impacto de programas de vacinação, com foco nas vacinas pneumocócica conjugada e de rotavírus nos países da América Latina e Caribe. MÉTODOS Para esta revisão narrativa, foi realizada busca nas bases de dados Medline e Lilacs, usando os termos "rotavirus", "pneumococcal", "conjugate vaccine", "vaccination", "program", e "impact". A busca foi estendida à literatura cinza no Google Acadêmico. Não houve limitação por ano de publicação. Foram incluídos estudos originais de avaliação do impacto dos programas de vacinação de pneumococo e rotavírus na América Latina e Caribe, publicados em inglês, espanhol ou português. RESULTADOS Foram identificados 207 artigos. Após remover duplicatas e avaliar elegibilidade, 33 estudos foram revisados, 25 sobre programas de vacinação de rotavírus e oito de pneumococo. Estudos ecológicos, com análise de série temporal ou comparação de períodos antes e após a vacinação, foram mais frequentes. As principais fontes de dados foram: sistemas de informação em saúde; sistemas de vigilância de base populacional, sentinela ou laboratorial; relatórios estatísticos; e prontuários médicos de um ou poucos serviços de saúde. Poucos estudos utilizaram dados primários. Hospitalizações e mortes foram os principais desfechos avaliados. CONCLUSÕES Nos últimos anos, número significativo de avaliações do impacto dos programas de vacinação de pneumococo e rotavírus foram realizados nos países da América Latina e Caribe. Esses estudos foram conduzidos poucos anos após a implementação dos programas, preenchem os requisitos metodológicos básicos e sugerem impacto positivo dos programas. Futuras avaliações devem considerar questões metodológicas e desafios que surgiram nesses primeiros estudos conduzidos na região.
Subject(s)
Humans , Vaccination , Immunization Programs , Pneumococcal Vaccines , Rotavirus Vaccines , Health Impact Assessment , Caribbean Region , Latin AmericaABSTRACT
OBJECTIVE: To analyze the evolution of relative prices of food groups and its influence on public healthy eating policies. METHODS: Data from the municipality of Sao Paulo between 1939 and 2010 were analyzed based on calculating index numbers. Data from the Economic Researches Foundation Institute price database and weight structures (1939 to 1988) and from the Brazilian Institute of Geography and Statistics (1989 to 2010) were used to. The price database was organized, its consistency tested and prices were deflated using the consumer price index. Relative prices were calculated and associated to food categories and groups, according to the food pyramid guide adapted for the Brazilian population. The price indices for each group were calculated according to Laspeyres modified formula. The general food price index was compared with the indices for each food group and respective category: fresh food, processed food, beverages, meat, legumes, milk and eggs, cereals and root vegetables and eating out. RESULTS: Price indices for fat, oil, spices, sugars and sweets and processed food showed relative price reduction. Fresh food, such as fruit and vegetables, showed an increase in relative prices. Other food groups, such as cereals, flour and pasta, meat, milk and egg, showed a steadier long term trend in relative prices. CONCLUSIONS: The evolution of relative prices of food in the city of Sao Paulo demonstrates a negative trend towards healthy eating at household level in the long run.
Subject(s)
Food/economics , Brazil , Budgets , Costs and Cost Analysis , Food, Organic/economics , Fruit , Humans , Income , Inflation, Economic , Nutrition Policy , Public Health , VegetablesABSTRACT
OBJETIVO: Analisar a evolução dos preços relativos dos grupos de produtos alimentares e sua influência nas políticas públicas para uma alimentação saudável. MÉTODOS: Foram analisados dados do município de São Paulo de 1939 a 2010, a partir da aplicação de métodos de cálculo de números-índices. Foram utilizados dados do banco de preços e estruturas de ponderação da Fundação Instituto de Pesquisas Econômicas (1939 a 1988) e do Instituto Brasileiro de Geografia e Estatística (1989 a 2010). O banco de preços foi organizado, sua consistência foi testada e os preços foram deflacionados pelo Índice de Preços ao Consumidor. Os dados relativos a preços deflacionados foram calculados e agregados por categorias e grupos alimentares da pirâmide alimentar adaptada. Os índices de preços de cada grupo foram construídos aplicando a fórmula de Laspeyres modificada. O índice geral de preços da alimentação foi comparado com índices de cada grupo alimentar e respectiva categoria: alimentos in natura; alimentos industrializados; bebidas; carnes, leguminosas, leite e ovos; cereais e tubérculos; e refeições fora do domicílio. RESULTADOS: Os grupos alimentares de gorduras, óleos, condimentos, açúcares e alimentos processados (alimentos industrializados) apresentaram tendência de redução de preços em termos relativos. O índice dos alimentos in natura, como frutas e verduras, apresentaram tendência de elevação de preços. Outros grupos alimentares, como cereais, farinhas e massas, carnes, leite e ovos, apresentaram estabilidade de preços relativos ao longo do tempo. CONCLUSÕES: A evolução dos preços relativos dos alimentos no município de ...
OBJETIVO: Analizar la evolución de los precios relativos de los grupos de productos alimenticios y su influencia en las políticas públicas para una alimentación saludable. MÉTODOS: Se analizaron datos del municipio de Sao Paulo de 1939 a 2010, a partir de la aplicación de métodos de cálculo de números-índices. Se utilizaron datos del banco de precios y estructuras de ponderación de la Fundación Instituto de Pesquisas Económicas (1939 a 1988) y del Instituto Brasileño de Geografía y Estadística (1989 a 2010). El banco de precios fue organizado, su consistencia fue evaluada y los precios fueron deflacionados por el Índice de Precio al Consumidor. Los datos relativos a precios deflacionados fueron calculados y agregados por categorías y grupos alimenticios de la pirámide alimenticia adaptada. Los índices de precios de cada grupo fueron construidos aplicando la fórmula de Laspeyres modificada. El índice general de precios de la alimentación fue comparado con los índices de cada grupo alimenticio y respectiva categoría: alimentos in natura; alimentos industrializados; bebidas; carnes, leguminosas, leche y huevos; cereales y tubérculos y comidas ingeridas fuera del domicilio. RESULTADOS: Los grupos alimenticios de grasas, aceites, condimentos, azúcares y alimentos procesados (alimentos industrializados) presentaron tendencia de reducción de precios en términos relativos. El índice de los alimentos in natura, como frutas y verduras, presentaron tendencia de elevación de precios. Otros grupos alimenticios, como cereales, harinas y pastas, carnes, leche y huevos presentaron estabilidad de precios relativos a lo largo del tiempo. CONCLUSIONES: La evolución de los precios relativos de los alimentos en el municipio de Sao Paulo muestra tendencia desfavorable para el mantenimiento ...
OBJECTIVE: To analyze the evolution of relative prices of food groups and its influence on public healthy eating policies. METHODS: Data from the municipality of Sao Paulo between 1939 and 2010 were analyzed based on calculating index numbers. Data from the Economic Researches Foundation Institute price database and weight structures (1939 to 1988) and from the Brazilian Institute of Geography and Statistics (1989 to 2010) were used to. The price database was organized, its consistency tested and prices were deflated using the consumer price index. Relative prices were calculated and associated to food categories and groups, according to the food pyramid guide adapted for the Brazilian population. The price indices for each group were calculated according to Laspeyres modified formula. The general food price index was compared with the indices for each food group and respective category: fresh food, processed food, beverages, meat, legumes, milk and eggs, cereals and root vegetables and eating out. RESULTS: Price indices for fat, oil, spices, sugars and sweets and processed food showed relative price reduction. Fresh food, such as fruit and vegetables, showed an increase in relative prices. Other food groups, such as cereals, flour and pasta, meat, milk and egg, showed a steadier long term trend in relative prices. CONCLUSIONS: The evolution of relative prices of food in the city of Sao Paulo demonstrates a negative trend towards healthy eating at household level in the long run. .
Subject(s)
Humans , Food/economics , Brazil , Budgets , Costs and Cost Analysis , Fruit , Whole Foods/economics , Income , Inflation, Economic , Nutrition Policy , Public Health , VegetablesABSTRACT
OBJECTIVE: To describe the progression and distribution of federal funds for programs and activities that fall within the scope of the guidelines of the Brazilian National Policy on Food and Nutrition Security (PNSAN) in the period from 2004 to 2010. METHODS: This descriptive study used data from the Transparency Website maintained by the Brazilian Public Sector Internal Control Office. Search results were exported to Excel spreadsheets. To determine the resources allocated to food security initiatives, a database was set up containing all actions developed by the federal government between 2004 and 2010. This database was reviewed and the actions that were not related to PNSAN were discarded. The annual amounts obtained were corrected by the Consumer Price Index and updated for the year 2010. Since actions are part of specific programs, the sum of the resources allocated for all the actions of a program amounted to the resources invested in the program as a whole. The programs were then prioritized according to the amount of resources received in 2010. RESULTS: Of the 5 014 actions receiving federal funds in the study period, 814 were related to PNSAN (229 programs). There was growth in resources allocated for PNSAN programs, reaching US$ 15 billion in 2010 (an 82% increase over the previous year). The largest amount was invested in Bolsa Família, a cash transfer program. Ten programs received 90% of the funds, of which five were linked to food production processes. CONCLUSIONS: The amount of resources invested in the PNSAN and in actions and programs that promote food and nutrition security is increasing in Brazil.
Subject(s)
Food Supply/statistics & numerical data , Nutrition Policy , Resource Allocation/statistics & numerical data , Brazil , HumansABSTRACT
OBJETIVO: Descrever a evolução e a distribuição dos recursos da União para programas e ações que se inserem nas diretrizes brasileiras da Política Nacional de Segurança Alimentar e Nutricional (PNSAN) no período de 2004 a 2010. MÉTODOS: Este estudo descritivo utilizou dados do Portal da Transparência mantido pela Controladoria Geral da União, que gera planilhas de Excel para cada pesquisa realizada. Para o levantamento dos recursos alocados, foi organizada uma base de dados contendo todas as ações executadas pelo governo federal entre 2004 e 2010. Essa base foi revisada e as ações que não eram relativas à PNSAN foram descartadas. Os montantes anuais obtidos tiveram os valores corrigidos pelo Índice de Preços ao Consumidor e atualizados para o ano de 2010. Como as ações são parte de programas específicos, a soma dos recursos destinados a todas as ações de um programa equivaleu aos recursos destinados ao programa como um todo. Os programas foram então hierarquizados de acordo com o volume de recursos recebidos em 2010. RESULTADOS: Das 5 014 ações que receberam recursos da União no período, 814 foram relacionadas à PNSAN (229 programas). Houve crescimento dos recursos alocados para os programas da PNSAN, alcançando, em 2010, US$ 15 bilhões (82% superior ao gasto no ano de 2004). A maior proporção dos recursos foi absorvida pelo Programa Bolsa Família. Dez programas receberam 90% dos recursos, sendo cinco ligados aos processos de produção alimentar. CONCLUSÕES: A PNSAN vem recebendo aporte crescente de recursos concentrados em ações e programas que favorecem a segurança alimentar e nutricional.
OBJECTIVE: To describe the progression and distribution of federal funds for programs and activities that fall within the scope of the guidelines of the Brazilian National Policy on Food and Nutrition Security (PNSAN) in the period from 2004 to 2010. METHODS: This descriptive study used data from the Transparency Website maintained by the Brazilian Public Sector Internal Control Office. Search results were exported to Excel spreadsheets. To determine the resources allocated to food security initiatives, a database was set up containing all actions developed by the federal government between 2004 and 2010. This database was reviewed and the actions that were not related to PNSAN were discarded. The annual amounts obtained were corrected by the Consumer Price Index and updated for the year 2010. Since actions are part of specific programs, the sum of the resources allocated for all the actions of a program amounted to the resources invested in the program as a whole. The programs were then prioritized according to the amount of resources received in 2010. RESULTS: Of the 5 014 actions receiving federal funds in the study period, 814 were related to PNSAN (229 programs). There was growth in resources allocated for PNSAN programs, reaching US$ 15 billion in 2010 (an 82% increase over the previous year). The largest amount was invested in Bolsa Família, a cash transfer program. Ten programs received 90% of the funds, of which five were linked to food production processes. CONCLUSIONS: The amount of resources invested in the PNSAN and in actions and programs that promote food and nutrition security is increasing in Brazil.