ABSTRACT
O Brasil vem promovendo avanços significativos desde os anos 1990 quanto à produção e ao uso de evidências econômicas na tomada de decisão sobre intervenções em saúde. Mas essa produção ainda é insuficiente para dar respostas a todas as questões formuladas no âmbito do sistema. Assim, o objetivo deste artigo é o de discutir as possibilidades de uso de evidências econômicas disponíveis na literatura científica internacional na tomada de decisão no Sistema Único de Saúde (SUS) e a necessidade de produção e uso dessas evidências na tomada de decisão em saúde. Para tanto, revisão bibliográfica da literatura foi realizada com o propósito de identificar estudos que apresentem resultados relevantes para as questões analisadas neste trabalho. Sobre a transferibilidade de evidências econômicas produzidas em outros países para uso na tomada de decisão sobre intervenções no SUS, o que os achados da literatura revelam é que existem muitas limitações a esse respeito. Ademais, os métodos para adaptação de avaliações econômicas ainda são pouco discutidos. Com isso, tem-se que as possibilidades de uso de evidências econômicas obtidas da literatura internacional em decisões no âmbito do SUS são extremamente limitadas e, portanto, ao se reconhecer a relevância dessas evidências na tomada de decisão em saúde, chega-se à conclusão de que é preciso produzi-las usando dados e informações do SUS.
Brazil has been promoting significant advances since the 1990s regarding the production and use of economic evidence in decision-making on health interventions. But this production is still insufficient to provide answers to all the questions raised within the system. Thus, the objective of this article is to discuss the possibilities of using economic evidence available at international scientific literature in decision-making of the Brazilian Public Health System (SUS) and the need to produce and use this evidence in health decision-making. For this purpose, literature review was carried out to identify studies that present relevant results for the issues analyzed in this study. Regarding the transferability of economic evidence produced in other countries for use in decision-making on SUS interventions, there are many limitations. In addition, the discussion about methods for adapting economic evaluations isn't enough yet. Thus, the possibilities of using economic evidence obtained from the international literature in decisions of the SUS are extremely limited and, therefore, it is necessary to produce them using data and information from the SUS, once it is recognized the relevance of these evidences in the health decision-making.
Subject(s)
Humans , Decision Making , Health Care Economics and Organizations , Health Evaluation , Unified Health SystemABSTRACT
BACKGROUND: Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). METHODS: The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches. RESULTS: The cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p < 0.001). The study showed no significant difference in total costs between OS and DMLS. Total costs of general surgery RAS were significantly higher than those of OS (p < 0.001), but not against DMLS general surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p < 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge. CONCLUSIONS: The present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach.
