Guidelines for Utility Measurement for Economic Analysis: The Brazilian Policy.

INTRODUCTION: Health-related quality of life is expressed in utilities, also referred to as utility estimates or parameters. Considerations about the source and type of utility values are especially important in a modeling context, where the lack of transparency, including the lack of a hierarchy for utility data sources, is a major issue to any estimation and can potentially compromise model reliability. OBJECTIVES: This document aims to present the first version of the Brazilian guidelines for utility measurement to support economic analysis. METHODS: A virtual workshop and a modified Delphi panel with 10 health technology specialists followed a rapid evaluation of 110 technical documents and indexed publications. The recommendations are based on the proposition that has received the most votes, although contentious issues are addressed in the suggestion or discussion. The rationale for the final decision is included in the text. RESULTS: The consensus includes 50 recommendations with the following topics: Transparency and Reliability, Model Design, Conditions Under Which Generic Questionnaires Are Not Sensible or Valid, Utility Evidence Hierarchy, Utility Data Searching, Modeling Utility Values, Extrapolating Quality Adjusted Life-Years for Models With Lifetime Horizons, Caregiver Utility, Utility Data Synthesis, Quality/Certainty of the Evidence, and Utility Estimates in End-of-Life Conditions. CONCLUSIONS: The goal of this project is to create unified national standards for using utility metrics in economic analysis in Brazil. This set of recommendations is not obligatory, but it is meant to serve as a guide and lead to the development of better and more transparent economic models in the country.

Custo-efetividade do uso da Tomografia de Emissão de Pósitrons (PET scan) no estadiamento inicial do câncer de esôfago / Cost-effectiveness of Positron Emission Tomography (PET scan) in the initial staging of oesophageal cancer

No câncer de esôfago, de elevada incidência e mortalidade no país, o estadiamento do câncer é um dos fatores mais importantes na definição da estratégia terapêutica a ser adotada e nas chances de seu sucesso. O uso da tomografia de emissão de pósitrons tem sido proposto de maneira substitutiva ou complementar às técnicas convencionais, ainda sem consenso acerca de seu valor clínico nesta indicação. Sua introdução pode também ter impacto significativo nos gastos em saúde do sistema. Foi realizada revisão sistemática da literatura sobre a acurácia da tecnologia no estadiamento inicial do câncer de esôfago. Examinou-se a eficiência comparativa decorrente da adição da tomografia de emissão de pósitrons associada à tomografia computadorizada (PET-TC) à estratégia diagnóstica convencional, baseada na tomografia computadorizada (TC) e ultrassonografia endoscópica (USE), através do desenvolvimento de modelo analítico de decisão, representado por coorte hipotética de 10.000 indivíduos com idade inicial de 60 anos, 75% homens, com tipo histológico de carcinoma de células escamosas e tumor em terço médio ou distal. O horizonte temporal compreendeu todo o período de vida dos indivíduos, e utilizou-se como medida de efetividade anos de vida adicionais gerados pela inclusão da tecnologia. Utilizou-se a perspectiva do Sistema Único de Saúde como financiador da assistência em saúde. Foram considerados apenas custos médicos diretos relacionados com a assistência médica. Resultados foram descontados em 5%. Foram realizadas análises de sensibilidade determinística univariada e probabilística. Na avaliação de linfonodos regionais e unidade de análise paciente, a sensibilidade e especificidade sumárias foram de, respectivamente, 41% (IC 95% 29%­55%) e 91% (IC 95% 85%­94%) para PET-TC e de 59% (IC 95% 48%­69%) e 83% (IC 95% 76%­88%) para PET simples. Na avaliação de metástases à distância para a unidade de análise paciente, foram obtidas sensibilidade e especificidade sumárias de 65% (IC 95% 41%­83%) e 96% (IC 95% 89%­98%) para PET-TC e de 75% (IC 95% 66%­82%) e 93% (IC 95% 91%­95%) para PET simples. Ambas as estratégias que avaliaram a introdução da PET-TC ao arsenal diagnóstico resultariam em aumento na efetividade e nos custos. A adição da PET-TC apenas para pacientes com resultado negativo para metastáses à distância pela TC (estratégia 2) produziria 10,6 anos de vida adicionais e custo adicional de R$ 11.689.055,95 em relação à estratégia de estadiamento convencional, resultando em razão de custo efetividade incremental descontada de R$ 1.103.952,69 por ano de vida adicional. Já o estadiamento baseado na oferta da PET-TC para todos os pacientes geraria 7,55 anos de vida adicionais, a um custo de R$ 13.467.972,09, sendo considerada dominada em relação à estratégia 2. As estimativas de sobrevida dos pacientes, as sensibilidades e/ou especificidades da biópsia, PET-TC e TC, a mortalidade pós-cirúrgica e a proporção de pacientes reavaliados como sem doença ou doença persistente após terapia neoadjuvante foram os parâmetros de maior impacto nos resultados. Os custos da adição da PETTC ao estadiamento do câncer esofagiano não justificam sua incorporação ao sistema de saúde nacional, dados pequeno benefício e elevado custo adicionais

Staging is one of the most important factors in defining the therapeutic strategy adopted and in the chances of its success in oesophagus cancer, a cancer of high incidence and mortality in the country. The use of positron emission tomography has been proposed in addition or to substitute conventional techniques, although there is no consensus about its clinical value in this indication. Its introduction may also have a significant impact on the health system's expenditures. A systematic review of the literature was performed on the accuracy of the technology in the initial staging of oesophageal cancer. The comparative efficiency of the addition of positron emission tomography associated with computed tomography (PET-CT) to the conventional diagnostic strategy, based on computed tomography (CT) and endoscopic ultrasonography (EUS), was examined. An analytical model was developed, which consisted of a hypothetical cohort of 10,000 individuals with initial age of 60 years, 75% of men, with squamous cell carcinoma and tumour located in the middle or distal third. Time horizon comprised the individuals' entire life span, and the measure of effectiveness was additional years of life generated by the inclusion of the technology. The perspective used was of the Brazilian Unified Health System as the funder of health care. Only direct medical costs related to medical care were considered. Costs and benefits were discounted at 5%. Univariate and probabilistic deterministic sensitivity analyses were performed. In regional lymph node evaluation and patient analysis, sensitivity and specificity were, respectively, 41% (95% CI: 29%­55%) and 91% (CI 95% 85%­94%) for PET-CT, and 59% (95% CI 48%­69%) and 83% (95% CI 76%­88%) for PET. In the evaluation of distant metastases for patient analysis, summary sensitivity and specificity of 65% (95% CI: 41%­83%) and 96% (95% CI 89%­98%) were obtained for PET-CT and of 75% (95% CI 66%­82%) and 93% (95% CI 91%­95%) for PET. Both strategies that evaluated the introduction of PET-CT to the diagnostic arsenal would result in an increase in effectiveness and costs. The addition of PET-CT only to patients with negative results by CT for metastatic metastasis (strategy 2) would produce an additional 10.6 years of life and an additional cost of R$ 11,689,055.95 in relation to the conventional staging strategy, resulting in a discounted incremental cost effectiveness ratio of R$ 1,103,952.69 per additional year of life. Staging based on PET-CT for all patients would generate an additional 7.55 years of life, at a cost of R$ 13,467,972.09, which was considered to be dominated in relation to strategy 2. Parameters of greatest impact on results were patient survival estimates, sensitivities and/or specificities of biopsy, PET-CT and CT, post-surgical mortality and proportion of patients re-evaluated as being without or with persistent disease after neoadjuvant therapy. The costs of adding PET-CT to oesophageal cancer staging do not justify its incorporation into the national health system, given the small benefit and high additional cost

A systematic review of economic evaluations of the use of memantine alone or combined with donepezil for moderate to severe Alzheimer's disease / Revisão sistemática de avaliações econômicas acerca do uso da memantina isolada ou combinada com o donepezil para a doença de Alzheimer moderada a grave

OBJECTIVE: To synthesize the available evidence and state of the art of economic evaluations which evaluate the use of memantine, whether alone or combined with donepezil, for moderate to severe Alzheimer's disease (AD), focusing on the analytical decision models built. METHOD: The electronic databases MEDLINE, EMBASE, NHS EED, CEA Registry and LILACS were searched for references. After duplicates were removed, two independent reviewers evaluated the titles and abstracts and subsequently the full texts. The Drummond M. tool was used to evaluate the quality of the studies. RESULTS: After the application of the eligibility criteria, twelve complete economic evaluations were included. One evaluation was a clinical trial, two involved simulations and nine used Markov models. The main outcome measure adopted was dominated by cost per quality adjusted life year (QALY). The use of memantine was considered cost-effective and dominant in eight studies; while in a single study, its use was dominated when compared to donepezil for moderate AD. Sensitivity analyzes were systematically performed, with robust results. The quality assessment indicated that the methodological quality of the studies was good. CONCLUSION: Although there is some controversy regarding the benefits derived from the use of memantine, whether combined or not with donepezil, the evidence collected suggests that it is cost-effective in the countries where the studies were performed. However, local economic studies need to be performed, given the significant variability derived from the different parameters adopted in the evaluations.

OBJETIVO: Sintetizar as evidências disponíveis e o estado da arte das avaliações econômicas que avaliaram a memantina isolada ou combinada com donepezil para a Doença de Alzheimer (DA) moderada a grave, com foco nos modelos de decisão analíticos elaborados. MÉTODO: As bases eletrônicas MEDLINE, EMBASE, NHS EED, CEA Registry e LILACS foram usadas para busca de referências. Após a remoção de duplicatas, dois revisores independentes avaliaram os títulos e resumos e, posteriormente, os textos completos. A ferramenta de Drummond M. foi utilizada para avaliação da qualidade dos estudos. RESULTADO: Após a aplicação dos critérios de elegibilidade, foram incluídas doze avaliações econômicas completas. Quanto aos desenhos de estudo, uma avaliação foi conduzida ao longo de ensaio clínico, duas fizeram simulação e nove utilizaram modelos de Markov. A principal medida de desfecho adotada foi custo por ano de vida ajustado por qualidade (QALY). O uso da memantina foi considerada custo-efetivo e dominante em oito estudos; em um único estudo, seu uso foi dominado quando comparado ao donepezil para a DA moderada. Análises de sensibilidade foram sistematicamente realizadas, evidenciando resultados robustos. A avaliação de qualidade apontou boa qualidade metodológica dos trabalhos. CONCLUSÃO: Apesar de existirem controvérsias quanto aos benefícios derivados do uso da memantina associada ou não ao donepezil, o levantamento das evidências sugere que ela é custo-efetiva nos países onde os estudos foram elaborados. No entanto, estudos econômicos locais necessitam ser realizados, dada a grande variabilidade derivada dos diferentes parâmetros adotados nas avaliações.

Incorporation of new medicines by the National Commission for Incorporation of Technologies, 2012 to June 2016. / Incorporação de novos medicamentos pela Comissão Nacional de Incorporação de Tecnologias do SUS, 2012 a junho de 2016.

The National Commission for incorporation of Health Technologies (CONITEC), established in 2011, advises the Ministry of Health in decisions related to the incorporation, exclusion or change of medicines, products and procedures in the Unified Health System (SUS).The study investigated the decision-making process, profile of demands and incorporation of new medicines in the SUS from January/2012 to June/2016, based on data available on the CONITEC website. All submissions were evaluated and characterized by technology and applicant type. The incorporations were analyzed according to the Anatomical-Therapeutic-Chemical classification, International Classification of Disease of the clinical indication and active record in the National Health Surveillance Agency. In the period, 485 submissions were received, 92.2% concerning requests for incorporation and 62.1% for medicines, of which 93 (30.1%) received a favorable recommendation for incorporation. Domestic demands were more successful than externally originated ones. Six unregistered drugs were incorporated. Infectious and parasitic diseases and musculoskeletal diseases constituted the main clinical indications. The recommendation of incorporation occurred mainly based on the additional clinical benefits and low budget impact.

Incorporação de novos medicamentos pela Comissão Nacional de Incorporação de Tecnologias do SUS, 2012 a junho de 2016 / Incorporation of new medicines by the National Commission for Incorporation of Technologies, 2012 to June 2016

Resumo A Comissão Nacional de Incorporação de Tecnologias em Saúde (Conitec), instituída em 2011, assessora o Ministério da Saúde nas decisões relacionadas à incorporação, exclusão ou alteração de novos medicamentos, produtos e procedimentos no Sistema Único de Saúde. O estudo investigou o processo de recomendação pela Conitec e o perfil das demandas e incorporações de medicamentos, de janeiro/2012 a junho/2016. A fonte de dados baseou-se nos registros disponíveis no site da Conitec. Demandas foram classificadas pelos tipos de submissão, de tecnologia e demandante. Medicamentos incorporados foram analisados segundo as classificações Anatômico-Terapêutica-Química e Internacional de Doença (CID) da indicação clínica, e presença de registro na Agência Nacional de Vigilância Sanitária. Foram recebidas 485 submissões, 92,2% relativas a pedidos de incorporação e 62,1% para medicamentos, dos quais 93 (30,1%) com recomendação favorável à incorporação. Demandas internas obtiveram maior sucesso que as originadas externamente. Seis medicamentos sem registro foram incorporados. Doenças infecto-parasitárias e osteomusculares foram as principais indicações clínicas. Benefícios clínicos adicionais e baixo impacto orçamentário foram as principais justificativas de recomendação.

Abstract The National Commission for incorporation of Health Technologies (CONITEC), established in 2011, advises the Ministry of Health in decisions related to the incorporation, exclusion or change of medicines, products and procedures in the Unified Health System (SUS).The study investigated the decision-making process, profile of demands and incorporation of new medicines in the SUS from January/2012 to June/2016, based on data available on the CONITEC website. All submissions were evaluated and characterized by technology and applicant type. The incorporations were analyzed according to the Anatomical-Therapeutic-Chemical classification, International Classification of Disease of the clinical indication and active record in the National Health Surveillance Agency. In the period, 485 submissions were received, 92.2% concerning requests for incorporation and 62.1% for medicines, of which 93 (30.1%) received a favorable recommendation for incorporation. Domestic demands were more successful than externally originated ones. Six unregistered drugs were incorporated. Infectious and parasitic diseases and musculoskeletal diseases constituted the main clinical indications. The recommendation of incorporation occurred mainly based on the additional clinical benefits and low budget impact.

Custo-efetividade do uso da tomografia de emissão de pósitrons na detecção de recorrência do câncer diferenciado de tireoide / Cost-effectiveness of the use of positron emission tomography in the detection of recurrence of differentiated thyroid cancer

Avaliou-se a custo-efetividade da adição da tomografia de emissão de pósitrons (18FDG-PET-TC) aos métodos convencionais na detecção de recorrência de cânceres diferenciados de tireoide. O modelo analítico de decisão representou coorte hipotética de pacientes adultos, de alto risco pela estratificação inicial, submetidos a tireoidectomia total e ablação com I131. A estratégia convencional de detecção foi comparada à adição da 18FDG-PET-TC aplicada aos indivíduos com resultados de cintigrafia com I131 negativos. O horizonte temporal foi de dez anos. Utilizou-se a perspectiva do Sistema Único de Saúde (SUS) e, como medida de efetividade, os casos adicionais diagnosticados pela inclusão da PET-TC. Foram considerados apenas os custos médicos diretos. O custo do PET-TC foi estimado por microcustos; os demais custos foram obtidos das tabelas de pagamento de procedimentos do SUS. Custos e benefícios foram descontados em 5%. Realizaram-se análises de sensibilidade determinística univariada e probabilística. Detectaram-se 1.875 casos de recorrência com a estratégia convencional. Uso da 18FDG-PET-TC permitiu a detecção adicional de 13 casos, com custo de R$477.633,05/caso detectado. Os parâmetros de maior impacto na análise foram: medidas de acurácia dos métodos convencionais, custo do PET-TC e taxa de desconto. Os custos da adição da PET-TC mostram-se significativos e sua introdução não é custo-efetiva.

The positron emission tomography (18FDG-PET/CT) was recently introduced in Brazilian health care for many oncology indications but accompanied by higher costs. In our study we performed a cost-effectiveness analysis of the addition of PET/CT to the conventional diagnostic work-up to detect recurrent differentiated thyroid cancers. The analytical decision model represented a hypothetical cohort of adults, thyroid cancer patients with high risk by initial stratification, submitted to total thyroidectomy and ablation with I131. The addition of PET/CT was applied to subjects with negative results on I131scintigraphy. The model was designed from the perspective of the Brazilian public health care system, with a time horizon of 10 years. Effectiveness was measured by the additional recurrent cases detected. Only direct medical costs were considered. Costs and benefits were discounted by 5%. Univariate deterministic and probabilistic sensitivity analyzes were performed to explore the uncertainties. The PET/CT diagnosed 13 additional cases compared to conventional strategy (1,888 vs 1,875) by a cost of R$477,633.05 per case detected. The parameters of greatest impact in the sensitivity analysis were the accuracy of conventional tests, cost of PET/CT and the discount rate. The costs of adding PET/CT seems significant and its introduction is not cost-effective on the Brazilian perspective.

Budget impact from the incorporation of positron emission tomography - computed tomography for staging lung cancers.

OBJECTIVE: To estimate the budget impact from the incorporation of positron emission tomography (PET) in mediastinal and distant staging of non-small cell lung cancer. METHODS: The estimates were calculated by the epidemiological method for years 2014 to 2018. Nation-wide data were used about the incidence; data on distribution of the disease's prevalence and on the technologies' accuracy were from the literature; data regarding involved costs were taken from a micro-costing study and from Brazilian Unified Health System (SUS) database. Two strategies for using PET were analyzed: the offer to all newly-diagnosed patients, and the restricted offer to the ones who had negative results in previous computed tomography (CT) exams. Univariate and extreme scenarios sensitivity analyses were conducted to evaluate the influence from sources of uncertainties in the parameters used. RESULTS: The incorporation of PET-CT in SUS would imply the need for additional resources of 158.1 BRL (98.2 USD) million for the restricted offer and 202.7 BRL (125.9 USD) million for the inclusive offer in five years, with a difference of 44.6 BRL (27.7 USD) million between the two offer strategies within that period. In absolute terms, the total budget impact from its incorporation in SUS, in five years, would be 555 BRL (345 USD) and 600 BRL (372.8 USD) million, respectively. The costs from the PET-CT procedure were the most influential parameter in the results. In the most optimistic scenario, the additional budget impact would be reduced to 86.9 BRL (54 USD) and 103.8 BRL (64.5 USD) million, considering PET-CT for negative CT and PET-CT for all, respectively. CONCLUSIONS: The incorporation of PET in the clinical staging of non-small cell lung cancer seems to be financially feasible considering the high budget of the Brazilian Ministry of Health. The potential reduction in the number of unnecessary surgeries may cause the available resources to be more efficiently allocated.

Budget impact from the incorporation of positron emission tomography - computed tomography for staging lung cancers / Impacto orçamentário da incorporação da tomografia de emissão de pósitrons - tomografia computadorizada para estadiamento de câncer pulmonar

OBJECTIVE To estimate the budget impact from the incorporation of positron emission tomography (PET) in mediastinal and distant staging of non-small cell lung cancer.METHODS The estimates were calculated by the epidemiological method for years 2014 to 2018. Nation-wide data were used about the incidence; data on distribution of the disease´s prevalence and on the technologies' accuracy were from the literature; data regarding involved costs were taken from a micro-costing study and from Brazilian Unified Health System (SUS) database. Two strategies for using PET were analyzed: the offer to all newly-diagnosed patients, and the restricted offer to the ones who had negative results in previous computed tomography (CT) exams. Univariate and extreme scenarios sensitivity analyses were conducted to evaluate the influence from sources of uncertainties in the parameters used.RESULTS The incorporation of PET-CT in SUS would imply the need for additional resources of 158.1 BRL (98.2 USD) million for the restricted offer and 202.7 BRL (125.9 USD) million for the inclusive offer in five years, with a difference of 44.6 BRL (27.7 USD) million between the two offer strategies within that period. In absolute terms, the total budget impact from its incorporation in SUS, in five years, would be 555 BRL (345 USD) and 600 BRL (372.8 USD) million, respectively. The costs from the PET-CT procedure were the most influential parameter in the results. In the most optimistic scenario, the additional budget impact would be reduced to 86.9 BRL (54 USD) and 103.8 BRL (64.5 USD) million, considering PET-CT for negative CT and PET-CT for all, respectively.CONCLUSIONS The incorporation of PET in the clinical staging of non-small cell lung cancer seems to be financially feasible considering the high budget of the Brazilian Ministry of Health. The potential reduction in the number of unnecessary surgeries may cause the available resources to be more efficiently allocated.

OBJETIVO Estimar o impacto orçamentário da incorporação da tomografia por emissão de pósitrons (PET) no estadiamento mediastinal e à distância do câncer pulmonar de células não pequenas.MÉTODOS As estimativas foram calculadas pelo método epidemiológico para os anos de 2014 a 2018. Utilizaram-se dados nacionais de incidência; de distribuição de doença e acurácia das tecnologias procedentes da literatura, e de custos, de estudo de microcustos e das bases de dados do Sistema Único de Saúde. Analisaram-se duas estratégias de uso da PET: oferta a todos os pacientes recém-diagnosticados, e restrita àqueles que apresentassem resultados negativos de tomografia computadorizada (TC) prévia. Foram realizadas análises de sensibilidade univariadas e por cenários extremos para avaliar influência de fontes de incertezas nos parâmetros utilizados.RESULTADOS A incorporação da PET-TC ao Sistema Único de Saúde implicaria na necessidade de recursos adicionais de R$158,1 (US$98,2) milhões para oferta restrita a R$202,7 (US$125,9) milhões para oferta abrangente em cinco anos, com diferença entre as duas estratégias de oferta de R$44,6 (US$27,7) milhões no período. Em termos absolutos, o impacto orçamentário total da incorporação no Sistema Único de Saúde, em cinco anos, seria de R$555 (US$345) e R$600 (US$372,8) milhões, respectivamente. Custos do procedimento PET-TC foram o parâmetro de maior influência nos resultados. No cenário por extremos mais otimista, os impactos orçamentários incrementais reduzir-se-iam para R$86,9 (US$54) e R$103,8 (US$64,5) milhões, considerando PET-TC para TC negativa e PET-TC para todos, respectivamente.CONCLUSÕES A incorporação da PET no estadiamento clínico do câncer pulmonar de células não-pequenas parece ser financeiramente factível frente à magnitude do orçamento do Ministério da Saúde. A potencial redução no número de cirurgias desnecessárias pode produzir maior eficiência na alocação dos recursos disponíveis.

[Cost analysis of18F-FDG PET-CT from the perspective of the Brazilian Unified National Health System as healthcare provider: a study in a public healthcare center in Rio de Janeiro, Brazil]. / Análise dos custos do procedimento PET-TC com 18 F-FDG na perspectiva do SUS provedor: estudo em uma unidade pública de saúde do Rio de Janeiro, Brasil.

Positron emission tomography (PET) has been introduced recently in Brazil and requires costs analysis to support economic evaluation studies on its use. The current study analyzed the use of 18 F-FDG PET-CT and estimated its costs from the perspective of a public healthcare provider. The micro-costing technique was used, identifying, quantifying, and valuing all the inputs used to perform the procedure. Cost estimates considered 85 tests performed at the Brazilian National Cancer Institute from March to June 2012. Reference cases were defined as adult cancer patients, output of five tests per day, and one dose of 18 F-FDG per patient. Unit cost for the procedure was BRL 3,150.30 based on career wages under the Ministry of Science and Technology and BRL 2,927.19 based on Ministry of Health career wages. The factor with the heaviest cost impact was daily output of tests. Other factors that could impact the test's cost in public healthcare institutions were also examined.

Análise dos custos do procedimento PET-TC com 18 F-FDG na perspectiva do SUS provedor: estudo em uma unidade pública de saúde do Rio de Janeiro, Brasil / Cost analysis of 18 F-FDG PET-CT from the perspective of the Brazilian Unified National Health System as healthcare provider: a study in a public healthcare center in Rio de Janeiro, Brazil / Análisis de costes del procedimiento PET-TC con 18 F-FDG desde la perspectiva del SUS proveedor: estudio en una unidad pública de salud de Río de Janeiro, Brasil

A tomografia de emissão de pósitrons (PET) é de uso recente no Brasil e há necessidade de se estimar os custos do procedimento, de forma a subsidiar estudos de avaliação econômica sobre a tecnologia. O trabalho analisou o processo de produção da PET-TC utilizando 18 F-FDG e estimou seus custos na perspectiva de um provedor público de serviços de saúde. Utilizou- se a técnica de microcustos, com identificação, quantificação e valoração de todos os insumos consumidos na produção do procedimento. As estimativas de custo consideraram a observação de 85 exames realizados no Instituto Nacional de Câncer, de março/julho de 2012. O caso de referência considerou pacientes oncológicos adultos, volume de produção de 5 exames/dia e uso de uma dose de 18 F-FDG por paciente. Os custos unitários do procedimento foram de R$ 3.150,30, na perspectiva salarial da carreira de Ciência & Tecnologia, e de R$ 2.927,19 na do Ministério da Saúde. O elemento de maior impacto nos custos correspondeu ao volume diário de produção dos exames. Foram explorados elementos que podem impactar no custo do exame nas instituições públicas de saúde.

Positron emission tomography (PET) has been introduced recently in Brazil and requires costs analysis to support economic evaluation studies on its use. The current study analyzed the use of 18 F-FDG PET-CT and estimated its costs from the perspective of a public healthcare provider. The micro-costing technique was used, identifying, quantifying, and valuing all the inputs used to perform the procedure. Cost estimates considered 85 tests performed at the Brazilian National Cancer Institute from March to June 2012. Reference cases were defined as adult cancer patients, output of five tests per day, and one dose of 18 F-FDG per patient. Unit cost for the procedure was BRL 3,150.30 based on career wages under the Ministry of Science and Technology and BRL 2,927.19 based on Ministry of Health career wages. The factor with the heaviest cost impact was daily output of tests. Other factors that could impact the test’s cost in public healthcare institutions were also examined.

La tomografía por emisión de positrones (PET) es de uso reciente en Brasil y es necesario estimar sus costes, con el fin de subsidiar estudios de evaluación económica sobre esta tecnología. El trabajo examina el proceso de producción de PET-TC con 18F-FDG y se estimaron sus costes desde la perspectiva de un prestador público de servicios de salud. Se empleó la técnica de microcostes, con la identificación, cuantificación y valoración de los insumos consumidos en la producción del procedimiento. Las estimaciones consideran la observación de 85 exámenes entre marzo y julio de 2012. El “caso base” considera pacientes adultos de cáncer, con una producción de 5 exámenes/día y el uso de una dosis de 18F-FDG por paciente. Los costes unitarios del procedimiento fueron, respectivamente, R$ 3.150.30 y R$ 2.927.19, desde la perspectiva del Ministerio de Ciencia y Tecnología y del Ministerio de Salud. El volumen diario de producción fue el elemento de mayor impacto en los costes. Además, se analizaron los factores que pueden repercutir en el coste del examen en instituciones de salud pública.