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2.
Cien Saude Colet ; 24(6): 2211-2220, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269180

RESUMO

This article analyzes the profile of research conducted in the Federal District of Brazil funded through public calls for proposals issued by the Research for the SUS Program: shared health management/Federal District (PPSUS/DF) and a research support program run by the Superior School of Health Sciences, maintained by the Health Sciences Teaching and Research Foundation (ESCS/FEPECS, acronym in Portuguese). A document analysis was undertaken of all research funded by the PPSUS/DF and ESCS/FEPECS's Research Support Program between 2008 and 2017 using the following variables: year, title, research themes of the National Agenda for Health Research Priorities (ANPPS, acronym in Portuguese), implementing organization, area of application of research, and amount of funding. PPSUS/DF funded 73 projects with a total investment of approximately R$8 million, while ESCS/FEPECS funded 85 projects with a total investment of R$2.3 million. This study provides a critical analysis of the research themes supported by ESCS/FEPECS and PPSUS/DF between 2008 and 2017. It is recommended that future calls for proposals should prioritize the three leading causes of death in the Federal District and the organization and evaluation of healthcare services.


Assuntos
Tecnologia Biomédica/economia , Pesquisa sobre Serviços de Saúde/organização & administração , Programas Nacionais de Saúde/organização & administração , Brasil , Pesquisa sobre Serviços de Saúde/economia , Humanos , Invenções/economia , Programas Nacionais de Saúde/economia , Apoio à Pesquisa como Assunto
3.
Cien Saude Colet ; 24(5): 1709-1722, 2019 May 30.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31166506

RESUMO

Given the financial impact of the adoption of new health technologies in health systems, choosing what technology should be introduced and when poses a major challenge for health managers. The health technology assessment (HTA) process should therefore be underpinned by transparent and objective criteria. The objective of this study was to analyze HTA processes in Brazil, overseen by the National Commission for the Incorporation of Health Technology (CONITEC), and to compare these processes with those in countries considered to be at the forefront of this field: Australia, Canada, and the United Kingdom. The following categories were used for the comparative analysis: program structure, definition and selection of topics, evidence review, use of HTA in decision making, program products and dissemination, and transparency. The findings show that there are more similarities than differences between these countries' processes and the CONITEC processes. The main differences identified were: composition of committees, entitlement to appeal, program evaluation, and timeframes for the implementation of recommendations/decisions. Despite making major strides in recent years, Brazil should continue to promote continuous improvement of its HTA process.


Assuntos
Tecnologia Biomédica , Tomada de Decisões , Avaliação da Tecnologia Biomédica/métodos , Tecnologia Biomédica/economia , Brasil , Assistência à Saúde/economia , Assistência à Saúde/métodos , Humanos , Internacionalidade , Programas Nacionais de Saúde/economia
4.
Int J Technol Assess Health Care ; 35(3): 168-175, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31122302

RESUMO

OBJECTIVES: Discussions at the Health Technology Assessment International (HTAi) Asia Policy Forum (HAPF) aimed to understand the meaning of "high-cost technologies," and to explore mechanisms to increase access to these technologies in publicly funded health systems in the Asia region. METHODS: Discussions and presentations at the 2018 HAPF, informed by a literature review and a premeeting survey of HTA agencies and industry, form the basis of this paper. RESULTS: Challenges payers in the public health system face when investing in high-cost technologies include a lack of data, especially real-world data, affordability, and the budgetary impact of high-cost technologies. Managed entry schemes (MES) are one means to enable earlier access to high-cost technologies, or at reduced cost to the system. Most countries surveyed had used an MES to introduce a new health technology and most industry representatives had experience with financial-based MES, such as discounts or rebates, with most put in place to increase access to pharmaceuticals. Little experience of outcome-based or evidence-generation MES was reported. CONCLUSIONS: Although it is early days in the implementation of MES in Asia, they have the potential to play an important role enabling access to new, mainly pharmaceutical, health technologies. The development of a "road map" of MES in the region should outline the intent and need for a MES, articulating the "rules of engagement" for all stakeholders-patients, providers, payers, and industry-which will assist countries to clearly identify the problem trying to be solved, and how an MES can be part of the solution.


Assuntos
Tecnologia Biomédica/economia , Avaliação da Tecnologia Biomédica/organização & administração , Ásia , Orçamentos , Análise Custo-Benefício , Tomada de Decisões , Acesso aos Serviços de Saúde/economia , Humanos
5.
Cad Saude Publica ; 35(3): e00153118, 2019 03 25.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30916181

RESUMO

The enormous development of genomics research in recent decades has raised great expectations concerning its impact on biomedicine. There has been growing investment in research in personalized or precision medicine, which aims to customize medical practice with a focus on the individual, based on the use of genetic tests, identification of biomarkers, and development of targeted drugs. However, the personalized or precision medicine movement is controversial and has sparked an important debate between its defenders and critics. This essay aims to discuss the assumptions, promises, limits, and possibilities of personalized or precision medicine based on a review of the recent literature situating the debate on the theme. The review indicates that many of the promises of personalized or precision medicine remain unfulfilled. While there has been huge progress in knowledge on the molecular mechanisms of diseases and the development of drugs that have significantly impacted the treatment of some types of cancer, thus far there is no evidence that this same pattern will be reproduced in other complex diseases. Personalized or precision medicine is expected to generate incremental developments in specific areas of medicine, but there are obstacles to its generalization. The high cost of new biotechnologies can exacerbate health inequalities and become a problem for health services' sustainability, especially in low and middle-income countries. The emphasis on personalized or precision medicine may shift funds away from less costly interventions that have greater public health impact.


Assuntos
Tecnologia Biomédica/tendências , Medicina de Precisão/tendências , Tecnologia Biomédica/economia , Genômica/economia , Genômica/métodos , Equidade em Saúde , Humanos , Neoplasias/economia , Neoplasias/terapia , Preparações Farmacêuticas/economia , Medicina de Precisão/economia
6.
Health Policy Plan ; 34(1): 37-46, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30715314

RESUMO

The rapid diffusion of medical technologies is widely recognized as a key driver of healthcare cost escalation. The excessive duplication of technologies gives rise to the so-called medical arms race. Conventional wisdom tends to explain this phenomenon by external reimbursement mechanisms and hospitals' competitive strategies, but has largely neglected the role played by health regulations that may also affect hospitals' technology adoption decisions. This study sheds new light on the medical arms race with evidence from China, which has witnessed an unprecedented expansion of big tertiary hospitals and a keen pursuit of expensive medical technologies. Chinese hospitals aggressively pursue high-tech medical equipment as an opportunistic reaction to the peculiar health regulatory environment. By analysing a panel dataset collected from Shenzhen City, this study reveals a series of important impacts of the medical arms race in Chinese public hospitals. High-tech medical equipment is found to lead to an increase in hospital revenues and patient volumes, but no significant impact is noted on unit costs. While high-tech medical equipment is associated with a discernible improvement in clinical outcomes, no contribution to hospitals' operational efficiency is noted. These findings are interpreted in the context of the broader health regulatory framework and China's public hospital reforms.


Assuntos
Tecnologia Biomédica/economia , Competição Econômica , Economia Hospitalar , Hospitais Públicos/economia , Hospitais Públicos/organização & administração , China , Eficiência Organizacional , Política de Saúde , Administração Hospitalar/métodos , Hospitais Públicos/legislação & jurisprudência , Humanos
8.
Health Aff (Millwood) ; 38(1): 115-123, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30615535

RESUMO

Digital health companies hold promise to address major health care challenges, though little has been published on their impact. We identified the twenty top-funded private US-based digital health companies to analyze their products and services, related peer-reviewed evidence, and the potential for impact on patients with high-burden conditions. Data analytics (including artificial intelligence and big data) was the most common company type. Companies producing biosensors had the greatest funding. Publications were concentrated among a small number of companies. Healthy volunteers were most commonly studied. Few studies enrolled high-burden populations, and few measured their impact in terms of outcomes, cost, or access to care. These data suggest that leading digital health companies have not yet demonstrated substantial impact on disease burden or cost in the US health care system. Our findings indicate the importance of fostering an environment, with regard to policy and the consumer market, that encourages the development of evidence-based, high-impact products.


Assuntos
Tecnologia Biomédica/economia , Efeitos Psicossociais da Doença , Assistência à Saúde/economia , Inteligência Artificial , Big Data , Estudos Transversais , Assistência à Saúde/métodos , Política de Saúde , Humanos , Invenções/economia , Invenções/tendências
9.
J Am Acad Orthop Surg ; 27(1): e9-e16, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30320732

RESUMO

Despite the wealth of innovation in the orthopaedic sciences, few technologies translate to clinical use. By way of a 2-day symposium titled "AAOS/ORS Translating Orthopaedic Technologies into Clinical Practice: Pathways from Novel Idea to Improvements in Standard of Care Research Symposium," key components of successful commercialization strategies were identified as a passionate entrepreneur working on a concept aimed at improving patient outcomes and decreasing the cost and burden of disease; a de-risking strategy that has due recognition of the regulatory approval process and associated costs while maximizing the use of institutional, state, and federal resources; and a well thought-out and prepared legal plan and high quality, protected intellectual property. Challenges were identified as a lack of education on the scale-up and commercialization processes; few opportunities to network, get feedback, and obtain funding for early stage ideas; disconnect between the intellectual property and the business model; and poor adoption of new technologies caused in part by un-optimized clinical trials. By leveraging the network of professional orthopaedic societies, there exists an opportunity to create an enlightened community of musculoskeletal entrepreneurs who are positioned to develop and commercialize technologies and transform patient care.


Assuntos
Tecnologia Biomédica/organização & administração , Contrato de Risco/organização & administração , Ortopedia , Transferência de Tecnologia , Tecnologia Biomédica/economia , Tecnologia Biomédica/legislação & jurisprudência , Contrato de Risco/legislação & jurisprudência , Organização do Financiamento , Obtenção de Fundos , Humanos , Propriedade Intelectual , Mentores , Cultura Organizacional , Papel do Médico , Rede Social
11.
Expert Rev Pharmacoecon Outcomes Res ; 19(4): 453-462, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30556745

RESUMO

Objectives: Our study explores whether, and how, different methodological choices are associated with different health technology assessment (HTA) outcomes. We focus on the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) in Germany and the National Institute for Health and Care Excellence (NICE) in England. Both agencies may be considered as exemplars for the application of the principles of evidence-based medicine and the logic of cost-effectiveness, respectively. Methods: We extracted data from all publically available G-BA appraisals until April 2015, as well as all NICE single technology appraisals completed during this period. We compared HTA results for matched condition-intervention pairs by G-BA and NICE, and explored other factors including therapeutic area, clinical effectiveness and cost-effectiveness. Results: NICE issued guidance for 88 technologies (125 subgroups) and recommended 67/88 technologies (99/125 subgroups). G-BA completed 105 appraisals (226 subgroups) and determined additional benefit for 64/105 appraisals (90/226 subgroups). We identified 37 matched pairs; for 24/37 drugs, evaluations diverged. NICE recommended 78% (29/37) of technologies appraised, whereas G-BA confirmed additional benefit for 57% (21/37) only (p < 0.05). Conclusions: NICE evaluates new drugs more favorably than G-BA. However, our analysis suggests differences by therapeutic area. Results indicate that different methods are associated with systematic differences in HTA outcomes.


Assuntos
Tecnologia Biomédica/métodos , Preparações Farmacêuticas/administração & dosagem , Avaliação da Tecnologia Biomédica/métodos , Tecnologia Biomédica/economia , Análise Custo-Benefício , Inglaterra , Medicina Baseada em Evidências/métodos , Alemanha , Humanos , Preparações Farmacêuticas/economia
12.
J Manag Care Spec Pharm ; 25(1): 66-71, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29927346

RESUMO

BACKGROUND: Developments in diagnostics, medical devices, procedures, and prescription drugs have increased life expectancy and quality of life after diagnosis for many diseases. Previous research has shown that, overall, increased investment in medical technology has led to increased health outcomes. In addition, the value of investment in specific innovations, particularly in new pharmaceuticals or biopharmaceuticals, has frequently been shown through an evaluation of the associated health outcomes and costs. Value assessments for all medical technologies and interventions are an important consideration in current debates on access and affordability of health care in the United States. OBJECTIVE: To identify practicing physician impressions of the historical effect of postdiagnosis innovations in medical technology on patient outcomes within the 8 health conditions that have the largest effect on health in the United States. METHODS: National statistics were used to identify the 8 conditions responsible for the most mortality and morbidity within the United States between 1990 and 2014. A physician survey was developed for each major condition to obtain physician opinion on the extent to which pharmaceuticals and biopharmaceuticals, medical devices, diagnostics, and surgical procedures contributed to improvements in postdiagnosis mortality and morbidity outcomes over the evaluated period. Respondents were provided with a fifth category, "cannot allocate," to account for postdiagnosis outcome gains resulting from other factors such as public health interventions. RESULTS: The conditions identified as having the greatest effect on morbidity and mortality since 1990 were breast cancer, ischemic heart disease, human immunodeficiency virus infection, diabetes, unipolar depression, chronic obstructive pulmonary disease, cerebrovascular disease, and lung cancer. After excluding other factors, physicians specializing in these conditions, with a mean of 21.4 years in practice, considered pharmaceuticals and biopharmaceuticals as having the greatest postdiagnosis effect across all 8 conditions, with 56% of outcome gains attributed to this innovation category. Diagnostics was the second biggest contributor at 20%. CONCLUSIONS: Physician perceptions indicated that attention should be paid to value assessments of innovative diagnostics, devices, and surgical procedures, as well as to pharmaceuticals and biopharmaceuticals, before goals for allocating health care expenditures among the different innovations are determined. DISCLOSURES: Funding for this study was provided by the National Pharmaceutical Council, a health policy research group that receives its funding from biopharmaceutical manufacturers. Wamble is employed by RTI Health Solutions, which received funding from the National Pharmaceutical Council to conduct this research. Ciarametaro and Dubois are employed by the National Pharmaceutical Council.


Assuntos
Tecnologia Biomédica/economia , Alocação de Custos , Invenções/economia , Médicos/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Técnicas e Procedimentos Diagnósticos/economia , Técnicas e Procedimentos Diagnósticos/instrumentação , Tratamento Farmacológico/economia , Tratamento Farmacológico/métodos , Gastos em Saúde/estatística & dados numéricos , Humanos , Morbidade , Mortalidade , Qualidade de Vida , Terapêutica/economia , Terapêutica/instrumentação , Terapêutica/métodos , Estados Unidos/epidemiologia
14.
Value Health Reg Issues ; 17: 219-223, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30528780

RESUMO

In February and September of 2017, the International Society for Pharmacoeconomics and Outcomes Research Health Technology Assessment Council held roundtables focused on Latin America to discuss health technology assessment best practices, collaboration opportunities, and regional experiences regarding health policies to improve the affordability of and access to healthcare technologies. The access to high-cost technologies, increased social pressure to achieve universal coverage, population aging, and the limits of traditional mechanisms to control costs create political pressure to begin considering other pricing alternatives, including value-based pricing, in Latin America. This article attempts to conceptualize key stakeholders' perceptions of their experiences, opportunities, and barriers to implementing value-based pricing in Latin America.


Assuntos
Custos e Análise de Custo , Farmacoeconomia/tendências , Avaliação da Tecnologia Biomédica/tendências , Cobertura Universal do Seguro de Saúde/tendências , Envelhecimento , Tecnologia Biomédica/economia , Política de Saúde , Humanos , América Latina
18.
Med Decis Making ; 38(7): 797-809, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30179585

RESUMO

BACKGROUND: The cost-effectiveness and value of additional information about a health technology or program may change over time because of trends affecting patient cohorts and/or the intervention. Delaying information collection even for parameters that do not change over time may be optimal. METHODS: We present a stochastic dynamic programming approach to simultaneously identify the optimal intervention and information collection policies. We use our framework to evaluate birth cohort hepatitis C virus (HCV) screening. We focus on how the presence of a time-varying parameter (HCV prevalence) affects the optimal information collection policy for a parameter assumed constant across birth cohorts: liver fibrosis stage distribution for screen-detected diagnosis at age 50. RESULTS: We prove that it may be optimal to delay information collection until a time when the information more immediately affects decision making. For the example of HCV screening, given initial beliefs, the optimal policy (at 2010) was to continue screening and collect information about the distribution of liver fibrosis at screen-detected diagnosis in 12 years, increasing the expected incremental net monetary benefit (INMB) by $169.5 million compared to current guidelines. CONCLUSIONS: The option to delay information collection until the information is sufficiently likely to influence decisions can increase efficiency. A dynamic programming framework enables an assessment of the marginal value of information and determines the optimal policy, including when and how much information to collect.


Assuntos
Análise de Dados , Técnicas de Apoio para a Decisão , Cadeias de Markov , Tecnologia Biomédica/economia , Análise Custo-Benefício , Hepatite C/diagnóstico , Programas de Rastreamento , Anos de Vida Ajustados por Qualidade de Vida
19.
Ann Acad Med Singapore ; 47(8): 338-344, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30242300

RESUMO

Healthcare decision-makers are constantly challenged by growing healthcare needs in tandem with rising healthcare costs. Disinvesting in technologies and practices that are "low in value" is one strategy to re-allocate limited resources to the most effective, safe and cost-effective technologies. We put forward a health technology reassessment framework and examined the opportunities and challenges on technology disinvestment in Singapore and deliberated on possible solutions. We coordinated and supported a disinvestment programme in 2 hospitals, 1 specialist centre and 9 primary care institutions in the public healthcare sector. The key processes were identifying, prioritising and assessing low-value health technologies and practices, disseminating and implementing disinvestment recommendations, and post-implementation evaluation. Through case studies, we explored the barriers and enablers to the success of the programme. One of the barriers to disinvestment included difficulty in demonstrating a lack of benefit of in-use technologies from published studies. Differing viewpoint and priority might preclude a healthcare leader's support in such initiatives and that posed an unsurmountable hurdle. On the other hand, engaging the stakeholder throughout the evidence review process and striking a balance between rigour and timeliness of review were likely to assure success. Lastly, monitoring the impact on resources and patient outcomes can be diverse and methods need to be developed. Understanding barriers and enablers in health technology disinvestment can translate into improved opportunities for eliminating and minimising resource wastage.


Assuntos
Tecnologia Biomédica/economia , Investimentos em Saúde/tendências , Controle de Custos , Setor Público , Singapura
20.
Pharmacoeconomics ; 36(11): 1309-1319, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30030816

RESUMO

In countries such as Australia, the UK and Canada, decisions on whether to fund new health technologies are commonly informed by decision analytic models. While the impact of making inappropriate structural choices/assumptions on model predictions is well noted, there is a lack of clarity about the definition of key structural aspects, the process of developing model structure (including the development of conceptual models) and uncertainty associated with the structuring process (structural uncertainty) in guidelines developed by national funding bodies. This forms the focus of this article. Building on the reports of good modelling practice, and recognising the fundamental role of model structuring within the model development process, we specified key structural choices and provided ideas about model structuring for the future direction. This will help to further standardise guidelines developed by national funding bodies, with potential impact on transparency, comprehensiveness and consistency of model structuring. We argue that the process of model structuring and structural sensitivity analysis should be documented in a more systematic and transparent way in submissions to national funding bodies. Within the decision-making process, the development of conceptual models and presentation of all key structural choices would mean that national funding bodies could be more confident of maximising value for money when making public funding decisions.


Assuntos
Tecnologia Biomédica/economia , Modelos Econômicos , Avaliação da Tecnologia Biomédica/métodos , Análise Custo-Benefício , Tomada de Decisões , Técnicas de Apoio para a Decisão , Guias como Assunto , Humanos , Modelos Teóricos , Incerteza
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