Modelo de decisão por análise multicritério para tomada de decisão em saúde- estudo de caso: cateter com revestimento hidrofílico de poliuretano pronto para uso para cateterismo intermitente em pacientes com retenção urinária devido à lesão medular

Abstract

Objective: To assess the use of hydrophilic catheter (SpeediCath®) and conventional PVC catheter for intermittent catheterization in patients with urinary retention due to spinal cord injury, from the perspective of patients and experts using a multi-criteria decision analysis (MCDA) model. Methods: Literature review was used to identify value criteria within the context of intermittent catheterization. Two 1-day workshops were carried out with 5 experts and 15 patients to attribute weights for criteria and scores to treatment performance. Experts’ results were captured individually and in consensus, while patients worked in 3 subgroups (2 composed by paraplegics and 1 by tetraplegics). 100 points were distributed for weighing the criteria, and the rating scale ranged from 1 (worst score) to 7 (best score). The maximum total weighted score consisted of 700 points. The Simple Additive Weighting approach was used. Sensitivity analyses were implemented to explore uncertainty. Results: Eight nonmonetary criteria were identified (urinary tract infection [UTI], hematuria, learning, preparation, comfort, performing the catheterization, safety and technologic innovation). Experts gave greater weight to performing the catheterization (25%), while patients identified UTI as the most important criteria (paraplegics: 50%; tetraplegics: 25%). In all cases, the hydrophilic catheter showed a higher overall value compared to PVC catheter (experts: 535 vs. 455, paraplegics: 515.5 vs. 425.5, tetraplegics: 525 vs. 355). Conclusions: The selection of criteria based on literature review was considered sufficient for assessing the value of catheters. The overall assessment of the technologies indicated that despite differences in scores and weights between specialists and patients, in all scenarios hydrophilic catheter was superior to PVC catheter.