Custos nas avaliações econômicas em saúde: uma análise das recomendações da Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde de 2012 a 2020.

Abstract

Brazil has a universal health system financed through taxes. The introduction of the Health Technology Assessment (HTA) in 2011 resulted in the recognition of the National Committee for Health Technology Assessment in the SUS (CONITEC) as the governmental body responsible for conducting HTA in the SUS. According to the legal framework that regulates HTA into the SUS, Health Economic Evaluation (HEE) and Budget Impact Analysis (BIA) are mandatory. Cost analysis is essential information in both complete and partial HEE. This thesis aimed to analyze the cost information as reported in the recommendations of CONITEC. The specific aims included contextualizing the process of HTA in the SUS, highlighting the relevant aspects of HEE; understanding the main concepts of cost management and analysis and their intersection with HEE. A single-case study was conducted using the formal reports of recommendations of CONITEC publicized from 2012 to 2020, available on the website Gov.Br/CONITEC, as the source of evidence for this research. In addition to the document analysis, a literature review and data extraction for quantitative analysis were conducted. The data were extracted and stored in a database developed for this purpose using the Microsoft Excel® program (Microsoft Corporation 2013). The development of the database considered the check list from ISPOR-CHEERS 2022. Statistical analyses used R® (2021) software. A total of 723 recommendations in 513 reports were analyzed. Of these recommendations, 376 were full HEE with cost information included in 374 HEE: two HEE referred direct accounting costs, 372 direct medical costs. Of these, 236 HHE considered only the direct medical costs of medicines, calculated through an estimated dose multiplied by the price (expense). A total of six full HEE mentioned the indirect costs, direct non-medical costs in three full HEE, intangible costs in two, future costs in two and opportunity costs in one. In 376 HEE, the direct costing method was mentioned in one, micro-costing in 17, and other methods in one. In 357 full HEE the costing method was not reported. The sources of information for valuing direct medical costs were multiple, including the reimbursement lists of SUS (SIGTAP), public procurement price lists, the governamental procurement website Comprasnet. Literature and expert opinion were the most frequent sources for estimating resource consumption. The study showed that cost information in HEE predominantly includes direct medical costs with significant use of expense information sources for valuation, which denotes the need for a cost system interconnecting the SUS network. The use of costs considering price multiplied by the estimated dose for evaluating drugs technologies leads to inconsistencies that highlight the need to implement a cost panel in the SUS with periodic updates. Given the universality of the SUS, a discussion about the perspective currently used as well the inclusion of indirect and direct non-medical costs is also relevant.