No abstract

Introduction: Health Technology Assessment (HTA) is a tool that assists in the management of health systems, in which economic assessments are frequently applied. It is possible that the use of multicriteria analysis (MCDA) increases the quality of decisions. Objective: Identify the potentialities of the application of Multiple Criteria Decision Analysis (MCDA) in studies that used this type of method for the selection of treatments. Methods: An integrative review was executed based on articles where MCDA methods had been applied for the selection of treatments between February and April 2017 in the following databases: Pubmed (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Embase, Science Direct, Scopus, Web of Science and Wiley Online Library. Results: Eighteen studies published between 1998 and 2017 in which different MCDA techniques were applied were selected. Growth in the number of published studies was observed, showing increasing interest in the use of this type of method in health decision making. Conclusion: MCDA may guide more adequate decisions compared to the traditional Health Technology Assessment (HTA) methods and has the potential to help in the selection of treatments and the construction of medicines' lists.

Objective: To investigate the cost-effectiveness of second-line pharmacological treatments for metastatic breast cancer (MBC) by comparing trastuzumab emtansine (T-DM1) versus a combination of lapatinib and capecitabine (LAP+CAP) from the perspective of the Brazilian health system, the Unified Health System (Sistema Único de Saúde–SUS).Methods: The results of each treatment were simulated based on a three-state Markov decision model applied to a hypothetical cohort of 1,000 women, aged 50 y old or older, with MBC and HER2 (human epidermal growth factor receptor 2) overexpression. The data on the effectiveness of treatments were taken from reports in the literature. The period considered for simulation was three years subdivided into monthly cycles of transition between health states. A discount rate of 5% per year was applied to costs and outcomes. Possible uncertainty was assessed by means of a sensitivity analysis.Results: Chemotherapy for women with refractory MBC using T-DM1 monotherapy was ruled out by extended dominance. Treatment with LAP+CAP proved to be the most efficient strategy because the cost in relation to the overall survival (BRL 72,035.43/quality-adjusted life year–QALY) was the lowest and fell within the acceptability threshold, BRL 86,628.00.Conclusion: T-DM1 demonstrated pharmacological superiority over other agents used for the treatment of MBC in clinical studies. However, the price set for T-DM1 in Brazil is the determinant variable that contraindicates its inclusion in the SUS, in agreement with other international assessments.

No abstract