BackgroundThe quality of the evidence used in health technology assessment (HTA) agency reports has been considered essential for decision-making processes and their legitimacy. In Brazil, CONITEC is the agency responsible for defining data mandatory for the submission of proposals for the incorporation of new technologies. The objective of this study was to analyse CONITEC recommendation reports, the type of scientific evidence used in them and their compliance with operational procedures.MethodsThis is a descriptive study based on CONITEC official reports from July 2012 through December 2016. Data were collected with a specific extraction form and analysed using descriptive statistics.ResultsWe evaluated 199 CONITEC recommendation reports. The annual number of reports increased during the study period. The absolute annual number of new technologies incorporated in 2013 (n = 24) was similar to that observed for 2014 (n = 24) and 2015 (n = 22), decreasing in 2016 (n = 13). The type of technology most frequently evaluated was ‘drugs’ (68.3%), followed by ‘procedures’ (20.1%). Overall, 117 (58.8%) reports were internal demands, 75 (37.7%) were external demands and 7 (3.5%) were mixed demands. There were differences between internal and external demands in terms of the evidence used in the reports and the decision regarding the recommendation to incorporate the technologies. Among the internal demands, the recommendation to incorporate the new technology was made for 70.9% of the reports, only 9.6% of which included full HTAs. Among the external demands, the incorporation of the new technology was recommended for 17.3% of the reports, 76.9% of which included full HTAs. Of the 101 reports in which incorporation of the new technology was recommended, 88 (87.1%) did not include a full health economic evaluation and ICER calculation. There are compliance difficulties with the recommendations in the CONITEC internal regulations regarding the type and quality of evidence considered in the analysis of recommendation reports.ConclusionsThe characteristics of the evidence used in recommendation reports and those considered to be mandatory were very different, indicating problems in decision-making processes. There is a need to study, with a broader perspective, the factors that influence the type of evidence used in decision-making processes in order to contribute to the development of better practices and policies.

The amount of resources invested in the PNSAN and in actions and programs that promote food and nutrition security is increasing in Brazil.

OBJECTIVE:To analyze the evolution of relative prices of food groups and its infl uence on public healthy eating policies. METHODS:Data from the municipality of São Paulo between 1939 and 2010 were analyzed based on calculating index numbers. Data from the Economic Researches Foundation Institute price database and weight structures (1939 to 1988) and from the Brazilian Institute of Geography and Statistics (1989 to 2010) were used to. The price database was organized, its consistency tested and prices were defl ated using the consumer price index. Relative prices were calculated and associated to food categories and groups, according to the food pyramid guide adapted for the Brazilian population. The price indices for each group were calculated according to Laspeyres modifi ed formula. The general food price index was compared with the indices for each food group and respective category: fresh food, processed food, beverages, meat, legumes, milk and eggs, cereals and root vegetables and eating out. RESULTS:Price indices for fat, oil, spices, sugars and sweets and processed food showed relative price reduction. Fresh food, such as fruit and vegetables, showed an increase in relative prices. Other food groups, such as cereals, fl our and pasta, meat, milk and egg, showed a steadier long term trend in relative prices. CONCLUSIONS:The evolution of relative prices of food in the city of Sao Paulo demonstrates a negative trend towards healthy eating at household level in the long run. Trends in the evolution of Brazilian eating patterns show a signifi cant increase in the consumption of processed foods with high levels of simple sugars, sodium and lipids (foods which characterize an unhealthy diet). Associated with reduced consumption of fresh foods (standard markers of healthy eating). 10 The nutritional profi le of Brazilian adults has changed signifi cantly since the 1970s. This transition process is characterized by the gradual decrease in the proportion of malnourished individuals and the continued increase in prevalence of obesity. 12 The change in Brazilian eating patterns is allied to life style changes due to urbanization and technological advances, such as the progressive reduction in energy expenditure at work and on household tasks. This results in an increase in the prevalence of overweight and obesity. 18,19 The result of the changing nutritional panorama in the country includes increased prevalence of overweight and obesity in the population and changes in the national morbidity profi le, burdening the health care system. 3,15,17 Food consumption is infl uenced by a wide variety of factors, especially economic determinants, such as relative prices and income. 4,11,17,a Since the end of the 1930s, factors linked to supply, such as improved technology and increased scales of production, accompanied by increased demand, have enabled the price per calorie of processed food to be reduced. 8,b Studies show that the price per calorie of fresh food, more subject to weather conditions and pests ...

OBJECTIVE To describe methods and challenges faced in the health impact assessment of vaccination programs, focusing on the pneumococcal conjugate and rotavirus vaccines in Latin America and the Caribbean.METHODS For this narrative review, we searched for the terms “rotavirus”, “pneumococcal”, “conjugate vaccine”, “vaccination”, “program”, and “impact” in the databases Medline and LILACS. The search was extended to the grey literature in Google Scholar. No limits were defined for publication year. Original articles on the health impact assessment of pneumococcal and rotavirus vaccination programs in Latin America and the Caribbean in English, Spanish or Portuguese were included.RESULTS We identified 207 articles. After removing duplicates and assessing eligibility, we reviewed 33 studies, 25 focusing on rotavirus and eight on pneumococcal vaccination programs. The most frequent studies were ecological, with time series analysis or comparing pre- and post-vaccination periods. The main data sources were: health information systems; population-, sentinel- or laboratory-based surveillance systems; statistics reports; and medical records from one or few health care services. Few studies used primary data. Hospitalization and death were the main outcomes assessed.CONCLUSIONS Over the last years, a significant number of health impact assessments of pneumococcal and rotavirus vaccination programs have been conducted in Latin America and the Caribbean. These studies were carried out few years after the programs were implemented, meet the basic methodological requirements and suggest positive health impact. Future assessments should consider methodological issues and challenges arisen in these first studies conducted in the region.