Health technology reassessment in the Brazilian public health system: Analysis of the current status

Abstract

Background The reassessment of technologies and services offered by healthcare systems is recent initiative and still without a widely adopted and evaluated method. To a better understanding of this process in Brazil, we have described the health technology reassessment (HTR) performed by the National Committee for Health Technology Incorporation (Conitec) into Brazilian public health system (SUS). Methods A documental, exploratory, descriptive, retrospective study with qualitative-quantitative approach regarding the HTR performed by Conitec from January 2012 to November 2017. Results After applying the criteria of inclusion and exclusion, we selected 47 technologies for this study. The vast majority of the demands (41 demands) came from the public sector, and only six from the private sector. Most of the requests referred to the exclusion of specific indication; followed by extension of use, withdraw of the technology from SUS, maintenance, and restriction of use. The dimensions of analysis found in the recommendation reports were scientific evidence on efficacy, effectiveness and safety, disease-related issues, issues related to the use of technology, costs, and social participation. However, these dimensions were not included in all analysis, and a standardized structure of the reports has not been observed. The most relevant decision factors considered for decision-making were efficacy, safety and use of the technology. Conclusion During a six-year period of Conitec actuation, we could find some reassessments of technologies that are available in SUS. We observed that these activities had enabled progress, however, they are still not yet structured, with gaps in the selection process, and the assessment since no methodology and criteria for proper conduct were established.

A landscape analysis of health technology assessment capacity in the Association of South-East Asian Nations region

“…Reassessment allows decision-makers to optimize the use of healthcare technologies to achieve the greatest clinical benefit as has been evidenced from global examples, highlighting their relevance for LMICs within ASEAN, which have limited healthcare resources [ 37 ]. As corroborated by examples from the United Kingdom, Australia, Brazil and the Republic of Korea [ 37 – 39 ], if applied correctly, reassessment can be embedded into the regular HTA process and applied as a tool to avoid wasteful buys. However, usage of reassessment would require stakeholder input, especially from clinicians, patient organizations and the public to establish a consensus on matters of ethics to avoid conflict with social values and alleviate inadvertent effects [ 37 ].…”

Building a National Reassessment Process for Oncology Drugs: Lessons Learned by the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration through a Simulated Reassessment Exercise

“…Insights from this simulation exercise may be valuable to international HTA agencies that have adopted, or are in the process of adopting, reassessment processes [ 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Since 2004, new drugs approved by the Health Ministry in France received a registration for reimbursement for 5 years, after which drugs are systematically re-evaluated by the Haute Authorite de Sante (HAS) [ 25 ].…”

Considerations for Developing a Reassessment Process: Report from the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration’s Reassessment and Uptake Working Group

“…Globally, there is widespread interest in the implementation of processes enabling reassessments. In 2011, Brazil developed the National Committee for Health Technology Incorporation (CONITEC), with the aim of improving HTA and reassessment [23]. A recent analysis of their reassessment processes highlighted numerous opportunities for improvement, specifically surrounding the selection of candidates and methods of conducting reassessments [23].…”

“…In 2011, Brazil developed the National Committee for Health Technology Incorporation (CONITEC), with the aim of improving HTA and reassessment [23]. A recent analysis of their reassessment processes highlighted numerous opportunities for improvement, specifically surrounding the selection of candidates and methods of conducting reassessments [23]. Candidates for reassessment are often selected via the emergence of new evidence, increasing public interest, or the presence of inconsistencies amongst guidelines [23].…”

“…A recent analysis of their reassessment processes highlighted numerous opportunities for improvement, specifically surrounding the selection of candidates and methods of conducting reassessments [23]. Candidates for reassessment are often selected via the emergence of new evidence, increasing public interest, or the presence of inconsistencies amongst guidelines [23]. HTA agencies in other countries, such as the National Institute for Health and Care Excellence (NICE) in the United Kingdom and the Institute of Medicine in the United States, have considered additional criteria when identifying candidates for reassessment [24,25].…”