Systematic Review of Health Economic Evaluations of Diagnostic Tests in Brazil: How accurate are the results?

The aim of this study is to identify and characterize the health economic evaluations (HEEs) of diagnostic tests conducted in Brazil, in terms of their adherence to international guidelines for reporting economic studies and specific questions in test accuracy reports. We systematically searched multiple databases, selecting partial and full HEEs of diagnostic tests, published between 1980 and 2013. Two independent reviewers screened articles for relevance and extracted the data. We performed a qualitative narrative synthesis. Forty-three articles were reviewed. The most frequently studied diagnostic tests were laboratory tests (37.2%) and imaging tests (32.6%). Most were non-invasive tests (51.2%) and were performed in the adult population (48.8%). The intended purposes of the technologies evaluated were mostly diagnostic (69.8%), but diagnosis and treatment and screening, diagnosis, and treatment accounted for 25.6% and 4.7%, respectively. Of the reviewed studies, 12.5% described the methods used to estimate the quantities of resources, 33.3% reported the discount rate applied, and 29.2% listed the type of sensitivity analysis performed. Among the 12 cost-effectiveness analyses, only two studies (17%) referred to the application of formal methods to check the quality of the accuracy studies that provided support for the economic model. The existing Brazilian literature on the HEEs of diagnostic tests exhibited reasonably good performance. However, the following points still require improvement: 1) the methods used to estimate resource quantities and unit costs, 2) the discount rate, 3) descriptions of sensitivity analysis methods, 4) reporting of conflicts of interest, 5) evaluations of the quality of the accuracy studies considered in the cost-effectiveness models, and 6) the incorporation of accuracy measures into sensitivity analyses

Systematic review of economic evaluation of health technologies developed in brazil from 1980-201

Introdução: As avaliações econômicas em saúde (AES) têm participado como ferramenta de apoio ao processo de decisão no setor de Saúde. No Brasil, seu uso passou a ser amplamente difundido na última década, já sendo obrigatória sua apresentação em processos de incorporações de novas tecnologias no sistema único de saúde. Embora muitas avaliações econômicas de saúde tenham sido conduzidas, nenhum estudo revisou sistematicamente a produção e qualidade das avaliações brasileiras. Objetivo: Revisar sistematicamente e avaliar a qualidade do relato dos estudos publicados de avaliação econômica de tecnologias em saúde desenvolvidos no Brasil. Métodos: Foi conduzida uma revisão sistemática incluindo AES completas e parciais desenvolvidas no Brasil, e publicadas entre 1980 e 2013. Foram utilizadas as bases de dados eletrônicas (Medline, Embase, Lilacs, Scielo, NHS EED, HTA database, Bireme e BVS ECO); os índices de citação (Scopus, Web of science) e Sisrebrats. Resultados: Foram incluídos 535 artigos, dos quais 36,8% foram considerados AES completas, sendo 39,1% análises de custo-efetividade. Quase metade (46,4%) dos estudos não relatou o tipo de análise conduzida, desses 91,9% eram AES parciais. Entre as que informaram, houve concordância entre o relato e o conduzido em 71,4% dos estudos. As modalidades das tecnologias, mais frequentemente, avaliadas foram procedimentos (34,8%) e medicamentos (28,8%) cujo objetivo principal era o de tratamento (72,1%). As três categorias de doenças cujas tecnologias foram, mais frequentemente, avaliadas foram: doenças infecciosas (17,4%), doenças do aparelho circulatório (12,9%) e neoplasia (10,3%). Entre as tecnologias avaliadas pelos estudos incluídos, apenas 64 haviam sido objeto de análise por comissões nacionais de incorporação (CITEC e CONITEC). A maioria dos artigos foi conduzida por autores da academia (65,1%), que se concentram, principalmente, na região Sudeste (73,6%) e Sul (12,5%). O principal veículo de publicação foram as revistas nacionais (72,5%), com escopo médico (55,5%). Apenas 43,5% dos estudos relataram a fonte de financiamento e 36,1% relataram presença de conflito de interesse. Setenta e nove por cento das AES completas obtiveram resultados favoráveis para as tecnologias avaliadas. Com relação à qualidade do relato, apenas 6,6% dos estudos relataram todos os itens avaliados no checklist, mas 47,7% foram considerados em conformidade (relato minimamente satisfatório). Alguns itens como 1) métodos utilizados para mensuração dos dados de custos, 2) taxa de desconto, 3) fontes de financiamento, e 4) conflitos de interesse foram relatados em apenas metade dos estudos. A qualidade do relato apresentou associação estatística significativa (p < 0,001) com o período de publicação (estudos mais recentes apresentaram maior qualidade) e com a presença de conflito de interesse (estudos com conflito de interesse apresentaram maior qualidade). As fontes de dados clínicos, de uso de recursos e de custos foram considerados com melhor nível de evidência quando comparadas às fontes de utilidade. Nos últimos anos, houve um aumento da produção de análises de custo-utilidade, porém a maioria dos estudos utilizou utilidades de outros países validadas por painéis de especialistas brasileiros. Conclusão: Um grande número de AES foi publicado no Brasil entre 1980 e 2013. A qualidade do relato foi considerada satisfatória, principalmente na AES publicadas mais recentemente. Para que as AES possam aumentar sua contribuição nos processos de decisão nacionais, são necessários esforços para melhora da qualidade dos relatos, transparência e padronização da metodologia utilizada e o aperfeiçoamento do sistema de revisão pelos pares nas revistas nacionais não específicas em economia da saúdeIntroduction: Health Economic Evaluation (HEE) have participated as a supportive tool to decision-making in health sector. In Brazil, their use has been widespread in the last decade having become mandatory as part of the processes for new technologies in the Brazilian Unified National Health System. Although many Health Economic Evaluation have been conducted, there are no studies that have systematically reviewed the production and quality of Brazilian evaluations. Objective: To systematically review and evaluate the quality of reporting of published studies of health economic evaluation developed in Brazil. Methods: Was conducted a systematic review including full and partial HEE developed in Brazil and published between 1980 and 2013. Electronic databases (Medline, Embase, Lilacs, Scielo, NHS EED, HTA database, Bireme and the BVS ECO); citation indexes (Scopus, Web of science) and Sisrebrats were searched. Results: We included 535 articles, of which 36.8% were considered full HEE, being 39.1% cost-effectiveness analysis. Almost half (46.4%) of the studies did not report the type of analysis conducted, of these 91.9% were partial HEE. Among the reported, there was 71.4% agreement between the reported and conducted in the studies. The most frequent evaluated modalities of technologies were procedures (34.8%) and drugs (28.8%), whose main objective was treatment (72.1%). The three most often evaluated categories of diseases were infectious diseases (17.4%), cardiovascular diseases (12.9%) and cancer (10.3%). Among the technologies evaluated by the included studies, only 64 had been the subject of analysis by incorporating national commissions (CITEC or CONITEC). Most articles were developed by Authors from academia (65.1%), who are mainly concentrated in the Southeast (73.6%) and South (12.5%) regions. The main vehicles for publication were national journals (72.5%), with medical scope (55.5%). Only 43.5% of the studies reported the source of funding and 36.1% reported conflict of interest. Seventy-nine percent of the full HEE obtained favourable results for the evaluated technologies. Regarding the quality of reporting, only 6.6% of the studies had all items evaluated in the checklist, but 47.7% was considered to be in accordance with the reporting requirements (minimally satisfactory reporting). Items such as 1) methods used to measure the cost data, 2) discount rate, 3) funding sources, and 4) conflicts of interest were reported in only half of the studies. The quality of reporting was significantly related (p < 0.001) to the publication period (more recent studies presented higher quality) and the presence of conflict of interest (presence of conflict of interest presented higher quality). Compared to the utilities, the clinical effect size, resources, and costs data were mostly estimated based on high-ranked evidence. In recent years, there has been an increase in production of cost-utility analysis, but most studies used utilities from other countries validated by Brazilian expert panels. Conclusion: A large number of HEE was published in Brazil between 1980 and 2013. The quality of reporting was considered satisfactory, particularly in most recently published HEE. To increase their contribution in national decision-making processes, efforts are needed in order to improve the quality of reports, transparency and standardization of the methodology and the improvement of the peer-review system in national non-specific journals of health economic

Systematic review of economic evaluation of health technologies developed in brazil from 1980-201

Introdução: As avaliações econômicas em saúde (AES) têm participado como ferramenta de apoio ao processo de decisão no setor de Saúde. No Brasil, seu uso passou a ser amplamente difundido na última década, já sendo obrigatória sua apresentação em processos de incorporações de novas tecnologias no sistema único de saúde. Embora muitas avaliações econômicas de saúde tenham sido conduzidas, nenhum estudo revisou sistematicamente a produção e qualidade das avaliações brasileiras. Objetivo: Revisar sistematicamente e avaliar a qualidade do relato dos estudos publicados de avaliação econômica de tecnologias em saúde desenvolvidos no Brasil. Métodos: Foi conduzida uma revisão sistemática incluindo AES completas e parciais desenvolvidas no Brasil, e publicadas entre 1980 e 2013. Foram utilizadas as bases de dados eletrônicas (Medline, Embase, Lilacs, Scielo, NHS EED, HTA database, Bireme e BVS ECO); os índices de citação (Scopus, Web of science) e Sisrebrats. Resultados: Foram incluídos 535 artigos, dos quais 36,8% foram considerados AES completas, sendo 39,1% análises de custo-efetividade. Quase metade (46,4%) dos estudos não relatou o tipo de análise conduzida, desses 91,9% eram AES parciais. Entre as que informaram, houve concordância entre o relato e o conduzido em 71,4% dos estudos. As modalidades das tecnologias, mais frequentemente, avaliadas foram procedimentos (34,8%) e medicamentos (28,8%) cujo objetivo principal era o de tratamento (72,1%). As três categorias de doenças cujas tecnologias foram, mais frequentemente, avaliadas foram: doenças infecciosas (17,4%), doenças do aparelho circulatório (12,9%) e neoplasia (10,3%). Entre as tecnologias avaliadas pelos estudos incluídos, apenas 64 haviam sido objeto de análise por comissões nacionais de incorporação (CITEC e CONITEC). A maioria dos artigos foi conduzida por autores da academia (65,1%), que se concentram, principalmente, na região Sudeste (73,6%) e Sul (12,5%). O principal veículo de publicação foram as revistas nacionais (72,5%), com escopo médico (55,5%). Apenas 43,5% dos estudos relataram a fonte de financiamento e 36,1% relataram presença de conflito de interesse. Setenta e nove por cento das AES completas obtiveram resultados favoráveis para as tecnologias avaliadas. Com relação à qualidade do relato, apenas 6,6% dos estudos relataram todos os itens avaliados no checklist, mas 47,7% foram considerados em conformidade (relato minimamente satisfatório). Alguns itens como 1) métodos utilizados para mensuração dos dados de custos, 2) taxa de desconto, 3) fontes de financiamento, e 4) conflitos de interesse foram relatados em apenas metade dos estudos. A qualidade do relato apresentou associação estatística significativa (p < 0,001) com o período de publicação (estudos mais recentes apresentaram maior qualidade) e com a presença de conflito de interesse (estudos com conflito de interesse apresentaram maior qualidade). As fontes de dados clínicos, de uso de recursos e de custos foram considerados com melhor nível de evidência quando comparadas às fontes de utilidade. Nos últimos anos, houve um aumento da produção de análises de custo-utilidade, porém a maioria dos estudos utilizou utilidades de outros países validadas por painéis de especialistas brasileiros. Conclusão: Um grande número de AES foi publicado no Brasil entre 1980 e 2013. A qualidade do relato foi considerada satisfatória, principalmente na AES publicadas mais recentemente. Para que as AES possam aumentar sua contribuição nos processos de decisão nacionais, são necessários esforços para melhora da qualidade dos relatos, transparência e padronização da metodologia utilizada e o aperfeiçoamento do sistema de revisão pelos pares nas revistas nacionais não específicas em economia da saúdeIntroduction: Health Economic Evaluation (HEE) have participated as a supportive tool to decision-making in health sector. In Brazil, their use has been widespread in the last decade having become mandatory as part of the processes for new technologies in the Brazilian Unified National Health System. Although many Health Economic Evaluation have been conducted, there are no studies that have systematically reviewed the production and quality of Brazilian evaluations. Objective: To systematically review and evaluate the quality of reporting of published studies of health economic evaluation developed in Brazil. Methods: Was conducted a systematic review including full and partial HEE developed in Brazil and published between 1980 and 2013. Electronic databases (Medline, Embase, Lilacs, Scielo, NHS EED, HTA database, Bireme and the BVS ECO); citation indexes (Scopus, Web of science) and Sisrebrats were searched. Results: We included 535 articles, of which 36.8% were considered full HEE, being 39.1% cost-effectiveness analysis. Almost half (46.4%) of the studies did not report the type of analysis conducted, of these 91.9% were partial HEE. Among the reported, there was 71.4% agreement between the reported and conducted in the studies. The most frequent evaluated modalities of technologies were procedures (34.8%) and drugs (28.8%), whose main objective was treatment (72.1%). The three most often evaluated categories of diseases were infectious diseases (17.4%), cardiovascular diseases (12.9%) and cancer (10.3%). Among the technologies evaluated by the included studies, only 64 had been the subject of analysis by incorporating national commissions (CITEC or CONITEC). Most articles were developed by Authors from academia (65.1%), who are mainly concentrated in the Southeast (73.6%) and South (12.5%) regions. The main vehicles for publication were national journals (72.5%), with medical scope (55.5%). Only 43.5% of the studies reported the source of funding and 36.1% reported conflict of interest. Seventy-nine percent of the full HEE obtained favourable results for the evaluated technologies. Regarding the quality of reporting, only 6.6% of the studies had all items evaluated in the checklist, but 47.7% was considered to be in accordance with the reporting requirements (minimally satisfactory reporting). Items such as 1) methods used to measure the cost data, 2) discount rate, 3) funding sources, and 4) conflicts of interest were reported in only half of the studies. The quality of reporting was significantly related (p < 0.001) to the publication period (more recent studies presented higher quality) and the presence of conflict of interest (presence of conflict of interest presented higher quality). Compared to the utilities, the clinical effect size, resources, and costs data were mostly estimated based on high-ranked evidence. In recent years, there has been an increase in production of cost-utility analysis, but most studies used utilities from other countries validated by Brazilian expert panels. Conclusion: A large number of HEE was published in Brazil between 1980 and 2013. The quality of reporting was considered satisfactory, particularly in most recently published HEE. To increase their contribution in national decision-making processes, efforts are needed in order to improve the quality of reports, transparency and standardization of the methodology and the improvement of the peer-review system in national non-specific journals of health economic

Higher MELD score increases the overall cost on the waiting list for liver transplantation: a micro-costing analysis based study

ABSTRACT BACKGROUND: The pre-transplant period is complex and includes lots of procedures. The severity of liver disease predisposes to a high number of hospitalizations and high costs procedures. Economic evaluation studies are important tools to handle costs on the waiting list for liver transplantation. OBJECTIVE: The objective of the present study was to evaluate the total cost of the patient on the waiting list for liver transplantation and the main resources related to higher costs. METHODS: A cost study in a cohort of 482 patients registered on waiting list for liver transplantation was carried out. In 24 months follow-up, we evaluated all costs of materials, medicines, consultations, procedures, hospital admissions, laboratorial tests and image exams, hemocomponents replacements, and nutrition. The total amount of each resource or component used was aggregated and multiplied by the unitary cost, and thus individual cost for each patient was obtained. RESULTS: The total expenditure of the 482 patients was US$6,064,986.51. Outpatient and impatient costs correspond to 32.4$ 1,965,045.52) and 67.6% (US$4,099,940.99) respectively. Main cost drivers in outpatient were: medicines (44.31$ 16,686.74 ± 16,105.02) and the less expensive were those with MELD below 17 (US$ 5,703.22 ± 9,318.68). CONCLUSION: Total costs on the waiting list for liver transplantation increased according to the patient’s severity. Individually, hospitalizations, hemocomponents reposition and hepatocellular carcinoma treatment were the main cost drivers to the patient on the waiting list. The longer the waiting time, the higher the total cost on list, causing greater impact on health systems

A systematic review of health economic evaluations of vaccines in Brazil

Background: In Brazil, since 2005, the Ministry of Health requires Health Economic Evaluation (HEE) of vaccines for introduction into the National Immunization Program. Objectives: To describe and analyze the full HEE on vaccines conducted in Brazil from 1980 to 2013. Methods: Systematic review of the literature. We searched multiple databases. Two researchers independently selected the studies and extracted the data. The methodological quality of individual studies was evaluated using CHEERS items. Results: Twenty studies were reviewed. The most evaluated vaccines were pneumococcal (25%) and HPV (15%). The most used types of HEE were cost-effectiveness analysis (45%) and cost-utility analysis (20%). The research question and compared strategies were stated in all 20 studies and the target population was clear in 95%. Nevertheless, many studies did not inform the perspective of analysis or data sources. Conclusions: HEE of vaccines in Brazil has increased since 2008. However, the studies still have methodological deficiencies

Systematic Review of Health Economic Evaluations of Diagnostic Tests in Brazil: How accurate are the results?

The aim of this study is to identify and characterize the health economic evaluations (HEEs) of diagnostic tests conducted in Brazil, in terms of their adherence to international guidelines for reporting economic studies and specific questions in test accuracy reports. We systematically searched multiple databases, selecting partial and full HEEs of diagnostic tests, published between 1980 and 2013. Two independent reviewers screened articles for relevance and extracted the data. We performed a qualitative narrative synthesis. Forty-three articles were reviewed. The most frequently studied diagnostic tests were laboratory tests (37.2%) and imaging tests (32.6%). Most were non-invasive tests (51.2%) and were performed in the adult population (48.8%). The intended purposes of the technologies evaluated were mostly diagnostic (69.8%), but diagnosis and treatment and screening, diagnosis, and treatment accounted for 25.6% and 4.7%, respectively. Of the reviewed studies, 12.5% described the methods used to estimate the quantities of resources, 33.3% reported the discount rate applied, and 29.2% listed the type of sensitivity analysis performed. Among the 12 cost-effectiveness analyses, only two studies (17%) referred to the application of formal methods to check the quality of the accuracy studies that provided support for the economic model. The existing Brazilian literature on the HEEs of diagnostic tests exhibited reasonably good performance. However, the following points still require improvement: 1) the methods used to estimate resource quantities and unit costs, 2) the discount rate, 3) descriptions of sensitivity analysis methods, 4) reporting of conflicts of interest, 5) evaluations of the quality of the accuracy studies considered in the cost-effectiveness models, and 6) the incorporation of accuracy measures into sensitivity analyses