The economic analysis in the incorporation of health technologies: reflections on the Brazilian experience

Nas ??ltimas d??cadas, os gastos crescentes no setor sa??de v??m preocupando diversos pa??ses, em especial aqueles cuja aten????o ?? sa??de ?? garantida pelo setor p??blico. A grande press??o pela incorpora????o de tecnologias cada vez mais caras, al??m de impactar no or??amento dos pa??ses, produz restri????o ao acesso dos servi??os de sa??de, visto que n??o ?? poss??vel garantir todas as interven????es a todos. Diante desta situa????o, t??cnicas para a racionaliza????o dos gastos, tais como as an??lises econ??micas em sa??de, s??o utilizadas na tentativa de maximizar a sa??de, mas resguardando a viabilidade financeira dos sistemas p??blicos de sa??de. Pa??ses desenvolvidos com forte financiamento p??blico, assim como Austr??lia, Canad?? e Reino Unido t??m empregado cada vez mais estas ferramentas para a tomada de decis??o acerca da incorpora????o de novas tecnologias. O Brasil, na ??ltima d??cada, tamb??m tem empreendido esfor??os para a ado????o de crit??rios de custo-efetividade, tanto na entrada de medicamentos no mercado privado, com a altera????o da lei de registro e com a cria????o da C??mara de Regula????o do Mercado de Medicamentos (CMED), quanto com o estabelecimento de uma Comiss??o de Incorpora????o de Tecnologias do Minist??rio da Sa??de (CITEC). As decis??es da CITEC s??o subsidiadas por estudos desenvolvidos pela ??rea de Avalia????o de Tecnologias em Sa??de (ATS) do Departamento de Ci??ncia e Tecnologia (DECIT) do Minist??rio da Sa??de. Neste aspecto, as Ag??ncias Nacionais de Vigil??ncia Sanit??ria e de Sa??de Suplementar tamb??m institu??ram ??reas de ATS para responder as suas demandas. E, apesar do avan??o na institucionaliza????o de ??reas que utilizam an??lises econ??micas na incorpora????o de tecnologias, ainda h?? uma fragilidade institucional nas etapas seguintes do ciclo de vida destas. O Pa??s tamb??m carece de profissionais capacitados e padece de uma desorganiza????o neste campo causa da principalmente pela sobreposi????o de atividades e atribui????es das ??reas que realizam a ATS no governo federal. Ademais, para que as an??lises econ??micas em sa??de sejam realmente ??teis na tomada de decis??o ?? imprescind??vel a defini????o de um limite custo-efetividade para o Brasil.In recent decades, increasing spending in the health sector is worrying many countries, particularly those whose health care is guaranteed by the public sector. The big push for the incorporation of technologies increasingly expensive is impacting the budgets of countries and producing a restriction on access to health services, since we cannot guarantee all interventions for everybody. Facing this situation, techniques for the rationalization of expenditures, such as health economic analysis, are used in an attempt to maximize health, but protecting the financial viability of public health systems. Developed countries with strong public support, such as Australia, Canada and the UK have progressively more used this tool for decision making regarding the incorporation of new technologies. Brazil, more recently, has also made efforts to adopt criteria of cost-effectiveness, both at the entrance of drugs in the private market, with the adjustment of the law of register and the establishment of the Board of Market Regulation of Medicines (CMED) and the Commission of Technology Incorporation of the Ministry of Health (CITEC). The decisions of CITEC are subsidized by studies undertaken by the area of Health Technology Assessment (HTA) at Department of Science and Technology (DECIT) of the Ministry of Health. The Brazilian Health Surveillance Agency and Brazilian National Private Health Insurance Agency also established areas of HTA to answer to their demands. Despite advances in the institutionalization of areas that use economic analysis in the incorporation of technologies, there is fragility in the following stages of the life cycle of these. The country also lacks qualified professionals and suffers from a disruption in this field mainly caused by overlapping of activities and tasks of the areas that hold the HTA in the Federal Government. Moreover, for the health economic analyses are really useful in decision making is essential to define threshold costeffectiveness for Brazil