-Background -The pretransplant 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 followup, 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. $ 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.

BackgroundBrazil has sought to use economic evaluation to support healthcare decision-making processes. While a number of health economic evaluations (HEEs) have been conducted, no study has systematically reviewed the quality of Brazilian HEE. The objective of this systematic review was to provide an overview regarding the state of HEE research and to evaluate the number, characteristics, and quality of reporting of published HEE studies conducted in a Brazilian setting.MethodsWe systematically searched electronic databases (MEDLINE, EMBASE, Latin American, and Caribbean Literature on Health Sciences Database, Scientific Electronic Library Online, NHS Economic Evaluation Database, health technology assessment Database, Bireme, and Biblioteca Virtual em Saúde Economia da Saúde); citation indexes (SCOPUS, Web of Science), and Sistema de Informação da Rede Brasileira de Avaliação de Tecnologia em Saúde. Partial and full HEEs published between 1980 and 2013 that referred to a Brazilian setting were considered for inclusion.ResultsIn total, 535 studies were included in the review, 36.8% of these were considered to be full HEE. The category of healthcare technologies more frequently assessed were procedures (34.8%) and drugs (28.8%) which main objective was treatment (72.1%). Forty-four percent of the studies reported their funding source and 36% reported a conflict of interest. Overall, the full HEE quality of reporting was satisfactory. But some items were generally poorly reported and significant improvement is required: (1) methods used to estimate healthcare resource use quantities and unit costs, (2) methods used to estimate utility values, (3) sources of funding, and (4) conflicts of interest.ConclusionA steady number of HEE have been published in Brazil since 1980. To improve their contribution to inform national healthcare policy efforts need to be made to enhance the quality of reporting of HEEs and promote improvements in the way HEEs are designed, implemented (i.e., using sound methods for HEEs) and reported.

for new drugs and new indications for existing drugs were identified from the European Medicines Agency (EMA) website. The decision to undertake an appraisal was obtained from the NICE website and NIHR Horizon Scanning Centre records, and the associations between this and characteristics of the drug and intended patient population were then determined. Results: For 2005-2011, we identified 134 MAs granted by the EMA (116 new drugs and 18 new indications) of which 72 (54%) were selected for appraisal. The decision to undertake an appraisal was significantly associated with an MA granted 2009-2011 (OR= 2.3, p< 0.01), the drug being a biological agent (OR= 3.9, p< 0.01), administered on a long-term basis (OR= 1.8, p< 0.05), indicated for a patient population < 1 in 1,000 (OR= 2.1, p< 0.05), or for malignant disease (OR= 5.1, p< 0.01). It was not associated with an indication for more severe disease (OR= 2.0, p= 0.06), an MA issued for a new indication (OR= 1.4, p= 0.50), or whether a drug was first-of-kind (OR= 1.8, p= 0.10). ConClusions: We identified several characteristics associated with the decision to undertake an appraisal relating to both the drug and intended patient population that do not completely match published topic selection criteria (e.g. severity). Further analyses are required to determine which are the most relevant factors in this decision.

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.

Many published Brazilian cost-utility studies adhere to key recommended general methods for HEE; however, the use of QALY calculations is far from being the current international standard. Development of health preferences research can contribute to quality improvement of health technology assessment reports in Brazil.

Durante esses três anos, só tenho que agradecer as pessoas que passaram pelo meu caminho e que, certamente, deixaram um pouco de si. Meus sinceros votos de agradecimento, À Profa. Dra. Patrícia Coelho de Soárez, minha orientadora, por ser paciente e verdadeira durante esse longo percurso de aprendizado e crescimento profissional. Agradeço, sinceramente, pela compreensão e pelo apoio que me ajudaram a tomar decisões importantes. À Roseli Leando e Luciana M. Rozman, pelo árduo trabalho como segundas revisoras, por toda a paciência, momentos de descontração e profissionalismo durante todos esses meses. Sem vocês eu não conseguiria completar essa dissertação. Meu muito obrigada! À Juliana Yukari Kodaira Viscondi, pelo auxílio com as análises estatísticas no momento da minha qualificação. À Andrea Tenório, pelos ensinamentos sobre produção e publicação científica, além da didática para explicar e conduzir a análise estatística desse estudo. Á Luciana da Silva Meira pela amizade, apoio e torcida desde que nos conhecemos. E também pela importante colocaboração nas referências dessa dissertação. NORMALIZAÇÃO ADOTADA Esta dissertação está de acordo com as seguintes normas, em vigor no momento desta publicação: Referências: adaptado de International Committee of Medical Journals Editors (Vancouver).

RESUMOO debate sobre a necessidade de melhoria da utilização de recursos em saúde fez aumentar o interesse em evidências do mundo real (EMR) nos últimos anos. No sétimo congresso Latino-Americano da Sociedade Internacional de Farmacoeconomia e Pesquisa de Desfechos, diferentes palestrantes exploraram como o manejo desses dados pode auxiliar no processo de tomada de decisão. Quatro membros representando diferentes segmentos do Sistema de Saúde Suplementar (SSS) brasileiro foram convidados a participar de um painel de especialistas, a fim de entender suas percepções sobre o assunto. O nível de confiança na informação atualmente disponível variou entre 70% e 90% e os dados são utilizados na rotina de tomada de decisão. Considerando a utilização de evidências para prever decisões, os especialistas relatam não existir uma matriz institucional, mas que as informações existentes são utilizadas na construção de modelos preditivos por meio da criação de pacotes de serviços. A priorização da tomada de decisão é hoje essencialmente baseada em estimativas de custos. Apesar disso, são observadas diferentes situações em que dados de mundo real podem balizar esse processo. Existiu consenso de que uma mudança de paradigmas está ocorrendo e que esses processos representam um futuro plausível. O uso de EMR é de grande importância no processo de tomada de decisão na perspectiva do SSS e, acima de tudo, no suporte de modelos de saúde baseados em valor, sendo recomendado pela Agência Nacional de Saúde Suplementar como um pilar estratégico para a sustentabilidade do sistema. ABSTRACTThe debate about the needs for healthcare resource utilization improvement has been soaring during the last years. As a result, discussions on enhancements of the decision-making process through the leverage of real-world evidence (RWE) has also been fostered. In the 7th Latin American congress of the International Society for Pharmacoeconomics and Outcomes Research, different speakers explored how the management of these data support real-life healthcare decisions. Four members representing different segments from the Brazilian Supplementary Healthcare System (SHS) were invited to participate on an expert panel in order to understand their perceptions on this subject. The confidence level on available data ranges from 70% to 90% and information is used on decision-making routine. When the use of real-world evidence to predict decision was considered, panelists reported the absence of an institutional decision matrix, but that existing information is used to build predictive models through the creation of service packages. The prioritization of decision-making today is essentially based on the estimation of costs. However, different situations in which real-world data can Recebido em: 19/11/2019 Aprovado para publicação em: 09/12/2019 1. IQVIA INC, USA 2. Sistema de Assistência à Saúde dos Servidores Públicos Estaduais (Planserv), Salvador, BA, Brasil 3. Unimed Curitiba, Curitiba, PR, Brasil 4. São Francisco, SP, Brasil 5. GEAP Saúde, Brasília, Brasil 6. J...

Further studies are needed in order to ensure that expenditures on health care in Brazil are made as fairly and efficiently as possible.