Evaluation of demands of inclusion, exclusion and alteration of technologies in the Brazilian Health System submitted to the National Committee on Technology Incorporation

Abstract

The steady increase in the number of health technologies and advances in associated research generate management challenges in the choice of technologies to be made available to the public. From 2011, the process of inclusion, exclusion and alteration of technologies to the Brazilian Unified Health System (SUS) has undergone major transformations, such as the creation of the National Committee on Technology Incorporation (CONITEC). This study analyzed the decisions of CONITEC since its inception until July 2015. The analyzed variables were: type of technology, reason for application, name of the technology, indication, claimant and CONITEC decision status. We found that the Government was the main claimant, accounting for 58.1% of the 420 cases. The most frequent request was inclusion (93.8%) and the technology type was medicine (61.4%). Of the incorporated medicines, the classes of antineoplastic/immunomodulatory were the most frequent (39.47%). Society's desire for inclusion of an increasing amount of health technology contrasts with the limited resources available to management, which causes budget concerns. Using Health Technology Assessment (HTA), advances resulting from these innovations in the process were highlighted, and challenges were identified for the management and the academic community.

Challenges to decision-making processes in the national HTA agency in Brazil: operational procedures, evidence use and recommendations

“…Regarding the type of technology analysed in the CONITEC reports, there was a predominance of drugs (68.3%), as has been the norm for most HTA agencies. Previous studies presented very similar figures of 61.4% [ 15 ] and 62.1% [ 16 ]. In the period under study, there was also a predominance of internal demands for CONITEC to recommend the incorporation of a given technology, and most of those demands originated in the public health sector, whereas most of the external demands came from the pharmaceutical industry.…”

A indústria farmacêutica interfere na sustentabilidade do sistema de saúde pública no Brasil? Uma reflexão sobre a pressão por incorporação de medicamentos

“…A predominância de solicitações de incorporação de medicamentos observada nesta análise parece em acordo com este contexto global. A indústria farmacêutica foi responsável por 37% destas solicitações, e padrões semelhantes foram observados por Caetano et al 21 e Nunes et al 5 , apontando, respectivamente, predominância da indústria farmacêutica entre os demandantes externos e demanda de 35,7% das solicitações pela indústria farmacêutica. Com relação à decisão final da CONITEC, observou-se associação significativa entre o tipo de demandante e o resultado da solicitação de incorporação de medicamentos, havendo forte relação entre a recusa da incorporação e a indústria farmacêutica como demandante.…”

O perfil das tecnologias em saúde incorporadas no SUS de 2012 a 2019: quem são os principais demandantes?

“…O estudo evidenciou que os medicamentos foram o tipo de tecnologia mais incorporada. No estudo de Nunes e colaboradores 13 sobre incorporação de medicamentos pela Conitec, entre 2012 e 2015, foi constatado que os medicamentos já obtinham maior número de incorporações em relação aos demais tipos de tecnologias naquele período. Segundo os mesmos autores, tal fato não causa surpresa, pois a investigação e a inovação relacionada com este tipo de tecnologia também dominam o mercado e a comunidade científica.…”