Revisitando a literatura sobre custo-efetividade e utilidade em saúde

Abstract

This study aims to contribute to the dissemination of the theoretical foundations for cost-effec- IntroduçãoA riqueza de debates sobre a fundamentação teórica da análise de custo-efetividade e utilidade e, por conseguinte, de suas abordagens, perspectivas e modelos de decisão atrelados às técnicas -mesmo que consagrado e incorporado como um instrumento adicional para a decisão na alocação de recursos em muitos países centrais -, ainda suscita, inclusive no contexto brasileiro, o sentimento de que não é confiável.Neumann 1 , no que tange ao sentimento de incredulidade perante o instrumento, discorre em seu artigo Why Don't Americans Use CostEffectiveness Analysis?, a relutância de médicos e gestores de planos de saúde em utilizá-lo. O argumento, em relação aos médicos, é que estes não foram ensinados a pensar profundamente sobre escassez de recursos (e trade-offs) e pelo fato de que não há protocolos claros para conduzir ou reportar os resultados dos estudos. Já em relação aos gestores, o argumento é que não há recomendação explícita da parte do governo para seu uso e que os planos têm outros processos mais sofisticados para administrar a atenção médica.No contexto brasileiro, o sentimento fica patente quando Silva 2 afirma que a análise de custo-efetividade ainda é considerada um mero recurso tecnocrático vinculado ao pensamento neoliberal de contenção de gastos no setor, por utilizar critérios de eficiência econômica. Argumento que, ainda segundo a autora, simplifica REVISÃO REVIEW

Cost-Effectiveness of a Home Visit Program for Patients with Heart Failure in Brazil: Evidence from a Randomized Clinical Trial

“…The difference between outcomes in the public and private health care settings may be associated with the fact that there is no perfect market in the health sector. Therefore, prices do not always reflect opportunity cost, which should then be appraised in terms of real value rather than by the prices paid for a certain service evidenced by the change in results with the sensitivity analysis [20]. In Brazil, values reimbursed by the PHS for emergency room visits are based on nationwide price setting and have not changed over the last 10 years.…”

Economic aspects of control and eradication of bovine tuberculosis and the managerial costs associated: Review

“…Productivity costs are associated with production loss and replacement costs due to illness, disability, and death (of productive persons, both paid and unpaid) (Brouwer et al, 1997). Given its complexity and difficulty to transpose such a concept into animal production systems, productivity cost usually is excluded from the economic evaluation of animal health (Sancho, 2008). Even for human health programs, a debate exists on the inclusion or not of productivity costs in economic evaluations (see definition below).…”

“…Understanding the methodologies of cost-effectiveness, studies are critical to conducting a proper judgment about total costs and cost-effectiveness of alternative diagnostic tests. Different methodologies produce distinct total costs and therefore distinct cost-effectiveness, reflecting the way we collected and interpret data (Sancho, 2008;Sohn et al, 2009). The case of human tuberculosis diagnostic systems is an example of how different research groups may distinctly evaluate costs (details in Sohn et al, 2009).…”

“…approach may create a debate on the value of statistical methods that generalize results of unlike realities, as costs vary following geographical location, demographic questions, epidemiological interpretations, and time (Sancho, 2008;Sohn et al, 2009). Additionally, Sohn et al (2009) suggest that to avoid or minimize variation, all considered cost for animal health program/project should be estimated for the year on which the study was conducted.…”

“…a diagnostic test) has in its composition the study perspective and the identification of the intervention effects on changing health status. This allows managers to identify, include or exclude, assess, and appraise resources (Caminiti et al, 2017;Sancho, 2008). In quantitative terms, the costs and the consequences of alternative diagnoses vary depending on the adopted perspective, which may reflect a vision of society or public services (Vanni et al, 2009).…”