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Navegando Produção Docente por Autor "Acurcio, Francisco de Assis"

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    Análise de custo-efetividade dos imunossupressores utilizados no tratamento de manutenção do transplante renal em pacientes adultos no Brasil
    (Cadernos de Saúde Pública, 2013) Acurcio, Francisco de Assis; Saturnino, Luciana Tarbes Mattana; Silva, Anderson Lourenço da; Oliveira, Gustavo Laine Araújo de; Andrade, Eli Iola Gurgel; Cherchiglia, Mariangela Leal; Ceccato, Maria das Graças Braga
    O objetivo do estudo foi realizar análise custo- efetividade de imunossupressores utilizados na terapia de manutenção pós-transplante renal. Coorte hipotética de adultos transplantados foi acompanhada por 20 anos, empregando-se mo- delo de Markov. Os 10 esquemas terapêuticos avaliados continham prednisona (P). O custo médio dos medicamentos foi obtido na Câma- ra de Regulação do Mercado de Medicamentos. Outros custos assistenciais compuseram cada estágio da doença. O custo foi expresso em reais, a efetividade em anos de vida ganhos e adotou- -se a perspectiva do sistema público de saúde. Ao fim do acompanhamento, a análise com descon- to mostrou que todos os esquemas foram domi- nados por ciclosporina(CSA)+azatioprina(AZA) +P. Nas demais análises, tacrolimo+AZA+P não foi dominado, mas a relação custo-efetividade incremental entre estes dois esquemas foi de R$ 156.732,07/ anos de vida ganhos, na análise sem desconto, valor que ultrapassa o limiar de três vezes o PIB per capita brasileiro. Nenhuma alte- ração qualitativa foi demonstrada pela análise de sensibilidade e a probabilidade do esquema CSA+AZA+P ser o mais custo-efetivo é superior a 85%.
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    The Assessment for Disinvestment of Intramuscular Interferon Beta for Relapsing-Remitting Multiple Sclerosis in Brazil
    (PharmacoEconomics, 2018-02) Lemos, Livia Lovato Pires de; Guerra Junior, Augusto Afonso; Santos, Marisa; Magliano, Carlos; Diniz, Isabela; Souza, Kathiaja; Pereira, Ramon Gonçalves; Alvares, Juliana; Godman, Brian; Bennie, Marion; Zimmermann, Ivan Ricardo; Santos, Vânia Cristina Canuto dos; Petramale, Clarice Alegre; Acurcio, Francisco de Assis
    In Brazil, inclusion and exclusion of health technologies within the Unified Health System (SUS) is the responsibility of the National Committee for Health Technology Incorporation (CONITEC). A recent Cochrane systematic review demonstrated that intramuscular interferon beta 1a (IFN-b-1a-IM) was inferior to the other beta interferons (IFN-bs) for multiple sclerosis (MS). As a result, CONITEC commissioned an analysis to review possible disinvestment within SUS. The objective of this paper is to describe the disinvestment process for IFN-b-1a-IM in Brazil. The first assessment comprised a literature review and mixed treatment comparison meta-analysis. The outcome of interest was the proportion of relapse-free patients in 2 years. This analysis confirmed the inferiority of IFN-b-1a-IM. Following this, CONITEC recommended disinvestment, with the decision sent for public consultation. More than 3000 contributions were made on CONITEC’s webpage, most of them against the preliminary decision. As a result, CONITEC commissioned a study to assess the effectiveness of IFN-b-1a-IM among Brazilian patients in routine clinical care. The second assessment involved an 11-year follow-up of a non-concurrent cohort of 12,154 MS patients developed by deterministic-probabilistic linkage of SUS administrative databases. The realworld assessment further demonstrated that IFN-b-1a-IM users had a statistically higher risk of treatment failure, defined as treatment switching or relapse treatment or death, with the assessment showing that IFN-b-1a-IM was inferior to the other IFN-bs and to glatiramer acetate in both direct and indirect analysis. In the drug ranking with 40,000 simulations, IFN-b-1a-IM was the worst option, with a success rate of only 152/40,000. Following this, CONITEC decided to exclude the intramuscular presentation of IFN-b from the current MS treatment guidelines, giving patients who are currently on this treatment the option of continuing until treatment failure. In conclusion, we believe this is the first example of this new disinvestment process in action, providing an exemplar for other treatments in Brazil as well as other countries.