Análise de decisão multicritérios (MCDA) como apoio à tomada de decisão no SUS pela CONITEC
Análise de decisão multicritérios (MCDA) como apoio à tomada de decisão no SUS pela CONITEC
Data
2016
Autores
Souza, Andrea Brigida de
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
O estabelecimento de prioridades é necessário para que as tecnologias sejam priorizadas e os recursos escassos da saúde sejam melhor alocados, uma estratégia essencial para a sustentabilidade do sistema. O processo decisório, onde múltiplos critérios são considerados, é realizado pelos gestores políticos e demanda transparência, reprodutibilidade e responsabilidade para que seja considerado legítimo pelo público e pelos profissionais de saúde. A análise de decisão multicritérios (MCDA) é um conjunto de métodos e abordagens que busca ordenar os critérios de forma explícita de acordo com a importância relativa de cada um por meio de pesos relativos. O MCDA deve ser abrangente, não-redundante, reprodutível e com uma abordagem transparente e estruturada. A CONITEC - Comissão Nacional de Incorporação de Tecnologias no SUS - assessora o Ministério da Saúde na incorporação, exclusão e alteração de tecnologias em saúde pelo SUS. Alguns critérios fundamentais para que este processo de avaliação ocorra são citados na legislação como: evidências científicas sobre eficácia, acurácia, efetividade e segurança, assim como avaliação econômica e impacto orçamentário. Apesar disso, sabe-se que vários critérios importantes não citados na legislação são levados em conta em decisões realizadas pela comissão. O objetivo deste estudo foi realizar uma revisão sistemática a fim de identificar os critérios utilizados internacionalmente numa tomada de decisão em saúde e realizar um comparativo com os critérios identificados em decisões da CONITEC. A busca por evidências identificou 2.881 artigos e foram selecionados 16 artigos. Dois revisores independentes realizaram a seleção dos artigos. Os critérios extraídos foram categorizados e seus respectivos atributos foram listados. Dez categorias foram apresentadas: Benefício e risco da intervenção (4 critérios); impacto da doença (4 critérios); impacto econômico (6 critérios); contexto terapêutico da intervenção (4 critérios); qualidade e incerteza da evidência (4 critérios); implementação da intervenção (5 critérios); benefícios para a sociedade (5 critérios); benefícios para o sistema de saúde público (5 critérios); benefícios para a indústria (1 critério); e outros (3 critérios). Na aplicação dos resultados, cinco decisões de incorporação de tecnologias realizadas pela CONITEC foram selecionadas para escuta das gravações, sendo eles: trastuzumabe para câncer de mama; fingolimode para esclerose múltipla; clozapina, lamotrigina, olanzapina, quetiapina e r isperidona para transtorno afetivo bipolar; transplante de células hematopoéticas para doença falciforme; e PET-CT para câncer de pulmão e câncer colorretal. Alguns critérios e atributos não incluídos na revisão sistemática foram identificados na escuta da gravação, assim como alguns critérios listados na literatura não foram mencionados em nenhuma das cinco decisões. É sugerida a análise desta lista de critérios com um grupo de especialistas e a elaboração de uma proposta de lista de critérios a ser incluída nos pareceres da CONITEC.
Priority setting is required to ensure that technologies are prioritized and scarce health resources are better allocated, it is an essential strategy for system sustainability. Decision-making process - which multiple criteria are considered - is carried out by policy makers and it demands transparency, reproducibility and responsibility to be considered legitimate by the public and health professionals. The multicriteria decision analysis (MCDA) is a set of methods and approaches that seeks to order the criteria explicitly according to the relative importance of each one by relative weights. MCDA should be comprehensive, not redundant, reproducible and with a clear and structured approach. The CONITEC - National Committee for Health Technology Incorporation - advises the Ministry of Health in the incorporation, exclusion and adjustment health technologies by the Brazilian public health system. For this evaluation process occur some key criteria are mentioned in the legislation as scientific evidence of efficacy, accuracy, effectiveness and safety, as well as economic evaluation and budget impact. Nevertheless, it is known that many important criteria not mentioned in the legislation are taken into account in decisions made by the committee. The aim of this study was undertake a systematic review to identify criteria used internationally in health decision-making and carry out a comparison with the criteria identified in CONITEC decisions. The search for evidence identified 2,881 articles and 16 articles were selected. Two researches independently carried out the selection of the articles. The extracted criteria were categorized and their related attributes were listed. Ten categories were presented: Benefit and risk of intervention (4 criteria); impact of the disease (4 criteria); economic impact (6 criteria); therapeutic context of intervention (4 criteria); quality and uncertainty of evidence (4 criteria); implementation of intervention (5 criteria); benefits for society (5 criteria); benefits for health public system (5 criteria); benefits for the industry (1 criteria); and others (3 criteria). In the application of the results, five decisions of technologies incorporation made by CONITEC were selected for listening to the recordings, which are: trastuzumab for breast cancer; fingolimod for multiple sclerosis; clozapine, lamotrigine, olanzapine, quetiapine and risperidone for bipolar disorder; transplantation of hematopoietic cells to sickle cell disease; and PET-CT for lung cancer and colorectal cancer. Some criteria and attributes were not included in the systematic review but they were identified in the recording listening, as well as some criteria listed in the literature were not mentioned in any of the five decisions. It is suggested the analysis of this criteria list with a group of experts and the elaboration a criteria list proposal to be included in CONITEC’s reports.
Priority setting is required to ensure that technologies are prioritized and scarce health resources are better allocated, it is an essential strategy for system sustainability. Decision-making process - which multiple criteria are considered - is carried out by policy makers and it demands transparency, reproducibility and responsibility to be considered legitimate by the public and health professionals. The multicriteria decision analysis (MCDA) is a set of methods and approaches that seeks to order the criteria explicitly according to the relative importance of each one by relative weights. MCDA should be comprehensive, not redundant, reproducible and with a clear and structured approach. The CONITEC - National Committee for Health Technology Incorporation - advises the Ministry of Health in the incorporation, exclusion and adjustment health technologies by the Brazilian public health system. For this evaluation process occur some key criteria are mentioned in the legislation as scientific evidence of efficacy, accuracy, effectiveness and safety, as well as economic evaluation and budget impact. Nevertheless, it is known that many important criteria not mentioned in the legislation are taken into account in decisions made by the committee. The aim of this study was undertake a systematic review to identify criteria used internationally in health decision-making and carry out a comparison with the criteria identified in CONITEC decisions. The search for evidence identified 2,881 articles and 16 articles were selected. Two researches independently carried out the selection of the articles. The extracted criteria were categorized and their related attributes were listed. Ten categories were presented: Benefit and risk of intervention (4 criteria); impact of the disease (4 criteria); economic impact (6 criteria); therapeutic context of intervention (4 criteria); quality and uncertainty of evidence (4 criteria); implementation of intervention (5 criteria); benefits for society (5 criteria); benefits for health public system (5 criteria); benefits for the industry (1 criteria); and others (3 criteria). In the application of the results, five decisions of technologies incorporation made by CONITEC were selected for listening to the recordings, which are: trastuzumab for breast cancer; fingolimod for multiple sclerosis; clozapine, lamotrigine, olanzapine, quetiapine and risperidone for bipolar disorder; transplantation of hematopoietic cells to sickle cell disease; and PET-CT for lung cancer and colorectal cancer. Some criteria and attributes were not included in the systematic review but they were identified in the recording listening, as well as some criteria listed in the literature were not mentioned in any of the five decisions. It is suggested the analysis of this criteria list with a group of experts and the elaboration a criteria list proposal to be included in CONITEC’s reports.
Description
Palavras-chave
Health Tecnology Assessment, Multicriteria decision analysis (MCDA), Técnicas de apoio para a decisão, Tomada de decisões, Avaliação de Tecnologias em Saúde, Análise de decisão multicritérios (ADMC), Decision-making, Decision support techniques
Citação
Souza AB. Análise de decisão multicritérios (MCDA) como apoio à tomada de decisão no SUS pela CONITEC. Rio de Janeiro. Dissertação [Mestrado Profissional em Avaliação de Tecnologias em Saúde] - Instituto Nacional de Cardiologia; 2016