Métodos de modelagem para adaptação da MCDA como apoio à tomada de decisão em saúde
Métodos de modelagem para adaptação da MCDA como apoio à tomada de decisão em saúde
Data
2016
Autores
Salgado, Jessica Baldissara
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Diante do orçamento público escasso, das ilimitadas demandas em
saúde, e dos elevados custos, faz-se imprescindível a alocação adequada dos
recursos econômicos, a fim de priorizar e otimizar os serviços públicos de
saúde. No Brasil, as decisões governamentais sobre incorporação e
desinvestimento em tecnologias de saúde são assessoradas pela Comissão
Nacional de Incorporação de Tecnologias no SUS (Conitec). A Análise de
Decisão Multicritério (MCDA) apresenta alto potencial para a sistematização e
gerenciamento do processo de tomada de decisão, complementando, assim, o
tradicional e atual uso da avaliação de tecnologias em saúde (ATS). A MCDA
consiste em um conjunto de métodos e abordagens com o propósito de auxiliar
as tomadas de decisões complexas que exigem a análise simultânea de
diversos critérios, explicitando a importância relativa a cada critério sob a
perspectiva individual do avaliador ou de um grupo de avaliadores. Este estudo
teve como objetivo identificar, descrever e comparar os principais métodos e
técnicas de MCDA por mensuração de valor para auxílio às tomadas de
decisão no âmbito da ATS. Para isto, realizou-se uma revisão sistemática da
literatura, com o intuito de identificar os métodos mais utilizados em diferentes
países. A busca por evidências resultou em 667 artigos, dos quais 20 foram
selecionados. Identificou-se a predominância de dois métodos: teoria do valor
multiatributo (MAVT) e processo de análise hierárquica (AHP). Apesar de terem
o mesmo objetivo final de gerar um valor numérico global que represente cada
alternativa avaliada, tais métodos apresentam diferenças significativas em seus
processos. O MAVT é mais facilmente compreendido pelos avaliadores e é
implementado em menor tempo. Em contrapartida, o AHP apresenta menor
risco de inconsistência nos julgamentos pessoais dos avaliadores, entretanto é
um processo mais lento, requer uma matemática mais complexa e utilização de
software para os cálculos da modelagem. Em ambos os métodos, a efetividade
dos resultados depende da competência dos avaliadores em fazer assertivos
seus julgamentos de valor. Portanto, o AHP está mais sujeito à inefetividade,
por exigir maior quantidade de julgamentos, o que pode invalidar os resultados,
caso não sejam consistentes. Concluiu-se que o MAVT é um método mais
intuitivo, com abordagem matemática menos complexa, apresentando maior
potencial para uma aplicação inicial da MCDA. Ao considerar o contexto de
saúde no Brasil, reconheceu-se a MCDA como uma oportunidade de apoio às
decisões tomadas pela referida comissão. Portanto, faz-se imprescindível a
condução de estudos pilotos da aplicabilidade da MCDA nas reuniões da
Conitec, a fim de propor o método que melhor se adaptaria às práticas da
referida comissão.
Due to poorly funded public budgets, unlimited health demands, and high costs, the proper allocation of health economic resources is essential in achieving a higher prioritization and optimization of public health services. In Brazil, health technologies are adopted in the Public Health System after assessed and recommended by the National Committee for Health Technology Incorporation (Conitec). The Multicriteria Decision Analysis (MCDA) presents high potential for the systematization and management of the decision making process, complementing the already existing health technology assessment (HTA). MCDA is a set of methods and approaches for the purpose of aiding in complex decision making, which require simultaneous analysis of several criteria, highlighting the relative importance of each criterion in the individual or group perspective. This study aimed to propose the value measurement MCDA method best suited to Conitec decision making, as well as describe and compare the main methods applied to the health sector for HTA purposes. To achieve these goals, a systematic literature review was conducted to identify the most commonly used methods in different countries. The evidence search yielded 667 articles, which 20 were selected. Two methods were more predominant: Multiatribute Value Theory (MAVT) and Analytic Hierarchy Process (AHP). Although both of them have the same final goal of generating an overall numerical value representing each evaluated alternative, such methods have significant differences in their processes. The MAVT is easily understood by the evaluators and is implemented in less time. On the other hand, the AHP has lower risk of inconsistencies in evaluators’ personal judgments but requires a more complex math and the use of software for modeling calculations. In both methods, the effectiveness of the results depends on the competence of the evaluators in making assertive value judgments. Therefore, the AHP is more susceptible to ineffectiveness owing to the higher number of judgments required, which may invalidate the results if they are not consistent. It was concluded that MAVT is an easily understood method with a less complex mathematics, presenting higher potential to be used in initial MCDA’s applications. Considering the Brazilian health scenario, it was recognized that MCDA is an opportunity to aid the decision-making by Conitec. Finally, it is important to conduct further pilot studies of MCDA applications in Conitec meetings, in order to purpose the method that best suits the referred commission needs.
Due to poorly funded public budgets, unlimited health demands, and high costs, the proper allocation of health economic resources is essential in achieving a higher prioritization and optimization of public health services. In Brazil, health technologies are adopted in the Public Health System after assessed and recommended by the National Committee for Health Technology Incorporation (Conitec). The Multicriteria Decision Analysis (MCDA) presents high potential for the systematization and management of the decision making process, complementing the already existing health technology assessment (HTA). MCDA is a set of methods and approaches for the purpose of aiding in complex decision making, which require simultaneous analysis of several criteria, highlighting the relative importance of each criterion in the individual or group perspective. This study aimed to propose the value measurement MCDA method best suited to Conitec decision making, as well as describe and compare the main methods applied to the health sector for HTA purposes. To achieve these goals, a systematic literature review was conducted to identify the most commonly used methods in different countries. The evidence search yielded 667 articles, which 20 were selected. Two methods were more predominant: Multiatribute Value Theory (MAVT) and Analytic Hierarchy Process (AHP). Although both of them have the same final goal of generating an overall numerical value representing each evaluated alternative, such methods have significant differences in their processes. The MAVT is easily understood by the evaluators and is implemented in less time. On the other hand, the AHP has lower risk of inconsistencies in evaluators’ personal judgments but requires a more complex math and the use of software for modeling calculations. In both methods, the effectiveness of the results depends on the competence of the evaluators in making assertive value judgments. Therefore, the AHP is more susceptible to ineffectiveness owing to the higher number of judgments required, which may invalidate the results if they are not consistent. It was concluded that MAVT is an easily understood method with a less complex mathematics, presenting higher potential to be used in initial MCDA’s applications. Considering the Brazilian health scenario, it was recognized that MCDA is an opportunity to aid the decision-making by Conitec. Finally, it is important to conduct further pilot studies of MCDA applications in Conitec meetings, in order to purpose the method that best suits the referred commission needs.
Description
Palavras-chave
Tomada de decisão, Avaliação de tecnologias em saúde, Análise multicritério, Análise de decisão multicritério (ADMC), Decision-making, Health technology assessment, Multicriteria analysis, Multicriteria decision analysis (MCDA)
Citação
Salgado JB. Métodos de modelagem para adaptação da MCDA como apoio à tomada de decisão em saúde. Rio de Janeiro. Dissertação [Mestrado Profissional em Avaliação de Tecnologias em Saúde] Instituto Nacional de Cardiologia - INC; 2016.