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Schwerpunkt| Volume 108, ISSUE 7, P405-412, 2014

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How health economic evaluation (HEE) contributes to decision-making in public health care: the case of Brazil

DOI:https://doi.org/10.1016/j.zefq.2014.08.021
How health economic evaluation (HEE) contributes to decision-making in public health care: the case of Brazil
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      Summary

      The universal access to a health care system for the Brazilian population was established in 1990. Brazil is a country with no tradition in the production and use of health economic evaluation (HEE) to guide decision making in the public health system. It is only within the last two decades that HEEs using a microeconomic approach have appeared in the academic field. On a national level, HEE and Health Technology Assessment (HTA), in a wider sense, were first taken into account in 2003. Two policies deserve to be mentioned – (i) the regulation of medicines in the Brazilian market, and (ii) science, technology and innovation policy. The latter required the fostering of applied research to encourage the application of methods which employ systematic reviews and economic analyses of cost-effectiveness to guide the incorporation of technologies in the Brazilian health care system. The Ministry of Health has initiated the process of incorporating these new technologies on a federal level during the last ten years. In spite of the improvement of HEE methods at Brazilian universities and research institutes, these technologies have not yet reached the governmental bodies. In Brazil, the main challenge lies in the production, interpretation and application of HEE to all technologies within the access scheme(s), and there is limited capacity building. Setting priorities can be the solution for Brazil to be able to perform HEE for relevant technologies within the access scheme(s) while the universal coverage system struggles with a triple burden of disease.

      Zusammenfassung

      1990 wurde der Zugang zu einer allgemeinen Gesundheitsversorgung für alle Brasilanerinnen und Brasilianer gesetzlich eingeführt. Dabei hatte Brasilien keine Tradition, auf die es bei der Durchführung und Nutzung von Kosten-Nutzen-Bewertungen in der Entscheidungsfindung im öffentlichen Gesundheitswesen zurückgreifen konnte. Kosten-Nutzen-Bewertungen haben erst in den letzten zwei Jahrzehnten Einzug in den akademischen Bereich gehalten. Im staatlichen Sektor hat man 2003 begonnen, gesundheitsökonomische Evaluation und Health Technology Assessment (HTA) im weiteren Sinne zu berücksichtigen. Insbesondere zwei Maßnahmen sind zu erwähnen: 1) Regulierung von Arzneimitteln im brasilianischen Markt und 2) die übergreifende Forschungs- und Technologiepolitik. Letztere hat dazu geführt, dass die Forschung zur Anwendung von systematischen Übersichtsarbeiten und Kosten-Nutzen-Bewertungen intensiviert wurde, um auf deren Grundlage Entscheidungen über die Erstattung im brasilianischen Gesundheitssystem zu fällen. In den letzten 10 Jahren hat auch das Gesundheitsministerium darauf hingewirkt, HTA und insbesondere Kosten-Nutzen-Bewertungen im Erstattungsprozess auf nationaler Ebene zu etablieren. Obwohl man sich an den Universitäten und Forschungsinstituten verstärkt mit den Methoden der Kosten-Nutzen-Bewertung beschäftigt, mangelt es in den Behörden und eigentlichen Zentren der Entscheidungsfindung an Experten auf diesem Gebiet. Daher liegt die große Herausforderung darin, trotz der nicht vorhandenen personellen Ausstattung Kosten-Nutzen-Bewertungen zu erstellen, zu verstehen und für Entscheidungen in der öffentlichen Gesundheitsversorgung anzuwenden. Hilfreich dafür kann es sein, Kosten-Nutzen-Bewertungen für die wirklich im System relevanten Gesundheitstechnologien prioritär durchzuführen, denn angesichts der Krankheitslast kämpft das System mit der finanziellen Nachhaltigkeit.

      Keywords

      Schlüsselwörter

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      Article info

      Publication history

      Accepted: August 28, 2014
      Received in revised form: August 28, 2014
      Received: May 8, 2014

      Identification

      DOI: https://doi.org/10.1016/j.zefq.2014.08.021

      Copyright

      © 2014 Published by Elsevier Inc.

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