SOURCES OF HOSPITAL ADMISSION COSTS IN HTA SUBMISSIONS IN THE BRAZILIAN PRIVATE HEALTHCARE SYSTEM
Author(s)
RODRIGO ANTONINI RIBEIRO, MSc, ScD, MD1, Letícia Cunha Pereira de Souza, BSc2, Miriam A. Marcolino, MSc, ScD2;
1TruEvidence, Porto Alegre, Brazil, 2HEMAP Consulting, Porto Alegre, Brazil
1TruEvidence, Porto Alegre, Brazil, 2HEMAP Consulting, Porto Alegre, Brazil
OBJECTIVES: The Brazilian Private Healthcare System, regulated by the Agência Nacional de Saúde Suplementar (ANS), covers about a quarter of the country population, with over 900 active private health insurance operators (PHIO). Considering the large number of players, it is likely that healthcare costs vary considerably, and a defined guideline for the cost information sources choice in health technology assessments by the ANS is warranted. We aimed to review submissions to ANS for incorporation of medicines and immunobiologicals, evaluating the sources for hospital costs used in such submissions.
METHODS: We included a random sample of 32 HTA submission dossiers from the last 3 years available on the ANS website. We evaluated what kind of data were used to estimate admission-related costs, including the ones related to management of adverse events.
RESULTS: Only 10 submissions (31.3%) used actual measured costs from the disease under evaluation, estimated either with data processing of the hospital procedure ANS database, or using published papers with actual billing information. Five submissions (15.6%) used the National Association of Self-Managed Health Institutions (UNIDAS) annual publication, which covers about 10% of the PHIO in Brazil, but the costs are for admissions in general, without stratification by disease/ICD codes. Sixteen (50%) used expert opinion to elicit items which would be used in the admissions, and estimated costs through codebooks, like CBHPM (Classificação Brasileira Hierarquizada de Procedimentos Médicos), which is a suggestion of values to be charged, but are not actual billing information. Finally, one of submissions incorrectly gathered cost data from the public sector.
CONCLUSIONS: Expert opinion is the most common source for admission costs estimation in the Brazilian Private Healthcare System perspective, even though ANS have a centralized database that consolidates standardized data for hospital procedures from the PHIO. The use of more accurate data would qualify the process.
METHODS: We included a random sample of 32 HTA submission dossiers from the last 3 years available on the ANS website. We evaluated what kind of data were used to estimate admission-related costs, including the ones related to management of adverse events.
RESULTS: Only 10 submissions (31.3%) used actual measured costs from the disease under evaluation, estimated either with data processing of the hospital procedure ANS database, or using published papers with actual billing information. Five submissions (15.6%) used the National Association of Self-Managed Health Institutions (UNIDAS) annual publication, which covers about 10% of the PHIO in Brazil, but the costs are for admissions in general, without stratification by disease/ICD codes. Sixteen (50%) used expert opinion to elicit items which would be used in the admissions, and estimated costs through codebooks, like CBHPM (Classificação Brasileira Hierarquizada de Procedimentos Médicos), which is a suggestion of values to be charged, but are not actual billing information. Finally, one of submissions incorrectly gathered cost data from the public sector.
CONCLUSIONS: Expert opinion is the most common source for admission costs estimation in the Brazilian Private Healthcare System perspective, even though ANS have a centralized database that consolidates standardized data for hospital procedures from the PHIO. The use of more accurate data would qualify the process.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HTA18
Topic
Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes, Value Frameworks & Dossier Format
Disease
No Additional Disease & Conditions/Specialized Treatment Areas