PATIENT CONTRIBUTIONS AND CHANGES IN COVERAGE RECOMMENDATIONS (2021-2025): EVIDENCE FROM PUBLIC CONSULTATIONS IN BRAZIL'S SUPPLEMENTARY HEALTH SYSTEM
Author(s)
Ligiane Alves de Oliveira Silva, Master1, Erika Resende, Master1, Helaine Capucho, PhD1, Rafael Raimondi Coelho, Master1, Aline Santos, Master1, Renato Porto, Bachelor's1, Danilo Moreira Simoes, MBA2, Mauricio Franca, Jr., MBA3, Rafael Miranda Magno Freixo, MBA2.
1Interfarma – Associação da Indústria Farmacêutica de Pesquisa, São Paulo, Brazil, 2L.E.K. Consulting, Boston, MA, USA, 3L.E.K. Consulting, Sao Paulo, Brazil.
1Interfarma – Associação da Indústria Farmacêutica de Pesquisa, São Paulo, Brazil, 2L.E.K. Consulting, Boston, MA, USA, 3L.E.K. Consulting, Sao Paulo, Brazil.
OBJECTIVES: Public consultations (PCs) allow stakeholders to contribute to Health Technology Assessment (HTA) and may influence coverage decisions. This study assessed how far patient contributions, relative to other stakeholders, drive reversals of initially negative coverage recommendations by Brazil's supplementary health agency (ANS) following PCs.
METHODS: For each HTA process from 2021 to 2025, ANS's initial and final recommendations and all PC contributions, by stakeholder type, were extracted from official sources. Analysis was restricted to submissions with an unfavorable preliminary recommendation, with post-PC reversal as the outcome. Contributions were grouped into four categories: health plan operators, healthcare professionals, patients and family members, and others. Univariate logistic regressions were estimated per category, with reversal as the dependent variable and the log-transformed count of favorable contributions as the predictor; discrimination was compared using the AUC. ANS members' statements in COSAÚDE were reviewed to contextualize findings.
RESULTS: Of 45 submissions with an unfavorable preliminary recommendation, 18 were reversed, drawn from 36,285 contributions (257 operators; 7,539 healthcare professionals; 14,495 patients and family members; 13,994 other). No category strongly predicted reversal: AUC ranged from 0.59 to 0.71, McFadden R² from 0.01 to 0.10. Healthcare professionals' favorable contributions were most informative (AUC 0.71), versus all categories combined (0.63) and patients and family members (0.59). With an AUC near 0.5 reflecting chance-level discrimination, the patient/family model carried little signal, while only the healthcare-professional model approached moderate discrimination. Statements corroborated this: contributions based on experience or opinion, not new clinical or methodological evidence, were less likely to change recommendations.
CONCLUSIONS: Although patients and families submitted the most contributions, theirs were least associated with reversal, while healthcare professionals carried the strongest signal. These results suggest that HTA should evolve to establish specific mechanisms and methods to enable and incorporate patient inputs, so it can meaningfully shape coverage decision.
METHODS: For each HTA process from 2021 to 2025, ANS's initial and final recommendations and all PC contributions, by stakeholder type, were extracted from official sources. Analysis was restricted to submissions with an unfavorable preliminary recommendation, with post-PC reversal as the outcome. Contributions were grouped into four categories: health plan operators, healthcare professionals, patients and family members, and others. Univariate logistic regressions were estimated per category, with reversal as the dependent variable and the log-transformed count of favorable contributions as the predictor; discrimination was compared using the AUC. ANS members' statements in COSAÚDE were reviewed to contextualize findings.
RESULTS: Of 45 submissions with an unfavorable preliminary recommendation, 18 were reversed, drawn from 36,285 contributions (257 operators; 7,539 healthcare professionals; 14,495 patients and family members; 13,994 other). No category strongly predicted reversal: AUC ranged from 0.59 to 0.71, McFadden R² from 0.01 to 0.10. Healthcare professionals' favorable contributions were most informative (AUC 0.71), versus all categories combined (0.63) and patients and family members (0.59). With an AUC near 0.5 reflecting chance-level discrimination, the patient/family model carried little signal, while only the healthcare-professional model approached moderate discrimination. Statements corroborated this: contributions based on experience or opinion, not new clinical or methodological evidence, were less likely to change recommendations.
CONCLUSIONS: Although patients and families submitted the most contributions, theirs were least associated with reversal, while healthcare professionals carried the strongest signal. These results suggest that HTA should evolve to establish specific mechanisms and methods to enable and incorporate patient inputs, so it can meaningfully shape coverage decision.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA303
Topic
Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas