CONITEC REIMBURSEMENT DECISIONS- IS THERE A COST-UTILITY DECISION THRESHOLD?

Author(s)

Lemmer T, Saad R, Piedade A, Julian GS, Moreira Ed, de Oliveira RW
Evidências - Kantar Health, São Paulo, Brazil

OBJECTIVES::  The National Commission for Incorporation of Technologies (CONITEC) performs and publishes Health technology assessments (HTAs) reports, deciding on the incorporation of technologies in the Brazilian public healthcare system. Therefore, the aim of this study was to assess incremental cost-effectiveness ratios (ICERs) results in cost-utility analyses (CUA) included in CONITEC´s reports, in order to evaluate whether there is a decision threshold. METHODS::  We assessed all CONITEC reports up to 9th June 2016 reporting cost-effectiveness (CE) and CUA, extracting data regarding type of analysis, comparators, type of health benefit measure and ICER results. Indications were categorized per International Statistical Classification of Diseases (ICD-10) Chapters. WHO thresholds of one PIB (28,876BRL) and three PIB per capita (952,908BRL) were set to assess ICER (BRL/QALY gained) results. RESULTS::  Fifty-nine reports, including CE and CUA, were assessed. Of the 21 CUA reports, four were published for ICD-10 Chapter-IX diseases, three for each Chapters-VI and II diseases. Among the HTA reports including CUA, eighteen were rejected, two approved and one had no decision taken yet. The year with most reports (6) including CUA was 2013. Of all ICERs results (BRL/QALY gained), four were dominant, with incorporation rejected. The ICERs results varied between BRL2,126/QALY and 642,673/QALY gained. Among CUA-containing analyses, the eighteen reports rejected had a mean ICER ± standard deviation of 168,474±228,245 BRL/QALY gained, while the two incorporations accepted had 20,045± 25,341 BRL/QALY gained. Among incorporated technology reports, the ICER varied between 2,126 to 37,963BRL/QALY gained. Using a threshold of one and three PIB/Capita, only 16.7% and 13.3% of the technologies presenting values lower than the threshold were incorporated, respectively. CONCLUSIONS::  Most reports with CE analyses use other health benefit measures but QALY gained. Currently, only few CONITEC HTA report CUA. There is an absence of pattern for HTA decisions based on ICER results.

Conference/Value in Health Info

2017-09, ISPOR Latin America 2017, Sao Paulo, Brazil

Value in Health, Vol. 20, No. 9 (October 2017)

Code

HT1

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Multiple Diseases

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