critérios de escolha do tratamento - denizar vianna

Critérios de escolha do tratamento no Sistema Único de Saúde

Denizar Vianna

Universidade do Estado do Rio de Janeiro Faculdade de Ciências Médicas

Departamento de Clínica Médica

"Promoting treatment irrespective of the evidence may garner votes, but will not create healthier voters."

Steven Woloshin, MD, MS; Lisa M. Schwartz, MD, MS VA Outcomes Group, White River Junction, Vermont, and the Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire.

SEGURANÇAEnsaios Clínicos

Fases I e II

EFICÁCIAEnsaios Clínicos

Fase III

EFETIVIDADEEstudos

Observacionais /Ensaios Clínicos

Pragmáticos

Etapas da Avaliação de Tecnologias em Saúde

EFICIÊNCIAAnálise de

Custo-Efetividade

FACTIBILIDADEImpacto

Orçamentário

Etapas da Avaliação de Tecnologias em Saúde

“The use of explicit, standard metrics such as cost-per-QALY ratios has the advantage of transparency and can help direct our resources toward the greatest health gains”.

“The cost for treating early-stage breast cancer

is $78 per DALY with surgery and radiotherapy

vs $4,986 per DALY with systemic chemotherapy

for metastatic disease”.

“These sorts of data allow health and finance

ministers to focus investment on interventions

that provide a cost-effective benefit and to

conclude, for example, that it is rational to

detect and treat early breast cancer”.

Summary of Therapy Value FrameworksOrganization Factors ConsideredAmerican Society of Clinical Oncology (ASCO) Clinical benefit

•Overall survival•Progression-free survival•Response rateToxicityBonus factors•Palliation•Time off all treatmentCost per month

Memorial Sloan Kettering Cancer Center Efficacy (survival)ToxicityNoveltyResearch and development costRarityPopulation health burden

Source: Neumann PJ, Cohen JT. Measuring the Value of Prescription Drugs. N Engl J Med. 2015;373(27):2595-7.

"Price is what you pay, value is what you get"

Warren Buffett

OBRIGADO

denizar@uerj.br

Universidade do Estado do Rio de Janeiro Faculdade de Ciências Médicas

Departamento de Clínica Médica