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Many Miles to Go: A Systematic Review of the State of Cost-Utility Analyses in Brazil

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Abstract

Background

Little is known about the quality and quantity of cost-utility analyses (CUAs) in Brazil.

Objective

The objective of this study was to provide a systematic review of published CUAs of healthcare technologies in Brazil.

Methods

We performed a systematic review of economic evaluations studies published in MEDLINE, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment) Database, Web of Science, Scopus, Bireme (Biblioteca Regional de Medicina), BVS ECOS (Health Economics database of the Brazilian Virtual Library of Health), and SISREBRATS (Sistema de Informação da Rede Brasileira de Avaliação de Tecnologias em Saúde [Brazilian Network for the Evaluation of Health Technologies]) from 1980 to 2013. Articles were included if they were CUAs according to the classification devised by Drummond et al. Two independent reviewers screened articles for relevance and carried out data extraction. Disagreements were resolved through discussion or through consultation with a third reviewer. We performed a qualitative narrative synthesis.

Results

Of the 535 health economic evaluations (HEEs) relating to Brazil, only 40 were CUAs and therefore included in the analysis. Most studies adhered to methodological guidelines for quality of reporting and 77.5% used quality-adjusted life-years (QALYs) as the health outcome. Of these studies, 51.6% did not report the population used to elicit preferences for outcomes and 45.2% used a specific population such as expert opinion. The preference elicitation method was not reported in 58.1% of these studies. The majority (80.6%) of studies did not report the instrument used to derive health state valuations and no publication reported whether tariffs (or preference weights) were national or international. No study mentioned the methodology used to estimate QALYs.

Conclusions

Many published Brazilian cost-utility studies adhere to key recommended general methods for HEE; however, the use of QALY calculations is far from being the current international standard. Development of health preferences research can contribute to quality improvement of health technology assessment reports in Brazil.

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Author contributions

TCD and PCDS designed the research; LMR, TCD, and RL performed the research; AGC, RL, HMDN, and PCDS analyzed the data; AGC and PCDS wrote the paper.

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Correspondence to Patrícia Coelho De Soárez.

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Funding

This study was partially funded by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP; São Paulo Research Foundation) as part of a larger project entitled “Systematic Review of Health Economic Evaluations Conducted in Brazil, 1980–2013”, carried out under the leadership of Professor Patricia Coelho de Soárez (FAPESP Research Grant No. 2012/22126-3) and by the Conselho Nacional de Desenvolvimento Cientifico e Tecnológico (CNPq; National Counsel of Technological and Scientific Development) (CNPq Research Grant No. 305614/2013-4). The research design, analysis, and interpretation were conducted independently of the funders.

Conflict of interest

The authors Alessandro G Campolina, Luciana M Rozman, Tassia C Decimoni T, Roseli Leandro, Hillegonda M D Novaes and Patrícia Coelho De Soárez have no conflicts of interest in regard to this article.

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Campolina, A.G., Rozman, L.M., Decimoni, T.C. et al. Many Miles to Go: A Systematic Review of the State of Cost-Utility Analyses in Brazil. Appl Health Econ Health Policy 15, 163–172 (2017). https://doi.org/10.1007/s40258-016-0290-x

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