ABSTRACT
Abstract Economic assessments are relevant to support the decision to incorporate more cost-effective strategies to reduce Cervical Cancer (CC) mortality. This systematic review analyzes the economic evaluation studies of CC prevention strategies (HPV DNA-based tests and conventional cytology) in low- and middle-income countries. Medline, EMBASE, CRD, and LILACS were searched for economic evaluation studies that reported cost and effectiveness measures of HPV DNA-based tests for CC screening and conventional cytology in women, without age, language, or publication date restrictions. Selection and data extraction were carried out independently. For comparability of results, cost-effectiveness measures were converted to international dollars (2019). Report quality was assessed using the CHEERS checklist. The Dominance Matrix Ranking (DRM) was used to analyze and interpret the results. The review included 15 studies from 12 countries, with cost-effectiveness analyzes from the health system's perspective and a 3% discount rate. The strategies varied in age and frequency of screening. Most studies used the Markov analytical model, and the cost-benefit threshold was based on the per capita GDP of each country. The sensitivity analysis performed in most studies was deterministic. The completeness of the report was considered sufficient in most of the items evaluated by CHEERS. The Dominance Interpretation (DRM) varied; in 6 studies, the HPV test was dominant, 5 studies showed a weak dominance evaluating greater effectiveness of the HPV test at a higher cost, yet in 2 studies conventional cytology was dominant. Although the context-dependent nature of economic evaluations, this review points out the challenge of methodological standardization in the analytical models.
ABSTRACT
A Avaliação de Tecnologias em Saúde (ATS) é um campo multidisciplinar de estudo, que busca analisar as implicações clínicas, sociais, éticas e econômicas do desenvolvimento, difusão e uso da tecnologia em saúde. O processo de definição de diretrizes metodológicas em ATS exige a construção de consenso entre um amplo conjunto de experts e tomadores de decisão na elaboração de um documento com robustez científica. No Brasil, a partir de 2008 com a criação da Rede Brasileira de Avaliação de Tecnologias em Saúde(REBRATS), a elaboração de diretrizes em ATS passou a ser realizada por meio de um processo colaborativo no âmbito da rede. Este processo tem contribuído não apenas para a padronização metodológica em ATS, mas também para a estruturação da inteligência avaliativa em rede no Brasil. Este artigo tem por objetivo discutir a estrutura e a dinâmica desta inteligência avaliativa, bem com sua evolução ao longo do tempo...
Health Technology Assessment (HTA) is a multidisciplinary field of study that seeks to analyze healthtechnologies development, diffusion and use and their clinical, social, economic and ethical implications.The defining process of HTA methodological guidelines requires consensus building among a broad range ofexperts and decision makers in the elaboration of a scientific robust document. In Brazil, since the creationof the Brazilian Network for Health Technology Assessment (REBRATS) in 2008, the elaboration of HTAguidelines has been performed through a collaborative process between network members. This processhas contributed not only to the HTA methodological standardization, but also to structure an assessmentintelligence network in Brazil. This article aims to discuss the structure and dynamics of this evaluativeintelligence and how it has improved over time...
La Evaluación de Tecnologías (HTA) es un campo multidisciplinar de estudio que busca analizar lascaracterísticas clínicas, el desarrollo social, ético y económico, la difusión y el uso de la tecnología en la salud.El proceso de definición de directrices metodológicas en ATS requiere el consenso entre una amplia gamade expertos y tomadores de decisiones en la elaboración de un documento con solidez científica. En Brasil,a partir de 2008 con la creación de la Red Brasileña de Evaluación de Tecnologías Sanitarias (REBRATS)la elaboración de directrices sobre ATS ahora se lleva a cabo a través de un proceso de colaboración dentrode la red. Este proceso ha contribuido no sólo a la estandarización metodológica en ATS, sino también aestructurar la red de inteligencia evaluativa en Brasil. Este artículo tiene como objetivo discutir la estructuray dinámica de esta inteligencia de evaluación, así como su evolución en el tiempo...