ABSTRACT
Objetivo: Realizar uma análise descritiva e avaliar a qualidade metodológica das análises de custo-efetividade dos medicamentos recomendados para incorporação pela Comissão Nacional de Incorporação de Tecnologias no SUS (Conitec) para o tratamento de câncer. Métodos: Um levantamento no site da Conitec foi realizado para identificar os relatórios de recomendação para medicamentos utilizados no tratamento de câncer, datados de janeiro/2012 a junho/2019. Os relatórios dos medicamentos com recomendação para incorporação e que apresentavam estudos de avaliação econômica em saúde foram incluídos. Uma análise descritiva e da qualidade metodológica (ferramenta Consensus on Health Economic Criteria [CHEC]) foi realizada. Resultados: Dez indicações diferentes, de oito medicamentos, para tratamento de câncer foram recomendadas pela Conitec de janeiro/2012 a junho/2019, porém somente cinco (50%) dispunham de estudos de avaliação econômica. Um estudo foi excluído da avaliação da qualidade devido a limitações de acesso às informações. A qualidade metodológica foi variável nos estudos apresentados, e os domínios com pior avaliação se relacionavam a medida apropriada do desfecho e custos, discussões sobre ética, conflito de interesse e generalização dos dados. Observa-se uma falta de padronização na forma como foram realizadas as avaliações econômicas dos estudos submetidos à Conitec. Conclusão: Há grande heterogeneidade em relação à qualidade dos estudos de custo-efetividade de medicamentos oncológicos recomendados para incorporação pela Conitec e limitações metodológicas relevantes foram identificadas na maioria dos estudos
Objective: To perform a descriptive analysis and evaluate the methodological quality of the costeffectiveness studies that based the "Comissão Nacional de Incorporação de Tecnologias no SUS" (Conitec) recommendations for cancer treatment. Methods: A survey on the Conitec website was performed in order to identify the recommendation reports for anticancer drugs, from January/2012 to June/2019. Reports for new drug incorporation that presented cost-effectiveness were included and analyzed. The methodological quality of these reports was assessed with the tool Consensus on Health Economic Criteria (CHEC). Results: Ten different indications of eight anticancer drugs were recommended by Conitec from 2012 to June/2019, but only five (50%) had health economic analysis. One study was excluded from quality assessment due to limited information access. Methodological quality varies among the studies. The worst domains assessed were related to appropriate measurement of outcome and costs, ethics-related discussions, conflict of interest, and generalizability of the results. A lack of standardization was observed in Conitec's assessment on health economic studies submitted. Conclusion: There is a great heterogeneity in cost-effectiveness study quality of cancer drugs recommended by Conitec and relevant methodological limitations was noticed
Subject(s)
Cost-Benefit Analysis , Public Sector , Health Care Economics and Organizations , Medical OncologyABSTRACT
Abstract Falls are the second leading cause of accidental and unintentional injury deaths worldwide. Inpatient falls in hospital settings are likely to prolong the length of stay of patients in nearly 6.3 days, leading to increased hospitalization costs. The causes of fall incidents in healthcare facilities are multifactorial in nature and certain medications use could be associated with these incidents. This review seeks to critically evaluate the available literature regarding the relationship between inpatient falls and medication use. A comprehensive search was performed on MEDLINE, EMBASE and Lilacs with no time restriction. The search was filtered using English, Spanish or Portuguese languages. Our study evaluated medication use and inpatients falls that effectively happen, considering all ages and populations. An assessment of bias and quality of the studies was carried out using an adapted tool from the literature. The drugs were classified according to the Anatomic Therapeutics Chemical Code. The search strategy retrieved 563 records, among which 23 met the eligibility criteria; ninety three different pharmacological subgroups were associated with fall incidents. Our critical review suggests that the use of central nervous system drugs (including anxiolytics; hypnotics and sedatives; antipsychotics; opioids; antiepileptics and antidepressants) has a greater likelihood of causing inpatient falls. A weak relationship was found between other pharmacological subgroups, such as diuretics, cardiovascular system-related medications, and inpatient fall. Remarkably, several problems of quality were encountered with regard to the eligible studies. Among such quality problems included retrospective design, the grouping of more than one medication in the same statistical analysis, limited external validity, problems related to medication classifications and description of potential confounders.