Critérios de escolha do tratamento - Denizar Vianna
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Transcript of Critérios de escolha do tratamento - Denizar Vianna
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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
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"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.
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SEGURANÇAEnsaios Clínicos
Fases I e II
EFICÁCIAEnsaios Clínicos
Fase III
EFETIVIDADEEstudos
Observacionais /Ensaios Clínicos
Pragmáticos
Etapas da Avaliação de Tecnologias em Saúde
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EFICIÊNCIAAnálise de
Custo-Efetividade
FACTIBILIDADEImpacto
Orçamentário
Etapas da Avaliação de Tecnologias em Saúde
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“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”.
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“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”.
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“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”.
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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.
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"Price is what you pay, value is what you get"
Warren Buffett
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OBRIGADO
Universidade do Estado do Rio de Janeiro Faculdade de Ciências Médicas
Departamento de Clínica Médica