Technology assessment and cost-effectiveness analysis in health care: the adoption of technologies and the development of clinical guidelines for the Brazilian national system

摘要

This work discusses the role of technology assessment in health care, particularly cost-effectiveness, for the planning and management of an evidence-based diffusion and incorporation (financing) of health technologies in the SUS. The paper also explains the role of technology assessment in the elaboration of evidence-based clinical practice guidelines, which can serve as important tools for improving quality and efficiency in the SUS. Initially the objectives, requirements and limitations of the main methodologies used for technology assessment to synthesize knowledge about the implications of the use of technologies are introduced. The relevance, for cost-effectiveness analysis, of the evidence regarding the benefits of the technology, of the use of (incremental) economic, rather than account/administrative, costs, and of making explicit the viewpoints assumed by the analysis are emphasized. A preliminary analysis of the processes of technology diffusion and incorporation in the SUS is presented. The importance and possibilities of improving such processes, as well as that related to the elaboration of clinical practice guidelines, through the implementation of well designed and performed technology assessment activities, which take both the government and society's viewpoints, are pointed out.