gms | German Medical Science

19. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

30.09. - 01.10.2020, digital

Strenghthening of Health Technology Assessment in Brazil and its impact on decision-making – an expert survey

Meeting Abstract

  • Julia Simoes Correa Galendi - Universität zu Köln, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Köln, Deutschland
  • Carlos Antonio Caramori - Universidade Estadual Paulista – UNESP, Internal Medicine Department, Botucatu, Brasilien
  • Clarissa Lemmens - Universität zu Köln, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Köln, Deutschland
  • Dirk Müller - Universität zu Köln, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Köln, Deutschland
  • Stephanie Stock - Universität zu Köln, Institut für Gesundheitsökonomie und Klinische Epidemiologie, Köln, Deutschland

19. Deutscher Kongress für Versorgungsforschung (DKVF). sine loco [digital], 30.09.-01.10.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. Doc20dkvf295

doi: 10.3205/20dkvf295, urn:nbn:de:0183-20dkvf2955

Published: September 25, 2020

© 2020 Simoes Correa Galendi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Background and current state of (inter)national research: In Brazil, Health Technology Assessment (HTA) was introduced as a mandatory element for incorporating new technologies into the benefits catalogue of the National Healthcare System (SUS) in 2009. Recent assessments have identified challenges to the application of the HTA processes, as proposed by the current national policy and international recommendations, particularly in regard to appropriate methodological quality and scope of HTA studies [1]. The usage of a cost-effectiveness threshold (CET) for decision-making and the unsuccessful attempt of HTA to protect the financial endowment of the SUS against legal actions are also debated in the literature [2].

Research questions and objectives: The objective was

to identify the expectation of experts regarding several theses for the advancement of HTA in Brazil and,
to derive possible actions to promote HTA in the Brazilian decision-making process.

Methods or hypothesis: An online survey was conducted among Brazilian experts recruited from regulatory institutions, the pharmaceutical industry, hospital based HTA nuclei and, the academics. Based on a literature review and expert interviews, a questionnaire featuring different theses related to the advancement of HTA in Brazil was developed. Participants expressed their agreement with proposed theses and rated actions for promoting HTA using a Likert scale. Results were analyzed as mean and SD. Consensus was considered as at least 70% of agreement.

Results: Complete response was obtained from thirty experts. For five out of eight theses proposed, there was moderate or strong consensus (mean ≥ 2.7): education and capacity building, role of cost-effectiveness analysis, scope and methodology of HTA and, HTA as basis for jurisdiction. There was no consensus among experts regarding public participation or adaptations to the current institutional framework. Experts agreed with several actions to promote HTA within the scope of each proposed thesis.

Discussion: According to Brazilian experts, there is potential for improvement of the HTA process in place. Key concerns were seen in the involvement of the public and the merging of private and public HTA appraisal processes. The development of the HTA process will be shaped in part by socio-economic and political influences. For Brazil, enhancement of the structured process will rely on finding adequate solutions for critical factors such as if the future direction should favor a private or a public appraisal system, the development of a national CET, the collection of national data and adequate capacity building. Main challenges related to low availability of funding.

Practical implications: Through this survey, actual measures were elicited to facilitate the advancement of HTA in Brazil.


Yuba TY, Novaes HMD, de Soárez PC. Challenges to decision-making processes in the national HTA agency in Brazil: operational procedures, evidence use and recommendations. Health Res Policy Syst. 2018 May;16(1):40. DOI: 10.1186/s12961-018-0319-8 External link