Health Technology Assessment: informed by science or in the service of politics?
DOI:
https://doi.org/10.11606/s1518-8787.2021055003234Keywords:
Biomedical Technology Assessment, Technology Assessment, Science, Technology, and Health Innovation Management, National Science, Technology, and Innovation Policy, Science, Technology, and SocietyAbstract
The youth of Health Technology Assessment (HTA), as an institutional policy at the national level, signals the need to reflect on how its implementation took place under the perspective of its insertion in health policy and the scientific field. At the end of its first decade, these questions arise: has HTA translated into a health policy informed by science? Has its scientific foundation been used in the service of politics? To understand this political process, we apply the multiple-streams framework formulated by John Kingdon. The use of science to inform policy and the political use of science present themselves in an unstable balance. The survival of this policy will depend not only on science but on the art of orchestrating the interests of various agents so that HTA becomes a health policy for strengthening and sustainability of SUS.
References
Capucho HC, Salomon FCR, Vidal AT, Louly PG, Santos VCC, Petramale CA. Incorporação de tecnologias em saúde no Brasil: novo modelo para o Sistema Único de Saúde. BIS Bol Inst Saude. 2012;13(13):215-22. [ Links ]
Kingdon JA. Agendas, alternatives, and public policies. 2. ed. New York: Longman; 2003. (Longman Classics in Political Science). [ Links ]
Walt G, Shiffman J, Schneider H, Murray SF, Brugha R, Gilson L. ‘Doing’ health policy analysis: methodological and conceptual reflections and challenges. Health Policy Plan. 2008;23(5):308-17. https://doi.org/10.1093/heapol/czn024 [ Links ]
Machado TRC. Judicialização da saúde: analisando a audiência pública no Supremo Tribunal Federal. Rev Bioet. 2014;22(3):561-8. https://doi.org/10.1590/1983-80422014223039 [ Links ]
Teixeira CF, Paim JS. A política de saúde no governo Lula e a dialética do menos pior. Saude Debate. 2005;29(71):268-83. [ Links ]
Ministério da Saúde BR), Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Departamento de Ciência e Tecnologia. Avaliação de Tecnologias em Saúde: institucionalização das ações no Ministério da Saúde. Rev Saude Publica. 2006;40(4):743-7. https://doi.org/10.1590/S0034-89102006000500029 [ Links ]
Ministério da Saúde (BR), Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Política Nacional de Gestão de Tecnologias em Saúde. Brasília, DF; 2010. (Série B. Textos Básicos em Saúde). [ Links ]
Yuba TY. Política nacional de gestão de tecnologias em saúde: um estudo de caso da Comissão Nacional de Incorporação de Tecnologias no SUS [tese]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 2018. [ Links ]
Rede Raras -Observatório de Doenças Raras. Incorporação de tecnologias no Sistema Único de Saúde: painel de monitoramento das solicitações de incorporação de tecnologias em saúde protocoladas na Conitec. Brasília, DF; 2020 [cited 2020 Oct 8]. Available from: http://rederaras.unb.br/?p=360 [ Links ]
Yuba TY, Novaes HMD, 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;16(1):40. https://doi.org/10.1186/s12961-018-0319-8 [ Links ]
Caetano R, Hauegen RC, Osorio-de-Castro CGS. A incorporação do nusinersena no Sistema Único de Saúde: uma reflexão crítica sobre a institucionalização da avaliação de tecnologias em saúde no Brasil. Cad Saude Publica. 2019;35(8):e00099619. https://doi.org/10.1590/0102-311X00099619 [ Links ]
Wilt GJ, Rüther A, Trowman R. Scientific Development of HTA-A proposal by the Health Technology Assessment International Scientific Development and Capacity Building Committee. Int J Technol Assess Health Care. 2019;35(4):263-5. https://doi.org/10.1017/S0266462319000539 [ Links ]
Caetano R, Silva RM, Pedro EM, Oliveira IAG, Biz AN, Santana P. Incorporação de novos medicamentos pela Comissão Nacional de Incorporação de Tecnologias do SUS, 2012 a junho de 2016. Cienc Saude Coletiva. 2017;22(8):2513-25. https://doi.org/10.1590/1413-81232017228.02002017 [ Links ]
Novaes HMD, Soárez PC. A Avaliação das Tecnologias em Saúde: origem, desenvolvimento e desafios atuais. Panorama internacional e Brasil. Cad Saude Publica. 2020;36(9):e00006820. https://doi.org/10.1590/0102-311X00006820 [ Links ]
Haas PM. Introduction: epistemic communities and international policy coordiantion. Int Organ. 1992;46(1):1-35. https://doi.org/10.1017/S0020818300001442 [ Links ]
Cross MKD. Rethinking epistemic communities twenty years later. Rev Int Stud. 2013;39(1):137-60. https://doi.org/10.1017/S0260210512000034 [ Links ]
Nestler-Parr S, Korchagina D, Toumi M, Pashos CL, Blanchette C, Molsen E, et al. Challenges in Research and Health Technology Assessment of Rare Disease Technologies: report of the ISPOR Rare Disease Special Interest Group. Value Health. 2018;21(5):493-500. https://doi.org/10.1016/j.jval.2018.03.004 [ Links ]
Novaes HMD, Soárez PC. Doenças raras, drogas órfãs e as políticas para avaliação e incorporação de tecnologias nos sistemas de saúde. Sociologias. 2019;21(51):332-64. https://doi.org/10.1590/15174522-0215121 [ Links ]
Marshall DA, Grazziotin LR, Regier DA, Wordsworth S, Buchanan J, Phillips K, et al. Addressing challenges of economic evaluation in precision medicine using dynamic simulation modeling. Value Health. 2020;23(5):566-73. https://doi.org/10.1016/j.jval.2020.01.016 [ Links ]
Love-Koh J, Peel A, Rejon-Parrilla JC, Ennis K, Lovett R, Manca A, et al. The future of precision medicine: potential impacts for health technology assessment. Pharmacoeconomics. 2018;36(12):1439-51. https://doi.org/10.1007/s40273-018-0686-6 [ Links ]
Avritzer L. O pêndulo da democracia no Brasil: uma análise da crise 2013-2018. Novos Estud CEBRAP. 2018;37(2):273-89. https://doi.org/10.25091/S01013300201800020006 [ Links ]
Kristensen FB, Nielsen CP, Panteli D. Regulating the input - Health Technology Assessment. In: Busse R, Klazinga N, Panteli D, Quentin W, editors. Improving healthcare quality in Europe: characteristics, effectiveness and implementation of different strategies. Copenhagen (DK): European Observatory on Health Systems and Policies; 2019. Part I-6. (Health Policy Series). [ Links ]
Donadelli F. When evidence does not matter: the barriers to learning from science in two cases of environmental policy change in Brazil. Sci Public Policy. 2020;47(3):313-21. https://doi.org/10.1093/scipol/scaa006 [ Links ]
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Copyright (c) 2021 Patrícia Coelho De Soárez
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Conselho Nacional de Desenvolvimento Científico e Tecnológico
Grant numbers 465518/2014-1
