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Vol. 43. Núm. S1.
Páginas S30 (Outubro 2021)
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Vol. 43. Núm. S1.
Páginas S30 (Outubro 2021)
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THE SICKLE CELL DISEASE PROFILE IN THE BRAZILIAN PUBLIC HEALTH SYSTEM: A MULTI-CRITERIA DECISION ANALYSIS APPROACH FOR PRIORITY SETTING
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HCR Souza-Filho, R Grothe, CT Bueno
Novartis Biociências S.A., São Paulo, SP, Brazil
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Objectives

Diseases included in the Strategic Component of Pharmaceutical Services (SCPS) are illness with high socioeconomic impact or considered as strategic by the Brazilian Ministry of Health. This study aims to identify how different stakeholder groups prioritize sickle cell disease (SCD) among other three diseases included in SCPS.

Materials and methods

A literature review (LR) was carried out to form a criteria set. A one day online panel with specialists, patient representatives, and public payers (n = 3, each from all areas) was conducted to validate the final criteria set and to apply a multi-criteria decision analysis (MCDA) approach to assign an importance weight for each criterion. The PROMÉTHÉE II MCDA method was applied to compare four SCPS diseases (hemophilia, SCD, HIV and tuberculosis) considering criteria weighting and their performances on each criterion. LR and a retrospective analysis of Brazilian Ambulatory Information System (SIA/SUS) and Brazilian Hospital Information System (SIH/SUS) database (2019) were carried out to complete the diseases performance matrix. PROMÉTHÉE II generated the following outcomes for each stakeholders'group: a disease prioritization ranking, prioritization level from A (main level to prioritization) to E (worst level), and a criteria panel classifying each criterion as strong or weak point for each disease in relation to the others.

Results

The final criteria set included: disease rarity, mortality, morbidity, acute complications, quality of life impact, access to treatment, specific treatment, direct costs and indirect costs. For specialists, the main criteria were quality of life impact and morbidity (15.90% and 15.07% of the total weight, respectively), while acute complications and mortality were the main criteria for patient representatives (13.83% and 13.43%, respectively). Public payers defined mortality and morbidity as the most important criteria, both with a weight equal to 14.65%. For specialists, the prioritization should be tuberculosis; SCD; HIV; hemophilia. For patient representatives, the prioritization established was: SCD; tuberculosis; hemophilia; HIV. Public payers defined the following prioritization: tuberculosis; SCD; HIV; hemophilia. Specialists assigned B level for tuberculosis and SCD and C level for HIV and hemophilia. It was assigned B prioritization level for SCD and tuberculosis, and C level for hemophilia and HIV according to patient'representatives. Tuberculosis received B level and the other diseases received C level through public payers'preferences. The criteria panel classified as strong points to prioritize SCD over the others were specific treatment, access to treatment, morbidity, and disease rarity.

Discussion

The specialists and patient representatives prioritize tuberculosis and SCD over the other two diseases. The same prioritization level (B) was assigned for these diseases by these two stakeholder groups. Public payers prioritize tuberculosis (level B) over the other diseases. The criteria panel results reflected the absence of SCD specific treatment in Brazil.

Conclusion

The MCDA approach for HTA process demonstrated that tuberculosis and SCD are the potential SCPS diseases to be prioritized of the 4 diseases in the Brazilian public healthcare system according to the three stakeholder groups preferences.

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Idiomas
Hematology, Transfusion and Cell Therapy
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