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0915 ndash 1030 Session 1
EvelindaTrindadeInCorUSPbr for the
bull The Information Resources Group of HTAi bull the Brazilian Cochrane Centre and bull the Iberoamerican Cochrane Centre
A brief history and current status of HTA organizations and
networks in Latin America
HTA products and other Latin American HTA organizations in
general
How HTA is used to inform research at InCor (specific) and
other Latin American health organizations in general
Search methods and practices including what sources are
recommended by health research educators
Search guidance updating of searches reference
management etc
HTA in Latin America is starting
But efforts are being made since mid 1980rsquos
For example
Efectiveness of perinatal technologies (Panerai et al 1989) PAHOWHO sponsored
Outpatient Continuous Peritoneal Dialysis - Current situation (CAPD) in Brazil (Cubas e Riella 1987)
Breast Radiology ndash mammography quality (Koch et al 1996)
Banta D The uses of modern technologies Problems and perspectives for industrialized and developing countries Bull PAHO 198418139-150
Pentildea Mohr J Coe G Investigacioacuten en Tecnologiacutea de Salud OPS January 1986
PAHO Regional strategy for health technology assessment Washington DC Pan American Health Organization 1998
PAHO Developing health technology assessment in Latin America and the Caribbean ISBN 92 75 07377 5Washington DC Pan American Health Organization 1998
PAHOrsquos Technology Development Unit Dr David Banta Mr Jorge Pentildea and Dr Gloria Coe
PNSP850411Washington 1985-1991
Panerai RB Almeida RT Freire SM Chaim DM Miranda MZ Madureira LC
Aguiar Neto MA Perspectives on health technology assessment in Latin
America The case of perinatal care in the literature Int J Technol Assess
Health Care 1993 Winter9(1)76-84
Does medical literature support technology assessments in
perinatal care
- studied references Latin America for the period 1984-88
Information on effectiveness safety costs and social impact of
perinatal technologies was extremely limited (A total of 1074 out gt
40000 references)
Conclusion immediate action needs to be taken to create the
necessary conditions for health technology assessment in Latin
America
Developing Health Technology Assessment in Latin America and the Caribbean 1999
Latin American and Caribbean (LAC) countries represent one of the most important emerging markets for HT and health authorities public and private insurers health professionals patients and the communications media and public opinion are gradually becoming more aware of the importance of HT and its evaluation
ldquoHTA is an essential component of the regulatory role of the health authorities and can help to strengthen their leadershiprdquo
Health Sector Reform Health Technology
There were deconcentration andor decentralization of services
The needs were growing and challenges were multiplying
There were incomplete transfer of technologies perfected in the developed countries
- incomplete adaptationplanning of the technologies to the organizational economic social and cultural situation of the receiving countries
the scarcity of many basic technologies
the excessive and indiscriminate use of expensive HT
the dearth of policies and standards to regulate the introduction and use of HT
the underdevelopment of support technologies (especially management information systems) and
inequalities in access to available HT were some of the more commonly cited problems in the Region
The more commonly cited problems in the region
2009 exploratory study to identify HTA programs in LA
An electronic search through two databases was performed to identify HTA programs in LA A content analysis was performed on HTA documents (n = 236) produced by six programs between January 2000 and March 2007 Results were analyzed by comparing document content with the main goals of HTA
Arellano LE Reza M Blasco JA Andradas E A content analysis of Health Technology Assessment
programs in Latin America Int J Technol Assess Health Care 2009 Oct25(4)570-6 PMID 19845988
[PubMed - indexed for MEDLINE]
0
10
20
30
40
50
60
IECS ndash Argentina
SSS ndash Argentina
ETESA ndash Chile
GT-ATS ndash Brazil
IMSS ndash Mexico
CENETEC ndash Mexico
Published HTA Documents (2000ndash2007) in Latin America Arellano 2009
82 in short documents format but Indeed gt 50 target Third party payers And gt 40 targetting Government policy makers
In general the documents were clearly written and
contained three types of conclusions
(i) negative (n = 27 11 percent)
(ii) neutral (n = 90 38 percent) and
(iii) positive (n = 114 48 percent)
From January 2000 to March 2007
40 percent of published HTA documents in LA addressed clinical effectiveness
while 26 percent attempted to correlate the efficacy
and safety of a new technology in economic terms
The Pan American Health Organization (PAHO) Regional Office of the World Health Organization (WHO) for the Americas has tried to promote health technology assessment (HTA) in Latin America for 25 years
Health Technology Assessment in Latin America
Brazil Mexico Argentina
Health Technology Assessment in Latin America
Chile 1997 Ministry of Healthrsquos HTA office ETESAmdash the Unit for Health Technology Assessment a member of INAHTA
Colombia the Ministry of Social Protection plan an HTA Agency with the
academic sector
Cuba =gt HTA amp EBM in their healthcare system
Uruguay 2007 Ministry of Healthrsquos HTA program in the Department of Medical Technology
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
A brief history and current status of HTA organizations and
networks in Latin America
HTA products and other Latin American HTA organizations in
general
How HTA is used to inform research at InCor (specific) and
other Latin American health organizations in general
Search methods and practices including what sources are
recommended by health research educators
Search guidance updating of searches reference
management etc
HTA in Latin America is starting
But efforts are being made since mid 1980rsquos
For example
Efectiveness of perinatal technologies (Panerai et al 1989) PAHOWHO sponsored
Outpatient Continuous Peritoneal Dialysis - Current situation (CAPD) in Brazil (Cubas e Riella 1987)
Breast Radiology ndash mammography quality (Koch et al 1996)
Banta D The uses of modern technologies Problems and perspectives for industrialized and developing countries Bull PAHO 198418139-150
Pentildea Mohr J Coe G Investigacioacuten en Tecnologiacutea de Salud OPS January 1986
PAHO Regional strategy for health technology assessment Washington DC Pan American Health Organization 1998
PAHO Developing health technology assessment in Latin America and the Caribbean ISBN 92 75 07377 5Washington DC Pan American Health Organization 1998
PAHOrsquos Technology Development Unit Dr David Banta Mr Jorge Pentildea and Dr Gloria Coe
PNSP850411Washington 1985-1991
Panerai RB Almeida RT Freire SM Chaim DM Miranda MZ Madureira LC
Aguiar Neto MA Perspectives on health technology assessment in Latin
America The case of perinatal care in the literature Int J Technol Assess
Health Care 1993 Winter9(1)76-84
Does medical literature support technology assessments in
perinatal care
- studied references Latin America for the period 1984-88
Information on effectiveness safety costs and social impact of
perinatal technologies was extremely limited (A total of 1074 out gt
40000 references)
Conclusion immediate action needs to be taken to create the
necessary conditions for health technology assessment in Latin
America
Developing Health Technology Assessment in Latin America and the Caribbean 1999
Latin American and Caribbean (LAC) countries represent one of the most important emerging markets for HT and health authorities public and private insurers health professionals patients and the communications media and public opinion are gradually becoming more aware of the importance of HT and its evaluation
ldquoHTA is an essential component of the regulatory role of the health authorities and can help to strengthen their leadershiprdquo
Health Sector Reform Health Technology
There were deconcentration andor decentralization of services
The needs were growing and challenges were multiplying
There were incomplete transfer of technologies perfected in the developed countries
- incomplete adaptationplanning of the technologies to the organizational economic social and cultural situation of the receiving countries
the scarcity of many basic technologies
the excessive and indiscriminate use of expensive HT
the dearth of policies and standards to regulate the introduction and use of HT
the underdevelopment of support technologies (especially management information systems) and
inequalities in access to available HT were some of the more commonly cited problems in the Region
The more commonly cited problems in the region
2009 exploratory study to identify HTA programs in LA
An electronic search through two databases was performed to identify HTA programs in LA A content analysis was performed on HTA documents (n = 236) produced by six programs between January 2000 and March 2007 Results were analyzed by comparing document content with the main goals of HTA
Arellano LE Reza M Blasco JA Andradas E A content analysis of Health Technology Assessment
programs in Latin America Int J Technol Assess Health Care 2009 Oct25(4)570-6 PMID 19845988
[PubMed - indexed for MEDLINE]
0
10
20
30
40
50
60
IECS ndash Argentina
SSS ndash Argentina
ETESA ndash Chile
GT-ATS ndash Brazil
IMSS ndash Mexico
CENETEC ndash Mexico
Published HTA Documents (2000ndash2007) in Latin America Arellano 2009
82 in short documents format but Indeed gt 50 target Third party payers And gt 40 targetting Government policy makers
In general the documents were clearly written and
contained three types of conclusions
(i) negative (n = 27 11 percent)
(ii) neutral (n = 90 38 percent) and
(iii) positive (n = 114 48 percent)
From January 2000 to March 2007
40 percent of published HTA documents in LA addressed clinical effectiveness
while 26 percent attempted to correlate the efficacy
and safety of a new technology in economic terms
The Pan American Health Organization (PAHO) Regional Office of the World Health Organization (WHO) for the Americas has tried to promote health technology assessment (HTA) in Latin America for 25 years
Health Technology Assessment in Latin America
Brazil Mexico Argentina
Health Technology Assessment in Latin America
Chile 1997 Ministry of Healthrsquos HTA office ETESAmdash the Unit for Health Technology Assessment a member of INAHTA
Colombia the Ministry of Social Protection plan an HTA Agency with the
academic sector
Cuba =gt HTA amp EBM in their healthcare system
Uruguay 2007 Ministry of Healthrsquos HTA program in the Department of Medical Technology
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
HTA in Latin America is starting
But efforts are being made since mid 1980rsquos
For example
Efectiveness of perinatal technologies (Panerai et al 1989) PAHOWHO sponsored
Outpatient Continuous Peritoneal Dialysis - Current situation (CAPD) in Brazil (Cubas e Riella 1987)
Breast Radiology ndash mammography quality (Koch et al 1996)
Banta D The uses of modern technologies Problems and perspectives for industrialized and developing countries Bull PAHO 198418139-150
Pentildea Mohr J Coe G Investigacioacuten en Tecnologiacutea de Salud OPS January 1986
PAHO Regional strategy for health technology assessment Washington DC Pan American Health Organization 1998
PAHO Developing health technology assessment in Latin America and the Caribbean ISBN 92 75 07377 5Washington DC Pan American Health Organization 1998
PAHOrsquos Technology Development Unit Dr David Banta Mr Jorge Pentildea and Dr Gloria Coe
PNSP850411Washington 1985-1991
Panerai RB Almeida RT Freire SM Chaim DM Miranda MZ Madureira LC
Aguiar Neto MA Perspectives on health technology assessment in Latin
America The case of perinatal care in the literature Int J Technol Assess
Health Care 1993 Winter9(1)76-84
Does medical literature support technology assessments in
perinatal care
- studied references Latin America for the period 1984-88
Information on effectiveness safety costs and social impact of
perinatal technologies was extremely limited (A total of 1074 out gt
40000 references)
Conclusion immediate action needs to be taken to create the
necessary conditions for health technology assessment in Latin
America
Developing Health Technology Assessment in Latin America and the Caribbean 1999
Latin American and Caribbean (LAC) countries represent one of the most important emerging markets for HT and health authorities public and private insurers health professionals patients and the communications media and public opinion are gradually becoming more aware of the importance of HT and its evaluation
ldquoHTA is an essential component of the regulatory role of the health authorities and can help to strengthen their leadershiprdquo
Health Sector Reform Health Technology
There were deconcentration andor decentralization of services
The needs were growing and challenges were multiplying
There were incomplete transfer of technologies perfected in the developed countries
- incomplete adaptationplanning of the technologies to the organizational economic social and cultural situation of the receiving countries
the scarcity of many basic technologies
the excessive and indiscriminate use of expensive HT
the dearth of policies and standards to regulate the introduction and use of HT
the underdevelopment of support technologies (especially management information systems) and
inequalities in access to available HT were some of the more commonly cited problems in the Region
The more commonly cited problems in the region
2009 exploratory study to identify HTA programs in LA
An electronic search through two databases was performed to identify HTA programs in LA A content analysis was performed on HTA documents (n = 236) produced by six programs between January 2000 and March 2007 Results were analyzed by comparing document content with the main goals of HTA
Arellano LE Reza M Blasco JA Andradas E A content analysis of Health Technology Assessment
programs in Latin America Int J Technol Assess Health Care 2009 Oct25(4)570-6 PMID 19845988
[PubMed - indexed for MEDLINE]
0
10
20
30
40
50
60
IECS ndash Argentina
SSS ndash Argentina
ETESA ndash Chile
GT-ATS ndash Brazil
IMSS ndash Mexico
CENETEC ndash Mexico
Published HTA Documents (2000ndash2007) in Latin America Arellano 2009
82 in short documents format but Indeed gt 50 target Third party payers And gt 40 targetting Government policy makers
In general the documents were clearly written and
contained three types of conclusions
(i) negative (n = 27 11 percent)
(ii) neutral (n = 90 38 percent) and
(iii) positive (n = 114 48 percent)
From January 2000 to March 2007
40 percent of published HTA documents in LA addressed clinical effectiveness
while 26 percent attempted to correlate the efficacy
and safety of a new technology in economic terms
The Pan American Health Organization (PAHO) Regional Office of the World Health Organization (WHO) for the Americas has tried to promote health technology assessment (HTA) in Latin America for 25 years
Health Technology Assessment in Latin America
Brazil Mexico Argentina
Health Technology Assessment in Latin America
Chile 1997 Ministry of Healthrsquos HTA office ETESAmdash the Unit for Health Technology Assessment a member of INAHTA
Colombia the Ministry of Social Protection plan an HTA Agency with the
academic sector
Cuba =gt HTA amp EBM in their healthcare system
Uruguay 2007 Ministry of Healthrsquos HTA program in the Department of Medical Technology
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Banta D The uses of modern technologies Problems and perspectives for industrialized and developing countries Bull PAHO 198418139-150
Pentildea Mohr J Coe G Investigacioacuten en Tecnologiacutea de Salud OPS January 1986
PAHO Regional strategy for health technology assessment Washington DC Pan American Health Organization 1998
PAHO Developing health technology assessment in Latin America and the Caribbean ISBN 92 75 07377 5Washington DC Pan American Health Organization 1998
PAHOrsquos Technology Development Unit Dr David Banta Mr Jorge Pentildea and Dr Gloria Coe
PNSP850411Washington 1985-1991
Panerai RB Almeida RT Freire SM Chaim DM Miranda MZ Madureira LC
Aguiar Neto MA Perspectives on health technology assessment in Latin
America The case of perinatal care in the literature Int J Technol Assess
Health Care 1993 Winter9(1)76-84
Does medical literature support technology assessments in
perinatal care
- studied references Latin America for the period 1984-88
Information on effectiveness safety costs and social impact of
perinatal technologies was extremely limited (A total of 1074 out gt
40000 references)
Conclusion immediate action needs to be taken to create the
necessary conditions for health technology assessment in Latin
America
Developing Health Technology Assessment in Latin America and the Caribbean 1999
Latin American and Caribbean (LAC) countries represent one of the most important emerging markets for HT and health authorities public and private insurers health professionals patients and the communications media and public opinion are gradually becoming more aware of the importance of HT and its evaluation
ldquoHTA is an essential component of the regulatory role of the health authorities and can help to strengthen their leadershiprdquo
Health Sector Reform Health Technology
There were deconcentration andor decentralization of services
The needs were growing and challenges were multiplying
There were incomplete transfer of technologies perfected in the developed countries
- incomplete adaptationplanning of the technologies to the organizational economic social and cultural situation of the receiving countries
the scarcity of many basic technologies
the excessive and indiscriminate use of expensive HT
the dearth of policies and standards to regulate the introduction and use of HT
the underdevelopment of support technologies (especially management information systems) and
inequalities in access to available HT were some of the more commonly cited problems in the Region
The more commonly cited problems in the region
2009 exploratory study to identify HTA programs in LA
An electronic search through two databases was performed to identify HTA programs in LA A content analysis was performed on HTA documents (n = 236) produced by six programs between January 2000 and March 2007 Results were analyzed by comparing document content with the main goals of HTA
Arellano LE Reza M Blasco JA Andradas E A content analysis of Health Technology Assessment
programs in Latin America Int J Technol Assess Health Care 2009 Oct25(4)570-6 PMID 19845988
[PubMed - indexed for MEDLINE]
0
10
20
30
40
50
60
IECS ndash Argentina
SSS ndash Argentina
ETESA ndash Chile
GT-ATS ndash Brazil
IMSS ndash Mexico
CENETEC ndash Mexico
Published HTA Documents (2000ndash2007) in Latin America Arellano 2009
82 in short documents format but Indeed gt 50 target Third party payers And gt 40 targetting Government policy makers
In general the documents were clearly written and
contained three types of conclusions
(i) negative (n = 27 11 percent)
(ii) neutral (n = 90 38 percent) and
(iii) positive (n = 114 48 percent)
From January 2000 to March 2007
40 percent of published HTA documents in LA addressed clinical effectiveness
while 26 percent attempted to correlate the efficacy
and safety of a new technology in economic terms
The Pan American Health Organization (PAHO) Regional Office of the World Health Organization (WHO) for the Americas has tried to promote health technology assessment (HTA) in Latin America for 25 years
Health Technology Assessment in Latin America
Brazil Mexico Argentina
Health Technology Assessment in Latin America
Chile 1997 Ministry of Healthrsquos HTA office ETESAmdash the Unit for Health Technology Assessment a member of INAHTA
Colombia the Ministry of Social Protection plan an HTA Agency with the
academic sector
Cuba =gt HTA amp EBM in their healthcare system
Uruguay 2007 Ministry of Healthrsquos HTA program in the Department of Medical Technology
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Panerai RB Almeida RT Freire SM Chaim DM Miranda MZ Madureira LC
Aguiar Neto MA Perspectives on health technology assessment in Latin
America The case of perinatal care in the literature Int J Technol Assess
Health Care 1993 Winter9(1)76-84
Does medical literature support technology assessments in
perinatal care
- studied references Latin America for the period 1984-88
Information on effectiveness safety costs and social impact of
perinatal technologies was extremely limited (A total of 1074 out gt
40000 references)
Conclusion immediate action needs to be taken to create the
necessary conditions for health technology assessment in Latin
America
Developing Health Technology Assessment in Latin America and the Caribbean 1999
Latin American and Caribbean (LAC) countries represent one of the most important emerging markets for HT and health authorities public and private insurers health professionals patients and the communications media and public opinion are gradually becoming more aware of the importance of HT and its evaluation
ldquoHTA is an essential component of the regulatory role of the health authorities and can help to strengthen their leadershiprdquo
Health Sector Reform Health Technology
There were deconcentration andor decentralization of services
The needs were growing and challenges were multiplying
There were incomplete transfer of technologies perfected in the developed countries
- incomplete adaptationplanning of the technologies to the organizational economic social and cultural situation of the receiving countries
the scarcity of many basic technologies
the excessive and indiscriminate use of expensive HT
the dearth of policies and standards to regulate the introduction and use of HT
the underdevelopment of support technologies (especially management information systems) and
inequalities in access to available HT were some of the more commonly cited problems in the Region
The more commonly cited problems in the region
2009 exploratory study to identify HTA programs in LA
An electronic search through two databases was performed to identify HTA programs in LA A content analysis was performed on HTA documents (n = 236) produced by six programs between January 2000 and March 2007 Results were analyzed by comparing document content with the main goals of HTA
Arellano LE Reza M Blasco JA Andradas E A content analysis of Health Technology Assessment
programs in Latin America Int J Technol Assess Health Care 2009 Oct25(4)570-6 PMID 19845988
[PubMed - indexed for MEDLINE]
0
10
20
30
40
50
60
IECS ndash Argentina
SSS ndash Argentina
ETESA ndash Chile
GT-ATS ndash Brazil
IMSS ndash Mexico
CENETEC ndash Mexico
Published HTA Documents (2000ndash2007) in Latin America Arellano 2009
82 in short documents format but Indeed gt 50 target Third party payers And gt 40 targetting Government policy makers
In general the documents were clearly written and
contained three types of conclusions
(i) negative (n = 27 11 percent)
(ii) neutral (n = 90 38 percent) and
(iii) positive (n = 114 48 percent)
From January 2000 to March 2007
40 percent of published HTA documents in LA addressed clinical effectiveness
while 26 percent attempted to correlate the efficacy
and safety of a new technology in economic terms
The Pan American Health Organization (PAHO) Regional Office of the World Health Organization (WHO) for the Americas has tried to promote health technology assessment (HTA) in Latin America for 25 years
Health Technology Assessment in Latin America
Brazil Mexico Argentina
Health Technology Assessment in Latin America
Chile 1997 Ministry of Healthrsquos HTA office ETESAmdash the Unit for Health Technology Assessment a member of INAHTA
Colombia the Ministry of Social Protection plan an HTA Agency with the
academic sector
Cuba =gt HTA amp EBM in their healthcare system
Uruguay 2007 Ministry of Healthrsquos HTA program in the Department of Medical Technology
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Developing Health Technology Assessment in Latin America and the Caribbean 1999
Latin American and Caribbean (LAC) countries represent one of the most important emerging markets for HT and health authorities public and private insurers health professionals patients and the communications media and public opinion are gradually becoming more aware of the importance of HT and its evaluation
ldquoHTA is an essential component of the regulatory role of the health authorities and can help to strengthen their leadershiprdquo
Health Sector Reform Health Technology
There were deconcentration andor decentralization of services
The needs were growing and challenges were multiplying
There were incomplete transfer of technologies perfected in the developed countries
- incomplete adaptationplanning of the technologies to the organizational economic social and cultural situation of the receiving countries
the scarcity of many basic technologies
the excessive and indiscriminate use of expensive HT
the dearth of policies and standards to regulate the introduction and use of HT
the underdevelopment of support technologies (especially management information systems) and
inequalities in access to available HT were some of the more commonly cited problems in the Region
The more commonly cited problems in the region
2009 exploratory study to identify HTA programs in LA
An electronic search through two databases was performed to identify HTA programs in LA A content analysis was performed on HTA documents (n = 236) produced by six programs between January 2000 and March 2007 Results were analyzed by comparing document content with the main goals of HTA
Arellano LE Reza M Blasco JA Andradas E A content analysis of Health Technology Assessment
programs in Latin America Int J Technol Assess Health Care 2009 Oct25(4)570-6 PMID 19845988
[PubMed - indexed for MEDLINE]
0
10
20
30
40
50
60
IECS ndash Argentina
SSS ndash Argentina
ETESA ndash Chile
GT-ATS ndash Brazil
IMSS ndash Mexico
CENETEC ndash Mexico
Published HTA Documents (2000ndash2007) in Latin America Arellano 2009
82 in short documents format but Indeed gt 50 target Third party payers And gt 40 targetting Government policy makers
In general the documents were clearly written and
contained three types of conclusions
(i) negative (n = 27 11 percent)
(ii) neutral (n = 90 38 percent) and
(iii) positive (n = 114 48 percent)
From January 2000 to March 2007
40 percent of published HTA documents in LA addressed clinical effectiveness
while 26 percent attempted to correlate the efficacy
and safety of a new technology in economic terms
The Pan American Health Organization (PAHO) Regional Office of the World Health Organization (WHO) for the Americas has tried to promote health technology assessment (HTA) in Latin America for 25 years
Health Technology Assessment in Latin America
Brazil Mexico Argentina
Health Technology Assessment in Latin America
Chile 1997 Ministry of Healthrsquos HTA office ETESAmdash the Unit for Health Technology Assessment a member of INAHTA
Colombia the Ministry of Social Protection plan an HTA Agency with the
academic sector
Cuba =gt HTA amp EBM in their healthcare system
Uruguay 2007 Ministry of Healthrsquos HTA program in the Department of Medical Technology
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
ldquoHTA is an essential component of the regulatory role of the health authorities and can help to strengthen their leadershiprdquo
Health Sector Reform Health Technology
There were deconcentration andor decentralization of services
The needs were growing and challenges were multiplying
There were incomplete transfer of technologies perfected in the developed countries
- incomplete adaptationplanning of the technologies to the organizational economic social and cultural situation of the receiving countries
the scarcity of many basic technologies
the excessive and indiscriminate use of expensive HT
the dearth of policies and standards to regulate the introduction and use of HT
the underdevelopment of support technologies (especially management information systems) and
inequalities in access to available HT were some of the more commonly cited problems in the Region
The more commonly cited problems in the region
2009 exploratory study to identify HTA programs in LA
An electronic search through two databases was performed to identify HTA programs in LA A content analysis was performed on HTA documents (n = 236) produced by six programs between January 2000 and March 2007 Results were analyzed by comparing document content with the main goals of HTA
Arellano LE Reza M Blasco JA Andradas E A content analysis of Health Technology Assessment
programs in Latin America Int J Technol Assess Health Care 2009 Oct25(4)570-6 PMID 19845988
[PubMed - indexed for MEDLINE]
0
10
20
30
40
50
60
IECS ndash Argentina
SSS ndash Argentina
ETESA ndash Chile
GT-ATS ndash Brazil
IMSS ndash Mexico
CENETEC ndash Mexico
Published HTA Documents (2000ndash2007) in Latin America Arellano 2009
82 in short documents format but Indeed gt 50 target Third party payers And gt 40 targetting Government policy makers
In general the documents were clearly written and
contained three types of conclusions
(i) negative (n = 27 11 percent)
(ii) neutral (n = 90 38 percent) and
(iii) positive (n = 114 48 percent)
From January 2000 to March 2007
40 percent of published HTA documents in LA addressed clinical effectiveness
while 26 percent attempted to correlate the efficacy
and safety of a new technology in economic terms
The Pan American Health Organization (PAHO) Regional Office of the World Health Organization (WHO) for the Americas has tried to promote health technology assessment (HTA) in Latin America for 25 years
Health Technology Assessment in Latin America
Brazil Mexico Argentina
Health Technology Assessment in Latin America
Chile 1997 Ministry of Healthrsquos HTA office ETESAmdash the Unit for Health Technology Assessment a member of INAHTA
Colombia the Ministry of Social Protection plan an HTA Agency with the
academic sector
Cuba =gt HTA amp EBM in their healthcare system
Uruguay 2007 Ministry of Healthrsquos HTA program in the Department of Medical Technology
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
the scarcity of many basic technologies
the excessive and indiscriminate use of expensive HT
the dearth of policies and standards to regulate the introduction and use of HT
the underdevelopment of support technologies (especially management information systems) and
inequalities in access to available HT were some of the more commonly cited problems in the Region
The more commonly cited problems in the region
2009 exploratory study to identify HTA programs in LA
An electronic search through two databases was performed to identify HTA programs in LA A content analysis was performed on HTA documents (n = 236) produced by six programs between January 2000 and March 2007 Results were analyzed by comparing document content with the main goals of HTA
Arellano LE Reza M Blasco JA Andradas E A content analysis of Health Technology Assessment
programs in Latin America Int J Technol Assess Health Care 2009 Oct25(4)570-6 PMID 19845988
[PubMed - indexed for MEDLINE]
0
10
20
30
40
50
60
IECS ndash Argentina
SSS ndash Argentina
ETESA ndash Chile
GT-ATS ndash Brazil
IMSS ndash Mexico
CENETEC ndash Mexico
Published HTA Documents (2000ndash2007) in Latin America Arellano 2009
82 in short documents format but Indeed gt 50 target Third party payers And gt 40 targetting Government policy makers
In general the documents were clearly written and
contained three types of conclusions
(i) negative (n = 27 11 percent)
(ii) neutral (n = 90 38 percent) and
(iii) positive (n = 114 48 percent)
From January 2000 to March 2007
40 percent of published HTA documents in LA addressed clinical effectiveness
while 26 percent attempted to correlate the efficacy
and safety of a new technology in economic terms
The Pan American Health Organization (PAHO) Regional Office of the World Health Organization (WHO) for the Americas has tried to promote health technology assessment (HTA) in Latin America for 25 years
Health Technology Assessment in Latin America
Brazil Mexico Argentina
Health Technology Assessment in Latin America
Chile 1997 Ministry of Healthrsquos HTA office ETESAmdash the Unit for Health Technology Assessment a member of INAHTA
Colombia the Ministry of Social Protection plan an HTA Agency with the
academic sector
Cuba =gt HTA amp EBM in their healthcare system
Uruguay 2007 Ministry of Healthrsquos HTA program in the Department of Medical Technology
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
2009 exploratory study to identify HTA programs in LA
An electronic search through two databases was performed to identify HTA programs in LA A content analysis was performed on HTA documents (n = 236) produced by six programs between January 2000 and March 2007 Results were analyzed by comparing document content with the main goals of HTA
Arellano LE Reza M Blasco JA Andradas E A content analysis of Health Technology Assessment
programs in Latin America Int J Technol Assess Health Care 2009 Oct25(4)570-6 PMID 19845988
[PubMed - indexed for MEDLINE]
0
10
20
30
40
50
60
IECS ndash Argentina
SSS ndash Argentina
ETESA ndash Chile
GT-ATS ndash Brazil
IMSS ndash Mexico
CENETEC ndash Mexico
Published HTA Documents (2000ndash2007) in Latin America Arellano 2009
82 in short documents format but Indeed gt 50 target Third party payers And gt 40 targetting Government policy makers
In general the documents were clearly written and
contained three types of conclusions
(i) negative (n = 27 11 percent)
(ii) neutral (n = 90 38 percent) and
(iii) positive (n = 114 48 percent)
From January 2000 to March 2007
40 percent of published HTA documents in LA addressed clinical effectiveness
while 26 percent attempted to correlate the efficacy
and safety of a new technology in economic terms
The Pan American Health Organization (PAHO) Regional Office of the World Health Organization (WHO) for the Americas has tried to promote health technology assessment (HTA) in Latin America for 25 years
Health Technology Assessment in Latin America
Brazil Mexico Argentina
Health Technology Assessment in Latin America
Chile 1997 Ministry of Healthrsquos HTA office ETESAmdash the Unit for Health Technology Assessment a member of INAHTA
Colombia the Ministry of Social Protection plan an HTA Agency with the
academic sector
Cuba =gt HTA amp EBM in their healthcare system
Uruguay 2007 Ministry of Healthrsquos HTA program in the Department of Medical Technology
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
0
10
20
30
40
50
60
IECS ndash Argentina
SSS ndash Argentina
ETESA ndash Chile
GT-ATS ndash Brazil
IMSS ndash Mexico
CENETEC ndash Mexico
Published HTA Documents (2000ndash2007) in Latin America Arellano 2009
82 in short documents format but Indeed gt 50 target Third party payers And gt 40 targetting Government policy makers
In general the documents were clearly written and
contained three types of conclusions
(i) negative (n = 27 11 percent)
(ii) neutral (n = 90 38 percent) and
(iii) positive (n = 114 48 percent)
From January 2000 to March 2007
40 percent of published HTA documents in LA addressed clinical effectiveness
while 26 percent attempted to correlate the efficacy
and safety of a new technology in economic terms
The Pan American Health Organization (PAHO) Regional Office of the World Health Organization (WHO) for the Americas has tried to promote health technology assessment (HTA) in Latin America for 25 years
Health Technology Assessment in Latin America
Brazil Mexico Argentina
Health Technology Assessment in Latin America
Chile 1997 Ministry of Healthrsquos HTA office ETESAmdash the Unit for Health Technology Assessment a member of INAHTA
Colombia the Ministry of Social Protection plan an HTA Agency with the
academic sector
Cuba =gt HTA amp EBM in their healthcare system
Uruguay 2007 Ministry of Healthrsquos HTA program in the Department of Medical Technology
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
In general the documents were clearly written and
contained three types of conclusions
(i) negative (n = 27 11 percent)
(ii) neutral (n = 90 38 percent) and
(iii) positive (n = 114 48 percent)
From January 2000 to March 2007
40 percent of published HTA documents in LA addressed clinical effectiveness
while 26 percent attempted to correlate the efficacy
and safety of a new technology in economic terms
The Pan American Health Organization (PAHO) Regional Office of the World Health Organization (WHO) for the Americas has tried to promote health technology assessment (HTA) in Latin America for 25 years
Health Technology Assessment in Latin America
Brazil Mexico Argentina
Health Technology Assessment in Latin America
Chile 1997 Ministry of Healthrsquos HTA office ETESAmdash the Unit for Health Technology Assessment a member of INAHTA
Colombia the Ministry of Social Protection plan an HTA Agency with the
academic sector
Cuba =gt HTA amp EBM in their healthcare system
Uruguay 2007 Ministry of Healthrsquos HTA program in the Department of Medical Technology
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
The Pan American Health Organization (PAHO) Regional Office of the World Health Organization (WHO) for the Americas has tried to promote health technology assessment (HTA) in Latin America for 25 years
Health Technology Assessment in Latin America
Brazil Mexico Argentina
Health Technology Assessment in Latin America
Chile 1997 Ministry of Healthrsquos HTA office ETESAmdash the Unit for Health Technology Assessment a member of INAHTA
Colombia the Ministry of Social Protection plan an HTA Agency with the
academic sector
Cuba =gt HTA amp EBM in their healthcare system
Uruguay 2007 Ministry of Healthrsquos HTA program in the Department of Medical Technology
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Health Technology Assessment in Latin America
Chile 1997 Ministry of Healthrsquos HTA office ETESAmdash the Unit for Health Technology Assessment a member of INAHTA
Colombia the Ministry of Social Protection plan an HTA Agency with the
academic sector
Cuba =gt HTA amp EBM in their healthcare system
Uruguay 2007 Ministry of Healthrsquos HTA program in the Department of Medical Technology
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Health Technology Assessment in Latin America
Mexico National Centre for Excellence in Health Technology (CENETEC) programs and seminars related to health technology assessment and management
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Health Technology Assessment in Latin America
Brazil
After important milestones
2nd National Conference on Science Technology and Innovation in Health
2004 - National Agenda of Priorities in Health Research
2006 =gt institutionalization DECIT-CGATS HTA in the national government and joined INAHTA
2007 DECIT-CGATS - National Policy on Health Technology Management
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Health Technology Assessment in Latin America
Brazil
National Agency for Health Surveillance ANVISA
1999 Techno-Surveillance Medical Devices Post Market Surveillance
2000 - Network of Sentinel Hospitals
- National Register of Drug and Health Devices
- National System of Health Surveillance reinforced with States and Municipalities - VISAs
2003 =gt Health Ministry - VISAs Management Pact contracts with hospitals ndash Local networks under development
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Latin American Regulatory authorities have being evolving regarding methods to evaluate health products
Professional Societies are adopting HTA methods to built guidelines An HTA status in depth survey in Latin America is ongoing (Ana Perez)
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Health Technology Assessment in Latin America
Brazil
National Network of HTA REBRATS
2008 Brazilian Health Technology Assessment Network (Rede Brasileira de Avaliaccedilatildeo de Tecnologias em Sauacutede ndash REBRATS) a network of 24 Sentinel Hospitals and research institutions to congregate HTA stakeholders
The HTA REBRATS validated studies are disseminated to the Commission for Technology Incorporation from Ministry of Health
Research database created SISREBRATS
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Review
Studies financed by DECIT Health Ministry
bull Near 100
bull Bilingual structured abstracts
bull 10 from NATS-HCFMUSP
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
NATS-HCFMUSP
Is the HTA Center InCor (Heart Institute) amp Clinics Hospital of the Satildeo Paulo University Medical School the HC-FMUSP
Brief Institutional highlights
2500 active beds 15 million outpatient visits 400 thousands emergency care 500 thousands imaging exams 72 thousands Inpatient care 50 thousands Surgeries 25 thousands High-risk deliveries and 600 organ amp tissue transplantations
bull internship and 12 thousands medical residency in 49 medical specialities
bull 500 studentship in 93 multi-professional post-graduate programs
bull produced 15 thousands MSc amp PhD in 2010
bull over 3 thousands Research published
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Escola de Enfermagem
Instituto de Medicina Legal Instituto de Medicina Tropical
Emiacutelio Ribas
FACULDADE de MEDICINA SECRETARIA DE SAUacuteDE de SP CEFACS ndash Aperfeiccediloam Ciecircncias Sauacutede
The HC-FMUSP
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
WorkFlow New Technologies Adoption Proposals
Evaluation Proposal reception(Mini Assessment)
Responsible Reviewer amp Group Designation
Independent relevant scientific literature review amp previous local technology utilization
analysis (research(s) or alternative financing) or review utilization in other jurisdictions
1st WG Report
Report Review by peers
Report adjustment public presentation and discussion
Interview Proponent Complete or Defend | ambiguous topics
NATS
SP
EC
IFIC
WG
Economic factibility analysis
Favorable Report
NATS Report with economic file
HC LIST INCORPORATION ADMINISTRACcedilAtildeO
SUPERIOR
Decision Aproval or Non-aproval
Evaluation Proposal reception(Mini Assessment) completed with Executive Direction SignatureAdmInst
Adjust amp Process Aquisition planning for Program
Proponent Requisition ndash Specify Bid
Non-aprovalProponent revision claim
WG Review claim
Proponent Information
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Existing HTAs regarding efficacy safety effectiveness
or economic aspects if applicable are used or
updated with independent literature searches
If data published is applicable it is reanalyzed and
adapted for the aspect under assessment
Else primary studies are searched systematically
Local data is used to contextualize adapt and cross-
validate applicability or other aspects
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
HTA reviewing data on HT utilization and on outcomes
research is being used to analyze consistency across
jurisdictions
Structured searches published when applicable are
reproduced to update or adapt for particular aspects
under assessment
NATS-HCFMUSP Scientific Evidence Working Grouprsquos
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
NATS-HCFMUSP
EXAMPLES HTAs completed
bull Positron Emission TomographyOncology
bull Multi-Slices Tomography Coronary Angiography
bull Tacrolimus in Pediatric Heart Transplantation
bull Technologies in Surgical Arrhythmia Ablation
bull Adult heart transplantation cohort study
bull Biologic Agents in Rheumatoid Arthritis
bull Administrative Public Data Mining OLAP instrument
bull Post-marketing surveillance of infusion sets
bull Cohort study congenital heart deffects surgeries
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
NATS-HCFMUSP EXAMPLES HTAs ongoing
bull Intravascular Ultrasound with virtual histology
bull Cost-effectiveness of Hepatic transplantation
bull Municipal Investigation Methods Coronary Disease
bull Endobronchial Ultrasound Lung Cancer Biopsies
bull Siphon Valves in Hydrocephalus Control
bull Mofetil mycophenolate in immuno-modulation
bull Implantable Devices for Emphysemas
bull Valve implants for Glaucoma control
bull News and existing drugs protocol for neuropathic pain
bull Surgical sutures postmarketing surveillance assessment
bull Cardiac valves replacement costs and effects
bull Lung transplantation cost-effectiveness
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Cochrane Handbook for
Systematic Reviews of
Interventions
copy The Cochrane Collaboration
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
Above cited references are being used for training
graduate and post-graduation students how to do
structured searches in big medical schools
published when applicable are reproduced to
update or adapt for particular aspects under
assessment
NATS-HCFMUSP Scientific Evidence Working Group
members are active in specific Medical or Multi-
professional disciplines at each Institute and perform
searches systematically
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention
the active Scientific Evidence Working Group use
specific management software mentioned previously
to perform systematic update alerts for Medical or
Multi-professional Faculty or students and update
searches at main bibliographic databases or editor
sites
You are the experts
Thank you for your attention