Health technology assessment in the Brazilian National Health System: profile of CONITEC exclusion recommendations, 2012-2023

Pinheiro, Francielli Salles; Borges, Stéfani Sousa; Rodrigues, Fernanda d’Athayde

doi:10.1590/S2237-96222024v33e20240057.en

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 33 • 2024 • https://doi.org/10.1590/S2237-96222024v33e20240057.en linkcopy

Health technology assessment in the Brazilian National Health System: profile of CONITEC exclusion recommendations, 2012-2023

Evaluación de tecnologías en salud en el Sistema Único de Salud: perfil de las recomendaciones de exclusión de Conitec, de 2012 a 2023

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective To analyze the recommendations for exclusion of health technologies in the Brazilian National Health System (SUS), made by the National Commission for the Incorporation of Technologies in the Brazilian National Health System (CONITEC) from 2012 to 2023, and to identify the disinvestment criteria used.

Methods Documentary, descriptive and retrospective analysis of CONITEC reports that assessed technology exclusion requests.

Results We identified 24 reports on 74 technologies, whereby the requests predominantly involved medications (95.9%). CONITEC favorably recommended 95% of the exclusions, prioritizing the absence of registration with the National Health Surveillance Agency and the existence of therapeutic alternatives.

Conclusion Low demand for exclusions compared to incorporations reveals challenges in identifying obsolescence and resistance to exclusion of technologies. The sustainability of the SUS requires greater monitoring of incorporated technologies, to optimize resources and promote the efficiency of the health system.

Keywords
Health Technology Assessment; Brazilian National Health System; Health Care Economics; Document Analysis

Main results The study identified that demands for exclusion of technologies in the Brazilian National Health System (Sistema Único de Saúde - SUS) are significantly lower than demands for incorporation, highlighting the need to pay greater attention to the disinvestment process, in order to guarantee the sustainability of the health system.

Implications for services The findings of this study point to the importance of structuring disinvestment assessment methods, with the aim of improving monitoring of health technology obsolescence and promoting more efficient allocation of resources in the SUS.

Perspectives We suggest that criteria be established for the periodic re-assessment of incorporated technologies, in order to guarantee regular reviews and the fluidity of CONITEC’s work in assessing health technologies.

Justifications for exclusion	Number of technologies (n = 70)	Percentage of technologies (%)
PCDT^a changes	13	18.57
ANVISA^b registration expired, cancelled or inexistent^b	22	31.43
Production discontinuation	3	4.28
Existence of available therapeutic alternatives with better therapeutic efficacy and safety profile	20	28.57
Clinical evidence of insufficient efficacy	14	20
Prohibition of commercialization, distribution, manufacture, import, manipulation and advertising	3	4.29
Exclusion of the technology with which its use was associated	2	2.86
Disuse of technology in the CEAF^c	14	20

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[1] a) Clinical Protocols and Treatment Guidelines; b) National Health Surveillance Agency; c) Specialized Component of Pharmaceutical Care.

Note: Multiple reasons for exclusion were identified for the same technology. The proportion in the third column refers to the total number of individual assessments that with final recommendation for exclusion from the SUS (n = 70).