Evaluación De Pertinencia Científica Y Análisis De Costo-Efectividad En Las Intervenciones De Salud

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de cuidados especializados tales: Médico, psicológico, enfermería, soporte nutricional, a los pacientes y a su familia, que incluyen los aspectos social y espiritual. El objetivo es brindar atención al paciente es controlar el dolor y otros síntomas ocasionados por la enfermedad. Esta propuesta nace de una necesidad de atención a una población de pacientes con enfermedades terminales, crónicas, degenerativas e irreversibles en diferentes fases de la enfermedad, con alto impacto en la calidad de vida. El plan de atención de cuidados paliativos y cuidados de fin de vida se direcciona a los usuarios con diagnóstico de una enfermedad terminal, crónica, degenerativa e irreversible de origen oncológico o no, desde su diagnóstico hasta la etapa “final de la vida”. Participar de forma activa en la atención con los cuidados adecuados y/o preferidos, sensibilización de la enfermedad por el paciente y su familia, con la gran meta de ofrecer una mejor calidad de vida con un mayor costo efectividad de los recursos disponibles. Iniciando el proceso desde la caracterización e identificación, hasta el seguimiento y la retroalimentación de resultados. PHP63 Detección Temprana Del Cáncer De Pulmón

health system 41 (36.6%) of the studies were observational, 64 (57.1%) comprised literature reviews and 7 (0.06%) were experimental. Observational studies have also comprised much of the results obtained for the SUS representing 86% of all studies, as a result of analytical studies with cohort design about cost-effectiveness, representing 68% of the total. Analysis of patient’s coverage by Obamacare financing system accounted for 31.2% of all the results. Most studies on diagnosis and prevention in Obamacare system are systematic reviews (54.2%), while for the SUS, 83.3% of the results were observational studies, in both systems the analysis focused on the cost-effectiveness of diagnostic techniques and the impact generated by them on a large scale.  Conclusions: None of the health systems studied completely meet the requirements for offering coverage to universal health care, as recommended by WHO. The ACA significantly increased the participation of state and federal US governments in financing public health, proposing to decrease the uncovered population, yet there are still large expenditures spent by the user. With wide population coverage, SUS tries today to expand the availability of services to all the population without requiring additional tax rates.

Fernandez JC, Remolina Medina C MUTUALSER EPS, PHAROS CENTRO DE ESTUDIOS CLINICOS, CARTAGENA DE INDIAS, Colombia

PHP66 A Via Administrativa E Judicial Como Forma De Acesso Aos Medicamentos No Sistema Público De Saúde Brasileiro

El Cáncer de Pulmón, es la principal causa de muerte por cáncer en el mundo, representando el 19% de las muertes por cáncer. Produce cerca de 1,6 millones de muertes/año. Es el cáncer más frecuente en hombres y el tercero en mujeres en el mundo. Es diagnosticado en aproximadamente 1.8 millones de personas/año, cerca del 13% de todos los cánceres, por lo que es considerado un problema de salud pública. El 10% de los pacientes diagnosticados con cáncer de pulmón en el mundo, están en estadios quirúrgicos. En Colombia solo el 5% son diagnosticados tempranamente. Los costos promedios de un paciente con cáncer de pulmón son de U$ 7.000 a >  U$40.000 por año: Quimioterapia 88%, Diagnóstico y estadificación 5%, Cirugía 5%, Hospitalización 2%. En la práctica clínica, la mayoría de pacientes con esta patología consulta al médico en estadios avanzados, en tanto que los estadios tempranos pueden pasar desapercibidos debido a que no presentan signos y síntomas sospechosos y no consigue identificar pacientes con posibles factores de riesgo para cáncer de pulmón, además No hay programas para detección temprana de cáncer de pulmón. Al desarrollar un programa para para la detección temprana, los pacientes con riesgo de desarrollar cáncer de pulmón serán llevados a un programa de seguimiento, que permita diagnosticar tempranamente esta enfermedad, con lo cual se podrá iniciar un tratamiento oportuno, con aumento de la sobreviva y disminución de los costos de tratamiento al sistema de salud e iniciar programas de tratamiento y seguimiento del tabaquismo, para eliminar este factor como riesgo de cáncer de pulmón. Este programa de detección temprana de cáncer de pulmón incluye además Programa de seguimiento de Nódulo pulmonar, Programa para prevención y tratamiento del tabaquismo. Con lo cual se obtiene una reducción en los costos directos de tratamientos a menos de U$2.000/año.

Chagas VO, Provin MP, Amaral RG Universidade Federal de Goiás, Goiânia, Goiás, Brazil

PHP64 Estratégias Intitucionais Como Mecanismo De Racionalização Das Demandas Judiciais De Medicamentos Chagas VO, Provin MP, Amaral RG Universidade Federal de Goiás, Goiânia, Goiás, Brazil

Objetivos: Identificar as estratégias institucionais criadas pelo agentes públicos, do setor saúde e do sistema de justiça, para racionalizar as demandas judiciais por medicamentos e garantir o acesso integral à saúde.  Métodos: Trata-se de um estudo de caso de abordagem qualitativa, em que os dados foram coletados por meio de pesquisa documental e entrevistas semiestruturadas com os atores-chave do setor saúde e do sistema de justiça em uma capital da região centro-oeste do Brasil. RESULTADOS : Identificou-se sete estratégias institucionais, sendo quatro criados pelo setor saúde e três pelo sistema de justiça. Dentre estas estratégias estão os departamentos, comissões, câmaras técnicas e termos de cooperação técnica, criadas como um mecanismo de racionalização das demandas judiciais por medicamentos. Evidenciou-se que estas estratégias solucionaram alguns problemas na gestão da assistência farmacêutica, ofereceram assessoria técnica ao sistema de justiça para análise das demandas judiciais e promoveram o diálogo e a aproximação entre as instituições envolvidas neste processo. Houve consenso de que as estratégias institucionais auxiliaram na garantia do acesso integral à saúde, reduziram o número de demandas judiciais por medicamentos propostas pelo sistema de justiça contra o setor saúde, ao priorizar a resolução dos conflitos de acesso a medicamentos de forma administrativa. Entretanto, estas demandas não foram extintas e trouxe poucos avanços à política farmacêutica vigente. CONCLUSÕES: Os resultados sugerem que o sistema de saúde deveria atender as necessidades dos usuários de forma integral, sem a necessidade de criar novos caminhos ou estratégias institucionais pelo setor saúde e pelo sistema de justiça. A criação de estratégias como um novo caminho à judicialização da política de assistência farmacêutica, não é a solução mais eficaz, sendo necessário tornar as vias de rotina de acesso aos medicamentos mais efetivas. PHP65 Accessibility To Oncologic Treatment In Sus Public Health Systems And Obamacare Rodrigues SR Universidade de São Paulo, São Paulo, Brazil

Objectives: Comparing the American financing system in healthcare (ACA) and the single system of Brazilian health (SUS), in relation to the population accessibility to treatment using oncotherapy as a model and the WHO recommendations as a parameter.  Methods: A survey was carried out on legal and organizational definitions of Brazilian and American public health systems in guides and portals specialized on the theme. For analysis of the impact and effectiveness of the two health systems in accessibility to cancer treatment a review of the available literature on the subject in PubMed and ISI Web of Science scientific databases was carried out.  Results: In accordance to the classification proposed for the American

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Objetivos: Analisar o perfil dos demandantes e o conteúdo dos processos judiciais e administrativos para fornecimento de medicamentos pelo sistema público de saúde. Trata-se de um estudo descritivo transversal realizado com uma amostra de 511 processos judiciais e 458 processos administrativos que solicitavam medicamentos ao sistema público de saúde de uma capital da região centro-oeste do Brasil. Utilizou-se um formulário contendo variáveis relacionadas às características sociodemográficas e enfermidades dos demandantes e as características e os custos dos medicamentos demandados. Realizou - se uma análise descritiva e comparativa das variáveis do processo, sendo utilizado um nível de significância de 5%. RESULTADOS: A média de idade dos demandantes foi de 44,2 anos (DP + 24,6) e da renda foi de 7,8 salários mínimos (DP + 6,2). Mais da metade dos demandantes eram do sexo masculino (55,2%). O número médio de medicamentos solicitados foi maior nos processos judiciais do que nos administrativos (2,9 versus 1,8; p < 0,001). Observou-se maior renda dos demandantes e custo dos medicamentos nos processos judiciais (p <  0,001). Verificou-se maior proporção de prescrições originárias do sistema público de saúde nos processos administrativos (p < 0,001). Verificou-se maior proporção de medicamentos padronizados e não padronizados com alternativa terapêutica disponível pelo sistema público de saúde nos processos judiciais (p< 0,001). CONCLUSÕES: Co nclui-se que a indisponibilidade de medicamentos padronizados pelas políticas de assistência farmacêutica não são suficientes para garantir o acesso fazendo com que as pessoas recorram ao poder Judiciário, por meio de processos judiciais, e ao poder Executivo, por meio de processos administrativos, para diminuir os as dificuldades no acesso aos medicamentos. No entanto, o fornecimento destes medicamentos pode aprofundar as iniquidades sociais e do próprio sistema de saúde, além de utilizar os recursos públicos escassos para o atendimento de uma parcela restrita da população. PHP67 Practical considerations for a dialysis provision model of care for end-stage renal disease (esrd). Benchmark of international experiences, opportunities for the mexican social security institute (imss) Brabata C BAXTER, MIAMI, FL, USA

Objective: This study aims to methodologically assess international dialysis provision models, analyze standard and innovative interventions used globally, and identify opportunities for improvement in the model of care for the Mexican Social Security Institute (IMSS).  Methods: Development of review framework is crucial to analysis, comparison and relevant benchmarking. Following a literature review of the international data (primary and secondary; English and Spanish) dating back to 2001, a methodological framework for the “Dialysis Provision Model” of care was developed to guide the assessment of international models and taking into consideration the current IMSS landscape.  Results: Internationally, a variety of policies, service organization, provider payment schemes and tracking for dialysis exist. Half of the articles discussing standard or innovative practices are from the United States, Canada, and Australia. However, despite few publications, innovative models were found in Colombia, China, Thailand and Hong Kong. Compared to other countries, IMSS has been successful in home dialysis (peritoneal dialysis), however, there exist a number of opportunities for IMSS to further regulate home-dialysis targets, including streamlining services, aligning provider payments and incentives across the continuum of care, and measuring results associated with the management of ESRD patients. CONCLUSION: This review establishes a practical framework that will allow IMSS – and the broader international community – to assess its dialysis provision model, and establishes a systematic path for improvements in the model of care in Mexico. PHP68 Evaluación De Pertinencia Científica Y Análisis De Costo-Efectividad En Las Intervenciones De Salud Fernandez JC1, Failach Zubiria C2 1MUTUALSER EPS, PHAROS CENTRO DE ESTUDIOS CLINICOS, CARTAGENA DE INDIAS, Colombia, 2MUTUALSER EPS, CARTAGENA DE INDIAS, Colombia

El aumento creciente de los costos de los servicios de Salud y la crisis económica del sector, ha creado la necesidad urgente de evaluar financieramente las tecnologías en salud, con el objetivo de priorizar las intervenciones que ofrecen mejor valor o beneficio en relación a sus costos El objetivo es presentar el modelo utilizado para determinar la pertinencia científica y análisis de costó-efectividad de las intervenciones en salud, que afectan la relación entre los actores (aseguradores, reguladores,

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prestadores y pacientes) del sistema y llevan a un desbalance por el aumento de costos de las nuevas tecnologías y las que realmente disminuyen las tasas de morbimortalidad. Se analizaron 36.890 pacientes en el año 2016 en los cuales se realizaron intervenciones de salud, pertenecientes a un asegurador privado del régimen subsidiado en Colombia. Este modelo está basado en la auditoría para el mejoramiento de la calidad de la atención en salud y la pertinencia científica. Entendiendo a la auditoría como una herramienta de gestión de la calidad y, a su vez la dirección científica como una herramienta de la gestión gerencial en el desarrollo de metodologías e instrumentos propuestos en las experiencias exitosas, basados en la evidencia científica demostrable, armonizándolas con sus condiciones específicas y adaptándolas de manera responsable tendientes a disminuir el consumo de recursos, que se traducen en costos en salud con mejores resultados para los pacientes y el sistema. Este método, mostro una reducción significativa en costos en salud, que son replicables en las organizaciones o aseguradores en salud, para lograr difundir el conocimiento, facilitar la participación de los actores del sistema de salud en la elaboración de protocolos clínicos y directrices terapéuticas que conllevan a mejorar la indicación de las intervenciones siendo más coto efectivas, generando mayor cobertura y calidad en la atención. PHP69 The Importance Of The Disinvestment Process In The Public Health System Correa JS1, Chabrol Haas L2, Vasconcellos JF3, Santiago IC4 1Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil, 2MSD Brasil, São Paulo, Brazil, 3Sense Company, Rio de Janeiro, Brazil, 4Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil

In recent years, discovery of new technologies were accompanied by a growth in treatment costs and put health spending among the largest expenses of public systems and families around the world. In order to respond to the need to evaluate and select health technologies that deserve to be incorporated to health systems, methods have been developed to support this process. However, post incorporation analyses of these technologies are necessary for safety or cost effectiveness of what is kept in circulation. This work aims to promote the understanding of the processes that lead to the elaboration of recommendations regarding the maintenance of technology or disinvestment in Brazil, through definitions, detailed descriptions and case studies. The reasons for evaluating the performance of technologies already included in the Brazilian Public Health System, such clinical effectiveness of incorporated technologies, were elucidated, determining the factors that influence the decision to disinvest. The decision to disinvest considered the results of review of health technologies. Additionally, case studies were obtained from the database of the Brazilian Public Health System and consist of the exclusion of Telaprevir and Boceprevir, used in the treatment of hepatitis C, and betainterferon 1A 6.000.000 UI (30 μ g) (Avonex®), used in the treatment of Relapsing Remitting Multiple Sclerosis. Based on the reported cases, it was concluded that the process of disinvestment and reinvestment in technologies should be focused on the best risk and benefit ratio for the population, aiming the availability of cost effective treatments and services, and that well-structured methods, such as the guideline published by National Committee for Health Technology Incorporation, could make the disinvestment process more transparent. PHP70 Un Marco Conceptual Para El Análisis De La Implementación De Los Componentes De La Salud Electrónica (E-Salud) Y Su Efecto En La Calidad En La Provisión De Servicios De Salud Díaz de León C Consejo Nacional de Ciencia y Tecnología - Infotec, Aguascalientes, Mexico

La salud electrónica (e-Salud) es un concepto amplio que implica la aplicación de las tecnologías de información y comunicación (TIC) en los sistemas de vigilancia, prevención y(o) atención a la salud. Como componentes de la e-Salud se incluye principalmente los sistemas de administración de insumos o recursos (agenda de citas, laboratorio clínico o farmacia), el expediente electrónico, la prescripción electrónica, los sistemas de apoyo a la decisión clínica, el uso de dispositivos móviles (salud móvil), los sistemas de imagenología, los sistemas de atención a distancia (telemedicina), así como la enseñanza a través de medios digitales. Otros componentes que pueden considerarse parte de la e-Salud son los sistemas de almacenamiento y análisis masivo de datos (“big data”), el aprendizaje artificial, así como los sistemas de “internet de las cosas”. En este trabajo se diseñó un marco conceptual para analizar la implementación de componentes de e-Salud y sus efectos (o impacto) en la calidad en la provisión de servicios de salud. Se incorporaron en el modelo elementos de implementación de los componentes de e-Salud en las organizaciones o instituciones de salud, así como el proceso de adopción-apropiamiento de estos componentes por actores clave de los procesos de prevención y(o) atención a la salud (profesionales sanitarios, usuarios de servicios o pacientes, personal técnico y administrativo). Las dimensiones de análisis de calidad incluidas en el modelo fueron accesibilidad y utilización de servicios, calidad técnica, calidad interpersonal, seguridad, efectividad, eficiencia, satisfacción y equidad. A través de una revisión bibliográfica en bases de datos y(o) literatura especializada se identificaron diversos criterios de análisis de los diferentes elementos incluidos en el marco conceptual. Los elementos del modelo fueron incorporados dentro del continuo “estructura proceso - resultado” de Donabedian y son susceptibles de analizarse a través de la aplicación de métodos cualitativos, cuantitativos o mixtos. DISEASE- SPECIFIC STUDIES CARDIOVASCULAR DISORDERS – Clinical Outcomes Studies PCV1 Systematic Review Of Statins Effectiveness In Prevention Secondary In Elderly

Shoshima AY1, Costa MG2, Tura BR2 1Secretaria Municipal de Saúde Santana de Parnaíba, Santana de Parnaiba, Brazil, 2Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil

Objectives: Although several studies have demonstrated the relationship between high serum cholesterol levels and cardiovascular disease incidence, this relationship for the elderly seems to be the opposite. Observational studies have shown that, in the elderly, higher serum cholesterol rates represented reduction in mortality. Statins have already demonstrated their benefits in the treatment of cardiovascular disease in adults. This correspondence is much clearer in secondary prevention of cardiovascular disease . Based on this context, the objective of this study was to evaluate the efficacy of statins in the secondary prevention of cardiovascular events in the elderly.  Methods: A systematic literature review was conducted in the databases: Medline (by PubMed), Embase, Cochrane Library, Center for Reviews and Dissemination (CRD), In which searched for randomized controlled trials (RCTs) that evaluated the efficacy of statins in the elderly whose outcomes were mortality (all causes or cardiovascular disease ), fatal and nonfatal myocardial infarction, stroke or revascularization. Two independently reviewers identified articles that met the inclusion and exclusion criteria. The quality of the evidence was verified using the Cochrane bias risk assessment tool. Six RCTs were included in the systematic review and meta-analysis was performed by outcome.  Results: this systematic review show that in the elderly with a pre-existing cardiovascular disease the statin is able to reduce death from all causes, presenting a relative risk of 0.78 (95%CI 0,70-0,86) I2= 0% (p= 0,7912), death by CVD RR= 0.69 (95%CI 0,60-0,80) I2= 0% (p= 0,5081), fatal and nonfatal acute myocardial infarction RR= 0,72 (95%CI 0,63-0,83) I2= 0% (p= 0,8489), nonfatal myocardial infarction RR= 0,75 (95%CI 0,64-0,87) I2= 0% (p= 0,7460), AVC RR= 0.80 (95%CI 0,66-0,96) I2= 42,6% (p= 0,1363) and revascularization RR= 0,70 (95%CI 0,60-0,81) I2= 0% (p= 0,5611).  Conclusions: Despite statins have shown efficacy, treatment decisions should consider the patient’s individual status regarding comorbidity, polypharmacy, and patient opinion, since the elderly have a higher risk of adverse effects by this drug’s class. PCV2 An Assessment Of Correlation Between Mortality And Distance From Patient’s Residence To Interventional Center In Percutaneous Coronary Intervention In Brazil Matsumoto YK1, Campos DF1, Rosim RP1, Duva AS1, Hirth WA1, Ballalai Ferraz AF1, Braile DM2 1QuintilesIMS, São Paulo, Brazil, 2FAMERP, São José do Rio Preto, Brazil

Objectives: To assess the relationship between myocardial infarction in-hospital mortality after percutaneous coronary intervention (PCI) and transportation time from patient’s residence to interventional center in the Brazilian public healthcare system (SUS).  Methods: Brazilian public healthcare claim databases (DataSUS) were used to assess the relationship between myocardial infarction in-hospital mortality and the transportation time from patients’ residence zip code to interventional center where PCI was performed. DataSUS data between June 2014 and June 2016 was extracted. Transportation time was obtained through Google Maps Distance Matrix API. Patients’ sample was defined selecting only patients with records of PCI through balloon inflation or stent placement. In order to reduce sampling noise, patients with inconsistent outcome data, zip code or interventional center identification were excluded from sample. Additionally, any transportation time higher than three hours were excluded in order to reduce risk of bias resulting from potential travel. Transportation times were stratified in two groups: less than one hour and more than one hour. Statistical significance was tested through Fisher’s exact test. Brazilian states were clustered according to their annual per capita gross domestic profit (GDP): one group higher than the country’s median (group A) and another one below the country’s median (group B).  Results: Out of 56.883 hospitalizations, 54.141 were included in the analysis. When analyzing the country as a whole, no difference in in-hospital mortality was observed between patients living closer or farther to the hospital that provided the PCI. However, patients living closer to the hospital in group B states had a lower mortality compared to those living farther (OR= 0.83. p= 0.03), what was not observed in group A states.  Conclusions: Distance between patients’ residence and hospital seems to have higher effect over mortality in lower GDP per capita states. Further investigation on reasons for differences between group A and B results is needed.

Cardiovascular Disorders – Cost Studies PCV3 Budget Impact Analysis Of Adopting Evolocumab In The Brazilian Private Healthcare System For Patients With Uncontrolled LDL-C And High Cardiovascular Risk dos Santos RF1, Alves FP1, Urbich M2, Villa G2, Farsky PS3 1Amgen, São Paulo, Brazil, 2Amgen (Europe) GmbH, Zug, Switzerland, 3Instituto Dante Pazzanese de Cardiologia (IDPC), São Paulo, Brazil

Objectives: To estimate the budget impact of adding evolocumab to standard lipidlowering therapy (LLT) (statins with or without ezetimibe) in high-risk patients from the Brazilian private healthcare system perspective.  Methods: This analysis considered high cardiovascular (CV) risk patients, specifically, individuals with non-familial hyperlipidemia or heterozygous familial hypercholesterolemia (HeFH), with history of CV event in the previous year and uncontrolled LDL-C (≥ 160 mg/dL). The baseline CV event rate was derived from a retrospective database study (SIDIAP), with inclusion criteria similar to the Brazilian population. This analysis used the relationship between LDL-C lowering and reduced CV event rates observed in the Cholesterol Treatment Trialists’ Collaboration (CTTC) meta-analyses. CV event costs (inflated to 2016 values) were taken from local published studies. The total budget impact was estimated as the difference between additional medication costs and reduced CV event and procedure costs associated with the introduction of evolocumab. The budget impact was also expressed per member per month, with respect to the total