The incorporation of Health Technologies: Brazil at the forefront

Incorporação de Tecnologias em Saúde: Brasil na Vanguarda

Abstract

Twenty years after the enactment of the Lei Orgânica da Saúde1 [Health Organic Law],
which created the Brazilian Unified Health System (SUS), Brazil changes it with the enactment
of Law No. 12,401/112, the Lei da Integralidade do SUS [SUS Integrality Law]. It provides for
therapeutic care and the incorporation of health technology. Despite the delay in defining how
the SUS would update itself, the enactment of this law occurred in an important time for the
country, which is rapidly growing and in a better position of strength to move toward evidencebased technological updates.
The law establishes that the incorporation, exclusion or change of medications, products and
procedures, as well as the development or change of clinical protocols and therapeutic guidelines,
should be based on reports taking into account scientific evidence concerning the efficiency,
accuracy, effectiveness and safety of medications, products or procedures. Additionally, it should
contain a comparative economic evaluation of the benefits and costs of new technology in
relation to already implemented technology, or in relation to home care, outpatient or hospital
care, when appropriate2. These changes place Brazil among a select group of countries that have
already adopted this model, such as England, Canada, Spain, Scotland, and Australia.
The standards that are now contained in the federal law have always been objects of discussion
in hospitals within the pharmacy and therapeutic committees, but it is known that there is great
difficulty in putting these standards into practice, which has been a challenge for pharmacists.
The evaluation and recommendation to incorporate new technologies within the SUS is
also defined by a committee, the National Committee of Technology Incorporation in the SUS
(CONITEC), created by the SUS Integrality Law. CONITEC is coordinated by the Department
of Science, Technology and Strategic Inputs (SCTIE) and also has the responsibility of updating
the National List of Essential Medication (RENAME).
The role of CONITEC’s Executive Secretariat, which is exercised by the Department of Management
and Incorporation of SCTIR, is to manage and coordinate CONITEC’s activities as well as to provide
reports on technology while considering scientific evidence, containing an economic assessment and the
impact of technologies within the SUS. To ensure that society has access to this decision-making process,
these reports will be freely accessible to stakeholders via the Brazilian Ministry of Health website3.
The availability to society of conclusive reports concerning CONITEC’s decisions will
provide transparency for the process and also guide decision-making on the part of SUS
managers and also for public and private health institutions. Additionally, the government’s
judiciary branch can use these reports to support its decisions concerning related processes3.
This entire process is based on very recent science in Brazil, but science that has spread very rapidly, especially in hospitals, which is the assessment of health technologies (ATS). Such
science is defined by the Ministry of Health as a “continuous process of the analysis and synthesis
of benefits for healthcare, and the economic and social consequences of the employment of
technologies, considering aspects such as safety, accuracy, efficacy, effectiveness, costs, costeffectiveness and also equity, as well as the ethical, cultural and environmental impacts involved
in its use.”4
The ATS’ objective is to support decision-making concerning the incorporation and
monitoring of technology, whether within the scope of each health institution or within the