Article type
Year
Abstract
Background: Since 2003, an evidence based medicine committee analyses the coverage criteria of new drugs, technologies and guidelines in a private health plan in Brazil. One of the main approaches was to establish parameters to the coverage of high cost diagnostic tests requested by the physicians. In parallel, an economic analysis of potential cost saving was made based upon the new established criteria.
Objectives: To determine parameters to the coverage of bone densitometry and potential cost saving originated from these new parameters in a private health plan in Brazil.
Methods: In February of 2004, the evidence based medicine committee performed a systematic search of literature in the electronic databases, brazilian guidelines and worldwide health plan policies for indications to perform bone densitometry. We searched for parameters as age, gender, diagnosis and previous interventions needed to validate the request for bone densitometry. We evaluated the pattern of the exams performed in 2002 and 2003, and assessed the potential cost saving after adopting these new parameters comparing the previous record.
Results: We evaluated information from 8 international guidelines and three systematic reviews considered of best quality. As a result of these analyses we determined that there is evidence to the use of bone densitometry in patients above 60 years, and with diagnostic hypothesis of osteoporosis without pathological fractures. It was established a two year minimum interval between exams. In patient younger than 60 years old shall have diagnostic hypothesis of osteoporosis due to medication use, and a minimum interval of 6 months between exams. We found that more than 80% of the exams covered in 2002 and 2003 did not match the established parameters. The economic analysis showed a potential cost saving of US$1.8 millions per year if unnecessary bone densitometries were not covered.
Conclusion: Bone densitometry had high rate of inadequate indication in a private health plan in Brazil. The evidence based committee could establish parameters to manage the costs of this diagnostic test. Defining parameters for high cost technology procedures could bring an important economic impact and also increase quality of healthcare in developing countries.
Objectives: To determine parameters to the coverage of bone densitometry and potential cost saving originated from these new parameters in a private health plan in Brazil.
Methods: In February of 2004, the evidence based medicine committee performed a systematic search of literature in the electronic databases, brazilian guidelines and worldwide health plan policies for indications to perform bone densitometry. We searched for parameters as age, gender, diagnosis and previous interventions needed to validate the request for bone densitometry. We evaluated the pattern of the exams performed in 2002 and 2003, and assessed the potential cost saving after adopting these new parameters comparing the previous record.
Results: We evaluated information from 8 international guidelines and three systematic reviews considered of best quality. As a result of these analyses we determined that there is evidence to the use of bone densitometry in patients above 60 years, and with diagnostic hypothesis of osteoporosis without pathological fractures. It was established a two year minimum interval between exams. In patient younger than 60 years old shall have diagnostic hypothesis of osteoporosis due to medication use, and a minimum interval of 6 months between exams. We found that more than 80% of the exams covered in 2002 and 2003 did not match the established parameters. The economic analysis showed a potential cost saving of US$1.8 millions per year if unnecessary bone densitometries were not covered.
Conclusion: Bone densitometry had high rate of inadequate indication in a private health plan in Brazil. The evidence based committee could establish parameters to manage the costs of this diagnostic test. Defining parameters for high cost technology procedures could bring an important economic impact and also increase quality of healthcare in developing countries.