Article type
Year
Abstract
Background: The decision of health plans and governments to adopt new technologies should be made ideally according to evidence-based information. Since 2003, an EBM program was established in one of the largest commercial health plans in Brazil, which insures half a million people.
Objectives: To evaluate the requests of incorporation of new technologies, and the quality of the literature sent as bibliographic support. To evaluate potential cost savings with the decision of not to include in coverage new technologies considered experimental or ineffective.
Methods: A group of four EBM trained physicians reviewed all the requests for adoption of new technologies from July 2003 until March 2005. Each request form should be accompanied by proper literature, selected by the requesters. For each request, a systematic search of literature was performed, followed by critical appraisal of the retrieved information. When possible, evaluation of the possible economic impact in the health plan was done. Based on the quality of evidence found, we recommended for or against the adoption of the new technology.
Results: 149 requests for new technologies were evaluated in 21 months. Of those, 42 (28%) were considered effective, and so recommended for adoption. 28 (19%) were considered ineffective, 79 (53%) experimental, making the requests denied. Of the original 149 procedures requests, 63 (42%) did not contain any bibliography. 69(46%) had as main source advertisement material provided by pharmaceutical companies and opinion-based literature. Only 17 (12%) were based on high quality literature (guidelines, randomized controlled trials or systematic reviews). Analysis of the economic impact in nine costly technology-based interventions showed annual potential savings of US$ 12.4 million.
Conclusions: The majority of specialist is not trained to retrieve and appraise information and most of the times do not have the ability to properly back up new procedures' requests with adequate literature. The implementation of an evidence-based coverage policy could bring a high economic impact and also increase quality of healthcare in developing countries.
Objectives: To evaluate the requests of incorporation of new technologies, and the quality of the literature sent as bibliographic support. To evaluate potential cost savings with the decision of not to include in coverage new technologies considered experimental or ineffective.
Methods: A group of four EBM trained physicians reviewed all the requests for adoption of new technologies from July 2003 until March 2005. Each request form should be accompanied by proper literature, selected by the requesters. For each request, a systematic search of literature was performed, followed by critical appraisal of the retrieved information. When possible, evaluation of the possible economic impact in the health plan was done. Based on the quality of evidence found, we recommended for or against the adoption of the new technology.
Results: 149 requests for new technologies were evaluated in 21 months. Of those, 42 (28%) were considered effective, and so recommended for adoption. 28 (19%) were considered ineffective, 79 (53%) experimental, making the requests denied. Of the original 149 procedures requests, 63 (42%) did not contain any bibliography. 69(46%) had as main source advertisement material provided by pharmaceutical companies and opinion-based literature. Only 17 (12%) were based on high quality literature (guidelines, randomized controlled trials or systematic reviews). Analysis of the economic impact in nine costly technology-based interventions showed annual potential savings of US$ 12.4 million.
Conclusions: The majority of specialist is not trained to retrieve and appraise information and most of the times do not have the ability to properly back up new procedures' requests with adequate literature. The implementation of an evidence-based coverage policy could bring a high economic impact and also increase quality of healthcare in developing countries.
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