An initiative to provide evidence-based support for judicial decision on healthcare in Brazil

Article type
Authors
1Centre of Health Technology Assessment (HTA), Hospital Sírio-Libanês, Universidade Federal de São Paulo
2Centre of Health Technology Assessment (HTA), Hospital Sírio-Libanês
Abstract
Background: Between the years of 2008 and 2017, judicial demands related to healthcare increased 130% in Brazil [1]. In 2016, the 10 most expensive drugs that were legally demanded comprised 91% of the resources guaranteed for the acquisition of technologies by the Brazilian Government. In this scenario, it is necessary to adopt strategies to enhance the judicial process, ensuring that the jurisdictional decision is informed by the best evidence. Objectives: To present the implementation and initial results of an initiative that comprises a set of strategies to provide evidence-based support during the judicial process on healthcare in Brazil. Methods: Descriptive study conducted at the Centre of Health Technology Assessment (HTA), Hospital Sírio-Libanês (São Paulo, Brazil). Results:Through a broad project of the Brazilian Ministry of Health, formally named PROADI-SUS, a partnership has been established between Hospital Sírio-Libanês and the National Council of Justice since 2016. This partnership was consolidated with the implementation of an initiative composed of a set of 7 strategies aimed at supporting the judicial process in healthcare. The strategies comprise: (1) three editions of an online course (300 hours) for 403 health and law professionals addressing topics related to evidence-based medicine (EBM) and HTA; (2) seven workshops, in all Brazilian geographic regions, for training 110 health professionals who provide technical support to the judiciary (NATJus), in the preparation of evidence reports on the efficacy and safety of healthcare technologies; (3) management and technical support for validate the evidence synthesis produced about the most legally requested technologies (69 drugs, devices or procedures to date) in Brazil; (4) creation and content maintenance of an online open access repository (e-natjus platform) for consulting evidence reports (487 to date) and evidence synthesis (69 to date) produced along this initiative; (5) online tutoring for NATJus’ team, via the e-natjus platform, to support scientific questions that arise during the production of short evidence reports; (6) blog with 3 to 4 weekly posts focused on events and supporting material related to judicial process on healthcare, EBM and HTA (www.redenatjus.com); and (7) three editions of a 2-days symposium addressing judicialisation issues and promoting debates among law and health professionals, health managers, consumers and journalists. Conclusion: We hope that the initiative, by the adoption of EBM practices, will contribute to (a) enhance the judicial process on healthcare in Brazil so the best possible option could be available within the context of a public and universal health system, (b) the sustainability of the Brazilian public health system. Patient or healthcare consumer: Conducting judicial process under the premises of EBM may contribute so that the population receives the best possible healthcare in a scenario of a public and universal system and scarce resources. Support:Brazilian Ministry of Health / PROADI-SUS, Hospital Sírio-Libanês.