ABSTRACT BACKGROUND: The relationship between spirituality and health has been the object of growing discussion. There is a lack of data on spiritual needs assessments in Brazil. OBJECTIVE: This study aimed to assess the spiritual needs of patients admitted to a public tertiary hospital and perform a comparative analysis between patients with and without indications for palliative care. DESIGN AND SETTING: A cross-sectional observational study included patients hospitalized between August and December 2020 in Hospital do Servidor Publico Municipal, Sao Paulo, Brazil. METHODS: The included patients answered a questionnaire consisting of sociodemographic data, the Duke religiosity scale, and the Spiritual Needs Assessment for Patients (SNAP) tool for a spiritual needs assessment. The World Health Organization Palliative Needs tool (NECPAL) was used to evaluate the indications for palliative care. The level of significance adopted was 5%. RESULTS: A total of 66 patients were included in this study. Most participants (97%) declared themselves as belonging to a religion. The group without indication for palliative care by the NECPAL showed greater spiritual (P = 0.043) and psychosocial needs (P = 0.004). No statistically significant difference was observed in the religious needs domain (P = 0.176). There were no statistically significant differences in the Duke scale scores between the two groups. CONCLUSION: Spiritual, psychosocial, and religious needs are prevalent among hospitalized patients, and multidisciplinary teams must consider these needs in their management approach. In addition, this study suggests that psychosocial and spiritual needs can be even higher in patients who do not receive palliative care.

Resumo Nos processos de avaliação de tecnologias em saúde (ATS), critérios de decisão são considerados relevantes para apoiar o complexo processo deliberativo que requer consideração simultânea de múltiplos fatores. Objetivou-se identificar e analisar os critérios de decisão que têm sido utilizados pela Comissão Nacional de Avaliação de Tecnologias em Saúde (CONITEC) na recomendação de incorporação de tecnologias para o tratamento do câncer. Trata-se de um estudo descritivo, baseado em relatórios da CONITEC, entre 2012 e 2018, sobre tecnologias em oncologia. Os dados foram coletados em formulário de extração específico e analisados por meio de estatísticas descritivas. Foram analisados 39 relatórios, 15 deles não apresentavam nenhum critério de decisão explícito. Os medicamentos constituíram o tipo de tecnologia mais frequentemente avaliado. Os tipos de cânceres mais frequentes foram: de mama, de cabeça e pescoço, colorretal, linfoma não Hodgkin e de pulmão. Os critérios considerados com mais frequência foram: impacto financeiro e efetividade. O estudo identificou os critérios de decisão que têm sido mais utilizados na área de oncologia, entretanto, a falta de transparência em relação ao peso desses critérios torna difícil compreender a influência deles no resultado das decisões tomadas.

Abstract In health technology assessment (HTA), decision criteria are considered relevant to support the complex deliberative process that requires simultaneous consideration of multiple factors. The aim was to identify and analyze the decision criteria that have been used by the National Health Technology Assessment Commission (CONITEC) when recommending the incorporation of technologies for the treatment of cancer. Descriptive study, based on reports from CONITEC, between 2012 and 2018, on oncology technologies. The data were collected in a specific extraction form and analyzed using descriptive statistics. 39 reports were analyzed, 15 of them did not present any explicit decision criteria. Medicines were the most frequently evaluated type of technology. The most frequent types of cancers were: breast cancer, head and neck cancer, colorectal cancer, non-Hodgkin’s lymphoma and lung cancer. The most frequently considered criteria were: financial impact and effectiveness. The study identified the decision criteria that have been most used in the area of oncology, however, the lack of transparency in relation to the weight of these criteria makes it difficult to understand their influence on the result of the decisions taken.

Resumo Nos processos de avaliação de tecnologias em saúde (ATS), critérios de decisão são considerados relevantes para apoiar o complexo processo deliberativo que requer consideração simultânea de múltiplos fatores. Objetivou-se identificar e analisar os critérios de decisão que têm sido utilizados pela Comissão Nacional de Avaliação de Tecnologias em Saúde (CONITEC) na recomendação de incorporação de tecnologias para o tratamento do câncer. Trata-se de um estudo descritivo, baseado em relatórios da CONITEC, entre 2012 e 2018, sobre tecnologias em oncologia. Os dados foram coletados em formulário de extração específico e analisados por meio de estatísticas descritivas. Foram analisados 39 relatórios, 15 deles não apresentavam nenhum critério de decisão explícito. Os medicamentos constituíram o tipo de tecnologia mais frequentemente avaliado. Os tipos de cânceres mais frequentes foram: de mama, de cabeça e pescoço, colorretal, linfoma não Hodgkin e de pulmão. Os critérios considerados com mais frequência foram: impacto financeiro e efetividade. O estudo identificou os critérios de decisão que têm sido mais utilizados na área de oncologia, entretanto, a falta de transparência em relação ao peso desses critérios torna difícil compreender a influência deles no resultado das decisões tomadas.

Abstract In health technology assessment (HTA), decision criteria are considered relevant to support the complex deliberative process that requires simultaneous consideration of multiple factors. The aim was to identify and analyze the decision criteria that have been used by the National Health Technology Assessment Commission (CONITEC) when recommending the incorporation of technologies for the treatment of cancer. Descriptive study, based on reports from CONITEC, between 2012 and 2018, on oncology technologies. The data were collected in a specific extraction form and analyzed using descriptive statistics. 39 reports were analyzed, 15 of them did not present any explicit decision criteria. Medicines were the most frequently evaluated type of technology. The most frequent types of cancers were: breast cancer, head and neck cancer, colorectal cancer, non-Hodgkin’s lymphoma and lung cancer. The most frequently considered criteria were: financial impact and effectiveness. The study identified the decision criteria that have been most used in the area of oncology, however, the lack of transparency in relation to the weight of these criteria makes it difficult to understand their influence on the result of the decisions taken.

ABSTRACT BACKGROUND: The relationship between spirituality and health has been the object of growing discussion. There is a lack of data on spiritual needs assessments in Brazil. OBJECTIVE: This study aimed to assess the spiritual needs of patients admitted to a public tertiary hospital and perform a comparative analysis between patients with and without indications for palliative care. DESIGN AND SETTING: A cross-sectional observational study included patients hospitalized between August and December 2020 in Hospital do Servidor Publico Municipal, Sao Paulo, Brazil. METHODS: The included patients answered a questionnaire consisting of sociodemographic data, the Duke religiosity scale, and the Spiritual Needs Assessment for Patients (SNAP) tool for a spiritual needs assessment. The World Health Organization Palliative Needs tool (NECPAL) was used to evaluate the indications for palliative care. The level of significance adopted was 5%. RESULTS: A total of 66 patients were included in this study. Most participants (97%) declared themselves as belonging to a religion. The group without indication for palliative care by the NECPAL showed greater spiritual (P = 0.043) and psychosocial needs (P = 0.004). No statistically significant difference was observed in the religious needs domain (P = 0.176). There were no statistically significant differences in the Duke scale scores between the two groups. CONCLUSION: Spiritual, psychosocial, and religious needs are prevalent among hospitalized patients, and multidisciplinary teams must consider these needs in their management approach. In addition, this study suggests that psychosocial and spiritual needs can be even higher in patients who do not receive palliative care.

ABSTRACT BACKGROUND: Management of rectal cancer has become more complex with multimodality therapy (neoadjuvant chemoradiotherapy and surgery) and this has led to the need to organize multidisciplinary teams. The aim of this study was to report on the planning, implementation and evaluation of an integrated care pathway for neoadjuvant treatment of middle and lower rectal cancer. DESIGN AND SETTING: This was a cross-sectional post-implementation study that was carried out at a public university cancer center. METHODS: The Framework for Program Evaluation in Public Health of the Centers for Disease Control and Prevention (CDC) was used to identify resources and activities; link results from activities and outcomes with expected goals; and originate indicators and outcome measurements. RESULTS: The logic model identified four activities: stakeholders’ engagement, clinical pathway development, information technology improvements and training programs; and three categories of outcomes: access to care, effectiveness and organizational outcomes. The measurements involved 218 patients, among whom 66.3% had their first consultation within 15 days after admission; 75.2% underwent surgery < 14 weeks after the end of neoadjuvant treatment and 72.7% completed the treatment in < 189 days. There was 100% adherence to the protocol for the regimen of 5-fluorouracil and leucovorin. CONCLUSIONS: The logic model was useful for evaluating the implementation of the integrated care pathways and for identifying measurements to be made in future outcome studies.

Resumo Objetivo: Este estudo descreve os escores sumários do questionário Short Form-12 (SF-12), de acordo com os fatores sociodemográficos obtidos em uma amostra probabilística e representativa da população urbana brasileira. Método: Cinco mil (5.000) indivíduos, com idade superior a 15 anos, foram avaliados nas cinco regiões do país, em 16 capitais. A seleção dos domicílios foi aleatória. A coleta de dados foi realizada através de entrevistas domiciliares. O questionário SF-12 foi utilizado para a avaliação de qualidade de vida. Características demográficas e socioeconômicas também foram avaliadas: sexo, idade, estado civil, cor da pele, região do país e uso do serviço público de saúde. Resultados: O valor médio (DP) do SF-12 para a população total foi de 49,3 (8,7) para o componente físico (PCS-12) e 52,7 (9,7) para o componente mental (MCS-12). Foram encontradas diferenças estatísticas para sexo (PCS-12 e MCS-12), idade (PCS-12) e estado laboral (PCS-12 e MCS-12). Mulheres, idosos, viúvos, indivíduos que não estavam trabalhando, pessoas com menor renda e queixas nos últimos sete dias apresentaram valores médios mais baixos (PCS-12 e MCS-12). Conclusão: Os resultados apresentados fornecem bases populacionais para comparações com pesquisas futuras que utilizem o SF-12 para a avaliação da qualidade de vida no Brasil. A população brasileira tem um menor grau de qualidade de vida relacionada ao componente físico, e o SF-12 é um instrumento útil e discriminativo para a avaliação de qualidade de vida em diferentes grupos sociodemográficos.

Summary Objective: This study describes the summary scores of the Short Form-12 (SF-12) questionnaire, according to socio-demographic factors obtained in a probabilistic and representative sample of the Brazilian urban population. Method: Five thousand (5,000) individuals, over the age of 15, were assessed in 16 capital cities, in the five regions of the country. The selection of households was random. Face-to-face approach was applied in the household interviews. The SF-12 questionnaire was used to assess quality of life. Demographic and socioeconomic characteristics were also evaluated: gender, age, marital status, skin color, region of the country and use of the public health service. Results: The mean value (SD) of the SF-12 for the entire population was 49.3 (8.7) for the physical component (PCS-12) and 52.7 (9.7) for the mental component (MCS-12). Statistical differences were found for gender (PCS-12 and MCS-12), age (PCS-12) and working status (PCS-12 and MCS-12). Women, elderly, widowed and unemployed individuals, those with lower income and with complaints in the last seven days showed lower mean values (PCS-12 and MCS-12). Conclusion: From this point forward, we can provide the basis for comparisons with future research that use the SF-12 for quality of life assessment in Brazil. The Brazilian population has a lower degree of quality of life related do the physical component, and the SF-12 is a useful and discriminative instrument for assessing quality of life in different socio-demographic groups.

ABSTRACT OBJECTIVE: To analyze the cost effectiveness of the diagnostic program for the germline mutation in BRCA1/2 genes and of preventative strategies for the relatives of patients diagnosed with ovarian cancer associated with this mutation. METHODS: The study analyzed the cost effectiveness by developing an analysis of the Markov decision process from the perspective of the National Health System. The strategies compared reflect upon the adoption of genetic testing and preventative strategies for relatives or the usual care currently proposed. The incremental cost-effectiveness ratio was expressed in terms of cost per case avoided. The sensitivity analysis was performed in a univariate and deterministic manner. RESULTS: The study showed increments for effectiveness and for costs when performing genetic testing and adopting prophylactic measures for family members. The incremental cost-effectiveness ratio was estimated at R$908.58 per case of cancer avoided, a figure considered lower than the study's cost-effectiveness threshold (R$7,543.50). CONCLUSIONS: The program analyzed should be considered a cost-effective strategy for the national situation. Studies in various other countries have reached similar conclusions. One possible ramification of this research might the need to perform a budgetary-impact analysis of making the program one of the country's health policies.

The aim of this study was to critically evaluate the quality of the models used in economic evaluations of screening strategies for cervical cancer prevention. We systematically searched multiple databases, selecting model-based full economic evaluations (cost-effectiveness analyses, cost-utility analyses, and cost-benefit analyses) of cervical cancer screening strategies. Two independent reviewers screened articles for relevance and performed data extraction. Methodological assessment of the quality of the models utilized formal checklists, and a qualitative narrative synthesis was performed. Thirty-eight articles were reviewed. The majority of the studies were conducted in high-income countries (82%, n=31). The Pap test was the most used screening strategy investigated, which was present in 86% (n=33) of the studies. Half of the studies (n=19) used a previously published Markov model. The deterministic sensitivity analysis was performed in 92% (n=35) of the studies. The mean number of properly reported checklist items was 9 out of the maximum possible 18. Items that were better reported included the statement of decision problem, the description of the strategies/comparators, the statement of time horizon, and information regarding the disease states. Compliance with some items of the checklist was poor. The Markov models for economic evaluation of screening strategies for cervical cancer varied in quality. The following points require improvement: 1) assessment of methodological, structural, heterogeneity, and parameter uncertainties; 2) model type and cycle length justification; 3) methods to account for heterogeneity; and 4) report of consistency evaluation (through calibration and validation methods).

ABSTRACT OBJECTIVE: To analyze the cost effectiveness of the diagnostic program for the germline mutation in BRCA1/2 genes and of preventative strategies for the relatives of patients diagnosed with ovarian cancer associated with this mutation. METHODS: The study analyzed the cost effectiveness by developing an analysis of the Markov decision process from the perspective of the National Health System. The strategies compared reflect upon the adoption of genetic testing and preventative strategies for relatives or the usual care currently proposed. The incremental cost-effectiveness ratio was expressed in terms of cost per case avoided. The sensitivity analysis was performed in a univariate and deterministic manner. RESULTS: The study showed increments for effectiveness and for costs when performing genetic testing and adopting prophylactic measures for family members. The incremental cost-effectiveness ratio was estimated at R$908.58 per case of cancer avoided, a figure considered lower than the study's cost-effectiveness threshold (R$7,543.50). CONCLUSIONS: The program analyzed should be considered a cost-effective strategy for the national situation. Studies in various other countries have reached similar conclusions. One possible ramification of this research might the need to perform a budgetary-impact analysis of making the program one of the country's health policies.

Recently, professional and healthcare-related entities have launched frameworks designed to assess the value of cancer innovations in multistakeholder decision processes. Among the most visible entities that propose and implement value frameworks in oncology are the European Society of Medical Oncology (ESMO), the American Society of Clinical Oncology (ASCO), the Memorial Sloan Kettering Cancer Center (MSKCC) and the National Comprehensive Cancer Network (NCCN). However, these value frameworks have been criticized for conceptual inconsistencies, inability to include a greater variety of value criteria, and inadequate explanation of the uncertainty approach used in the modeling process. On the other hand, Multi-Criteria Decision Analysis (MCDA) is a set of methods and processes that allow the multiple criteria involved in a decision to be explicitly addressed. This approach allows the identification of relevant decision criteria, gathering of evidence based on scientific literature, attribution of weights to the criteria and scores to the evidence raised, and aggregation of the weighted scores to constitute a global metric of value. The purpose of this article is to review the main features of these value frameworks in oncology and the importance of perspective for framework readiness to support healthcare decision-making based on MCDA methodology.

RESUMO CONTEXTO: O período pré-transplante é complexo e inclui grande quantidade de procedimentos. A gravidade da doença hepática predispõe a um alto número de internações e procedimentos de alto custo. Estudos em avaliação econômica são uma importante ferramenta para o manejo dos custos em lista de espera para o transplante hepático. OBJETIVO: O objetivo do presente estudo foi avaliar o custo total do paciente em lista de espera para o transplante hepático e os principais recursos relacionados ao alto custo. MÉTODOS: Foi realizado um estudo de coorte em 482 pacientes registrados em lista de espera para o transplante hepático. Os pacientes foram acompanhados por um período de 24 meses, no qual foram avaliados todos os custos de materiais, medicamentos, consultas, procedimentos internações, exames laboratoriais e de imagem, reposição de hemocomponentes e nutrição recebida. A quantidade total de cada recurso e componente utilizado foi obtida e multiplicada pelo seu valor unitário e, desta maneira, o custo individual de cada paciente foi obtido. RESULTADOS: O total gasto pelos 482 pacientes foi de US$ 6.064.986,51. Os custos ambulatoriais corresponderam a 32,4% do total (US$ 1.965.045,52) e os custos em internação corresponderam a 67,6% do total (US$ 4.099.940,99). Os principais determinantes do custo em ambulatório foram: medicamentos (44,31%) e exames laboratoriais e de imagem (31,68%). Os principais determinantes de custo em internações foram: medicamentos (35,20%), utilização do leito em enfermaria e em UTI (26,38%) e exames laboratoriais (13,72%) Pacientes com valores de MELD entre 25-30 foram os de maiores custos em lista de espera (US$ 16.686,74 ± 16,105.02) e os de menor custo foram os pacientes com MELD abaixo de 17 (US$ 5.703,22 ± 9.318,68). CONCLUSÃO: O custo total em lista de espera para o transplante hepático aumenta de acordo com a gravidade do paciente. Individualmente, internações, reposição de hemocomponentes e o tratamento do paciente com carcinoma hepatocelular são os principais determinantes de custo para os pacientes em lista de espera para o transplante hepático. Quanto maior o tempo de espera, maiores serão os custos em lista, causando maior impacto nos sistemas de saúde.

ABSTRACT BACKGROUND: The pre-transplant period is complex and includes lots of procedures. The severity of liver disease predisposes to a high number of hospitalizations and high costs procedures. Economic evaluation studies are important tools to handle costs on the waiting list for liver transplantation. OBJECTIVE: The objective of the present study was to evaluate the total cost of the patient on the waiting list for liver transplantation and the main resources related to higher costs. METHODS: A cost study in a cohort of 482 patients registered on waiting list for liver transplantation was carried out. In 24 months follow-up, we evaluated all costs of materials, medicines, consultations, procedures, hospital admissions, laboratorial tests and image exams, hemocomponents replacements, and nutrition. The total amount of each resource or component used was aggregated and multiplied by the unitary cost, and thus individual cost for each patient was obtained. RESULTS: The total expenditure of the 482 patients was US$ 6,064,986.51. Outpatient and impatient costs correspond to 32.4% of total cost (US$ 1,965,045.52) and 67.6% (US$ 4,099,940.99) respectively. Main cost drivers in outpatient were: medicines (44.31%), laboratorial tests and image exams (31.68%). Main cost drivers regarding hospitalizations were: medicines (35.20%), bed use in ward and ICU (26.38%) and laboratorial tests (13.72%). Patients with MELD score between 25-30 were the most expensive on the waiting list (US$ 16,686.74 ± 16,105.02) and the less expensive were those with MELD below 17 (US$ 5,703.22 ± 9,318.68). CONCLUSION: Total costs on the waiting list for liver transplantation increased according to the patient’s severity. Individually, hospitalizations, hemocomponents reposition and hepatocellular carcinoma treatment were the main cost drivers to the patient on the waiting list. The longer the waiting time, the higher the total cost on list, causing greater impact on health systems.

A análise de decisão multicritérios (ADMC) é uma ferramenta emergente que permite a integração de fatores relevantes para os processos de avaliação de tecnologias em saúde (ATS). O objetivo deste estudo é apresentar uma síntese dos aspectos metodológicos da ADMC: definições, abordagens, aplicações e etapas de implementação. Realizou-se um estudo de caso no Instituto do Câncer do Estado de São Paulo (ICESP) com a intenção de compreender as perspectivas de tomadores de decisão no processo de elaboração de uma recomendação de incorporação de tecnologia no âmbito do Sistema Único de Saúde (SUS), por um relatório da Comissão Nacional de Incorporação de Tecnologias no SUS (CONITEC). A lógica paraconsistente anotada evidencial Eτ foi a abordagem metodológica escolhida por ser capaz de ser uma lógica subjacente para construtos capazes de sintetizar informações objetivas (provenientes da literatura científica) e subjetivas (provenientes de valores e preferências de especialistas na área de conhecimento); além de permitir a incorporação de informações conflitantes (contradições), vagas e mesmo incompletas no processo de valoração, resultantes da imperfeição das evidências científicas disponíveis. Foram identificadas como vantagens do método: permitir considerar de modo explícito os critérios que influenciaram a decisão; facilitar o acompanhamento e visualização das etapas do processo; permitir avaliar a contribuição de cada critério de modo isolado e agregado para o resultado da decisão; facilitar a discussão de perspectivas divergentes dos grupos de interesse e aumentar a compreensão das recomendações elaboradas. O emprego de uma abordagem explícita de ADMC poderá facilitar a mediação de conflitos e otimizar a participação de diferentes grupos de interesse.

Multi-criteria decision analysis (MCDA) is an emerging tool that allows the integration of relevant factors for health technology assessment (HTA). This study aims to present a summary of the methodological characteristics of MCDA: definitions, approaches, applications, and implementation stages. A case study was conducted in the São Paulo State Cancer Institute (ICESP) in order to understand the perspectives of decision-makers in the process of drafting a recommendation for the incorporation of technology in the Brazilian Unified National Health System (SUS), through a report by the Brazilian National Commission for the Incorporation of Technologies in the SUS (CONITEC). Paraconsistent annotated evidential logic Eτ was the methodological approach adopted in the study, since it can serve as an underlying logic for constructs capable of synthesizing objective information (from the scientific literature) and subjective information (from experts’ values and preferences in the area of knowledge). It also allows the incorporation of conflicting information (contradictions), as well as vague and even incomplete information in the valuation process, resulting from imperfection of the available scientific evidence. The method has the advantages of allowing explicit consideration of the criteria that influenced the decision, facilitating follow-up and visualization of process stages, allowing assessment of the contribution of each criterion separately, and in aggregate, to the decision’s outcome, facilitating the discussion of diverging perspectives by different stakeholder groups, and increasing the understanding of the resulting recommendations. The use of an explicit MCDA approach should facilitate conflict mediation and optimize participation by different stakeholder groups.

El análisis de decisión multicriterio (ADMC) es una herramienta emergente que permite la integración de factores relevantes en los procesos de evaluación de tecnologías en salud (ATS). El objetivo de este estudio es presentar una síntesis de los aspectos metodológicos de la ADMC: definiciones, enfoques, aplicaciones y etapas de implementación. Se realizó un estudio de caso en el Instituto del Cáncer del Estado de São Paulo (ICESP), con la intención de comprender las perspectivas de los tomadores de decisión, en el proceso de elaboración de una recomendación para la incorporación de tecnología en el ámbito del Sistema Único de Salud (SUS), mediante informes de la Comisión Nacional de Incorporación de Tecnologías en el SUS (CONITEC). La lógica paraconsistente anotada de evidencias Eτ fue el enfoque metodológico seleccionado, al tratarse de una lógica subyacente para constructos capaces de sintetizar información objetiva (procedente de la literatura científica) y subjetiva (procedente de valores y preferencias de especialistas en el área de conocimiento); además de permitir la incorporación de información conflictiva (contradicciones), vaga e incluso incompleta en el proceso de valoración, resultante de la imperfección en las evidencias científicas disponibles. Se identificaron como ventajas de este método: permitir considerar de modo explícito los criterios que influenciaron las decisiones; facilitar el seguimiento y visualización de las etapas del proceso; permitir la evaluación de la contribución de cada criterio de modo aislado y agregado para el resultado de las decisiones; facilitar la discusión de perspectivas divergentes en los grupos de interés y aumentar la comprensión de las recomendaciones elaboradas. El empleo de un enfoque explícito de ADMC podrá facilitar la comprobación de conflictos y optimizar la participación de diferentes grupos de interés.

A análise de decisão multicritérios (ADMC) é uma ferramenta emergente que permite a integração de fatores relevantes para os processos de avaliação de tecnologias em saúde (ATS). O objetivo deste estudo é apresentar uma síntese dos aspectos metodológicos da ADMC: definições, abordagens, aplicações e etapas de implementação. Realizou-se um estudo de caso no Instituto do Câncer do Estado de São Paulo (ICESP) com a intenção de compreender as perspectivas de tomadores de decisão no processo de elaboração de uma recomendação de incorporação de tecnologia no âmbito do Sistema Único de Saúde (SUS), por um relatório da Comissão Nacional de Incorporação de Tecnologias no SUS (CONITEC). A lógica paraconsistente anotada evidencial Eτ foi a abordagem metodológica escolhida por ser capaz de ser uma lógica subjacente para construtos capazes de sintetizar informações objetivas (provenientes da literatura científica) e subjetivas (provenientes de valores e preferências de especialistas na área de conhecimento); além de permitir a incorporação de informações conflitantes (contradições), vagas e mesmo incompletas no processo de valoração, resultantes da imperfeição das evidências científicas disponíveis. Foram identificadas como vantagens do método: permitir considerar de modo explícito os critérios que influenciaram a decisão; facilitar o acompanhamento e visualização das etapas do processo; permitir avaliar a contribuição de cada critério de modo isolado e agregado para o resultado da decisão; facilitar a discussão de perspectivas divergentes dos grupos de interesse e aumentar a compreensão das recomendações elaboradas. O emprego de uma abordagem explícita de ADMC poderá facilitar a mediação de conflitos e otimizar a participação de diferentes grupos de interesse.

Multi-criteria decision analysis (MCDA) is an emerging tool that allows the integration of relevant factors for health technology assessment (HTA). This study aims to present a summary of the methodological characteristics of MCDA: definitions, approaches, applications, and implementation stages. A case study was conducted in the São Paulo State Cancer Institute (ICESP) in order to understand the perspectives of decision-makers in the process of drafting a recommendation for the incorporation of technology in the Brazilian Unified National Health System (SUS), through a report by the Brazilian National Commission for the Incorporation of Technologies in the SUS (CONITEC). Paraconsistent annotated evidential logic Eτ was the methodological approach adopted in the study, since it can serve as an underlying logic for constructs capable of synthesizing objective information (from the scientific literature) and subjective information (from experts’ values and preferences in the area of knowledge). It also allows the incorporation of conflicting information (contradictions), as well as vague and even incomplete information in the valuation process, resulting from imperfection of the available scientific evidence. The method has the advantages of allowing explicit consideration of the criteria that influenced the decision, facilitating follow-up and visualization of process stages, allowing assessment of the contribution of each criterion separately, and in aggregate, to the decision’s outcome, facilitating the discussion of diverging perspectives by different stakeholder groups, and increasing the understanding of the resulting recommendations. The use of an explicit MCDA approach should facilitate conflict mediation and optimize participation by different stakeholder groups.

El análisis de decisión multicriterio (ADMC) es una herramienta emergente que permite la integración de factores relevantes en los procesos de evaluación de tecnologías en salud (ATS). El objetivo de este estudio es presentar una síntesis de los aspectos metodológicos de la ADMC: definiciones, enfoques, aplicaciones y etapas de implementación. Se realizó un estudio de caso en el Instituto del Cáncer del Estado de São Paulo (ICESP), con la intención de comprender las perspectivas de los tomadores de decisión, en el proceso de elaboración de una recomendación para la incorporación de tecnología en el ámbito del Sistema Único de Salud (SUS), mediante informes de la Comisión Nacional de Incorporación de Tecnologías en el SUS (CONITEC). La lógica paraconsistente anotada de evidencias Eτ fue el enfoque metodológico seleccionado, al tratarse de una lógica subyacente para constructos capaces de sintetizar información objetiva (procedente de la literatura científica) y subjetiva (procedente de valores y preferencias de especialistas en el área de conocimiento); además de permitir la incorporación de información conflictiva (contradicciones), vaga e incluso incompleta en el proceso de valoración, resultante de la imperfección en las evidencias científicas disponibles. Se identificaron como ventajas de este método: permitir considerar de modo explícito los criterios que influenciaron las decisiones; facilitar el seguimiento y visualización de las etapas del proceso; permitir la evaluación de la contribución de cada criterio de modo aislado y agregado para el resultado de las decisiones; facilitar la discusión de perspectivas divergentes en los grupos de interés y aumentar la comprensión de las recomendaciones elaboradas. El empleo de un enfoque explícito de ADMC podrá facilitar la comprobación de conflictos y optimizar la participación de diferentes grupos de interés.

Resumo Objetivo: descrever a qualidade de vida dos idosos frágeis atendidos pelo Centro de Referência à Saúde do Idoso (CRI), de Campinas, São Paulo. Métodos: a amostra de conveniência incluiu 122 idosos frágeis, que iniciaram tratamento a partir de janeiro de 2010 até julho de 2011, de um universo de 668 idosos frágeis encaminhados ao CRI após aplicação da ficha de avaliação breve do idoso, preconizada pelo Ministério da Saúde, que identifica o idoso com algum grau de fragilidade. Estudo observacional descritivo coletou dados por meio de questionário sociodemográfico e questionários de qualidade de vida: WHOQOL-BREF, WHOQOL- -OLD e SF-36. Resultados: participaram do estudo 122 idosos frágeis. Desses, 74,6% (91) eram do sexo feminino, com média de idade de 73 anos, 46,7% (57) eram casados, 51,6% (63) apresentaram até 3 anos de escolaridade e 87,7% (107) informaram renda de um a quatro salários mínimos. O escore total médio do WHOQOL-BREF foi 56,6, o do WHOQOL- OLD, 57,6; e no SF-36 o Componente Físico Sumarizado foi 34,5, enquanto o Componente Mental Sumarizado foi de 43,6. Conclusão: o conhecimento do perfil de comprometimento de qualidade de vida de idosos frágeis é, portanto, fundamental para o planejamento da atenção à saúde dessa população.

Summary Objective: describe the quality of life of frail elderly assisted by the Centro de Referência à Saúde do Idoso (CRI), Campinas, São Paulo, Brazil. Methods: the convenience sample included 122 frail elderly being treated from January 2010 to July 2011, out of a total of 668 frail elderly who were referred to the CRI after application of the brief evaluation form of the elderly, recommended by Ministry of Health, which identifies the elderly with some degree of frailty. Descriptive observational study collected data through sociodemographic questionnaire and quality of life questionnaires: WHOQOL-BREF, WHOQOLOLD and SF-36. Results: the study included 122 frail elderly. Of these, 74.6% (91) were female, mean age 73 years, 46.7% (57) were married, 51.6% (63) had less than 3 years of schooling and 87.7% (107) reported income of one to four minimum wages. The mean total score of the WHOQOL-BREF was 56.6, the WHOQOL-OLD 57.6 and SF-36 Physical Component Summary 34.5 and Mental Component Summary 43.6. Conclusion: knowledge of the impairment profile of quality of life among frail elderly is, therefore, essential for planning health care to this population.

Objetivo: analisar as mudanças na expectativa de vida (EV) e na expectativa de vida livre de incapacidade (EVLI) dos indivíduos idosos do município de São Paulo, de 2000 a 2010, de modo a avaliar a ocorrência de compressão ou expansão da morbidade nessa população. Métodos: estudo transversal repetido, de base populacional, utilizando dados oficiais secundários para o município de São Paulo e dados obtidos a partir do Estudo Saúde Bem-Estar e Envelhecimento (SABE). A incapacidade funcional foi definida como dificuldade para a realização de pelo menos uma atividade básica de vida diária. O método de Sullivan foi utilizado para o cálculo de EV e EVLI para os anos de 2000 e 2010. Resultados: de 2000 a 2010, observou-se um aumento da expectativa de vida com incapacidade (EVCI) em todas as faixas etárias, em ambos os sexos. A proporção de anos de vida livres de incapacidade, aos 60 anos, decresceu de 57,94% para 46,23% em mulheres, e de 75,34% para 63,65% em homens. Já aos 75 anos, esta proporção decresceu de 47,55% para 34,54% em mulheres, e de 61,31% para 56,01% em homens. Conclusão: a expansão da morbidade é um processo em curso na população idosa do município de São Paulo, no período de 2000 a 2010. Os resultados apresentados podem colaborar para a elaboração de estratégias preventivas e para o planejamento de serviços de saúde adequados às futuras gerações de idosos.

Objective: to analyze the changes in life expectancy (LE) and disability-free life expectancy (DFLE) in São Paulo's elderly population to assess the occurrence of compression or expansion of morbidity, between 2000 and 2010. Methods: cross-sectional and population survey, based on official data for the city of São Paulo, Brazil, and data obtained from the Health, Well-Being and Aging Survey (SABE). Functional disability was defined as difficulty in performing at least one basic activity of daily living. The Sullivan method was used to calculate LE and DFLE for the years 2000 to 2010. Results: from 2000 to 2010, there was an increase in disabled life expectancy (DLE) in all age groups and both sexes. The proportion of years of life free of disability, at 60 years of age, decreased from 57.94% to 46.23% in women, and from 75.34% to 63.65% in men. At 75 years of age, this ratio decreased from 47.55% to 34.54% in women, and from 61.31% to 56.01% in men. Conclusion: the expansion of morbidity is an ongoing process in the elderly population of the municipality of São Paulo, in the period of 2000-2010. These results can contribute to the development of preventive strategies and planning of adequate health services to future generations of seniors.