title: Many Miles to Go: A Systematic Review of the State of Cost-Utility Analyses in Brazil.
abstract: BACKGROUND
  Little is known about the quality and quantity of cost-utility analyses (CUAs) in Brazil.
  
  
  OBJECTIVE
  The objective of this study was to provide a systematic review of published CUAs of healthcare technologies in Brazil.
  
  
  METHODS
  We performed a systematic review of economic evaluations studies published in MEDLINE, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment) Database, Web of Science, Scopus, Bireme (Biblioteca Regional de Medicina), BVS ECOS (Health Economics database of the Brazilian Virtual Library of Health), and SISREBRATS (Sistema de Informação da Rede Brasileira de Avaliação de Tecnologias em Saúde [Brazilian Network for the Evaluation of Health Technologies]) from 1980 to 2013. Articles were included if they were CUAs according to the classification devised by Drummond et al. Two independent reviewers screened articles for relevance and carried out data extraction. Disagreements were resolved through discussion or through consultation with a third reviewer. We performed a qualitative narrative synthesis.
  
  
  RESULTS
  Of the 535 health economic evaluations (HEEs) relating to Brazil, only 40 were CUAs and therefore included in the analysis. Most studies adhered to methodological guidelines for quality of reporting and 77.5% used quality-adjusted life-years (QALYs) as the health outcome. Of these studies, 51.6% did not report the population used to elicit preferences for outcomes and 45.2% used a specific population such as expert opinion. The preference elicitation method was not reported in 58.1% of these studies. The majority (80.6%) of studies did not report the instrument used to derive health state valuations and no publication reported whether tariffs (or preference weights) were national or international. No study mentioned the methodology used to estimate QALYs.
  
  
  CONCLUSIONS
  Many published Brazilian cost-utility studies adhere to key recommended general methods for HEE; however, the use of QALY calculations is far from being the current international standard. Development of health preferences research can contribute to quality improvement of health technology assessment reports in Brazil.
authors: Center for Translational Research in Oncology, Cancer Institute of Sao Paulo (ICESP), University of São Paulo School of Medicine, Av. Dr. Arnaldo 251, 8 andar, São Paulo, SP, 01246-000, Brazil.|National Institute for Science and Technology for Health Technology Assessment (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil.
authors: Alessandro G
authors: AG
authors: Campolina
authors: Department of Preventive Medicine, University of São Paulo School of Medicine, Av. Dr. Arnaldo 455, 2 andar sala 2228, São Paulo, SP, 01246-903, Brazil.
authors: Luciana M
authors: LM
authors: Rozman
authors: Department of Preventive Medicine, University of São Paulo School of Medicine, Av. Dr. Arnaldo 455, 2 andar sala 2228, São Paulo, SP, 01246-903, Brazil.
authors: Tassia C
authors: TC
authors: Decimoni
authors: Department of Preventive Medicine, University of São Paulo School of Medicine, Av. Dr. Arnaldo 455, 2 andar sala 2228, São Paulo, SP, 01246-903, Brazil.
authors: Roseli
authors: R
authors: Leandro
authors: Department of Preventive Medicine, University of São Paulo School of Medicine, Av. Dr. Arnaldo 455, 2 andar sala 2228, São Paulo, SP, 01246-903, Brazil.|National Institute for Science and Technology for Health Technology Assessment (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil.
authors: Hillegonda M D
authors: HM
authors: Novaes
authors: Department of Preventive Medicine, University of São Paulo School of Medicine, Av. Dr. Arnaldo 455, 2 andar sala 2228, São Paulo, SP, 01246-903, Brazil. patricia.soarez@usp.br.|National Institute for Science and Technology for Health Technology Assessment (IATS/CNPq), Porto Alegre, Rio Grande do Sul, Brazil. patricia.soarez@usp.br.
authors: Patrícia Coelho
authors: PC
authors: De Soárez
mesh_terms: D001938:Brazil; D003362:Cost-Benefit Analysis / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D019057:Quality-Adjusted Life Years; D013673:Technology Assessment, Biomedical / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D016896:Treatment Outcome