0388/2020 - Decision-making in the midst of uncertainty: appraising expensive medicines in England Tomada de decisão em meio à incerteza: avaliando medicamentos de alto preço na Inglaterra
O Serviço Nacional de Saúde Inglêsprecisa tomar decisões sobre quais serviços ou tecnologias devem ser priorizados. A análise se concentra no Instituto Nacional de Excelência em Saúde e Cuidados (NICE) e em como avalia medicamentos de alto preço. Essa análise adota uma perspectiva sociológicana tomada de decisões em relação à incerteza e como elas são gerenciadas, com base em um estudo etnográfico e um estudo de escopo. As incertezas foram centrais para essas decisões. Três tipos de camadas de incerteza - sistêmica, processual e interpessoal - mostraram-se salientes. Outra forma de incerteza estava associada à complexidade da ciência e que incluía o nível de tecnicidade das informações fornecidas. A análise enfatizou particularmente a importância das incertezas associadas às relações interpessoais e às relações entre os comitês e os fabricantes de medicamentos, especialistas clínicos e de pacientes. Um elemento-chave nesses relacionamentos foi a confiança. Os tomadores de decisão adotaram uma mistura de estratégias formais e informais, coletivas e individuais na tomada de decisões e a necessidade de exercer o pragmatismo dentro de uma estrutura institucional formal. O texto finaliza com considerando o desenvolvimento mais recente de políticas relacionadas à avaliação de medicamentos caros, em que a incerteza é aumentada em um cenário de mudanças no mercado farmacêutico.
Palavras-chave:
Avaliação de tecnologias; Medicina baseada em evidências; Sociologia médica; Incerteza.
Abstract:
Decisions need to be made about which services or technologies should be prioritized for provision in the NHS in England .The analysis focuses specifically on the National Institute for Health and Care Excellence (NICE), and on how they appraise expensive medicines. This analysis takes a sociological perspectiveon decision-making in relation to uncertainty and how uncertainties are managed, drawing on evidencea scoping study and an ethnographic study. Uncertainties were central to these rationing decisions. Three types of layers of uncertainty -epistemic, procedural and interpersonal – were shown to be salient. Another form of uncertainty was associated with the complexity of the science and that included the level of technicality of the information provided. The analysis highlighted the salience of uncertainties associated with interpersonal relations and the relations between the committees and the drug industry, clinical and patient experts. A key element in these relationships was trust. Decision makers adopted a mixture of formal and informal, collective and individual strategies in making decisions and a need to exercise pragmatism within a more formal institutional framework. The paper concludes by considering more recent policy developments in relation to appraising expensive medicines uncertainty is enhanced due to a changing landscape in the pharmaceutica
Keywords:
Technology assessment; Evidence-based medicine; Medical sociology; Uncertainty.
Tomada de decisão em meio à incerteza: avaliando medicamentos de alto preço na Inglaterra
Resumo (abstract):
Decisions need to be made about which services or technologies should be prioritized for provision in the NHS in England .The analysis focuses specifically on the National Institute for Health and Care Excellence (NICE), and on how they appraise expensive medicines. This analysis takes a sociological perspectiveon decision-making in relation to uncertainty and how uncertainties are managed, drawing on evidencea scoping study and an ethnographic study. Uncertainties were central to these rationing decisions. Three types of layers of uncertainty -epistemic, procedural and interpersonal – were shown to be salient. Another form of uncertainty was associated with the complexity of the science and that included the level of technicality of the information provided. The analysis highlighted the salience of uncertainties associated with interpersonal relations and the relations between the committees and the drug industry, clinical and patient experts. A key element in these relationships was trust. Decision makers adopted a mixture of formal and informal, collective and individual strategies in making decisions and a need to exercise pragmatism within a more formal institutional framework. The paper concludes by considering more recent policy developments in relation to appraising expensive medicines uncertainty is enhanced due to a changing landscape in the pharmaceutica
Palavras-chave (keywords):
Technology assessment; Evidence-based medicine; Medical sociology; Uncertainty.
Calnan, M. Decision-making in the midst of uncertainty: appraising expensive medicines in England. Cien Saude Colet [periódico na internet] (2020/dez). [Citado em 22/12/2024].
Está disponível em: http://cienciaesaudecoletiva.com.br/artigos/decisionmaking-in-the-midst-of-uncertainty-appraising-expensive-medicines-in-england/17870?id=17870
