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Distance practical course on systematic reviews to support decisions of Brazilian regulatory agency for supplementary healthcare system
  1. Rafael Leite Pacheco1,2,3,
  2. Angela Maria Bagattini1,4,5,
  3. Daniela Vianna Pachito1,6,
  4. Ana Luiza Cabrera Martimbianco2,7,
  5. Fernanda d Athayde Rodrigues5,
  6. Roberta de Fátima Carreira Moreira8,
  7. Rachel Riera1,3
  1. 1 Center of Health Technology Assessment, Hospital Sírio-Libanês, Sao Paulo, São Paulo, Brazil
  2. 2 Departamento de Medicina, Centro Universitário São Camilo, São Paulo, São Paulo, Brazil
  3. 3 Escola Paulista de Medicina, Universidade Federal de São Paulo, Sao Paulo, São Paulo, Brazil
  4. 4 Institute of Tropical Pathology and Public Health, Universidade Federal de Goiás, Goiania, GO, Brazil
  5. 5 Instituto Nacional de Ciência e Tecnologia de Avaliação em Tecnologias em Saúde (INCT/IATS), Porto Alegre, RS, Brazil
  6. 6 Instituto de Desenvolvimento Educacional, Fundação Getúlio Vargas, São Paulo, Brazil
  7. 7 Programa de pos-graduação em saúde e meio ambiente, Universidade Metropolitana de Santos, Santos, SP, Brazil
  8. 8 Departamento de Fisioterapia, Universidade Federal de São Carlos, Sao Carlos, SP, Brazil
  1. Correspondence to Angela Maria Bagattini, Hospital Sírio-Libanês, Sao Paulo, São Paulo 01308-050, Brazil; angelabagattini{at}

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The healthcare service in Brazil comprises a public and universal system (Sistema Único de Saúde, SUS), but a considerable part of the population (59.7 million) also maintains a private health insurance as a supplementary care.1 The supplementary system is regulated by an autonomous governmental agency, formally Agência Nacional de Saúde Suplementar (ANS), which regulates the relationship between users and health operators and plans, including financial, legal and coverage aspects.

The catalogue of drugs, devices and procedures that should be offered by health plans to their users is updated by ANS every other year for adding, replacing or excluding technologies through a complex process. The process was revisited and has been improved over the last years to integrate the evidence-based medicine (EBM) principles to technology assessment.

An innovative strategy adopted during the 2020 catalogue update was to qualify the ANS team (responsible for assessing proposals for incorporation submitted by different civil society players), on systematic reviews (SRs) methods. Then, a practical course has been conducted through a collaborative agreement with Hospital Sírio-Libanês (mainly its Health Technology Assessment Center). The course is supported by the Brazilian Ministry of Health, by means of PROADI-SUS programme.

All course content was developed by NATS-HSL based on Cochrane Handbook.2 EBM core tools and key concepts were adopted for planning, developing and reporting the systematic reviews, including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist3 and the Portuguese version of the CEBM Catalogue of Bias4 (table 1).

Table 1

Characteristics and details of the systematic review course for Brazilian regulatory agency of supplementary healthcare system

A barrier we faced was the heterogenous knowledge background of the audience. As the ANS has a broad set of responsibilities, there is a wide multidisciplinary team, including professionals who had no health-related graduation. This barrier was overcome by assuming small groups for practical activities when tutors could focus on specific demands. The course was conducted during the pandemic then engagement strategies and extra meetings for adjustments were necessary.

In addition to the relevance of training the decision-makers on SRs methods, including critical appraisal, we learnt about the need of develop and adopt knowledge translation strategies to bring these professionals to the methodological issues. We hope the establishment of a specialised team within ANS could enhance the autonomy of the agency to conduct each step in the process of technology assessment for incorporation.

By reporting this study case, we have presented a teaching training on SRs and critical appraisal skills for decision-makers from the Brazilian regulatory agency for supplementary healthcare system. Similar initiatives could be adopted by other countries in their regulatory healthcare settings.

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  • Twitter @RieraRachel

  • Contributors Conception and design was done by RLP and RR. Data collection was done by RLP, AMB, ALCM, FdAR and RdFCM. Manuscript drafting was done by RLP, RR and AMB. RLP, AMB, DVP, ALCM, FdAR, RdFCM and RR were content revisors. All authors provided final approval.

  • Funding This study was supported by the Brazilian Ministry of Health by the Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS), led by Hospital Sírio- Libanês, São Paulo, Brazil.

  • Competing interests All the author acted as coordinator, or professor or tutor of the course described.

  • Provenance and peer review Not commissioned; internally peer reviewed.