National Committee Research Articles

The 50 years of the World Heritage Convention in Spain: implementation, effects, and challenges

Due to the diversity of characteristics and the high number of World Heritage sites (49) inscribed by Spain, this country and its ICOMOS National Committee have a long experience in the application of the World Heritage Convention throughout these 50 years. The World Heritage Working Group of the Spanish National Committee of ICOMOS has therefore carried out an analysis of these sites, their history and evolution, typology, and state of conservation with the final goal of assessing their current heritage situation and the contribution of the Convention to the conservation of the Spanish natural and cultural heritage. We also aim to reflect on how Spain has contributed to the World Heritage Convention during these five decades and about the most important challenges that our country needs to confront in order to continue complying with the spirit of the Convention and the principles of its Operational Guidelines. To conduct this analysis, we first deal with the background of the ratification of the Convention in Spain, provide an overview of its application, and describe the evolution of the Spanish Tentative List. Second, we deepen on the Spanish nominations and the typologies of the Spanish properties inscribed on the World Heritage List. Thirdly, we focus on the preservation of the Spanish World Heritage sites basing on the State of Conservation Reports (SOCs) that affect them and the results of the first survey on these properties’ conservation, management and presentation carried out by the Heritage Observatory of ICOMOS Spain. This allows us to share some conclusions about the most positive effects of the Convention for the protection of Spanish cultural heritage and the most important challenges for its future development, many of which can be extended at least to the European context.

Walka o Lwów w Pamiętnikach z lat 1916-1918 Ludomiła Germana

THE STRUGGLE FOR LVIV IN THE “DIARIES FROM THE YEARS 1916-1918” BY LUDOMIŁ GERMANThis edition covers the final section of the diary of Ludomił German (1851-1920), a Galician teacher and school inspector, playwright, translator, politician, and activist in the National-Democratic Party and the Polish Democratic Party. He served as a member of the Imperial Council in Vienna (1907-1918) and the Regional Sejm in Lviv (1912-1914), vice president of the Austrian Chamber of Deputies, and vice president of the Polish Circle. In his diary, kept from July 1914 to January 1919, German documented his activities in the Supreme National Committee, the Polish Circle, and the Imperial Council. He also chronicled the history of the Polish Legions, the struggle for their leadership, and the aspirations of politicians from Galicia and the Kingdom of Poland aiming to establish a more or less independent Polish state. The diary, now divided into two parts, is preserved in the Jagiellonian Library in the manuscript collection under the signature 8537 I (‘Notes from Great Times,’ the original written by Ludomił German) and in the Lviv National Scientific Library of Ukraine named after V. Stefanyk (fond 5, signature 6415, vol. 1-3, ‘Diaries from the Years 1916-1918,’ a copy made in 1935-1936 by Ludomił’s son, Juliusz German). The presented fragment covers almost three months (from November 1, 1918 to January 24, 1919), during which the author was in Lviv during the Polish-Ukrainian battles for the city, initially occupied and later besieged by Ukrainian forces. The author describes, based on his own experiences and information from other sources, the course of military actions, the difficulties of daily life associated with them, attempts by both sides to end the fighting, and the establishment of new municipal authorities and their initial political decisions. As much as possible, he tries to track events in other parts of the re-emerging Poland (critically evaluating the actions of the new state authorities) and throughout Europe, especially within the former Austro-Hungarian borders.

Pentingnya Penguatan Moderasi Beragama dalam Bahan Ajar Pendidikan Kewarganegaraan

Having a good attitude in inter-religious relations in Indonesia is very important. This is a priority in the content that needs to be included in citizenship education teaching materials. The aim of this research is to analyze important religious moderation studies formulated in citizenship education teaching materials. The research method used was qualitative-descriptive. The data obtained was produced in the form of a series of academic perception data and theoretical studies on strengthening the concept of religious moderation in citizenship education teaching materials. The research results obtained are the dynamics of attitudes toward understanding national commitment and the development of attitudes toward religious tolerance, which are discussed in the theoretical analysis of citizenship education teaching materials. The conclusions obtained are that academics' national commitment attitude is still strong in their need for teaching materials and the importance of developing an attitude of tolerance in the development of teaching materials in the Citizenship Education scheme.

Role of the International Humanitarian Law Committee of Malaysia in Implementation of International Humanitarian Law

The objective of this article is to study the need for a national International Humanitarian Law (IHL) committee to domesticate the Geneva Conventions of 1949 in Malaysia. This study focuses on the core functions of the national IHL committee as recommended by the International Committee of the Red Cross (ICRC). The methodology to be used is by analysing the Geneva Conventions of 12 August 1949, observing the activities of Jawatankuasa Undang-Undang Kemanusiaan Antarabangsa Malaysia (JUKAM), attending IHL symposiums and conducting interviews. The findings confirm that there is a need to have an active national IHL committee. It is unnecessary to be highly ambitious by creating a complex structured national IHL committee with a high annual budget. It is sufficient for the structure of the national IHL committee to develop gradually or to consider other alternatives. Based on the evidence provided by national IHL committees in other countries, success in domesticating IHL in Malaysia is achievable with an active JUKAM and a strong political will by all stakeholders, including the decision-makers.

Acceleration sensing based on the bifurcation dynamics of parametrically excited mode-localized resonators

A parametrically excited mode-localized accelerometer is designed using the bifurcation phenomenon to improve the robustness of the fluctuation of the driving voltage and damping while maintaining high sensitivity. A dynamic multi-physics model was established while considering both mechanical and electrostatic nonlinearities. The equation was solved by method of multiple scales and verified by harmonic balanced method coupled with the asymptotic numerical method. Two types of bifurcation exist in amplitude frequency response, namely Saddle-Node bifurcation and Supercritical Hopf bifurcation. By introducing Saddle-Node bifurcation, the response amplitude and measurement range can be improved by 100% and 1000%, respectively, while the sensitivity of the amplitude ratio is about 2 orders of magnitude higher than that based on the frequency ratio. At the Supercritical Hopf bifurcation point, a small acceleration will change the topological structure from Supercritical Hopf to Saddle-Node bifurcation. The variation in the amplitude ratio of the Supercritical Hopf point with acceleration is similar to the sign function, which leads to an extremely high sensitivity of 10000%/g in a dynamic range of ±0.001 g. Moreover, the Supercritical Hopf bifurcation point is not affected by the amplitude of the excitation voltage and damping coefficient, which provides a new method for improving the sensing robustness. Ethical Compliance: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Conflict of Interest declaration: The authors declare that they have NO affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.

SPEECH STYLE USED BY SETO MULYADI IN ISLAMIC DA’WAH

Speech is a fundamental component of human communication, and it is shaped by a multitude of factors, leading to the emergence of various speech styles. Speech style is a type of communicative style that is determined by an intuitive understanding of the levels of familiarity or intimacy between individuals. These variations in speech style can be influenced by cultural, social, and situational factors, which contribute to the richness and diversity of human communication. This study aimed to explore speech style used by Seto Mulyadi Islamic da’wah in Tarawih sermon at Mosque of Gajah Mada University in 2023. Seto Mulyadi is a child psychologist and was the chairman of National Commission for Child Protection of Indonesia who tends to speak in story telling way. This research used qualitative descriptive method as foundation in conducting research. The research data consists of script of Seto Mulyadi's video speech from Youtube. The data analysis process involves four steps: data collection, data condensation, data display, and conclusion drawing/verification. Based on finding, there are frozen style, formal style, consultative style, and casual style occurred in Seto Mulyadi’s utterances. Formal style is the most occurrence speech style in his speech. Furthermore, the personal background of Seto Mulyadi and the recipients of the message also influence variation of his speech style.

Promoting mental health and preventing mental health problems in child and adolescent refugees and asylum seekers: A systematic review on psychosocial interventions.

According to the United Nations Commissioner for Refugees (UNHCR), children and adolescents represent 41% of all forcibly displaced individuals. They have to deal with conflicts, violence, and the many difficulties of flight and resettlement during a critical stage of their emotional, social, cognitive, and physical development. They are more likely to experience mental health problems during migration. Despite the several known risk factors, it is frequently challenging for refugees and asylum seekers to get mental health care. In this paper we review available studies on interventions aimed at promoting mental health and at preventing common mental disorders in immigrant adolescents and children. The relevant PubMed, Scopus, PsychINFO and Web of Science databases were searched for papers published until March 21, 2023, using ("immigrants" OR "migration" OR "asylum seekers" OR "refugees") AND ("promotion" OR "prevention") AND ("mental health" OR "mental disorders" OR "psych*") AND ("children" OR "adolescents" OR "young adults") as search string. Fourteen articles qualified for the detailed review. The majority of available interventions, although highly heterogeneous in format and content, showed significant improvement in several psychopathological dimensions, including trauma-related symptoms, psychological stress, anxiety, depressive and cognitive symptoms. Available studies on interventions for the prevention of mental disorders and the promotion of mental health in refugees and asylum seekers children and adolescents indicate that provided interventions were associated with a global improvement for participants. Implementation strategies to improve their scalability are highly needed.

The Perception of Muslim Converts on Religious Moderation and the Importance of Tolerance: A Study at the Mualaf Center Malang, Indonesia

This study aims to show how important it is to cultivate the values of moderation in a convert. This is important in order to anticipate the thoughts and attitudes of someone who has just become a Muslim towards the influence of intolerance and radicalism. Researchers used surveys with descriptive analysis techniques to measure the level of religious moderation. In this study, researchers also used qualitative methods with a phenomenological approach aimed at understanding the mindsets and perceptions of participants in diverse moderation. Participants in this study were five converts who were at least 3 years old and studying Islam. The perception of religious moderation among converts at the Muallaf Center Malang is shown through the views, attitudes, and practices of converts who accept the principles of nationhood. The results of the analysis showed that the level of religious moderation among converts in Muallaf Center Malang was in the high category. In addition, converts demonstrate conscious adherence to basic values, harmoniously integrating national aspirations into religious beliefs without contradicting state ideology. They showed a positive attitude towards national commitment, emphasized the importance of the ideals of Pancasila, respected the national flag, and implemented Pancasila in religious life. Their understanding of tolerance is prominent, as evidenced by their recognition of diversity, willingness to share facilities, and efforts to help non-Muslims. It all reflects a commitment to positive social contribution. Converts strongly oppose violence in religious conflicts, which means they are in line with the principles of religious moderation that reject violent extremism. Their adaptive approach to local culture, by embracing diverse practices, shows a willingness to acculturate while still maintaining religious beliefs.

Understanding the process of building institutional trust among digital payment users through national cybersecurity commitment trustworthiness cues: a critical realist perspective

PurposeThe current body of empirical research regarding the impact of trust in the cybersecurity commitment of institutions on digital payment usage has focused solely on a macro-level analysis, overlooking the intricate dynamics between institutions' cybersecurity commitments and the trust levels of digital payment users. In light of this limitation, this study aims to offer a more comprehensive understanding of this complex relationship.Design/methodology/approachA case study was conducted on digital payment users in India through the critical realist lens. To gather data, interviews and focus group discussions were conducted with digital payment users from various regions of the country.FindingsThe citizen-centric outcomes of the national cybersecurity commitment (performance and responsiveness) are the most prominent and impactful trust indicators. These outcomes play a crucial role in shaping digital payment users' perception and trust in the cybersecurity commitment of public institutions. Individuals' value positions also influence trust judgments, as it is essential to recognize the value tensions that may arise due to security implementation and their congruence with citizens' values.Research limitations/implicationsThe findings of this study have significant implications for policymakers. They are potentially an artifact of the security and perception of digital payment users and the cultural uniqueness of digital payment users in India.Originality/valueThe study proposes a holistic understanding of the relationship between institutions' cybersecurity commitments and the trust levels of digital payment users. It offers a qualitative evaluation of how digital payment users perceive and construe efficient information security management implemented by public institutions.

Latin American Cerebral Palsy Register (LATAM-CPR): study protocol to develop a collaborative register with surveillance of children with cerebral palsy in Latin American countries

IntroductionCerebral palsy (CP) is one of the leading causes of childhood disability globally with a high burden in low-income and middle-income countries (LMICs). Preliminary findings from the global LMIC CP...

Biodiversity management policy in indonesia

The study examines policies for managing biodiversity in Indonesia from 1990-2020. The study uses evaluation research, especially regulatory impact analysis (RIA), with a qualitative approach. The objects of this research are ten regulatory documents in the form of laws that have received stipulations and various relevant national government commitment actions. The analysis process uses the RIA technique, which includes analysis of strategic problems in biodiversity management and regulatory analysis through the comparison of policy content with issues of public interest, including climate change mitigation, welfare, empowerment, intergovernmental relations, and others. The results: 1) The issue of damage and reduction of biodiversity in Indonesia is high; 2) The government’s partiality through laws reflects limited focus and required actions, minimal regulation of responsibilities across sectors and between institutions (government and non-government), weak sanctions; 3) The law has not placed the community/stakeholders outside the government as subjects in biodiversity management, the government still dominates it. The study contributes to improving the quality of regulations. Public costs can be minimized in the context of policy revisions; on the content side of regulatory revisions, it can suppress lost resources, protect the environment from damage, and mitigate climate change.

OP07 Eleven Years Of Conitec: Advances And Challenges Of Patient And Public Involvement In The Brazilian Health Technology Assessment Process

IntroductionPatient and public involvement (PPI) is a core element of the health technology assessment (HTA) process. Since its creation in 2011, the National Committee for Health Technology Incorporation (Conitec) has promoted initiatives to include stakeholders in HTA for the Brazilian Public Health System (SUS). This work aimed to present a report on the advances and challenges related to PPI in 11 years of Conitec.MethodsA retrospective analysis of PPI actions carried out at Conitec was conducted, based on an analysis of minutes and records of meetings and discussions held internally and documents published on Conitec´s website.ResultsEvents and meetings were held over the years with different actors interested in the HTA process. Since 2015, a plain-language version of the technical report has been made available to the public during public consultations for each HTA topic. Recently, a register of patients, specialists, and SUS managers was created to form a database and establish a network with the stakeholders. Since 2020, SUS users have been allocated time to speak at Conitec´s meetings. Qualitative analysis of public consultation documents started in 2021 and a pilot qualitative evidence synthesis was carried out in 2022. These initiatives, although not directly focused on PPI, increase the consideration of the perspectives of patients, family members, and caregivers in the HTA process.ConclusionsPPI actions implemented at Conitec have significantly promoted inclusiveness and exchanges among stakeholders, contributing to a greater transparency regarding Conitec’s actions. Nonetheless, we have important challenges on our horizon, such as strengthening connections with primary healthcare managers and professionals and social movements. It is also strategic to expand the technical and scientific discussion on PPI and qualitative approaches with HTA researchers and the voting members of Conitec. Finally, another aim is to improve knowledge of HTA and public health policy among law professionals and the pharmaceutical industry in Brazil.

OP54 Experiences With Out-Of-Hospital Drug Treatment For Systemic Lupus Erythematosus: A Thematic Synthesis

IntroductionSystemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects quality of life and sometimes requires the use of multiple drugs. Therefore, it is relevant to address the experiences of patients, family members, and caregivers in relation to out-of-hospital SLE drug treatment. This paper presents the results of a pilot project of a Qualitative Evidence Synthesis (QES) conducted by the National Committee for Health Technology Incorporation (Conitec) in the Brazilian public health system.MethodsFor this thematic synthesis, a structured search was conducted in the MEDLINE, CINAHL, and LILACS databases. Seventeen articles were included, and their quality was evaluated using the Critical Appraisal Skills Program criteria. Article content, which was extracted into a spreadsheet adapted from JBI SUMARI, underwent thematic content analysis. Confidence in the findings was evaluated using the GRADE Confidence in the Evidence from Reviews of Qualitative Research tool.ResultsFifteen findings related to three central themes: self-image and appearance; SLE as a chronic disease (disease oscillation, recurrence of symptoms, fear of organ damage, expectation of cure or modification of the disease course, and frequency of medical appointments); and experience with drug therapy (belief in the need for drugs, skepticism, chronicity of treatment, financial difficulty, adverse effects as obstacles to adherence and a source of suffering, efficacy/effectiveness, large quantity and frequency of drugs, and multiple therapeutic attempts).ConclusionsThe findings suggest that patients, family members, and caregivers have an ambivalent relationship with drug treatment. Even though they believe in the effectiveness of the drugs, they also distrust the need to keep using them, especially when SLE is controlled. The improvement of cosmetic manifestations and adverse effects also seem to be important outcomes. Furthermore, the high occurrence of adverse effects and the daily use of many drugs can make treatment adherence harder. In any case, there is an expectation of cure or more significant impact on the course of the disease through pharmacotherapy.

PP19 Health Technology Assessment Reports In Brazilian Unified Health System: Number Of Potential Beneficiaries in 2022

IntroductionUniversal access to health public services was established in Brazil 32 years ago. However, health technology assessment (HTA) as a requirement for the decision-making process in the Unified Health System (SUS) was defined only in 2011 with the National Committee for Health Technology Incorporation of the SUS (Conitec), which advises the Ministry of Health on the decision to incorporate health technologies into the SUS. All of Conitec’s recommendations are based on the best available scientific evidence regarding efficacy, effectiveness, and safety of a technology, but also include economic evaluation studies of these technologies, developed from the perspective of the SUS. Considering this an estimate of the population eligible for use of the technology under evaluation, if it is incorporated into the SUS, it is considered in the decision-making process.MethodsThis descriptive study, based on open access data from Conitec’s website, aimed at identifying the estimated number of patients potentially benefitting by the recommendations published in 2022, from January to November. Since each report includes an estimate for the first five years of incorporation of the technologies, all data were collected to check whether population growth was considered.ResultsFinally, 38 recommendation reports were identified, with 28 reports on incorporation and 10 reports for expansion of technology use. Among them, they related to 31 medicines and seven procedures or products. In the first year after incorporating the listed technologies, a total of 7,767,321 potential beneficiary patients were estimated, while over five years the total number would increase to approximately 7,967,874 patients. There were recommended drugs for rare diseases whose benefited population did not exceed the estimate of 10 patients per year; as an example is cerliponase alfa for treating neuronal ceroid lipofuscinosis. In another example, an estimate of 4,494,539 women would benefit by incorporated contraceptives into the SUS.ConclusionsThis study describes how accessible public health is becoming, meeting more health policies, showing potential to benefit more patients every day and showing what trends can be expected in the future.

Field Efficacy of Topical Nano-Liposomal Amphotericin B (Sina Ampholeish®) Alone or in Combination with Glucantime® and Cryotherapy on Human Cutaneous Leishmaniasis.

Cutaneous leishmaniasis (CL) is a parasitic disease that presents a broad spectrum of clinical features. Treatment of CL is problematic. We aimed to compare the field therapeutic efficacy of topical nanoliposomes containing 0.4% amphotericin B (Nano Lip-AmB) alone and in combination with cryotherapy and/or Glucantime® on human CL in the endemic areas of Iran. This retrospective study was performed based on the results of using Nano Lip-AmB alone or with Glucantime® and/or cryotherapy in the treatment of zoonotic cutaneous leishmaniasis (ZCL) in patients referred to health centers of Isfahan, Golestan and Ilam Provinces of Iran as endemic foci of ZCL caused by Leishmania major besides Mashhad and Bam cities as endemic foci of anthroponotic cutaneous leishmaniasis (ACL) caused by with L. tropica. Two hundred and seventy-eight patients with CL were included in the current study. All of the patients (100%) who received Nano Lip-AmB alone or in combination with Glucantime® and/or cryotherapy based on guideline of Iranian national committee for the treatment of CL. Two patients with 7 skin lesions, who was resident in ACL endemic area and received Nano Lip-AmB plus Glucantime® and another patient was a resident of ZCL endemic area and received Nano Lip-AmB plus cryotherapy showed clinical relapses after treatment. Sina Ampholeish® in combination with other standard protocols of treatment of CL is well tolerated and with acceptable clinical efficacy rate.

Family-focused intervention to promote adolescent mental health and well-being in Moldova and North Macedonia (FLOURISH): feasibility study protocol

IntroductionFamily-Focused Adolescent & Lifelong Health Promotion (FLOURISH) project will adapt, implement and evaluate a programme to support adolescent mental health and well-being through strategies, such as strengthening parenting practices, adolescent-caregiver...

OP165 Changing Decision Criteria: An Analysis Of Health Technology Assessment Reports To The Brazilian Unified Health System

IntroductionIn Brazil, the National Committee for Health Technology Incorporation of the Brazilian Public Health System (Conitec) defines the criteria for incorporating technologies into the public health system. However, all recommendations are submitted to public consultations to ensure transparency and public participation.Contributions from the public consultation are analyzed and entered into Conitec’s final report and sometimes change the preliminary recommendation.MethodsThis descriptive, retrospective exploratory study aimed to gather qualitative and quantitative data on criteria considered by healthcare decision makers from Conitec and to identify which criteria most changed after reports were submitted to public consultation. Data from 2012 to November 2022 were collected from the Conitec website, entered into a specific extraction form, and analyzed using descriptive statistics.ResultsMedicines (77%) were the most frequently evaluated type of technology, followed by procedures (15%), and products (8%). A total of 763 recommendations were analyzed. Of these, 70 percent did not change the decision criteria from the preliminary to the final published report, 9 percent did change, and 20 percent were simplified analyses of technologies of relevant public interest that were of low cost and low budget impact (these were not submitted to public consultation or public hearing). As pharmaceutical companies usually propose cost reductions or discounts during the Conitec public consultations, most of the recommendations (45%) were modified in the final report, with incremental budgetary reduction being the main criterion. This study identified that most of the changes occurred in neurology and were related to the high incremental budgetary impact of technologies for the care of rare diseases like spinal muscular atrophy.ConclusionsAlthough different criteria are considered for Conitec recommendations, some of these are regarded as crucial for decision-making. Unfortunately, as there is no definition for the weight of each of these criteria, it is difficult to understand their influence on the recommendations made. Therefore, it is crucial to establish standardized criteria for proper decision-making.

PP42 Insights Of Health Technology Assessment In Brazilian Health Unified System: Areas Of Interests In Health

IntroductionThe National Committee for Health Technology Incorporation of the Brazilian Public Health System’ s (Conitec) principle is to advise the Ministry of Health (MS) in the tasks related to incorporation, exclusion or modification of any health technologies into the Unified Health System (SUS). Moreover, this also involves alteration of clinical protocols or therapeutic guidelines. All of the recommendations consider the international classification of diseases (CID) as a common language that allows health professionals and managers to understand standardized information, to identify trends and benefits of recommendations in each therapeutic area.MethodsThis exploratory, descriptive and retrospective study aims to provide qualitative and quantitative data from the technologies evaluated by the Conitec in the period June 2012 to November 2022. Data were extracted in Conitec’s website.ResultsThe searches resulted in 763 recommendations in total. Among them, the most evaluated therapeutic area was Infectology with 126 technologies (16.5%). In this field the highlighted diseases and conditions were Hepatitis 42 (33.3%); HIV 23 (18.3%) and COVID-19 11 (8.7%). In Oncology, 113 recommended technologies (14.8%) were identified, in order of prominence for the diseases: Breast Cancer 21 (18.6%); Colorectal Cancer 11 (9.7%); Leukemias 17 (15.0%). In the Respiratory Diseases area, 89 technologies (11.7%) were recommended, among them: Chronic obstructive pulmonary disease (COPD) 17 (19.1%); Asthma 15 (16.9%) and COVID-19 11 (12.4%). These results clarify which diseases are most needing new technologies to be treated.ConclusionsThe results show what conditions and fields in health needs to be prioritized for public policies and prevention measures. This study demonstrates how important is to make accessible the public health information, improving public knowledge and social actions in SUS.

OP167 An Analysis Of Medication Exclusion Reports In The Health Technology Assessment Process For The Brazilian Unified Health System

IntroductionThe National Committee for Health Technology Incorporation of the Brazilian Public Health System (Conitec), which was created in 2011 by federal law, defines the criteria for incorporating and excluding health technologies in the Brazilian health system. For technology evaluation proposals a recommendation report is carried out, which finds the best scientific evidence about the efficacy, accuracy, effectiveness, and safety of the technology being analyzed. The report also provides a comparative economic evaluation of the technologies already in the health system to promote and protect public health, achieve the best allocation of resources, and reduce regional inequalities.MethodsThis exploratory, descriptive, and retrospective study aimed to identify the criteria considered for the exclusion of medicines within the Brazilian health system from 2012 to November 2022. Data were extracted from Conitec’s website into a specific extraction form and analyzed using descriptive statistics.ResultsDuring the evaluation period, 763 technology recommendations by Conitec were identified, of which 75 (10%) related to the exclusion of medicines. Several criteria were identified among the exclusion recommendations, including protocol updates, expiry or lack of registration in the National Health Surveillance Agency, and drugs whose clinical indication was not included in the list of drugs registered for treatments in the health system.ConclusionsAlthough there is no standardization of criteria in Conitec for recommendations on the exclusion of health technologies, this study contributes to a better understanding of these technologies. Disinvestment of technologies positively impacted the population because it resulted in better allocation of resources in the health system, and some of the excluded technologies presented a greater risk of interactions and undesirable adverse reactions.

PP17 Rare Diseases: An Analysis Of Assessments Carried Out By The National Committee For Health Technology Incorporation In Brazilian Public Health System (Conitec)

IntroductionThe treatment of rare diseases has been a challenge for the Brazilian Unified Health System. In addition to the high costs of treatments, the characteristics inherent to this type of disease bring weaknesses to the scientific evidence of efficacy and safety. The National Committee for Health Technology Incorporation In Brazilian Public Health System (Conitec) is formed by a plenary of experts who monthly assess demands for incorporation into the public health system.MethodsThis exploratory, descriptive, and retrospective study aims to gather qualitative and quantitative data on criteria considered by healthcare decision-makers from Conitec and analyzes which rare diseases were benefited by the commission recommendations. Data from June 2012 to November 2022 were collected from the Conitec website to a specific extraction form and analyzed using descriptive statistics.ResultsA total of 763 technologies were evaluated from June 2012 to November 2022, with 158 being drugs for rare diseases. Among these, those with the highest number of diseases benefited were multiple sclerosis 13.3 percent (n=21), cystic fibrosis 6.3 percent (n=10) and pulmonary hypertension 5.7 percent (n=9). About 70 (44.3%) technologies were incorporated into the Unified Health System to treat rare diseases. In these incorporations, 25 technologies initially had an unfavorable recommendation, and only after the public consultation they were recommended for incorporation. Reasons that contributed to this change in recommendation were the new scientific evidence presented (64%), new negotiation of the drug price (28%), and new budgetary impact by revising the calculation of the target population (8%).ConclusionsThe criteria for evaluating technologies for rare diseases are similar to those adopted for other clinical conditions. However, it is important to adopt specific criteria in analysis of drugs targeted at diseases considered rare for the population. Negotiating prices with industry is an important factor that was highlighted, potentially favoring access to new treatments that can modify the progress of these diseases.