Fifteen years of Conitec: strengthening science to safeguard the SUS

Abstract

In 2026, Brazil’s National Committee for Health Technology Incorporation into the Unified Health System (Conitec) turns fifteen. This opinion article argues that the main challenge of the next decade is not expanding the number of incorporations, but consolidating the technical excellence of decisions, a distinction that matters to public health and to everyday pharmacy practice, since it shapes the population’s access to medicines, clinical protocols, and care within the SUS. It contends that Conitec was born with the legal institutionalization brought by Law No. 12,401/2011 and Decree No. 7,646/2011, grew by consolidating a public and transparent process comparable to that of reference international agencies, and now must mature scientifically. Three critical axes are discussed: governance, still vulnerable to market, political, and media pressure, with social participation confined to the final and least influential stage of decision-making; the debate over adopting a single cost-effectiveness threshold, from which the author dissents for algebraic reasons and because of the difficulty of standardizing effectiveness for rare diseases and pediatric populations; and the need to modernize the methodology of Brazilian health technology assessment, incorporating multi-criteria decision analysis, real-world data, and causal methods. The article ultimately advocates transforming the Brazilian Health Technology Assessment Network (Rebrats) into permanent scientific infrastructure, rather than an occasional collaboration network. It concludes that the credibility of health technology assessment in Brazil should be measured by the technical soundness of each decision, favorable or not, rather than by the volume of technologies incorporated into the SUS.