ABC | Volume 114, Nº2, February 2020

Viewpoint Arq Bras Cardiol. 2020; 114(2):313-318 Lopes et al. Treatment of aortic stenosis in elderly individuals in Brazil Figure 2 – Mortality rate at all ages due to Non-rheumatic calcific aortic valve disease in Brazil from 1990 to 2017 (Global Burden of Disease 2017). 7 Figure 3 – Proportional mortality from non-rheumatic calcific aortic valve disease in Brazil from 1990 to 2017 (Global Burden of Disease 2017). 7 the Brazilian population by SUS. Instead, estimated data from other countries were primarily considered for the analysis. Without a clear connection with the remainder of the opinion, page 25 of the final Conitec report presents the budgetary impact estimate, which is subject to several criticisms in addition to those presented. First, it should be emphasized the mentioning of the study by Wood 13 showing the estimated increasing use of TAVI in Europe, with an annual rate of 40.9 million inhabitants, which would be proportional to 8,025 procedures/year in Brazil. Conitec constantly criticizes the use of international instead of national data. Interestingly, in this case, to calculate the budgetary impact, Conitec used an European estimate, which would be particularly questionable in this context, since 1) TAVI has been registered and practiced for much longer in Europe than in Brazil; 2) the epidemiological characteristics of the European population are different from those of the Brazilian population in terms of being older and with a longer time elapsed since the epidemiological transition, which increases the number of patients aged over 75 years, and consequently the prevalence and the number of procedures. It is important to mention that the European population is estimated at 700 million inhabitants, that is, much larger than the Brazilian population; 3) the European health care systems, particularly in Germany, have a different stance from that of the Brazilian government regarding the emergence of technological innovations and is much more receptive to new 315