Iris Contreras Hernández

Status Update of the Reimbursement Review Environment in the Public Sector across Four Latin American Countries

In Latin America, social security and public sectors represent the largest financiers and providers of health care. Many countries in the region have compulsory packages of basic health care benefits. As part of an effort to improve quality of care and access, several health technology assessment agencies, both governmental and academia, among a number of Latin American countries have been formally established in the past few years. Several Latin American countries have recently developed and published methodological guidelines in economic evaluation, indicating that there is a growing interest in evaluating health-related products, drugs, and technologies used by the population. Presentations on the health care system and the role of health technology assessment, pharmacoeconomics, and risk sharing policies, from the public sector perspective, in the Latin American countries Argentina, Brazil, Colombia, and Mexico were made at the 3rd Latin American ISPOR Conference held in Mexico City in 2011 and are discussed in this article. In conclusion, there is a clear need for Latin American countries to evaluate the value of new technologies that are being incorporated into their health care system. In addition, health technology assessment guidelines are important for their local needs in terms of regulation along with common country unions. In the future, the Latin American region needs to increase drug access along with implementing cost-containment measures to improve quality and health outcomes.

The willingness-to-pay concept in question

La idoneidad del concepto de willingness to pay (disponibilidad a pagar) es revisado en las evaluaciones economicas que se realizan en el campo de la salud. Por un lado, existe dentro de la literatura economica un numero importante de investigadores que senalan los multiples problemas metodologicos que entranan las estimaciones de willingness to pay. Por otro lado, aun el debate teorico-conceptual acerca de la agregacion de las preferencias individuales dentro de una demanda agregada no esta del todo resuelto. Sin embargo, durante los ultimos 20 anos la estimacion de la disponibilidad a pagar dentro de las investigaciones economicas ha aumentado de forma significativa, siendo en muchos casos uno de los principales factores de la toma de decision en politicas de salud. Plantease alguna de las limitaciones de esta tecnica, asi como el posible efecto distorsionador que podria tener sobre las evaluaciones economicas que se realizan en el area de la economia de la salud.The adequacy of the concept of willingness to pay within health economics evaluations is reviewed. A considerable number of researchers in the literature have pointed out multiple methodological issues involving willingness-to-pay estimates. On the other hand, the theoretical discussion about the aggregation of individual preferences within an aggregate demand remains open. However, over the last 20 years, willingness-to-pay estimates alongside health economics research significantly increased and in many cases they are one of the key factors for decision making on issues of health policies. The article describes some limitations of this approach as well as the potential distorting effect that it might have on health economics evaluations.

El concepto de willingness-to-pay en tela de juicio

La idoneidad del concepto de willingness to pay (disponibilidad a pagar) es revisado en las evaluaciones economicas que se realizan en el campo de la salud. Por un lado, existe dentro de la literatura economica un numero importante de investigadores que senalan los multiples problemas metodologicos que entranan las estimaciones de willingness to pay. Por otro lado, aun el debate teorico-conceptual acerca de la agregacion de las preferencias individuales dentro de una demanda agregada no esta del todo resuelto. Sin embargo, durante los ultimos 20 anos la estimacion de la disponibilidad a pagar dentro de las investigaciones economicas ha aumentado de forma significativa, siendo en muchos casos uno de los principales factores de la toma de decision en politicas de salud. Plantease alguna de las limitaciones de esta tecnica, asi como el posible efecto distorsionador que podria tener sobre las evaluaciones economicas que se realizan en el area de la economia de la salud.The adequacy of the concept of willingness to pay within health economics evaluations is reviewed. A considerable number of researchers in the literature have pointed out multiple methodological issues involving willingness-to-pay estimates. On the other hand, the theoretical discussion about the aggregation of individual preferences within an aggregate demand remains open. However, over the last 20 years, willingness-to-pay estimates alongside health economics research significantly increased and in many cases they are one of the key factors for decision making on issues of health policies. The article describes some limitations of this approach as well as the potential distorting effect that it might have on health economics evaluations.

Análisis de coste-efectividad en el tratamiento farmacológico del síndrome de fibromialgia en México

OBJECTIVE To identify, from the Mexican Public Health System perspective, which would be the most cost-effective treatment for patients with Fibromyalgia (FM). MATERIAL AND METHODS A Markov model including three health states, divided by pain intensity (absence or presence of mild, moderate or severe pain) and considering three-month cycles; costs and effectiveness were estimated for amitriptyline (50mg/day), fluoxetine (80 mg/day), duloxetine (120 mg/day), gabapentin (900 mg/day), pregabalin (450 mg/day), tramadol/acetaminophen (150 mg/1300 mg/día) and amitriptyline/fluoxetine (50mg/80 mg/día) for the treatment of FM. The clinical outcome considered was the annual rate of pain control. Probabilities assigned to the model were collected from published literature. Direct medical costs for FM treatment were retrieved from the 2006 data of the Mexican Institute of Social Security (IMSS) databases and were expressed in 2010 Mexican Pesos. Probabilistic Sensitivity Analyses were conducted. RESULTS The best pain control rate was obtained with pregabalin (44.8%), followed by gabapentin (38.1%) and duloxetine (34.2%). The lowest treatment costs was for amitriptyline (

O conceito de willingness to pay em questão

9047.01), followed by fluoxetine (

Competencia en el sector salud: análisis de la reforma sueca (1992 - 1995)

10,183.89) and amitriptyline/fluoxetine (

Competência no setor saúde: análise da reforma sueca (1992-1995)

10,866.01). By comparing pregabalin vs amitriptyline, additional annual cost per patient for pain control would be around

Competitiveness in the health care sector: analysis of the Swedish reform (1992-1995)

50.000 and

Cost-effectiveness Analysis of Pharmacologic Treatment of Fibromyalgia in Mexico

75.000 and would result cost-effective in 70% and 80% of all cases. CONCLUSIONS Among all treatment options for FM, pregabalin achieved the highest pain control and was cost-effective in 80% of patients of the Mexican Public Health System.

Costo-efectividad de maraviroc más tratamiento de base optimizado en pacientes con VIH/SIDA

La idoneidad del concepto de willingness to pay (disponibilidad a pagar) es revisado en las evaluaciones economicas que se realizan en el campo de la salud. Por un lado, existe dentro de la literatura economica un numero importante de investigadores que senalan los multiples problemas metodologicos que entranan las estimaciones de willingness to pay. Por otro lado, aun el debate teorico-conceptual acerca de la agregacion de las preferencias individuales dentro de una demanda agregada no esta del todo resuelto. Sin embargo, durante los ultimos 20 anos la estimacion de la disponibilidad a pagar dentro de las investigaciones economicas ha aumentado de forma significativa, siendo en muchos casos uno de los principales factores de la toma de decision en politicas de salud. Plantease alguna de las limitaciones de esta tecnica, asi como el posible efecto distorsionador que podria tener sobre las evaluaciones economicas que se realizan en el area de la economia de la salud.The adequacy of the concept of willingness to pay within health economics evaluations is reviewed. A considerable number of researchers in the literature have pointed out multiple methodological issues involving willingness-to-pay estimates. On the other hand, the theoretical discussion about the aggregation of individual preferences within an aggregate demand remains open. However, over the last 20 years, willingness-to-pay estimates alongside health economics research significantly increased and in many cases they are one of the key factors for decision making on issues of health policies. The article describes some limitations of this approach as well as the potential distorting effect that it might have on health economics evaluations.