Joaquín Caporale

A cross-sectional study of the microeconomic impact of cardiovascular disease hospitalization in four low- and middle-income countries.

Objective To estimate individual and household economic impact of cardiovascular disease (CVD) in selected low- and middle-income countries (LMIC). Background Empirical evidence on the microeconomic consequences of CVD in LMIC is scarce. Methods and Findings We surveyed 1,657 recently hospitalized CVD patients (66% male; mean age 55.8 years) from Argentina, China, India, and Tanzania to evaluate the microeconomic and functional/productivity impact of CVD hospitalization. Respondents were stratified into three income groups. Median out-of-pocket expenditures for CVD treatment over 15 month follow-up ranged from 354 international dollars (2007 INT

Estimation of the burden of cardiovascular disease attributable to modifiable risk factors and cost-effectiveness analysis of preventative interventions to reduce this burden in Argentina

, Tanzania, low-income) to INT

Estimación de la carga de las enfermedades cardiovasculares atribuible a factores de riesgo modificables en Argentina

2,917 (India, high-income). Catastrophic health spending (CHS) was present in >50% of respondents in China, India, and Tanzania. Distress financing (DF) and lost income were more common in low-income respondents. After adjustment, lack of health insurance was associated with CHS in Argentina (OR 4.73 [2.56, 8.76], India (OR 3.93 [2.23, 6.90], and Tanzania (OR 3.68 [1.86, 7.26] with a marginal association in China (OR 2.05 [0.82, 5.11]). These economic effects were accompanied by substantial decreases in individual functional health and productivity. Conclusions Individuals in selected LMIC bear significant financial burdens following CVD hospitalization, yet with substantial variation across and within countries. Lack of insurance may drive much of the financial stress of CVD in LMIC patients and their families.

Economic evaluation guidelines in Latin America: a current snapshot.

BackgroundCardiovascular disease (CVD) is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL). The aim of the study was to estimate the burden of acute coronary heart disease (CHD) and stroke and the cost-effectiveness of preventative population-based and clinical interventions.MethodsAn epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF) of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY) were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I

Residual economic burden of Streptococcus pneumoniae- and nontypeable Haemophilus influenzae-associated disease following vaccination with PCV-7: a multicountry analysis.

). Incremental cost-effectiveness ratios (ICER) were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20% in 10 years.ResultsAn estimated total of 611,635 DALY was lost due to acute CHD and stroke for 2005. Modifiable risk factors explained 71.1% of DALY and more than 80% of events. Two interventions were cost-saving: lowering salt intake in the population through reducing salt in bread and multidrug therapy targeted to persons with an absolute risk above 20% in 10 years; three interventions had very acceptable ICERs: drug therapy for high blood pressure in hypertensive patients not yet undergoing treatment (I

Eliminating artificial trans fatty acids in Argentina: estimated effects on the burden of coronary heart disease and costs

2,908 per DALY saved), mass media campaign to promote tobacco cessation amongst smokers (I

Costos de atención médica de personas con diabetes anteriores y posteriores a su hospitalización en Argentina

3,186 per DALY saved), and lowering cholesterol with statin drug therapy (I

Hospitalization Costs for Heart Failure in People with Type 2 Diabetes: Cost-Effectiveness of its Prevention Measured by a Simulated Preventive Treatment

14,432 per DALY saved); and one intervention was not found to be cost-effective: tobacco cessation with bupropion (I

Institutionalizing health technology assessment for priority setting and health policy in Latin America: from regional endeavors to national experiences

59,433 per DALY saved)ConclusionsMost of the interventions selected were cost-saving or very cost-effective. This study aims to inform policy makers on resource-allocation decisions to reduce the burden of CVD in Argentina.

Is Equity of Access to Health Care Achievable in Latin America

OBJECTIVE Estimate the burden of disease, the proportion attributable to the principal modifiable cardiovascular risk factors, and the direct medical cost of hospitalization associated with coronary heart disease and stroke in Argentina. METHODOLOGY An analitical model was prepared using Argentinas 2005 mortality data and the prevalence of the principal cardiovascular risk factors (hypertension, hypercholesterolemia, overweight, obesity, hyperglycemia, current and past smoking, sedentary lifestyle, and inadequate intake of fruits and vegetables). The burden of disease-years of potential life lost (YPLL) and years of healthy life lost (YHLL)- and hospitalization costs for the cardiovascular diseases analyzed were estimated. RESULTS In 2005 over 600 000 YHL were lost in Argentina and the number of YPLL due to heart disease and stroke was calculated at 400 000; 71.1% of the YHLL, 73.9% of the YPLL, and 76.0% of the associated costs were attributable to modifiable risk factors. Hypertension was the risk factor with the greatest impact in both men and in women, responsible for 37.3% of the total cost, 37.5% of the YPLL, and 36.6% of the YHLL. CONCLUSIONS Most of the burden of disease from cardiovascular disease in Argentina is associated with modifiable, and therefore preventable, risk factors and could be reduced through population-based and clinical interventions that employ a risk approach; such interventions have already proven to be cost effective, accessible, and feasible in countries like Argentina.