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Worldwide, 1 % of the population receives anticoagulation therapy, with prevalence higher in older adults. Difficulties in the adequate management of these patients have led to the development of strategies focused on achieving therapeutic control and reducing adverse events with efficient use of resources.To estimate the cost utility and budget impact on the Argentinean health system of implementation of anticoagulation clinics (ACs) (with and without use of point-of-care [POC] CoaguChekFor the cost-utility analysis, a cohort-based state transition model was designed to compare costs and health outcomes of implementing ACs for outpatient management of anticoagulated patients. The budget impact analysis used an analytical model to estimate the differential costs of implementing an AC and the expected adverse events avoided, and the differential costs of an international normalized ratio (INR) determination using a POC device rather than a conventional laboratory.We calculated the study outcomes for a cohort of 1000 patients. Considering a 5 % discount rate, the use of ACs generated 13.9 additional quality-adjusted life-years (0.014 per patient) and 12.5 additional life-years (0.013 per patient). Incremental cost-effectiveness ratios of AC implementation with and without the use of POC devices compared with the scenario without ACs were dominant in both cases. In the probabilistic sensitivity analysis, nearly all simulated results were cost effective (i.e., below the 1 or 3 gross domestic product per capita thresholds). Budget impact analysis results showed AC implementation generated savings from the first year of implementation, with savings of AR $265,325 by year 5. The addition of POC devices in the ACs also generated savings as early as the first year of implementation, with savings of AR $488,072 by year 5 (AR $488 per patient).Anticoagulation clinics are estimated to be cost effective and generate notable savings in the treatment of patients on long-term oral anticoagulant therapy when compared with non-AC settings. These savings are considerably higher when POC devices are added as part of the patient management, due to lower laboratory technician costs per INR determination.

Background The treatment of choice for advanced non–small cell lung cancer is selected according to the presence of specific alterations. Patients should undergo molecular testing for relevant modifications and the mutational status of EGFR and translocation of ALK and ROS1 are commonly tested to offer the best intervention. In addition, the tests costs should also be taken in consideration. Therefore, this work was performed in order to evaluate the cost-effectiveness of a unique exam using NGS (next generation sequencing) versus other routinely used tests which involve RT-PCR and FISH. Methods The target population was NSCLC, adenocarcinoma, and candidates to first-line therapy. Two strategies were undertaken, strategy 1 corresponded to sequential tests with EGFR RT-PCR, then FISH for ALK and ROS1. Strategy 2 differed from 1 in that ALK and ROS1 translocation testing were performed simultaneously by FISH. Strategy 3 considered single test next-generation sequencing, a platform that includes EGFR, ALK and ROS1 genes. A decision tree analysis was used to model genetic testing options. From the test results, a microsimulation model was nested to estimate survival outcomes and costs of therapeutic options. Results The use of NGS added 24% extra true cases as well as extra costs attributed to the molecular testing. The ICER comparing NGS with sequential tests was US$ 3479.11/correct case detected. The NGS improved a slight gain in life years and QALYs. Conclusion Our results indicated that, although precise, the molecular diagnosis by NGS of patients with advanced stage NSCLC adenocarcinoma histology was not cost-effective in terms of quality-adjusted life years from the perspective of the Brazilian supplementary health system.

Preeclampsia (PE) is a hypertensive disorder of pregnancy that can cause severe complications and adverse fetal/maternal outcomes. We aimed to estimate the annual economic impact of incorporating Elecsys® sFlt-1/PlGF PE ratio, which measures soluble fms-like tyrosine kinase-1 and placental growth factor, into routine clinical practice in Argentina to aid diagnosis of PE and hemolysis, elevated liver enzymes, and low platelets syndrome from second trimester onward in pregnancies with clinical suspicion of PE.A decision tree was used to estimate annual economic impact on the Argentine health system as a whole, including relevant costs associated with diagnosis, follow-up, and treatment from initial presentation of clinically suspected PE to delivery. Annual costs of a standard-of-care scenario and a scenario including PE ratio (reference year 2021) were analyzed.The economic model estimated that using the sFlt-1/PlGF ratio would enable the overall health system to save ∼$6987 million Argentine pesos annually (95% confidence interval $12 045-$2952 million), a 39.1% reduction in costs versus standard of care, mainly due to reduced hospitalizations of women with suspected PE. The economic impact calculation estimated net annual savings of approximately $80 504 Argentine pesos per patient with suspected PE. Based on the assumed uncertainty of the parameters, the likelihood the intervention would be cost saving was 100% for the considered scenarios.Our analysis suggests that the implementation of the sFlt-1/PlGF ratio in women with suspected PE in Argentina will enable the health system to achieve significant savings, contributing to more efficient clinical management through the likely reduction of unnecessary hospitalizations, depending on assumptions. Results rest on the payers' ability to recover savings generated by the intervention.

Objectives Cervical cancer (ICC) is the fourth leading cause of mortality in women in Argentina and primary screening with conventional cytology (Papanicolaou smear) is the most widely used strategy despite its limitations. Strategies based on human papillomavirus (HPV) testing have the potential to improve detection and reduce mortality. The objective of this study is to evaluate the cost-effectiveness and budgetary impact of a strategy based on HPV testing with genotyping. Methods We used a decision model to compare the ICC screening strategies. The population consisted of 30- to 65-year-old females suitable for screening in Argentina. Inputs comprised epidemiologic, diagnostic performance, and costs data. The clinical impact was represented by the number of ICC detected and ICC-related mortality. Incremental cost-effectiveness ratio, estimated in terms of Argentinean pesos per life-year gained, and the budgetary impact were calculated at 5, 10, and 20 years. Univariate and probabilistic sensitivity analyses were performed. Results Primary screening with HPV testing would prevent 1853 ICC deaths and reduce mortality by 13% at year 10 compared with Papanicolaou smear. With an incremental cost-effectiveness ratio of AR$329 042 in the base case, it would be cost-effective for a cost-effectiveness threshold of 1 gross domestic product per capita. It would imply an additional expense in the first 5 years and probably savings in the subsequent ones. Sensitivity analyses confirm the robustness of the findings. Conclusions The primary screening strategy based on HPV testing with genotyping compared with conventional cytology is most likely a cost-effective strategy in Argentina.

Background Inappropriate antibiotic use represents a major global threat. Sepsis and bacterial lower respiratory tract infections (LRTIs) have been linked to antimicrobial resistance, carrying important consequences for patients and health systems. Procalcitonin-guided algorithms may represent helpful tools to reduce antibiotic overuse but the financial burden is unclear. The aim of this study was to estimate the healthcare and budget impact in Argentina of using procalcitonin-guided algorithms to guide antibiotic prescription. Methods A decision tree was used to model health and cost outcomes for the Argentinean health system, over a one-year duration. Patients with suspected sepsis in the intensive care unit and hospitalized patients with LRTI were included. Model parameters were obtained from a focused, non-systematic, local and international bibliographic search, and validated by a panel of local experts. Deterministic and probabilistic sensitivity analyses were performed to analyze the uncertainty of parameters. Results The model predicted that using procalcitonin-guided algorithms would result in 734.5 [95% confidence interval (CI): 1,105.2;438.8] thousand fewer antibiotic treatment days, 7.9 [95% CI: 18.5;8.5] thousand antibiotic-resistant cases avoided, and 5.1 [95% CI: 6.7;4.2] thousand fewer Clostridioides difficile cases. In total, this would save $422.4 US dollars (USD) [95% CI: $935;$267] per patient per year, meaning cost savings of $83.0 [95% CI: $183.6;$57.7] million USD for the entire health system and $0.4 [95% CI: $0.9;$0.3] million USD for a healthcare provider with 1,000 cases per year of sepsis and LRTI patients. The sensitivity analysis showed that the probability of cost-saving for the sepsis patient group was lower than for the LRTI patient group (85% vs. 100%). Conclusions Healthcare and financial benefits can be obtained by implementing procalcitonin-guided algorithms in Argentina. Although we found results to be robust on an aggregate level, some caution must be used when focusing only on sepsis patients in the intensive care unit.

Evaluar la eficiencia de la atencion a la salud recibida por los pacientes diagnosticados de cancer de celulas escamosas de cabeza y cuello en estadios avanzados, incluidos en el ensayo clinico fase iv realizado en Cuba. Evaluacion economica completa de coste-efectividad. Universo de 386 pacientes. Se evaluaron cinco opciones de tratamiento: radioterapia (RT) + nimotuzumab, RT/quimioterapia (QT) concurrente + nimotuzumab, RT/QT secuencial + nimotuzumab, nimotuzumab y QT + nimotuzumab. La variable efectividad fue la supervivencia global medida en anos de vida ganados (AVG). Se estimaron los costes directos sanitarios relevantes. Se hizo analisis de sensibilidad, teniendo en cuenta los limites inferior y superior IC 95% de los costes y efectividad, creando cuatro escenarios. La opcion mas efectiva fue RT/QT secuencial + nimotuzumab con 2,53 AVG. La alternativa mas eficiente fue QT concurrente + nimotuzumab con un coste-efectividad medio 26.450,20 $/AVG. El coste-efectividad incremental de la opcion RT/QT secuencial + nimotuzumab respecto a QT concurrente + nimotuzumab fue 33.119,63 $/AVG extra. Segun criterio CHOISE-OMS es una opcion no coste-efectiva, por tanto habra que valorar la estrategia farmacoterapeutica a seguir. El analisis de sensibilidad arrojo valores similares, demostrando robustez de los resultados. La opcion RT/QT secuencial + nimotuzumab tiene mayor efectividad, pero es menos eficiente que QT concurrente + nimotuzumab. Lograr una mayor supervivencia en el tratamiento de este tipo de pacientes significa un coste adicional para el Sistema Nacional de Salud, por lo que se requerira de una estrategia farmacoterapeutica para su utilizacion en los casos que lo requieran.

Background: Acute kidney injury (AKI) is a public health problem that affects millions of hospitalized patients worldwide. In Argentina, evidence suggests that its incidence has risen in recent years. When severe, AKI may require a renal replacement therapy (RRT) where continuous RRT (CRRT) and intermittent RRT (IRRT) are plausible options for patients in the intensive care unit. Objective: To evaluate the cost utility of CRRT versus IRRT for the National Institute of Social Services for Retirees and Pensioners, the largest social security health insurance for elders in Argentina. Methods: This was a model-based cost-utility analysis. Long-term costs and health outcomes were estimated for a hypothetical cohort with a Markov model. Parameters used were obtained from published literature and validated with local experts. Local costs were estimated and expressed in $AR of 2016. Several sensitivity analyses were run to analyze the impact of uncertainty on results. Results: Continuous RRT dominated IRRT by cumulating over the model more quality-adjusted life years and less costs. Total discounted quality-adjusted life years for both cohorts were 1049 and 1034, respectively, and total costs were $95 362 and $103 871. Cost-effectiveness (CE) results reflect these differences in favor of CRRT with a deterministic cost-saving incremental CE ratio and a probability of CRRT being CE of 65.4%, considering a CE threshold of 1 gross domestic product per capita. Conclusions: Continuous RRT for patients with AKI eligible for CRRT or IRRT would probably be a cost-effective intervention for the National Institute of Social Services for Retirees and Pensioners’ view. Nevertheless, there is considerable uncertainty around results, mainly due to the lack of adequate controlled studies and local data on the prognosis of these patients in Argentina. Fil: Garay, Osvaldo Ulises. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Palacios, Alfredo. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Pichón-riviere, Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Augustovski, Federico Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: García Martí, Sebastián. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Hernández Vásquez, Akram. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: López, Elena Tapia. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Rosa Diez, Guillermo Javier. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Bardach, Ariel Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina

Background: Around 6% of total deaths are related to alcohol consumption worldwide. Mathematical models are important tools to estimate disease burden and to assess the cost-effectiveness of interventions to address this burden. Methods: We carried out a systematic review on models, searching main health literature databases up to July 2017. Pairs of reviewers independently selected, extracted data and assessed the quality of the included studies. Discrepancies were resolved by consensus. We selected those models exploring: a) disease burden (main metrics being attributable deaths, disability-adjusted life years, quality-adjusted life years) or b) economic evaluations of health interventions or policies, based on models including the aforementioned outcomes. We grouped models into broad families according to their common central methodological approach. Results: Out of 4295 reports identified, 63 met our inclusion criteria and were categorized in three main model families that were described in detail: 1) State transition-i.e Markov-models, 2) Life Table-based models and 3) Attributable fraction-based models. Most studies pertained to the latter one (n = 29, 48.3%). A few miscellaneous models could not be framed into these families. Conclusions: Our findings can be useful for future researchers and decision makers planning to undertake alcohol-related disease burden or cost-effectiveness studies. We found several different families of models. Countries interested in adopting relevant public health measures may choose or adapt the one deemed most convenient, based on the availability of existing data at the local level, burden of work, and public health and economic outcomes of interest. Fil: Bardach, Ariel Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Alcaraz, Andrea Olga. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Ciapponi, Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Garay, Osvaldo Ulises. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Pichón-riviere, Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina Fil: Palacios, Alfredo. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Cremonte, Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Psicología Básica, Aplicada y Tecnología. Universidad Nacional de Mar del Plata. Facultad de Psicología. Instituto de Psicología Básica, Aplicada y Tecnología; Argentina Fil: Augustovski, Federico Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina

Objectives: To assess, describe and compare the requirements and pathwaysof medical devices from licensing to coverage in four Latin American countries(LAC) health systems. Methods: We conducted a literature search (February 2015)on Pubmed, Lilacs and Value in Health Regional Issues journal. We also searchedspecific websites of Health Technology Assessment (HTA) and regulatory agencies,ministries of health and health agencies; and a performed generic Internet search.We included all publications describing aspects related to regulation, coverage,medical technology innovation, and HTA and Economic Evaluation (EE) guidelines.We additionally interviewed key informants from all countries to gather informationrelated to the aforementioned processes. We present here the literature searchresults. Results: We included 60 studies out of 2190. Five percent of the publicationsanalyzed the four countries jointly, 75% were from Brazil, 8.3% from Mexico, 5%from Colombia and 5.7% from LAC in general. Half of the studies described the roleof the HTA and EE in decision-making and aspects or policies related to innovation(25% and 23.3%). Regarding the description of the coverage process, it was addressedin 13.3% of the studies; 10% of the publications focused on technovigilance; and also10% on regulatory aspects. Remaining publications were methodological guidelinesand general descriptions of the health systems and the role of medical devices. Allcountries had HTA and EE guidelines, although there did not include device specificrecommendations. There is a spectrum of HTA formalization for technology incorporationafter licensing, higher in Brazil and lower in Argentina Conclusions:There is scarce information on the processes and requirements to achieve coveragefor medical devices in these countries. Processes differ, are in general not explicit,lack transparency, and usually replicate those of drugs not taking into account thespecificities of medical devices. Fil: Rey Ares, Lucila. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Hernández Vásquez, Akram. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Garay, Osvaldo Ulises. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Pichón-Riviere, Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: García Martí, Sebastián. Instituto de Efectividad Clínica y Sanitaria; Argentina Fil: Gilardino, Ramiro. Johnson & Johnson Medical Companies; Argentina Fil: Cabra, Hermilio Arturo. Johnson & Johnson Medical Companies; Argentina Fil: Augustovski, Federico Ariel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina

To explore the motivations and expectations of the users of the Program for Healthy Centers in the Autonomous City of Buenos Aires and to evaluate its potential health impact.In-depth interviews were conducted (n = 34) and a self-administered survey was sent to users of the program (n = 605). An epidemiological model was developed to estimate the impact of the program on cardiovascular events (CVE) and disability-adjusted life years (DALYs).The main motivating factors for using the healthy centers were geographic and economic accessibility (free services) and satisfaction with the care received. 14.4% (95% CI, 10.3-18.5%) of hypertensive users and 24.8% (95% CI, 17.6-32.0%) of diabetic users reported having learned of their altered values in the healthy center. More than half of the respondents reported some improvement in their knowledge about the benefits of physical activity and healthy eating; this was more frequent among those who were younger, of lower educational level, users of the public health system, users of a healthy center in the South zone and those who had a cardiometabolic risk factor (p0.05). It was estimated that the healthy centers would prevent 12.5 cardiovascular and cerebrovascular events per year in the assisted population (4.75 events/100 000) and 47.75 DALYs due to these causes.The healthy centers are a favorable space for the implementation of health promotion and prevention actions, contributing to the detection of and facilitating the monitoring of risk factors, with a potential to prevent cardiovascular events and its consequences.Explorar as motivações e expectativas dos usuários do Programa Estações Saudáveis na Cidade Autônoma de Buenos Aires e avaliar seu impacto potencial na saúde.Foram realizadas entrevistas em profundidade (n = 34) e uma pesquisa auto-administrada (n = 605) a usuários do programa. Um modelo epidemiológico foi desenvolvido para estimar o impacto do programa em eventos cardiovasculares e anos de vida ajustados por incapacidade (DALY).Os principais fatores motivadores para o uso do estações saudáveis foram a acessibilidade geográfica, econômica (serviços gratuitos) e a satisfação com o atendimento recebido. 14,4% (intervalo de confiança de 95% [IC95%] 10,3-18,5%) de usuários hipertensos e 24,8% (IC95% 17,6-32,0%) dos diabéticos relataram ter aprendido sobre seus valores alterados na estação saudável. Mais da metade dos entrevistados relataram alguma melhora no conhecimento sobre os benefícios da atividade física e da alimentação saudável, com maior freqüência entre os mais jovens, de menor escolaridade, usuários do sistema público de saúde, usuários de estações saudáveis na zona sul e aqueles que apresentaram algum fator de risco cardiometabólico (p0,05). Estimou-se que, devido à existência de estações saudáveis, 12,5 eventos cardiovasculares e cerebrovasculares por ano seriam evitados na população atendida (4,75 eventos/100 000) e 47,75 DALY por essas causas.As estações saudáveis são um espaço propício para a implementação de ações de promoção e prevenção da saúde, contribuindo para a detecção e facilitação do monitoramento dos fatores de risco, com potencial para prevenir os eventos cardiovasculares e suas consequências.

Objective Pemetrexed plus carboplatin offers survival advantage in first line treatment of advanced lung cancer patients with performance status of 2. We estimated the cost-effectiveness of this combined regimen compared to pemetrexed alone in a Brazilian population. Methods A cost-effectiveness analysis was conducted based on a randomized phase III trial in patients with advanced non-small cell lung cancer (NSCLC) and ECOG performance status of 2 (PS2), comparing doublet regimen pemetrexed plus carboplatin with pemetrexed alone. The perspective adopted was the public health care sector over a three-year period. Direct medical costs and survival time were calculated from patient-level data and utility values were extracted from the literature. Sensitivity analyses were performed to evaluate uncertainties in the results. Results and conclusion The combined regimen pemetrexed plus carboplatin yielded a gain of 0.16 life year (LY) and 0.12 quality-adjusted life year (QALY) compared to pemetrexed alone. The total cost was 17,674.31 USD for the combined regimen and 15,722.39 USD for pemetrexed alone. The incremental cost-effectiveness ratio (ICER) was $12,016.09 per LY gained and $15,732.05 per QALY gained. The factors with the greatest impact on the ICER are pemetrexed price and the time to progression utility value. The cost-effectiveness acceptability curve showed an upper 90% probability of pemetrexed plus carboplatin being cost-effective with a threshold between two and three GDP per capita. Our study suggests superiority of the combined pemetrexed plus carboplatin regimen in terms of efficacy as well as cost-effectiveness in advanced NSCLC patients with a poor performance status of 2.

To derive a value set from Uruguayan general population using the EQ-5D-5L questionnaire and report population norms. General population individuals were randomly assigned to value 10 health states using composite time trade off and 7 pairs of health states through discrete choice experiments. A stratified sampling with quotas by location, gender, age and socio-economic status was used to respect the Uruguayan population structure. Trained interviewers conducted face-to-face interviews. The EuroQol valuation technology was used to administer the protocol as well as to collect the data. OLS and maximum likelihood robust regression models with or without interactions were tested. We included 794 respondents between 20 and 83 years. Their characteristics were broadly similar to the Uruguayan population. The main effects robust model was chosen to derive social values. Values ranged from −0.264 to 1. States with a misery index = 6 had a mean predicted value of 0.965. When comparing the Uruguayan population with the Argentinian EQ-5D-5L crosswalk value set, the prediction for states which differed from full health only in having one of the dimensions at level 2 were about 0.05 higher in Uruguay. The mean index value, using the selected Uruguayan EQ-5D-5L value set, for the general population in Uruguay was 0.895. In general, older people had worse values and males had slightly better values than females. We derived the EQ-5D-5L Uruguayan value set, the first in Latin America. These results will help inform decision-making using economic evaluations for resource allocation decisions.

To estimate the impact of Argentine policies to reduce trans fatty acids (TFA) on coronary heart disease (CHD), disability-adjusted life years (DALYs) and associated health-care costs.We estimated the baseline intake of TFA before 2004 to be 1.5% of total energy intake. We built a policy model including baseline intake of TFA, the oils and fats used to replace artificial TFAs, the clinical effect of reducing artificial TFAs and the costs and DALYs saved due to averted CHD events. To calculate the percentage of reduction of CHD, we calculated CHD risks on a population-based sample before and after implementation. The effect of the policies was modelled in three ways, based on projected changes: (i) in plasma lipid profiles; (ii) in lipid and inflammatory biomarkers; and (iii) the results of prospective cohort studies. We also estimated the present economic value of DALYs and associated health-care costs of coronary heart disease averted.We estimated that projected changes in lipid profile would avert 301 deaths, 1066 acute CHD events, 5237 DALYs and 17 million United States dollars (US$) in health-care costs annually. Based on the adverse effects of TFA intake reported in prospective cohort studies, 1517 deaths, 5373 acute CHD events, 26 394 DALYs and US$ 87 million would be averted annually.Even under the most conservative scenario, reduction of TFA intake had a substantial effect on public health. These findings will help inform decision-makers in Argentina and other countries on the potential public health and economic impact of this policy.Estimer l'impact des politiques argentines de réduction des acides gras trans (AGT) sur les cardiopathies coronariennes (CC), les années de vie corrigées du facteur incapacité (AVCI) et les coûts des soins de santé associés.Nous sommes partis d'une estimation de l'apport de référence en AGT avant 2004 représentant 1,5% de l'apport énergétique total. Nous avons conçu un modèle pour ces politiques, en intégrant cet apport en AGT de référence, les huiles et graisses utilisées pour remplacer les AGT artificiels, les effets cliniques de la réduction des AGT artificiels, les coûts associés ainsi que les AVCI épargnées du fait des accidents coronariens évités. Pour calculer le pourcentage de réduction des CC, nous avons calculé les risques de CC sur un échantillon en population, avant et après la mise en œuvre de ces politiques. Les effets de ces politiques ont été modélisés de trois manières, en fonction des changements projetés: (i) au niveau des profils lipidiques plasmatiques; (ii) au niveau des biomarqueurs lipidiques et inflammatoires et (iii) en fonction des résultats des études prospectives de cohortes. Nous avons également estimé la valeur économique actuelle des AVCI et du coût des soins de santé associés correspondant aux cardiopathies coronariennes évitées.Selon nos estimations, les changements projetés des profils lipidiques devraient permettre d'éviter 301 décès, 1 066 accidents coronariens aigus, 5 237 AVCI et 17 millions de dollars des États-Unis d'Amérique ($US) de dépenses annuelles en soins de santé. À partir des effets défavorables des apports en AGT indiqués dans les études prospectives de cohortes, ce sont 1 517 décès, 5 373 accidents coronariens aigus, 26 394 AVCI et 87 millions de $US de dépenses qui pourraient être évités chaque année.Même dans le scénario le plus prudent, la réduction de l'apport en AGT a un effet considérable sur la santé publique. Ces résultats permettront d'informer les décideurs en Argentine et dans d'autres pays sur les impacts potentiels de ce type de politiques sur le plan économique et en termes de santé publique.Estimar el impacto de las políticas argentinas para la reducción de los ácidos grasos de tipo trans (AGT) en las cardiopatías coronarias, los años de vida ajustados en función de la discapacidad (AVAD) y los costes de la atención sanitaria asociados.Se estimó que la ingesta base de AGT antes de 2004 era de 1,5% de la ingesta de energía total. Se construyó un modelo de política que incluía la ingesta base de AGT, los aceites y grasas utilizados para reemplazar los AGT artificiales, el efecto clínico de reducir los AGT artificiales y el coste y los AVAD salvados debido a los casos de cardiopatías coronarias evitadas. Para calcular el porcentaje de reducción de cardiopatías coronarias, se calcularon los riesgos de cardiopatías coronarias en un modelo basado en la población antes y después de la implementación. El efecto de las políticas fue modelado de tres formas, en base a cambios estimados: (i) perfiles de plasma de lípidos; (ii) marcados biológicos inflamatorios de lípidos; y (iii) los resultados de estudios de cohortes prospectivos. También se estimó el valor económico actual de los AVAD y los costes de atención sanitaria asociados a las cardiopatías coronarias evitadas.Se estimó que los cambios estimados en el perfil de lípidos evitarían 301 muertes, 1.066 casos graves de cardiopatías coronarias, 5.237 AVAD y 17 millones de dólares estadounidenses (USD) en atención sanitaria cada año. Basándose en los efectos adversos del consumo de AGT de los estudios de cohortes prospectivos, se evitarían 1.517 muertes, 5.373 casos graves de cardiopatías coronarias, 26.394 AVAD y 87 millones de USD cada año.Incluso bajo el escenario más conservador, la reducción del consumo de AGT tuvo un efecto sustancial en la salud pública. Estos resultados ayudarán a informar a los responsables de la toma de decisiones en Argentina y otros países sobre el potencial impacto económico y de salud pública de esta política.تقدير أثر السياسات الأرجنتينية للحد من الأحماض الدهنية المتحولة (TFA) على مرض القلبي الوعائي (CHD)، وسنوات العمر المصححة باحتساب مدد العجز (DALYs)، ونفقات الرعاية الصحية المرتبطة بها.تشير تقديراتنا إلى أن نسبة المدخول الأساسي من الأحماض الدهنية المتحولة قبل عام 2004 كانت تبلغ 1.5% من إجمالي مدخول الطاقة. لذلك، قمنا بوضع نموذج لسياسة تتضمن المدخول الأساسي من الأحماض الدهنية المتحولة والزيوت والدهون المستخدمة لتحل محل تلك الأحماض الدهنية المتحولة، والأثر الإكلينيكي لتقليل الأحماض الدهنية المتحولة والتكاليف وسنوات العمر المصححة باحتساب مدد العجز التي يتم توفيرها بسبب تحاشي وقائع الإصابة بالأمراض القلبية الوعائية. ولكي يتم حساب النسبة المئوية لتقليل الإصابة بالأمراض القلبية الوعائية، فقد احتسبنا مخاطر تلك الأمراض على عينة تستند إلى شريحة سكانية قبل تنفيذ السياسة وبعدها. وتم وضع نماذج لأثر السياسات باتباع ثلاث طرق استناداً إلى التغييرات المتوقعة: (1) في أنماط دهون البلازما، و(2) في الدهون والمحددات الحيوية الالتهابية (Inflammatory biomarkers، و(3) نتائج الدراسات الأترابية الاستباقية (Prospective cohort studies). كما وضعنا تقديرًا للقيمة الاقتصادية الحالية لسنوات العمر المصححة باحتساب مدد العجز وما يرتبط بها من تكاليف للرعاية الصحية لمرض القلب الوعائي الذي تم تحاشي الإصابة به.تشير تقديراتنا إلى أن التغييرات المتوقعة في نمط الدهون سيؤدي إلى تحاشي 301 حالة وفاة، و1066 واقعة إصابة بحالات حادة من الأمراض القلبية الوعائية، وإنقاذ 5237 سنة عمر مصححة باحتساب مدد العجز، و17 مليون دولار أمريكي سنويًا من نفقات الرعاية الصحية. وبناءً على الآثار الجانبية لمدخول الأحماض الدهنية المتحولة التي وردت تقارير بشأنها في الدراسات الأترابية الاستباقية، فسيتم تجنب 1517 حالة وفاة، و5373 واقعة إصابة بحالات حادة من الأمراض القلبية الوعائية، وإنقاذ 26,394 سنة عمر مصححة باحتساب مدد العجز، و87 مليون دولار أمريكي سنويًا.حتى في ظل السيناريوهات الأكثر تحفظًا، فقد كان للحد من مدخول الأحماض الدهنية المتحولة أثر كبير على الصحة العامة. ومن شأن هذه النتائج أن تفيد في تقديم المعلومات الكافية لصناع القرار بالأرجنتين وغيرها من البلدان بشأن الأثر المحتمل على الصحة العامة والآثار الاقتصادية لهذه السياسية.旨在评估阿根廷境内关于减少使用反式脂肪酸 (TFA) 的政策对冠心病 (CHD)、残疾调整生命年 (DALY) 和相关医疗保健成本产生的影响。.我们估计出 2004 年之前对反式脂肪酸 (TFA) 的基准摄入量为总能量摄入的 1.5%。 我们构建了政策模型，包括对反式脂肪酸 (TFA) 的基准摄入量、用于代替人工反式脂肪酸 (TFA) 的油脂、减少使用人工反式脂肪酸 (TFA) 的临床效果，以及因预防冠心病 (CHD) 事件而节约的成本和残疾调整生命年 (DALY)。 为了计算冠心病 (CHD) 减少的百分比，我们在实施前后基于研究人群计算了冠心病 (CHD) 风险。 根据预测的变化，以三种方式模拟政策的影响： (i) 血浆中的血脂；(ii) 脂质和炎性标记物；以及 (iii) 前瞻性群组研究的结果。 我们还估计了残疾调整生命年 (DALY) 在当下的经济价值，以及预防冠心病的相关医疗保健成本。.我们估计，血脂变化预计每年将会避免 301 人死亡、1066 例急性冠心病 (CHD) 事件和 5237 个残疾调整生命年 (DALY)，并可节约 1700 万美元 (US$) 的医疗保健成本。 基于前瞻性群组研究中所报告的摄入反式脂肪酸 (TFA) 后产生的不良影响，每年可防止 1517 人死亡、5373 例急性冠心病 (CHD) 事件和 26 394 个残疾调整生命年 (DALY)，并可节约 8700 万美元 (US$)。.即使是在最为保守的情况中，减少摄入反式脂肪酸 (TFA) 也可对公众健康产生重大影响。 这些调查结果将有助于让阿根廷和其他国家的决策制定者了解潜在的公众健康问题和这项政策的经济影响。.Оценить воздействие применяемых в Аргентине политик по уменьшению количества трансжирных кислот в пище (ТЖК) на развитие ишемической болезни сердца (ИБС), на количество лет жизни, утраченных в результате болезни, и на сопутствующие расходы на здравоохранение.По нашим оценкам, до 2004 года 1,5% общего количества пищевых калорий приходилось на ТЖК, и эту величину мы приняли за базовый уровень. Мы разработали модель политики, включающую базовый уровень потребления ТЖК, жиры и масла, которыми планировалось заменить искусственные ТЖК, клинический эффект от снижения уровня ТЖК, а также уровень экономии и количество спасенных лет жизни в результате предотвращения случаев ИБС. Для расчета процентной доли снижения ИБС были рассчитаны риски возникновения ИБС для популяционной выборки до и после реализации вышеуказанной политики. Эффект от применения политик моделировался тремя путями в зависимости от предполагаемых изменений: (i) по профилям липидов в плазме, (ii) по липидам и биомаркерам воспалительного процесса и (iii) по результатам проспективных когортных исследований. Мы также оценили текущее экономическое значение спасенных лет жизни и уменьшения сопутствующих расходов на лечение в случае предотвращения ишемической болезни сердца.По предварительным оценкам, предполагаемые изменения в профиле липидов позволят предотвратить 301 смерть, 1066 острых случаев ИБС, спасти 5237 лет жизни и сэкономить 17 млн долл. США на ежегодных расходах на здравоохранение. Если исходить из неблагоприятных последствий употребления пищевых ТЖК, о которых сообщалось в проспективных когортных исследованиях, то ежегодно можно будет предотвратить 1517 смертей, 5373 острых случая ИБС, спасти 26 394 года жизни и сэкономить 87 млн долл. США на медицинских расходах.Даже при самом неблагоприятном сценарии уменьшение употребления ТЖК в значительной мере повлияет на здоровье населения. Эти результаты помогут информировать ответственных лиц в Аргентине и других странах о потенциальном воздействии такой политики на здоровье населения и национальную экономику.

Postpartum hemorrhage (PPH) is a leading cause of maternal death. Despite strong evidence showing the efficacy of routine oxytocin in preventing PPH, the proportion of women receiving it after delivery is still below 100%. The Uniject injection system prefilled with oxytocin (Uniject) has the potential advantage, due to its ease of use, to increase oxytocin utilization rates. We aimed to assess its cost-effectiveness in Latin America and the Caribbean (LAC). We used an epidemiological model to estimate: a) the impact of replacing oxytocin in ampoules with Uniject on the incidence of PPH, quality-adjusted life years (QALYs) and costs from a health care system perspective, and b) the minimum increment in oxytocin utilization rates required to make Uniject a cost-effective strategy. A consensus panel of LAC experts was convened to quantify the expected increase in oxytocin rates as a consequence of making Uniject available. Deterministic and probabilistic sensitivity analyses were performed. In the base case, the incremental cost of Uniject with respect to oxytocin in ampoules was estimated to be USD 1.00 (2013 US dollars). In the cost-effectiveness analysis, Uniject ranged from being cost-saving (in 8 out of 30 countries) to having an incremental cost-effectiveness ratio (ICER) of USD 8,990 per QALY gained. In most countries these ICERs were below one GDP per capita. The minimum required increment in oxytocin rates to make Uniject a cost-effective strategy ranged from 1.3% in Suriname to 16.2% in Haiti. Switching to Uniject could prevent more than 40,000 PPH events annually in LAC. Uniject was cost-saving or very cost-effective in almost all countries. Even if countries can achieve only small increases in oxytocin rates by incorporating Uniject, this strategy could be considered a highly efficient use of resources. These results were robust in the sensitivity analysis under a wide range of assumptions.

Objectives:Differential pricing, based on countries’ purchasing power, is recommended by the World Health Organization to secure affordable medicines. However, in developing countries innovative drugs often have similar or even higher prices than in high-income countries. We evaluated the potential implications of trastuzumab global pricing policies in terms of cost-effectiveness (CE), coverage, and accessibility for patients with breast cancer in Latin America (LA).Methods:A Markov model was designed to estimate life-years (LYs), quality-adjusted life-years (QALYs), and costs from a healthcare perspective. To better fit local cancer prognosis, a base case scenario using transition probabilities from clinical trials was complemented with two alternative scenarios with transition probabilities adjusted to reflect breast cancer epidemiology in each country.Results:Incremental discounted benefits ranged from 0.87 to 1.00 LY and 0.51 to 0.60 QALY and incremental CE ratios from USD 42,104 to USD 110,283 per QALY (2012 U.S. dollars), equivalent to 3.6 gross domestic product per capita (GDPPC) per QALY in Uruguay and to 35.5 GDPPC in Bolivia. Probabilistic sensitivity analysis showed 0 percent probability that trastuzumab is CE if the willingness-to-pay threshold is one GDPPC per QALY, and remained so at three GDPPC threshold except for Chile and Uruguay (4.3 percent and 26.6 percent, respectively). Trastuzumab price would need to decrease between 69.6 percent to 94.9 percent to became CE in LA.Conclusions:Although CE in other settings, trastuzumab was not CE in LA. The use of health technology assessment to prioritize resource allocation and support price negotiations is critical to making innovative drugs available and affordable in developing countries.

Budgetary Impact Analysis (BIA) applied to health care can be defined as the estimate of the net financial costs that a given intervention would represent for a health care institution given the case it was covered. Routinely, BIAs are used to decide the inclusion or exclusion of drugs in therapeutic schemes; actually, the increased use of BIAs have raised awareness about the fact that health economic evaluations represent a partial view in the analysis of the consequences of incorporating health technologies. This paper seeks to identify the determinants and components of BIA, and to describe the development of a spreadsheet model that enables us to assess the Budget impact of any health technology and perform estimations with differing degrees of complexity. Its design explicitly adapts to the user skills and gaps in information, thus seeking to promote the development of these tools in the management fields in our countries.

Economic evaluation guidelines are widespread in developed countries with fourth hurdle systems but as of yet not in Latin America. In the present article, a systematic search was conducted in order to retrieve regional guidelines in PubMed, Latin American and Caribbean Health Sciences Literature (LILACS) and the gray literature. Four national guidelines were found: Brazil, Colombia, Cuba and Mexico. We report a thorough review of these documents, as well as a comparison among them. We conclude that, despite some differences found, they are broadly similar, and are broadly in accordance with international documents. The existence of these documents, together with other experiences in the region that explicitly use economic evaluation information for health decision making clearly shows that this global tendency is gaining momentum in Latin America, although there is still a long way to go. In the near future we will be able to see if these documents were successfully used and applied for transparent and evidence-based decision making.