Advertisement

Brief Latin American Update: One More ViHRI Annual Issue, and Another Exciting Biennial ISPOR Conference

Open ArchivePublished:December 04, 2015DOI:https://doi.org/10.1016/j.vhri.2015.10.005
      It is our pleasure to present a new annual issue of Value in Health Regional Issues from the Latin American (LA) region, and a good opportunity to provide our readership with fresh news about the ISPOR 5th LA Conference recently held in Chile. Let us start with the latter, and then get to the former.
      ISPOR LA meetings started 8 years ago, with nearly 300 people gathering in Cartagena. In Santiago, there were 940 attendees from 51 countries, reflecting the growing momentum and interest for this field in our region. There were 6 short courses, 38 research podiums, 15 workshops, 10 issue panels, and 392 posters. The two plenaries were aligned with the meeting’s overarching theme, “Increasing Access to Health Care in Latin America: Making Better Decisions for Greater Equity,” and focused on how to improve access to health technologies in Latin America on the basis of methods that are transparent and fairly representative of all stakeholders’ perspectives [

      LA meeting Web page. Available from: http://www.ispor.org/event/index/2015santiago. [Accessed October 05, 2015].

      ].
      The first plenary, “Is HTA [health technology assessment] fair? Analyzing the HTA process in Latin America & its implications for access to health care,” was focused on high-level system objectives (such as efficiency and equity) and principles (transparency, or appeal mechanisms). Stimulating presentations by world experts (Anthony Culyer and Norman Daniels) provided some insights that challenged mainstream ideas such as the one that states that efficiency and equity cannot be both improved, and that there is always a trade-off. They also argued how decisions can be made fairly and represent all stakeholders, while balancing the requirements of a rigorous scientific method to evaluate the usefulness of drugs and devices for their populations [

      Garrison L, Culyer A, Daniels N. Is HTA fair? Analyzing the HTA process in Latin America & its implications for access to health care. First Plenary Session. Available from: http://www.ispor.org/Event/ProgramList/2015Santiago?type=Plenary#ProgramItemMon. [Accessed October 05, 2015].

      ].
      The second plenary was “Access to high-cost drugs in Latin America: Who goes first?” This is an important emerging topic in the region that has been addressed in several developed countries through the creation of specialized programs that established processes that balance equity and efficiency principles according to local jurisdictions. In Latin America, Mexico has implemented coverage for a number of high-cost drugs for which prices are negotiated independently by a special commission created by presidential agreement. However, it represents a hazard that could allow external pressure to play a role in the decision-making process, threatening the rational allocation of resources. In the case of Colombia, multiple health policies have been implemented to face the challenge of financing high-cost drugs, including the creation of an independent body to centrally manage funds across all health care subsystems and the development of legislation and tools to regulate drug prices. Chile has recently tackled the issue of access to high-cost drugs through its public health insurer, the National Health Fund (Fondo Nacional de Salud (FONASA)). This institution implemented a specific program in 2007 to fund drugs for certain rare diseases and other health conditions that require expensive medications, such as breast cancer and rheumatoid arthritis, which have been provided to the population on the basis of restricted patient quotas. In 2015, a law that establishes a new universal fund to cover high-cost drugs has been enacted. Nonetheless, the organizations and mechanisms involved in this task are yet to agree on the procedures and rules that will regulate in practice the provision of these services in the country, which plan to formally incorporate HTA tools and principles [

      Lenz Alcayaga R, Acuña Merchán L, González Rétiz ML, Vega Morales J. Access to high cost drugs in Latin America: Who goes first? Second Plenary Session. Available from: http://www.ispor.org/Event/ProgramList/2015Santiago?type=Plenary#ProgramItemTue. [Accessed October 05, 2015].

      ].
      Other regional collaborations strengthening outcome research and HTA are also rather active: some examples are the XIV Iberoamerican Cochrane Network meeting held during May of this year in Uruguay [

      Reunión anual de la red Cochrane. Available from: http://www.fnr.gub.uy/?q=evento_cochrane. [Accessed October 05, 2015].

      ]; REDETSA’s (regional HTA network) latest annual meeting held in Chile after the ISPOR regional meeting; and the first upcoming LA HTAi policy forum to be held next April [].
      In this issue (volume 8, the fourth issue devoted to LA), we can have an overview of the significant progress our field is making in our region. There are studies from the northern to the southern parts of LA, with several studies from Mexico [
      • Neslusan C
      • Teschemaker A
      • Johansen P
      • et al.
      Cost-effectiveness of canagliflozin versus sitagliptin as add-on to metformin in patients with type 2 diabetes mellitus in Mexico.
      ,
      • Hunt B
      • Aguilar Garza JL
      • Enríquez Vázquez CJ
      • et al.
      Evaluating the long-term health economic implications of improving the proportion of patients with type 2 diabetes meeting treatment targets in Mexico.
      ] and two from Chile [
      • Balmaceda C
      • Espinoza MA.
      Impacto de una política de equivalencia terapéutica en el precio de medicamentos en Chile.
      ,
      • Carvajal Macaya M
      • Hernández Ridulfo A
      • Ramírez-Santana M.
      Comparación de costos y resultados sanitarios en usuarios con neumonia adquirida en comunidad atendidos en domicilio o en hospitalización tradicional: estudio exploratorio de 40 casos.
      ]. Researchers from Brazil [
      • Ribeiro de Souza CP
      • Santoni NB
      • Melo TG
      • et al.
      Cost-effectiveness and cost-utility analyses of dabigatran compared with warfarin in patients with nonvalvular atrial fibrillation and risk factors for stroke and systemic embolism within Brazilian private and public healthcare systems perspectives.
      ,
      • Aparecido Nunes A
      • Marques de Mello L
      • Barbosa Coelho E
      • et al.
      Analyses of budget impact considering the use of the picture archiving and communication system (PACS).
      ,
      • de Bitencourt FH
      • Vieira TA
      • Steiner CE
      • et al.
      Medical costs related to enzyme replacement therapy for mucopolysaccharidosis types I, II and VI in Brazil: a multicenter study.
      ] and Colombia [
      • Diaz-Jimenez D
      • Castañeda-Orjuela C
      • Castillo-Rodríguez L
      • De la Hoz-Restrepo F.
      Economic costs analysis of the avoidable mortality in Colombia 1998–2011.
      ,
      • Atehortúa S
      • Florez ID
      • Ceballos M
      • et al.
      Análisis de costo efectividad de ondansetrón para el tratamiento del vómito en niños menores de cinco años con gastroenteritis en Colombia.
      ,
      • Castro JC
      • Daza AM
      • Misas JD.
      Cost-effectiveness analysis of viscosupplementation vs. conventional supportive therapy for knee osteoarthritis in Colombia.
      ,
      • Machado-Alba JE
      • Torres D
      • Potilla A
      • Arias AF.
      Results of the inclusion of new medications in the obligatory health system plan in Colombia, 2012-2013.
      ,
      • Vecino Ortiz AI
      • Bardey D
      • Castano Yepes RA.
      Hospital variation in cesarean delivery: a multilevel analysis.
      ] continue to produce several articles, but we also find articles from Guatemala [
      • Cruz Rodriguez JB
      • Leal S
      • Calvimontes SG
      • Hutton D.
      Cost-effectiveness of radiofrequency ablation for supraventricular tachycardia in Guatemala.
      ] and Uruguay [
      • González-Vacarezza N
      • Poggi M
      • Arroyo G.
      Equidad en el acceso a los medicamentos oncológicos de alto costo en Uruguay.
      ]. Three of the studies deal with regional topics and do not deal specifically with a country-specific issue [
      • Winnette R
      • Zárate V
      • Machnicki G.
      Patient-reported outcomes in Latin America: implementation in research and role in emerging HTA systems.
      ,
      • Constenla D
      • Armien B
      • Arredondo J
      • et al.
      Costing dengue fever cases and outbreaks: recommendations from a costing dengue working group in the Americas.
      ,
      • Bardach AE
      • Ciapponi A
      • Rey-Ares L.
      Epidemiology of malaria in Latin America and the Caribbean from 1990 to 2009: systematic review and meta-analysis.
      ]. We are publishing not only traditional cost-effectiveness analysis comparing several technologies, the site of administration of the treatment (at home vs at hospital management of pneumonia) [
      • Carvajal Macaya M
      • Hernández Ridulfo A
      • Ramírez-Santana M.
      Comparación de costos y resultados sanitarios en usuarios con neumonia adquirida en comunidad atendidos en domicilio o en hospitalización tradicional: estudio exploratorio de 40 casos.
      ], or an image archiving methodology, but also a budget impact analysis [
      • Aparecido Nunes A
      • Marques de Mello L
      • Barbosa Coelho E
      • et al.
      Analyses of budget impact considering the use of the picture archiving and communication system (PACS).
      ], a systematic review [
      • Bardach AE
      • Ciapponi A
      • Rey-Ares L.
      Epidemiology of malaria in Latin America and the Caribbean from 1990 to 2009: systematic review and meta-analysis.
      ], and a multicenter study using chart reviews [
      • de Bitencourt FH
      • Vieira TA
      • Steiner CE
      • et al.
      Medical costs related to enzyme replacement therapy for mucopolysaccharidosis types I, II and VI in Brazil: a multicenter study.
      ]. One study examines epidemiological aspects of malaria in our region, whereas another examines how to estimate dengue-related costs [
      • Constenla D
      • Armien B
      • Arredondo J
      • et al.
      Costing dengue fever cases and outbreaks: recommendations from a costing dengue working group in the Americas.
      ]. The scope of topics being evaluated is really interesting: some examples are avoidable mortality [
      • Diaz-Jimenez D
      • Castañeda-Orjuela C
      • Castillo-Rodríguez L
      • De la Hoz-Restrepo F.
      Economic costs analysis of the avoidable mortality in Colombia 1998–2011.
      ], inclusion of new drugs into a national benefit package [
      • Machado-Alba JE
      • Torres D
      • Potilla A
      • Arias AF.
      Results of the inclusion of new medications in the obligatory health system plan in Colombia, 2012-2013.
      ], implementation of patient-reported outcomes [
      • Winnette R
      • Zárate V
      • Machnicki G.
      Patient-reported outcomes in Latin America: implementation in research and role in emerging HTA systems.
      ], consequences of chemotherapy wastage [
      • Hyeda A
      • da Costa ESM
      Uma análise preliminar do desperdício de quimioterapia no tratamento do câncer.
      ], equity in access to oncological drugs [
      • González-Vacarezza N
      • Poggi M
      • Arroyo G.
      Equidad en el acceso a los medicamentos oncológicos de alto costo en Uruguay.
      ], and unexplained variation in cesarean deliveries [
      • Vecino Ortiz AI
      • Bardey D
      • Castano Yepes RA.
      Hospital variation in cesarean delivery: a multilevel analysis.
      ]. One article focuses on children younger than 5 years [
      • Atehortúa S
      • Florez ID
      • Ceballos M
      • et al.
      Análisis de costo efectividad de ondansetrón para el tratamiento del vómito en niños menores de cinco años con gastroenteritis en Colombia.
      ]. In summary, we have a very rich 2015 issue, and we definitely think our readers will have a lot to enjoy.
      And, last but not the least, some other issues: 1) we are in the queue for National Library of Medicine PubMed/Medline, to be reviewed in the fall of 2015, for a decision approximately in the spring of 2016. We hope we succeed, and this will make our journal much more visible and attractive for researchers; 2) this year we are launching the first Value in Health Regional Issues Excellent Article Award for each region, for articles published in the previous 2 years. This award will be given to the best article published in ViHRI from each region biennially; and 3) our journal outreach is steadily increasing in our rather young existence of 3.5 years. Some metrics are the more than 1600 monthly full-text downloads, or the nearly 2300 monthly page views in 2015.
      Hope that you enjoy the current issue and the buoyant life of our field in LA, aiming to contribute to the use of sound societal principles for decision making in our region (public and transparent grounds for decisions, relevant reasons, revision mechanisms, and enforcement of the previous three) [
      • Daniels N
      • Sabin JE.
      Accountability for reasonableness: an update.
      ].

      Acknowledgments

      We thank Maria Cook, ViHRI regional manager, Jerusha Harvey, the ISPOR key person for our region, and Steve Priori, the ISPOR senior staff for its publications.

      References

      1. LA meeting Web page. Available from: http://www.ispor.org/event/index/2015santiago. [Accessed October 05, 2015].

      2. Garrison L, Culyer A, Daniels N. Is HTA fair? Analyzing the HTA process in Latin America & its implications for access to health care. First Plenary Session. Available from: http://www.ispor.org/Event/ProgramList/2015Santiago?type=Plenary#ProgramItemMon. [Accessed October 05, 2015].

      3. Lenz Alcayaga R, Acuña Merchán L, González Rétiz ML, Vega Morales J. Access to high cost drugs in Latin America: Who goes first? Second Plenary Session. Available from: http://www.ispor.org/Event/ProgramList/2015Santiago?type=Plenary#ProgramItemTue. [Accessed October 05, 2015].

      4. Reunión anual de la red Cochrane. Available from: http://www.fnr.gub.uy/?q=evento_cochrane. [Accessed October 05, 2015].

      5. Available from: http://www.htai.org/htai/advisory-committees/policy-forum.html. [Accessed October 05, 2015].

        • Neslusan C
        • Teschemaker A
        • Johansen P
        • et al.
        Cost-effectiveness of canagliflozin versus sitagliptin as add-on to metformin in patients with type 2 diabetes mellitus in Mexico.
        Value Health Regional. 2015; 8: 8-19
        • Hunt B
        • Aguilar Garza JL
        • Enríquez Vázquez CJ
        • et al.
        Evaluating the long-term health economic implications of improving the proportion of patients with type 2 diabetes meeting treatment targets in Mexico.
        Value Health Regional. 2015; 8: 20-27
        • Balmaceda C
        • Espinoza MA.
        Impacto de una política de equivalencia terapéutica en el precio de medicamentos en Chile.
        Value Health Regional. 2015; 8: 43-48
        • Carvajal Macaya M
        • Hernández Ridulfo A
        • Ramírez-Santana M.
        Comparación de costos y resultados sanitarios en usuarios con neumonia adquirida en comunidad atendidos en domicilio o en hospitalización tradicional: estudio exploratorio de 40 casos.
        Value Health Regional. 2015; 8: 112-115
        • Ribeiro de Souza CP
        • Santoni NB
        • Melo TG
        • et al.
        Cost-effectiveness and cost-utility analyses of dabigatran compared with warfarin in patients with nonvalvular atrial fibrillation and risk factors for stroke and systemic embolism within Brazilian private and public healthcare systems perspectives.
        Value Health Regional. 2015; 8: 37-42
        • Aparecido Nunes A
        • Marques de Mello L
        • Barbosa Coelho E
        • et al.
        Analyses of budget impact considering the use of the picture archiving and communication system (PACS).
        Value Health Regional. 2015; 8: 62-68
        • de Bitencourt FH
        • Vieira TA
        • Steiner CE
        • et al.
        Medical costs related to enzyme replacement therapy for mucopolysaccharidosis types I, II and VI in Brazil: a multicenter study.
        Value Health Regional. 2015; 8: 99-106
        • Diaz-Jimenez D
        • Castañeda-Orjuela C
        • Castillo-Rodríguez L
        • De la Hoz-Restrepo F.
        Economic costs analysis of the avoidable mortality in Colombia 1998–2011.
        Value Health Regional. 2015; 8: 129-135
        • Atehortúa S
        • Florez ID
        • Ceballos M
        • et al.
        Análisis de costo efectividad de ondansetrón para el tratamiento del vómito en niños menores de cinco años con gastroenteritis en Colombia.
        Value Health Regional. 2015; 8: 1-7
        • Castro JC
        • Daza AM
        • Misas JD.
        Cost-effectiveness analysis of viscosupplementation vs. conventional supportive therapy for knee osteoarthritis in Colombia.
        Value Health Regional. 2015; 8: 56-61
        • Machado-Alba JE
        • Torres D
        • Potilla A
        • Arias AF.
        Results of the inclusion of new medications in the obligatory health system plan in Colombia, 2012-2013.
        Value Health Regional. 2015; 8: 28-35
        • Vecino Ortiz AI
        • Bardey D
        • Castano Yepes RA.
        Hospital variation in cesarean delivery: a multilevel analysis.
        Value Health Regional. 2015; 8: 116-121
        • Cruz Rodriguez JB
        • Leal S
        • Calvimontes SG
        • Hutton D.
        Cost-effectiveness of radiofrequency ablation for supraventricular tachycardia in Guatemala.
        Value Health Regional. 2015; 8: 92-98
        • González-Vacarezza N
        • Poggi M
        • Arroyo G.
        Equidad en el acceso a los medicamentos oncológicos de alto costo en Uruguay.
        Value Health Regional. 2015; 8: 122-128
        • Winnette R
        • Zárate V
        • Machnicki G.
        Patient-reported outcomes in Latin America: implementation in research and role in emerging HTA systems.
        Value Health Regional. 2015; 8: 49-55
        • Constenla D
        • Armien B
        • Arredondo J
        • et al.
        Costing dengue fever cases and outbreaks: recommendations from a costing dengue working group in the Americas.
        Value Health Regional. 2015; 8: 80-91
        • Bardach AE
        • Ciapponi A
        • Rey-Ares L.
        Epidemiology of malaria in Latin America and the Caribbean from 1990 to 2009: systematic review and meta-analysis.
        Value Health Regional. 2015; 8: 69-79
        • Hyeda A
        • da Costa ESM
        Uma análise preliminar do desperdício de quimioterapia no tratamento do câncer.
        Value Health Regional. 2015; 8: 107-111
        • Daniels N
        • Sabin JE.
        Accountability for reasonableness: an update.
        BMJ. 2008; 337: a1850