Rede Nevalat: estruturae experiências

Joan Rovira FornsUniversidad de Barcelona - SOIKOS

16 de marzo de 2006

NEVALATTHEMATIC NETWORK ON THE ECONOMIC

EVALUATION HEALTH PROGRAMMES AND ITS APPLICATIONS TO DECISION

MAKING IN LATIN AMERICAN COUNTRIES

Funded by the INCO Programme of the European Union, DG XII (2001-2004)

OBJECTIVES

• To promote the application of economic evaluation of health programmes to decision making and resource allocation in the Latin American region.

• To create a solid structure to support the research in economic evaluation of health technologies and programmes in the Latin American region

• To develop the local capacity to carry out studies by means of a transfer of know how from EU countries with a larger experience in that domain

Centros de Investigación vinculados inicialmente al proyecto

Soikos, Barcelona, EspañaUniversidad de York (Centre for Health Economics),York, RUOffice for Health Economics, Londres, RUCentro de Investigación sobre Economía Portuguesa (CISEP), Lisboa, PortugalEscuela de Salud Pública (FIOCRUZ), Rio de Janeiro, BrasilEscuela Nacional de Salud Pública, La Habana, CubaFundación Santa Fe de Bogotá, Bogotá, D.C.,ColombiaFundación Mexicana para la Salud FUNSALUD, México D.F. MéxicoCentro de Investigaciones y Estudios de la Salud – CIES, Managua, NicaraguaUniversidad Nacional Mayor de San Marcos, Lima, PerúCentro de Investigaciones Económicas CINVE, Montevideo, Uruguay

Entidades vinculadas al Proyecto a partir del año 2002

Instituto de Efectividad Clínica y Sanitaria, Ciudad de Buenos Aires, ArgentinaInstituto Nacional de Salud Pública de México, Cuernavaca, Morelos, MéxicoUnidad de Políticas Públicas (USB). Univ. Simón Bolívar,Caracas, Venezuela

WORK PACKAGE LIST (I)

• Database of Economic Evaluation in LAC

• Database of Researchers and Resources• Webpage • Decision making processess• Decision makers knowledge and

attitudes

WORK PACKAGE LIST (II)

• Methodogical standards and guidelines• Support tools (Software and unit cost

database)• Strategies for development• Lessons for LA and EU Countries

RESULTS (1)

• Identification and dissemination ofinformation– Web page (www.nevalat.org)– Studies of economic evaluation in LA

(OHE format, grey literature, etc)– List of economic evaluation experts

(criteria for selection)– List of specialized centers

RESULTS (2)

• Studies of economic evaluation in LA (OHE format, grey literature, etc)

• Artículos recibidos de los investigadores NEVALAT Latinoamerica: 256

• Otras búsquedas: 83

Figure 1 HEED entries by year of publication 1992 - 2002

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5

10

15

20

25

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Applied Studies

All Studies

Figure 2 Distribution of reviewed studies by study type 1992 - 2002

Other 2Letter 2

Government/Public Policy 1Methodological 1

Review s of Applied Studies 15

Applied Studies 94

Figure 3 Distribution of Applied Studies by Type of Economic Evaluation

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5

10

15

20

25

30

35

40

45

50

CMA CEA CBA CCA CUA CA CoI

CMA - Cost Minimisation AnalysisCEA - Cost Effectiveness AnalysisCBA - Cost Benefit AnalysisCCA - Cost Consequences AnalysisCUA C t Utilit A l i

Figure 4 Distribution of Applied Studies by Type of Technology

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10

20

30

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60

Pharmaceutic

al

SurgicalDiagnos ticScreeningPreventio

n

Device sProcedures

Education

CareIm

munisation

O ther

Figure 5 Distribution of Applied Studies by ICD-9 Classification

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35

I II III IV V VI VII VIII IX X XI XII XIII XIV XV XVI XVII Vcodes

I - Infectious ans parasitic diseasesII - NeoplasmsIII - Endocrine, nutritional and metabolic diseases, and immunity disordersIV - Diseases of the blood and blood-forming organsV - Mental disordersVI - Diseases of the nervous system and sense organsVII - Diseases of the circulatory systemVIII - Diseases of the respiratory systemIX - Diseases of the digestive systemX - Diseases of the digestive systemXI - Complications of pregnancy, childbirth, and the puerperiumXII Diseases of the skin and s bc taneo s tiss e

Figure 7 Sponsors of Applied Studies

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19

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9

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11

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11

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PharmaceuticalIndustry

Non-pharmaceuticalIndustry

Gov/Publicly FundedPolicy Making Body

Public Health CareInstitution

ResearchCouncil/University

Charity

All Technologies

Pharmaceuticals

Figure 8 Distribution of Studies by Multinational and Individual Country

Multinational 54

Other 5 Peru 5

Mexico 16

Colombia 3Chile 2

Brazil 18

Agentina 10

Other comprise the follow ing countries: Belize, Costa Rica, Ecuador, Guatemala, Paraguay, Uruguay and Venezuela

RESULTS (3)

Analysis of the decision-making processes

• Healthcare decision making processes in Latin America

• Focus group analysis on decision makers’knowledge and attitudes

RESULTS (3)

Analysis of the decision-making processes

• Little evidence of the conduct and use of EE withinthe healthcare systems in LA.

• Electronic searches retrieved 554 records: 93 EE. • Broad allocation of healthcare resources is

primarily based on political criteria, historicalrecords, geographical areas, and specific groups ofpatients and diseases.

RESULTS (3)

Analysis of the decision-making processes

• Public health provision and inclusion of servicesin health insurance package are responsibilitiesof the Ministry of Health.

• Decisions regarding the purchase of medicines are primarily made through public tenders, andmainly based on differences in clinical efficacyand the price of health technologies of interest.

RESULTS (4)

Standardizing the methodology and tools

• Setting up national guidelines/standards(Cuba)

• Unit cost databases• Development of a user friendly program

for carrying out CEA: PREVE

Unit cost country databases

• Objectives: – To reduce the cost and increase the

comparability of CE studies– facilitate multicountry studies and the

transfer from study results between countries.

• The structure of the database was adapted from the existing Base de Datos de Costos SanitariosSoikos, set up for Spain in 1997.

Unit cost country databasesInformation was received from 5 countries (Argentina, Colombia, Mexico, Peru and Uruguay) for the tariffs of 76 previously selected cost ítems, and consolidated in a single data base (available in CD).

A simple program allows retrieving the information:

• By country• By cathegory of cost. • In the currencies of any of the countries included: peso argentino, peso colombiano, nuevo peso mexicano, nuevo sol peruano, nuevo peso uruguayo

marca Descripción Moneda originalPeso argentino Año Fuente País 1

x

Moneda original

Moneda seleccionada Moneda seleccionada

Promedio ? ?Rango ? ?Casos 0 0

Marca DescripciónMoneda original Peso argentino Año

FuentePaís

Albumina (Orina) 2,00 2,0 2003 1 ArgentinaAlbumina (suero) 2,00 2,0 2003 1 ArgentinaAlbumina (suero) 5,00 5,0 2003 2 ArgentinaAngiografia 600,00 600,0 2003 1 ArgentinaAngiografia 200,00 200,0 2003 2 ArgentinaAntibiograma 15,00 15,0 2003 1 ArgentinaAntibiograma 15,00 15,0 2003 2 ArgentinaArteriografia 600,00 600,0 2003 1 ArgentinaAudiometria 15,00 15,0 2003 1 ArgentinaBiopsia 30,00 30,0 2003 1 ArgentinaBiopsia 100,00 100,0 2003 2 ArgentinaClearance renal 5,00 5,0 2003 1 ArgentinaClearance renal 5,00 5,0 2003 2 ArgentinaColesterol HDL 2,00 2,0 2003 1 ArgentinaColesterol HDL 5,00 5,0 2003 2 ArgentinaColesterol LDL 2,00 2,0 2003 1 ArgentinaColesterol LDL 5,00 5,0 2003 2 Argentina

Descripción

Pais

Peso argentino

Quitar marcas

Tipos de cambio

Listado

por País

por Descripción

Ordenar datos Imprimir listadosPonga una 'X' en esta columna para seleccionar un registro

BASE DE DATOS DE COSTOS SANITARIOS LATINOAMERICANOS - NEVALAT(Versión 1.0 - Diciembre de 2.003)

Diagrama de funcionamiento del PREVE

INTRODUCCIÓN DE DATOS

Informe:

Vector recursos

Informe:

Vector efectos

Vector recursos

(3a)

Vector efectos

(4a)

Informe:

ProbabilidadesFicha

RAMAS (2)

FichaRECURSOS

(3b)

FichaEFECTOS

SOBRE LA

SALUD (4b)

Unidades rama porpaciente Coste ramapaciente (SA)

-Coste anual porpoblación de la rama

-Coste del camino sin descontar

-Coste de las opcionessin actualizar

-Costes del caminodescontado

-Coste de las opcionesactualizado

-Unidades efectos

-Efectos poblaciónterminal sin descontar

-Efectos descontados

-Resumen efectos parael camino

-Resumen de los efectospor cada opción

Árbol de decisión

RESULTADOS INTERMEDIOS

Informe:

Resultados

-Dif. Costes-Dif. efectividad-Coste/efectividad medio-Coste/efectividadincremental-Análisis de dominancia-Gráfico

RESULTADOS FINALES

Informe:Recursos y costes por

rama

Datos generales(1)

Ventana de gestión de ACEs – datosgenerales (1)

Cuadro de lista de los ACEscreados

Ventana de gestión del ACE activo -detalles (2)

La barra de título muestra el nombre del ACE activo (el ACE seleccionado)

Área de dibujo del árbol de decisión. El tamaño del área esajustable.

Resúmenes de los costes y efectossobre la salud con diferentes nivelesde agregación

Lista de las ramas del árbol de decisiónFichas para la

introducción de datossobre las ramas, los

recursos y los efectossobre la salud

Ventana ejemplo: proceso de añadiruna rama (5)

Puede hacer clic sobre estos encabezados para actualizar los cálculos de la población en cada rama o bien para actualizarsu coste.

Árbol de decisión de la EnfermedadE (8)

La población (“pob.”) y el coste del camino se actualizan cada vez quese dibuja el árbol.En este ejemplo el coste del camino escero porque todavía no se han añadido los recursos

FUTURE STEPS AND ACTIVITIES (I)

• Creation of a permanent structure(consortium)

• Maintain, update and broaden the functions ofthe web-page

• Multicountry economic evaluation studies: cost-of-illness, selected technologies or diseases. (A project on Cost of Ilness was recentlysubmitted to the UE , but not approved)

FUTURE STEPS AND ACTIVITIES (II)

• Reinforce links to WHO (Choiceprogram), PAHO (Guaranteed benefitspackages)

• Develop free-access distance learningcourses in Spanish and Portuguese runby local institutions and tutors)

• Continue standardization and tooldevelopment

Pending issues

• Group leadership• Future development limited to economic

evaluation vs. broader health economics focus• Other functions to be developed by the

consortium• Institutionalization: Creating a new

organization or building an LA ISPOR Chapter?

• How to reach out other potentially interestedparties (e.g. sponsors of multicountry studies)?