17 2023 May
GAZETTE
ARGENTINE SCIENTISTS PROPOSE IN THE LANCET A GLOBAL EQUATION FOR THE MORE EQUITABLE ALLOCATION OF HEALTH RESOURCES
TOGETHER WITH A COLLEAGUE FROM THE UK, RESEARCHERS FROM THE INSTITUTE FOR CLINICAL AND HEALTH EFFECTIVENESS (IECS) FORMULATED A NEW, SIMPLE AND DIRECT EQUATION THAT CAN HELP HEALTH SYSTEMS IN 174 COUNTRIES DECIDE WHICH MEDICINES, DEVICES AND VACCINES THEY SHOULD USE. THE WORK WAS PUBLISHED IN THE LANCET- GLOBAL HEALTH.
In a context of finite economic resources and multiple health demands that must be addressed, how to identify the best medications, vaccines, diagnostic procedures, and biomedical devices? How do we know what a fair price is so that patients can access these innovations? To help health systems 174 countries can answer this question in a more efficient and equitable, researchers from the Institute of Clinical and Health Effectiveness (IECS) formulated and presented in The Lancet– Global Health la first equation based on data available in most countries, which offers decision makers a critical parameter for guide the appropriate allocation of health resources.
“Allows you to take better decisions and that health systems can concentrate their efforts and resources on those interventions and technologies that are truly worthwhile. In other words, it helps produce more health with the same budget", said the first author of the study, the Dr. Andrés Pichon-Riviere, general director of the IECS, an academic institution affiliated with the Faculty of Medicine of the University of Buenos Aires that is home to an executing unit of the CONICET. Pichon Riviere also has a master's degree in Clinical Epidemiology, a doctor in Public Health and principal investigator of CONICET. The tool, which has already begun to be used by governments of countries in the region, “It is also a incentive to lower prices for technologies that do not offer great benefits", added Dr. Pichon-Riviere, who signed the work together with three colleagues from the IECS and the Dr. Michael Drummond, professor of Health Economics at the University of York, in the United Kingdom, and an international leader in health economics.
When health systems choose which technologies to incorporate, they take into account different elements, such as, for example, what level of benefit it produces in patients, their safety or the quality of the scientific evidence that supports their use. One of these elements is the cost-effectiveness of the technology, which measures the relationship between the benefits it produces and the costs it implies. The new equation allows us to calculate the “threshold” or limit that technologies must not exceed to be worth incorporating into the health system. Until now, most countries calculated this cost-effectiveness threshold based on a rough rule of thumb. proposed by the World Health Organization (WHO) 20 years ago, and which postulated that an intervention was cost-effective when the cost per disability-adjusted life years or DALYs (a measure of the loss of 100% healthy years due to premature death or disability) was less than 3 gross domestic products (GDP). ). And “very” cost-effective when that same result cost less than 1 GDP. However, the same body later questioned the validity of that formula, admitting that it could lead to an overestimation of the figure.
With the application of the new proposed equation, Dr. Pichon-Riviere and his collaborators confirmed this assumption: The “real” cost-effectiveness thresholds are substantially lower than those estimated by most countries, especially low- and middle-income countries. “That implies that Countries could be 'losing' health when they decide to cover certain technologies, that is, the health gained is less than that lost by not using those resources in other interventions. "That is to say that there are things that were being left out of coverage due to implicit rationing," explained Dr. Pichon-Riviere.
When countries use the wrong threshold, it means that they are incorporating benefits, misusing their budget and leaving more beneficial interventions unprovided or uncovered, the researcher highlighted. For example: perhaps they are financing a very expensive drug for the terminal stage of a disease, but they are not making preventive interventions in the population to prevent the disease from appearing.
"The new equation allows resources to be distributed equitably and gives clear rules for health systems and for the technology producing industry regarding the prices that can be covered.", assured Dr. Pichon-Riviere, who added that countries can adjust the results and lower or raise cost-effectiveness thresholds based on more ambitious health investment goals or current situations.
Until now, only a few countries had been able to approximately estimate their cost-effectiveness thresholds, because the methods were very complex and required a quantity and quality of information usually not available, especially in lower-income countries. One of the greatest contributions of this work is that, not only provides a novel method to estimate thresholds, but also does in a surprisingly simple way and with data easily accessible in most countries, including those with low and middle incomes.
Although the main results are now being published in The Lancet magazine, the IECS team has been working for years on this project that had already generated very important reports and progress, partially presented since 2015 at specialty conferences held in Rome (Italy), Tokyo (Japan) and São Paulo (Brazil)[I]. In fact, the Brazilian government incorporated this tool since August 31 for its calculation of the cost-effectiveness threshold, and it also serves as a reference input in Peru and Argentina.
In addition to Pigeon Riviere y Drummond, the other authors of the work are Dr. Federico Augustovski, director of the Department of Health Technology Assessment and Health Economics of the IECS; he Dr. Sebastián García Martí, coordinator of said department, and economist Alfredo Palacios, who is currently a research fellow at the Center for Health Economics at the University of York, York, United Kingdom.
To access the publication click here
To access the video click here
CETQALY: cost-effectiveness threshold to gain one year of life in full health; %Δh: expected increase in health spending per capita; HEpc: health expenditure per capita; LE: life expectancy at birth; ΔLE: expected increase in life expectancy; QYr= ratio between quality-adjusted life expectancy and life expectancy measured in years; QALY: quality-adjusted life year
* Pichon-Riviere A, Augustovski F, García-Martí S, Garay OU. [Consultancy for the development of tools for the evaluation of the cost-effectiveness and cost-utility in the decision-making process related to the incorporation of new and existing health technologies]. Buenos Aires: Institute of Clinical and Health Effectiveness (IECS); 2016: https://www.iecs.org.ar/wp-content/uploads/IECS_Informe-Final_Consultor%C3%ADa_16_12_2016.pdf
[1] The first results of this research were presented at the ISPOR Europe 2015 conference, held in Rome, Italy (https://www.valueinhealthjournal.com/action/showPdf?pii=S1098-3015%2815%2904668-9), at the annual meeting of Health Technology Assessment international (HTAi) 2016, in Tokyo, Japan, and at ISPOR Latin America 2017, in São Paulo, Brazil
___________________________________________________________
ABOUT IECS: The IECS is an independent academic institution dedicated to research, education and technical cooperation in health. Founded in 2002, it is an institution affiliated with the Faculty of Medicine of the University of Buenos Aires (UBA) that is home to a CONICET executing unit, a WHO Collaborating center and a Cochrane Center. The mission of the IECS is “to contribute to improving global health, generating and promoting the application of the best scientific evidence.”
See institutional video here
Visit institutional website at: www.iecs.org.ar
IECS PRESS CONTACT:
Lic. Mariana Comolli, Coordinator of the Communication Unit mcomolli@iecs.org.ar