International Journal of Technology Assessment in Health Care


Health-care decision-making processes in Latin America: Problems and prospects for the use of economic evaluation

Cynthia P. Iglesias a1, Michael F. Drummond a1, Joan Rovira a2 and for the NEVALAT Project Group 1
a1 University of York
a2 University of Barcelona and SOIKOS


Objectives: The use of economic evaluation studies (EE) in the decision-making process within the health-care system of nine Latin American (LA) and three European countries was investigated. The aim was to identify the opportunities, obstacles, and changes needed to facilitate the introduction of EE as a formal tool in health-care decision-making processes in LA.

Methods: A comparative study was conducted based on existing literature and information provided through a questionnaire applied to decision makers in Argentina, Brazil, Colombia, Cuba, Mexico, Nicaragua, Peru, Portugal Spain, United Kingdom, Uruguay, and Venezuela. Systematic electronic searches of HEED, NHS EED, and LILACS were conducted to identify published economic evaluation studies in LA from 1982 onward.

Results: There is relatively little evidence of the conduct and use of EE within the health care systems in LA. Electronic searches retrieved 554 records; however, only 93 were EE. In the nine LA participating countries, broad allocation of health-care resources is primarily based on political criteria, historical records, geographical areas, and specific groups of patients and diseases. Public-health provision and inclusion of services in health-insurance package are responsibilities of the Ministry of Health. Decisions regarding the purchase of medicines are primarily made through public tenders, and mainly based on differences in clinical efficacy and the price of health technologies of interest.

Conclusions: To expedite the process of incorporating EE as a formal tool to inform decision-making processes within the health-care systems in LA countries, two main conditions need to be fulfilled. First, adequate resources and skills need to be available to conduct EE of good quality. Second, decision-making procedures need to be modified to accommodate “evidence-based” approaches such as EE.

Key Words: Economic evaluation; Latin America; Decision-making; Survey; Review.


1 NEVALAT Project Group: Fernando Antoñanzas, Spain; SOIKOS and Universidad de la Rioja. Gabriel Carrasquilla, Colombia, Fundacion FES. Gerry Crosbie, UK, Office for Health Economics. Michael Drummond, UK. Centre for Health Economics, University of York. Ana María Galvez, Cuba; Escuela Nacional de Salud Pública. Martha González, Nicaragua; Centro de Investigaciones y Estudios de la Salud (CIES). Marino Gonzalez, Venezuela; Universidad Simón Bolívar. Carlos Gouveia Pinto, Portugal; Centro de Investigaciones Sobre Economia Portuguesa. Patricia Hernández, Mexico; World Health Organization. Cynthia Iglesias, UK; Centre for Health Economics/Department of Health Sciences, University of York. Luis Lazarov, Uruguay; Centro de Investigaciones Economicas (CINVE). Kely Rely, Mexico, Secretaria de Salud Pública. Joan Rovira, Spain; SOIKOS and Universidad de Barcelona. Adolfo Rubinstein, Argentina; Hospital Italiano. César Sanabria, Peru; Universidad Nacional Mayor de San Marcos, Adrian Towse, UK, Office for Health Economics. This report was prepared as part of Work Package 5 for the Thematic Network on the Economic Evaluation of Healthcare Programmes and its Applications to Decision Making in Latin American Countries (NEVALAT). Funded by the European Union. We would like to thank Lisa Matter and Sue Golder for conducting the electronic searches.