Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-19T13:57:39.208Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 March 2005

Cynthia P. Iglesias ,
Michael F. Drummond  and
Joan Rovira
Cynthia P. Iglesias
Affiliation:
University of York
Michael F. Drummond
Affiliation:
University of York
Joan Rovira
Affiliation:
University of Barcelona and SOIKOS
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Keywords

Economic evaluationLatin AmericaDecision-makingSurveyReview
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 21 , Issue 1 , January 2005 , pp. 1 - 14
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alcázar Valdivia L, Balcázar Suárez RA, Francke Ballve P, et al. 1999. Impacto económico de la Malaria en el Perú. Convenio de cooperación entre el Ministerio de Salud del Perú y la Agencia de los Estados Unidos para el Desarrollo Internacional, (USAID). Lima Perú: USAID;
Australian Pharmaceutical Benefits Advisory Committee. Available at: www.health.gov.au/pbs/general/listing/committee.htm.
Balcazar Suarez RA, Francke Ballve P, Portocarrero GA, et al. 1999. Impacto económico de la tuberculosis en Perú. Ministerio de Salud. Proyecto Vigia. Lima Perú: USAID;
BIREME. Latin American and Caribbean Health Sciences Literature (LILACS), 2003. Available at: http://www.bireme.br/bvs.
Cataño C, Rojas G. 1992: Evaluación costo-eficiencia de estrategias de control y prevención de la malaria en comunidades de la costa pacífica colombiana. Facultad de Ciencias Económicas. Universidad de Antioquia. Medellín, Colombia: 49.
Cook JR, Drummond M, Glick H, Heyse JF. 2003 Assessing the appropriateness of combining economic data from multinational clinical trials. Stat Med. 22: 1955– 1976.Google Scholar
CRD. 2003. NHS Economic Evaluation Database (NHS EED). United Kingdom: Centre for Reviews and Dissemination, University of York
Drummond M, Dubois D, Garattini L, et al. 1999 Current trends in the use of pharmacoeconomics and outcomes research in Europe. Value Health. 2: 323– 332.Google Scholar
Drummond M, Pang F. Transferability of economic evaluation results. In: Drummund M, McGuire A, eds. 2001. Economic evaluation in health care—Merging theory with practice. Chapt. 11. Oxford: Oxford University Press/Office of Health Economics;
Galvez AM, Gálvez M, Sanabria G. Economic evaluation alongside an antenatal trial in developing countries. Report on Cuba. HPP Report Series. Norfolk, UK: UEA Norwich School of Health Policy and Practice.
Instituto Nacional da Farmácia e do Medicamento. Available at: www.infarmed.pt.
Kielhorn A, Graf von der Schulenburg J-M. 2000. The health economics handbook. Adis International;
Martínez Ravelo R, Rivalta del Sol D, Peña Gallo A, Díaz Machado O. 1989 El costo en un hospital pediátrico. Rev Cuba Pediatría. 61: 675– 681.Google Scholar
Nunes A. O Impacto Econômico da AIDS/HIV no Brasil. Texto para discussãon 505. Agosto 1997. Brasil: IPEA.
OHE-IFPMA. 2003. Health economic evaluation database (HEED). London: Office for Health Economics;
Pan American Health Organization. 1998–1999. Country specific profile of health services system: Program on organization and management of health systems and services division of health systems and services development. PAHO;
Pan American Health Organization. 1998. Health in the Americas. PAHO;
Rodríguez M, Soler A, Deleón G, et al. 1995; Impacto económico y relación costo efectividad Unidad de Medicina Intensiva. 3: 147.Google Scholar
Salinas Ortiz J, Sánchez Módena C, Recuenco S. 2000. Estudio de costos y evaluación de estrategias para la prevención y control de la fiebre amarilla en el Perú (Informe final). Lima: Ministerio de Salud, Proyecto Vigia;
Sanabria C. 2001. Estudio de costos del Programa de Atención Integral de Salud (PAIS) en las poblaciones de las Comunidades Indígenas del Alto Amazonas. Perú: Ministerio de Salud del Perú, Dirección Regional de Salud de Loreto (informe parcial);
The National Drug Scheduling Advisory Committee. Available at: www.napra.org.
The National Institute for Clinical Excellence. Available at: www.nice.org.uk.
Ugá MAD. 1988: Economic analysis of the vaccination strategies adopted in Brazil in 1982. Boletim da OPAS. Brazilia: OPAS; 22.