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ISPOR 3rd Latin
America Conference
8-10 September 2011
Hilton MExico City Reforma
MExico City, MExico
Building Networks Across Institutions for Access to Health Care in Latin America
PROGRAM AND
Schedule of Events
Organized by:
International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the
ISPOR Latin America Consortium, in coordination with the ISPOR Mexico Regional Chapter
CONFERENCE CO-SPONSORS
Institute for Clinical Effectiveness & Health Policy (IECS), Argentina
Mexican College for Pharmacoeconomics, Mexico
Mexican Foundation for Health (FUNSALUD), Mexico
National Independent University of Mexico, Mexico
São Paulo Center for Health Economics – Federal University of São Paulo, Brazil
1
ISPOR in Latin America
The ISPOR Distance Learning Program (iDLP) is designed
to provide knowledge and skills on pharmacoeconomic
and outcomes research topics (clinical, economic, patientreported outcomes) via the internet in multiple languages.
2
www.ispor.org
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Creando enlaces interinstitucionales para el acceso a la salud en América Latina
Building Networks Across Institutions for Access to Health Care in Latin America
ÍNDICE
Table of Contents
Carta del Presidente del Comité Ejecutivo del Consorcio
ISPOR para América Latina
6
Letter from the ISPOR Latin America
Consortium Executive Committee Chair
34
Carta de los Co-presidentes del Comité de Planificación
de la 3ª Conferencia ISPOR para América Latina
7
Letter from the ISPOR 3rd Latin America Conference
Program Committee Co-Chairs
35
Comité de Planificación de la Conferencia 8
Conference Program Committee 36
Información clave
8
Key Information
36
Resumen de la conferencia
10
Conference at-a-glance
38
Programa de cursos cortos de la conferencia
11
Conference Short Course Program
39
Programa y agenda de eventos
13
Program & Schedule of Events
41
Patrocinadores corporativos y de eventos
20
Corporate & Event Supporters
48
Descripciones de las mesas redondas y talleres
21
Issue Panel & Workshop Descriptions
49
Descripciones de los simposios patrocinados
25
Sponsored Symposia Descriptions
53
Información biográfica de los ponentes invitados
29
Invited Speaker Biographical Information
57
Listado de los pósters de investigación
62
Research Poster Listing
62
Resúmenes de las presentaciones de investigación
en podio
73
Research Podium Abstracts
73
Research Poster Abstracts
83
Resúmenes de los pósters de investigación
Resúmenes de los estudios de casos de la toma de
decisiones en salud
83
120
Miembros del Comité de Revisión de la 3ª Conferencia
ISPOR para América Latina
122
Programa de la exposición 124
Directorio de liderazgo
129
Health Care Decision-Maker Case Study Abstracts
120
ISPOR 3rd Latin America Conference
Review Committee Members
122
Exhibit Program 124
Leadership Directory
129
3
International Society for
Pharmacoeconomics and Outcomes Research
Translating Outcomes Research to Health Care Decisions
LATIN AMERICA
ISPOR 4th Latin America Conference
12-14 September 2013
Buenos Aires, Argentina
• Short Courses • Issue Panels • Workshops • Research Podium &
Poster Presentations • Forums • Educational Symposia • Exhibits • Welcome Reception
Abstract Submission Deadline: 21 March 2013
EUROPE
ISPOR 14th Annual European Congress
5-8 November 2011
Madrid, Spain
Rational Health Care Decision Making in Challenging
Economic Times
CONGRESS HIGHLIGHTS:
Plenary Sessions
- Pros and Cons of a Centralized European Pricing & Reimbursement Agency
- The Reality of Real World Data and Its Use in Health Care Decisions in Europe
- Heterogeneity in the Cost-Effectiveness of Medical Interventions: The Challenge of
Matching Patients to Appropriate Care
• Short Courses • Issue Panels • Workshops • Research Podium & Poster Presentations
• Forums • Educational Symposia • Exhibits • Social Event
Early Registration Deadline: 20 September 2011
NORTH AMERICA
ISPOR 17th Annual International Meeting
June 2-6, 2012
Washington, D.C., USA
Improving Health Care Efficiency
Abstract Submission Deadline: January 19, 2012
Early Registration Deadline: April 17, 2012
www.ispor.org
4
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
Carta del Presidente del Comité Ejecutivo del Consorcio
ISPOR para América Latina
Carta de los Co-presidentes del Comité de Planificación de la
3ª Conferencia ISPOR para América Latina
Comité de Planificación de la Conferencia
Información clave
Resumen de la conferencia
Programa de cursos cortos de la conferencia
Programa y agenda de eventos
Patrocinadores corporativos y de eventos
Descripciones de las mesas redondas y talleres
Descripciones de los simposios patrocinados
Información biográfica de los ponentes invitados
ESPAÑOL
5
Estimados colegas:
Me enorgullece darles la bienvenida a la 3ª Conferencia ISPOR para América Latina en la Ciudad de México, México, la
cual está organizada por ISPOR y por el Consorcio ISPOR para América Latina, junto con el Capítulo Regional ISPOR de
México.
Durantes los últimos dos años, los miembros del Consorcio ISPOR para América Latina han estado trabajando
estrechamente con ISPOR para que esta conferencia sea un éxito.
El Consorcio ISPOR para América Latina es un grupo de personas interesadas en promover la ciencia de la farmacoeconomía e
investigación de resultados para que se tomen mejores decisiones en el área del cuidado de la salud de la región. Para esta conferencia,
el Consorcio estará muy bien representado por sus miembros de toda América Latina provenientes de Argentina, Brasil, Colombia, Chile,
Ecuador, México, Perú, Puerto Rico, Uruguay, Venezuela y otras partes del mundo.
El Consorcio, bajo el liderazgo de su Comité Ejecutivo, también está compuesto por un Comité Consejero y 7 Comités de Trabajo
organizados ya sea por tarea o por entorno de trabajo:
• Comité de Conferencias ISPOR para América Latina
• Comité de Educación
• Comité de Publicaciones
• Comité de Productores de Tecnología Sanitaria (Industria)
• Comité de Proveedores de Servicios de Salud
• Comité de Agencias de Evaluación de Tecnología Sanitaria (HTA)
• Comité de Encargados de la Política y los Contribuyentes en Salud
Estos comités trabajan estrechamente entre sí para garantizar que el Consorcio cumpla con sus objetivos de suministrar una plataforma
para compartir información a nivel regional entre los investigadores, médicos y encargados de la toma de decisiones en el área de salud;
fomentar el establecimiento de contactos profesionales interesados en la farmacoeconomía y la investigación de resultados en la región
y en el extranjero, estimulando el uso de la farmacoeconomía e investigación de resultados por parte de los encargados de toma de
decisiones en el área de la salud en América Latina; promover los conceptos de eficiencia y rentabilidad para una mejor utilización de los
recursos de atención de la salud en América Latina; brindar una oportunidad para que los miembros de ISPOR se familiaricen con el uso
de esta ciencia y con las políticas del área del cuidado de la salud en América Latina; servir como un recurso regional para los interesados
en la farmacoeconomía e investigación de resultados; y promover y apoyar la formación y actividades de los Capítulos Regionales ISPOR
en América Latina.
Una de las actividades principales del Consorcio es desarrollar y facilitar las conferencias bienales de ISPOR en América Latina. Tras
la 1ª Conferencia ISPOR para América Latina en Cartagena, Colombia, que se llevó a cabo en septiembre de 2007, el Consorcio ISPOR
para América Latina co-organizó exitosamente la 2ª Conferencia ISPOR para América Latina en Río de Janeiro en septiembre de 2009.
Además de estas conferencias, el Consorcio ha publicado el primer número especial regional de Value in Health “Farmacoeconomía e
Investigación de Resultados en América Latina”, que se publicó recientemente y que presenta manuscritos en inglés, español y portugués
sobre estudios de poblaciones latinoamericanas. El Consorcio también ha lanzado su primer programa de educación a distancia en
español, disponible en el sitio web de ISPOR.
Con respecto a la formación y el apoyo de los Capítulos Regionales ISPOR en América Latina, el Consorcio ha jugado un papel muy
importante a través de sus miembros en cada país. Desde su inicio en 2007, el Consorcio ISPOR para América Latina ha crecido hasta
incluir 11 capítulos que abarcan a más de 700 miembros regionales. El Consorcio también brinda apoyo científico a los capítulos para la
organización de sus conferencias anuales y foros educativos.
Para reconocer los logros del Consorcio, me gustaría agradecer el liderazgo del Dr. Federico Augustovski, Presidente Anterior 2010-2012
del Comité Ejecutivo del Consorcio, del Dr. Márcio Machado, Presidente 2010-2012 del Comité Consejero, de los Presidentes actuales de
los Comités del Consorcio y de todos los miembros que han dedicado su tiempo, su esfuerzo y su conocimiento en forma voluntaria para
que esta iniciativa sea un éxito.
¡Mis deseos sinceros que disfruten de esta maravillosa conferencia!
Atentamente,
Dr. Guillermo Meléndez, MSc
Presidente 2010-2012, Comité Ejecutivo del Consorcio ISPOR para América Latina
Coordinador Científico
Fondo Nestlé para la Nutrición
Fundación Mexicana para la Salud (FUNSALUD)
Ciudad de México, México
6
Estimados colegas:
Es para nosotros un honor poder darles la bienvenida a la 3ª Conferencia ISPOR
para América Latina y a la Ciudad de México.
México es conocido por su diversidad cultural, sus museos de alto nivel y por ser un A. Marasco
G. Meléndez
componente importante de la historia del continente Americano. Nuestra conferencia
se sitúa a unos pocos pasos de algunos de los lugares más interesantes de la Ciudad de México: en el corazón
de la ciudad, “Bellas Artes”, uno de los edificios más bellos dedicado al arte y a la música, se encuentra a poca
distancia, al igual que el “Zócalo”, el “Palacio Nacional” y muchos otros edificios y palacios coloniales destacados.
Nos gustaría extender nuestro agradecimiento a los miembros del Comité de Planificación de la Conferencia
por haber desarrollado un programa científico comprensivo, lo cual ofrece lo último en farmacoeconomía e
investigación de resultados para la práctica clínica, con la oportunidad de tener debates y discusiones abiertas en
los diversos cursos cortos educativos, sesiones plenarias y presentaciones científicas.
La primera sesión plenaria se centra en el tema “Retos para la cobertura universal frente a los altos costos de
nuevas tecnologías en salud”, un tema de gran importancia para los países de nuestra región. La segunda sesión
plenaria destaca un tema muy importante: “¿Cuál es el valor de la investigación de resultados para los tomadores
de decisiones?: Una discusión franca entre tomadores de decisiones en instituciones públicas”, en la cual los
representantes de distintos países ofrecerán su perspectiva acerca de la validez de la investigación de resultados
para la salud, y cómo los hallazgos de esta investigación se utilizan para tomar decisiones informadas.
Con más de 200 presentaciones educativas y científicas programadas (muchas de las cuales ofrecen interpretación
simultánea para facilitar la participación de los asistentes), además de diversas oportunidades para establecer
contactos profesionales, estamos seguros que disfrutarán de todos los beneficios que brinda la 3ª Conferencia
ISPOR para América Latina.
¡Esperamos que disfruten la conferencia!
Atentamente,
Dr. Antonio Caso Marasco, MEd
Co-presidente del Comité de Planificación de la
3ª Conferencia ISPOR para América Latina
Profesor Posgraduado de Hematología y Coordinador
del Programa de Educación a Distancia
Subdivisión de Educación Médica Continua
División Posgrado, Facultad de Medicina
Universidad Nacional Autónoma de México y
Presidente, Colegio Mexicano de Farmacoeconomía
Ciudad de México, México.
Dr. Guillermo Meléndez, MSc
Co-presidente del Comité de Planificación de la
3ª Conferencia ISPOR para América Latina
Coordinador Científico
Fondo Nestlé para la Nutrición
Fundación Mexicana para la Salud
(FUNSALUD)
Ciudad de México, México
7
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
COMITÉ DE PLANIFICACIÓN DE LA CONFERENCIA
CO-PRESIDENTES DEL COMITÉ DE PLANIFICACIÓN
Dr. Antonio Caso Marasco, MEd
Profesor Posgraduado de Hematología y Coordinador
del Programa de Educación a Distancia, Subdivisión
de Educación Médica Continua, División Posgrado,
Facultad de Medicina, Universidad Nacional
Autónoma de México y Presidente, Colegio Mexicano
de Farmacoeconomía, Ciudad de México, México.
CO-PRESIDENTES DEL COMITÉ DE REVISIÓN
DE MESAS REDONDAS
Dr. Guillermo Meléndez, MSc
Coordinador Científico, Fondo Nestlé para la Nutrición,
Fundación Mexicana para la Salud (FUNSALUD),
Ciudad de México, México.
CO-PRESIDENTES DEL COMITÉ DE REVISIÓN DE
INVESTIGACIÓN
Joaquín Federico Mould-Quevedo, PhD, MSc, MBA
Director de Economía de la Salud e Investigación
de Resultados para Latinoamérica y Productos de
Atención Primaria, Pfizer Inc., New York, NY, EE.UU.
Yajaira Bastardo, PhD
Directora Administrativa y Profesora, Facultad
de Farmacia, Universidad Central de Venezuela,
Caracas, Venezuela.
Gabriela Tannus Araújo, MSc, MBA
Directora de Economía de la Salud, Axia.Bio
Consulting, São Paulo, Brasil.
Dra. Iris Contreras, MSC
Investigadora Clínica, Instituto Mexicano del Seguro
Social, Ciudad de México, México.
CO-PRESIDENTES DEL COMITÉ DE REVISIÓN DE
TALLERES
Dr. Carlos Andrés Castañeda Orjuela, MSc
Investigador, Grupo de Evaluación de Epidemiología
y Salud Pública, Universidad Nacional de Colombia,
Bogotá, Colombia.
Gerardo Machnicki, MSc
Director, Economía de la Salud e Investigación de
Resultados Global, Novartis Argentina, Buenos Aires,
Argentina.
CO-PRESIDENTES DEL COMITÉ DE REVISIÓN
DE ESTUDIOS DE CASO SOBRE LA TOMA DE
DECISIONES EN SALUD
Carlos Cruz
Director, Instituto de Salud Pública, Centro de
Excelencia Profesional, Quito, Ecuador.
Alfonso Reyes López, PhD
Investigador Senior, Hospital Infantil de México
Federico Gómez, Ciudad de México, México.
INFORMACIÓN CLAVE
OBJETIVOS DE LA CONFERENCIA
Los participantes podrán:
• Aprender nuevas metodologías farmacoeconómicas y técnicas para la
investigación de resultados;
• Mejorar la calidad de la toma de decisiones mediante una mejor utilización de los
estudios farmacoeconómicos; y
• Aprender lo más reciente sobre la medida de la calidad de vida y la selección de
instrumentos apropiados de encuestas.
IDIOMAS DE LA CONFERENCIA / INTERPRETACIÓN
SIMULTÁNEA
Los idiomas oficiales de la conferencia son español e inglés. Las sesiones plenarias
se presentan con interpretación simultánea en inglés y español. Los idiomas de
cada sesión se indican junto al título de la sesión en el Programa y Agenda de
Eventos. Las sesiones con interpretación simultánea se indican con
.
GUÍA DEL PROGRAMA Y AGENDA DE EVENTOS
Para su comodidad, este Programa y Agenda de Eventos ha sido impreso en
español y en inglés. Para ver la versión en español, consulte las páginas 5-32 y para
ver la versión en inglés, consulte las páginas 33-59.
Los resúmenes de las presentaciones en podio y pósters se incluyen en el idioma
en el cual se enviaron por los autores. Consulte las páginas 73-120 para ver los
resúmenes de las presentaciones en podio y pósters .
8
MATERIALES DE INSCRIPCIÓN
Los siguientes materiales se incluyen en su sobre de inscripción:
• NUEVO Boleto de cursos cortos, uno para cada curso corto al cual se
haya inscrito (DEBE presentar su boleto a la entrada de la sala para recibir sus
materiales del curso);
• Un tiquete para una bebida de cortesía para la Recepción de Bienvenida ISPOR:
Jueves, el 8 de septiembre, 20.45-23.00
• Un tiquete para una bebida de cortesía para la Recepción de los Expositores
y Hora de Presentaciones de Pósters por los autores: Viernes 9 de
septiembre,18.30-20.00;
• Una lista de asistentes que incluye el nombre del asistente, su organización y
país, basado en los datos recopilados al momento de la inscripción; y
• Otra información promocional.
RESÚMENES DE PRESENTACIONES DE INVESTIGACIÓN EN
PODIO Y PÓSTERS
Los resúmenes de todas las presentaciones de investigación en podio y los pósters
que se presentarán en la 3ª Conferencia ISPOR para América Latina, se publicarán
en Value in Health Volumen 14, Número 7. Value in Health Volumen 14, Número 7
estará disponible para todos los miembros de ISPOR y para todos los inscritos a la
3ª Conferencia ISPOR para América Latina en: http://www.ispor.org/valueinhealth_
index.asp en octubre de 2011.
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
Los resúmenes de las presentaciones de investigación en podio y los pósters, y los
resúmenes de la toma de decisiones en el área de la salud, también se incluyen en
este Programa y Agenda de Eventos. Consulte la página 62 para ver un listado de
las presentaciones de póster (investigaciones y estudios de caso) y la sección del
Programa de Eventos para ver las presentaciones de investigación en podio. Los
números de página a la izquierda del código de las presentaciones se refieren a la
ubicación del resumen en este Programa y Agenda de Eventos.
DIVULGACIÓN DE LA INFORMACIÓN FINANCIERA
La divulgación de la información financiera estará disponible en línea luego de la
conferencia, en el mes de octubre de 2011, en: http://www.ispor.org/valueinhealth_
index.asp y en Value in Health Volumen 14, Número 7.
INFORMACIÓN HISTÓRICA SOBRE EL ENVÍO DE RESÚMENES:
Año Investigación Taller Mesa Estudios
Total
Redonda de caso No
Aceptados (%)
2007 117
12
-
-
129
7,8%
2009 256
8
5
8
277
7,2%
2011 212
14
5
4
235
4,3%
Durante la 3ª Conferencia ISPOR para América Latina, se presentarán 158
pósters de investigación y estudios de caso de los tomadores de decisiones, 38
investigaciones en podio, 10 talleres y 4 mesas redondas.
INFORMACIÓN PARA LOS PONENTES
Se les ha pedido a todos los ponentes que lleguen a la sala de presentación 15
minutos antes de que la sesión empiece, con su presentación en un USB/Pen Drive
y las copias/los folletos necesarios (para las presentaciones de investigación
en podio, talleres y mesas redondas). El personal de ISPOR ayudará a los
presentadores a cargar su presentación. Por favor, tenga en cuenta que todas las
presentaciones enviadas a ISPOR antes de la fecha de entrega especificada, serán
precargadas en la computadora en la sala de la sesión.
NOTAS/COPIAS/FOLLETOS
• Sesiones plenarias
Los folletos para las sesiones plenarias estarán disponibles en el salón de la sesión
a la hora de la presentación.
• Presentaciones de investigación, talleres y mesas redondas
Los folletos para las presentaciones (en podio y de pósters) de investigación,
talleres y mesas redondas son la responsabilidad exclusiva del/los autor/es de la
presentación. ISPOR solicita a todos los presentadores que entreguen al menos 200
copias de sus folletos.
• Simposios educativos
Los folletos de los simposios educativos son la responsabilidad exclusiva de la/s
organización/es anfitriona/s. ISPOR sugiere a todas las organizaciones de los
simposios que entreguen al menos 100 copias de sus materiales.
• Todos los folletos restantes y adicionales
Todos los folletos restantes y adicionales estarán disponibles en la mesa de folletos,
próximo al área de inscripción de ISPOR.
POR FAVOR TENGA EN CUENTA: luego de la conferencia y sujeto a la autorización
del autor, las presentaciones de investigaciones autorizadas se publicarán en el
ISPOR Outcomes Research Digest:
Una base de datos con más de 17.000 resúmenes de
investigación presentados en las reuniones de ISPOR desde
1998 hasta la fecha, disponible en www.ispor.org .
PRESENTACIONES DE INVESTIGACIÓN EN PODIO
Las investigaciones de resultados (clínicos, económicos y reportados por
pacientes), las investigaciones sobre políticas sanitarias y las investigaciones
sobre métodos para los siguientes temas se presentarán en sesiones orales de 15
minutos:
CN- Investigación de resultados sobre el cáncer
CV- Investigación de resultados sobre trastornos cardiovasculares
EX- Estudios sobre gastos o reembolsos en el área del cuidado de la salud
HS- Investigación sobre servicios del cuidado de la salud
IN- Investigación de resultados sobre infecciones
QA- Examinando el QALY
PR- Investigación de resultados reportados por pacientes
RM- Investigación sobre métodos
TP- Patrones de tratamiento en políticas sanitarias
VA- Investigación de resultados sobre vacunas
Consulte las páginas 73-82 para ver los resúmenes de las presentaciones de
investigación en podio.
PRESENTACIONES DE PÓSTERS DE INVESTIGACIÓN
Las presentaciones de pósters se expondrán en la sala Don Diego 1.
Horas de exposición de los pósters:
Viernes 9 de septiembre: 8.30-20.00
Sábado 10 de septiembre: 8.00-13.45
Montaje de los pósters: Viernes, 9 de septiembre: 8.00-8.30
Hora para discusión con el autor del póster: Viernes, 9 de septiembre: 18.30-19.30
Desmontaje de pósters: Sábado, 10 de septiembre: 13.45-14.15
Los autores de los pósters deben estar presentes junto a sus pósters durante la
hora de discusión con el autor. Consulte las páginas 62-72 para ver los títulos y
autores de las presentaciones de pósters de investigación y las páginas 83-119
para ver los resúmenes de los pósters de investigación
*Por favor tenga en cuenta: los pósters que no sean retirados durante el horario
programado para desmontaje de pósters serán desechados.
Clasificación de los pósters de investigación:
PCN – CÁNCER
PCV – TRASTORNOS CARDIOVASCULARES (derrame cerebral, otros trastornos
cardiovasculares)
PDB – DIABETES/TRASTORNOS ENDOCRINOS
PGI – TRASTORNOS GASTROINTESTINALES
PHP – ESTUDIOS SOBRE EL USO Y LAS POLÍTICAS DEL CUIDADO DE LA SALUD
PIH – SALUD DE INDIVIDUOS (niños, ancianos, hombres, mujeres)
PIN – INFECCIÓN
PMH – SALUD MENTAL
PMS – TRASTORNOS ÓSEO-MUSCULARES (artritis, osteoporosis, otros trastornos
óseo-musculares)
PND – TRASTORNOS NEUROLÓGICOS
PRM – INVESTIGACIÓN SOBRE MÉTODOS
PRS – TRASTORNOS RELACIONADOS CON LAS VÍAS RESPIRATORIAS (alergia,
asma, tabaquismo, otros trastornos respiratorios)
PSS – TRASTORNOS DE LOS SISTEMAS SENSORIALES (oído, vista, piel)
PSY – TRASTORNOS SISTÉMICOS (enfermedades autoinmunes, trastornos
hematológicos, trastornos metabólicos, obesidad, dolor)
PUK – TRASTORNOS URINARIOS/RENALES
PCASE – ESTUDIOS DE CASOS DE LA TOMA DE DECISIONES EN LA SALUD
PRESENTACIÓN DE PREMIOS DE INVESTIGACIÓN
Se entregan premios a las mejores presentaciones de investigación en
podio (hasta 6) y a las mejores presentaciones de pósters de investigación
(hasta 6). Se consideran todas las presentaciones de investigación en podio
para premiación. Las presentaciones de pósters de investigación que
estén entre los primeros 40%, basados en la puntuación obtenida durante el
proceso de revisión de los resúmenes, se consideran para premiación. Los posters
considerados se indiquen con una roseta.
La premiación ISPOR a las presentaciones de investigación se anunciará el
sábado 10 de septiembre de 13.30-13.45 en la sala Don Diego 4.
EXPOSICIONES
Las exposiciones estarán a la vista en el vestíbulo Don Diego.
Viernes 9 de septiembre de 2011: 8.30-20.00
Sábado 10 de septiembre de 2011: 8.00-13.45
AVISO DEL USO DE IMÁGENES FOTOGRÁFICAS Y
GRABACIÓN DE LA CONFERENCIA
Por favor, tenga presente que la grabación, por cualquier medio, de
presentaciones de la conferencia, está prohibida. ISPOR (International Society
for Pharmacoeconomics and Outcomes Research) hará cumplir estrictamente
sus derechos como licenciatario exclusivo de los derechos de toda publicación y
reproducción de cada presentación, y ninguna presentación, en su totalidad o en
parte, puede ser reproducida sin la autorización expresa de ISPOR.
La inscripción y la asistencia a la 3ª Conferencia ISPOR para América Latina
constituye un acuerdo por el inscrito al uso de su imagen (fotografía y video) por
ISPOR ahora y en el futuro.
9
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
resumen de la conferencia
JUEVES 8 DE SEPTIEMBRE
8.00-17.00 CURSO CORTO DÍA COMPLETO
INTRODUCCIÓN A LA FARMACOECONOMÍA (FARMACOECONOMÍA PARA LOS TOMADORES
DE DECISIONES) Don Diego 1
8.00-12.00 CURSOS CORTOS MATUTINOS
INTRODUCCIÓN A LA MODELACIÓN Don Diego 2
SISTEMAS DE SALUD Y REEMBOLSO EN AMÉRICA LATINA Don Diego 3
INTRODUCCIÓN A LA CALIDAD DE VIDA / RESULTADOS REPORTADOS POR PACIENTES Don Genaro
INTRODUCCIÓN AL META-ANÁLISIS Y LA REVISIÓN SISTEMÁTICA Don Americo
ANÁLISIS DEL IMPACTO DEL PRESUPUESTO Don Diego 4
12.00-13.00
ALMUERZO (a cargo de los asistentes)
13.00-17.00 CURSOS CORTOS VESPERTINOS
MODELACIÓN APLICADA Don Diego 2
EVALUACIÓN DE TECNOLOGÍAS SANITARIAS Don Diego 4
MEDIDAS DE UTILIDAD Don Diego 3
EXTRACCIÓN DE DATOS DE COSTOS PARA EL ANÁLISIS ECONÓMICO EN AMÉRICA LATINA Don
Americo
REGISTROS DE PACIENTES Don Genaro
17.15-18.15 SIMPOSIO EDUCATIVO Don Diego 4
EL TRATAMIENTO DEL CÁNCER EN AMÉRICA LATINA: PERSPECTIVAS, ACCESO Y SOSTENTABILIDAD
(Patrocinado por Sanofi)
18.30-19.30
SIMPOSIO EDUCATIVO Don Diego 4
¿CÓMO PODEMOS PREVENIR LA CRISIS DE ENFERMEDAD CEREBROVASCULAR EN AMÉRICA LATINA?
INFORME DE UN GRUPO DE TRABAJO INDEPENDIENTE (Patrocinado por Bayer HealthCare)
19.45-20.45
20.45-23.00 RECEPCIÓN DE BIENVENIDA Terraza Alameda
VIERNES 9 DE SEPTIEMBRE
DISCURSO DE BIENVENIDA Y COMENTARIOS DE
APERTURA Don Diego 4
8.45-9.15
MENSAJE INAUGURAL Don Diego 4
9.15-10.30
PRIMERA SESIÓN PLENARIA Don Diego 4
RETOS PARA LA COBERTURA UNIVERSAL FRENTE A LOS ALTOS COSTOS DE NUEVAS TECNOLOGIAS
EN SALUD
10.30-11.00 RECESO, EXPOSICIONES Y REVISIÓN DE PÓSTERS DE
INVESTIGACIÓN Don Diego 1 y vestíbulo
11.00-12.00 PRESENTACIONES DE INVESTIGACIÓN EN PODIO – SESIÓN I
INVESTIGACIÓN DE RESULTADOS SOBRE TRASTORNOS CARDIOVASCULARES Don Americo
ESTUDIOS SOBRE GASTOS O REEMBOLSOS EN EL ÁREA DEL CUIDADO DE LA SALUD Don Diego 3
EXAMINANDO EL QALY Don Diego 2
PATRONES DE TRATAMIENTO EN POLÍTICAS SANITARIAS Don Diego 4
INVESTIGACIÓN DE RESULTADOS SOBRE VACUNAS Don Genaro
12.00-15.00 ALMUERZO, EXPOSICIONES Y REVISIÓN DE PÓSTERS DE
INVESTIGACIÓN Don Diego 1 y vestíbulo
12.30-13.30
SIMPOSIO EDUCATIVO Don Diego 4
ANÁLISIS DE ECONOMÍA DE LA SALUD EN AMÉRICA LATINA ¿SE PUEDEN APLICAR LAS LECCIONES
APRENDIDAS EN OTRAS PARTES DEL MUNDO? (Patrocinado por IMS Consulting Group)
13.45-14.45
SIMPOSIO EDUCATIVO Don Diego 4
MEDICAMENTOS DE ALTO COSTO: ¿AGREGAN VALOR A LOS SISTEMAS DE SALUD EN AMÉRICA
LATINA? ¿CÓMO GARANTIZAR UN ACCESO ADECUADO? (Patrocinado por Eli Lilly and Company)
15.00-16.00 MESAS REDONDAS Y TALLERES – SESIÓN I
IP1: NIVEL DE INFLUENCIA DE LAS EVALUACIONES DE TECNOLOGÍAS SANITARIAS (HTA): ¿HASTA
QUÉ PUNTO INFLUYEN LAS HTA EN LAS DECISIONES DE ACCESO AL MERCADO EN DISTINTAS
REGIONES GEOGRÁFICAS? Don Diego 2
W1: MÉTODOS PARA UN ANÁLISIS CRÍTICO DE LOS MODELOS DE COSTO-EFECTIVIDAD
ENVIADOS A LAS AUTORIDADES DE REEMBOLSO: UN APRENDIZAJE A PARTIR DE LA EXPERIENCIA
INTERNACIONAL Don Diego 4
W3: USO DE DATOS DEL MUNDO REAL PARA LA INVESTIGACIÓN EN AMÉRICA LATINA Don Diego 3
10
RECESO, EXPOSICIONES Y REVISIÓN DE PÓSTERS DE
INVESTIGACIÓN Don Diego 1 y vestíbulo
16.15-17.15
MESAS REDONDAS Y TALLERES – SESIÓN II
IP2: ESQUEMAS DE RIESGO COMPARTIDO EN PAÍSES EMERGENTES: ¿CUÁLES SON LOS PASOS A
SEGUIR PARA ALCANZAR EL ÉXITO? Don Diego 4
W4: PAUTAS PARA UNA SELECCIÓN ADECUADA DEL MÉTODO DE MODELACIÓN EN LA EVALUACIÓN
FARMACOECONÓMICA EN AMÉRICA LATINA Don Americo
W5: EQ-5D: UNA PARTE FUNDAMENTAL DE LAS HERRAMIENTAS PARA LOS ENCARGADOS DE LA
TOMA DE DECISIONES EN AMÉRICA LATINA Don Diego 2
W6: EVALUACIÓN DE TECNOLOGÍAS SANITARIAS EN CHILE: PASADO, PRESENTE Y FUTURO
Don Diego 3
17.30-18.30
PRESENTACIONES DE INVESTIGACIÓN EN PODIO – SESIÓN II
INVESTIGACIÓN DE RESULTADOS SOBRE EL CÁNCER Don Diego 4
INVESTIGACIÓN SOBRE SERVICIOS DEL CUIDADO DE LA SALUD Don Americo
INVESTIGACIÓN DE RESULTADOS SOBRE INFECCIONES Don Diego 2
INVESTIGACIÓN DE RESULTADOS REPORTADOS POR PACIENTES Don Genaro
INVESTIGACIÓN SOBRE MÉTODOS Don Diego 3
18.30-19.30
HORA DE DISCUSIÓN CON LOS AUTORES DE LOS PÓSTERS
DE INVESTIGACIÓN Don Diego 1
18.30-20.00
RECEPCIÓN DE EXPOSITORES Y REVISIÓN DE PRESENTACIONES
DE PÓSTERS DE INVESTIGACIÓN Don Diego 1 y vestíbulo
19.30-21.00
SIMPOSIO EDUCATIVO Don Diego 4
ACTUALIZACIÓN DEL ESTADO DEL ENTORNO DE REEMBOLSO EN AMÉRICA LATINA (Patrocinado por
Millcreek Outcomes Group)
SÁBADO 10 DE SEPTIEMBRE DE 2011
SIMPOSIO EDUCATIVO Don Diego 4
EL NIVEL ADECUADO: HTA “MICRO Y MACRO” EN LOS MERCADOS EMERGENTES / SISTEMAS DE
SALUD (Patrocinado por PhRMA)
8.30-8.45
16.00-16.15
7.45-8.45
SIMPOSIO EDUCATIVO Don Diego 4
FÁRMACOS BIOLÓGICOS Y BIOSIMILARES EN AMÉRICA LATINA: DESAFÍOS DE LOS FONDOS PARA
CONTRIBUYENTES Y DESARROLLADORES (Patrocinado por Pfizer)
8.00-9.00
EXPOSICIONES Y REVISIÓN DE PÓSTERS DE INVESTIGACIÓN
Don Diego 1 y vestíbulo
9.00-10.30
BIENVENIDA, PRESENTACIÓN DE LOS PREMIOS ISPOR PARA
LA EXCELENCIA EN EL SERVICIO Y SEGUNDA SESIÓN PLENARIA Don Diego 4
¿CUAL ES EL VALOR DE LA INVESTIGACION DE RESULTADOS PARA LOS TOMADORES DE
DECISIONES?: UNA DISCUSION FRANCA ENTRE TOMADORES DE DECISIONES EN INSTITUCIONES
PÚBLICAS
10.30-11.00
RECESO, EXPOSICIONES Y REVISIÓN DE PÓSTERS DE
INVESTIGACIÓN Don Diego 1 y vestíbulo
11.00-12.00
MESAS REDONDAS Y TALLERES – SESIÓN III
IP3: EL PAPEL DE LAS AGENCIAS DE EVALUACIÓN DE TECNOLOGÍAS EN AMÉRICA LATINA
Don Diego 2
W7: EL ROL DE LA EVIDENCIA DE LA ECONOMÍA DE LA SALUD Y LA INVESTIGACIÓN DE
RESULTADOS (HEOR) EN LAS DECISIONES SOBRE VADEMÉCUM Y REEMBOLSOS EN AMÉRICA LATINA
VERSUS LOS ESTADOS UNIDOS Don Diego 4
W8: MÉTODOS PARA COMPARACIONES DE TRATAMIENTOS INDIRECTOS Y MIXTOS: HERRAMIENTAS
PARA LA EVALUACIÓN DE TECNOLOGÍAS SANITARIAS EN AUSENCIA DE EVIDENCIA DIRECTA
Don Americo
W9: MÉTODOS INNOVADORES PARA MEJORAR LA ADHESIÓN A UN MEDICAMENTO Don Diego 3
12.15-13.15
MESAS REDONDAS Y TALLERES – SESIÓN IV
IP4: EL COSTO DE LOS TRASTORNOS DEL ESTADO DE ÁNIMO: ¿QUÉ ASPECTO GENERA EL MAYOR
GASTO PARA LOS SISTEMAS DE SALUD? ¿QUÉ GENERA LA ALTA DISCAPACIDAD ASOCIADA? UNA
PERSPECTIVA SOCIAL, ECONÓMICA Y GLOBAL Don Diego 3
W10: FALTA DE DATOS LOCALES SOBRE EFECTIVIDAD, COSTO Y EPIDEMIOLOGÍA; ¿CUÁLES SON LAS
OPCIONES PARA REALIZAR ESTUDIOS DE FARMACOECONOMÍA EN AMÉRICA LATINA? Don Diego 2
W12: EL FUTURO DE LOS CONTROLES DE COSTOS FARMACÉUTICOS EN AMÉRICA LATINA: ¿HTA O
PRECIOS DE REFERENCIA? Don Diego 4
13.30-13.45
ENTREGA DE LOS PREMIOS ISPOR PARA LAS
PRESENTACIONES DE INVESTIGACIÓN Y CIERRE Don Diego 4
HORAS DE INSCRIPCIÓN ISPOR:
Jueves 8 de septiembre: 7.00-17.00
Viernes 9 de septiembre: 7.00-18.00
Sábado 10 de septiembre: 7.30-13.30
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
PROGRAMA DE CURSOS CORTOS
JUEVES 8 DE SEPTIEMBRE DE 2011
CURSO DÍA COMPLETO (DE 8.00 A 17.00)
INTRODUCCIÓN A LA FARMACOECONOMÍA
(FARMACOECONOMÍA PARA LOS TOMADORES DE DECISIONES)
Presentado en español Don Diego 1
Cuerpo docente: Dr. Diego Rosselli, MEd, MHP, Profesor
Docente Asociado de Economía de la Salud, Pontificia
Universidad Javeriana, Bogotá, Colombia. Dr. Adolfo
Rubinstein, MSC, PhD, Presidente, Instituto de Efectividad
Clínica y Sanitaria (IECS) y Director del Programa de Maestría
de Efectividad Clínica, Facultad de Medicina, Universidad de D. Rosselli A. Rubinstein
Buenos Aires, Buenos Aires, Argentina.
Descripción: Este curso está diseñado para enseñar a los médicos y nuevos
investigadores cómo incorporar la farmacoeconomía en el diseño de estudios y
análisis de datos. Los participantes aprenderán cómo recolectar y calcular los
costos de los distintos tratamientos alternativos de atención médica o su evaluación
económica, determinar el impacto económico de los resultados clínicos, y cómo
identificar, rastrear y asignar costos a los distintos tipos de recursos de atención
médica utilizados. Se hablará acerca del desarrollo de protocolos económicos
y hojas de recolección de datos. Se demostrarán distintos modelos y técnicas
de farmacoeconomía, además de estudios de casos. Estos incluyen análisis de:
minimización de costos, costo de la enfermedad, costo-efectividad, costo-beneficio y
costo-utilidad. También se demostrarán y practicarán análisis de decisiones, análisis
de sensibilidad y descuentos. Los participantes también aprenderán a comparar y
evaluar las intervenciones, como los fármacos, dispositivos y servicios clínicos.
Nivel: Introductorio. Este curso es apto para quienes tienen poco o nada de
experiencia en la farmacoeconomía.
CURSOS MATUTINOS (DE 8.00 A 12.00)
INTRODUCCIÓN A LA MODELACIÓN
Presentado en español Don Diego 2
Cuerpo docente: Dr. Federico Augustovski, MSC, PhD,
Director, Departamento de Evaluaciones Económicas y
HTA, Instituto de Efectividad Clínica y Sanitaria (IECS),
Profesor de Salud Pública, Universidad de Buenos Aires
y Médico, Servicio de Medicina Familiar y Comunitaria,
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; F. Augustovski P. Anaya
Pablo Anaya, MHA, Gerente de Economía de la Salud e
Investigación de Resultados, GlaxoSmithKline México, Bosque Real, Ciudad de México,
México.
Descripción: Este curso incluye un análisis de los modelos de Markov, los modelos
de eventos discretos y otras técnicas de modelación y sus aplicaciones relevantes,
incluyendo un análisis de los Informes de Buenas Prácticas de Investigación en
Modelación de ISPOR. A través del uso de una serie de ejemplos relacionados, el
curso analizará en detalle los pasos prácticos que deben seguirse para el desarrollo y
uso de estos modelos. Los ejemplos se presentarán principalmente usando Microsoft
Excel, complementado con un software de simulación. Este curso hablará sobre los
pasos prácticos que deben seguirse para la selección y modelación de datos, y los
aspectos prácticos relacionados con la decisión de cuándo, por qué y cómo manipular
la estocástica (es decir, las simulaciones de Montecarlo de primer orden) y la
incertidumbre probabilística (es decir, simulaciones de Montecarlo de segundo orden).
Se hablará sobre los temas relacionados a la selección de parámetros de entrada del
modelo y sus distribuciones, para el uso en análisis de sensibilidad probabilística. Los
participantes aprenderán cuáles son los pasos a seguir para la realización, análisis,
interpretación y presentación de resultados de análisis de sensibilidad probabilística
(por ejemplo: uso de análisis del plano de costo-efectividad, las “elipses” y las curvas
de aceptabilidad).
Nivel: Introductorio. Este curso exige cierta familiaridad con el análisis de decisiones.
SISTEMAS DE SALUD Y REEMBOLSO EN AMÉRICA LATINA
Presentado en español Don Diego 3
Cuerpo docente: Dr. Leonardo Cubillos, MPH, Práctica de
sistemas de salud, Banco Mundial, Washington, DC, EE.UU.
Dr. Diego Guarín, MPH, MA, Director, Acceso al Mercado
Latinoamericano, Merck Sharp & Dohme, Ciudad de México,
México. Dr. Henry Maquera Colque, MBA, Secretario
Ejecutivo del Fondo Intagible Solidario de Salud del Perú,
Lima, Perú. Giota Panopoulou, PhD, Asesora, Dirección de
L. Cubillos
Finanzas, Instituto Mexicano del Seguro Social, Ciudad de
México, México. Dr. Alarico Rodríguez de
Leon, Gerente de Beneficios Médicos, Fondo
Nacional de Recursos, Montevideo, Uruguay.
Descripción: En esta sesión primero
se hablará sobre los sistemas de salud
actuales de los países más importantes de
G. Panopoulou A. Rodríguez
Latinoamérica, incluyendo la implementación H. Colque
de Leon
de investigaciones y su vinculación con las
prioridades de la región. El cuerpo docente luego describirá la legislación sobre
reembolsos, los procesos y organizaciones en estos países, además del papel del
fabricante de dispositivos médicos y/o fármacos. Luego, este curso se centrará
en brindar a los participantes una descripción de los diversos procedimientos que
emplean las autoridades sanitarias de Latinoamérica para regular el acceso al
mercado, en virtud de la evaluación del valor clínico y, en algunos países, económico,
de las nuevas tecnologías en medicina. Las pautas para las presentaciones de
vademécum establecen normas analíticas y probatorias que los fabricantes de
fármacos y de otros productos deben respetar para justificar su producto. El cuerpo
docente también hablará sobre las normas probatorias para las presentaciones de
vademécum.
Nivel: Introductorio.
INTRODUCCIÓN A LA CALIDAD DE VIDA / RESULTADOS
REPORTADOS POR PACIENTES
Presentado en español Don Genaro
Cuerpo docente: Yajaira Bastardo, PhD, Directora
Administrativa y Profesora, Escuela de Farmacia,
Universidad Central de Venezuela, Caracas, Venezuela.
Dr. Nelson Alvis Guzmán, PhD, MPH, Profesor y Director
de Investigación sobre Economía de la Salud, Profesor de
Y. Bastardo N. Guzmán
Ciencias Económicas y Director de Grupo de Investigación
sobre Economía de la Salud, Universidad de Cartagena, Cartagena, Colombia.
Descripción: Se presentarán diversos métodos conceptuales, metodológicos y
prácticos para medir la calidad de vida, el estado de salud y otros tipos de resultados
en salud. Se hablará sobre marcos teóricos, confiabilidad, validez, capacidad de
respuesta, métodos de administración, cargas administrativas y de los informantes,
y cuestiones de análisis e interpretación, a través del uso de ejemplos extraídos de
instrumentos específicos para la calidad de vida y sus aplicaciones. Se presentará un
modelo para la selección adecuada de instrumentos entre los diversos instrumentos
genéricos y específicos de cada enfermedad.
Nivel: Introductorio. Este curso está diseñado para quienes tienen poca experiencia
con estas metodologías.
INTRODUCCIÓN AL META-ANÁLISIS Y LA REVISIÓN
SISTEMÁTICA
Presentado en español Don Americo
Cuerpo docente: Dr. Agustín Ciapponi, Coordinador Centro Cochrane,
IECS (Instituto de Efectividad Clínica y Sanitaria), Red Cochrane
Iberoamericana, y Servicio de Medicina Familiar y Comunitaria, Hospital
Italiano de Buenos Aires, Buenos Aires, Argentina.
Descripción: El meta-análisis puede definirse como el análisis estadístico A. Ciapponi
de datos a partir de estudios múltiples, con el objetivo de sintetizar
y resumir los resultados, además de evaluar cuantitativamente las fuentes de
heterogeneidad e imparcialidad. Una revisión sistemática de la literatura a menudo
incluye el meta-análisis e implica una descripción explícita y detallada de cómo se
realizó dicha revisión. Este curso se concentra y expone cuatro áreas destacadas: 1)
incentivos para el meta-análisis y las revisiones sistemáticas; 2) medidas básicas a
tomar para realizar una revisión cuantitativa sistemática; 3) métodos estadísticos para
combinar datos; y 4) una introducción a los métodos para comparaciones indirectas.
El material incluye ejemplos prácticos de bibliografía relevante a la farmacoeconomía
e investigaciones profesionales. Este curso está diseñado para quienes tienen poca
experiencia con el meta-análisis e incluye ejercicios interactivos.
Nivel: Introductorio. Este curso está diseñado para quienes tienen poca experiencia
con el meta-análisis.
ANÁLISIS DEL IMPACTO DEL PRESUPUESTO
D. Guarín
Presentado en inglés y en español con interpretación
simultánea Don Diego 4
Cuerpo docente: C. Daniel Mullins, PhD, Profesor y
Director, Investigación en Servicios de Salud Farmacéutica,
Escuela de Farmacia, Universidad de Maryland, Baltimore,
C. D. Mullins A. García
11
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
PROGRAMA DE CURSOS CORTOS JUEVES 8 DE SEPTIEMBRE DE 2011
MD, EE.UU. Ariadna Juárez García, PhD, MSC, Gerente de Economía de la Salud e
Investigación de Resultados, Economía de la Salud, Bristol-Myers Squibb, Ciudad de
México, México.
Descripción: Este curso describirá los métodos para determinar los costos asociados
con una enfermedad y el impacto de las nuevas tecnologías en el presupuesto
asociado a esa enfermedad. El curso presentará las estrategias de cálculo de
costos basadas en la prevalencia y en la incidencia. Se demostrarán algoritmos de
tratamiento y métodos basados en eventos para costos asociados a enfermedades
específicas, desde diversas perspectivas de la toma de decisiones. Se presentarán los
métodos estáticos y dinámicos para calcular el impacto que tiene sobre el presupuesto
el hecho de agregar un nuevo fármaco al vademécum de un plan de salud. También se
debatirá sobre los temas relacionados a la entrada de datos faltantes
Nivel: Intermedio. Este curso está diseñado para quienes tienen algo de experiencia
con el análisis farmacoeconómico.
CURSOS VESPERTINOS (DE 13.00 A 17.00)
MODELACIÓN APLICADA
Presentado en español Don Diego 2
Cuerpo docente: Dr. Federico Augustovski,
MSC, PhD, Director, Evaluaciones Económicas
y HTA, IECS (Instituto de Efectividad Clínica
y Sanitaria), Profesor de Salud Pública,
Universidad de Buenos Aires y Médico de la
F. Augustovski A. P
ichon- S. Martí
división de medicina familiar y comunitaria,
Riviere
Hospital Italiano de Buenos Aires, Buenos
Aires, Argentina. Dr. Andrés Pichon-Riviere,
MSC, PhD, Director Ejecutivo del IECS (Instituto de Efectividad Clínica y Sanitaria) y
Profesor Adjunto de Salud Pública, Escuela de Salud Pública, Facultad de Medicina,
Universidad de Buenos Aires, Buenos Aires, Argentina. Dr. Sebastián García Martí,
MSC, Evaluaciones Económicas y de Tecnologías Sanitarias, IECS (Instituto de
Efectividad Clínica y Sanitaria), Buenos Aires, Argentina.
Descripción: Este curso es una introducción práctica al uso de software para la
creación y análisis de modelos de decisión de costo-efectividad. Se hablará sobre
los principios básicos de la toma de decisiones de costo-efectividad, la creación y el
análisis de un simple árbol de decisión. Se presentarán la modelación de Markov y
la simulación de Montecarlo. Todos los participantes deben traer una computadora
portátil con Windows, y una copia de TreeAge Pro Suite instalada y funcionando. Se le
darán instrucciones de descarga e instalación cuando se preinscriba al curso.
Nivel: Avanzado.
*Pre-requisito: Este curso es apto para quienes están familiarizados con los diversos
métodos de modelación o quienes han tomado el curso de la mañana, ‘Introducción a
la modelación’.
EVALUACIÓN DE TECNOLOGÍAS SANITARIAS
Presentado con interpretación simultánea Don Diego 4
Cuerpo docente: Dra. Carisi Anne Polanczyk, PhD, Profesora Adjunto de
Medicina, División Cardiología, Universidad Federal de Rio Grande do Sul,
Porto Alegre, RS y del Instituto Nacional de Evaluación de Tecnologías
Sanitarias, CNPq/Brasil.
C. Polanczyk
Descripción: La evaluación de tecnologías sanitarias (HTA) es la
evaluación sistemática de propiedades, efectos y/o impactos de la
tecnología sanitaria. A lo largo de todo el proceso de introducción de una nueva
tecnología, la evaluación de su efectividad, la aprobación de su inclusión en el
mercado y las tomas de decisiones relacionadas, deben tratarse temas éticos, clínicos
y económicos importantes. Este curso hablará sobre los procesos actuales que
se usan en todo el mundo para introducir una nueva tecnología y las agencias que
realizan estos procesos. Incluirá un análisis de los diversos métodos utilizados para
evaluar la seguridad, la eficacia y la adhesión y difusión de una tecnología, con un
especial énfasis en cómo realizar una HTA usando evidencia real. El cuerpo docente
abordará algunos de los temas que enfrentan los procesos de HTA actuales, además
de su impacto sobre el entorno económico y social, la necesidad de exigir las mejores
prácticas y la necesidad de una mayor cooperación entre los involucrados.
Nivel: Intermedio. Este curso está diseñado para quienes tienen algo de experiencia
con la farmacoeconomía.
MEDIDAS DE UTILIDAD
Presentado en español Don Diego 3
Cuerpo docente: Dr. Rafael Alfonso, MSC, Programa de Políticas y la
Investigación de Resultados Farmacéuticos, Universidad de Washington,
Seattle, WA, EE.UU.
Descripción: La medición de la utilidad es un método para determinar la R. Alfonso
12
preferencia individual por un cierto resultado, representado por un puntaje cuantitativo
(utilidad). Durante este curso, se demostrarán métodos para medir los resultados
basados en la preferencia, como el juego estándar, la equivalencia temporal y la
escala analógica visual. Además, se hablará brevemente sobre los instrumentos
basados en la utilidad (EQ-5D, HUI, QWQ, SF-36). No obstante, la medición de la
utilidad no sólo se trata de dominar estas técnicas, sino también de usarlas de tal
modo que los encargados de la toma de decisiones en el área de atención de la
salud puedan aplicar los resultados, por ejemplo, en análisis de costo por QALY. Para
este fin, uno debe estar al tanto de las deficiencias de las mediciones de utilidad
disponibles y sus posibles soluciones. Además, es necesario conocer el contexto de
toma de decisiones y el modo en el que se interpretan los resultados. Para que los
participantes se especialicen en el campo de la medición de la utilidad, se tratarán los
temas más importantes. Por ejemplo, consideraremos la insensibilidad potencial de los
instrumentos genéricos para problemas específicos de una enfermedad y hablaremos
acerca de hasta qué punto la adaptación de los instrumentos de calidad de vida
genéricos o específicos de una enfermedad, pueden ofrecer una solución. Además,
se debatirá sobre el interrogante: “¿Qué valores cuentan: los valores del paciente o
los valores del público general?”. Finalmente, recurriremos a la interpretación en el
contexto de la asignación de recursos.
Nivel: Intermedio. Este curso está diseñado para quienes tienen algo de experiencia
con las medidas de la calidad de vida en la evaluación de economía de la salud.
EXTRACCIÓN DE DATOS DE COSTOS PARA EL ANÁLISIS
ECONÓMICO EN AMÉRICA LATINA
Presentado en español Don Americo
Cuerpo docente: Dra. Ximena BurbanoLevy, Directora de Proyectos, Universidad
Internacional de Florida, Facultad de Ciencias
Integrado y la Humanidad, Miami, FL, EE.UU.
Dr. Nelson Alvis Guzmán, PhD, MSC, Profesor
y Director de Investigación sobre Economía
N. Guzmán X. Burbano-Levy H. Cáceres
de la Salud, Profesor de Ciencias Económicas
y Director de Grupo de Investigación sobre Economía de la Salud, Universidad de
Cartagena, Cartagena, Colombia. Dra. Heidy Cáceres, MHE, Gerente de Investigación
de Resultados, Pfizer Colombia, Bogotá, Colombia.
Descripción: Este curso se centrará en los aspectos prácticos del desarrollo de costos
para los estudios de farmacoeconomía. El objetivo es ayudar a los participantes a
cerrar la brecha entre la teoría de la farmacoeconomía y la práctica del desarrollo de
cálculos de costos. Se presentarán los factores a considerar cuando se calculan los
costos de los análisis de farmacoeconomía, como la perspectiva, las fuentes de datos,
los sistemas de clasificación de datos, el desarrollo de perfiles de uso de recursos,
la obtención de costos de unidades y la realización de ajustes de costos. Se debatirá
sobre los ejemplos de problemas que se presentan al identificar y extraer los datos de
costos.
Nivel: Intermedio. Este curso está diseñado para quienes tienen algo de experiencia
con el análisis fármacoeconómico.
REGISTROS DE PACIENTES
Presentado en español Don Genaro
Cuerpo docente: Dr. Manuel De la Llata Romero, Director
General de Hospitales Regionales Altamente Especializados,
Ciudad de México, México. Dr. Jose Antonio Magaña
Serrano, Jefe de la División de Educación en Salud, Hospital
de Cardiología, Centro Médico Nacional Siglo XXI, Instituto
Mexicano del Seguro Social, Ciudad de México, México.
M. De la Llata J. Serrano
Dr. Carlos Martínez Sanchez, Presidente, Sociedad Mexicana
de Cardiología, Ciudad de México, México. Dr. Guillermo
Meléndez, MSC, Coordinador Científico, Fondo Nestlé para
la Nutrición (FUNSALUD), Ciudad de México, México.
Descripción: Este curso está diseñado para dar una visión
general de los registros de los pacientes y su aplicación
para identificar problemas “del mundo real” clínicos, de
C. Sanchez
G. Meléndez
seguridad y de la perspectiva del paciente. Se presentarán
los pros y contras de los datos de registro en comparación con la recolección de otros
datos “reales” y de ensayos clínicos. Se abordará el tema acerca de cómo se puede
usar la información de registro para apoyar otras iniciativas de economía de la salud /
investigación de resultados y la toma de decisiones en el área de atención de la salud.
Se hablará sobre la estrategia, diseño, operaciones de registros y de las mediciones
para el éxito del programa. Además, se examinarán las tendencias y requisitos de
regulación
Nivel: Introductorio. Este curso está diseñado para quienes tienen poca experiencia
con los registros de los pacientes.
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
Creando enlaces interinstitucionales para el acceso a la salud en América Latina
PROGRAMA
JUEVES 8 DE SEPTIEMBRE
8.00-17.00
PROGRAMA DE CURSOS CORTOS PREVIO A LA CONFERENCIA Se debe inscribir a los cursos cortos por separado.
(Consulte las páginas 11-12 para ver una descripción de los cursos cortos).
Almuerzo: a cargo de los asistentes
REUNIONES ISPOR (SÓLO POR INVITACIÓN)
12.30-13.30
COMITÉ DE PRODUCTORES DE TECNOLOGIAS SANITARIAS (INDUSTRIA) DEL CONSORCIO ISPOR PARA AMÉRICA LATINA Don Alberto 3 (4º Piso)
14.30-15.30
COMITÉ DE PUBLICACIONES DEL CONSORCIO ISPOR PARA AMÉRICA LATINA Don Alberto 3 (4º Piso)
17.15-18.15
SIMPOSIO EDUCATIVO Don Diego 4
Presentado en inglés.
EL TRATAMIENTO DEL CÁNCER EN AMÉRICA LATINA: PERSPECTIVAS, ACCESO Y SOSTENTABILIDAD
(Consulte la página 25 para ver una descripción del simposio)
Patrocinado por Sanofi
18.30-19.30
SIMPOSIO EDUCATIVO Don Diego 4
Presentado en inglés y español con interpretación simultánea.
¿CÓMO PODEMOS PREVENIR LA CRISIS DE ENFERMEDAD CEREBROVASCULAR EN AMÉRICA LATINA? INFORME DE UN GRUPO DE TRABAJO INDEPENDIENTE
(Consulte la página 25 para ver una descripción del simposio)
Patrocinado por Bayer HealthCare
18.30-20.30
REUNIONES ISPOR (SÓLO POR INVITACIÓN) Don Alberto 3 (4º Piso)
REUNIÓN DEL COMITÉ EJECUTIVO DEL CONSORCIO ISPOR PARA AMÉRICA LATINA
19.45-20.45
SIMPOSIO EDUCATIVO Don Diego 4
Presentado en inglés con interpretación simultánea.
EL NIVEL ADECUADO: HTA “MICRO Y MACRO” EN LOS MERCADOS EMERGENTES / SISTEMAS DE SALUD
(Consulte la página 26 para ver una descripción del simposio)
Patrocinado por PhRMA
20.45-23.00
RECEPCIÓN DE BIENVENIDA ISPOR Terraza Alameda
Abierto a todos los asistentes de la conferencia.
Recepción co-patrocinada por OptumInsight
VIERNES 9 DE SEPTIEMBRE
8.30-8.45
DISCURSO DE BIENVENIDA Y COMENTARIOS DE APERTURA Don Diego 4
Presentado con interpretación simultánea español-inglés.
(Consulte la página 29 para ver información biográfica)
Mark J. Sculpher, MSc, PhD, Presidente de ISPOR 2011-2012, Profesor de Economía de la Salud, Centro de Economía de la Salud,
Universidad de York, y Asesor Ejecutivo, Oxford Outcomes Ltd., Heslington, York, Reino Unido
Dr. Antonio Caso Marasco, MEd, Co-Presidente del Comité del Programa, Profesor Posgraduado de Hematología y Coordinador del
Programa de Educación a Distancia, Subdivisión de Educación Médica Continua, División Posgrado de la Facultad de Medicina,
Universidad Nacional Autónoma de México, y Presidente del Colegio Mexicano de Farmacoeconomía, Ciudad de México, México
M. Sculpher
A. Marasco
G. Meléndez
Dr. Guillermo Meléndez, MSc, Co-Presidente del Comité del Programa y Coordinador Científico, Fondo Nestlé para la Nutrición,
Fundación Mexicana para la Salud (FUNSALUD), Ciudad de México, México
8.45-9.15 MENSAJE INAUGURAL Don Diego 4
Presentado con interpretación simultánea español-inglés.
Dr. José Ángel Córdova Villalobos, Secretario de Salud, Secretaría de Salud, Ciudad de México, México
J. Villalobos
13
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
PROGRAMA: VIERNES 9 DE SEPTIEMBRE
9.15-10.30
PRIMERA SESIÓN PLENARIA Don Diego 4
RETOS PARA LA COBERTURA UNIVERSAL FRENTE A LOS ALTOS COSTOS DE NUEVAS TECNOLOGIAS EN SALUD
Presentado con interpretación simultánea español-inglés.
(Consulte la página 29 para ver información biográfica)
Representantes de diversos países en América Latina presentarán las perspectivas de sus países con respecto a los altos costos de la evaluación de tecnología
en salud y de nuevos medicamentos, y su impacto en los presupuestos y en los objetivos de universalidad. Habrá una discusión sobre cómo lograr a la cobertura
universal, dado que los crecientes costos de medicamentos y los métodos de implementación del cuidado de la salud en estos países pueden suponer un
M. Escobar
obstáculo significativo para lograr este objetivo.
Moderadora: Dra. Maria-Luisa Escobar, MA, Gerente de la Práctica de Sistemas de Salud, Instituto del Banco Mundial, Washington,
DC, EE.UU.
Ponentes:
Dra. Mercedes Juan López, Presidenta Ejecutiva, Fundación Mexicana para la Salud (FUNSALUD), México D.F., México
Sr. Luis Romero Strooy, MBA, Superintendente de Salud, Superintendencia de Salud, Gobierno de Chile, Santiago, Chile
Dr. Guillermo Williams, Director, Dirección Nacional de Regulación Sanitaria y Calidad en Servicios de Salud, Ministerio de Salud de
la Nación, Buenos Aires, Argentina
10.30-11.00
M. Lopez
G. Williams
L. Strooy
RECESO, EXPOSICIONES Y REVISIÓN DE PÓSTERS DE INVESTIGACIÓN Don Diego 1 y vestíbulo
(Consulte la página 62-72 para ver las presentaciones de pósters de investigación)
Café patrocinado por GADIC, SA de CV
11.00-12.00
PRESENTACIONES DE INVESTIGACIÓN EN PODIO – SESIÓN I
Los números de páginas se refieren a la ubicación del resumen en este Programa y Agenda de Eventos
INVESTIGACIÓN DE RESULTADOS SOBRE TRASTORNOS CARDIOVASCULARES Presentado en español Don Americo
Moderador: Dr. J. Jaime Caro, MDCM, FRCPC, FACP, Vice-presidente Principal de Economía de la Salud, United BioSource Corporation, Lexington, MA, EE.UU.
pg 73 CV1 A COST-UTILITY ANALYSIS OF PROPHYLACTIC THERAPY FOR VENOUS THROMBOEMBOLISM WITH DABIGATRAN ETEXILATE OR ENOXAPARIN
11.00-11.15
Burbano-Levy X1, Herrán S1, Sánchez G1, Mieth K2, Alfonso-Cristancho R3, 1RANDOM Foundation, Bogotá, Colombia, 2Fundación Santa Fe de Bogotá - Banco de
Huesos y Tejidos de la Fundación Cosme y Damián, Bogotá, Colombia, 3University of Washington, Seattle, WA, USA
pg 73 CV2 COST-EFFECTIVENESS OF PRASUGREL VERSUS CLOPIDOGREL IN PATIENTS WITH ACUTE CORONARY SYNDROMES UNDERGOING PERCUTANEOUS
11.15-11.30 CORONARY INTERVENTION IN THE PRIVATE SECTOR IN MÉXICO
Mondragon R1, Arrieta-Maturino E2, Vargas-Valencia JJ3, Ramírez-Gámez J2, Martínez-Fonseca J2, Guzman-Sotelo M2, 1Hospital Central-Sur de Alta
Especialidad PEMEX, México D.F., México, 2Eli Lilly and Company, México D.F., México, 3Econopharma Consulting S. A. de C. V., México D.F., México
pg 73 CV3 ANÁLISIS DE COSTO EFECTIVIDAD EN EL CIERRE DE LA COMUNICACIÓN INTERATRIAL OSTIUM SECUNDUM: TÉCNICA PERCUTÁNEA VERSUS QUIRÚRGICA
11.30-11.45
Flores A1, Contreras I2, Alva E3, 1CMN 20 de Noviembre ISSSTE, México D.F., México, 2Instituto Mexicano del Seguro Social, México D.F., México, 3CMN SXXI,
México D.F., México
pg 73 CV4 COST-EFFECTIVENESS OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR IN PATIENTS WITH RISK FACTORS FOR SUDDEN DEATH IN ARGENTINA
11.45-12.00Alcaraz A1, Gonzalez Zuelgaray J2, Augustovski F1, 1Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina, 2PRONETAC, Buenos Aires,
Argentina
ESTUDIOS SOBRE GASTOS O REEMBOLSOS EN EL ÁREA DEL CUIDADO DE LA SALUD Presentado en español Don Diego 3
Moderador: Dr. Fernando Lopezmalo Bourlon, MSc, Director, Acesso al Mercado Global, LA, Merck Corporation, White House Station, NJ, EE.UU.
EX1 RETIRADO
11.00-11.15
pg 74 EX2 HEALTH CARE RESOURCE USE AMONG PATIENTS WITH BIPOLAR DISORDER FROM BRAZIL AND VENEZUELA: SUBGROUP ANALYSIS OF DATA FROM A
11.15-11.30 LARGE MULTINATIONAL LONGITUDINAL STUDY (WAVE-BD STUDY)
Vieta E1, Baptista T2, Bifano M3, Kerr-Corrêa F4, Grohs G5, de Oliveira I6, Vielma X7, Montes C8, Beluche S8, 1Bipolar Disorders Programme University of Barcelona,
Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain, 2Instituto Autónomo Universidad de Los Andes, Departmento de Fisiología, Facultad de Medicina
Universidad de Los Andes, Mérida, Venezuela, 3Humana Docencia, Instituto de Medicina Integral, Caracas, Venezuela, 4Universidade Estadual Paulista
(UNESP), Botucatu, Brazil, 5Instituto de Psiquiatria de Santa Catarina, Florianópolis, Brazil, 6Sanatório São Paulo, Salvador, Brazil, 7Hospital General Dr. Miguel
Pérez Carreño, Caracas, Venezuela, 8Medical Department, AstraZeneca Pharmaceuticals, Caracas, Venezuela
pg 74 EX3 INCREMENTAL COST OF IMPLEMENTING A CARE PROGRAM FOR PEOPLE WITH TYPE 2 DIABETES IN ARGENTINA
11.30-11.45Gonzalez L, Caporale JE, Elgart JF, Gagliardino JJ, CENEXA - Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET La Plata, Centro Colaborador
OPS/OMS), La Plata, Buenos Aires, Argentina
pg 74 EX4 EFECTIVIDAD DE LOS INDICADORES DE CALIDAD DE LA PRESCRIPCIÓN REGIONALES EN EL SNS ESPAÑOL
11.45-12.00
Garrido E1, Sabater FJ2, Hurtado P1, Espinós B1, Guarga L1, García Losa M2, Vieta A1, Badia X1, 1IMS Health HEOR, Barcelona, Spain, 2IMS Health HEOR, Madrid, Spain
EXAMINANDO EL QALY Presentado en español Don Diego 2
Moderador: Dr. Antonio Caso Marasco, MEd, Profesor Posgraduado de Hematología y Coordinador del Programa de Educación a Distancia, Subdivisión de Educación Médica
Continua, División Posgrado de la Facultad de Medicina, Universidad Nacional Autónoma de México, y Presidente del Colegio Mexicano de Farmacoeconomía, Ciudad de
México, México.
pg 74 QA1 MEASURING THE BENEFITS OF HEALTH CARE: DALYS AND QALYS – DOES THE CHOICE OF MEASURE MATTER? A CASE STUDY
11.00-11.15Colantonio L1, Augustovski F1, Galante J1, Bardach A1, Caporale J1, Zarate V2, Chuang LH3, Kind P2, 1IECS - Instituto de Efectividad Clinica y Sanitaria, Buenos
Aires, Argentina, 2University of York, York, UK, 3York Trials Unit, York, UK
14
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
PROGRAMA: VIERNES 9 DE SEPTIEMBRE
pg 75 QA2 ANÁLISIS DE COSTO-UTILIDAD DE RITUXIMAB POSTERIOR AL FALLO POR ANTI-TNF EN ARTRITIS REUMATOIDE PARA COLOMBIA
11.15-11.30Romero M1, Latorre M2, Alvarado C2, Karpf E1, Alvis N3, 1Fundación Salutia, Bogotá, Colombia, 2Productos Roche Colombia, Bogotá, Colombia, 3Universidad de
Cartagena, Cartagena de Indias, Bolívar, Colombia
pg 75 QA3 COSTO-EFECTIVIDAD DE DABIGATRAN VERSUS WARFARINA EN EL MANEJO DE LA FIBRILACION AURICULAR EN COLOMBIA
11.30-11.45Alfonso-Cristancho R1, Herran S2, Caicedo M2, Gomez E3, 1University of Washington, Seattle, WA, USA, 2RANDOM Foundation, Bogotá, DC, Colombia, 3Clinica
Shaio, Bogotá, Colombia
pg 75 QA4 COST-UTILITY OF SACRAL NEUROMODULATION VERSUS AUGMENTATION CYSTOPLASTY FOR TREATMENT OF REFRACTORY URGE INCONTINENCE IN MÉXICO
11.45-12.00
Oliva-Oropeza P1, Quiroz Angulo ME2, Marco Antonio AC3, 1Institute of Social and Security Services for State Workers, México D.F., México, 2Medtronic México,
México D.F., México, 3V&M Servicios de Consultoria S.C., México D.F., México
PATRONES DE TRATAMIENTO EN POLÍTICAS SANITARIAS TP1 presentado en inglés; TP2 y TP3 presentados en español; interpretación simultánea
Don Diego 4
Moderadora: Yajaira Bastardo, PhD, Directora Administrativa y Profesora, Facultad de Farmacia, Universidad Central de Venezuela, Caracas, Venezuela.
pg 75 TP1 PREVALENCE OF LIPID ABNORMALITIES BEFORE AND AFTER INTRODUCTION OF LIPID MODIFYING THERAPY AMONG MEXICAN PATIENTS
11.00-11.15Aguilar-Salinas CA1, Rivera MDR2, Perez J2, Limon F3, Diggle A3, Ambegaonkar BM4, 1Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran,
México City, DF, México, 2OMEESTADISTICOS, S.C., México D.F., México, 3MSD México, México D.F., México, 4Merck and Co., Inc., Whitehouse Station, NJ, USA
pg 76 TP2 PATRONES DE TRATAMIENTO DE LA LEUCEMIA MIELOIDE CRÓNICA (LMC) EN PACIENTES RESISTENTES O INTOLERANTES A IMATINIB EN INSTITUCIONES
11.15-11.30
DE SALUD PÚBLICA EN MÉXICO
Hernández-Rivera G1, Aguayo-González Á2, Cantu-Rodríguez OG3, Cervera E4, Gomez-Almaguer D3, Gutiérrez-Aguirre CH3, Lopez-Hernández M5, Martínez-Baños
D6, Oropeza P7, Rico E8, Juarez-Garcia A1, Vargas-Valencia J9, 1Bristol-Myers Squibb, México D.F., México, 2Instituto Nacional de Ciencias Médicas y Nutrición
Salvador, México D.F., México, 3Hospital Universitario Dr. José Eleuterio González, Monterrey, México, 4Instituto Nacional de Cancerología, México D.F.,
México, 5Centro Médico Nacional 20 de Noviembre ISSSTE, México City, DF, México, 6Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,
México D.F., México, 7Hospital General de Zona 8 IMSS, México D.F., México, 8Hospital General Regional 110 IMSS, Guadalajara, México, 9Econopharma
Consulting, México D.F., México
pg 76 TP3 PATRONES DE TRATAMIENTO Y COSTOS DE ATENCION EN PACIENTES CON ARTRITIS REUMATOIDE, DESDE LA PERSPECTIVA DEL PROVEEDOR DE
11.30-11.45 SERVICIOS DE SALUD EN MÉXICO
Contreras I1, Juarez-Garcia A2, Martinez-Rivera G2, Vallejos Parás A3, Ojeda Méndez J3, Villasis-Keever A2, Rangel S2, 1Instituto Mexicano del Seguro Social,
México D.F., México, 2Bristol-Myers Squibb, México D.F., México, 3Universidad Nacional Autónoma de México, México D.F., México
TP4 RETIRADO
11.45-12.00
INVESTIGACIÓN DE RESULTADOS SOBRE VACUNAS Presentado en español Don Genaro
Moderadora: Gabriela Tannus Araújo, MSc, MBA, Directora de Economía de la Salud, Axia.Bio Consulting, São Paulo, Brasil.
pg 76 VA1EVALUACION RÁPIDA DEL IMPACTO DE LA INTRODUCCIÓN DE LA VACUNA CONTRA EL ROTAVIRUS EN COLOMBIA
11.00-11.15Rico Mendoza FA1, Porras A1, Alvis N2, De La Hoz F1, Cediel N1, Del Rio F2, 1Universidad Nacional de Colombia, Bogotá, Colombia, 2Universidad de Cartagena,
Cartagena de Indias, Bolívar, Colombia
pg 76 VA2 COST EFFECTIVENESS ANALYSIS OF VACCINATION PROGRAMS WITH 10-VALENT (PCV10) AND 13-VALENT (PCV13) PNEUMOCOCCAL VACCINES IN BOGOTÁ,
11.15-11.30 COLOMBIA
Torres C1, Jaramillo J2, Coronell W3, Gutierrez MV4, Caceres HA4, 1Universidad del Bosque, Bogotá, Colombia, 2Hospital Universitario del Valle, Universidad del
Valle - Centro IMBANACO, Cali, Colombia, 3Universidad de Cartagena, Hospital Bocagrande, Cartagena, Colombia, 4Pfizer S.A., Bogotá, Colombia
pg 77 VA3 A COST-EFFECTIVENESS ANALYSIS OF A 10-VALENT PNEUMOCOCCAL CONJUGATE VACCINE IN CHILDREN IN SIX LATIN AMERICAN COUNTRIES
11.30-11.45García Martí S1, Colantonio L1, Bardach A1, Lopez A1, Caporale J1, Augustovski F1, Pichon Riviere A1, Knerer G2, Gomez JA3, 1Institute for Clinical Effectiveness
and Health Policy, Buenos Aires, Argentina, 2GlaxoSmithKline Biologicals, Wavre, Belgium, 3GlaxoSmithKline, Victoria, Buenos Aires, Argentina
pg 77 VA4 COSTO-EFECTIVIDAD DE LA VACUNA CONTRA EL VPH SUBTIPOS 16 Y 18 EN MÉXICO
11.45-12.00Muciño-Ortega E1, Valencia-Mendoza A1, Flores-Leonard Y2, Bertozzi Kenefick SM1, 1Instituto Nacional de Salud Pública, Cuernavaca, México, 2Instituto
Mexicano del Seguro Social, Cuernavaca, México
12.00-15.00
ALMUERZO, EXPOSICIONES Y REVISIÓN DE PÓSTERS DE INVESTIGACIÓN Don Diego 1 y vestíbulo
(Consulte las páginas 62-72 para ver las presentaciones de pósters de investigación)
REUNIONES ISPOR (SÓLO POR INVITACIÓN)
12.15-13.15 COMITÉ DE EDUCACIÓN DEL CONSORCIO ISPOR PARA AMÉRICA LATINA (SOLO POR INVITACIÓN) Don Emiliano (4º Piso)
13.45-14.45 COMITÉ DE PROVEEDORES DE LOS CUIDADOS DE LA SALUD DEL CONSORCIO ISPOR PARA AMÉRICA LATINA (SOLO POR INVITACIÓN)
12.30-13.30
Don Emiliano (4º Piso)
SIMPOSIO EDUCATIVO Don Diego 4
Presentado en inglés con interpretación simultánea al español.
ANÁLISIS DE ECONOMÍA DE LA SALUD EN AMÉRICA LATINA ¿SE PUEDEN APLICAR LAS LECCIONES APRENDIDAS EN OTRAS PARTES DEL MUNDO?
(Consulte la página 26 para ver una descripción del simposio)
Patrocinado por IMS Consulting Group
13.45-14.45
SIMPOSIO EDUCATIVO Don Diego 4
Presentado en inglés con interpretación simultánea al español.
MEDICAMENTOS DE ALTO COSTO: ¿AGREGAN VALOR A LOS SISTEMAS DE SALUD EN AMÉRICA LATINA? ¿CÓMO GARANTIZAR UN ACCESO ADECUADO?
(Consulte la página 27 para ver una descripción del simposio)
Patrocinado por Eli Lilly and Company
15
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
PROGRAMA: VIERNES 9 DE SEPTIEMBRE
15.00-16.00
MESAS REDONDAS Y TALLERES – SESIÓN I
(Consulte las páginas 21-24 para ver las descripciones de las mesas redondas y los talleres)
IP1: NIVEL DE INFLUENCIA DE LAS EVALUACIONES DE TECNOLOGÍAS SANITARIAS (HTA): ¿HASTA QUÉ PUNTO INFLUYEN LAS HTA EN LAS DECISIONES DE ACCESO AL
MERCADO EN DISTINTAS REGIONES GEOGRÁFICAS? Presentado en español Don Diego 2
Moderador: Dr. J. Jaime Caro, Doctor en Medicina y Magíster en Cirugía, FRCPC (Fellow of the Royal College of Physicians and Surgeons of Canada), FACP, Vicepresidente
Ejecutivo de Economía de la Salud, United BioSource Corporation, Lexington, MA, EE.UU.
Panelistas: Pablo Anaya, MSC, Gerente de Economía de la Salud e Investigación de Resultados, GlaxoSmithKline, México D.F., México. Dra. Iris Contreras, MSC,
Investigadora clínica, Instituto Mexicano del Seguro Social, México D.F., México; Joaquín Federico Mould-Quevedo, PhD, MBA, MSc, Director de Economía de la Salud e
Investigación de Resultados para América Latina y Atención Primaria, Pfizer Laboratories Inc., New York, NY, EE.UU.
W1: MÉTODOS PARA UN ANÁLISIS CRÍTICO DE LOS MODELOS DE COSTO-EFECTIVIDAD ENVIADOS A LAS AUTORIDADES DE REEMBOLSO: UN APRENDIZAJE A PARTIR
DE LA EXPERIENCIA INTERNACIONAL Presentado con interpretación simultánea español-inglés Don Diego 4
Líderes del debate: Mark J. Sculpher, PhD, Profesor de Economía de la Salud, Centro de Economía de la Salud, Universidad de York y Asesor Ejecutivo de Oxford Outcomes
Ltd., Heslington, York, Reino Unido. Dr. Federico Augustovski, MSC, PhD, Director del Departamento de Evaluación de Economía de la Salud y HTA, Hospital Italiano de
Buenos Aires, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina. Jorge Alberto Gómez, PhD, Gerente de Economía de la Salud, Biologics, Latinoamérica,
GlaxoSmithKline, Buenos Aires, Argentina. Clarice Petramale, PhD, Comisión de Incorporación de Tecnología Sanitaria - CITEC, Departamento de Ciencia, Tecnología y
Suministros Estratégicos, Ministerio de Salud, Brasilia, Brasil.
W3: USO DE DATOS DEL MUNDO REAL PARA LA INVESTIGACIÓN EN AMÉRICA LATINA Presentado en español Don Diego 3
Líderes del debate: Dr. Leonardo Tamariz, MPH, Profesor, Universidad de Miami, Miami, FL, EE.UU.; Dra. Ana Palacio, MPH, Profesora, Universidad de Miami, Miami, FL,
EE.UU. Dr. Alfredo Palacio, Decano de la Universidad de Especialidades Espíritu Santo, Guayaquil, Guayas, Ecuador.
16.00-16.15
RECESO, EXPOSICIONES Y REVISIÓN DE PÓSTERS DE INVESTIGACIÓN Don Diego 1 y vestíbulo
(Consulte las páginas 62-72 para ver las presentaciones de pósters de investigación)
Café patrocinado por Technical Language Service
16.15-17.15
MESAS REDONDAS Y TALLERES – SESIÓN II
(Consulte las páginas 21-24 para ver una descripción de las mesas redondas y los talleres)
IP2: ESQUEMAS DE RIESGO COMPARTIDO EN PAÍSES EMERGENTES: ¿CUÁLES SON LOS PASOS A SEGUIR PARA ALCANZAR EL ÉXITO? Presentado con interpretación
simultánea español-inglés Don Diego 4
Moderador: Lou Garrison, PhD, Profesor, Programa de Política e Investigación de Resultados Farmacéuticos, Facultad de de Farmacia, Universidad de Washington, Seattle,
WA, EE.UU.
Panelistas: Sean D. Sullivan, PhD, RPh, MSC, Profesor y Director, Programa de Políticas e Investigación de Resultados Farmacéuticos, Facultad de Farmacia, Universidad de
Washington, Seattle, WA, EE.UU. Dr. Diego Guarín, MPH, MA, Director, Acceso al Mercado Latinoamérica, Merck Sharp & Dohme, México D.F., México. Jianwei Xuan, PhD,
Director Ejecutivo y Líder de Equipo, Pfizer, New York, NY, EE.UU.
W4: PAUTAS PARA UNA SELECCIÓN ADECUADA DEL MÉTODO DE MODELACIÓN EN LA EVALUACIÓN FARMACOECONÓMICA EN AMÉRICA LATINA Presentado en español
Don Americo
Líderes del debate: Pablo Anaya, MSC, Gerente de Economía de la Salud e Investigación de Resultados, GlaxoSmithKline, México D.F., México. Dr. Guillermo Meléndez, MSC,
Coordinador Científico, Fondo Nestlé para la Nutrición, Fundación Mexicana para la Salud, México D.F., México. Joaquín Federico Mould-Quevedo, PhD, MBA, MSC, Director
de Economía de la Salud e Investigación de Resultados para América Latina y Atención Primaria, Pfizer, Laboratories Inc., New York, NY, EE.UU.
W5: EQ-5D: UNA PARTE FUNDAMENTAL DE LAS HERRAMIENTAS PARA LOS ENCARGADOS DE LA TOMA DE DECISIONES EN AMÉRICA LATINA Presentado en español
Don Diego 2
Líderes del debate: Paul Kind, Profesor, Centro de Economía de la Salud, Universidad de York, York, Reino Unido. Dr. Víctor Zárate, MSC, Estudiante del Doctorado en Filosofía,
Centro de Economía de la Salud, Universidad de York, York, Reino Unido. Fabiola Rosso, MSC, Investigadora, Departamento de Epidemiología, Ministerio de Salud, Santiago,
Chile. Catalina Gutiérrez, MSC, Investigadora, Departamento de Salud Pública, Universidad de Los Andes, Santiago, Chile.
W6: EVALUACIÓN DE TECNOLOGÍAS SANITARIAS EN CHILE: PASADO, PRESENTE Y FUTURO Presentado en español Don Diego 3
Líderes del debate: Dr. Manuel Antonio Espinoza, MSc, Académico, Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile; Marianela
Castillo, MSc, Economista de la Salud, Ministerio de Salud de Chile, Santiago, Chile; Dr. Luis Vera, MSc, Departamento de Calidad y Seguridad del Paciente, Ministerio de
Salud de Chile, Santiago, Chile
17.30-18.30
PRESENTACIONES DE INVESTIGACIÓN EN PODIO – SESIÓN II
Los números de páginas se refieren a la ubicación del resumen en este programa y agenda de eventos
INVESTIGACIÓN DE RESULTADOS SOBRE EL CÁNCER CN1 and CN3 presentado en inglés; CN2 y CN4 presentados en español; interpretación simultánea
Don Diego 4
Moderador: Dr. Rafael Alfonso, MSC, Programa de Políticas y la Investigación de Resultados Farmacéuticos, Universidad de Washington, Seattle, WA, EE.UU.
pg 78 CN1 COST-EFFECTIVENESS OF TRASTUZUMAB IN THE ADJUVANT TREATMENT OF EARLY BREAST CANCER IN SIX LATIN AMERICAN COUNTRIES
17.30-17.45Pichon-Riviere A1, Augustovski F1, Garay OU1, Buendia J2, Rodríguez A3, Vallejos C4, Huayanay L5, Oliveira C6, 1Institute for Clinical Effectiveness and Health
Policy, Buenos Aires, Argentina, 2Universidad de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina, 3Fondo Nacional de Recursos, Montevideo,
Uruguay, 4Universidad de La Frontera, Temuco, Chile, 5Universidad Peruana Cayetano Heredia, Lima, Peru, 6ANVISA, Brasilia, Brazil
pg 78 CN2 CANCER DE PULMON Y TABACO, ANALISIS DEL COSTO DE ATENCION MEDICA
17.45-18.00Quintana Carrillo R1, Arrieta Rodríguez O2, Zinser Sierra J2, Correa Acevedo M2, Mohar Betancurt A2, Reynales Shigematsu L3, 1Instituto Nacional de Salud
Pública, México D.F., México, 2Instituto Nacional de Cancerología, México D.F., México, 3Instituto Nacional de Salud Pública, Cuernavaca, México
pg 78 CN3 COST EFFECTIVENESS OF LIPOSOMAL DOXORUBICIN VERSUS PACLITAXEL FOR THE TREATMENT OF AIDS-KS
18.00-18.15Raimundo K1, Asche C2, 1University of Utah College of Pharmacy, Salt Lake City, UT, USA, 2Center for Health Outcomes Research, University of Illinois College of
Medicine and University of Utah College of Pharmacy, Salt Lake City, UT, USA
16
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
PROGRAMA: VIERNES 9 DE SEPTIEMBRE
pg 78 CN4 EVALUACION DE COSTOS DEL TRATAMIENTO DE PRIMERA LINEA PARA CANCER COLORRECTAL METASTASICO (MCRC) CON ESQUEMAS BASADOS EN:
18.15-18.30 FOLFIRI, FOLFOX O XELOX MAS BEVACIZUMAB, EN CINCO INSTITUCIONES MEXICANAS
Calderillo Ruiz G, Instituto Nacional de Cancerología, México D.F., México
INVESTIGACIÓN SOBRE SERVICIOS DEL CUIDADO DE LA SALUD Presentado en español Don Americo
Moderador: Dr. Sebastián García Martí, MSC, Evaluaciones Económicas y de Tecnologías Sanitarias, IECS (Instituto de Efectividad Clínica y Sanitaria), Buenos Aires,
Argentina.
pg 79 HS1 INTERCHANGEABILITY BETWEEN PNEUMOCOCCAL CONJUGATE VACCINES AND SCHEMES
17.30-17.45Ciapponi A, García Martí S, Rey-Ares L, Glujovsky D, Bardach A, Valanzasca P, Lee A, Cafferata ML, Institute for Clinical Effectiveness and Health Policy,
Buenos Aires, Argentina
pg 79 HS2 ANALISIS DE COSTOS DEL PROGRAMA AMPLIADO DE INMUNIZACIONES EN COLOMBIA 2009
17.45-18.00Romero M1, Arango C1, Chavez D1, Otero J1, Alvis N2, 1Fundación Salutia, Bogotá, Colombia, 2Universidad de Cartagena, Cartagena de Indias, Bolívar, Colombia
pg 79 HS3 THE ECONOMIC BURDEN OF ROAD TRAFFIC INJURIES ON HEALTH SYSTEM AND SOCIETY IN BELIZE
18.00-18.15Heredia Pi IB1, Pérez Núñez R1, Hijar Medina M1, Jones S2, Silveira Rodrigues EM3, 1National Institute of Public Health, Cuernavaca, México, 2Pan American
Health Organization/World Health Organization, Trinidad and Tobago, 3Pan American Health Organization/World Health Organization, Washington, DC, USA
pg 79 HS4 IMPACTO ECONOMICO EN LA ATENCION MEDICA DE ENFERMEDADES ASOCIADAS AL TABAQUISMO EN UNA POBLACION MEXICANA
18.15-18.30Pérez Zincer F1, Quintana Carrillo R2, Barrios Nanni R1, Chagoya Bello J1, Ramos Reyna E1, Reynales Shigematsu L3, 1Hospital Central Militar, México D.F.,México,
2
Instituto Nacional de Salud Pública, México D.F., México, 3Instituto Nacional de Salud Pública, Cuernavaca, México
INVESTIGACIÓN DE RESULTADOS SOBRE INFECCIONES IN1, IN3, IN4 presentado en español; IN2 presentado en inglés Don Diego 2
Moderador: Dr. Carlos Izquierdo, MSc, Economista de Salud y Gerente de Farmacoeconomía, Janssen Colombia, Bogotá, Colombia.
pg 80 IN1 EVALUACION DE COSTO-EFECTIVIDAD CON EL USO DE LINEZOLID PARA EL TRATAMIENTO DE INFECCIONES COMPLICADAS DE PIEL Y TEJIDOS BLANDOS
17.30-17.45Vargas-Valencia JJ1, Sotelo-Guzmán M1, Díaz-Ponce H2, Galindo-Suárez RM2, Muciño-Ortega E2, Mould-Quevedo J3, 1Econopharma Consulting S.A. de C.V.,
México D.F., México, 2Pfizer S.A. de C.V., México D.F., México, 3Pfizer, New York, NY, USA
pg 80 IN2 CHRONIC HEPATITIS C TREATMENT FOR GENOTYPE 2 OR 3: COST-EFFECTIVENESS ANALYSIS OF PEG AS FIRST LINE TREATMENT WITH THE BRAZILIAN
17.45-18.00 PROTOCOL
Blatt CR1, Storb BH1, Mühlberger N2, Wurm J2, Farias MR1, Siebert U2, 1Universidade Federal de Santa Catarina / UNISUL /UMIT, Florianopolis, Santa Catarina,
Brazil, 2UMIT - University for Health Sciences, Medical Informatics and Technology / ONCOTYROL, Hall i. T., Tirol, Austria
pg 80 IN3 DENGUE MÁS QUE UN PROBLEMA DE SALUD PÚBLICA: ESTIMACIÓN DE LOS COSTOS DIRECTOS DE LA EPIDEMIA DEL AÑO 2010 EN COLOMBIA
18.00-18.15Bello SL1, Díaz E2, Malagon JN2, Romero M2, Salazar V2, 1Instituto Nacional de Salud de Colombia, Bogotá, DC, Colombia, 2Fundación Salutia, Bogotá, DC,
Colombia
pg 80 IN4 MORBIDITY AND MORTALITY OF COMMUNITY ACQUIRED PNEUMONIA IN ADULTS IN SIX COUNTRIES IN LATIN AMERICA
18.15-18.30Rosado-Buzzo A1, Garcia-Mollinedo L1, Camacho-Cordero L1, Roberts CS2, Mould-Quevedo JF2, Trejo-Martinez A1, Luna-Casas G1, 1Links & Links S.A, de C.V.,
México D.F., México, 2Pfizer Inc, New York, NY, USA
INVESTIGACIÓN DE RESULTADOS REPORTADOS POR PACIENTES Presentado en español Don Genaro
Moderador: Dr. Marcos Bosi Ferraz, PhD, Profesor y Director, Centro Paulista de Economía de la Salud (CPES), Universidad Federal de São Paulo, Director, Economía Médica,
Asociación Brasilera de Medicina y Director de Relaciones Institucionales, Fleury Group São Paulo, São Paulo, Brasil.
pg 81 PR1 RESPONSIVENESS OF THE COPD ASSESSMENT TEST (CAT) QUESTIONNAIRE DURING EXACERBATIONS OF COPD
17.30-17.45Agusti A1, Soler JJ2, Molina J3, Muñoz MJ4, Garcia-Losa M5, Roset M6, Jones PW7, Badia X6, 11 Hospital Clínic IDIBAPS, Barcelona & CIBER Enfermedades
Respiratorias (Spain), Barcelona, Spain, 2Hospital de Requena, Requena (Valencia), Spain, 3Centro de Salud Francia, Madrid, Spain, 4GlaxoSmithKline SA, Tres
Cantos (Madrid), Spain, 5IMS Health, Madrid, Spain, 6IMS Health, Barcelona, Spain, 7St George’s, University of London, London, UK
pg 81 PR2 THE BEAUTY OF MAPPING: NEED THE MEAN HEALTH-RELATED QUALITY OF LIFE SCORE FOR A GROUP OF HIP PATIENTS AND DON’T HAVE EQ-5D? JUST USE
17.45-18.00 THE OXFORD HIP SCORE!
Pinedo Villanueva RA1, Turner D1, Judge A2, Raftery JP1, Arden NK2, 1University of Southampton, Southampton, Hampshire, UK, 2University of Oxford, Oxford,
Oxfordshire, UK
pg 81 PR3 PRIMARY HEALTH CARE EVALUATION IN CHILE: PATIENTS’ PERSPECTIVE
18.00-18.15Leisewitz T1, Nogueira L2, Peñaloza B1, Bastías G1, Villarroel L1, 1Pontificia Universidad Católica de Chile, Santiago, RM, Chile, 2Harvard University, Boston, MA,
USA
pg 81 PR4 CALIDAD DE VIDA Y VICTIMIZACION EN ADOLESCENTES ESTUDIANTES DE MÉXICO
18.15-18.30Hidalgo CA, Jiménez G, 1Universidad de Guadalajara, Jalisco, México
INVESTIGACIÓN SOBRE MÉTODOS Presentado en español Don Diego 3
Moderadora: Edith Arely Lemus, MSc, Gerente de Economia de la Salud, Novartis Pharma Mexico, México D.F., México.
pg 81 RM1 COMPARING THE USE OF DYNAMIC AND STATIC INFECTIOUS DISEASE MODELS IN LATIN AMERICA WITH NORTH AMERICA, EUROPE, ASIA AND OTHER
17.30-17.45 REGIONS
Vargas-Palacios A1, Stevenson M1, Dueñas A2, Wailloo A1, 1The University of Sheffield, Sheffield, South Yorkshire, UK, 2IÉSEG School of Management - LilleParis, Paris, France
pg 82 RM2 APLICACION DE MODELOS DE REGRESION CON STATA PARA EL ESTUDIO DEL CONSUMO DE RECURSOS EN UNIDADES DE CUIDADOS INTENSIVOS
17.45-18.00 NEONATALES
Reyes-Lopez A, Hospital Infantil de México Federico Gómez, México D.F., México
pg 82 RM3 A COMPARISON BETWEEN MARKOV CHAINS AND SYSTEM DYNAMICS MODELING FOR THE ESTIMATION OF METABOLIC SYNDROME COSTS IN A PUBLIC
18.00-18.15 HEALTH CARE DELIVERY ORGANIZATION IN MÉXICO
Olmedo-Bustillo C, Oliva-Oropeza P, Rivas-Oropeza I, Aranzeta-Ojeda F, Institute of Social and Security Services for State Workers, México D.F., México
17
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
PROGRAMA: VIERNES 9 DE SEPTIEMBRE Y SÁBADO 10 DE SEPTIEMBRE
pg 82 RM4 FACTORES PREDICTORES DE OBSTRUCCIONES CORONARIAS SIGNIFICATIVAS EN PACIENTES ADULTOS CON CINEANGIOCORONARIOGRAFÍAS REALIZADAS
18.15-18.30 EN URUGUAY, FINANCIADAS POR EL FONDO NACIONAL DE RECURSOS
Morales M, Perna A, Fernández G, Lombide I, Fondo Nacional de Recursos, Montevideo, Uruguay
18.30-19.30
HORA DE DISCUSIÓN CON LOS AUTORES DE LOS PÓSTERS DE INVESTIGACIÓN Don Diego 1
(Consulte las páginas 62-72 para ver las presentaciones de los pósters de investigación)
18.30-20.00
RECEPCIÓN DE EXPOSITORES Y REVISIÓN DE PÓSTERS DE INVESTIGACIÓN Don Diego 1 y vestíbulo
(Consulte las páginas 62-72 para ver las presentaciones de los pósters de investigación)
19.30-21.00
SIMPOSIO EDUCATIVO Don Diego 4
Presentado en inglés y español con interpretación simultánea.
ACTUALIZACIÓN DEL ESTADO DEL ENTORNO DE REEMBOLSO EN AMÉRICA LATINA
(Consulte la página 27 para ver una descripción del simposio)
Patrocinado por Millcreek Outcomes Group
19.45-21.45
REUNIONES ISPOR (Sólo por inivitación)
COMITÉ ASESOR DEL CONSORCIO ISPOR PARA AMÉRICA LATINA (SOLO POR INVITACIÓN) Don Genaro
SÁBADO 10 DE SEPTIEMBRE DE 2011
7.45-8.45
SIMPOSIO EDUCATIVO Don Diego 4
Presentado en inglés y español con interpretación simultánea.
FÁRMACOS BIOLÓGICOS Y BIOSIMILARES EN AMÉRICA LATINA: DESAFÍOS DE LOS FONDOS PARA CONTRIBUYENTES Y DESARROLLADORES
(Consulte la página 28 para ver una descripción del simposios)
Patrocinado por Pfizer
7.45-8.45
REUNIONES ISPOR (Sólo por inivitación)
COMITÉ DE ENCARGADOS DE LA POLÍTICA DE LA SALUD Y LOS CONTRIBUYENTES DEL CONSORCIO ISPOR PARA AMERICA LATINA (SOLO POR INVITACIÓN) Don Genaro
8.00-9.00
EXPOSICIONES Y REVISIÓN DE PÓSTERS DE INVESTIGACIÓN Don Diego 1 y vestíbulo
(Consulte las páginas 62-72 para ver las presentaciones de los pósters de investigación)
9.00-10.30
BIENVENIDA, PRESENTACIÓN DE LOS PREMIOS ISPOR PARA LA EXCELENCIA EN EL SERVICIO Y SEGUNDA SESIÓN PLENARIA
Presentado con interpretación simultanea español-inglés. Don Diego 4
BIENVENIDA Y PRESENTACIÓN DE LOS PREMIOS ISPOR PARA LA EXCELENCIA EN EL SERVICIO
(Consulte la página 29 para ver información biográfica)
Presentado por: Mark J. Sculpher, MSc, PhD, Presidente de ISPOR 2011-2012, Profesor de Economía de la Salud, Centro de Economía de la Salud, Universidad de
York, y Asesor Ejecutivo, Oxford Outcomes Ltd., Heslington, York, Reino Unido
Premiados:
Dr. Antonio Caso Marasco, MEd, Co-Presidente del Comité del Programa, Profesor Posgraduado de Hematología y Coordinador del Programa de
Educación a Distancia, Subdivision de Educación Médica Continua, División Posgrado de la Facultad de Medicina, Universidad Nacional Autónoma
de México, y Presidente del Colegio Mexicano de Farmacoeconomía, Ciudad de México, México
M. Sculpher
Dr. Guillermo Meléndez, MSc, Co-Presidente del Comité del Programa y Coordinador Científico, Fondo Nestlé para la Nutrición, Fundación
Mexicana para la Salud (FUNSALUD), Ciudad de México, México
A. Marasco
G. Meléndez
¿CUAL ES EL VALOR DE LA INVESTIGACION DE RESULTADOS PARA LOS TOMADORES DE DECISIONES?: UNA DISCUSION FRANCA ENTRE TOMADORES DE DECISIONES EN
INSTITUCIONES PÚBLICAS
Presentado con interpretación simultanea español-inglés.
(Consulte la página 29 para ver información biográfica)
A pesar del gran crecimiento a lo largo de los últimos años, nuestro campo no ha logrado el impacto esperado en las decisiones sobre tecnología sanitaria en
América Latina. Un panel de los encargados de la toma de decisiones en el ámbito de la salud, provenientes de las instituciones más importantes de diversos
países, dará su punto de vista sobre la validez de las investigaciones de resultados en la salud, incluyendo dónde y cómo se utilizan los resultados de las
investigaciones para tomar decisiones sobre la cobertura. Los panelistas también brindarán recomendaciones sobre el uso de la investigación de resultados
para la salud en la toma de decisiones reales.
Moderador: Dr. J. Jaime Caro, MDCM, FRCPC, FACP, Profesor Adjunto de Medicina, Profesor Adjunto de Epidemiología y Bioestadística, McGill University,
Montreal PQ y Vice-presidente Principal de Economía de la Salud, United BioSource Corporation, Lexington, MA, EE. UU.
Ponentes:
Dr. Juan Garduño Espinosa, Subdirector de Gestión de Investigación, Dirección de Investigación, Hospital Infantil de México “Federico
Gómez”, México D.F., México
Lic. Tomás Pippo Briant, MA, MPH, Director de Economía de la Salud del Ministerio de Salud, Buenos Aires, Argentina
Dr. Alarico Rodríguez de León, Gerente de Beneficios Médicos, Fondo Nacional de Recursos, Montevideo, Uruguay
J. Garduño
18
T. Pippo
J. Caro
A. Rodríguez
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
PROGRAMA: SÁBADO 10 DE SEPTIEMBRE
10.30-11.00
RECESO, EXPOSICIONES Y REVISIÓN DE PÓSTERS DE INVESTIGACIÓN Don Diego 1 y vestíbulo
(Consulte las páginas 62-72 para ver las presentaciones de los pósters de investigación)
11.00-12.00
MESAS REDONDAS Y TALLERES – SESIÓN III
(Consulte las páginas 21-24 para ver las descripciones de las mesas redondas y los talleres)
IP3: EL PAPEL DE LAS AGENCIAS DE EVALUACIÓN DE TECNOLOGÍAS EN AMÉRICA LATINA Presentado en español Don Diego 2
Moderadora: Dra. Iris Contreras, MSc, Investigadora Clínica, Instituto Mexicano del Seguro Social, Mexico D.F., Mexico
Panelistas: Alexandre Lemgruber, MSc, Asesor, Administración de Tecnologías Sanitarias, Organización Panamericana de la Salud (OPS), Washington, D.C., EE.UU. Dr. Luis
Vera, MSc, Asesor Profesional, Evaluación de Tecnologías Sanitarias, Departamento de Calidad y Seguridad del Paciente, Ministerio de Salud, Santiago, Chile. Dr. Esteban
Hernandez-San Roman, Director, Evaluación de Tecnologías de Salud, Centro Nacional de Excelencia Tecnológica en Salud, México D.F., México.
W7: EL ROL DE LA EVIDENCIA DE LA ECONOMÍA DE LA SALUD Y LA INVESTIGACIÓN DE RESULTADOS (HEOR) EN LAS DECISIONES SOBRE VADEMÉCUM Y
REEMBOLSOS EN AMÉRICA LATINA VERSUS LOS ESTADOS UNIDOS Presentado con interpretación simultánea español-inglés Don Diego 4
Líderes del debate: Anke-Peggy Holtorf, PhD, MBA, Profesor Adjunto, Centro de Investigación de Resultados en Farmacoterapia, Universidad de Utah, Salt Lake City, UT,
EE.UU. Gary Oderda, Doctor en Farmacia, MPH, Profesor y Director, Departamento de Farmacoterapia, Facultad de Farmacia, Universidad de Utah, Salt Lake City, UT, EE.UU.
Dr. Federico Augustovski, MD, MSc, PhD, Director, Departamento de Evaluaciones Económicas y HTA, Instituto de Efectividad Clínica y Sanitaria (IECS), Hospital Italiano de
Buenos Aires, Buenos Aires, Argentina. Dr. Abdulkadir Keskinaslan, MBA, MPH, Director, Precios de Mercado, Países de Asia Pacífico, Medio Oriente y África, Global Pricing
& Market Access, Novartis Pharma AG, Basilea, Suiza.
W8: MÉTODOS PARA COMPARACIONES DE TRATAMIENTOS INDIRECTOS Y MIXTOS: HERRAMIENTAS PARA LA EVALUACIÓN DE TECNOLOGÍAS SANITARIAS EN AUSENCIA
DE EVIDENCIA DIRECTA Presentado en español Don Americo
Líderes del debate: Dr. Rafael Alfonso-Cristancho, MSC, Asociado de Investigación, Escuela de Farmacia, Programa de Investigación de Resultados Farmacéuticos y
Políticas, Universidad de Washington, Seattle, WA, EE.UU. Beth Devine, Doctora en Filosofía, Doctora en Farmacia, MBA, Profesora Adjunta, Universidad de Washington,
Seattle, WA, EE.UU. Dra. Ximena Burbano-Levy, Directora de Proyecto, Facultad de Ciencias Integradas y Humanidades, Miami, FL, EE.UU.
W9: MÉTODOS INNOVADORES PARA MEJORAR LA ADHESIÓN A UN MEDICAMENTO Presentado en español Don Diego 3
Líderes del debate: Dra. Ana Palacio, MPH, Profesora de la Universidad de Miami, Miami, FL, EE.UU. Dr. Leonardo Tamariz, MPH, Profesor de la Universidad de Miami, Miami,
FL, EE.UU. Dr. Alfredo Palacio, Decano de la Universidad de Especialidades Espíritu Santo, Guayaquil, Guayas, Ecuador.
12.15-13.15
MESAS REDONDAS Y TALLERES – SESIÓN IV
(Consulte las páginas 21-24 para ver las descripciones de las mesas redondas y los talleres)
IP4: EL COSTO DE LOS TRASTORNOS DEL ESTADO DE ÁNIMO: ¿QUÉ ASPECTO GENERA EL MAYOR GASTO PARA LOS SISTEMAS DE SALUD? ¿QUÉ GENERA LA ALTA
DISCAPACIDAD ASOCIADA? UNA PERSPECTIVA SOCIAL, ECONÓMICA Y GLOBAL Presentado en español Don Diego 3
Moderadora: Dra. Claudia Becerra-Palars, MSc, Coordinadora Clínica de Trastornos del Afecto, Instituto Nacional de Psiquiatria, “Ramón de la Fuente”, México D.F., México
Panelistas: Dr. Mauricio Palma, MSc, Estudiente de Psiquiatría, Secretaria de Salud, Instituto Nacional de Psiquiatría, México D.F., México; Dr. Jeremy Cruz, Universidad
Nacional Autónoma de México/INP, México D.F., México; Dra. Ingrid Vargas, MSc, Investigadora, Académica, Departamento de Psiquiatría y Salud Mental, Universidad
Nacional Autónoma de México, México D.F., México.
W10: FALTA DE DATOS LOCALES SOBRE EFECTIVIDAD, COSTO Y EPIDEMIOLOGÍA; ¿CUÁLES SON LAS OPCIONES PARA REALIZAR ESTUDIOS DE FARMACOECONOMÍA EN
AMÉRICA LATINA? Presentado en español Don Diego 2
Líderes del debate: Dr. J. Jaime Caro, Doctor en Medicina y Magíster en Cirugía, FRCPC (Fellow of the Royal College of Physicians and Surgeons of Canada), FACP,
Vicepresidente Ejecutivo de Economía de la Salud, United BioSource Corporation, Lexington, MA, EE.UU. Dr. Rafael Alfonso-Cristancho, MSC, Asociado de Investigación,
Escuela de Farmacia, Programa de Investigación de Resultados Farmacéuticos y Políticas, Universidad de Washington, Seattle, WA, EE.UU. Dra. Ximena Burbano-Levy,
Directora de Proyecto, Facultad de Ciencias Integradas y Humanidades, Universidad Internacional de Florida, Miami, FL, EE.UU. Rosa María Galindo-Suárez, MSC, Gerente de
Investigación de Resultados, Pfizer, México D.F., México.
W12: EL FUTURO DE LOS CONTROLES DE COSTOS FARMACÉUTICOS EN AMÉRICA LATINA: ¿HTA O PRECIOS DE REFERENCIA? Presentado con interpretación simultánea
español-inglés Don Diego 4
Líderes del debate: Monica Martin de Bustamante, AB, Becaria, Acceso al Mercado Global, Insight Strategy Advisors, New York City, NY, EE.UU. Cyrus A. Chowdhury, MSC,
Vicepresidente, Acceso al Mercado Global, Insight Strategy Advisors, New York, NY, EE.UU.
13.30-13.45
ENTREGA DE LOS PREMIOS ISPOR PARA LAS PRESENTACIONES DE INVESTIGACIÓN Y CIERRE Don Diego 4
Presentado con interpretación simultánea español-inglés.
Moderado por: Dr. Antonio Caso Marasco, MEd, Co-Presidente del Comité del Programa, Profesor Posgraduado de Hematología y Coordinador del Programa de
Educación a Distancia, Subdivisión de Educación Médica Continua, División Posgrado de la Facultad de Medicina, Universidad Nacional Autónoma de México, y
Presidente del Colegio Mexicano de Farmacoeconomía, Ciudad de México, México
PREMIOS ISPOR PARA LAS PRESENTACIONES DE INVESTIGACIÓN
Presentados por:
Dra. Iris Contreras, MSc, Investigadora Clínica, Instituto Mexicano del Seguro Social, Ciudad de México, México
Joaquín Federico Mould-Quevedo, PhD, MSc, MBA, Director de Economía de la Salud e Investigación de Resultados para América Latina y Productos de
Atención Primaria, Pfizer Inc., New York, NY, EE.UU.
CIERRE
Dr. Guillermo Meléndez, MSc, Co-Presidente del Comité del Programa y Coordinador Científico, Fondo Nestlé para la Nutrición, Fundación Mexicana para la
Salud (FUNSALUD), Ciudad de México, México
A. Marasco
G. Melendez
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3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
PATROCINADORES DE LA CONFERENCIA
PATROCINADOR CORPORATIVO
Janssen
PATROCINADORES DE EVENTOS
Bayer de Mexico SA de CV
OptumInsight
GADIC SA de CV
Technical Language Service
Kantar Health
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3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
MESAS REDONDAS Y TALLERES
MESAS REDONDAS Y TALLERES - SESIÓN I
VIERNES 9 DE SEPTIEMBRE DE 2011: 15.00-16.00
IP1: NIVEL DE INFLUENCIA DE LAS EVALUACIONES DE TECNOLOGÍAS SANITARIAS
(HTA): ¿HASTA QUÉ PUNTO INFLUYEN LAS HTA EN LAS DECISIONES DE ACCESO
AL MERCADO EN DISTINTAS REGIONES GEOGRÁFICAS? Presentado en español
Don Diego 2
Moderador: Dr. J. Jaime Caro, Doctor en Medicina y Magíster en Cirugía, FRCPC
(Fellow of the Royal College of Physicians and Surgeons of Canada), FACP,
Vicepresidente Ejecutivo de Economía de la Salud, United BioSource Corporation,
Lexington, MA, EE.UU.
Panelistas: Pablo Anaya, MSC, Gerente de Economía de la Salud e Investigación
de Resultados, GlaxoSmithKline, México D.F., México. Dra. Iris Contreras, MSC,
Investigadora clínica, Instituto Mexicano del Seguro Social, México D.F., México;
Joaquín Federico Mould-Quevedo, PhD, MBA, MSc, Director de Economía de la
Salud e Investigación de Resultados para América Latina y Atención Primaria, Pfizer
Laboratories Inc., New York, NY, EE.UU.
TEMA: A lo largo y a lo ancho de América Latina, algunos sistemas de cuidado de
la salud han recurrido a la evaluación de tecnologías sanitarias para obtener una
mayor rentabilidad. Esta necesidad que tienen los sistemas del cuidado de la salud
de gastar moderadamente se vuelve aún más apremiante a la luz de la situación
económica actual. Las autoridades de las instituciones del cuidado de la salud se
encuentran bajo una tremenda presión para mantenerse dentro de (o reducir) sus
presupuestos. Pueden utilizar diversas medidas para ahorrar costos, incluyendo la
adopción de los resultados de las HTA de otros países o regiones.
DESCRIPCIÓN GENERAL: En este entorno actual, en el cual es fundamental
mantener la rentabilidad y reducir costos, el moderador interrogará a los
panelistas acerca de cuánto influyen las HTA sobre las decisiones de acceso en
otros mercados, si se trata de algo inteligente o problemático y cómo esto puede
impactar sobre el acceso de los pacientes. Los puntos específicos del debate
incluirán: ¿Cuáles HTAs pueden tener mayor influencia y por qué? ¿Hasta qué
punto sus evaluaciones tendrán influencia en otros mercados? ¿Qué países o
regiones tienen mayores probabilidades de recurrir a una evaluación externa de
HTA? ¿Cuáles son los desafíos que presenta este tipo de “influencia”? ¿Qué papel
jugarán en el futuro las iniciativas regionales como la red HTA para América Latina
patrocinada por la OPS? Durante los últimos 20 minutos, se instará a los integrantes
del público a compartir sus opiniones sobre las preguntas planteadas y hacer sus
propias preguntas al panel.
W1: MÉTODOS PARA UN ANÁLISIS CRÍTICO DE LOS MODELOS DE COSTOEFECTIVIDAD ENVIADOS A LAS AUTORIDADES DE REEMBOLSO: UN APRENDIZAJE
A PARTIR DE LA EXPERIENCIA INTERNACIONAL Presentado con interpretación
simultánea Don Diego 4
Líderes del debate: Mark J. Sculpher, PhD, Profesor de Economía de la Salud,
Centro de Economía de la Salud, University of York y Asesor Ejecutivo de Oxford
Outcomes Ltd., Heslington, York, Reino Unido. Dr. Federico Augustovski, MSC, PhD,
Director del Departamento de Evaluación de Economía de la Salud y HTA, Hospital
Italiano de Buenos Aires, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires,
Argentina. Jorge Alberto Gómez, PhD, Gerente de Economía de la Salud, Biologics,
Latinoamérica, GlaxoSmithKline, Buenos Aires, Argentina. Clarice Petramale, PhD,
Comisión de Incorporación de Tecnología Sanitaria - CITEC, Departamento de
Ciencia, Tecnología y Suministros Estratégicos, Ministerio de Salud, Brasilia, Brasil.
OBJETIVO: Explorar los métodos actuales y la experiencia de los métodos de
evaluación crítica y ‘destrucción del modelo’ desde las perspectivas alternativas
internacionales, con ponentes que tienen una vasta experiencia en el campo
de la modelación y en trabajar con agencias de reembolso, tanto en los países
desarrollados como en la región de América Latina.
DESCRIPCIÓN: El uso de la modelación analítica para la toma de decisiones es
considerado cada vez más importante para el proceso general de la HTA y su papel
es fundamental para la toma de decisiones informadas sobre el reembolso de las
tecnologías sanitarias. Ahora es muy común que un modelo de decisión sea una
parte central de los manuales para la presentación de evidencia que se envían a
las agencias de reembolso y que sirven para sintetizar los datos de diversas fuentes
y facilitar la toma de decisiones específicas para un contexto determinado. El
creciente énfasis en el modelo de decisión como el vehículo principal de evaluación
ha generado el desarrollo de varias normas de “buenas prácticas” de modelación
y listas de verificación, tanto por parte de las agencias de reembolso individuales
como de grupos académicos. No obstante, a medida que los modelos de decisión
se vuelven más complejos y sofisticados, los métodos de evaluación crítica se han
ampliado en diversas jurisdicciones para incluir la revisión del modelo electrónico
en sí mismo. Esta ampliación de las tareas de evaluación crítica trae aparejada una
necesidad de considerar métodos alternativos a la ‘destrucción del modelo’ y de
aprender a partir de la experiencia existente a la hora de emprender dichas tareas.
W3: USO DE DATOS DEL MUNDO REAL PARA LA INVESTIGACIÓN EN AMÉRICA
LATINA Presentado en español Don Diego 3
Líderes del debate: Dr. Leonardo Tamariz, MPH, Profesor, Universidad de Miami,
Miami, FL, EE.UU.; Dra. Ana Palacio, MPH, Profesora, Universidad de Miami, Miami,
FL, EE.UU. Dr. Alfredo Palacio, Decano de la Universidad de Especialidades Espíritu
Santo, Guayaquil, Guayas, Ecuador
OBJETIVO: El objetivo de esta propuesta es debatir sobre las ventajas y desventajas
de utilizar los datos de los reclamos administrativos para la investigación, identificar
oportunidades para utilizar los datos de los reclamos en América Latina y debatir
sobre la experiencia de la Universidad de Miami usando conjuntos de datos sobre
seguros médicos.
DESCRIPCIÓN: El uso de bases de datos de reclamos para analizar la efectividad
comparativa se ha ampliado en los últimos años. Un motivo de la creciente
popularidad de las bases de datos de reclamos públicos y privados es la
creencia de que es importante usar la efectividad comparativa de los fármacos,
dispositivos y procedimientos médicos en la medicina actual, usando una población
representativa grande y a escala nacional. Una ventaja importante de los conjuntos
de datos de reclamos es su gran población, lo cual brinda una fuerza estadística
suficiente para detectar resultados infrecuentes y permitir la comparación entre
diferentes grupos etáreos y de raza/etnia. Además, los datos de los reclamos a
menudo contienen un registro de varios años sobre la utilización, los diagnósticos,
procedimientos y prescripciones en una amplia variedad de escenarios mundiales
de atención de la salud, lo cual permite realizar un análisis longitudinal. También
permite realizar estudios de cohorte sin los altos costos que implica la recolección
primaria de datos. Al mismo tiempo, los conjuntos de datos sobre reclamos tienen
algunas desventajas. Durante este taller, los presentadores harán lo siguiente:
primero, los presentadores debatirán sobre las ventajas y desventajas del uso de
reclamos administrativos y otros conjuntos de datos de fácil acceso (10 minutos).
Luego, la audiencia se dividirá en grupos pequeños e identificarán los conjuntos de
datos administrativos usados en América Latina, debatiendo específicamente sobre
el tipo de datos recolectados (15 minutos). En tercer lugar, la audiencia compartirá
la discusión que ha surgido en los grupos pequeños (15 minutos). Por último, los
presentadores hablarán sobre su experiencia en la utilización de datos de reclamos
administrativos. Debatiremos con la audiencia acerca del uso de datos sobre los
beneficios médicos de una empresa, sobre los conjuntos de datos nacionales y
locales sobre farmacoepidemiología y sobre la investigación de resultados. El
debate incluirá cuestiones como la validez, tendencias de selección y métodos de
corrección.
MESAS REDONDAS Y TALLERES - SESIÓN II
VIERNES 9 DE SEPTIEMBRE DE 2011: 16.15-17.15
IP2: ESQUEMAS DE RIESGO COMPARTIDO EN PAÍSES EMERGENTES: ¿CUÁLES
SON LOS PASOS A SEGUIR PARA ALCANZAR EL ÉXITO?
Presentado con interpretación simultánea Don Diego 4
Moderador: Lou Garrison, PhD, Profesor, Programa de Política e Investigación de
Resultados Farmacéuticos, Facultad de de Farmacia, Universidad de Washington,
Seattle, WA, EE.UU.
Panelistas: Sean D. Sullivan, PhD, RPh, MSC, Profesor y Director, Programa de
Políticas e Investigación de Resultados Farmacéuticos, Facultad de Farmacia,
Universidad de Washington, Seattle, WA, EE.UU. Dr. Diego Guarín, MPH, MA,
Director, Acceso al Mercado Latinoamérica, Merck Sharp & Dohme, México D.F.,
México. Jianwei Xuan, PhD, Director Ejecutivo y Líder de Equipo, Pfizer, New York,
NY, EE.UU.
TEMA: Los métodos novedosos de reembolso farmacéutico se están volviendo
cada vez más comunes dentro de los mercados de Europa, Australia y EE.UU.,
ya que los contribuyentes tratan continuamente de controlar los gastos. Los
contratos de reembolso basados en los resultados dentro del área del cuidado
de la salud (a menudo denominados esquemas “basados en el desempeño”, “de
21
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
MESAS REDONDAS Y TALLERES
riesgo compartido” o “del acceso del paciente”), ofrecen medios para que los
contribuyentes vinculen el reembolso farmacéutico con el valor esperado del
producto (es decir, con mejores resultados para la salud de los destinatarios).
En algunas jurisdicciones, estos esquemas permiten que el fabricante y el
contribuyente reduzcan el costo real sin tener un impacto adverso en el precio
de lista. Además, se han desarrollado nuevos diseños de riesgo compartido
que toman en cuenta otros temas relacionados con el mercado (por ejemplo,
desempeño comparado con los tratamientos alternativos, reembolso relacionado
con las mejorías en la salud de una población grande en vez de algunas personas,
etc.). A pesar del aumento en la cantidad y el tipo de acuerdos, no ha surgido un
método estándar para diseñar e implementar estos esquemas y quedan varios
temas clave respecto de la metodología científica aún sin resolver (por ejemplo,
definir cómo luce el “éxito”, determinar cómo medir los resultados para la salud
rápidamente para permitir un reembolso a tiempo, la presencia de cofundadores,
etc.) que amenazan potencialmente con la viabilidad de estos acuerdos a largo
plazo. Además, a pesar del crecimiento en la aplicación de estos acuerdos, unos
pocos, si es que los hay, se han desarrollado en los mercados de América Latina
y Asia Pacífico, lo cual genera la pregunta acerca de si, potencialmente, pueden
adecuarse a estos mercados.
DESCRIPCIÓN GENERAL: Este panel presentará un panorama breve acerca de los
acuerdos basados en los resultados a nivel mundial, además de las perspectivas
iniciales sobre el potencial y la adecuación de estos acuerdos innovadores
dentro de los mercados emergentes. Los panelistas presentarán perspectivas
metodológicas y basadas en el mercado para garantizar una claridad en los temas,
examinar los obstáculos actuales en América Latina y Asia, y explorar los pasos
potenciales a seguir para permitir la adopción de esquemas de riesgo compartido
en estos países.
W4: PAUTAS PARA UNA SELECCIÓN ADECUADA DEL MÉTODO DE MODELACIÓN
EN LA EVALUACIÓN FARMACOECONÓMICA EN AMÉRICA LATINA
Presentado en español Don Americo
Líderes del debate: Pablo Anaya, MSC, Gerente de Economía de la Salud e
Investigación de Resultados, GlaxoSmithKline, México D.F., México. Dr. Guillermo
Meléndez, MSC, Coordinador Científico, Fondo Nestlé para la Nutrición, Fundación
Mexicana para la Salud, México D.F., México. Joaquín Federico Mould-Quevedo,
PhD, MBA, MSC, Director de Economía de la Salud e Investigación de Resultados
para América Latina y Atención Primaria, Pfizer, Laboratories Inc., New York, NY,
EE.UU.
OBJETIVO: Debatir acerca de las diferencias metodológicas entre los distintos
métodos de modelación alternativos, y ofrecer una orientación práctica para
seleccionar el método más apropiado de acuerdo con las diversas circunstancias
de los países latinoamericanos.
DESCRIPCIÓN: En los últimos años hemos evidenciado un refinamiento continuo
de las herramientas y técnicas disponibles para la modelación de la economía
de la salud. Frecuentemente se ofrecen talleres y cursos cortos en ISPOR
y en otros lugares que brindan oportunidades para aprender cómo usar las
metodologías tradicionales, como el árbol de decisión y la modelación de Markov,
además de otras avanzadas, como la simulación a nivel del paciente. Con menos
frecuencia se ofrecen oportunidades para que los investigadores aprendan
cómo ser pragmáticos a la hora de seleccionar la metodología más adecuada al
momento de tener que modelar el área de una cierta enfermedad y el conjunto
de tratamientos disponibles, tomando en cuenta las restricciones que imponen el
tiempo, el presupuesto y la disponibilidad de datos. Pero, la orientación práctica
es sumamente importante para garantizar que los modelos farmacoeconómicos
se adapten a su objetivo, respondiendo a las preguntas adecuadas con el rigor
científico apropiado, de modo de facilitar una toma de decisiones informada.
En este taller, ofreceremos una descripción general de las metodologías más
comúnmente usadas en el análisis de costo-efectividad, incluyendo los modelos de:
1) decisión analítica; 2) transición de estado; y 3) simulación a nivel del paciente,
incluyendo la simulación de eventos discretos. Se prestará especial atención a la
descripción de sus fortalezas y limitaciones en relación con una amplia variedad
de criterios, incluyendo la compatibilidad con tipos de enfermedades alternativas
(agudas, crónicas, infecciosas) e intervenciones médicas (preventivas, curativas,
paliativas); la transparencia de las estructuras de los modelos, la dificultad para
cumplir con los requisitos de datos para un cálculo de parámetros, la adaptabilidad
a varios escenarios y/o usuarios, la necesidad de un software especializado y
otras cuestiones. Se presentarán casos de estudio reales para ilustrar cómo estos
criterios han modelado la toma de decisión de los presentadores para adoptar un
22
método de modelación en particular. Se pondrá énfasis en la importancia de ser
pragmático al momento de seleccionar el método adecuado de modelación. Los
participantes compartirán sus ideas y experiencias de selección de métodos de
modelación adecuados para la evaluación farmacoeconómica en América Latina.
W5: EQ-5D: UNA PARTE FUNDAMENTAL DE LAS HERRAMIENTAS PARA LOS
ENCARGADOS DE LA TOMA DE DECISIONES EN AMÉRICA LATINA
Presentado en español Don Diego 2
Líderes del debate: Paul Kind, Profesor, Centro de Economía de la Salud,
Universidad de York, York, Reino Unido. Dr. Víctor Zárate, MSC, Estudiante del
Doctorado en Filosofía, Centro de Economía de la Salud, Universidad de York, York,
Reino Unido. Fabiola Rosso, MSC, Investigadora, Departamento de Epidemiología,
Ministerio de Salud, Santiago, Chile. Catalina Gutiérrez, MSC, Investigadora,
Departamento de Salud Pública, Universidad de Los Andes, Santiago, Chile.
OBJETIVO: Es preciso contar con mediciones del estado de la salud para una gran
variedad de objetivos: informar acerca del desarrollo de una política de salud,
monitorear el progreso de los programas de salud para la población, evaluar el
costo-efectividad de nuevas tecnologías sanitarias y, finalmente, brindar datos
para la toma de decisiones clínicas. EQ-5D es un índice genérico de calidad de
vida ampliamente utilizado que está disponible en más de 150 idiomas, y que tiene
una historia de 25 años del desarrollo de investigación. EQ-5D define a la salud
en 5 dimensiones (movilidad, auto cuidado, actividades usuales, dolor/molestias
y ansiedad/depresión) y 3 niveles de gravedad. Esta clasificación describe 243
estados de salud únicos. EQ-5D combina los beneficios descriptivos de un perfil con
las propiedades cuantitativas de una medida de índice. Los conjuntos de valores
para calcular el índice han sido desarrollados en Argentina y Chile, entre otros
países. Hay otros países latinoamericanos que planean establecer sus propios
conjuntos de valores. El taller brindará una descripción breve sobre el estado
actual del EQ-5D y además presentará ejemplos de su uso a partir de estudios
realizados en Chile y el Reino Unido.
DESCRIPCIÓN: EQ-5D actualmente se utiliza para medir los resultados en una
gran variedad de aplicaciones: medición de la salud de la población en encuestas
nacionales y regionales, cálculo de QALYs para la evaluación económica, y como
indicador de desempeño para el benchmarking de los proveedores de atención
médica. Este taller brindará información para los encargados de la toma de
decisiones, basada en la experiencia obtenida en el Reino Unido y Chile al medir y
valorar la salud a través del uso de EQ-5D en encuestas de población y pacientes.
Los presentadores incluyen a representantes del gobierno chileno, académicos
y el EuroQoL Group. Los asistentes que no tengan conocimiento previo de EQ-5D
pueden esperar adquirir información suficiente en el taller como para poder evaluar
su valor en sus actividades profesionales. Se entregarán notas en español y en
inglés.
W6: EVALUACIÓN DE TECNOLOGÍAS SANITARIAS EN CHILE: PASADO, PRESENTE Y
FUTURO Presentado en español Don Diego 3
Líderes del debate: Dr. Manuel Antonio Espinoza, MSc, Académico, Departamento
de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile;
Marianela Castillo, MSc, Economista de la Salud, Ministerio de Salud de Chile,
Santiago, Chile; Dr. Luis Vera, MSc, Departamento de Calidad y Seguridad del
Paciente, Ministerio de Salud de Chile, Santiago, Chile
OBJETIVO: Chile ha avanzado en la reforma de su sistema de salud los últimos
diez años. Sin embargo, uno de los desafíos pendientes es la institucionalización
de un proceso de Evaluación de Tecnologías Sanitarias (ETESA). En el contexto de
la definición del plan nacional de salud en década 2011-2020 (PNS) se definieron
los objetivos ligados al desarrollo de ETESA. Este panel expondrá el proceso en
torno al que se están definiendo los lineamientos para el desarrollo de ETESA en
Chile con el objeto de compartir la experiencia chilena en un ambiente crítico
latinoamericano. Objetivo Específico: Describir el proceso de institucionalización
de ETESA en Chile, puntualizando en aquellos elementos necesarios para el
cumplimiento de los objetivos planteados por PNS.
DESCRIPCIÓN: El moderador presentará un marco conceptual del análisis
de la situación de ETESA, focalizándose en los elementos que constituyen la
institucionalización del proceso de evaluación de tecnologías. Se destacarán las
aproximaciones actuales en la evaluación clínico-epidemiológica y económica,
ejemplificando con casos internacionales tipo. A continuación, el primer panelista
describirá el contexto histórico de ETESA en Chile y su actual marco normativo
e institucional. Luego, presentará los resultados del comité técnico ministerial
que definió los objetivos y estrategias del PNS en los subtemas de tecnologías
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
MESAS REDONDAS Y TALLERES
sanitarias. El segundo panelista presentará un análisis crítico de los desafíos para
el cumplimiento de las metas planteadas. Esta presentación estará enfocada al
incipiente uso de las evaluaciones económicas en salud dentro del proceso de
evaluación de tecnologías y al desarrollo de una guía metodológica en esta materia.
En cuarto lugar, el moderador estimulará la discusión en torno a aquellos elementos
que pudieran dificultar el alcance de los objetivos planteados por el PNS en Chile.
Finalmente se abrirá espacio para preguntas y comentarios de la audiencia para
cerrar con un conjunto de conclusiones emitidas por el moderador.
MESAS REDONDAS Y TALLERES - SESIÓN III
SÁBADO 10 DE SEPTIEMBRE DE 2011: 11.00-12.00
IP3: EL PAPEL DE LAS AGENCIAS DE EVALUACIÓN DE TECNOLOGÍAS EN AMÉRICA
LATINA Presentado en español Don Diego 2
Ponentes para este panel estuvieron invitados; consulte la página 29-32 para
información biográfica.
Moderadora: Dra. Iris Contreras, MSc, Investigadora Clínica, Instituto Mexicano del
Seguro Social, Mexico D.F., Mexico
Panelistas: Alexandre Lemgruber, MSc, Asesor, Administración de Tecnologías
Sanitarias, Organización Panamericana de la Salud (OPS), Washington, D.C., EE.UU.
Dr. Luis Vera, MSc, Asesor Profesional, Evaluación de Tecnologías Sanitarias,
Departamento de Calidad y Seguridad del Paciente, Ministerio de Salud, Santiago,
Chile. Dr. Esteban Hernandez-San Roman, Director, Evaluación de Tecnologías de
Salud, Centro Nacional de Excelencia Tecnológica en Salud, México D.F., México
TEMA: El análisis de evaluación de tecnologías en salud, representa una
herramienta útil en la toma de decisiones para el uso y difusión de nuevas
tecnologías en los cuidados para la salud. En el mundo existen al menos 52
agencias identificadas, de las cuales 4 se encuentran en América Latina. Objetivo:
Describir el papel que juegan las agencias de evaluación de tecnologías en las
políticas en salud en la región y cuáles son los potenciales alcances para la
utilización de recursos en América Latina.
SINOPSIS: El moderador describirá un panorama general de las agencias de
evaluación de tecnologías en América Latina, su impacto en la región, semejanzas
y diferencias entre ellos. El panel describirá de manera particular tres de las
agencias de mayor impacto en América Latina (Chile, Brasil y México), mostrando
en forma sintetizada la estructura y función de la agencia; el nivel de influencia
de las recomendaciones emitidas por la agencia, en la toma de decisiones en
las políticas públicas de salud y en especial en la utilización de recursos. Como
ejemplo se mostrará un caso de éxito de los resultados y recomendaciones
realizados por la agencia y su impacto en la toma de decisiones en el sector. En
la última parte del desarrollo del panel el moderador llevará a los panelistas a
una discusión sobre el futuro en el desarrollo de evaluación de tecnologías en
salud en América Latina, la factibilidad de generar un mayor número de ellas en
la región para apoyar la toma de decisiones y la necesidad de generar una red
de comunicación entre las agencias de los países latinoamericanos, exponiendo
los potenciales objetivos y posibles alcances para Latinoamérica. Finalmente el
moderador emitirá las conclusiones de la discusión.
W7: EL ROL DE LA EVIDENCIA DE LA ECONOMÍA DE LA SALUD Y LA
INVESTIGACIÓN DE RESULTADOS (HEOR) EN LAS DECISIONES SOBRE
VADEMÉCUM Y REEMBOLSOS EN AMÉRICA LATINA VERSUS LOS ESTADOS
UNIDOS Presentado con interpretación simultánea Don Américo
Líderes del debate: Anke-Peggy Holtorf, PhD, MBA, Profesor Adjunto, Centro de
Investigación de Resultados en Farmacoterapia, Universidad de Utah, Salt Lake
City, UT, EE.UU. Gary Oderda, Doctor en Farmacia, MPH, Profesor y Director,
Departamento de Farmacoterapia, Facultad de Farmacia, Universidad de Utah, Salt
Lake City, UT, EE.UU. Dr. Federico Augustovski, MSC, PhD, Director, Departamento
de Evaluaciones Económicas y HTA, Instituto de Efectividad Clínica y Sanitaria
(IECS), Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Dr. Abdulkadir
Keskinaslan, MBA, MPH, Director, Precios de Mercado, Países de Asia Pacífico,
Medio Oriente y África, Global Pricing & Market Access, Novartis Pharma AG,
Basilea, Suiza.
OBJETIVO: El objetivo de este taller es analizar de qué forma los encargados de
la toma de decisiones en América Latina usan la información del HEOR durante el
proceso de toma de decisiones versus las experiencias globales y de los Estados
Unidos, basado en una revisión de la literatura, resultados de encuestas y el uso de
un sistema interactivo de respuesta del público.
DESCRIPCIÓN: Tradicionalmente, los ensayos clínicos aleatorizados (RCT) han sido
considerados el método por excelencia para generar evidencia sobre la eficacia y
la seguridad a la hora de la toma de decisiones en materia regulatoria. En el último
tiempo, la evidencia de la economía de la salud y la investigación de resultados
(HEOR) se ha vuelto de igual importancia para la toma de decisiones sobre
reembolsos de fármacos y acceso de los pacientes a los fármacos. El principal
problema en torno al uso de la evidencia de la HEOR para la toma de decisiones
es la incertidumbre acerca de los datos. Si bien los datos proporcionados por los
ensayos clínicos aleatorizados (RCT) minimizan el sesgo de la selección, también
existe una generalizabilidad limitada debido a un protocolo restringido. Mientras
que la evidencia de la HEOR es más generalizable, se necesita abordar problemas
metodológicos de forma transparente para garantizar que la evidencia sea
significativa para la toma de decisiones. Muchos países han comenzado a integrar
la información de la economía de la salud a sus procesos de toma de decisiones
a escala nacional, regional o local, y las agencias evaluadoras de la tecnología
de la salud utilizan esos datos en diferentes medidas. El taller comenzará con un
panorama general de las principales características de evaluación y el acceso de
los pacientes a nuevas tecnologías médicas considerando efectividad comparativa,
evaluación de tecnología de la salud y contrataciones basadas en resultados. Se
presentarán los resultados de una encuesta realizada entre los encargados de
toma decisiones de los Estados Unidos sobre el uso actual y futuro de los datos
HEOR en sus procesos de decisión y los resultados de encuestas regionales
realizadas entre investigadores y encargados de toma de decisiones con respecto
al proceso de HTA y la relevancia de los recientes “Principios Clave” de HTA para
esta región. Utilizando un sistema de respuesta del público, el panel facilitará el
debate con el público para obtener interpretaciones críticas y aportes en relación
al significado y las consecuencias del estudio para la región y los países de
América Latina.
W8: MÉTODOS PARA COMPARACIONES DE TRATAMIENTOS INDIRECTOS Y
MIXTOS: HERRAMIENTAS PARA LA EVALUACIÓN DE TECNOLOGÍAS SANITARIAS
EN AUSENCIA DE EVIDENCIA DIRECTA Presentado en español Don Americo
Líderes del debate: Dr. Rafael Alfonso-Cristancho, MSC, Asociado de Investigación,
Escuela de Farmacia, Programa de Investigación de Resultados Farmacéuticos y
Políticas, Universidad de Washington, Seattle, WA, EE.UU. Beth Devine, Doctora
en Filosofía, Doctora en Farmacia, MBA, Profesora Adjunta, Universidad de
Washington, Seattle, WA, EE.UU. Dra. Ximena Burbano-Levy, Directora de Proyecto,
Facultad de Ciencias Integradas y Humanidades, Miami, FL, EE.UU.
OBJETIVO: Describir y debatir sobre los métodos actuales para comparaciones
de tratamientos indirectos y mixtos, que pueden utilizarse como herramientas que
sirvan de ayuda para los encargados de la toma de decisiones ante la ausencia de
comparaciones directas.
DESCRIPCIÓN: Como las restricciones de recursos y comerciales limitan las
posibilidades de que se realicen ensayos aleatorizados controlados, no se
llevan a cabo rutinariamente comparaciones directas simultáneas para cada
enfermedad o clase terapéutica, especialmente en el caso de los tratamientos
que se comercializan desde hace poco tiempo. No obstante, la disponibilidad de
estas comparaciones puede ser útil para servir de apoyo a la toma de decisiones
en el contexto del tratamiento clínico de los pacientes o del desarrollo del
vademécum de fármacos. Un nuevo conjunto de métodos estadísticos, llamados
“comparaciones de tratamientos indirectos” (ITC, por su sigla en inglés) o
“comparaciones de tratamientos mixtos” (MTC, por su sigla en inglés) se han
desarrollado para ser utilizados cuando las comparaciones directas simultáneas
no se encuentran disponibles. Estos métodos son una extensión del meta-análisis
tradicional y pueden ser empleados para realizar comparaciones entre productos
de forma indirecta. Los métodos ITC suelen llevarse a cabo adoptando un enfoque
bayesiano. Nuestro taller se basará en las normas de Buenas Prácticas de
Investigación de ISPOR e incluirá un ejercicio práctico utilizando WinBUGS para
explicar los detalles del desarrollo del modelo en este paquete estadístico.
W9: MÉTODOS INNOVADORES PARA MEJORAR LA ADHESIÓN A UN
MEDICAMENTO Presentado en español Don Diego 3
Líderes del debate: Dra. Ana Palacio, MPH, Profesora de la Universidad de Miami,
Miami, FL, EE.UU. Dr. Leonardo Tamariz, MPH, Profesor de la Universidad de Miami,
Miami, FL, EE.UU. Dr. Alfredo Palacio, Decano de la Universidad de Especialidades
Espíritu Santo, Guayaquil, Guayas, Ecuador
OBJETIVO: Los propósitos específicos de esta propuesta son los siguientes: 23
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
MESAS REDONDAS Y TALLERES
1) Debatir sobre intervenciones innovadoras que mejoren la adhesión a un
medicamento por parte de las poblaciones vulnerables con enfermedades crónicas
en los EE.UU. y Ecuador. 2) Debatir sobre las barreras que dificultan la adhesión a
los medicamentos y la viabilidad de las intervenciones en América Latina.
DESCRIPCIÓN: Existen diversas intervenciones que han demostrado ser
promisorias en cuanto al mejoramiento de la adhesión a los medicamentos y el
control de los resultados clínicos entre los pacientes con condiciones crónicas.
Durante los primeros 20 minutos de este taller presentaremos bibliografía reciente,
que incluye proyectos liderados por los presentadores que describen diferentes
medidas de adhesión, así como también enfoques innovadores para mejorar estos
resultados. Entre estos se encuentra el uso de los datos de reclamos para reclutar a
pacientes en riesgo para intervenciones conductuales y realizar un seguimiento de
las medidas de adhesión, el uso de sistemas de reparto de fármacos en puntos de
cuidado que les permiten a los médicos entregar fármacos genéricos previamente
sellados sin ningún costo al momento de las visitas, el uso de avatares para
intervenciones educativas y la creación de un sistema de seguro de salud para los
pacientes más vulnerables. Dedicaremos los siguientes 20 minutos a presentar los
obstáculos y los facilitadores de la implementación de estas intervenciones en los
EE.UU. y América Latina y, por último, brindar un marco para que los participantes
dediquen los 20 minutos finales del taller a identificar sus propios obstáculos, así
como también a realizar sugerencias para explorar posibles soluciones a esos
obstáculos. El objetivo principal de este taller es que los asistentes comprendan
las diferentes medidas de adhesión que pueden ser utilizadas con fines de
investigación y la expansión hacia el ámbito clínico, como también identificar las
mejores medidas para su aplicación en América Latina.
MESAS REDONDAS Y TALLERES - SESIÓN IV
SÁBADO 10 DE SEPTIEMBRE DE 2011: 12.15-13.15
IP4: EL COSTO DE LOS TRASTORNOS DEL ESTADO DE ÁNIMO: ¿QUÉ ASPECTO
GENERA EL MAYOR GASTO PARA LOS SISTEMAS DE SALUD? ¿QUÉ GENERA LA
ALTA DISCAPACIDAD ASOCIADA? UNA PERSPECTIVA SOCIAL, ECONÓMICA Y
GLOBAL Presentado en español Don Diego 3
Moderadora: Dra. Claudia Becerra-Palars, MSc, Coordinadora Clínica de
Trastornos del Afecto, Instituto Nacional de Psiquiatría, “Ramón de la Fuente”,
México D.F., México
Panelistas: Dr. Mauricio Palma, MSc, Estudiante de Psiquiatría, Secretaria de
Salud, Instituto Nacional de Psiquiatría, México D.F., México. Dr. Jeremy Cruz,
Universidad Nacional Autónoma de México/INP, México D.F., México; Dr. Ingrid
Vargas, MSc, Investigadora, Académica, Departamento de Psiquiatría y Salud
Mental, Universidad Nacional Autónoma de México, México D.F., México
TEMA: Los Trastornos del Estado de Ánimo forman parte de las 10 primeras causas
de discapacidad a nivel mundial de acuerdo con la OMS; ¿Cuáles son los aspectos
psicosociales y económicos que generan dicha discapacidad? ¿En dónde radica
el alto costo de estas enfermedades? Dr. Mauricio Palma: Perspectiva Económica:
Costos indirectos y Carga global (15 min); Dr. Jeremy Cruz: Perspectiva Económica:
Costos directos (15 min); Dra. Ingrid Vargas: Perspectiva Psicosocial del costo
asociado. (15min); Discusión Pública (15 min).
SINOPSIS: Se ha identificado que el trastorno depresivo mayor (TDM) ocupa el
tercer lugar en discapacidad (precedido por el Trastorno Bipolar). Las estimaciones
de CGE en el 2000 indican que la depresión unipolar contribuye al 4.4% de la
Carga Global de Enfermedad (OMS 2002). El promedio anual de costos directos
por paciente deprimido varía de $1000 a $2500 (Dólares). Los estudios de costos
indirectos reportan entre $2000 a $3700 dólares para costos de morbilidad y $200 a
$400 de mortalidad. Se ha observado que el TDM y el TB son causas de ausentismo
laboral: con un promedio de 3,2 días de incapacidad laboral al mes. El TB es una
enfermedad crónica, recurrente que genera alta morbilidad y mortalidad. Los
costos del TB se asocian con costos directos del tratamiento, pérdida de ingreso
y productividad, muerte prematura por efectos adversos y suicidio. Estudios en
México han reportado un costo promedio del tratamiento por episodio agudo de
Manía es de $6877 (dólares), mientras que el tratamiento de mantenimiento a un
año genera un costo de $1270 (dólares). Se ha documentado que las ganancias
obtenidas al reducir el ausentismo y mejorar la productividad en el trabajo podría
compensar el costo del tratamiento. Es importante la identificación de las áreas
generadoras de costo para diseñar intervenciones dirigidas a reducir los costos.
24
W10: FALTA DE DATOS LOCALES SOBRE EFECTIVIDAD, COSTO Y
EPIDEMIOLOGÍA; ¿CUÁLES SON LAS OPCIONES PARA REALIZAR ESTUDIOS DE
FARMACOECONOMÍA EN AMÉRICA LATINA? Presentado en español
Don Diego 2
Líderes del debate: J. Jaime Caro, Doctor en Medicina y Magíster en Cirugía,
FRCPC (Fellow of the Royal College of Physicians and Surgeons of Canada), FACP,
Vicepresidente Ejecutivo de Economía de la Salud, United BioSource Corporation,
Lexington, MA, EE.UU. Dr. Rafael Alfonso-Cristancho, MSC, Asociado de Investigación,
Escuela de Farmacia, Programa de Investigación de Resultados Farmacéuticos y
Políticas, Universidad de Washington, Seattle, WA, EE.UU. Dra. Ximena Burbano-Levy,
Directora de Proyecto, Facultad de Ciencias Integradas y Humanidades, Universidad
Internacional de Florida, Miami, FL, EE.UU. Rosa María Galindo-Suárez, MSC, Gerente
de Investigación de Resultados, Pfizer, México D.F., México
OBJETIVO: Debatir sobre los desafíos de la farmacoeconomía en América Latina,
una región que carece de muchos datos fundamentales acerca de los resultados
locales sobre eficacia/ efectividad, utilización de recursos, medidas de utilidad,
costos de la información epidemiológica.
DESCRIPCIÓN: La sesión abarcará las alternativas elegidas por los investigadores
de farmacoeconomía y los gerentes de investigación de resultados para recopilar
datos y sus problemas para presentar sus resultados a los encargados de la toma
de decisiones y los líderes de opinión locales. Además, el taller abarcará las
técnicas y metodologías comunes que se utilizan actualmente para sobreponerse
a la falta de información que existe en la región, tomando como ejemplo a tres
países de América Latina y tres enfermedades. El debate también abordará cómo
estos enfoques afectan la credibilidad, la transparencia y la aceptabilidad de los
descubrimientos de la farmacoeconomía por parte de los reguladores de las HTA y
los encargados de la toma de decisiones en América Latina.
W12: EL FUTURO DE LOS CONTROLES DE COSTOS FARMACÉUTICOS
EN AMÉRICA LATINA: ¿HTA O PRECIOS DE REFERENCIA? Presentado con
interpretación simultánea Don Diego 4
Líderes del debate: Monica Martin de Bustamante, AB, Becaria, Acceso al
Mercado Global, Insight Strategy Advisors, New York City, NY, EE.UU. Cyrus A.
Chowdhury, MSC, Vicepresidente, Acceso al Mercado Global, Insight Strategy
Advisors, New York, NY, EE.UU.
OBJETIVO: El propósito de este taller es explorar el desarrollo futuro de dos
mecanismos de reducción de costos de gran potencial, precios de referencia y las
HTA, que actualmente están siendo aprovechadas de diversas maneras por varios
países de América Latina, y la evolución resultante de bases de datos al nivel de los
pacientes para el éxito de las HTA.
DESCRIPCIÓN: En toda América Latina, la expansión de la cobertura de salud
provista por los gobiernos, sumada a los costos farmacéuticos en constante
crecimiento, ha generado la necesidad de mecanismos de reducción de costos
aplicables a escala nacional. Algunos países como México han creado una
organización de HTA para ayudar a definir y defender sus decisiones de reembolso
de productos. Otros países, como Brasil, han utilizado los precios de referencia
para mantener controlados los precios de lanzamiento, y las HTA para ayudar
a anunciar las decisiones nacionales en materia de reembolsos. Aunque se
implementan con frecuencia en todo el mundo, los precios de referencia no
incentivan la innovación ni exploran el valor inherente de un producto. Por
otro lado, los estudios de HTA pueden incorporar datos clínicos, de costos y de
resultados reales para crear una herramienta de reducción de costos sustentable
y beneficiosa. Actualmente, los fabricantes proveen dossiers sobre el valor del
producto a los organismos de HTA establecidos en toda América Latina, pero en
este momento la disponibilidad de resultados al nivel de los pacientes que apoyen
el valor del producto es escasa. La descentralización de la información en todos
los países de América Latina crea un obstáculo para un mejor funcionamiento de
los organismos de HTA. La necesidad de métodos sustentables y que reduzcan los
costos fomentando la innovación en toda la región requiere de un mayor desarrollo
de HTA y de la obligación de la centralización e interconexión de las bases de
datos reales al nivel del paciente que existen en América Latina y otras partes. El
taller incluirá una parte interactiva, que les permitirá a los participantes expresar
las ventajas y desventajas de los precios de referencia y las HTA dentro de estos
mercados de rápido desarrollo.
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
SIMPOSIOS
Los simposios son gratuitos y abiertos a todos los delegados de ISPOR, no se necesita inscripción anticipada.
JUEVES 8 DE SEPTIEMBRE DE 2011
17.15-18.15 Don Diego 4
EL TRATAMIENTO DEL CÁNCER EN LATINOAMÉRICA: PERSPECTIVAS, ACCESO Y SOSTENIBILIDAD
Presentado en inglés.
Este simposio dará una visión general de los parámetros clínicos más importantes en el ámbito de la oncología, con el fin de ofrecer datos relevantes de las
decisiones sobre la cobertura para los encargados de toma de decisiones. Los nuevos tratamientos oncológicos pueden representar un desafío para los
procesos de reembolso, debido a sus costos elevados. Se presentará un análisis de la radiografía, desde la evidencia clínica hasta la toma de decisiones en
dos países latinoamericanos.
Moderadora: Dra. Alma Gabriela Valenzuela Flores, MSc, Jefa de Calidad, Centro Médico Nacional SXXI, IMSS, Ciudad de México, México.
Cómo evaluar las nuevas tecnologías en Oncología
Ponente: Dr. Octavio Clark, Oncólogo, EBM y HE, São Paulo, Brasil.
Costo del control integral del cáncer de próstata: una propuesta de cobertura
Ponente: Dr. Abelardo Meneses García, MSc, Director Médico, Instituto Nacional de Cancerología, Ciudad de México, México.
JUEVES 8 DE SEPTIEMBRE DE 2011
18.30-19.30 Don Diego 4
¿CÓMO PODEMOS PREVENIR LA CRISIS DE ENFERMEDAD CEREBROVASCULAR EN AMÉRICA LATINA? INFORME
DE UN GRUPO DE TRABAJO INDEPENDIENTE
Presentado en español e inglés con interpretación simultánea.
El simposio brindará una visión general de la carga que conlleva la crisis a causa de los derrames cerebrales para los pacientes, los cuidadores y la
sociedad toda, y motivará una llamada a la acción para prevenirla. Cada año, 15 millones de personas en todo el mundo sufren de un derrame cerebral.
Aproximadamente 5 millones de éstas sufren de discapacidades permanentes y más de 5 millones más mueren. En América Latina, en el año 2004,
aproximadamente 437.000 personas sufrieron de su primer derrame cerebral y más de 250.000 fallecieron a causa de ello. Quienes sobreviven a un derrame
cerebral, deben lidiar con una gran carga emocional y física, lo cual tiene un fuerte impacto en su calidad de vida. Acción para la prevención de derrames
cerebrales, un grupo de expertos en salud de todo el mundo, incluyendo a América Latina, además de otras sociedades médicas y organizaciones de
pacientes que patrocinan las recomendaciones, motiva a los encargados de la creación de políticas y a los gobiernos locales a actuar antes de que la
creciente frecuencia de los derrames cerebrales se convierta en una gran crisis para la salud pública.
Ponente / Moderador: Dr. Carlos Cantú, Profesor del Programa contra Derrames Cerebrales de la Universidad Nacional de México, Clínica de Derrames
Cerebrales, Departamento de Neurología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubiran, México, y Miembro Fundador de la
Asociación Mexicana de Derrames Cerebrales, Ciudad de México, México.
La carga de la apoplejía isquémicas, factores de riesgo y opciones terapéuticas
Ponente: Dr. Jorge González-Zuelgaray, Jefe del Servicio de Arritmias y Electrofisiología (Sanatorio de la Trinidad San Isidro, Buenos Aires, Argentina);
Director del Centro de Arritmias, Universidad de Buenos Aires, Presidente de la Alianza contra la Arritmia y Fibrilación Auricular de Argentina; Director de la
Carrera de Especialización en Electrofisiología, Universidad de Buenos Aires, Argentina.
La perspectiva del paciente
Ponente: Trudie Lobban, MBE, Fundadora y Administradora de la Alianza contra Arritmia; Fundadora y Directora Ejecutiva de la Asociación de Fibrilación
Auricular, Buenos Aires, Argentina.
Una llamada a la acción
Ponente: Dr. Carlos Cantú, Profesor del Programa contra la Apoplejía de la Universidad Nacional de México, Clínica de Derrames Cerebrales, Departamento
de Neurología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México y Miembro Fundador de la Asociación Mexicana de Apoplejía,
Ciudad de México, México.
25
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
SIMPOSIOS
Los simposios son gratuitos y abiertos a todos los delegados de ISPOR, no se necesita inscripción anticipada.
JUEVES 8 DE SEPTIEMBRE DE 2011
19.45-20.45 Don Diego 4
EL NIVEL ADECUADO: HTA “MICRO Y MACRO” EN LOS MERCADOS EMERGENTES / SISTEMAS DE SALUD
Presentado en inglés con interpretación simultánea.
Se expondrá el potencial para recolectar, analizar y utilizar los datos de resultados de la salud, como parte del entendimiento de los sistemas de salud,
la utilización de tecnología y la efectividad. Se presentarán las conclusiones más destacadas del informe sobre cómo entender los sistemas de salud en
constante evolución. Esto incluirá una discusión breve sobre las “ineficiencias del sistema de salud”, tales como las cadenas de distribución y los márgenes,
el rol de los medicamentos genéricos, los incentivos nocivos y los problemas con la mano de obra. Se analizarán las conclusiones adicionales sobre los roles
posibles para la evaluación de tecnología en los sistemas de salud en constante evolución, a un nivel más “macro”.
Moderador: Dr. David Grainger, Director Global de Políticas Públicas, Eli Lilly and Company, Indianápolis, IN, EE.UU.
Ponentes:
Adrian Towse, MA, MPhil, Director, Oficina de Economía de la Salud en Londres, Reino Unido.
Lou Garrison, PhD, Profesor y Director Adjunto, Programa de Políticas e Investigación de Resultados Farmacéuticos, Departamento de Farmacia, Universidad
de Washington, Seattle, WA, EE.UU.
VIERNES 9 DE SEPTIEMBRE DE 2011
12.30-13.30 Don Diego 4
ANÁLISIS DE ECONOMÍA DE LA SALUD EN AMÉRICA LATINA ¿SE PUEDEN APLICAR LAS LECCIONES
APRENDIDAS EN OTRAS PARTES DEL MUNDO?
Presentado en inglés con interpretación simultánea.
En esta sesión analizaremos los procesos actuales de reembolso y toma de decisiones sobre precios en América Latina, incluyendo el uso de la información
sobre economía de la salud para informar acerca de estos procesos y el uso de la modelación y las evidencias de casos reales.
Factores del mercado que influyen a la demanda y al uso de la información sobre la economía de la salud en América Latina
Ponente: Michael Nelson, Doctor en Farmacia, Líder Regional de las Américas, Economía de la Salud e Investigación de Resultados, IMS Consulting Group,
Alexandria, VA, EE.UU.
Los procesos actuales de la toma de decisiones sobre reembolso y precios en América Latina: el uso de la información sobre economía de la salud en
mercados selectos
Ponente: Joaquín F. Mould-Quevedo, PhD, Director de Economía de la Salud e Investigación de Resultados para Latinoamérica y de la Unidad de Negocio de
Productos de Atención Primaria para Mercados Emergentes, Pfizer Laboratories, New York, NY, EE.UU.
Requisitos de presentación/prácticas de economía de la salud en otras partes del mundo e implicancias para América Latina
Ponente: Juliet Munakata, MS, Directora, IMS Consulting Group, Redwood City, CA, EE.UU.
26
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
SIMPOSIOS
Los simposios son gratuitos y abiertos a todos los delegados de ISPOR, no se necesita inscripción anticipada.
VIERNES 9 DE SEPTIEMBRE DE 2011
13.45-14.45 Don Diego 4
MEDICAMENTOS DE ALTO COSTO: ¿AGREGAN VALOR A LOS SISTEMAS DE SALUD EN AMÉRICA LATINA?
¿CÓMO GARANTIZAR UN ACCESO ADECUADO?
Presentado en inglés y español con interpretación simultánea.
Los medicamentos de alto costo son, por definición, los medicamentos caros, y representan un porcentaje cada vez mayor del gasto en fármacos. Este
simposio se centrará en los impulsores de los costos en salud y el rol potencial que tienen los nuevos medicamentos para brindar beneficios económicos
y sanitarios en la región, además de soluciones prácticas (o estudios de casos locales) para garantizar un acceso adecuado a estos medicamentos. Se
presentará un panel de ponentes internacionales y locales.
Moderador: Herman Soto Molina, MSc, Consultor Privado, Ciudad de México, Distrito Federal, México.
Impulsores de los costos en salud / Beneficios económicos de los nuevos medicamentos en América Latina
Ponente: Lou Garrison, PhD, Profesor y Director Adjunto, Programa de Políticas e Investigación de Resultados Farmacéuticos, Departamento de Farmacia,
Universidad de Washington, Seattle, WA, EE.UU.
Cómo garantizar el acceso adecuado a los medicamentos de alto costo
Ponentes:
Dr. Marcos Bosi Ferraz, PhD, Profesor y Director, Centro Paulista de Economía de la Salud (CPES), Universidad Federal de São Paulo, Director, Economía
Médica, Asociación Brasilera de Medicina y Director de Relaciones Institucionales, Fleury Group São Paulo, São Paulo, Brasil.
María Cristina Gutierrez Delgado, PhD, Matemática Actuarial, Vicedirectora General, Unidad de Economía y Análisis de Economía de la Salud, Ministerio de
Salud, Ciudad de México, Distrito Federal, México.
VIERNES 9 DE SEPTIEMBRE DE 2011
19.30-21.00 Don Diego 4
ACTUALIZACIÓN DEL ESTADO DEL ENTORNO DE REEMBOLSO EN AMÉRICA LATINA
Presentado en inglés y español con interpretación simultánea.
En América Latina, existen varios temas y cuestiones referentes a las decisiones de reembolso de fármacos y al uso de la información sobre investigaciones
de resultados y evaluaciones de tecnología sanitaria en estas decisiones. En la 1ª Conferencia ISPOR para América Latina y en la 2ª Conferencia ISPOR
para América Latina, se presentaron varios temas sobre el valor clínico y económico de los productos que se están introduciendo en América Latina. Para
propiciar el debate, el intercambio de conocimiento y las experiencias relacionadas con estos temas, este simposio servirá para brindar una actualización
sobre los requisitos actuales de reembolso y el entorno para las evaluaciones en América Latina. Además, brindará una visión general sobre las
presentaciones para la revisión de reembolsos y las actividades posteriores a estas presentaciones en América Latina.
Moderador/Ponente:
Dr. Federico Augustovski, PhD, MSc, Director, Departamento de Evaluaciones Económicas y HTA, Instituto de Efectividad Clínica y Sanitaria (IECS), y
Profesor de Salud Pública en la Universidad de Buenos Aires, Buenos Aires, Argentina.
Ponentes:
Dr. Marcos B. Ferraz, PhD, Profesor Adjunto y Director, Centro Paulista de Economía de la Salud, Departamento de Medicina, Universidad Federal de São
Paulo y Director Médico, Asociación Brasilera de Medicina, São Paulo, Brasil.
Jorge Augusto Díaz Rojas, MSc (Farmacología), MSc (Economía), PhD (c), Profesor Adjunto, Unidad de Hospital y Farmacia Clínica, Facultad de Farmacia,
Universidad Nacional de Colombia, Bogotá D.C, Bogotá, Colombia.
Dra. Iris Contreras Hernández, MS, Jefa de Medicina Interna, Hospital General Zona Nº 1-A “Los Venados”, IMSS, Ciudad de México, México
Carl Asche, PhD, MBA, Director y Profesor, Centro de Investigación de Resultados para la Salud, Universidad de Illinois, Facultad de Medicina,
Peoria, Illinois, EE. UU.
27
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
SIMPOSIOS
Los simposios son gratuitos y abiertos a todos los delegados de ISPOR, no se necesita inscripción anticipada.
SÁBADO 10 DE SEPTIEMBRE DE 2011
7.45-8.45 Don Diego 4
FÁRMACOS BIOLÓGICOS Y BIOSIMILARES EN AMÉRICA LATINA: DESAFÍOS DE LOS FONDOS PARA
CONTRIBUYENTES Y DESARROLLADORES
Presentado con interpretación simultánea español-inglés.
El desarrollo de fármacos biológicos y su uso en América Latina aparentemente dará a los pacientes con enfermedades crónicas la posibilidad de obtener
tratamientos más nuevos, mejores y más específicos. No obstante, los desafíos para las autoridades de la salud, las fundaciones para la lucha contra
ciertas enfermedades o las aseguradoras, quienes deberán pagar estos nuevos tratamientos, se están agudizando. Los biosimilares pueden ser una opción
para reducir los precios/costos, aunque las regulaciones y la evidencia clínica aún no son claras en la región. A menos que se encuentren nuevas formas
de financiar y permitir a los pacientes un acceso a estos nuevos fármacos, la falta de iniciativas comerciales desalentará el desarrollo a futuro. Este
simposio explorará los diversos desafíos y problemas asociados con la financiación de fármacos biológicos y biosimilares en los mercados de América
Latina, especialmente en Brasil, México y Colombia. Se pondrá énfasis en los recientes desarrollos y los cambios esperados para el entorno de acceso al
mercado, que podrían permitir un acceso al mercado más amplio y sencillo para las tecnologías biológicas y, por lo tanto, mejores iniciativas para que los
desarrolladores inviertan en dichas tecnologías. Los panelistas presentarán las perspectivas de los distintos interesados acerca de los temas clave para
explicar cómo está cambiando el entorno.
Ponentes:
Gilberto Castañeda, PhD, Profesor, Sección de Farmacología, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de
México, México
Dr. Valdair Pinto, Consultoría en Medicina Farmacéutica, São Paulo, Brasil
Dr. Renato Guzmán, Director Científico, IDEARG, Bogotá, Colombia
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3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
INFORMACIÓN BIOGRÁFICA DE LOS PONENTES INVITADOS
INFORMACIÓN BIOGRÁFICA DEL PRESIDENTE DE ISPOR
Presidente de ISPOR
Mark Sculpher, PhD, MSC
Mark Sculpher es profesor de Economía de la Salud en el Centro
de Economía de la Salud, Universidad de York, Reino Unido, y es el
Director del Programa de Evaluación Económica y Evaluación de
Tecnologías Sanitarias. Mark ha trabajado en el área de la evaluación económica
y la evaluación de tecnologías sanitarias durante más de 20 años. Ha investigado
en diversas áreas clínicas como enfermedades cardiovasculares, cáncer,
diagnóstico y salud pública. También ha contribuido con métodos en el campo,
particularmente relacionados con la modelación de decisión analítica y de técnicas
para manejar la incertidumbre, la heterogeneidad y las generalidades. Tiene más
de 170 publicaciones evaluadas por colegas y es el co-autor de dos libros de texto
importantes en el campo de estudio: Methods for the Economic Evaluation of
Health Care Programmes (OUP, 2005 con Drummond, Torrance, O’Brien y Stoddart)
y Decision Modelling for Health Economic Evaluation (OUP, 2006 con Briggs y
Claxton).
Es miembro del National Institute of Health Research (NIHR) del Reino Unido,
College of Senior Investigators, y también ha sido miembro del Comité de
Evaluación de Tecnologías en el National Institute for Health and Clinical
Excellence (NICE) y del Comité Asesor de Intervenciones en Salud Pública del
NICE. Actualmente forma parte del Comité Asesor de Diagnósticos del NICE. Ha
presidido el Grupo de Tareas del NICE en el año 2004, el cual se encargaba de
la guía de métodos para la evaluación económica, y ha Asesorado al Methods
Working Party para la actualización de su guía del año 2008. Además, ha asesorado
acerca de la evaluación de tecnologías sanitarias (HTA) a sistemas de salud en
todo el mundo, incluyendo a países como Irlanda, Alemania, Portugal y Nueva
Zelanda. Ha sido miembro del Commissioning Board del Programa de Evaluación
de Tecnologías Sanitarias de los INS del Reino Unido y del Panel de Metodología
de la Investigación Médica del NIHR/Reino Unido. Actualmente es el Presidente
2011-2012 de la ISPOR (International Society for Pharmacoeconomics and
Outcomes Research).
INFORMACIÓN BIOGRÁFICA DE LOS PRESIDENTES DEL COMITÉ DE
PLANIFICACIÓN DE LA CONFERENCIA
Dr. Antonio Caso Marasco, MEd
Egresado de la Facultad de Medicina de la Universidad Nacional
Autónoma de México como Médico cirujano posteriormente curso
la especialidad de Hematología en el Hospital General de México de
la Secretaria de Salud, ha tenido una práctica profesional constante
tanto en el ámbito privado como público.
Ha tomado diversos cursos sobre Economía de la Salud y Farmacoeconomía a
lo largo de su vida profesional, en el ámbito académico es profesor de posgrado
de la Facultad de Medicina en el área de la Hematología y ha ocupado múltiples
funciones académico administrativas en la Propia Universidad Nacional.
Fue fundador y ex presidente de ISPOR México, y de diversos proyectos
relacionados con la difusión de esta disciplina en México, ha continuado su
preparación y hasta ahora lleva cursados tres diplomados de posgrado en las
áreas de Toxicología Médica, Tecnologías de la información y comunicación,
entre otros, ha impartido diversos cursos relacionados con su especialidad y ha
participado en protocolos de investigación básica y clínica.
En congresos internacionales ha participado como profesor en más de 30
congresos internacionales y un sin número de reuniones y congresos nacionales
ha editado revistas de difusión médica y ha publicado múltiples artículos, ha
organizado congresos y cursos de temas relacionados con el acceso a los
servicios y tecnologías para la salud.
Ha publicado cuatro libros, y editado dos revistas de difusión médica, ha sido autor
de diversos proyectos que han tenido alcance nacional.
Actualmente es Coordinador del programa de educación médica a distancia de
la División de Estudios de Posgrado Facultad de Medicina, UNAM y Presidente y
fundador del Colegio Mexicano de Farmacoeconomía; Miembro de la Sociedad
Médica del Hospital General de México; asesor del Consejo Académico de Discovery
Health Latinoamérica Iberia; Asesor científico del Instituto de California, Los Ángeles,
CA, USA. Ha colaborado con la oficina de asuntos internacionales con la Universidad
del Sur de California USA. Editor de revistas médicas, y autor de diversos trabajos y
proyectos sobre acceso a medicamentos, apego terapéutico, y farmacoeconomía.
Ha sido asesor de varias compañías farmacéuticas en diversas áreas.
Ha colaborado y participado en los diversos medios de comunicación de radio y
televisión a fin de informar y difundir el conocimiento.
Dr. Guillermo Meléndez, MSc
PRESIDENTE DEL CONSORCIO ISPOR PARA AMéRICA
LATINA 2010-2012
El Dr. Guillermo Meléndez, MSc, es un especialista en medicina
interna que obtuvo su título de médico en la Universidad Nacional
Autónoma de México y luego su título en Medicina Interna de la misma institución.
Recibió su título de Magíster en Ciencias, especialización en Nutrición Humana,
en London School of Hygiene and Tropical Medicine, Londres, Inglaterra. Tiene
un diploma en mercadotecnia de la Universidad Iberoamericana y otro título en
Farmacoeconomía en el Instituto Nacional de Salud Pública de México.
Guillermo es un investigador especializado en obesidad infantil y economía
de la salud en la Fundación Mexicana para la Salud A.C. – FUNSALUD, donde
dirige el Programa de Intervención en Obesidad Infantil. Es profesor fundador
de la especialidad de nutrición clínica en México, miembro fundador y primer
presidente del Capítulo Regional México de la ISPOR (International Society of
Pharmacoeconomics and Outcomes Research), y miembro fundador del Colegio
Mexicano de Farmacoeconomía. Ha fundado y dirige Medical and Nutritional Trials,
un centro de investigación dedicado a la investigación clínica y de economía de la
salud.
En el campo de la investigación, su interés se concentra en la obesidad infantil,
incluyendo las intervenciones preventivas que tienen un impacto sobre la obesidad
infantil, desde el ámbito lúdico hasta las políticas nacionales. También está
involucrado en el análisis de procesos y usos de los recursos en las instituciones
públicas, y en la evaluación de tecnologías sanitarias e investigación clínica sobre
el síndrome metabólico y su relación con la obesidad infantil.
El Dr. Meléndez ha publicado artículos y capítulos de libros sobre meta-análisis,
medicina, economía y nutrición. Su primer libro, editado en 2008, se titulaba
“Factores asociados con sobrepeso y obesidad en el ambiente escolar”, en el
cual se presentaba un modelo de simulación de eventos discretos para predecir la
carga de la obesidad infantil sobre el sistema de salud.
Guillermo ha prestado sus servicios en la ISPOR desde 2006 como revisor de
resúmenes de reuniones, contribuyente y revisor del Capítulo Regional de ISPOR,
fundador y primer presidente del Capítulo Regional México de ISPOR, miembro del
comité organizador de la 1ª Conferencia ISPOR para América Latina y, actualmente,
como copresidente de la 3ª Conferencia ISPOR para América Latina y el Presidente
2010-2012 del Consorcio ISPOR para América Latina.
Secretario de Salud de México, 2006-2012
Dr. José Ángel Córdova Villalobos
El doctor José Ángel Córdova Villalobos es originario de León,
Guanajuato, es Médico Cirujano egresado de la Facultad de
Medicina de León de la Universidad de Guanajuato, especialista
en Medicina Interna por el Instituto Nacional de Ciencias Médicas
y Nutrición Salvador Zubirán, en Cirugía General y Endoscopía Digestiva por
la Universidad Paul Sabatier de Toulouse, Francia. Realizó una Especialidad en
Administración Pública Municipal y Estatal; posteriormente obtiene la Maestría
en Administración Pública por la Universidad de Guanajuato. Asimismo, tiene
el nombramiento de Doctor Honoris Causa por la Universidad Paul Sabatier de
Toulouse, Francia. Fue director de la Facultad de Medicina de la Universidad
de Guanajuato de 1990 a 1997; Jefe de Servicio de Cirugía General del
29
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
INFORMACIÓN BIOGRÁFICA DE LOS PONENTES INVITADOS
Hospital Regional de León de 1983 a 1987; Subdirector Médico del Hospital de
Especialidades del IMSS de esa ciudad de 1985 a 1990; Presidente de la Asociación
Mexicana de Endoscopía Digestiva, de 1995 a 1996 y Secretario de Relaciones de
la Asociación Mexicana de Gastroenterología en 1993. Presidente de la Asociación
Mexicana de Facultades y Escuelas de Medicina 1995 – 1997. Recibió el premio
“Robins”, por el mejor promedio de la Carrera de Medicina en la Facultad de la
Universidad de Guanajuato durante 1973, 1974 y 1975 y el premio que se otorga
a los mejores estudiantes de México en 1976. También fue Premio Nacional
de Investigación por la Asociación Mexicana de Gastroenterología, Premio de
Investigación en Salud en el Estado de Guanajuato a nivel nacional; Premio
Afacinera y Orden al Mérito Francisco Hernández en Educación Médica en Buenos
Aires, Argentina en 1997 y Premio FUNSALUD “ Robinson Bours” en Educación
Médica en 1997. De igual forma ha recibido diversos reconocimientos como el del
Gobierno de Guanajuato por su trayectoria académica; por la Academia Nacional
de Medicina por su trayectoria legislativa y por la Secretaría de Salud Federal por
su trabajo legislativo y recibió por parte del Gobierno Francés en febrero 2010 la
Condecoración de la Orden Nacional de la Legión de Honor en grado de Caballero.
Ha recibido varios reconocimientos entre los que destacan: El de las Naciones
Unidas Llamado “Mas México en Naciones Unidas, Más Naciones Unidas en
México” y el de la Cruz Roja “Medalla de la Gran Cruz”.
Ha presentado 233 trabajos científicos como autor en diferentes foros nacionales
y del extranjero, así como también artículos o resúmenes en revistas médicas,
tanto nacionales como internacionales y 21 capítulos de libros de medicina;
es editor de 5 libros. Pertenece a 13 asociaciones científicas nacionales e
internacionales, tiene seis certificaciones por los diferentes consejos de
especialidades en México, participó en 11puestos directivos diferentes y fue
jurado en diversas ocasiones para eventos científicos. Pertenece a la Academia
Mexicana de Cirugía y a la Academia Nacional de Medicina. Actualmente es el
Presidente del 50Consejo Directivo de Organización Panamericana de Salud. Fue
Consejero Ciudadano del Instituto Electoral de Guanajuato y Presidente del Consejo
General del mismo.
Diputado Federal por el Partido Acción Nacional en la LIX legislatura. Dentro de la
Diputación participó en la Comisión de Ciencia y Tecnología; Presidió la Comisión
de Salud y el del Grupo de Amistad México-Polonia. Considerado por consulta
Mitofsky en una encuesta sobre todos los integrantes de la Cámara baja como el
legislador que mas trabajo realizó en Comisiones. Presentó 18iniciativas y 8 puntos
de Acuerdo de trascendencia nacional como impulsar la creación del Instituto
Nacional de Medicina Genómica.
INFORMACIÓN BIOGRÁFICA DE PONENTES INVITADOS:
SESIONES PLENARIAS
Dr. J. Jaime Caro, MDCM, FRCPC, FACP
Jaime Caro es un experto en evaluación de tecnologías sanitarias.
El Dr. Caro se capacitó en la McGill University, donde ejerció
la medicina interna y ahora es Profesor Adjunto en Medicina y
además en Epidemiología y Bioestadística. Ha fundado el curso de
posgrado en farmacoeconomía en la universidad y también ejerce sus habilidades
de enseñanza en otras instituciones académicas, organizaciones gubernamentales
y asociaciones profesionales. Luego de fundar y dirigir el Instituto de Investigación
Caro durante más de una década, ahora es el Vicepresidente Ejecutivo de United
BioSource Corporation.
Su trabajo inicial en epidemiología teórica condujo a una investigación aplicada
para el Consejo de Evaluación de Tecnologías Sanitarias de Quebec, pionero en el
aquel momento, campo incipiente. Su interés temprano en encontrar un método
adecuado para evaluar las intervenciones de cuidado de la salud ha dado como
resultado un esfuerzo para ayudar a que las organizaciones gubernamentales de
países tan diversos como Alemania y Colombia puedan desarrollar e implementar
sus metodologías; y posiciones en los comités directivos de diversas iniciativas
globales para atender a enfermedades específicas
Además del trabajo del Dr. Caro y las publicaciones sobre más de 100 modelos
de enfermedades, ha continuado investigando activamente sobre las técnicas
avanzadas de modelación que se utilizan para informar acerca de decisiones
30
complejas en el área del cuidado de la salud y sobre la aplicación de los conceptos
epidemiológicos en los estudios económicos. Esto ha incluido el desarrollo de
métodos para lidiar con necesidades complejas de tiempo y la transferencia de
técnicas de modelación de otros campos a la medicina (modificando la simulación
de eventos discretos para su uso en análisis económicos y de riesgo-beneficio
y modelación de ensayos clínicos adaptativos). Más recientemente se ha
concentrado en el desarrollo de mediciones adecuadas para guiar las decisiones
en el área del cuidado de la salud.
Maria-Luisa Escobar, MA, PhD
La Dra. Escobar (PhD) es una economista especialista en temas
sanitarios que cuenta con más de veinte años de experiencia
trabajando en políticas de salud, economía sanitaria y reforma
del sistema de salud. Actualmente es Gerente de la Práctica de
Sistemas de Salud del Banco Mundial. Ha trabajado con gobiernos
de países en vías de desarrollo en el análisis y diseño de políticas de salud pública,
a través del Banco Interamericano de Desarrollo y luego a través del Banco
Mundial. Además de su experiencia internacional, la Dra. Escobar ha sido Directora
de Planificación y Asesora Principal del Ministerio de Salud de Colombia, y más
tarde fue Asesora Técnica del Ministerio de la Protección Social de la República de
Colombia.
Más recientemente, y antes de unirse al Instituto del Banco Mundial, trabajó en
el análisis de mecanismos innovadores de financiamiento de la salud mundial
como Miembro Residente en la Brookings Institution de Washington D.C., y llevó
adelante una agenda de investigaciones sobre el impacto del seguro médico en
los países en vías de desarrollo. Sus principales intereses son el financiamiento
de la atención médica y las políticas de salud, así como también el desarrollo
de estrategias eficaces para transformar el conocimiento técnico en la
implementación de políticas de salud en los países emergentes.
Sus publicaciones más recientes son: María-Luisa Escobar, Charles C. Griffin, R.
Paul Shaw, eds. “The impact of Health Insurance in Low- and Middle- Income
Countries”. The Brookings Institution, diciembre de 2010.
Glassman, Amanda, María-Luisa Escobar, Ursula Giedion y Antonio Giuffrida,
eds. “From few to many: a decade of health insurance expansion in Colombia”.
Washington, DC: IDB y Brookings Institution, diciembre de 2009.
Dr. Juan Garduño ESPINOSA
Nació en Maravatío, Michoacán (México) en 1954. Es médico
cirujano por la Facultad de Medicina de la Universidad Nacional
Autónoma de México (UNAM), con especialidad en Medicina
Interna. Maestro y Doctor en Ciencias Médicas por la UNAM. Ha
llevado a cabo adiestramientos en Epidemiología Clínica en el Instituto Nacional
de la Nutrición “Salvador Zubirán” y en Economía de la Salud en el Centro de
Investigación y Docencia Económicas e Instituto Nacional de Salud Pública. Cursó
el Diplomado en Alta Dirección de Empresas en el Instituto Panamericano de Alta
Dirección de Empresas.
Tutor Académico y Profesor titular del Seminario de Investigación de la Maestría en
Ciencias Médicas de la UNAM. Ha graduado 18 alumnos, 12 en el nivel de Maestría
y 6 en el nivel de especialidad. Profesor de fármaco-economía en el Instituto
Tecnológico de Estudios Superiores de Monterrey.
Ha publicado 90 artículos de investigación relacionados con la epidemiología
clínica, calidad de la atención y economía de la salud. Tiene 16 capítulos en libros y
es coautor de 4 libros. Miembro del Sistema Nacional de Investigadores.
Se desempeño en el Instituto Mexicano del Seguro Social como médico, asesor,
Coordinador de Programas Médicos, jefe de Unidad de Investigación, jefe de
División y Coordinador de Áreas Médicas. Actualmente es subdirector de
Investigación en el Hospital Infantil de México “Federico Gómez”.
Dra. Mercedes Juan López
Médica Cirujana con especialidad en Medicina de Rehabilitación
por la Universidad Nacional Autónoma de México (UNAM),
Postgrado en Rehabilitación Neurológica por la Universidad
Autónoma de Metropolitana (UAM) y del Programa Especial de Alta
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
INFORMACIÓN BIOGRÁFICA DE LOS PONENTES INVITADOS
Dirección del Instituto Panamericano de Alta Dirección de Empresas (IPADE).
En la administración pública ha ocupado los cargos de Secretaria Técnica del
Gabinete de Salud de la Presidencia de la República; Subsecretaria de Regulación
y Fomento Sanitario de la Secretaría de Salud, donde impulsó el Programa de
Modernización de la Regulación Sanitaria; Secretaria del Consejo Nacional de
Salud; Secretaria del Consejo de Salubridad General; Titular de la Unidad de Enlace
con el Congreso de la Unión de la Secretaría de Salud; Titular de la Comisión de
Operación Sanitaria de la Comisión Federal para la Protección contra Riesgos
Sanitarios, y actualmente Presidenta Ejecutiva de la Fundación Mexicana para la
Salud.
En el campo legislativo, se desempeñó como Diputada Federal en la LVII
Legislatura, en la que fue Secretaria de las Comisiones de Salud y de Población y
Desarrollo y Vicepresidenta de la Mesa Directiva.
Ha publicado diversos artículos científicos, es autora de 8 libros y coautora de 20
más en diferentes temas de la salud.
En la docencia, ha sido profesora de posgrado en la Facultad de Medicina de la
UNAM y de la UAM.
Es miembro de diversas asociaciones de rehabilitación y salud pública.
Ha recibido premios y distinciones científicas, entre los que se destacan la
condecoración de la Orden Nacional del Mérito con el grado de Oficial, otorgada
por el Gobierno de Francia y el reconocimiento “Commissioner’s Special Citation”
concedido por la Food and Drug Administration del Gobierno de los Estados Unidos
de América.
Tomás A. Pippo Briant, MA, MPH
Economista (Universidad Nacional de La Plata -UNLP-), Máster en
Políticas y Gestión de la Salud (Università di Bologna), Maestrando
en Finanzas Públicas (UNLP). Actualmente se desempeña como
Director a cargo de la Dirección de Economía de la Salud del
Ministerio de Salud de la Nación Argentina, Coordinador del Grupo Técnico de
Acceso Universal a Medicamentos del Consejo Suramericano de Salud (UNASUR)
y representante Argentino en la Comisión Intergubernamental de Política de
Medicamentos de MERCOSUR; es miembro de la Unidad de Coordinación de
Evaluación de Tecnologías Sanitarias del Ministerio de Salud de la Nación y ha
realizado numerosos trabajos de evaluaciones económicas en salud. En el pasado
ha desempeñado actividades docentes en macroeconomía en la Universidad
Católica de La Plata y en economía de la salud en la Universidad ISALUD y ha
desarrollado actividades de consultoría en el ámbito público y privado en temas de
economía de la salud; innovación, ciencia y técnica; y en desarrollo productivo.
Dr. Alarico Rodríguez de León
Alarico Rodríguez de León obtuvo su título de médico en la Facultad
de Medicina de UDELAR, al igual que su título de posgrado y
de Magíster en Salud Pública. Es el Vicedirector (Gerente de
Beneficios) de la Agencia Uruguaya de Procedimientos Médicos
Altamente Especializados (FNR). Ha participado y dirigido
investigaciones sobre la evaluación de tecnologías sanitarias, sistemas de
salud, políticas y financiación de cobertura de salud, políticas sobre fármacos,
transplante de órganos, infecciones hospitalarias, garantía de calidad en servicios
de salud y revisión de la utilización de los servicios de salud. Ha publicado muchos
artículos científicos en suplementos y reseñas, además de capítulos de libros sobre
políticas y administración de la salud, recursos humanos y sanitarios, y bioética. Ha
sido profesor invitado en universidades nacionales e internacionales en cátedras
de magíster y posgrado, tutor del Campus Virtual de la OPS y miembro de la Junta
de Examinadores. Ha brindado conferencias en diversas actividades científicas de
organizaciones internacionales en América Latina, Europa, África y Asia. También
es miembro del Centro Colaborador Cochrane para Uruguay e investigador del
Programa de Evaluación de la Calidad de FNR, representante latinoamericano del
WMA Council, Gerente de Relation Officers with the PAHO of CONFEMEL, miembro
de CGD’s Working Group on Priority-Setting Institutions in Health, socio fundador de
SUSAC, socio fundador y vicepresidente de AESUruguay. Fue Presidente de SMU
SMU (2005); Consejero del Comité de Ética, WMA (2005-2006); Secretario General
de SMU (2003-2004); Gerente de 1727-Emergencias (1998-2000); Gerente de CASMU
(1993-1996); y Docente de la Facultad de Medicina de UDELAR (1994-1995). Además,
ha trabajado en comités oficiales y académicos de instituciones nacionales y
extranjeras.
Dr. Guillermo Williams
El Dr. Guillermo Williams es un especialista en pediatría, diplomado
en Salud Pública por la Universidad Nacional de Buenos Aires.
Actualmente se desempeña como Director Nacional de Regulación
Sanitaria y Calidad en Servicios de Salud en el Ministerio de Salud
de la Nación Argentina. Es el Coordinador Operativo de la Unidad
de Coordinación y Administración de Evaluación de Tecnologías Sanitarias para el
Ministerio de Salud, y el Coordinador por Argentina de la Comisión de Prestación
de Servicios de Salud del SGT-11 Mercosur Salud.
El Dr. Williams es Coordinador y Docente de la Maestría en Salud Pública de la
Universidad Nacional de Buenos Aires, Departamento de Políticas, Sistemas y
Servicios de Salud. Asesor en materia de servicios de salud de la Organización
Mundial de la Salud/Organización Panamericana de la Salud, es ex residente del
programa de salud internacional en la misma institución, y fue Subsecretario de
Salud de la Municipalidad de Moreno, en la provincia de Buenos Aires.
Luis Romero Strooy, MBA
Sr. Romero es el actual Superintendente de Salud del Gobierno
de Chile. Asumió el cargo a partir del 8 de julio de 2010, tras ganar
el correspondiente proceso de selección a través del Sistema de
Alta Dirección Pública. Ingeniero civil industrial de la Pontificia
Universidad Católica de Chile y Master en Administración de
Negocios de la Universidad de San Francisco, California. El es un ejecutivo de
dilatada trayectoria profesional con más de 20 años de experiencia en empresas
nacionales e internacionales relacionadas con el área de Seguros, Salud y
Tecnología (Exxon, Cigna, Colmena Golden Cross). Se desempeñó por muchos años
como director de sociedades gremiales y de clínicas.
INFORMACIÓN BIOGRÁFICA DE PONENTES INVITADOS:
MESAS REDONDAS
Dra. Iris Contreras, MSc
Cirujano (Universidad Nacional Autónoma de México, UNAM),
especialidad en Medicina Interna, maestría en Ciencias SocioMédicas (énfasis en epidemiología, UNAM). Ha trabajado como
internista por más de 10 años y como investigador en la Unidad
de Investigación en Economía de la Salud durante 6 años (ambos
puestos desempeñados en el Instituto Mexicano del Seguro Social, IMSS). Ha sido
líder de proyectos multicéntricos sobre temas de calidad de la atención médica
en pacientes oncológicos, riesgos cardiovasculares, incapacidad temporal para
el trabajo y el VIH / SIDA. Ha participado como consultor en varios proyectos de
investigación sobre temas farmacoeconómicos para Pfizer, Schering-Plough,
MSD y Teva. Profesor de Introducción a la Economía de la Salud de la Maestría en
Ciencias de la Salud (UNAM) y la Maestría en Sistemas de Salud (Instituto Nacional
de Salud Pública). Coordina el diplomado en Economía de la Salud del IMSS y
es profesor del diplomado en Economía de la Salud del Instituto Tecnológico
y de Estudios Superiores de Monterrey. Es autora o co-autora de 18 artículos
científicos, la mayoría de ellos en el área de fármaco-economía. Miembro activo de
International Society For Pharmacoeconomics and Outcomes Research (ISPOR),
actualmente presidente del comité de agencias de evaluación de tecnologías para
el Consorcio latinoamericano de ISPOR. Al presente se encuentra laborando como
Jefe del servicio de Medicina Interna en el Hospital General de Zona con Unidad de
Medicina Familiar No. 26 “Chilpancingo” del IMSS, en México Distrito Federal.
31
3ª Conferencia ISPOR para América Latina
8–10 de septiembre de 2010 • Hilton Mexico City Reforma • Ciudad de México, México
INFORMACIÓN BIOGRÁFICA DE LOS PONENTES INVITADOS
Alexandre Lemgruber, MSc
Alexandre Lemgruber, MSc, recientemente ha asumido como
Asesor de Gerente de Tecnologías Sanitarias en la Organización
Panamericana de la Salud (OPS). Hasta julio de 2011 fue Jefe de
la Oficina de Evaluación Económica de Nuevas Tecnologías en
la Agencia Nacional de Vigilancia Sanitaria de Brasil (ANVISA),
responsable de las evaluaciones que apoyan las decisiones sobre los precios
de los nuevos fármacos. Previamente trabajó en el Ministerio de Salud de Brasil
y en la Agencia Nacional de Salud Suplementaria (ANS) de Brasil. Desde 2001
hasta 2011 trabajó en ANVISA, donde era responsable de proponer políticas de
regulación de precios en base a las evaluaciones de tecnologías sanitarias (HTA) y
ha contribuido significativamente al apoyo de las actividades de HTA en el país.
Es el fundador del Boletín Brasileño de Evaluación de Tecnologías en Salud
(BRATS) y fue miembro de la Comisión de Evaluación de Tecnologías en Salud
(CITEC), responsable de tomar decisiones acerca de las tecnologías cubiertas por
el Sistema de Salud Pública (SUS). Como uno de los representantes brasileños
de la Comisión de Evaluación de Tecnologías Sanitarias del MERCOSUR, ha
contribuido significativamente al apoyo de actividades de HTA en la región. Ha
coordinado varios proyectos en el área de las HTA, en cooperación con ANVISA
y la Organización Panamericana de la Salud (OPS), y fue el co-autor de la Política
Nacional sobre Administración de Tecnologías Sanitarias.
Dr. Luis Vera Benavides, MEBPH
Médico Cirujano, Magister en Salud Pública Basada en la
Evidencia. Actualmente es Profesional Asistente del Departamento
de Calidad y Seguridad del Paciente del Ministerio de Salud y
los últimos tres años se ha enfocado a relacionar la Evaluación
de Tecnologías Sanitarias con las Políticas Públicas y la toma
de decisiones en Salud. Forma parte de la Subcomisión Técnica Regional del
Organismo Regional Andino de Salud, Comisión que actualmente preside y donde
ha impulsado la generación de la Política Andina de Evaluación de Tecnologías
Sanitarias y las Directrices para Evaluación de Tecnologías Sanitarias con énfasis
32
en los procesos de implementación que llevan a cabo los países de la subregión.
En docencia universitaria apoya actualmente Tesis tanto de pregrado como de
Postgrado en carreras como Ingeniería Biomédica y Enfermería en universidades
nacionales y también en el Programa Internacional Ullyses. Participa también en
Proyectos de Investigación del Fondo Nacional de Salud (FONIS) como investigador
principal y alterno y otros de financiamiento internacional, intentando mantener
una estrecha relación entre la investigación y la toma de decisiones en salud.
Dr. Esteban Hernandez-San Roman
El Dr. Esteban Hernández San Román es Médico Cirujano con
especialidad en Cirugía General; realizó estudios de postgrado en
Ginecología Oncológica, Cirugía Gastrointestinal y Laparoscópica,
Gerencia y Economía de los Servicios de Salud así como en
Medicina Basada en la Evidencia.
Estuvo adscrito durante 17 años al Servicio de Cirugía General del Hospital General
del Centro Médico Nacional “La Raza” donde durante 10 de dichos años fue
Profesor Adjunto del Curso de Especialización en Cirugía General.
Ha ocupado varios cargos en el Sector Público y Privado entre los que destacan:
Director de Equipamiento de la Secretaría de Salud, Jefe del Área de Planeación
del Equipamiento en el Instituto Mexicano del Seguro Social y Director General de
la Empresa de Consultoría Proyectos y Equipamiento en Salud (PROESA). A partir
de mayo de 2006 es Director de Evaluación de Tecnologías en Salud en el Centro
Nacional de Excelencia Tecnológica en Salud.
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Letter from the ISPOR Latin America Consortium
Executive Committee Chair
Letter from the ISPOR 3rd Latin America Conference
Program Committee Co-Chairs
Conference Program Committee
Key Information
Conference at-a-glance
Conference Short Course Program
Program & Schedule of Events
Corporate & Event Supporters
Issue Panel & Workshop Descriptions
Sponsored Symposia Descriptions
Invited Speaker Biographical Information
ENGLISH
33
Dear Colleagues:
It is my great pleasure to welcome you to the ISPOR 3rd Latin American Conference in Mexico City, Mexico,
which is co-organized by ISPOR and the ISPOR Latin America Consortium, in conjunction with the ISPOR
Mexico Regional Chapter.
During the past two years, members of the ISPOR Latin America Consortium have been working closely with
ISPOR to make this Conference a success.
The ISPOR Latin America Consortium is a group of individuals interested in promoting the science of pharmacoeconomics and
outcomes research for better health care decision making in the region. For this Conference, the Consortium is well-represented
by members throughout Latin America, and benefits from the participation of its many members in Argentina, Brazil, Colombia,
Chile, Ecuador, Mexico, Peru, Puerto Rico, Uruguay, Venezuela and elsewhere.
The Consortium, under the leadership of its Executive Committee, is also composed of an Advisory Committee and 7 Working
Committees, organized either by task or working environment:
• ISPOR Latin America Conference Committee
• Education Committee
• Publication Committee
• Health Technology Producers (Industry) Committee
• Health Service Providers Committee
• Health Technology Assessment Agencies (HTA) Committee
• Health Policymakers and Payers Committee
These committees work closely together to ensure that the Consortium meets its goals of providing a platform for informationsharing at a regional level for researchers, health care practitioners and decision-makers; fostering networking among
professionals interested in pharmacoeconomics and outcomes research in the region and abroad; encouraging the use of
pharmacoeconomics and outcomes research by health care decision-makers in Latin America; promoting the concepts of
efficiency and affordability for better utilization of health care resources in Latin America; providing an opportunity for ISPOR
members to become more familiar with the use of this science as well as health care policies in Latin America and worldwide;
serving as a resource at the regional level for individuals interested in pharmacoeconomics and outcomes research; and
promoting and supporting the formation and activities of the ISPOR Regional Chapters in Latin America.
One of the main activities of the Consortium is to develop and facilitate the ISPOR Latin America biennial conferences. Following
the ISPOR 1st Latin American Conference in Cartagena, Colombia in September 2007, the ISPOR Latin American Consortium
successfully co-organized the ISPOR 2nd Latin America Conference in Rio de Janeiro in September 2009. In addition to these
conferences, the Consortium recently published its first Value in Health Special Issue “Pharmacoeconomics and Outcomes
Research in Latin America”, which features manuscripts in English, Spanish and Portuguese that focus on study populations in
Latin America. The Consortium also launched its first Spanish Distance Learning Program, available at the ISPOR website.
In the formation and support of ISPOR Regional Chapters in Latin America, the Consortium has played a significant role through
its members in each country. Since its initiation in 2007, the Latin American Consortium has grown to include 11 Chapters
encompassing over 700 regional members. The Consortium also provides scientific support for chapters in organizing their annual
conferences and educational forums.
In recognizing the achievements of the Consortium, I would like to acknowledge the leadership of Dr. Federico Augustovski,
2010-2012 Past Chair of the Consortium Executive Committee, Dr. Márcio Machado, 2010-2012 Chair of the Advisory Committee,
current Consortium Working Committee Chairs, and all Consortium members who have dedicated their time, effort, and expertise
voluntarily to make this Consortium a success.
My best wishes that you enjoy this great conference.
Sincerely,
Guillermo Meléndez, MD, MSc
2010-2012 Chair, ISPOR Latin America Consortium Executive Committee
Scientific Coordinator
Nutrition Nestlé Fund
Mexican Foundation for Health (FUNSALUD)
Mexico City, Mexico
34
Dear Colleagues:
It is an honor for us to be able to welcome you to the ISPOR 3rd Latin America
Conference and to Mexico City.
Mexico is known for its cultural diversity, world-class museums and as an
A. Marasco
G. Meléndez
important component of the history of the American continent. Our conference is
located within steps of some of the most striking cultural aspects of Mexico City: in the heart of the city, Bellas
Artes, one of the most beautiful buildings dedicated to art and music, and also within walking distance the
“Zócalo”, “Palacio Nacional”, and many other notable colonial buildings and palaces.
We would like to extend our thanks to the members of the Conference Program Committee for developing a
comprehensive scientific program, offering the latest in pharmacoeconomics and outcomes research in clinical
practice, with the opportunity for open discussions and debates at the various educational short courses, plenary
sessions and scientific presentations.
The first Plenary Session focuses on “Universal Coverage in the Face of Rising Costs of New Health Care
Technologies: Is It Achievable?”, an issue of great importance to countries in our region. The second Plenary
Session features an important discussion: “What Is the Value of Health Outcomes Research to Decision-Makers:
A Candid Discussion with Public Decision-Makers”, where different country representatives will provide their
perspective on the validity of health outcomes research, and how research findings are being used to make
informed decisions.
With over 200 educational and scientific presentations scheduled (many of which feature simultaneous
interpretation to facilitate attendee participation) as well as the many networking opportunities available, we are
sure that you will enjoy all the benefits provided by the ISPOR 3rd Latin America Conference.
We hope you enjoy the conference!
Best regards,
Antonio Caso Marasco, MD, MEd
ISPOR 3rd Latin America Conference
Program Committee Co-Chair
Post Graduate Hematology Professor
& Distance Learning Coordinator
Subdivision of Continuing Medical Education
Post Graduate Division, Faculty of Medicine
National Independent University of Mexico
and President, Mexican College for
Pharmacoeconomics, Mexico City, Mexico
Guillermo Meléndez, MD, MSc
ISPOR 3rd Latin America Conference
Program Committee Co-Chair
Scientific Coordinator
Nutrition Nestlé Fund
Mexican Health Foundation (FUNSALUD)
Mexico City, Mexico
35
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
CONFERENCE PROGRAM COMMITTEE CHAIRS
PROGRAM COMMITTEE CO-CHAIRS
Antonio Caso Marasco, MD, MEd
Post Graduate Hematology Professor & Distance
Learning Coordinator, Subdivision of Continuing
Medical Education, Post Graduate Division, Faculty
of Medicine, National Independent University
of Mexico, and President, Mexican College for
Pharmacoeconomics, Mexico City, Mexico
ISSUE PANEL REVIEW COMMITTEE CO-CHAIRS
Guillermo Meléndez, MD, MSc
Scientific Coordinator, Nutrition Nestlé Fund, Mexican
Health Foundation (FUNSALUD), Mexico City, Mexico
RESEARCH REVIEW COMMITTEE CO-CHAIRS
Joaquín Federico Mould-Quevedo, PhD, MSc, MBA
HE&OR Director for Latin America and Primary Care,
Pfizer Laboratories Inc., New York, NY, USA
Yajaira Bastardo, PhD
Administrative Director & Professor, School of
Pharmacy, Central University of Venezuela, Caracas,
Venezuela
Gabriela Tannus Araújo, MSc, MBA
Health Economics Director, Axia.Bio Consulting, São
Paulo, Brazil
Iris Contreras, MD, MSc
Clinical Researcher, Mexican Institute of Social
Security, Mexico City, Mexico
WORKSHOP REVIEW COMMITTEE CO-CHAIRS
Carlos Andrés Castañeda Orjuela, MD, MSc
Researcher, Epidemiologic Group & Public Health
Evaluation, National University of Colombia, Bogotá,
Colombia
HEALTH CARE DECISION-MAKER CASE STUDY
REVIEW COMMITTEE CO-CHAIRS
Carlos Cruz
Director, Public Health Institute,
Central University of Ecuador, Quito, Ecuador
Gerardo Machnicki, MSc
Director, Global HE&OR, Novartis Argentina, Buenos
Aires, Argentina
Alfonso Reyes López, PhD
Senior Researcher, Federico Gómez Mexican
Children’s Hospital, Mexico City, Mexico
KEY INFORMATION
CONFERENCE OBJECTIVES
REGISTRATION MATERIALS
Participants will be able to:
• Learn new pharmacoeconomic methodologies and outcomes research
techniques;
• Improve the quality of their decision making by better utilization of
pharmacoeconomic studies; and
• Learn the latest about measuring quality of life and selecting appropriate survey
instruments.
The following materials are included in your registration envelope:
CONFERENCE LANGUAGES/TRANSLATION
Official Conference Languages are Spanish and English. Plenary Sessions will be
presented with simultaneous Spanish - English interpretation. Session languages
are indicated next to the session title in the Program & Schedule of Events.
Sessions with simultaneous interpretation are indicated by
.
GUIDE TO THE PROGRAM & SCHEDULE OF EVENTS
For your convenience, this Program & Schedule of Events has been printed in
Spanish and English. For the Spanish version, refer to pages 5-32 and for the
English version, refer to pages 33-59.
Podium and poster abstracts are included in the language submitted by the authors.
See page 73 for podium and poster abstracts.
36
• NEW Short Course ticket for each Short Course for which you are registered
(you MUST bring your Short Course ticket to the Short Course room to receive
your Short Course materials);
• One complimentary drink ticket to the ISPOR Welcome Reception: Thursday, 8
September 21:00-23:00;
• One complimentary drink ticket to the Research Poster Presentations & Exhibitors’
Reception: Friday, 9 September 18:30-20:00;
• Attendee list which includes attendee name, organization, and country, based on
the data collected at the time of registration; and
• Other promotional information.
RESEARCH PODIUM & POSTER PRESENTATION ABSTRACTS
Abstracts for all research podium and poster presentations given at the ISPOR 3rd
Latin America Conference will be published in Value in Health Volume 14, Issue
7. Value in Health Volume 14, Issue 7 will be available to ISPOR members and
ISPOR 3rd Latin America Conference registrants on-line at: http://www.ispor.org/
valueinhealth_index.asp in October 2011.
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research podium, poster, and health care decision-maker abstracts are also
included in this Program & Schedule of Events. See page 62 for a listing of Poster
Presentations (Research and Case Studies) and the Schedule of Events section for
Research Podium Presentations. Page numbers to the left of the presentation code
refer to the abstract location in this Program & Schedule of Events.
FINANCIAL DISCLOSURE INFORMATION
Research podium and poster presentation financial disclosure information will be
available on-line after the Conference in October 2011 at: http://www.ispor.org/
valueinhealth_index.asp and in Value in Health Volume 14, Issue 7.
ABSTRACT SUBMISSION HISTORICAL INFORMATION:
Year Research Workshop Issue Panel
Case
Total
Studies
Not
Accepted (%)
2007
117
12
-
-
129
7.8%
2009
256
8
5
8
277
7.2%
2011
212
14
5
4
235
4.3%
During the ISPOR 3rd Latin America Conference, 158 research and decision-maker
case study posters, 38 research podiums, 10 workshops and 4 issue panels will be
presented.
SPEAKER INFORMATION
All speakers are requested to arrive at their presentation room 15 minutes prior to
the session start time with their presentation on a USB/Flash Drive and required
handouts (for podium, workshop and issue panel presentations). ISPOR staff
will assist the presenter with loading their presentation. Please note that all
presentations submitted to ISPOR by the specified advance deadline will be preloaded onto the computer in the session room.
HANDOUTS
• Plenary Sessions
Handouts for the plenary session are available in the session room at the time of
the presentations.
• Research Presentations, Workshops & Issue Panels
Handouts for Contributed Presentations (research podiums, posters, workshops
and issue panels) are the sole responsibility of the presenting author(s). ISPOR
requires all contributed presenters to provide at least 200 copies of their
handouts.
• Educational Symposia
Handouts for symposia are the sole responsibility of the host organizations.
ISPOR suggests all symposium organizations provide at least 100 copies of their
handouts.
• All Remaining & Additional Handouts
All remaining or additional handouts will be made available at the handout table
near the ISPOR Registration Desk.
PLEASE NOTE: Following the conference, subject to
author’s permission, released research presentations are
available in the
ISPOR Outcomes Research Digest:
A searchable database of over 17,000 research abstracts
presented at ISPOR’s meetings from 1998 to date available
at www.ispor.org.
RESEARCH PODIUM PRESENTATIONS
Outcomes research (clinical, economic, and patient-reported), health policy
research and research on methods for the following topics will be presented as
15-minute oral presentations:
CN - Cancer Outcomes Research
CV - Cardiovascular Disorders Outcomes Research
EX - Health Care Expenditure or Reimbursement Studies
HS - Health Services Research
IN - Infection Outcomes Research
QA - Examining the QALY
PR - Patient-Reported Outcomes Studies
RM - Research on Methods
TP - Health Policy Treatment Patterns
VA - Vaccine Outcomes Research
See pages 73-82 for Research Podium Presentation Abstracts
RESEARCH POSTER PRESENTATIONS
Poster presentations will be on view in Don Diego 1.
Poster Display Hours:
Friday, 9 September: 8:30-20:00
Saturday, 10 September: 8:00-13:45
Poster Set-Up: Friday, 9 September: 8:00-8:30
Poster Author Discussion Hour: Friday, 9 September: 18:30-19:30
Poster Dismantle: Saturday, 10 September: 13:45-14:15
Presenters are required to stand at their posters during the Poster Author
Discussion Hour. See pages 62-72 for research poster presentation titles and
authors and pages 83-119 for research poster abstracts.
Please note: Posters not removed during the scheduled dismantle time will be
discarded.
Research Poster Presentation Classification:
PCN - CANCER
PCV - CARDIOVASCULAR DISORDERS (Stroke, Other Cardiovascular)
PDB - DIABETES/ENDOCRINE DISORDERS
PGI - GASTROINTESTINAL DISORDERS
PHP - HEALTH CARE USE & POLICY STUDIES
PIH - INDIVIDUAL’S HEALTH (Children’s, Elderly’s, Men’s, Women’s)
PIN - INFECTION
PMH - MENTAL HEALTH
PMS - MUSCULAR-SKELETAL DISORDERS (Arthritis, Osteoporosis,
Other Muscular-Skeletal)
PND - NEUROLOGICAL DISORDERS
PRM - RESEARCH ON METHODS
PRS - RESPIRATORY-RELATED DISORDERS (Allergy, Asthma, Smoking, Other
Respiratory)
PSS - SENSORY SYSTEMS DISORDERS (Ear, Eye, Skin)
PSY - SYSTEMIC DISORDERS/CONDITIONS (Auto-Immune Disorders,
Hematological Disorders, Metabolic Disorders, Obesity, Pain)
PUK - URINARY/KIDNEY DISORDERS
PCASE - HEALTH CARE DECISION-MAKER’S CASE STUDIES
RESEARCH PRESENTATION AWARDS
Awards are given for the Best Research Podium Presentations (up to 6) and
Best Research Poster Presentations (up to 6). All podium presentations
are considered for an award. Poster research presentations in the top 40%,
based on abstract review score, are considered for a poster award. These
are identified with a rosette.
ISPOR Research Awards Presentation will be presented on Saturday, 10
September at 13:30-13:45 in Don Diego 4.
EXHIBITS
Exhibits will be on view in the Don Diego Foyer.
Friday, 9 September: 8:30-20:00
Saturday, 10 September: 8:00-13:45
MEETING PROGRAM WARNING & USE OF PHOTOGRAPHIC
IMAGES
Please be advised that recording, by any means, of Conference presentations
is prohibited. The International Society for Pharmacoeconomics and Outcomes
Research (ISPOR) will strictly enforce its rights as the exclusive licensee of all
publication and reproduction rights to each presentation, and no presentation, in
whole or in part, may be reproduced without prior approval from ISPOR.
Registration and attendance at the ISPOR 3rd Latin America Conference constitutes
an agreement by the registrant to ISPOR’s use of their image (photograph and
video) now and in the future.
37
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
CONFERENCE AT-A-GLANCE
THURSDAY, 8 SEPTEMBER
8:00-17:00
ALL DAY SHORT COURSES (registration required)
INTRODUCTION TO PHARMACOECONOMICS (PHARMACOECONOMICS FOR DECISIONMAKERS) Don Diego 1
8:00-12:00
MORNING SHORT COURSES (registration required)
INTRODUCTION TO MODELING Don Diego 2
HEALTH CARE & REIMBURSEMENT SYSTEMS IN LATIN AMERICA Don Diego 3
INTRODUCTION TO QUALITY OF LIFE / PATIENT-REPORTED OUTCOMES Don Genaro
INTRODUCTION TO META-ANALYSIS & SYSTEMATIC LITERATURE REVIEW Don Americo
BUDGET IMPACT ANALYSIS Don Diego 4
12:00-13:00 LUNCH (Attendees on their own)
13:00-17:00 AFTERNOON SHORT COURSES (Registration required)
APPLIED MODELING Don Diego 2
HEALTH TECHNOLOGY ASSESSMENT Don Diego 4
UTILITY MEASURES Don Diego 3
EXTRACTING COST DATA FOR ECONOMIC ANALYSIS IN LATIN AMERICA Don Americo
PATIENT REGISTRIES Don Genaro
16:00-16:15 BREAK, EXHIBITS & RESEARCH POSTER PRESENTATIONS
Don Diego 1 & Foyer
16:15-17:15 ISSUE PANELS & WORKSHOPS – SESSION II
IP2: RISK-SHARING SCHEMES IN EMERGING COUNTRIES: WHAT ARE THE STEPS FOR
SUCCESS? Don Diego 4
W4: GUIDELINES FOR APPROPRIATE SELECTION OF MODELING APPROACH IN
PHARMACOECONOMIC EVALUATION IN LATIN AMERICA Don Americo
W5: EQ-5D: A KEY PART OF THE LATIN AMERICAN DECISION-MAKERS’ TOOLKIT Don Diego 2
W6: EVALUACIÓN DE TECNOLOGÍAS SANITARIAS EN CHILE: PASADO, PRESENTE Y FUTURO
Don Diego 3
17:30-18:30 RESEARCH PODIUM PRESENTATIONS – SESSION II
CANCER OUTCOMES RESEARCH Don Diego 4
HEALTH SERVICES RESEARCH Don Americo
INFECTION OUTCOMES RESEARCH Don Diego 2
PATIENT-REPORTED OUTCOMES STUDIES Don Genaro
RESEARCH ON METHODS Don Diego 3
18:30-19:30 RESEARCH POSTER AUTHOR DISCUSSION HOUR Don Diego 1
17:15-18:15 EDUCATIONAL SYMPOSIUM Don Diego 4
18:30-20:00EXHIBITORS’ RECEPTION & RESEARCH POSTER PRESENTATIONS
VIEWING Don Diego 1 & Foyer
CANCER TREATMENT IN LATIN AMERICA: PERSPECTIVES, ACCESS, AND SUSTAINABILITY
(Sponsored by Sanofi)
19:30-21:00
18:30-19:30
EDUCATIONAL SYMPOSIUM Don Diego 4
HOW CAN WE AVOID A STROKE CRISIS IN LATIN AMERICA? A REPORT FROM AN
INDEPENDENT WORKING GROUP (Sponsored by Bayer HealthCare)
19:45-20:45
EDUCATIONAL SYMPOSIUM Don Diego 4
EDUCATIONAL SYMPOSIUM Don Diego 4
STATUS UPDATE OF THE REIMBURSEMENT REVIEW ENVIRONMENT ACROSS LATIN AMERICA
(Sponsored by Millcreek Outcomes Group)
SATURDAY, 10 SEPTEMBER 2011
7:45-8:45
EDUCATIONAL SYMPOSIUM Don Diego 4
STRIKING THE RIGHT LEVEL: “MICRO AND MACRO” HTA IN EMERGING MARKETS / HEALTH
SYSTEMS (Sponsored by PhRMA)
BIOLOGIC AND BIOSIMILAR DRUGS IN LATIN AMERICA: FUNDING CHALLENGES FOR PAYERS
AND DEVELOPERS (Sponsored by Pfizer)
20:45-23:00 WELCOME RECEPTION Terraza Alameda
8:00-9:00
FRIDAY, 9 SEPTEMBER
EXHIBITS & RESEARCH POSTER PRESENTATIONS
Don Diego 1 & Foyer
8:30-8:45
WELCOME ADDRESS & OPENING REMARKS Don Diego 4
9:00-10:30
WELCOME, ISPOR DISTINGUISHED SERVICE AWARDS
PRESENTATION & SECOND PLENARY SESSION Don Diego 4
8:45-9:15
INAUGURAL MESSAGE Don Diego 4
9:15-10:30
FIRST PLENARY SESSION
WHAT IS THE VALUE OF HEALTH OUTCOMES RESEARCH TO DECISION-MAKERS:
A CANDID DISCUSSION WITH PUBLIC DECISION-MAKERS
Don Diego 4
UNIVERSAL COVERAGE IN THE FACE OF RISING COSTS OF NEW HEALTH CARE TECHNOLOGIES:
IS IT ACHIEVABLE?
10:30-11:00 BREAK, EXHIBITS & RESEARCH POSTER PRESENTATIONS
Don Diego 1 & Foyer
10:30-11:00 BREAK, EXHIBITS & RESEARCH POSTER PRESENTATIONS
Don Diego 1 & Foyer
11:00-12:00 ISSUE PANELS & WORKSHOPS – SESSION III
CARDIOVASCULAR DISORDERS OUTCOMES RESEARCH Don Americo
HEALTH CARE EXPENDITURE OR REIMBURSEMENT STUDIES Don Diego 3
EXAMINING THE QALY Don Diego 2
HEALTH POLICY TREATMENT PATTERNS Don Diego 4
VACCINE OUTCOMES RESEARCH Don Genaro
IP3: EL PAPEL DE LAS AGENCIAS DE EVALUACIÓN DE TECNOLOGÍAS EN AMÉRICA LATINA
Don Diego 2
W7: THE ROLE OF HEALTH ECONOMIC AND OUTCOMES RESEARCH (HEOR) EVIDENCE IN
FORMULARY AND REIMBURSEMENT DECISIONS IN LATIN AMERICA VERSUS THE UNITED
STATES Don Diego 4
W8: METHODS FOR INDIRECT AND MIXED TREATMENT COMPARISONS: TOOLS FOR
ASSESSING HEALTH TECHNOLOGIES IN THE ABSENCE OF DIRECT EVIDENCE Don Americo
W9: INNOVATIVE APPROACHES TO IMPROVE MEDICATION ADHERENCE Don Diego 3
12:00-15:00 LUNCH, EXHIBITS & RESEARCH PRESENTATIONS
12:15-13:15 ISSUE PANELS & WORKSHOPS – SESSION IV
11:00-12:00 RESEARCH PODIUM PRESENTATIONS – SESSION I
12:30-13:30
EDUCATIONAL SYMPOSIUM Don Diego 4
HEALTH ECONOMIC ANALYSIS IN LATIN AMERICA: CAN LESSONS LEARNED FROM OTHER
PARTS OF THE WORLD BE APPLIED? (Sponsored by IMS Consulting Group)
13:45-14:45
EDUCATIONAL SYMPOSIUM Don Diego 4
HIGH COST MEDICINES: DO THEY BRING VALUE TO HEALTH SYSTEMS IN LATIN AMERICA
AND HOW TO ENSURE APPROPRIATE ACCESS? (Sponsored by Eli Lilly and Company)
15:00-16:00 ISSUE PANELS & WORKSHOPS – SESSION I
IP1: HTA LEVEL OF INFLUENCE: TO WHAT EXTENT DOES HTA INFLUENCE MARKET ACCESS
DECISIONS ACROSS GEOGRAPHIES? Don Diego 2
W1: METHODS FOR THE CRITICAL REVIEW OF COST-EFFECTIVENESS MODELS SUBMITTED
TO REIMBURSEMENT AUTHORITIES: LEARNING FROM INTERNATIONAL EXPERIENCE
Don Diego 4
W3: USE OF REAL WORLD DATA FOR RESEARCH IN LATIN AMERICA Don Diego 3
38
IP4: EL COSTO DE LOS TRASTORNOS DEL ESTADO DE ÁNIMO: ¿QUÉ ASPECTO GENERA EL
MAYOR GASTO PARA LOS SISTEMAS DE SALUD? ¿QUÉ GENERA LA ALTA DISCAPACIDAD
ASOCIADA? UNA PERSPECTIVA SOCIAL, ECONÓMICA Y GLOBAL Don Diego 3
W10: A LACK OF LOCAL EFFECTIVENESS, COST AND EPIDEMIOLOGIC DATA: WHAT ARE THE
OPTIONS FOR CONDUCTING PE STUDIES IN LATIN AMERICA? Don Diego 2
W12: THE FUTURE OF PHARMACEUTICAL COST CONTROLS IN LATIN AMERICA: HTA OR
REFERENCE PRICING? Don Diego 4
13:30-13:45
ISPOR RESEARCH PRESENTATIONS AWARDS &
CLOSING REMARKS Don Diego 4
ISPOR Registration HOURs:
Thursday, 8 September 7:00-17:00
Friday, 9 September 7:00-18:00
Saturday, 10 September 7:30-13:30
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Short Course Program
Thursday, 8 September 2011
ALL DAY COURSE (8:00-17:00)
INTRODUCTION TO PHARMACOECONOMICS
(PHARMACOECONOMICS FOR DECISION-MAKERS)
Presented in Spanish Don Diego 1
Faculty: Diego Rosselli, MD, MEd, MHP, Associate Professor, Health Economics, Javeriana Papal University, Bogota,
Colombia; Adolfo Rubinstein, MD, MSc, PhD, President,
Institute for Clinical Effectiveness and Health Policy (IECS)
and Director of the Master´s Program in Clinical EffectiveD. Rosselli A. Rubinstein
ness, Faculty of Medicine, University of Buenos Aires,
Buenos Aires, Argentina
Course Description: This course is designed to teach clinicians and new researchers how to incorporate pharmacoeconomics into study design and data analysis.
Participants will learn how to collect and calculate the costs of different health care
or health care economic evaluation alternative treatments, determine the economic
impact of clinical outcomes, and how to identify, track and assign costs to different
types of health care resources used. The development of economic protocols and
data collection sheets will be discussed. Different pharmacoeconomic models and
techniques will be demonstrated as well as case studies. These include cost-minimization, cost-of-illness, cost-effectiveness, cost-benefit, and cost-utility analysis.
Decision analysis, sensitivity analysis, and discounting, will all be demonstrated and
practiced. Participants will also learn to compare and evaluate interventions such as
drugs, devices and clinical services.
Level: Introductory. This course is suitable for those with little or no experience with
pharmacoeconomics.
MORNING COURSES (8:00-12:00)
INTRODUCTION TO MODELING
Presented in Spanish Don Diego 2
Faculty: Federico Augustovski, MD, MSc, PhD, Director,
Economic Evaluations and HTA Department, Institute for
Clinical Effectiveness and Health Policy (IECS), Professor
of Public Health, University of Buenos Aires, and Staff
F. Augustovski P. Anaya
Physician, Family and Community Medicine Division, Italian
Hospital of Buenos Aires, Buenos Aires, Argentina; Pablo Anaya, MHA, HE&OR
Manager, GlaxoSmithKline Mexico, Bosque Real, Mexico City, Mexico
Course Description: This course includes a review of Markov models, discrete event
models, and other modeling techniques and their appropriate applications, including
a review of the ISPOR Principles of Good Practice for Decision Analytic Modeling in
Health Care Evaluations. Using a series of related examples, the course will carefully
review the practical steps involved in developing and using these kinds of models.
Examples will be presented using predominantly Microsoft Excel, supplemented with
add-on simulation software. This course will cover the practical steps involved in the
selection and modeling of data inputs and practical aspects related to the determination of when, why and how to handle stochastic (i.e., first order Monte Carlo Simulations) and probabilistic uncertainty (i.e., second order Monte Carlo Simulations).
Issues related to the selection of model input parameters and their distributions for
use in probabilistic sensitivity analyses will be considered. Participants will learn
the steps required in conducting, analyzing, interpreting, and presenting results
from probabilistic sensitivity analyses (e.g., using analyses of the cost-effectiveness
plane, the “ellipses”, and acceptability curves).
Level: Introductory. This course requires some familiarity with decision analysis.
HEALTH CARE & REIMBURSEMENT SYSTEMS IN LATIN AMERICA
Presented in Spanish Don Diego 3
Faculty: Leonardo Cubillos, MD, MPH, Health Systems
Practice, World Bank Institute, Washington, DC, USA;
Diego Guarín, MD, MPH, MA, Director, Market Access
Latin America, Merck Sharp & Dohme, Mexico City, Mexico;
Henry Maquera Colque, MBA, Executive Secretary,
L. Cubillos
D. Guarín
Solidarity Health Fund of Peru (FISSAL), Lima,
Peru; Giota Panopoulou, PhD, Consultant,
Finance Division, Mexican Institute of Social
Security, Mexico City, Mexico; Alarico
Rodríguez de Leon, MD, Assistant Director of Medical Technologies, Uruguayan
H. Colque
G. Panopoulou A. Rodríguez
de Leon
National Agency for Highly Specialized Medical Procedures, Montevideo, Uruguay
Course Description: This session will first discuss the current health care systems
in the main Latin American countries, discussing research implementation and its
linkage with regional priorities. The faculty will then describe the reimbursement
legislation, processes and organizations within these countries as well as the role of
the pharmaceutical and/or medical device manufacturer. This course will then focus
on providing participants with an understanding of the various procedures employed
by Latin American health authorities to regulate market access based upon the
appraisal of the clinical and in some countries economic value of new medical technologies. Formulary submission guidelines set analytical and evidentiary standards
which drug manufacturers and others are required to meet in making a case for their
product. Faculty will discuss evidentiary standards in formulary submissions.
Level: Introductory.
INTRODUCTION TO QUALITY OF LIFE / PATIENT-REPORTED
OUTCOMES
Presented in Spanish Don Genaro
Faculty: Yajaira Bastardo, PhD, Administrative Director
and Professor, School of Pharmacy, Central University of
Venezuela, Caracas, Venezuela; Nelson Alvis Guzmán,
PhD, MD, MPH, Professor and Researcher, Faculty of
Y. Bastardo N. Guzmán
Economic Sciences & Director, Health Economics Research
Group, University of Cartagena, Cartagena, Colombia
Course Description: Conceptual, methodological, and practical methods for measuring quality of life, health status and other types of health outcomes will be presented.
Theoretical frameworks, reliability, validity, responsiveness, methods of administration, respondent and administrative burdens, and issues of analysis and interpretation will be discussed using examples drawn from specific quality of life instruments
and their applications. A model of selecting appropriate instruments from the many
existing generic and disease-specific instruments will be presented. Level: Introductory. This course is intended for those with little experience with
these methodologies.
INTRODUCTION TO META-ANALYSIS AND SYSTEMATIC
LITERATURE REVIEW
Presented in Spanish Don Americo
Faculty: Agustín Ciapponi, MD, Coordinator, Argentine Cochrane Centre
IECS (Institute for Clinical Effectiveness and Health Policy), Iberoamerican Cochrane Network, and Family and Community Medicine Service,
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
A. Ciapponi
Course Description: Systematic literature review and meta-analytic
methods to assess the quality of evidence for health care interventions
will be discussed. Statistical approaches to pooling results from several studies
and application of meta-analysis in pharmacoeconomics studies and health care
decision-making will be presented.
Level: Introductory. This course is designed for individuals with little experience with
meta-analysis.
BUDGET IMPACT ANALYSIS
Presented with simultaneous English-Spanish interpretation Don Diego 4
Faculty: C. Daniel Mullins, PhD, Professor and Chair,
Pharmaceutical Health Services Research, University
of Maryland School of Pharmacy, Baltimore, MD, USA;
Ariadna Juárez García, PhD, MSc, HEOR Manager, Health
Economics, Bristol-Myers Squibb, Mexico City, Mexico
Course Description: This course will describe methods
C. D. Mullins A. García
39
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Short Course Program: Thursday, 8 September 2011
to determine the costs associated with a health condition and the budget impact of
new technologies for that condition. The course will present incidence- and prevalence-based costing strategies. Treatment algorithms and event-based approaches
will be demonstrated for disease-specific costs from different decision-maker
perspectives. Both static and dynamic methods for estimating the budget impact
of adding a new drug to a health plan formulary will be presented. Issues related to
imputing missing data will also be discussed.
Level: Intermediate. This course is designed for those with some experience with
pharmacoeconomic analysis.
AFTERNOON COURSES (13:00-17:00)
APPLIED MODELING
Presented in Spanish Don Diego 2
Faculty: Federico Augustovski, MD, MSc,
PhD, Director, Economic Evaluations and
HTA Department, Institute for Clinical Effectiveness and Health Policy (IECS), Professor
F. Augustovski A. P
ichon- S. Martí
of Public Health, University of Buenos Aires,
Riviere
and Staff Physician, Family and Community
Medicine Division, Italian Hospital of Buenos Aires, Buenos Aires, Argentina; Andrés
Pichon-Riviere, MD, MSc, PhD, Executive Director, IECS, and Adjunct Professor, School of Public Health, Department of Medicine, University of Buenos Aires,
Buenos Aires, Argentina; Sebastián García Martí, MD, MSc, Health Technology
Assessment & Economic Evaluation, IECS, Buenos Aires, Argentina
Course Description: This course is a hands-on introduction to the use of software
in the creation and analysis of cost-effectiveness decision models. The basics of
cost-effectiveness decision making, building and analyzing a simple decision tree
will be discussed. Markov modeling and Monte Carlo simulation will be introduced.
All participants must bring a Windows laptop computer with a copy of TreeAge Pro
Suite installed and running. You will be provided download and installation instructions when you pre-register for the course.
Level: Advanced.
*Pre-requisite: This course is suitable for those who are familiar with the various
modeling methods or who have taken the morning course, ‘Introduction to Modeling’.
HEALTH TECHNOLOGY ASSESSMENT
Presented with simultaneous interpretation Don Diego 4
Faculty: Carisi Anne Polanczyk, MD, PhD, Professor of Medicine,
Cardiology Division, Federal University of Rio Grande do Sul, Porto
Alegre, RS and National Institute for Health Technology Assessment,
CNPq/Brazil
Course Description: Health technology assessment (HTA) is the systematic evaluation of properties, effects and/or impacts of health care
C. Polanczyk
technology. Throughout the process of introducing a new technology,
evaluating its effectiveness, approving its addition to the market and
related decision-making, important ethical, clinical and economic issues need to be
addressed. This course will discuss current processes used globally to introduce
a new technology and the agencies that perform these processes. It will include a
review of the various methods used to evaluate safety, efficacy, and technology adoption and diffusion with emphasis on how to conduct HTA using real-world evidence.
Faculty will address some of the issues facing current HTA processes such as their
impact on the social and economic environment, the need for best practices, and the
need for better cooperation among stakeholders.
Level: Intermediate. This course is designed for those with some experience in
pharmacoeconomics.
UTILITY MEASURES
Presented in Spanish Don Diego 3
Faculty: Rafael Alfonso, MD, MSc, Pharmaceutical Outcomes
Research & Policy Program, University of Washington, Seattle,
WA, USA
Course Description: Utility measurement is a method of determining an
R. Alfonso
individual’s preference for a certain outcome represented by a quantitative score (utility). During this course, methods for measuring preference-based
40
outcomes like the standard gamble, time trade-off, and visual analogue scale will be
demonstrated. Additionally, utility-based instruments (EQ-5D, HUI, QWQ, SF-36) will
be briefly discussed. Utility measurement however is not only about mastering these
techniques; it is about using them in such a way that health care decision-makers
can apply the results, for instance in cost per QALY-analyses. For this purpose, one
needs to be aware of shortcomings of the available utility measures and potential
solutions. Furthermore, one should be aware of the decision-making context and the
way results are interpreted. To equip participants with expertise in the field of utility
measurement, the most important issues will be discussed. For instance, we will
consider potential insensitivity of generic instruments for particular disease-specific
problems, and discuss to what extent adaptation of generic or disease-specific quality of life instruments may offer a solution. Also, the issue of “whose values count:
patient values or values from the general public?” will be discussed. Finally, we turn
to the interpretation in the context of resource allocation.
Level: Intermediate. This course is for those with some experience with quality of life
measures in health economic evaluation.
EXTRACTING COST DATA FOR ECONOMIC ANALYSIS IN LATIN
AMERICA
Presented in Spanish Don Americo
Faculty: Nelson Alvis Guzmán, PhD, MD,
MPH, Professor and Researcher, Faculty
of Economic Sciences & Director, Health
Economics Research Group, University of
Cartagena, Cartagena, Colombia; Ximena
Burbano-Levy, MD, Project Director, School N. Guzmán X. Burbano-Levy H. Cáceres
of Integrated Science and Humanity, Florida International University, Miami, FL, USA;
Heidy Alexandra Cáceres R., MD, MHE, Market Access Manager, Biopas Laboratories, Bogotá, Colombia
Course Description: This course will focus on practical aspects of cost development
for pharmacoeconomic studies. The objective is to help the participant bridge the
gap between understanding pharmacoeconomic theory and the practice of developing cost estimates. Factors to consider when costing pharmacoeconomic analyses
such as perspective, data sources, data classification systems, developing resource
use profiles, obtaining unit costs, and making cost adjustments will be presented.
Examples of issues encountered when identifying and extracting cost data will be
discussed.
Level: Intermediate. This course is designed for those with some experience with
pharmacoeconomic analysis.
PATIENT REGISTRIES
Presented in Spanish Don Genaro
Faculty: Manuel de La Llata Romero, MD, Director General
of Highly Specialized Regional Hospitals, Mexico City,
Mexico; Jose Antonio Magaña Serrano, MD, Chief of
Health Education Division, Cardiology Hospital, National
M. De la Llata J. Serrano
Medical Center XXI Century, Mexican Institute of Social
Security, Mexico City, Mexico; Carlos Martínez Sanchez,
MD, President, Mexican Society of Cardiology, Mexico
City, Mexico; Guillermo Meléndez, MD, MSc, Scientific
Coordinator, Nutrition Nestle Fund, Mexican Health Foundation, Mexico City, Mexico
Course Description: This course is designed to provide
C. Sanchez
G. Meléndez
an overview of patient registries and their applications in
identifying “real world” clinical, safety, and patient-perspective issues. The pros and
cons of registry data compared to other “real world” and clinical trial data collection
will be presented. How registry information can be used to support other health
economics /outcomes research initiatives and health care decision making will be
addressed. Registry strategy, design, operations and measures of program success
will be discussed. In addition, regulatory trends and requirements will be examined. Level: Introductory. This course is designed for those with little experience with
patient registries.
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Building Networks Across Institutions for Access to Health Care in Latin America
schedule of events
THURSDAY, 8 SEPTEMBER
8:00-17:00
PRE-CONFERENCE SHORT COURSES Separate Short Course registration required
(See pages 39-40 for short course descriptions)
Lunch: Attendees on their own
ISPOR MEETINGS (BY INVITATION ONLY)
12:30-13:30
ISPOR LATIN AMERICA CONSORTIUM HEALTH TECHNOLOGY PRODUCERS (INDUSTRY) COMMITTEE Don Alberto 3 (4th Floor)
14:30-15:30
ISPOR LATIN AMERICA CONSORTIUM PUBLICATIONS COMMITTEE Don Alberto 3 (4th Floor)
17:15-18:15
EDUCATIONAL SYMPOSIUM Presented in English Don Diego 4
CANCER TREATMENT IN LATIN AMERICA: PERSPECTIVES, ACCESS, AND SUSTAINABILITY
(See page 53 for Symposium description)
Sponsored by Sanofi
18:30-19:30
EDUCATIONAL SYMPOSIUM Presented in English and Spanish with simultaneous interpretation Don Diego 4
HOW CAN WE AVOID A STROKE CRISIS IN LATIN AMERICA? A REPORT FROM AN INDEPENDENT WORKING GROUP
(See page 53 for Symposium description)
Sponsored by Bayer HealthCare
18:30-20:30
ISPOR MEETINGS (BY INVITATION ONLY) Don Alberto 3 (4th Floor)
ISPOR LATIN CONSORTIUM EXECUTIVE COMMITTEE MEETING
19:45-20:45
EDUCATIONAL SYMPOSIUM Presented in English with simultaneous interpretation Don Diego 4
STRIKING THE RIGHT LEVEL: “MICRO AND MACRO” HTA IN EMERGING MARKETS / HEALTH SYSTEMS
(See page 54 for Symposium description)
Sponsored by PhRMA
20:45-23:00
ISPOR WELCOME RECEPTION Terraza Alameda
All attendees welcome
Reception Co-Sponsored by OptumInsight
FRIDAY, 9 SEPTEMBER
8:30-8:45
WELCOME ADDRESS & OPENING REMARKS Presented with simultaneous interpretation Don Diego 4
(See page 57 for biographical information)
Mark J. Sculpher, MSc, PhD, 2011-2012 ISPOR President, Professor of Health Economics, Centre for Health Economics, University of
York and Senior Advisor, Oxford Outcomes Ltd., Heslington, York, UK
Antonio Caso Marasco, MD, MEd, Program Committee Co-Chair, and Post Graduate Hematology Professor & Distance Learning
Coordinator, Subdivision of Continuing Medical Education, Post Graduate Division, Faculty of Medicine, National Independent University
of Mexico, and President, Mexican College for Pharmacoeconomics, Mexico City, Mexico
M. Sculpher A. Marasco
Guillermo Meléndez, MD, MSc, Program Committee Co-Chair and Scientific Coordinator, Nutrition Nestlé Fund, Mexican Foundation for
Health (FUNSALUD), Mexico City, Mexico
8:45-9:15 G. Meléndez
INAUGURAL MESSAGE Presented with simultaneous interpretation Don Diego 4
José Ángel Córdova Villalobos, MD, Secretary of Health, Ministry of Health, Mexico City, Mexico
J. Villalobos
41
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
schedule of events: friday, 9 September 2011
9:15-10:30
FIRST PLENARY SESSION Presented with simultaneous interpretation Don Diego 4
UNIVERSAL COVERAGE IN THE FACE OF RISING COSTS OF NEW HEALTH CARE TECHNOLOGIES: IS IT ACHIEVABLE?
(See page 57 for biographical information)
epresentatives from various Latin American countries will present country perspectives regarding the high costs of health technology evaluation and new
R
medicines, and their impact on both country budgets and universal coverage objectives. Panelists will discuss how to achieve universal coverage, given that
rising health care costs and current health care implementation methods in these countries can pose significant barriers to meeting this goal.
Moderator: Maria-Luisa Escobar, MA, PhD, Manager, Health Systems Practice, World Bank Institute, Washington, DC, USA
peakers:
S
Mercedes Juan López, MD, Executive Director, Mexican Health Foundation (FUNSALUD), Mexico City, Mexico
Guillermo Williams, MD, Director, National Board of Health Regulation and Quality Health Care, Ministry of Health, Buenos Aires,
Argentina
Luis Romero Strooy, MBA, Superintendent of Health, Superintendence of Health, Government of Chile, Santiago, Chile
10:30-11:00
M. Lopez
G. Williams
M. Escobar
L. Strooy
BREAK, EXHIBITS & RESEARCH POSTER PRESENTATIONS VIEWING Don Diego 1 & Foyer
(See pages 62-72 for Research Poster Presentations)
Coffee Sponsored by GADIC, SA de CV
11:00-12:00
RESEARCH PODIUM PRESENTATIONS – SESSION I
Page numbers refer to the abstract location in this Program & Schedule of Events
CARDIOVASCULAR DISORDERS OUTCOMES RESEARCH Presented in Spanish Don Americo
Moderator: J. Jaime Caro, MDCM, FRCPC, FACP, Senior Vice President of Health Economics, United BioSource Corporation, Lexington, MA, USA
pg 73 CV1 A COST-UTILITY ANALYSIS OF PROPHYLACTIC THERAPY FOR VENOUS THROMBOEMBOLISM WITH DABIGATRAN ETEXILATE OR ENOXAPARIN
11:00-11:15
Burbano-Levy X1, Herrán S1, Sánchez G1, Mieth K2, Alfonso-Cristancho R3, 1RANDOM Foundation, Bogotá, Colombia, 2Fundación Santa Fe de Bogotá - Banco de
Huesos y Tejidos de la Fundación Cosme y Damián, Bogotá, Colombia, 3University of Washington, Seattle, WA, USA
pg 73 CV2 COST-EFFECTIVENESS OF PRASUGREL VERSUS CLOPIDOGREL IN PATIENTS WITH ACUTE CORONARY SYNDROMES UNDERGOING PERCUTANEOUS
11:15-11:30 CORONARY INTERVENTION IN THE PRIVATE SECTOR IN MÉXICO
Mondragon R1, Arrieta-Maturino E2, Vargas-Valencia JJ3, Ramírez-Gámez J2, Martínez-Fonseca J2, Guzman-Sotelo M2, 1Hospital Central-Sur de Alta
Especialidad PEMEX, México D.F., México, 2Eli Lilly and Company, México D.F., México, 3Econopharma Consulting S. A. de C. V., México D.F., México
pg 73 CV3 ANÁLISIS DE COSTO EFECTIVIDAD EN EL CIERRE DE LA COMUNICACIÓN INTERATRIAL OSTIUM SECUNDUM: TÉCNICA PERCUTÁNEA VERSUS QUIRÚRGICA
11:30-11:45
Flores A1, Contreras I2, Alva E3, 1CMN 20 de Noviembre ISSSTE, México D.F., México, 2Instituto Mexicano del Seguro Social, México D.F., México, 3CMN SXXI,
México D.F., México
pg 73 CV4 COST-EFFECTIVENESS OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR IN PATIENTS WITH RISK FACTORS FOR SUDDEN DEATH IN ARGENTINA
11:45-12:00Alcaraz A1, Gonzalez Zuelgaray J2, Augustovski F1, 1Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina, 2PRONETAC, Buenos Aires,
Argentina
HEALTH CARE EXPENDITURE OR REIMBURSEMENT STUDIES Presented in Spanish Don Diego 3
Moderator: Fernando Lopezmalo Bourlon, MD, MSc, Director, Global Market Access LA, Merck Corporation, White House Station, NJ, USA
EX1 WITHDRAWN
11:00-11:15
pg 74 EX2 HEALTH CARE RESOURCE USE AMONG PATIENTS WITH BIPOLAR DISORDER FROM BRAZIL AND VENEZUELA: SUBGROUP ANALYSIS OF DATA FROM A
11:15-11:30 LARGE MULTINATIONAL LONGITUDINAL STUDY (WAVE-BD STUDY)
Vieta E1, Baptista T2, Bifano M3, Kerr-Corrêa F4, Grohs G5, de Oliveira I6, Vielma X7, Montes C8, Beluche S8, 1Bipolar Disorders Programme University of Barcelona,
Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain, 2Instituto Autónomo Universidad de Los Andes, Departmento de Fisiología, Facultad de Medicina
Universidad de Los Andes, Mérida, Venezuela, 3Humana Docencia, Instituto de Medicina Integral, Caracas, Venezuela, 4Universidade Estadual Paulista
(UNESP), Botucatu, Brazil, 5Instituto de Psiquiatria de Santa Catarina, Florianópolis, Brazil, 6Sanatório São Paulo, Salvador, Brazil, 7Hospital General Dr. Miguel
Pérez Carreño, Caracas, Venezuela, 8Medical Department, AstraZeneca Pharmaceuticals, Caracas, Venezuela
pg 74 EX3 INCREMENTAL COST OF IMPLEMENTING A CARE PROGRAM FOR PEOPLE WITH TYPE 2 DIABETES IN ARGENTINA
11:30-11:45Gonzalez L, Caporale JE, Elgart JF, Gagliardino JJ, CENEXA - Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET La Plata, Centro Colaborador
OPS/OMS), La Plata, Buenos Aires, Argentina
pg 74 EX4 EFECTIVIDAD DE LOS INDICADORES DE CALIDAD DE LA PRESCRIPCIÓN REGIONALES EN EL SNS ESPAÑOL
11:45-12:00Garrido E1, Sabater FJ2, Hurtado P1, Espinós B1, Guarga L1, García Losa M2, Vieta A1, Badia X1, 1IMS Health HEOR, Barcelona, Spain, 2IMS Health HEOR, Madrid,
Spain
EXAMINING THE QALY Presented in Spanish Don Diego 2
Moderator: Antonio Caso Marasco, MD, MEd, Post Graduate Hematology Professor & Distance Learning Coordinator, Subdivision of Continuing Medical Education, Post
Graduate Division, Faculty of Medicine, National Independent University of Mexico and President, Mexican College for Pharmacoeconomics, Mexico City, Mexico
pg 74 QA1 MEASURING THE BENEFITS OF HEALTH CARE: DALYS AND QALYS – DOES THE CHOICE OF MEASURE MATTER? A CASE STUDY
11:00-11:15Colantonio L1, Augustovski F1, Galante J1, Bardach A1, Caporale J1, Zarate V2, Chuang LH3, Kind P2, 1IECS - Instituto de Efectividad Clinica y Sanitaria, Buenos
Aires, Argentina, 2University of York, York, UK, 3York Trials Unit, York, UK
42
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
schedule of events friday, 9 September 2011
pg 75 QA2 ANÁLISIS DE COSTO-UTILIDAD DE RITUXIMAB POSTERIOR AL FALLO POR ANTI-TNF EN ARTRITIS REUMATOIDE PARA COLOMBIA
11:15-11:30Romero M1, Latorre M2, Alvarado C2, Karpf E1, Alvis N3, 1Fundación Salutia, Bogotá, Colombia, 2Productos Roche Colombia, Bogotá, Colombia, 3Universidad de
Cartagena, Cartagena de Indias, Bolívar, Colombia
pg 75 QA3 COSTO-EFECTIVIDAD DE DABIGATRAN VERSUS WARFARINA EN EL MANEJO DE LA FIBRILACION AURICULAR EN COLOMBIA
11:30-11:45Alfonso-Cristancho R1, Herran S2, Caicedo M2, Gomez E3, 1University of Washington, Seattle, WA, USA, 2RANDOM Foundation, Bogotá, DC, Colombia, 3Clinica
Shaio, Bogotá, Colombia
pg 75 QA4 COST-UTILITY OF SACRAL NEUROMODULATION VERSUS AUGMENTATION CYSTOPLASTY FOR TREATMENT OF REFRACTORY URGE INCONTINENCE IN
11:45-12:00 MÉXICO
Oliva-Oropeza P1, Quiroz Angulo ME2, Marco Antonio AC3, 1Institute of Social and Security Services for State Workers, México D.F., México, 2Medtronic México,
México D.F., México, 3V&M Servicios de Consultoria S.C., México D.F., México
HEALTH POLICY TREATMENT PATTERNS TP1 presented in English; TP2 and TP3 presented in Spanish; simultaneous interpretation provided Don Diego 4
Moderator: Yajaira Bastardo, PhD, Administrative Director & Professor, School of Pharmacy, Central University of Venezuela, Caracas, Venezuela
pg 75 TP1 PREVALENCE OF LIPID ABNORMALITIES BEFORE AND AFTER INTRODUCTION OF LIPID MODIFYING THERAPY AMONG MEXICAN PATIENTS
11:00-11:15Aguilar-Salinas CA1, Rivera MDR2, Perez J2, Limon F3, Diggle A3, Ambegaonkar BM4, 1Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran,
México City, DF, México, 2OMEESTADISTICOS, S.C., México D.F., México, 3MSD México, México D.F., México, 4Merck and Co., Inc., Whitehouse Station, NJ, USA
pg 76 TP2 PATRONES DE TRATAMIENTO DE LA LEUCEMIA MIELOIDE CRÓNICA (LMC) EN PACIENTES RESISTENTES O INTOLERANTES A IMATINIB EN
11:15-11:30
INSTITUCIONESDE SALUD PÚBLICA EN MÉXICO
Hernández-Rivera G1, Aguayo-González Á2, Cantu-Rodríguez OG3, Cervera E4, Gomez-Almaguer D3, Gutiérrez-Aguirre CH3, Lopez-Hernández M5, Martínez-Baños
D6, Oropeza P7, Rico E8, Juarez-Garcia A1, Vargas-Valencia J9, 1Bristol-Myers Squibb, México D.F., México, 2Instituto Nacional de Ciencias Médicas y Nutrición
Salvador, México D.F., México, 3Hospital Universitario Dr. José Eleuterio González, Monterrey, México, 4Instituto Nacional de Cancerología, México D.F.,
México, 5Centro Médico Nacional 20 de Noviembre ISSSTE, México City, DF, México, 6Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,
México D.F., México, 7Hospital General de Zona 8 IMSS, México D.F., México, 8Hospital General Regional 110 IMSS, Guadalajara, México, 9Econopharma
Consulting, México D.F., México
pg 76 TP3 PATRONES DE TRATAMIENTO Y COSTOS DE ATENCION EN PACIENTES CON ARTRITIS REUMATOIDE, DESDE LA PERSPECTIVA DEL PROVEEDOR DE
11:30-11:45 SERVICIOS DE SALUD EN MÉXICO
Contreras I1, Juarez-Garcia A2, Martinez-Rivera G2, Vallejos Parás A3, Ojeda Méndez J3, Villasis-Keever A2, Rangel S2, 1Instituto Mexicano del Seguro Social,
México D.F., México, 2Bristol-Myers Squibb, México D.F., México, 3Universidad Nacional Autónoma de México, México D.F., México
TP4 WITHDRAWN
11:45-12:00
VACCINE OUTCOMES RESEARCH Presented in Spanish Don Genaro
Moderator: Gabriela Tannus Araújo, MSc, MBA, Health Economics Director, Axia.Bio Consulting, São Paulo, Brazil
pg 76 VA1EVALUACION RÁPIDA DEL IMPACTO DE LA INTRODUCCIÓN DE LA VACUNA CONTRA EL ROTAVIRUS EN COLOMBIA
11:00-11:15Rico Mendoza FA1, Porras A1, Alvis N2, De La Hoz F1, Cediel N1, Del Rio F2, 1Universidad Nacional de Colombia, Bogotá, Colombia, 2Universidad de Cartagena,
Cartagena de Indias, Bolívar, Colombia
pg 76 VA2 COST EFFECTIVENESS ANALYSIS OF VACCINATION PROGRAMS WITH 10-VALENT (PCV10) AND 13-VALENT (PCV13) PNEUMOCOCCAL VACCINES IN BOGOTÁ,
11:15-11:30 COLOMBIA
Torres C1, Jaramillo J2, Coronell W3, Gutierrez MV4, Caceres HA4, 1Universidad del Bosque, Bogotá, Colombia, 2Hospital Universitario del Valle, Universidad del
Valle - Centro IMBANACO, Cali, Colombia, 3Universidad de Cartagena, Hospital Bocagrande, Cartagena, Colombia, 4Pfizer S.A., Bogotá, Colombia
pg 77 VA3 A COST-EFFECTIVENESS ANALYSIS OF A 10-VALENT PNEUMOCOCCAL CONJUGATE VACCINE IN CHILDREN IN SIX LATIN AMERICAN COUNTRIES
11:30-11:45García Martí S1, Colantonio L1, Bardach A1, Lopez A1, Caporale J1, Augustovski F1, Pichon Riviere A1, Knerer G2, Gomez JA3, 1Institute for Clinical Effectiveness
and Health Policy, Buenos Aires, Argentina, 2GlaxoSmithKline Biologicals, Wavre, Belgium, 3GlaxoSmithKline, Victoria, Buenos Aires, Argentina
pg 77 VA4 COSTO-EFECTIVIDAD DE LA VACUNA CONTRA EL VPH SUBTIPOS 16 Y 18 EN MÉXICO
11:45-12:00Muciño-Ortega E1, Valencia-Mendoza A1, Flores-Leonard Y2, Bertozzi Kenefick SM1, 1Instituto Nacional de Salud Pública, Cuernavaca, México, 2Instituto
Mexicano del Seguro Social, Cuernavaca, México
12:00-15:00
LUNCH, EXHIBITS & RESEARCH POSTER PRESENTATIONS VIEWING Don Diego 1 & Foyer
(See pages 62-72 for Research Poster Presentations)
ISPOR MEETINGS (BY INVITATION ONLY)
12:15-13:15
ISPOR LATIN AMERICA CONSORTIUM EDUCATION COMMITTEE MEETING (BY INVITATION ONLY) Don Emiliano (4th Floor)
13:45-14:45 ISPOR LATIN AMERICA CONSORTIUM HEALTH CARE PROVIDERS COMMITTEE MEETING (BY INVITATION ONLY) Don Emiliano (4th Floor)
12:30-13:30
EDUCATIONAL SYMPOSIUM Presented in English with simultaneous translation Don Diego 4
HEALTH ECONOMIC ANALYSIS IN LATIN AMERICA: CAN LESSONS LEARNED FROM OTHER PARTS OF THE WORLD BE APPLIED?
(See page 54 for Symposium description)
Sponsored by IMS Consulting Group
13:45-14:45
EDUCATIONAL SYMPOSIUM Presented in English and Spanish with simultaneous interpretation Don Diego 4
HIGH COST MEDICINES: DO THEY BRING VALUE TO HEALTH SYSTEMS IN LATIN AMERICA AND HOW TO ENSURE APPROPRIATE ACCESS?
(See page 55 for Symposium description)
Sponsored by Eli Lilly and Company
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
schedule of events: friday, 9 September 2011
15:00-16:00
ISSUE PANELS & WORKSHOPS – SESSION I
(See pages 49-52 for Issue Panels and Workshop Descriptions)
IP1: HTA LEVEL OF INFLUENCE: TO WHAT EXTENT DOES HTA INFLUENCE MARKET ACCESS DECISIONS ACROSS GEOGRAPHIES? Presented in Spanish Don Diego 2
Moderator: J. Jaime Caro, MDCM, FRCPC, FACP, Senior Vice President of Health Economics, United BioSource Corporation, Lexington, MA, USA
Panelists: Pablo Anaya, MSc, HE&OR Manager, GlaxoSmithKline, Mexico City, Mexico; Iris Contreras, MD, MSc, Clinical Researcher, Mexican Institute of Social Security,
Mexico City, Mexico; Joaquin Federico Mould-Quevedo, PhD, MBA, MSc, Health Economics & Outcomes Research Director for Latin America and Primary Care, Pfizer
Laboratories Inc., New York, NY, USA
W1: METHODS FOR THE CRITICAL REVIEW OF COST-EFFECTIVENESS MODELS SUBMITTED TO REIMBURSEMENT AUTHORITIES: LEARNING FROM INTERNATIONAL
EXPERIENCE Presented in English and Spanish with simultaneous interpretation Don Diego 4
Discussion Leaders: Mark J. Sculpher, PhD, Professor of Health Economics, Centre for Health Economics, University of York and Senior Advisor, Oxford Outcomes Ltd.,
Heslington, York, UK; Federico Augustovski, MD, MSc, PhD, Director, Health Economic Evaluation and Technology Assessment Department, Hospital Italiano de Buenos
Aires, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina; Jorge Alberto Gomez, PhD, Senior Health Economics Manager, Biologics, Latin America,
GlaxoSmithKline, Buenos Aires, Argentina; Clarice Petramale, PhD, Health Technology Incorporation Commission - CITEC, Department of Science, Technology and Strategic
Supplies, Ministry of Health, Brasilia, Brazil
W3: USE OF REAL WORLD DATA FOR RESEARCH IN LATIN AMERICA Presented in Spanish Don Diego 3
Discussion Leaders: Leonardo Tamariz, MD, MPH, Professor, University of Miami, Miami, FL, USA; Ana Palacio, MD, MPH, Professor, University of Miami, Miami, FL, USA;
Alfredo Palacio, MD, Educational Dean, Universidad de Especialidades Espiritu Santo, Guayaquil, Guayas, Ecuador
16:00-16:15
BREAK, EXHIBITS & RESEARCH POSTER PRESENTATIONS VIEWING Don Diego 1 & Foyer
(See pages 62-72 for Research Poster Presentations)
Coffee sponsored by Technical Language Service
16:15-17:15
ISSUE PANELS & WORKSHOPS – SESSION II
(See pages 49-52 for Issue Panels and Workshop Descriptions)
IP2: RISK-SHARING SCHEMES IN EMERGING COUNTRIES: WHAT ARE THE STEPS FOR SUCCESS? Presented in English and Spanish with simultaneous interpretation
Don Diego 4
Moderator: Lou Garrison, PhD, Professor, Pharmaceutical Outcomes Research and Policy Program, University of Washington School of Pharmacy, Seattle, WA, USA
Panelists: Sean D. Sullivan, PhD, RPh, MS, Professor & Director, Pharmaceutical Outcomes Research and Policy Program, University of Washington School of Pharmacy,
Seattle, WA, USA; Diego Guarin, MD, MPH, MA, Director, Market Access, Latin America, Merck Sharp & Dohme, Mexico City, Mexico; Jianwei Xuan, PhD, Senior Director
and Team Leader, Pfizer, New York, NY, USA
W4: GUIDELINES FOR APPROPRIATE SELECTION OF MODELING APPROACH IN PHARMACOECONOMIC EVALUATION IN LATIN AMERICA Presented in Spanish
Don Americo
Discussion Leaders: Pablo Anaya, MSc, HE&OR Manager, GlaxoSmithKline, Mexico City, Mexico; Guillermo Meléndez, MD, MSc, Scientific Coordinator, Nutrition Nestlé
Fund, Mexican Foundation for Health (FUNSALUD), Mexico City, Mexico; Joaquin Federico Mould-Quevedo, PhD, MBA, MSc, Health Economics & Outcomes Research
Director for Latin America and Primary Care, Pfizer Laboratories, Inc., New York, NY, USA
W5: EQ-5D: A KEY PART OF THE LATIN AMERICAN DECISION-MAKERS’ TOOLKIT Presented in Spanish Don Diego 2
Discussion Leaders: Paul Kind, Professor, Centre for Health Economics, University of York, York, UK; Victor Zarate, MD, MSc, PhD Student, Centre for Health Economics,
University of York, York, UK; Fabiola Rosso, MSc, Researcher, Department of Epidemiology, Ministry of Health, Santiago, Chile; Catalina Gutierrez, MSc, Researcher,
Departamento de Salud Pública, Universidad de Los Andes, Santiago, Chile
W6: EVALUACIÓN DE TECNOLOGÍAS SANITARIAS EN CHILE: PASADO, PRESENTE Y FUTURO Presented in Spanish Don Diego 3
Discussion Leaders: Manuel Antonio Espinoza, MD, MSc, Académico, Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile; Marianela
Castillo, MSc, Economista de la Salud, Ministerio de Salud de Chile, Santiago, Chile; Luis Vera, MD, MSc, Departamento de Calidad y Seguridad del Paciente, Ministerio de
Salud de Chile, Santiago, Chile
17:30-18:30
RESEARCH PODIUM PRESENTATIONS – SESSION II
Page numbers refer to the abstract location in this Program & Schedule of Events
CANCER OUTCOMES RESEARCH CN1 and CN3 presented in English; CN2 and CN4 presented in Spanish; simultaneous interpretation provided
Don Diego 4
Moderator: Rafael Alfonso-Cristancho, MD, MSc, Research Associate, School of Pharmacy, Pharmaceutical Outcomes Research & Policy Program, University of Washington
School of Pharmacy, Seattle, WA, USA
pg 78 CN1 COST-EFFECTIVENESS OF TRASTUZUMAB IN THE ADJUVANT TREATMENT OF EARLY BREAST CANCER IN SIX LATIN AMERICAN COUNTRIES
17:30-17:45Pichon-Riviere A1, Augustovski F1, Garay OU1, Buendia J2, Rodríguez A3, Vallejos C4, Huayanay L5, Oliveira C6, 1Institute for Clinical Effectiveness and Health
Policy, Buenos Aires, Argentina, 2Universidad de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina, 3Fondo Nacional de Recursos, Montevideo,
Uruguay, 4Universidad de La Frontera, Temuco, Chile, 5Universidad Peruana Cayetano Heredia, Lima, Peru, 6ANVISA, Brasilia, Brazil
pg 78 CN2 CANCER DE PULMON Y TABACO, ANALISIS DEL COSTO DE ATENCION MEDICA
17:45-18:00Quintana Carrillo R1, Arrieta Rodríguez O2, Zinser Sierra J2, Correa Acevedo M2, Mohar Betancurt A2, Reynales Shigematsu L3, 1Instituto Nacional de Salud
Pública, México D.F., México, 2Instituto Nacional de Cancerología, México D.F., México, 3Instituto Nacional de Salud Pública, Cuernavaca, México
pg 78 CN3 COST EFFECTIVENESS OF LIPOSOMAL DOXORUBICIN VERSUS PACLITAXEL FOR THE TREATMENT OF AIDS-KS
18:00-18:15Raimundo K1, Asche C2, 1University of Utah College of Pharmacy, Salt Lake City, UT, USA, 2Center for Health Outcomes Research, University of Illinois College of
Medicine and University of Utah College of Pharmacy, Salt Lake City, UT, USA
44
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
schedule of events friday, 9 September 2011
pg 78 CN4 EVALUACION DE COSTOS DEL TRATAMIENTO DE PRIMERA LINEA PARA CANCER COLORRECTAL METASTASICO (MCRC) CON ESQUEMAS BASADOS EN:
18:15-18:30 FOLFIRI, FOLFOX O XELOX MAS BEVACIZUMAB, EN CINCO INSTITUCIONES MEXICANAS
Calderillo Ruiz G, Instituto Nacional de Cancerología, México D.F., México
HEALTH SERVICES RESEARCH Presented in Spanish Don Americo
Moderator: Sebastián García Martí, MD, MSc, Coordinator, Health Technology Assessment Department, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos
Aires, Argentina
pg 79 HS1 INTERCHANGEABILITY BETWEEN PNEUMOCOCCAL CONJUGATE VACCINES AND SCHEMES
17:30-17:45Ciapponi A, García Martí S, Rey-Ares L, Glujovsky D, Bardach A, Valanzasca P, Lee A, Cafferata ML, Institute for Clinical Effectiveness and Health Policy,
Buenos Aires, Argentina
pg 79 HS2 ANALISIS DE COSTOS DEL PROGRAMA AMPLIADO DE INMUNIZACIONES EN COLOMBIA 2009
17:45-18:00Romero M1, Arango C1, Chavez D1, Otero J1, Alvis N2, 1Fundación Salutia, Bogotá, Colombia, 2Universidad de Cartagena, Cartagena de Indias, Bolívar, Colombia
pg 79 HS3 THE ECONOMIC BURDEN OF ROAD TRAFFIC INJURIES ON HEALTH SYSTEM AND SOCIETY IN BELIZE
18:00-18:15Heredia Pi IB1, Pérez Núñez R1, Hijar Medina M1, Jones S2, Silveira Rodrigues EM3, 1National Institute of Public Health, Cuernavaca, México, 2Pan American
Health Organization/World Health Organization, Trinidad and Tobago, 3Pan American Health Organization/World Health Organization, Washington, DC, USA
pg 79 HS4 IMPACTO ECONOMICO EN LA ATENCION MEDICA DE ENFERMEDADES ASOCIADAS AL TABAQUISMO EN UNA POBLACION MEXICANA
18:15-18:30Pérez Zincer F1, Quintana Carrillo R2, Barrios Nanni R1, Chagoya Bello J1, Ramos Reyna E1, Reynales Shigematsu L3, 1Hospital Central Militar, México D.F.,México,
2
Instituto Nacional de Salud Pública, México D.F., México, 3Instituto Nacional de Salud Pública, Cuernavaca, México
INFECTION OUTCOMES RESEARCH IN1, IN3, IN4 presented in Spanish; IN2 presented in English Don Diego 2
Moderator: Carlos Izquierdo, MD, MSc, Health Economist & Pharmacoeconomics Manager, Janssen Colombia, Bogotá, Colombia
pg 80 IN1 EVALUACION DE COSTO-EFECTIVIDAD CON EL USO DE LINEZOLID PARA EL TRATAMIENTO DE INFECCIONES COMPLICADAS DE PIEL Y TEJIDOS BLANDOS
17:30-17:45Vargas-Valencia JJ1, Sotelo-Guzmán M1, Díaz-Ponce H2, Galindo-Suárez RM2, Muciño-Ortega E2, Mould-Quevedo J3, 1Econopharma Consulting S.A. de C.V.,
México D.F., México, 2Pfizer S.A. de C.V., México D.F., México, 3Pfizer, New York, NY, USA
pg 80 IN2 CHRONIC HEPATITIS C TREATMENT FOR GENOTYPE 2 OR 3: COST-EFFECTIVENESS ANALYSIS OF PEG AS FIRST LINE TREATMENT WITH THE BRAZILIAN
17:45-18:00
PROTOCOL
Blatt CR1, Storb BH1, Mühlberger N2, Wurm J2, Farias MR1, Siebert U2, 1Universidade Federal de Santa Catarina / UNISUL /UMIT, Florianopolis, Santa Catarina,
Brazil, 2UMIT - University for Health Sciences, Medical Informatics and Technology / ONCOTYROL, Hall i. T., Tirol, Austria
pg 80 IN3 DENGUE MÁS QUE UN PROBLEMA DE SALUD PÚBLICA: ESTIMACIÓN DE LOS COSTOS DIRECTOS DE LA EPIDEMIA DEL AÑO 2010 EN COLOMBIA
18:00-18:15Bello SL1, Díaz E2, Malagon JN2, Romero M2, Salazar V2, 1Instituto Nacional de Salud de Colombia, Bogotá, DC, Colombia, 2Fundación Salutia, Bogotá, DC,
Colombia
pg 80 IN4 MORBIDITY AND MORTALITY OF COMMUNITY ACQUIRED PNEUMONIA IN ADULTS IN SIX COUNTRIES IN LATIN AMERICA
18:15-18:30Rosado-Buzzo A1, Garcia-Mollinedo L1, Camacho-Cordero L1, Roberts CS2, Mould-Quevedo JF2, Trejo-Martinez A1, Luna-Casas G1, 1Links & Links S.A, de C.V.,
México D.F., México, 2Pfizer Inc, New York, NY, USA
PATIENT-REPORTED OUTCOMES STUDIES Presented in Spanish Don Genaro
Moderator: Marcos B. Ferraz MD, PhD, Director, Professor and Director, São Paulo Center for Health Economics, Federal University of São Paulo, São Paulo, Brazil
pg 81 PR1 RESPONSIVENESS OF THE COPD ASSESSMENT TEST (CAT) QUESTIONNAIRE DURING EXACERBATIONS OF COPD
17:30-17:45Agusti A1, Soler JJ2, Molina J3, Muñoz MJ4, Garcia-Losa M5, Roset M6, Jones PW7, Badia X6, 11 Hospital Clínic IDIBAPS, Barcelona & CIBER Enfermedades
Respiratorias (Spain), Barcelona, Spain, 2Hospital de Requena, Requena (Valencia), Spain, 3Centro de Salud Francia, Madrid, Spain, 4GlaxoSmithKline SA, Tres
Cantos (Madrid), Spain, 5IMS Health, Madrid, Spain, 6IMS Health, Barcelona, Spain, 7St George’s, University of London, London, UK
pg 81 PR2 THE BEAUTY OF MAPPING: NEED THE MEAN HEALTH-RELATED QUALITY OF LIFE SCORE FOR A GROUP OF HIP PATIENTS AND DON’T HAVE EQ-5D? JUST USE
17:45-18:00 THE OXFORD HIP SCORE!
Pinedo Villanueva RA1, Turner D1, Judge A2, Raftery JP1, Arden NK2, 1University of Southampton, Southampton, Hampshire, UK, 2University of Oxford, Oxford,
Oxfordshire, UK
pg 81 PR3 PRIMARY HEALTH CARE EVALUATION IN CHILE: PATIENTS’ PERSPECTIVE
18:00-18:15Leisewitz T1, Nogueira L2, Peñaloza B1, Bastías G1, Villarroel L1, 1Pontificia Universidad Católica de Chile, Santiago, RM, Chile, 2Harvard University, Boston, MA,
USA
pg 81 PR4 CALIDAD DE VIDA Y VICTIMIZACION EN ADOLESCENTES ESTUDIANTES DE MÉXICO
18:15-18:30Hidalgo CA, Jiménez G, 1Universidad de Guadalajara, Jalisco, México
RESEARCH ON METHODS Presented in Spanish Don Diego 3
Moderator: Edith Arely Lemus, MSc, Health Economics Manager, Novartis Pharma Mexico, Mexico City, Mexico
pg 81 RM1 COMPARING THE USE OF DYNAMIC AND STATIC INFECTIOUS DISEASE MODELS IN LATIN AMERICA WITH NORTH AMERICA, EUROPE, ASIA AND OTHER
17:30-17:45
REGIONS
Vargas-Palacios A1, Stevenson M1, Dueñas A2, Wailloo A1, 1The University of Sheffield, Sheffield, South Yorkshire, UK, 2IÉSEG School of Management - LilleParis, Paris, France
pg 82 RM2 APLICACION DE MODELOS DE REGRESION CON STATA PARA EL ESTUDIO DEL CONSUMO DE RECURSOS EN UNIDADES DE CUIDADOS INTENSIVOS
17:45-18:00 NEONATALES
Reyes-Lopez A, Hospital Infantil de México Federico Gómez, México D.F., México
pg 82 RM3 A COMPARISON BETWEEN MARKOV CHAINS AND SYSTEM DYNAMICS MODELING FOR THE ESTIMATION OF METABOLIC SYNDROME COSTS IN A PUBLIC
18:00-18:15 HEALTH CARE DELIVERY ORGANIZATION IN MÉXICO
Olmedo-Bustillo C, Oliva-Oropeza P, Rivas-Oropeza I, Aranzeta-Ojeda F, Institute of Social and Security Services for State Workers, México D.F., México
45
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
schedule of events: friday, 9 September & SATURDAY, 10 SEPTEMBER 2011
pg 82 RM4 FACTORES PREDICTORES DE OBSTRUCCIONES CORONARIAS SIGNIFICATIVAS EN PACIENTES ADULTOS CON CINEANGIOCORONARIOGRAFÍAS REALIZADAS
18:15-18:30 EN URUGUAY, FINANCIADAS POR EL FONDO NACIONAL DE RECURSOS
Morales M, Perna A, Fernández G, Lombide I, Fondo Nacional de Recursos, Montevideo, Uruguay
18:30-19:30
RESEARCH POSTER AUTHOR DISCUSSION HOUR Don Diego 1
(See pages 62-72 for Research Poster Presentations)
18:30-20:00
RESEARCH POSTER PRESENTATIONS & EXHIBITORS’ RECEPTION Don Diego 1 & Foyer
(See pages 62-72 for Research Poster Presentations)
19:30-21:00
EDUCATIONAL SYMPOSIUM Presented in English and Spanish with simultaneous interpretation Don Diego 4
STATUS UPDATE OF THE REIMBURSEMENT REVIEW ENVIRONMENT ACROSS LATIN AMERICA
(See page 55 for Symposium description)
Sponsored by Millcreek Outcomes Group
19:45-21:45 ISPOR MEETING (By Invitation Only)
ISPOR LATIN AMERICA CONSORTIUM ADVISORY COMMITTEE Don Genaro
SATURDAY, 10 SEPTEMBER 2011
7:45-8:45
EDUCATIONAL SYMPOSIUM Presented in English and Spanish with simultaneous interpretation Don Diego 4
BIOLOGIC AND BIOSIMILAR DRUGS IN LATIN AMERICA: FUNDING CHALLENGES FOR PAYERS AND DEVELOPERS
(See page 56 for Symposium descriptions)
Sponsored by Pfizer
7:45-8:45
ISPOR MEETING (By Invitation Only)
ISPOR LATIN AMERICA CONSORTIUM POLICY-MAKERS & PAYERS COMMITTEE MEETING (BY INVITATION ONLY) Don Genaro
8:00-9:00
EXHIBITS & RESEARCH POSTER PRESENTATIONS VIEWING Don Diego 1 & Foyer
(See pages 62-72 for Research Poster Presentations)
9:00-10:30
WELCOME, ISPOR DISTINGUISHED SERVICE AWARDS PRESENTATION & SECOND PLENARY SESSION
Presented with simultaneous interpretation Don Diego 4
WELCOME & PRESENTATION OF ISPOR DISTINGUISED SERVICE AWARDS
(See page 57 for biographical information)
Speaker/Presented by: Mark J. Sculpher, MSc, PhD, 2011-2012 ISPOR President, Professor of Health Economics, Centre for Health Economics, University of York,
and Senior Advisor, Oxford Outcomes Ltd., Heslington, York, UK
Awardees:
Antonio Caso Marasco, MD, MEd, Program Committee Co-Chair and Post Graduate Hematology Professor & Distance Learning Coordinator,
Subdivision of Continuing Medical Education, Post Graduate Division, Faculty of Medicine, National Independent University of Mexico, and
President, Mexican College for Pharmacoeconomics, Mexico City, Mexico
Guillermo Meléndez MD, MSc, Program Committee Co-Chair and Scientific Coordinator, Nutrition Nestlé Fund, Mexican Foundation for Health
(FUNSALUD), Mexico City, Mexico
M. Sculpher
A. Marasco
G. Meléndez
WHAT IS THE VALUE OF HEALTH OUTCOMES RESEARCH TO DECISION-MAKERS: A CANDID DISCUSSION WITH PUBLIC DECISION-MAKERS
Despite its tremendous growth over the past years, our field has not achieved the expected impact on health technology decisions in Latin America. A panel
of health care decision-makers from principle institutions in different countries will be asked to provide their perspective on the validity of health outcomes
research, including where and how research findings are being used to make coverage decisions. Panelists will also provide recommendations on the use of
health outcomes research in real decisions.
oderator: J. Jaime Caro, MDCM, FRCPC, FACP, Adjunct Professor of Medicine & Adjunct Professor of Epidemiology and Biostatistics, McGill University,
M
Montreal PQ and Senior Vice President of Health Economics, United BioSource Corporation, Lexington, MA, USA
J. Caro
Speakers:
Tomás A. Pippo Briant, MA, MPH, Director of Health Economics, Ministry of Health, Buenos Aires, Argentina
Juan Garduño, MD, Deputy Director, Research Management, Research Department, “Federico Gómez” Children’s Hospital of Mexico,
México City, Mexico
Alarico Rodriguez, MD, Medical Benefits Manager, Uruguayan National Agency for Highly Specialized Medical Procedures,
Montevideo, Uruguay
A. Rodriguez
46
T. Pippo
J. Garduño
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
schedule of events: SATURDAY, 10 SEPTEMBER 2011
10:30-11:00
BREAK, EXHIBITS & RESEARCH POSTER PRESENTATIONS VIEWING Don Diego 1 & Foyer
(See pages 62-72 for Research Poster Presentations)
11:00-12:00
ISSUE PANELS & WORKSHOPS – SESSION III
(See pages 49-52 for Issue Panel and Workshop Descriptions)
IP3: EL PAPEL DE LAS AGENCIAS DE EVALUACIÓN DE TECNOLOGÍAS EN AMÉRICA LATINA Presented in Spanish Don Diego 2
(Speakers for this panel were invited, see pages 57-59 for biographical information)
Moderator: Iris Contreras, MD, MSc, Clinical Researcher, Mexican Institute of Social Security, Mexico City, Mexico
Panelists: Alexandre Lemgruber, MSc, Advisor for Health Technology Management, Pan American Health Organization (PAHO), Washington, DC, USA; Luis Vera, MD, MSc,
Professional Adviser, Health Technology Assessment, Department of Quality and Safety Patient, Ministry of Health, Santiago, Chile; Esteban Hernandez-San Roman, MD,
Director, Evaluation of Health Technologies, The National Center for Health Technology Excellence, Mexico City, Mexico
W7: THE ROLE OF HEALTH ECONOMIC AND OUTCOMES RESEARCH (HEOR) EVIDENCE IN FORMULARY AND REIMBURSEMENT DECISIONS IN LATIN AMERICA VERSUS
THE UNITED STATES Presented in English and Spanish with simultaneous interpretation Don Diego 4
Discussion Leaders: Anke-Peggy Holtorf, PhD, MBA, Adjunct Faculty, Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake City, UT, USA; Gary Oderda,
PharmD, MPH, Professor & Director, Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA; Federico Augustovski, MD, MSc,
PhD, Director, Health Economic Evaluation and Technology Assessment Department, Hospital Italiano de Buenos Aires, Institute for Clinical Effectiveness and Health Policy,
Buenos Aires, Argentina; Abdulkadir Keskinaslan, MD, MBA, MPH, Director, Market Pricing, Asia Pacific, Middle East and African Countries, Global Pricing & Market Access,
Novartis Pharma AG, Basel, Switzerland
W8: METHODS FOR INDIRECT AND MIXED TREATMENT COMPARISONS: TOOLS FOR ASSESSING HEALTH TECHNOLOGIES IN THE ABSENCE OF DIRECT EVIDENCE
Presented in Spanish Don Americo
Discussion Leaders: Rafael Alfonso-Cristancho, MD, MSc, Research Associate, School of Pharmacy, Pharmaceutical Outcomes Research & Policy Program, University of
Washington School of Pharmacy, Seattle, WA, USA; Beth Devine, PhD, PharmD, MBA, Associate Professor, University of Washington, Seattle, WA, USA; Ximena BurbanoLevy, MD, Project Director, School of Integrated Sciences and Humanity, Florida International University, Miami, FL, USA
W9: INNOVATIVE APPROACHES TO IMPROVE MEDICATION ADHERENCE Presented in Spanish Don Diego 3
Discussion Leaders: Ana Palacio, MD, MPH, Professor, University of Miami, Miami, FL, USA; Leonardo Tamariz, MD, MPH, Professor, University of Miami, Miami, FL, USA;
Alfredo Palacio, MD, Educational Dean, Universidad de Especialidades Espiritu Santo, Guayaquil, Guayas, Ecuador
12:15-13:15
ISSUE PANELS & WORKSHOPS – SESSION IV
(See pages 49-52 for Issue Panel and Workshop Descriptions)
IP4: EL COSTO DE LOS TRASTORNOS DEL ESTADO DE ÁNIMO: ¿QUÉ ASPECTO GENERA EL MAYOR GASTO PARA LOS SISTEMAS DE SALUD? ¿QUÉ GENERA LA ALTA
DISCAPACIDAD ASOCIADA? UNA PERSPECTIVA SOCIAL, ECONÓMICA Y GLOBAL Presented in Spanish Don Diego 3
Moderator: Claudia Becerra-Palars, MD, MSc, Coordinadora Clínica de Trastornos del Afecto, Instituto Nacional de Psiquiatria, “Ramón de la Fuente”, México D.F., México
Panelists: Mauricio Palma, MSc, MD, Estudiente de psiquiatria, Secretaria de Salud, Instituto Nacional de Psiquiatría, México D.F., México; Jeremy Cruz, MD, Universidad
Nacional Autónoma de México/INP, México D.F., México; Ingrid Vargas, MD, MSc, Investigadora, Académica, Departamento de Psiquiatría y Salud Mental, Universidad
Nacional Autónoma de México, México D.F., México
W10: A LACK OF LOCAL EFFECTIVENESS, COST AND EPIDEMIOLOGIC DATA: WHAT ARE THE OPTIONS FOR CONDUCTING PE STUDIES IN LATIN AMERICA? Presented in
Spanish Don Diego 2
Discussion Leaders: J. Jaime Caro, MDCM, FRCPC, FACP, Senior Vice President of Health Economics, United BioSource Corporation, Lexington, MA, USA; Rafael AlfonsoCristancho, MD, MSc, Research Associate, Pharmaceutical Outcomes Research & Policy Program, University of Washington School of Pharmacy, Seattle, WA, USA; Ximena
Burbano-Levy, MD, Project Director, School of Integrated Sciences and Humanity, Florida International University, Miami, FL, USA; Rosa Maria Galindo-Suarez, MSc, Health
Outcomes Research Manager, Pfizer, Mexico City, Mexico
W12: THE FUTURE OF PHARMACEUTICAL COST CONTROLS IN LATIN AMERICA: HTA OR REFERENCE PRICING? Presented in English and Spanish with simultaneous
interpretation Don Diego 4
Discussion Leaders: Monica Martin de Bustamante, AB, Fellow, Global Market Access, Insight Strategy Advisors, New York, NY, USA; Cyrus A. Chowdhury, MSc, Vice
President, Global Market Access, Insight Strategy Advisors, New York, NY, USA
13:30-13:45
ISPOR RESEARCH PRESENTATIONS AWARDS & CLOSING REMARKS Presented in English and Spanish with simultaneous interpretation
Don Diego 4
oderated by: Antonio Caso Marasco, MD, MEd, Program Committee Co-Chair and Post Graduate Hematology Professor & Distance Learning Coordinator,
M
Subdivision of Continuing Medical Education, Post Graduate Division, Faculty of Medicine, National Independent University of Mexico, and President, Mexican
College for Pharmacoeconomics, Mexico City, Mexico ISPOR RESEARCH AWARDS PRESENTATION
Presented by: Joaquín Federico Mould-Quevedo, PhD, MBA, MSc, Health Economics & Outcomes Research Director for Latin America and Primary Care, Pfizer
Laboratories Inc., New York, NY, USA; Iris Contreras, MD, MSc, Clinical Researcher, Mexican Institute of Social Security, Mexico City, Mexico
A. Marasco
CLOSING REMARKS
Guillermo Meléndez, MD, MSc, Program Committee Co-Chair and Scientific Coordinator, Nutrition Nestlé Fund, Mexican Foundation for Health (FUNSALUD),
Mexico City, Mexico
G. Melendez
47
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
CONFERENCE SUPPORTERS
CORPORATE SUPPORTER
Janssen
EVENT SUPPORTERS
Bayer de Mexico SA de CV
OptumInsight
GADIC SA de CV
Technical Language Service
Kantar Health
48
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
issue panels & workshops
ISSUE PANELS & WORKSHOPS – SESSION I
Friday, 9 September: 15:00-16:00
IP1: HTA LEVEL OF INFLUENCE: TO WHAT EXTENT DO HTAS INFLUENCE MARKET
ACCESS DECISIONS ACROSS GEOGRAPHIES?
Presented in Spanish Don Diego 2
Moderator: J. Jaime Caro, MDCM, FRCPC, FACP, Senior Vice President of Health
Economics, United BioSource Corporation, Lexington, MA, USA
Panelists: Pablo Anaya, MSc, HE&OR Manager, GlaxoSmithKline, Mexico City,
Mexico; Iris Contreras, MD, MSc, Clinical Researcher, Mexican Institute of Social
Security, Mexico City, Mexico; Joaquin Federico Mould-Quevedo, PhD, MBA, MSc,
Health Economics & Outcomes Research Director for Latin America and Primary
Care, Pfizer Laboratories Inc., New York, NY, USA
ISSUE: Across Latin America, some health care systems have turned to health
technology assessment as a means to obtain value for money. This need for health
care systems to spend wisely is all the more compelling in light of the current,
global economic situation. Health care authorities are under immense pressure to
stay within, or cut, their drug budgets. They may use a wide variety of cost-saving
measures, including the adoption of HTA results from other countries or regions.
OVERVIEW: In this cost-conscious, value-for-money environment, the moderator
will probe panelists on the extent to which HTAs influence access decisions in
other markets, whether this is wise or problematic, and how this may impact patient
access. Specific points of debate will include: Which HTAs may become the most
influential and why? To what extent will their assessments influence other markets?
Which countries or regions will most likely look to external HTA assessment? What
are the challenges to this type of “influence” present? What role will regional
initiatives, such as PAHO sponsored LA HTA network, play in the future? During the
last 20 minutes, audience members will be encouraged to share their opinions on
the questions posed and to ask their own questions to the panel.
W1: METHODS FOR THE CRITICAL REVIEW OF COST-EFFECTIVENESS
MODELS SUBMITTED TO REIMBURSEMENT AUTHORITIES: LEARNING FROM
INTERNATIONAL EXPERIENCE
Presented in English and Spanish with simultaneous interpretation
Don Diego 4
Discussion Leaders: Mark J. Sculpher, PhD, Professor of Health Economics, Centre
for Health Economics, University of York and Senior Advisor, Oxford Outcomes
Ltd., Heslington, York, UK; Federico Augustovski, MD, MSc, PhD, Director, Health
Economic Evaluation and Technology Assessment Department, Hospital Italiano
de Buenos Aires, Institute for Clinical Effectiveness and Health Policy, Buenos
Aires, Argentina; Jorge Alberto Gomez, PhD, Senior Health Economics Manager,
Biologics, Latin America, GlaxoSmithKline, Buenos Aires, Argentina; Clarice
Petramale, PhD, Health Technology Incorporation Commission - CITEC, Department
of Science, Technology and Strategic Supplies, Ministry of Health, Brasilia, Brazil
PURPOSE: To explore current methods and experience of critical appraisal and
‘model busting’ approaches from alternative international perspectives with
speakers with extensive modelling experience and working with reimbursement
agencies both in the developed world as well as in the Latin American region.
DESCRIPTION: The use of decision-analytic modelling is increasingly considered
central to the process of HTA generally, and it plays a key role in informing
decisions on the reimbursement of health technologies. It is now common
that a decision model forms the core of the evidence submission dossiers to
reimbursement agencies, serving to synthesise data from a range of sources
and facilitate context-specific decision making. The increased emphasis on the
decision model as the main vehicle of assessment has led to the development of a
number of ‘good practice’ modelling guidelines and checklists both from individual
reimbursement agencies and academic groups. Nevertheless, as decision models
become ever more complex and sophisticated, the methods of critical appraisal
have usually been extended in some jurisdictions to include the revision of the
electronic model itself. This extension of the tasks of critical appraisal brings with
it a need to consider alternative approaches to ‘model busting’ and to learn from
existing experience in undertaking these tasks.
W3: USE OF REAL WORLD DATA FOR RESEARCH IN LATIN AMERICA
Presented in Spanish Don Diego 3
Discussion Leaders: Leonardo Tamariz, MD, MPH, Professor, University of Miami,
Miami, FL, USA; Ana Palacio, MD, MPH, Professor, University of Miami, Miami,
FL, USA; Alfredo Palacio, MD, Educational Dean, Universidad de Especialidades
Espiritu Santo, Guayaquil, Guayas, Ecuador
PURPOSE: The aim of this proposal is to discuss the advantages and disadvantages
of using administrative claims data for research, identify opportunities to use claims
data in Latin-America and to discuss the experience of the University of Miami
using health insurance datasets.
DESCRIPTION: The use of claims databases to analyze comparative effectiveness
has expanded in recent years. One reason for the increasing popularity of public
and private claims databases is the belief that it is important to study comparative
effectiveness of drugs, devices and medical procedures in current practice using
a large and nationally representative population. An important strength of claims
data sets is their large populations providing sufficient statistical power to detect
infrequent outcomes and allowing for comparisons across different age and race/
ethnic groups. In addition, the claims data often contain a multi-year record of
utilization, diagnoses, procedures, and prescriptions across the full range of real
world health care settings that permits longitudinal analysis. They also allow
cohort studies to be conducted without the high costs involved in primary data
collection. At the same time claims data sets contain several weaknesses. During
this workshop the presenters will do the following: First, the presenters will discuss
the advantages and disadvantages of the use of administrative claims and other
easily accessible datasets (10 minutes); second, the audience in small groups will
identify administrative datasets used in Latin America with a specific discussion
in the type of data that is collected (15 minutes); third, the audience will share the
discussion that was produced in the small groups (15 minutes); last, the presenters
will discuss their experience using administrative claims data. We will discuss with
the audience the use of health benefits company data, national and local datasets
for pharmacoepidemiology and outcomes research. The discussion will include
issues with validity, selection bias and methods for correction.
ISSUE PANELS & WORKSHOPS – SESSION II
Friday, 9 September: 16:15-17:15
IP2: RISK-SHARING SCHEMES IN EMERGING COUNTRIES: WHAT ARE THE
STEPS FOR SUCCESS?
Presented in English and Spanish with simultaneous interpretation
Don Diego 4
Moderator: Lou Garrison, PhD, Professor, Pharmaceutical Outcomes Research and
Policy Program, University of Washington School of Pharmacy, Seattle, WA, USA
Panelists: Sean D. Sullivan, PhD, RPh, MS, Professor & Director, Pharmaceutical
Outcomes Research and Policy Program, University of Washington School of
Pharmacy, Seattle, WA, USA; Diego Guarin, MD, MPH, MA, Director, Market
Access, Latin America, Merck Sharp & Dohme, Mexico City, Mexico; Jianwei Xuan,
PhD, Senior Director and Team Leader, Pfizer, New York, NY, USA
ISSUE: Novel approaches to pharmaceutical reimbursement are quickly becoming
more common within the European, Australian and US marketplaces as payers
continually try to control expenditures. Health outcomes-based reimbursement
agreements (often referred to as “performance based”, “risk-sharing” or “patient
access” schemes) offer ways for payers to tie pharmaceutical reimbursement to
the expected value of the product (i.e., improved health outcomes of recipients).
In some jurisdictions, these schemes allow the manufacturer and payer to reduce
the actual cost without adversely impacting the list price. Additionally, new risksharing designs have been developed that account for other market-focused issues
(e.g., performance compared to alternative treatments, reimbursement tied to
health improvements for a large population rather than individuals, etc.). Despite
the rise in number and type of agreements, no standard approach to designing and
implementing these schemes has emerged and key issues of scientific methodology
remain unresolved (e.g., defining what “success” looks like, determining how to
49
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
ISSUE PANELS & WORKSHOPS – SESSION II CONTINUED
measure health outcomes quickly to enable timely reimbursement, the presence
of confounders, etc.) that potentially threaten the long-term viability of these
agreements. Further, despite the growth in the application of these agreements,
few, if any, have been developed within Latin American and Asia Pacific markets,
raising the question of their potential appropriateness within these markets.
OVERVIEW: This panel will present a brief landscape of outcomes-based
agreements worldwide, as well as initial perspectives on the potential for, and
appropriateness of, innovative agreements within emerging markets. Panelists will
present methodological and market-based perspectives to ensure topic clarity,
examine current barriers in Latin America and Asia, and explore potential steps to
enable adoption of appropriate risk-sharing schemes within these countries.
W4: GUIDELINES FOR APPROPRIATE SELECTION OF MODELING APPROACH IN
PHARMACOECONOMIC EVALUATION IN LATIN AMERICA
Presented in Spanish Don Americo
Discussion Leaders: Pablo Anaya, MSc, HE&OR Manager, GlaxoSmithKline,
Mexico City, Mexico; Guillermo Meléndez, MD, MSc, Scientific Coordinator,
Nutrition Nestlé Fund, Mexican Foundation for Health (FUNSALUD), Mexico City,
Mexico; Joaquin Federico Mould-Quevedo, PhD, MBA, MSc, Health Economics
& Outcomes Research Director for Latin America and Primary Care, Pfizer
Laboratories Inc., New York, NY, USA
PURPOSE: To discuss methodological differences across alternative modeling
approaches, and to offer practical guidance for selecting the most appropriate
approach under a range of circumstances in Latin American countries.
DESCRIPTION: Recent years have witnessed continuous refinement in available
tools and techniques for health economic modeling. Workshops and short courses
are frequently offered at ISPOR and other venues to provide opportunities to
learn how to use the traditional methodologies, such as decision tree and Markov
modeling, as well as advanced ones, such as patient-level simulation. Less
frequently offered are opportunities for researchers to learn how to be pragmatic
in selecting the most appropriate methodological approach when faced with the
task of modeling a given disease area and set of treatments under the typical
constraints imposed by time, budget, and data availability. Yet, practical guidance
along these lines is crucially important to ensure that pharmacoeconomics models
are “fit for purpose”, answering the right questions with appropriate scientific
rigor so as to facilitate informed decision making. In this workshop, we will
provide a broad overview of the most widely employed methodologies in costeffectiveness analysis, including: 1) decision-analytic; 2) state-transition; and 3)
patient-level simulation models, including discrete-event simulation. Particular
attention will be paid to outlining their relative strengths and limitations vis-àvis a range of criteria, including amenability to alternative disease types (acute,
chronic, infectious) and medical interventions (preventive, curative, palliative);
transparency of model structures; difficulty of fulfilling data requirements for
parameter estimation; adaptability to multiple settings and/or users; need for
specialized software; and others. Real-world case studies will be introduced to
illustrate how these criteria shaped the presenters’ decision making in adopting
a particular modeling approach. The importance of being pragmatic in selecting
the appropriate modeling approach will be emphasized. Participants will share
their thoughts and experiences in selecting appropriate modeling approaches for
pharmacoeconomics evaluation in Latin-America.
W5: EQ-5D: A KEY PART OF THE LATIN AMERICAN DECISION-MAKERS’ TOOLKIT
Presented in Spanish Don Diego 2
Discussion Leaders: Paul Kind, Professor, Centre for Health Economics,
University of York, York, UK; Victor Zarate, MD, MSc, PhD Student, Centre for
Health Economics, University of York, York, UK; Fabiola Rosso, MSc, Researcher,
Department of Epidemiology, Ministry of Health, Santiago, Chile; Catalina Gutierrez,
MSc, Researcher, Departamento de Salud Pública, Universidad de Los Andes,
Santiago, Chile
PURPOSE: Generic measures of health status are required for a wide range of
purposes - informing the development of health policy, monitoring the progress of
population health programmes, evaluating the cost-effectiveness of new health
technologies and ultimately providing data for clinical decision-making. EQ-5D is
a widely used generic index of health-related quality of life available in more than
50
150 language versions, with a 25-year history of research development behind it.
EQ-5D defines health in terms of 5 dimensions (mobility, self care, usual activities,
pain/discomfort and anxiety/depression) and 3 levels of severity. This classification
describes 243 unique health states. EQ-5D combines the descriptive benefits
of a profile with the quantitative properties of an index measure. Value sets for
calculating the index have been developed in Argentina and Chile, amongst other
countries. Other Latin American countries are planning to establish their own
national value sets. The workshop will provide a briefing on the current status of
EQ-5D as well as presenting examples of its use from studies conducted in Chile
and the UK.
DESCRIPTION: EQ-5D is currently being used to measure outcomes in a wide range
of applications – in the measurement of population health in national and regional
surveys, in calculating QALYs for economic evaluation and as a performance
indicator in benchmarking health providers. This workshop will provide information
for decision-makers based on experience gained in the UK and Chile in measuring
and valuing health using EQ-5D in population and patient surveys. Presenters
include representatives of the Chilean Government, academia and the EuroQoL
Group. Attendees with no prior knowledge of EQ-5D can expect to acquire
sufficient information from the workshop to enable them to assess its value in their
professional activities. Handouts will be provided in both Spanish and English.
W6: EVALUACIÓN DE TECNOLOGÍAS SANITARIAS EN CHILE: PASADO, PRESENTE
Y FUTURO Presented in Spanish Don Diego 3
Discussion Leaders: Manuel Antonio Espinoza, MD, MSc, Académico,
Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago,
Chile; Marianela Castillo, MSc, Economista de la Salud, Ministerio de Salud de
Chile, Santiago, Chile; Luis Vera, MD, MSc, Departamento de Calidad y Seguridad
del Paciente, Ministerio de Salud de Chile, Santiago, Chile
PROPÓSITO: Chile ha avanzado en la reforma de su sistema de salud los últimos
diez años. Sin embargo, uno de los desafíos pendientes es la institucionalización
de un proceso de Evaluación de Tecnologías Sanitarias (ETESA). En el contexto de
la definición del plan nacional de salud en década 2011-2020 (PNS) se definieron
los objetivos ligados al desarrollo de ETESA. Este panel expondrá el proceso en
torno al que se están definiendo los lineamientos para el desarrollo de ETESA en
Chile con el objeto de compartir la experiencia chilena en un ambiente crítico
latinoamericano. Objetivo Específico: Describir el proceso de institucionalización
de ETESA en Chile, puntualizando en aquellos elementos necesarios para el
cumplimiento de los objetivos planteados por PNS.
DESCRIPCIÓN: El moderador presentará un marco conceptual del análisis
de situación de ETESA, focalizándose en los elementos que constituyen la
institucionalización del proceso de evaluación de tecnologías. Se destacarán las
aproximaciones actuales en la evaluación clínico-epidemiológica y económica,
ejemplificando con casos internacionales tipo. A continuación, el primer panelista
describirá el contexto histórico de ETESA en Chile y su actual marco normativo
e institucional. Luego, presentará los resultados del comité técnico ministerial
que definió los objetivos y estrategias del PNS en los subtemas de tecnologías
sanitarias. El segundo panelista presentará un análisis crítico de los desafíos
para el cumplimiento de las metas planteadas. Esta presentación estará enfocada
al incipiente uso de las evaluaciones económicas en salud dentro del proceso
de evaluación de tecnologías y al desarrollo de una guía metodológica en esta
materia. En cuarto lugar, el moderador estimulará la discusión en torno a aquellos
elementos que pudieran dificultar el alcance de los objetivos planteados por el
PNS en Chile. Finalmente se abrirá espacio para preguntas y comentarios de la
audiencia para cerrar con un conjunto de conclusiones emitidas por el moderador.
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
ISSUE PANELS & WORKSHOPS – SESSION III
ISSUE PANELS & WORKSHOPS – SESSION III
Saturday, 10 September: 11:00-12:00
IP3: EL PAPEL DE LAS AGENCIAS DE EVALUACIÓN DE TECNOLOGÍAS EN AMÉRICA
LATINA Presented in Spanish Don Diego 2
(Speakers for this panel were invited, see pages 57-59 for biographical
information)
Moderator: Iris Contreras, MD, MSc, Clinical Researcher, Mexican Institute of
Social Security, Mexico City, Mexico
Panelists: Alexandre Lemgruber, MSc, Advisor for Health Technology Management,
Pan American Health Organization (PAHO), Washington, DC, USA; Luis Vera, MD,
MSc, Professional Adviser, Health Technology Assessment, Department of Quality
and Safety Patient, Ministry of Health, Santiago, Chile; Esteban Hernandez-San
Roman, MD, Director, Evaluation of Health Technologies, The National Center for
Health Technology Excellence, México D.F., México
TEMA: El análisis de evaluación de tecnologías en salud, representa una
herramienta útil en la toma de decisiones para el uso y difusión de nuevas
tecnologías en los cuidados para la salud. En el mundo existen al menos 52
agencias identificadas, de las cuales 4 se encuentran en América Latina. Objetivo:
Describir el papel que juegan las agencias de evaluación de tecnologías en las
políticas en salud en la región y cuáles son los potenciales alcances para la
utilización de recursos en América Latina. SINOPSIS: El moderador describirá un panorama general de las agencias de
evaluación de tecnologías en América Latina, su impacto en la región, semejanzas
y diferencias entre ellos. El panel describirá de manera particular tres de las
agencias de mayor impacto en América Latina (Chile, Brasil y México), mostrando
en forma sintetizada la estructura y función de la agencia; el nivel de influencia
de las recomendaciones emitidas por la agencia, en la toma de decisiones en
las políticas públicas de salud y en especial en la utilización de recursos. Como
ejemplo se mostrará un caso de éxito de los resultados y recomendaciones
realizados por la agencia y su impacto en la toma de decisiones en el sector. En
la última parte del desarrollo del panel el moderador llevará a los panelistas a
una discusión sobre el futuro en el desarrollo de evaluación de tecnologías en
salud en América Latina, la factibilidad de generar un mayor número de ellas en
la región para apoyar la toma de decisiones y la necesidad de generar una red
de comunicación entre las agencias de los países latinoamericanos, exponiendo
los potenciales objetivos y posibles alcances para Latinoamérica. Finalmente el
moderador emitirá las conclusiones de la discusión.
W7: THE ROLE OF HEALTH ECONOMIC AND OUTCOMES RESEARCH (HEOR)
EVIDENCE IN FORMULARY AND REIMBURSEMENT DECISIONS IN LATIN AMERICA
VERSUS THE UNITED STATES
Presented in English and Spanish with simultaneous interpretation
Don Diego 4
Discussion Leaders: Anke-Peggy Holtorf, PhD, MBA, Adjunct Faculty,
Pharmacotherapy Outcomes Research Center, University of Utah, Salt Lake
City, UT, USA; Gary Oderda, PharmD, MPH, Professor & Director, Department of
Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA;
Federico Augustovski, MD, MSc, PhD, Director, Health Economic Evaluation and
Technology Assessment Department, Hospital Italiano de Buenos Aires, Institute
for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina; Abdulkadir
Keskinaslan, MD, MBA, MPH, Director, Market Pricing, Asia Pacific, Middle East
and African Countries, Global Pricing & Market Access, Novartis Pharma AG,
Basel, Switzerland
PURPOSE: The objective of this workshop is to consider how decision makers in
Latin America use HEOR information in the decision-making process versus global
experiences and the United States based on literature review, survey results and
using an interactive audience response system.
DESCRIPTION: Traditionally, randomized clinical trials (RCTs) have been considered
as the gold standard to generate efficacy and safety evidence for regulatory
decision-making. Recently, the importance of health economic and outcomes
research (HEOR) evidence in making decisions on drug reimbursement and patient
access to drugs has become as important. The key issue concerning the use
of HEOR evidence in decision-making is the uncertainty around the data. While
randomized clinical trial (RCT) data minimizes selection bias, there is also limited
generalizability due to a restricted protocol. Whereas HEOR evidence is more
generalizable, one needs to address methodological issues in a transparent manner
to make sure the evidence is meaningful in decision-making. Many countries have
started to integrate health economic information into their national, regional, or
local decision-making processes and health technology assessment agencies use
such data to a variable degree. The workshop will lead with an overview on key
characteristics of evaluation and patient access for new medical technologies
considering comparative effectiveness, health technology assessment, and
outcomes based contracting. The results from a survey to US decision-makers
on the current and future use of HEOR data in their decision processes and
results of regional surveys to researchers and decision-makers regarding the HTA
process and the relevance of the recent HTA “Key Principles” to this region will be
presented. Using an audience response system, the panel will facilitate discussion
with the audience to elicit critical interpretation and input relating to the meaning
and consequence of the study for the Latin Americas region and countries.
W8: METHODS FOR INDIRECT AND MIXED TREATMENT COMPARISONS: TOOLS
FOR ASSESSING HEALTH TECHNOLOGIES IN THE ABSENCE OF DIRECT EVIDENCE
Presented in Spanish Don Americo
Discussion Leaders: Rafael Alfonso-Cristancho, MD, MSc, Research Associate,
Pharmaceutical Outcomes Research & Policy Program, University of Washington
School of Pharmacy, Seattle, WA, USA; Beth Devine, PhD, PharmD, MBA,
Associate Professor, University of Washington, Seattle, WA, USA; Ximena BurbanoLevy, MD, Project Director, School of Integrated Sciences and Humanity, Florida
International University, Miami, FL, USA
PURPOSE: To describe and discuss current methods for indirect and mixed
treatment comparisons for use in the absence of direct head to head comparisons,
as tools to help decision-makers.
DESCRIPTION: Since resource and commercial constraints limit the conduct of
randomized controlled trials, direct head-to-head comparisons of therapeutic
agents are not conducted routinely for every disease or therapeutic class,
especially for recently marketed treatments. Yet, availability of these comparisons
would be useful to inform decision making in the context of clinical management
of patients or drug formulary development. An emerging set of statistical methods,
called ‘indirect treatment comparisons (ITC)’ or ‘mixed treatment comparisons
(MTC)’ have been developed for use when direct head-to-head comparisons are
not available. These methods are an extension of traditional meta-analysis and
can be employed to make between-product comparisons indirectly. ITC methods
are usually conducted in a Bayesian framework. Our workshop will be based on
the ISPOR Good Research Practice standards and will include a practical exercise
using WinBUGS to explain the details of developing the model in this statistical
package.
W9: INNOVATIVE APPROACHES TO IMPROVE MEDICATION ADHERENCE
Presented in Spanish Don Diego 3
Discussion Leaders: Ana Palacio, MD, MPH, Professor, University of Miami, Miami,
FL, USA; Leonardo Tamariz, MD, MPH, Professor, University of Miami, Miami, FL,
USA; Alfredo Palacio, MD, Educational Dean, Universidad de Especialidades
Espiritu Santo, Guayaquil, Guayas, Ecuador
PURPOSE: The following are the specific aims of this proposal: 1) Discuss
innovative interventions to improve medication adherence among vulnerable
populations with chronic diseases in the US and Ecuador. 2) Discuss barriers to
medication adherence and feasibility of interventions in Latin America.
DESCRIPTION: A number of interventions have shown promise in the improvement
of medication adherence and control of clinical outcomes among patients with
chronic conditions. During the initial 20 minutes of this workshop we will present
recent literature including projects led by the presenters that describe different
types of adherence measures as well as innovative approaches to improve this
outcome. Among the latter are the use of claims data to recruit at risk subjects
for behavioral interventions and to follow up adherence measures, the use of
point of care medication delivery systems that allow physicians to dispense presealed generic medications at no cost at the time of the visits, the use of avatars
for educational interventions and the creation of a health insurance system for the
most vulnerable subjects. We will dedicate the following 20 minutes to present
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
ISSUE PANELS & WORKSHOPS – SESSION III & IV
barriers and facilitators for the implementation of these interventions in the US and
in Latin America and finally provide a framework for participants to devote the last
20 minutes of the workshop identifying their own barriers as well as suggestions to
explore solutions to those barriers. The main goal of this workshop is for attendants
to understand the different adherence measures that can be used for research
purposes and the expansion into the clinical world as well as identify the best
measures to be used in Latin America.
ISSUE PANELS & WORKSHOPS – SESSION IV
Saturday, 10 September: 12:15-13:15
IP4: EL COSTO DE LOS TRASTORNOS DEL ESTADO DE ANIMO: zQUÉ ASPECTO
GENERA EL MAYOR GASTO PARA LOS SISTEMAS DE SALUD? zQUÉ GENERA LA
ALTA DISCAPACIDAD ASOCIADA?; UNA PERSPECTIVA SOCIAL, ECONÓMICA Y
GLOBAL Presented in Spanish Don Diego 3
Moderator: Claudia Becerra-Palars, MD, MSc, Coordinadora Clínica de Trastornos
del Afecto, Instituto Nacional de Psiquiatria, “Ramón de la Fuente”, México D.F.,
México
Panelists: Mauricio Palma, MSc, MD, Estudiente de psiquiatriat, Secretaria de
Salud, Instituto Nacional de Psiquiatría, México D.F., México; Jeremy Cruz, MD,
Universidad Nacional Autónoma de México/INP, México D.F., México; Ingrid
Vargas, MD, MSc, Investigadora, Académica, Departamento de Psiquiatría y Salud
Mental, Universidad Nacional Autónoma de México, México D.F., México
TEMA: Los Trastornos del Estado de Ánimo forman parte de las 10 primeras causas
de discapacidad a nivel mundial de acuerdo con la OMS: ¿Cuáles son los aspectos
psicosociales y económicos que generan dicha discapacidad? ¿En dónde radica
el alto costo de estas enfermedades? Dr. Mauricio Palma: Perspectiva Económica:
Costos indirectos y Carga global (15 min); Dr. Jeremy Cruz: Perspectiva Económica:
Costos directos (15 min); Dra. Ingrid Vargas: Perspectiva Psicosocial del costo
asociado. (15min); Discusión Pública (15 min) SINOPSIS: Se ha identificado que el trastorno depresivo mayor (TDM) ocupa el
tercer lugar en discapacidad (precedido por el Trastorno Bipolar). Las estimaciones
de CGE en el 2000 indican que la depresión unipolar contribuye al 4.4% de la
Carga Global de Enfermedad (OMS 2002). El promedio anual de costos directos
por paciente deprimido varía de $1000 a $2500 (Dólares). Los estudios de costos
indirectos reportan entre $2000 a $3700 dólares para costos de morbilidad y $200 a
$400 de mortalidad. Se ha observado que el TDM y el TB son causas de ausentismo
laboral: con un promedio de 3,2 días de incapacidad laboral al mes. El TB es una
enfermedad crónica, recurrente que genera alta morbilidad y mortalidad. Los
costos del TB se asocian con costos directos del tratamiento, pérdida de ingreso
y productividad, muerte prematura por efectos adversos y suicidio. Estudios en
México han reportado un costo promedio del tratamiento por episodio agudo de
Manía es de $6877 (dólares), mientras que el tratamiento de mantenimiento a un
año genera un costo de $1270 (dólares). Se ha documentado que las ganancias
obtenidas al reducir el ausentismo y mejorar la productividad en el trabajo podría
compensar el costo del tratamiento. Es importante la identificación de las áreas
generadoras de costo para diseñar intervenciones dirigidas a reducir los costos.
W10: A LACK OF LOCAL EFFECTIVENESS, COST AND EPIDEMIOLOGIC DATA: WHAT
ARE THE OPTIONS FOR CONDUCTING PE STUDIES IN LATIN AMERICA?
Presented in Spanish Don Diego 2
Discussion Leaders: J. Jaime Caro, MDCM, FRCPC, FACP, Senior Vice President
of Health Economics, United BioSource Corporation, Lexington, MA, USA; Rafael
Alfonso-Cristancho, MD, MSc, Research Associate, Pharmaceutical Outcomes
Research & Policy Program, University of Washington School of Pharmacy, Seattle,
WA, USA; Ximena Burbano-Levy, MD, Project Director, School of Integrated
Sciences and Humanity, Florida International University, Miami, FL,USA; Rosa Maria
Galindo-Suarez, MSc, Outcomes Research Manager, Pfizer, Mexico City, Mexico
PURPOSE: Discuss the challenges in conducting pharmacoeconomics in Latin
America, a region lacking many key data from local efficacy/effectiveness results,
resource use, utility measures, costs to epidemiologic information.
DESCRIPTION: The session will cover the options taken by pharmacoeconomics
researchers and outcomes research managers to collect data and the problems
in presenting their results to local decision-makers and KOLs. In addition, the
52
workshop will cover the common techniques and methodologies currently used to
overcome the lack of information within the region using as an example three LA
countries and three diseases. Discussion will also address how these approaches
affect credibility, transparency and acceptability of pharmacoeconomics findings
by HTA regulators and LA decision-makers.
W12: THE FUTURE OF PHARMACEUTICAL COST CONTROLS IN LATIN
AMERICA: HTA OR REFERENCE PRICING?
Presented in English and Spanish with simultaneous interpretation
Don Diego 4
Discussion Leaders: Monica Martin de Bustamante, AB, Fellow, Global Market
Access, Insight Strategy Advisors, New York, NY, USA; Cyrus A. Chowdhury, MSc,
Vice President, Global Market Access, Insight Strategy Advisors, New York, NY,
USA
PURPOSE: This workshop aims to explore the future development of two highpotential cost-containment mechanisms, reference pricing and HTA, currently
being leveraged in assorted forms by various Latin American countries, and the
resultant evolution of patient-level databases for the success of HTA.
DESCRIPTION: Throughout Latin America, the expansion of government-provided
healthcare coverage coupled with consistently increasing pharmaceutical costs
has created a need for national cost-containment mechanisms. Some countries,
like Mexico, have developed an HTA organisation to help define and defend their
product reimbursement decisions; while others, like Brazil, have utilised reference
pricing to rein in launch prices and HTA to help disclose national reimbursement
decisions. Although commonly implemented around the world, reference pricing
does not reward innovation or explore a product’s inherent value. On the other
hand, HTA studies can incorporate clinical, cost and real-world outcomes data
to create a sustainable and rewarding cost-containment tool. Manufacturers
currently provide product value dossiers to established HTA bodies throughout Latin
America, but the availability of patient-level outcomes to support product value is
scarce at this time. The decentralization of information throughout countries in
Latin America creates a barrier to the fuller realization of HTA bodies. The need
for sustainable and innovation-inducing cost-containment methods throughout
the region necessitates the further development of HTA and the obligation for the
centralization and inter-connection of existing real-world patient-level databases in
Latin America and beyond. The workshop will include an interactive portion which
allows participants to vocalise the trade-offs of reference pricing and HTA within
these rapidly developing markets.
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
SYMPOSIA
Symposia are free and open to all ISPOR delegates, no pre-registration required.
THURSDAY, 8 SEPTEMBER 2011
17:15-18:15 Don Diego 4
CANCER TREATMENT IN LATIN AMERICA: PERSPECTIVES, ACCESS AND SUSTAINABILITY
Presented in English
This symposium will provide a broad overview of the most important clinical parameters in oncology in order to offer meaningful data on coverage decisions
to decision-makers. New oncology treatments can represent a challenge for reimbursement process due to high costs. A review of radiography from clinical
evidence to decision-making in two Latin American countries will be presented.
Moderator: Alma Gabriela Valenzuela Flores, MD, MSc, Head of Quality, Centro Médico Nacional SXXI, IMSS, Mexico City, Mexico
How to Evaluate New Technologies in Oncology
Speaker: Octavio Clark, MD, Oncologist, EBM and HE, São Paulo, Brazil
Cost of Integral Prostate Cancer Management: A Proposal for Coverage
Speaker: Abelardo Meneses García, MD, MSc, Medical Director, National Institute of Cancerology, Mexico City, Mexico
THURSDAY, 8 SEPTEMBER 2011
18:30-19:30 Don Diego 4
HOW CAN WE AVOID A STROKE CRISIS IN LATIN AMERICA? A REPORT FROM AN INDEPENDENT WORKING GROUP
Presented in Spanish and English with simultaneous interpretation
The symposium will provide a broad overview of the burden of stroke crisis among patients, caregivers and society and will encourage a call for action to
prevent it. Every year 15 million people worldwide experience a stroke. Approximately five million of these suffer from permanent disabilities and over five
million more die. In Latin America in 2004 approximately 437,000 people suffered from a first stroke crisis and more than 250,000 died from it. For those who
survive it imposes a physical and emotional burden, heavily impacting their quality of life. Action for Stroke Prevention, a group of health experts from across
the globe, including Latin America, as well as other global medical societies and patient organizations who endorse the recommendations, encourage policymakers and local governments to act before the increasing frequency of strokes becomes a major public health crisis.
Speaker/Moderator: Carlos Cantú, MD, Professor of Stroke Program, National University of Mexico, Stroke Clinic, Department of Neurology, National Institute
of Medical Sciences and Nutrition, Salvador Zubiran, Mexico and Founding Member of the Mexican Stroke Association, Mexico City, Mexico
The Burden of Ischemic Stroke, Risk Factors and Therapeutic Options
Speaker: Jorge Gonzalez-Zuelgaray, MD, Chief of Service of Arrhythmias and Electrophysiology (Sanatorio de la Trinidad San Isidro, Buenos Aires,
Argentina), Director of Arrhythmia Center, University of Buenos Aires; President of Arrhythmia Alliance and Atrial Fibrillation Association in Argentina,
Director, Career of Specialists in Electrophysiology, University of Buenos Aires, Buenos Aires, Argentina
The Patient Perspective
Speaker: Trudie Lobban, MBE, Founder & Trustee, Arrhythmia Alliance, Founder and Chief Executive Officer, Atrial Fibrillation Association, Buenos Aires,
Argentina
A Call to Action
Speaker: Carlos Cantú, MD, Professor of Stroke Program, National University of Mexico, Stroke Clinic, Department of Neurology, National Institute of Medical
Sciences and Nutrition, Salvador Zubiran, Mexico and Founding Member of the Mexican Stroke Association, Mexico City, Mexico
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
SYMPOSIA
Symposia are free and open to all ISPOR delegates, no pre-registration required.
THURSDAY, 8 SEPTEMBER 2011
19:45-20:45 Don Diego 4
STRIKING THE RIGHT LEVEL: “MICRO AND MACRO” HTA IN EMERGING MARKETS / HEALTH SYSTEMS
Presented in English with simultaneous interpretation
The potential to collect, analyse, and utilise health outcomes data as one part of understanding health systems, technology utilisation and effectiveness will
be discussed. The symposium will provide key conclusions from the report on understanding the evolving health systems. This will include a brief discussion
of “health system inefficiencies”, such as distribution chains and margins, the role of generic medicines, perverse incentives, and work force issues.
Additional conclusions on the possible roles for technology assessment in evolving health systems, at a more “macro” level will also be reviewed.
Moderator: David Grainger, MD, Global Public Policy Director, Eli Lilly and Company, Indianapolis, IN, USA
Speakers:
Adrian Towse, MA, MPhil, Director, Office of Health Economics, London, UK
Lou Garrison, PhD, Professor & Associate Director, Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of
Washington, Seattle, WA, USA
FRIDAY, 9 SEPTEMBER 2011
12:30-13:30 Don Diego 4
HEALTH ECONOMIC ANALYSIS IN LATIN AMERICA: CAN LESSONS LEARNED FROM OTHER PARTS OF THE
WORLD BE APPLIED?
Presented in English with simultaneous interpretation
This session will review the current reimbursement and pricing decision-making processes in Latin America, including the use of health economic information
to inform these processes and the use of health economic modeling and real-world evidence.
Market Factors Influencing Demand and Use of Health Economic Information in Latin America
Speaker: Michael Nelson, PharmD, Regional Leader Americas, Health Economics & Outcomes Research, IMS Consulting Group, Alexandria, VA, USA
Current Reimbursement and Pricing Decision-Making Processes in Latin America: The Use of Health Economic
Information in Select Markets
Speaker: Joaquin F. Mould, PhD, HE & OR Director Latin America and Primary Care Emerging Market Business Unit, Pfizer Laboratories, New York, NY, USA
Health Economic Submission Requirements/Practices from Other Parts of the World and Implications for Latin America
Speaker: Juliet Munakata, MS, Principal, IMS Consulting Group, Redwood City, CA, USA
54
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
SYMPOSIA
Symposia are free and open to all ISPOR delegates, no pre-registration required.
FRIDAY, 9 SEPTEMBER 2011
13:45-14:45 Don Diego 4
HIGH COST MEDICINES: DO THEY BRING VALUE TO HEALTH SYSTEMS IN LATIN AMERICA AND HOW TO
ENSURE APPROPRIATE ACCESS?
Presented in English and Spanish with simultaneous interpretation
High cost medicines are by definition expensive and represent a growing percentage of payer spend on pharmaceuticals. This symposium will focus on the
drivers of health costs and the potential role of new medicines on positive health and economic benefits for the region, as well as on practical solutions (or
local case studies) to ensure appropriate access for these medicines. A panel of international and local speakers will present.
Moderator: Herman Soto Molina, MSc, Private Consultant, Mexico City, Mexico
Drivers of Health Costs and Health/Economic Benefits of New Medicines in Latin America
Speaker: Lou Garrison, PhD, Professor & Associate Director, Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of
Washington, Seattle, WA, USA
Ensuring Appropriate Access to High Cost Medicines
Speakers:
Marcos Bosi Ferraz, PhD, Professor & Director, São Paulo Center for Health Economics (CPES), Federal University of São Paulo, Director, Medical Economics,
Brazilian Medical Association and Director, Institutional Relations, Fleury Group São Paulo, São Paulo, Brazil
Maria Cristina Gutierrez Delgado, PhD, Deputy General Director, Economy and Health Economic Analysis Unit, Ministry of Health, Mexico City, Mexico
FRIDAY, 9 SEPTEMBER 2011
19:30-21:00 Don Diego 4
STATUS UPDATE OF THE REIMBURSEMENT REVIEW ENVIRONMENT ACROSS LATIN AMERICA
Presented in English and Spanish with simultaneous interpretation
In Latin America, there are many existing open issues and questions concerning drug reimbursement decisions and the use of outcomes research and health
technology assessment information in these decisions. At the ISPOR 1st Latin America Conference and the ISPOR 2nd Latin America Conference various
issues concerning the clinical and economic value of products being introduced into Latin America were presented. To foster the discussion, exchange of
knowledge, and experiences related to these issues, this symposium will serve to provide an update on the current reimbursement review requirements and
environment for assessments in Latin America; and will give an overview of the reimbursement review submissions and post-submission activities in Latin
America.
Moderator/Speaker: Federico Augustovski, MD, PhD, MSc, Director, Health Economic Evaluation and Technology Assessment, IECS (Institute for Clinical
Effectiveness and Health Policy) & Staff Physician, Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Speakers:
Marcos B. Ferraz, MD, PhD, Associate Professor & Director, São Paulo Center for Health Economics, Department of Medicine, Federal University of São
Paulo and Medical Director, Brazilian Medical Association, São Paulo, Brazil
Jorge Augusto Diaz Rojas, MSc (Pharmacology), MSc (Economics), PhD (c), Associate Professor, Hospital and Clinical Pharmacy Unit,
College of Pharmacy, Universidad Nacional de Colombia, Bogotá, Colombia
Iris Contreras Hernandez, MD, MS, Head of Internal Medicine, General Hospital Zone No. 1-A “Los Venados”, IMSS, Mexico City, Mexico
Carl Asche, PhD, MBA, Director & Professor, Center for Health Outcomes Research, University of Illinois College of Medicine, Peoria, IN, USA
55
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
SYMPOSIA
Symposia are free and open to all ISPOR delegates, no pre-registration required.
SATURDAY, 10 SEPTEMBER 2011
7:45-8:45 Don Diego 4
BIOLOGIC AND BIOSIMILAR DRUGS IN LATIN AMERICA: FUNDING CHALLENGES FOR PAYERS AND
DEVELOPERS
Presented in English and Spanish with simultaneous interpretation
The development of biologic drugs and their use in Latin America appears to give patients with chronic diseases opportunities for newer, better and more
focused treatments. However, the challenges for health authorities, sickness funds, or insurers to pay for these new treatments are becoming more acute.
Biosimilars could be an option for reducing prices/costs, however regulations or clinical evidence is not yet clear in the region. Unless new ways of funding
and allowing patients access to these new drugs can be found, the lack of commercial incentives will discourage future development. This symposium
will explore various challenges and issues associated with funding for biologics and biosimilars in Latin American markets, especially in Brazil, Mexico
and Colombia. An emphasis will be placed on recent developments and expected changes to the market access environment, which could lead to easier
and broader market access for biologic technologies and hence better incentives for developers to invest in such technologies. The panelists will present
different stakeholder perspectives regarding some of the key issues to set out how the environment is changing.
Speakers:
Gilberto Castañeda, PhD, Professor, Section of Pharmacology, Center for Research and Advanced Studies, National Polytechnic Institute, Mexico City,
Mexico
Valdair Pinto, MD, Advisor in Pharmaceutical Medicine, São Paulo, Brazil
Renato Guzmán, MD, Scientific Director, IDEARG, Bogotá, Colombia
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
INVITED SPEAKER BIOGRAPHICAL INFORMATION
ISPOR PRESIDENT
Mark Sculpher, PhD, MSc
Mark Sculpher is Professor of Health Economics at the Centre
for Health Economics, University of York, UK and is Director of
the Programme on Economic Evaluation and Health Technology
Assessment. Mark has worked in the field of economic evaluation
and health technology assessment for over 20 years. He has
researched in a range of clinical areas including heart disease, cancer, diagnostics
and public health. He has also contributed to methods in the field, in particular
relating to decision analytic modelling and techniques to handle uncertainty,
heterogeneity and generalisability. He has over 170 peer-reviewed publications
and is a co-author of two major textbooks in the area: Methods for the Economic
Evaluation of Health Care Programmes (OUP, 2005 with Drummond, Torrance,
O’Brien and Stoddart) and Decision Modelling for Health Economic Evaluation (OUP,
2006 with Briggs and Claxton).
He is a member of the UK National Institute of Health Research (NIHR) College
of Senior Investigators, and has also been a member of the National Institute for
Health and Clinical Excellence (NICE) Technology Appraisal Committee and the
NICE Public Health Interventions Advisory Committee. He currently sits on NICE’s
Diagnostics Advisory Committee. He chaired NICE’s 2004 Task Group on methods
guidance for economic evaluation and advised the Methods Working Party for the
2008 update of this guidance; he has also advised health systems internationally
on HTA methods including those in Ireland, Germany, Portugal and New
Zealand. He was a member of the Commissioning Board for the UK NHS Health
Technology Assessment Programme and the UK NIHR/Medical Research Council’s
Methodology Research Panel. He is the 2011-2012 President of the International
Society for Pharmacoeconomics and Outcomes Research (ISPOR).
PROGRAM COMMITTEE CO-CHAIRS
Antonio Caso Marasco, MD, MEd
Dr. Caso graduated from the School of Medicine at the National
University of Mexico (UNAM) as a surgeon and later specialized in
hematology at the Ministry of Health’s General Hospital of Mexico.
He also concurrently maintained his professional practice in the
private as well as public sectors.
Dr. Caso has completed various courses in health economics and
pharmacoeconomics throughout his professional life. He is Postgraduate
Professor of Hematology at the School of Medicine and has multiple academic and
administrative roles at the National University of Mexico.
In addition, he was a founding member and Past-President of the ISPOR Mexico
Regional Chapter and worked on many diverse projects related to the diffusion
of the discipline in Mexico. He continued his professional training by obtaining
three postgraduate degrees in the area of medical toxicology, communication, and
information technology, and also taught several courses in related disciplines and
participated in both clinical and basic research protocols.
Dr. Caso has served as an instructor at more than 30 international congresses,
and organized congresses and courses on issues related to access to health
services and technology. He has edited medical outreach magazines for countless
meetings and international congresses, published four books and numerous articles
and edited two medical distribution journals. He has been an author of many
projects of a national scope.
Currently, Dr. Caso is the Program Coordinator for Medical Distance Learning for
the Division of Postgraduate Studies in Medicine with the National Independent
University of Mexico (UNAM), and President and Founder of the Mexican College
of Pharmacoeconomics. He is also a member of the Medical Society of the General
Hospital of Mexico, Consultant to the Academic Council of Discovery Health Latin
America Iberia; and Scientific Advisor to the Institute of California, Los Angeles.
He has collaborated with the Office of International Affairs with the University of
Southern California. He has acted as editor for medical journals, author of various
projects on drugs, medication compliance, and pharmacoeconomics. He has been
an advisor to numerous drug companies in diverse disciplines.
Dr. Caso has collaborated and participated with diverse media outlets through radio
and television in order to inform and enhance public knowledge on the topic of
pharmacoeconomics and outcomes research.
Guillermo Meléndez, MD, MSc
2010-2012 Chair, ISPOR latin america Consortium
Guillermo Meléndez, MD, MSc, an internist, obtained his MD
degree and later, his Internal Medicine degree from the National
Autonomous University of Mexico. He received his Master of
Science Degree in Human Nutrition from the London School of
Hygiene and Tropical Medicine, London, England and completed a diploma in
marketing at the Universidad Iberoamericana and another in pharmacoeconomics
at the National Institute of Public Health of Mexico.
Guillermo is a researcher in childhood obesity and health economics at the
Mexican Health Foundation (Fundación Mexicana para la Salud A.C. – FUNSALUD),
where he directs the Childhood Obesity Intervention Program. He is a founding
Professor of the clinical nutrition specialty in Mexico, founding member and first
President of the International Society for Pharmacoeconomics and Outcomes
Research (ISPOR) México Regional Chapter, and founding member of the Mexican
College of Pharmacoeconomics. He founded and directs Medical and Nutritional
Trials, a research center dedicated to clinical and health economics research.
His research interest focuses on childhood obesity, including preventive
interventions impacting childhood obesity, from the playground to national
policy. He is also involved in analyzing processes and use of resources in public
institutions, and health technology assessment and clinical research on metabolic
syndrome and its relationship to childhood obesity.
Dr. Melendez has published articles and book chapters on meta-analysis, medicine,
economics and nutrition topics. His first book, edited in 2008, was titled “Overweight
and Obesity-associated Factors in the School Environment”, in which a discrete
event simulation model to predict the burden of childhood obesity for the health
system was presented.
Guillermo has served ISPOR since 2006 as a meeting abstracts reviewer, ISPOR
Regional Chapter contributor and reviewer, founder and first President of the ISPOR
Mexico Regional Chapter, member of the organizing committee for the ISPOR 1st
Latin America Conference and currently as Co-Chair of the ISPOR 3rd Latin America
Conference and as the 2010-2012 Chair of the ISPOR Latin America Consortium.
secretary of health of mexico 2006-2012
José Ángel Córdova Villalobos, MD
Dr. José Ángel Córdova Villalobos is originally from Leon, Guanajuato.
He is a medical doctor who graduated from the Faculty of Medicine
of the University of León, Guanajuato, and a specialist in Internal
Medicine at the National Institute of Medical Sciences and Nutrition
Salvador Zubirán, and General Surgery and Digestive Endoscopy, University
Paul Sabatier in Toulouse, France. He specialized in Municipal and State Public
Administration and subsequently obtained a Masters in Public Administration from
the University of Guanajuato. He has been appointed as Doctor Honoris Causa by
the University Paul Sabatier in Toulouse, France. He was Director of the Faculty of
Medicine of the University of Guanajuato from 1990 to 1997, Head of General Surgery
of the Regional Hospital of León from 1983 to 1987, Medical Assistant and General
Manager of the IMSS Specialty Hospital in the same city from 1985 to 1990, President
of the Mexican Association of Gastrointestinal Endoscopy from 1995 to 1996 and
Secretary of Foreign Relations of the Mexican Association of Gastroenterology in
1993. He was the president of the Mexican Association of Colleges and Schools of
Medicine, from 1995 to 1997, and received the “Robins Award” for the best career
average scores during his time at the Faculty of Medicine of the University of
Guanajuato in 1973, 1974 and 1975 – the prize awarded to the best students in Mexico
in 1976. He was also awarded the National Research Award given by the Mexican
Association of Gastroenterology and the Research Award in Health from the State
of Guanajuato at a national level; the Afacinera Award and Order of Merit Francisco
Hernández in Medical Education in Buenos Aires, Argentina in 1997 and won the
FUNSALUD “Robinson Bours” award for Medical Education in 1997. Likewise, he
has received several awards including that of the Government of Guanajuato for his
academic career, the National Academy of Medicine and the Federal Ministry of
Health for his legislative work, and the Decoration of the National Order of the Legion
of Honor for receiving the Grade of Knight by the French Government in February 2010.
Additional awards include “More Mexico at the United Nations, More United Nations
in Mexico” from the United Nations and the Red Cross Medal of the Grand Cross.
Dr. Córdova Villalobos has presented 233 scientific papers at several national
forums and abroad, as well as articles or abstracts in national and international
medical journals, 21 chapters of medical books, and has edited 5 books. He is a
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
INVITED SPEAKER BIOGRAPHICAL INFORMATION
member of 13 national and international scientific associations, has 6 different
certifications from specialty boards in Mexico, participated in 11 different
management positions and was member of the jury for several scientific events.
He is a member of the Mexican Academy of Surgery and the National Academy
of Medicine. He is currently Chairman of the 50th Board of Directors of the Pan
American Health Organization. He was City Counselor and President of the Electoral
Institute of Guanajuato.
Dr. Córdova Villalobos has also served as the Federal Deputy for the National Action
Party in the LIX Legislature. Within the deputy chamber, he participated in the
Committee on Science and Technology, chaired the Committee on Health and the
Friendship Group Mexico and Poland. He was considered in a survey performed by
Mitofsky consultation of all members of the Chamber of Deputies as the legislator
that did the most work in committees. He presented 18 initiatives and 8 points
of agreement of national importance to encourage the creation of the National
Institute of Genomic Medicine.
PLENARY SPEAKERS
J. Jaime Caro, MDCM, FRCPC, FACP
Jaime Caro is an expert in health technology assessment. Dr.
Caro trained at McGill University, where he practiced internal
medicine and is now Adjunct Professor of Medicine, as well as of
Epidemiology and Biostatistics. He has established the graduatelevel course in pharmacoeconomics at the University and also lends
his teaching ability to other academic institutions, government organizations, and
professional associations. After founding and leading the Caro Research Institute
for more than a decade, he is now Senior Vice President at United BioSource
Corporation.
His initial work in theoretical epidemiology led to applied research for the Health
Technology Assessment Council of Quebec, a pioneer in the then nascent field.
This early interest in the proper approach to evaluating health care interventions
has resulted in efforts to help government organizations in countries as diverse
as Germany and Colombia develop and implement their methodologies; and to
appointments on the steering committees of various global initiatives to address
specific diseases.
In addition to Dr. Caro’s work and publications on more than 100 disease models, he
has continued active research on advanced modeling techniques used to inform
complex health care decisions, and the application of epidemiologic concepts to
economic studies. This has included the development of approaches for dealing
with complex time dependencies and the transfer of modeling techniques from
other fields to medicine—modifying discrete event simulation for use in economic
and risk-benefit analyses and the modeling of adaptive clinical trials. More
recently, he has focused on the development of a suitable metric to guide health
care decisions.
Maria-Luisa Escobar, MA, PhD
Dr. Escobar is a health economist with twenty years of experience
working on health policy, health economics and health system
reform. She is currently the Manager of the Health Practice at the
World Bank. She has worked with developing countries on the
analysis and design of health policies, through the Inter-American
Development Bank and later through the World Bank. Besides the international
experience, Dr. Escobar served as Director of Planning and Senior Advisor to the
Minister of Health in Colombia, and later as Technical Advisor to the Minister of
Social Protection of the government of Colombia.
More recently, before joining the World Bank Institute, she worked on the analysis
of innovative financing mechanisms for global health as a Fellow in Residence at
the Brookings Institution in Washington D.C. and developed a research agenda
on the impact of health insurance in developing countries. Her main interests are
on health care financing and health policy, and on the development of effective
strategies to transform technical knowledge into the implementation of health
policy in developing countries.
Her more recent publications are: Maria-Luisa Escobar, Charles C. Griffin, R. Paul
Shaw, eds. “The impact of Health Insurance in Low- and Middle- Income Countries:
The Brookings Institution, December 2010.
Glassman, Amanda, María-Luisa Escobar, Ursula Giedion and Antonio Giuffrida,
eds. “From few to many: a decade of health insurance expansion in Colombia.”
Washington, DC: IDB and Brookings Institution, December 2009.
58
Juan Garduño ESPINOSA, MD
Juan is originally from Maravatio, Michoacán (Mexico). He is
a surgeon for the Medical Faculty of the National Independent
University of Mexico (UNAM), specializing in Internal Medicine
and having received his Master and Doctor of Medical Sciences
degrees from the same university. He has carried out Clinical
Epidemiology teaching and training activities at the “Salvador Zubirán” National
Institute of Nutrition and taught Health Economics at the Center for Economic
Research and Education and National Institute of Public Health. He received a
Diploma in Upper Business Management from the Pan-American Institute of Upper
Management.
As an Academic Tutor and Full-Time Professor of the Masters in Medical Sciences
Research Seminar at UNAM, he has graduated 18 students: 12 at the Master’s
level and 6 at the specialty level. He is also a Pharmacoeconomics Professor at the
Monterrey Institute of Technology and Higher Education.
He has published 90 research papers related to clinical epidemiology, quality
of health care and health economics. He has written 16 book chapters and is
a co-author of 4 books. In addition, he is a member of the National System of
Researchers.
He served in the Mexican Institute of Social Security as a doctor, advisor, Medical
Programs Coordinator, Head of Research Unit, Division Chief and Medical Areas
Coordinator. He is currently the Assistant Director of Research at the “Federico
Gómez” Children’s Hospital of Mexico.
Mercedes Juan López, MD
Dr. Juan is a graduate of the School of Medicine of the National
Independent University of Mexico (Universidad Nacional Autonóma
de México, UNAM), with a specialization in rehabilitation medicine
from UNAM. She obtained a Master’s degree in neurological
rehabilitation from the Metropolitan Independent University
(Universidad Autónoma Metropolitana) and graduated from the Special Program of
High Direction of IPADE.
She worked in the Colonia Hospital of Ferrocarriles Nacionales de México.
In the public administration she has been Technical Secretary of the Health Cabinet
of the President of Mexico, Under Secretary of Sanitary Regulation of the Health
Ministry, Secretary of the National Health Council, was in charge of the link unit of
the Health Ministry with Congress, Secretary of the General Health Council, and
was also in charge of health care operation commissioner of COFEPRIS.
Since September 2009, Dr. Juan is the Executive President of Fundación Mexicana
para la Salud.
In the legislative field she was Federal Deputy of the XXVII Legislature, Secretary
of the Health and Population Commissions, and member of the Handicapped
Commission. When Congress enacted its first Directive Board, she was the first
vice president.
Dr. Juan is an author of 48 scientific articles, author of 8 books and co-author of
20 books on topics such as: Handicap and Rehabilitation; the role of woman in the
actions of health care; Pollution, Modernization of Sanitary Regulation in Mexico;
and decentralization of health services. She has presented at 240 conferences and
workshops, at different medical events.
She is a Postgraduate Professor of The School of Medicine of UNAM.
Dr. Juan has been certified and recertified for the Rehabilitation Medicine Council,
and is a member of the Mexican Academy of Surgery (Academia Mexicana de
Cirugía) and of different medical associations.
Dr. Juan has received various prizes and distinctions including Orden Nacional del
Mérito con el grado official from the French Government and recognition with the
“Commissioner’s Special Citation” awarded by the Food and Drug Administration of
the United States of America.
Tomás A. Pippo Briant, MA, MPH
Tomás A. Pippo Briant is an economist and graduate of the National
University of La Plata (UNLP). He has a Masters’ degree in Health
Management and Policy from the University of Bologna, as well
as a Masters’ degree in public finance (UNLP). Currently, he is
the Director in charge of the Department of Health Economics
for the Ministry of Health of the Nation of Argentina, Coordinator of the Technical
Group on Universal Access to Medicine for the Union of South American Nations
(UNASUR) and the Argentinean representative to the Intergovernmental Institution
of Medical Policy for MERCOSUR. He is member of the Unit of Coordination of
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
INVITED SPEAKER BIOGRAPHICAL INFORMATION
Health Technology Assessment of the Ministry of Health of the Nation of Argentina
and has conducted numerous health economic evaluation studies during his career.
Previously he developed teaching activities in macroeconomics for the Catholic
University of La Plata and in health economics for the ISALUD University. He also
developed consulting projects in the public and private arena in the area of health
economics, scientific and technical innovation and product development.
Alarico Rodríguez de León, MD
Alarico Rodríguez de León obtained his medical degree from the
School of Medicine, UDELAR, as well as his Post-graduate and
Master’s degree in Public Health. He is the Vice Director (Benefits
Manager) of the Uruguayan National Agency for Highly Specialized
Medical Procedures (FNR). He has participated in and lead
research on health technology assessment, health systems, policy and funding
for health coverage, policies on drugs, organ transplantation, hospital infections,
quality assurance in health services and utilization review of health services. He
has published many scientific articles in supplements and reviews, as well as
book chapters on health policy and management, health and human resources
and bioethics. He has been an invited professor at the postgraduate and masters
level of national and foreign universities, a tutor for PAHO’s Virtual Campus and
member of the Board of Examiners. He has lectured on several scientific activities
of international organizations in Latin America, Europe, Africa and Asia. He is also
member of the Uruguayan Cochrane Collaboration Center and researcher at the
Evaluation Quality Program of FNR, Latin American representative in the WMA
Council, Manager for Relation Officers with the PAHO of CONFEMEL, member of
CGD’s Working Group on Priority-Setting Institutions in Health, founding partner of
SUSAC, founding partner and Vice Chairman of AESUruguay. He was President of
SMU (2005); Advisor to the Ethical Committee, WMA (2005-2006); Secretary General
of SMU (2003-2004); Manager of 1727-Emergencias (1998-2000); Manager of CASMU
(1993-1996); and Faculty Member of the School of Medicine at UDELAR (1994-1995).
In addition, he has served on official and academic committees from national and
foreign institutions.
Guillermo Williams, MD
Dr. Guillermo Williams is a pediatrician with a degree in Public
Health from the National University of Buenos Aires. He is currently
the National Director of Health Care Quality and Regulation in
Health Services at the Ministry of Health of the Nation of Argentina.
He is the Operational Coordinator for the Unit of Coordination and Administration of
Health Technology Assessment for the Ministry of Health, and the Coordinator for
the Argentine Commission of Health Care Services SGT-11 Mercosur Health.
Dr. Williams is Coordinator and Faculty for the Masters program in Public Health at
the National University of Buenos Aires, Department of Health Policy, Systems and
Services. A consultant on health services for the World Health Organization/Pan
American Health Organization, he was previously a resident with the international
health program at the same institution, and was formerly the Under Secretary of
Health for the Municipality of Moreno in Buenos Aires Province.
Luis Romero Strooy, MBA
Luis Romero is currently the Superintendent of Health for the
Government of Chile. He acceded to this position on 8 July 2010,
after winning the corresponding selection process through the
System of Upper Public Management. An industrial civil engineer
by training, he received his engineering degree at the Pontificial
Catholic University of Chile, and his Masters in Business Administration from the
University of San Francisco in California. Mr. Romero is an executive with more
than 20 years of professional experience working with national and international
companies in the area of insurance, health and technology (Exxon, Cigna, Colmena
Golden Cross). He served for many years as director of various corporate trade
associations and clinics.
INVITED ISSUE PANEL SPEAKERS
Iris Contreras, MD, MSc
Iris Contreras is a surgeon who matriculated from the National
Independent University of Mexico (UNAM), with a specialization
in Internal Medicine. She also holds a master’s degree in SocioMedical Sciences (with an emphasis on epidemiology) from
the same University. She has worked as an internist for over 10
years and as a researcher at the Health Economics Research Unit for 6 years
(both positions held with the Mexican Institute of Social Security (IMSS)). She
has been leader of multicenter projects on issues of quality of care in oncology
patients, cardiovascular risks, temporary inability to work and HIV/AIDS. She has
participated as consultant in several research projects on pharmacoeconomics
for Pfizer, Schering-Plough, MSD and Teva. Professor of Introduction to Health
Economics for the MSc Program in Health Sciences at UNAM and the MSc in
Health Systems at the National Health Institute of Mexico (Instituto Nacional de
Salud Pública), she has coordinated the Health Economics Diploma at IMSS and is
currently professor of the Diploma in Health Economics at Instituto Tecnológico y
de Estudios Superiores de Monterrey. Author of 18 scientific articles, Dr. Contreras
is the 2010-2012 Chair of the ISPOR Latin America Consortium Health Technology
Assessment Agencies Committee and is currently in charge of the Internal
Medicine Department for General Hospital No. 26 “Chilpancingo” at IMSS.
Luis Vera Benavides, MD, MEBPH
Luis Vera Benavides is a surgeon with a Master in Evidence-Based
Public Health. Luis is currently a Professional Assistant to the
Department of Patient Quality and Safety of the Ministry of Health
and has focused on relating Health Technology Assessment with
Public Policies and Health decision making for the past three
years. He is a member of the Regional Technical Subcommittee of the Andean
Regional Health Committee, said committee in which he holds the position of
chairman and has encouraged the creation of the Andean Health Technology
Assessment Policy and Health Technology Assessment Guidelines with emphasis
on the implementation processes carried out by countries of the sub-region. Luis’
university teaching position currently supports the thesis and dissertation of both
undergraduate and graduate careers such as Biomedical Engineering and Nursing
at national universities as well as in the Ullyses International Program. He also
participates in the National Fund for Health Research and Development (FONIS)
Projects as head and alternate researcher, in addition to other international
financing positions, while attempting to maintain a close relationship between the
research and health decision making.
Alexandre Lemgruber, MSc
Alexandre Lemgruber has recently assumed the position of Advisor
for Health Technology Management at the Pan American Health
Organization (PAHO). Until July 2011 he was the Head of the Office
of Economic Evaluation of New Technologies at the Brazilian Health
Regulatory Agency (ANVISA), responsible for the assessments
that support pricing decisions of new drugs. He worked previously at the Brazilian
Ministry of Health and at the Brazilian Agency of Supplementary Health (ANS). From
2001 to July 2011 he worked at ANVISA, where he was responsible for proposing
price-regulation policy based on Health Technology Assessment (HTA) and has
contributed significantly to the support of HTA activities in the country.
He is the founder of the Brazilian Bulletin of Health Technology Assessment
(BRATS) and was a member of the National Commission of Health Technologies
Incorporation (CITEC), responsible for decisions regarding technologies covered
by the Public Health System (SUS). As one of the Brazilian representatives in the
Health Technology Assessment Commission at MERCOSUR, he has contributed
significantly to the support of HTA activities in the region. He has coordinated
several projects in the field of HTA, in cooperation with ANVISA and the Pan
American Health Organization (PAHO) and was co-author of the National Policy of
Health Technology Management.
Esteban Hernandez-San Roman, MD
Dr. Esteban Hernández San Román is a surgeon specializing
in general surgery. He completed his postgraduate studies in
gynecological oncology, laparoscopic and gastrointestinal surgery,
health care management and economics as well as evidencebased medicine.
He was employed for 17 years at the General Surgery Service General Hospital
of the National Medical Center “La Raza”, where for 10 years he was Associate
Professor of the Specialization Course in General Surgery.
He has held various positions in public and private sectors, including Director of
Equipment for the Ministry of Health, Head of Equipment Planning for the Mexican
Institute of Social Security and Director General of the consulting firm Health
Projects and Equipment (PROESA). He has been the Director of Health Technology
Assessment at the National Center of Excellence in Health Technology, Mexico
since May 2006.
59
Value in Health Special Issue:
Pharmacoeconomics & Outcomes Research
in Latin America
The goal of the Value in Health Special Issue:
Pharmacoeconomics and Outcomes Research
in Latin America, is to promote the science of
pharmacoeconomics and outcomes research
in Latin America, by providing an additional
publication opportunity to researchers,
practitioners and policy makers in the
region where this science is being
developed, and to share pharmaceutical
and medical device outcomes research
results from Latin America with the
rest of the world.
Value in Health Special Issue:
Pharmacoeconomics and Outcomes Research in Latin America
Volume 14 Issue 5 (Supplement 1) July/August 2011
This issue features 32 articles (17 English, 13 Spanish and 2 Portuguese)
on health-study populations from the region, including selected articles
presented at the ISPOR 2nd Latin America Conference held
in September 2009 in Rio de Janeiro, Brazil.
All articles were peer-reviewed and cover health policy,
economic and health outcomes analysis.
Available at www.ispor.org
60
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
LISTADO DE LOS PÓSTERS DE INVESTIGACIÓN
Research Poster Listing
RESÚMENES DE LAS PRESENTACIONES EN PODIO
Research Podium Abstracts
RESÚMENES DE LOS PÓSTERS DE INVESTIGACIÓN
Research Poster Abstracts
RESÚMENES DE LOS ESTUDIOS DE CASOS DE LOS TOMADORES
DE DECISIONES EN EL CUIDADO DE LA SALUD
Health Care Decision-Maker Case Study Abstracts
MIEMBROS DEL COMITÉ DE REVISIÓN DE LA 3ª CONFERENCIA ISPOR
PARA AMÉRICA LATINA
ISPOR 3rd Latin America Conference Review Committee Members
PROGRAMA DE LA EXPOSICIÓN
Exhibit Program
DIRECTORIO DE LIDERAZGO
Leadership Directory
61
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster PRESENTATIONS
POSTER DISPLAY HOURS: FRIDAY, 9 SEPTEMBER: 8:30-20:00 & SATURDAY, 10 SEPTEMBER: 8:00-13:45
POSTER AUTHOR DISCUSSION HOUR: FRIDAY, 9 SEPTEMBER: 18:30-19:30
Don Diego 1
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PCN
PCN
CANCER – Cost Studies
pg 83 PCN1 SELECTING A MIX OF PREVENTION STRATEGIES AGAINST CERVICAL CANCER FOR MAXIMUM EFFICIENCY WITH AN OPTIMISATION PROGRAM
Demarteau N1, Gomez JA2, Lorenzato F3, Standaert B1, 1GlaxoSmithKline Biologicals, Wavre, Belgium, 2GlaxoSmithKline, Middlesex, UK, 3GlaxoSmithKline, Rio
de Janeiro, Brazil
pg 83 PCN2 COST-EFFECTIVENESS AND BUDGET IMPACT ANALYSIS OF AN IMMEDIATE CARE CENTER AT THE NATIONAL CANCER INSTITUTE, MEXICO
Nieves U1, Guajardo J1, Cerezo O1, Plancarte R1, Apodaca A1, Torres J1, Rodriguez F2, 1National Cancer Institute, México, Tlalpan, México, 2Universidad
Nacional Autónoma de México, México, Coyoacan, México
pg 83 PCN3 ESTIMACION DE LA CARGA DE LOS TUMORES NEUROENDOCRINOS EN COLOMBIA
Ruiz A1, Alfonso-Cristancho R2, Mejia A1, Gonzalez D3, Maestre K4, Herran S1, 1RANDOM Foundation, Bogotá, Colombia, 2University of Washington, Seattle, WA,
USA, 3Fundación Santa Fe de Bogotá, Bogotá, Colombia, 4Novartis Pharma AG, Bogotá, Colombia
pg 83
PCN4COSTO-EFECTIVIDAD DE OCTREOTIDE COMPARADO CON TERAPIA DE SOPORTE USUAL PARA EL TRATAMIENTO DE TUMORES NEUROENDOCRINOS EN
COLOMBIA
Ruiz A1, Alfonso-Cristancho R2, Mejia A1, Gonzalez D3, Maestre K4, Herran S1, 1RANDOM Foundation, Bogotá, Colombia, 2University of Washington, Seattle, WA,
USA, 3Fundación Santa Fe de Bogotá, Bogotá, Colombia, 4Novartis Pharma AG, Bogotá, Colombia
pg 84 PCN5 EFECTIVIDAD CLÍNICA Y COSTO-EFECTIVIDAD DEL TRATAMIENTO DE SEGUNDA LÍNEA PARA CARCINOMA METASTÁSICO DE CÉLULAS RENALES
Romero M, Díaz E, Malagon J, Fundación Salutia, Bogotá, Colombia
Poster presentation topic codes are provided in Spanish on page 9 and English on page 37.
Page numbers shown to the left refer to the abstract location in this Program & Schedule of Events.
62
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
POSTER DISPLAY HOURS: FRIDAY, 9 SEPTEMBER: 8:30-20:00 & SATURDAY, 10 SEPTEMBER: 8:00-13:45
POSTER AUTHOR DISCUSSION HOUR: FRIDAY, 9 SEPTEMBER: 18:30-19:30
pg 84
PCN6EVALUACION ECONOMICA DEL DASATINIB EN EL TRATAMIENTO DE LA LEUCEMIA MIELOIDE CRONICA EN PACIENTES RESISTENTES AL IMATINIB EN
CHILE
Orozco JJ1, Valencia JE2, Aiello E3, Caputo M4, 1Universidad CES, Medellin, Colombia, 2Bristol-Myers Squibb, Bogotá, Colombia, 3Bristol-Myers Squibb, Buenos
Aires, Argentina, 4Bristol-Myers Squibb, Santiago de Chile, Chile
pg 84
PCN7IMPACTO PRESUPUESTARIO DEL TRATAMIENTO EN PRIMERA LÍNEA PARA CÁNCER COLORRECTAL METASTÁSICO BASADO EN XELOX + ANTI-VEGF O
XELOX + ANTI-EGFR
Gomez E, Torrecillas L, Cervantes L, Centro Médico Nacional 20 de Noviembre ISSSTE, México, D.F., México
pg 84
PCN8COST-EFFECTIVENESS ANALYSIS OF AN OPIOID IN COMBINATION WITH GABAPENTIN VERSUS MONOTHERAPY FOR THE TREATMENT OF NEUROPATHIC
PAIN
Galindo L1, Guajardo J1, Plancarte R1, Cerezo O2, Najera E3, Gonzalez I1, 1National Cancer Institute, México, Tlalpan, México, 2Oncology National Institute,
México D.F., México, 3Universidad Nacional Autónoma de México, México, Coyoacan, México
pg 85
PCN9ECONOMIC EVALUATION OF PANITUMUMAB VS CETUXIMAB IN PATIENTS WITH COLORECTAL CARCINOMA (CRCM) WITH NON-MUTATED (WILD-TYPE)
KRAS AFTER FAILURE OF CHEMOTHERAPY REGIMENS IN MEXICO
Arocho R1, Rivera Hurtado R2, 1Amgen, Inc., Barcelona, Spain, 2Amgen México, México D.F., México
pg 85
PCN10ANALISIS DE MINIMIZACION DE COSTOS ENTRE EL USO DE IOPROMIDE MEDIANTE UN SISTEMA DE APLICACION EN CASCADA (SIAC) FRENTE AL USO DE
OTROS MEDIOS DE CONTRASTE CONVENCIONALES EN RADIOLOGIA INVASIVA EN COLOMBIA
Romero M1, Karpf E1, Oyuela M2, 1Fundación Salutia, Bogotá, Colombia, 2Bayer Colombia, Bogotá, Colombia
CARDIOVASCULAR DISORDERS – Cost Studies
pg 85
PCV1COSTS, LENGTH OF STAY AND ALL-CAUSE MORTALITY IN RUPTURED VERSUS UNRUPTURED CEREBRAL ANEURYSM AMONG INPATIENTS IN THE UNITED
STATES
Wallace KL, Hashemi L, Minshall ME, Covidien, Mansfield, MA, USA
pg 85 PCV2 ESTIMATED COST OF ACUTE CORONARY SYNDROME FOR 2011: CASE OF MEXICO
Ramirez MA1, Sanchez A1, Piha T2, Polanco AC1, Hernandez R3, De los Rios M4, 1AstraZeneca, México D.F., México, 2AstraZeneca, Cotia, São Paulo, SP, Brazil,
3
AstraZeneca, Miami, FL, USA, 4Centro para el Des. de la Medicina y de Asistencia Medica Esp., Culiacan, Sinaloa, México
pg 86 PCV3 ESTIMATED COST OF ACUTE CORONARY SYNDROME FOR 2011: CASE OF BRAZIL
Piha T1, Ramirez MA2, Sanchez A2, Mariz VO1, Neves JE3, Teich V4, Araujo DV4, 1AstraZeneca, Cotia, São Paulo, SP, Brazil, 2AstraZeneca, Ciudad del México,
México D.F., México, 3AstraZeneca, Miami, FL, USA, 4MedInsight Evidências, São Paulo, SP, Brazil
pg 86
PCV4ANALISIS COSTO EFECTIVIDAD EN EL LARGO PLAZO DE LOS STENTS LIBERADORES DE FARMACO VS STENTS CONVENCIONALES EN PACIENTES CON
CARDIOPATIA ISQUEMICA EN EL IMSS
Gonzalez-Diaz BE1, Salinas Escudero G2, Granados-Garcia V1, Contreras Hernández I1, Calderón Abbo M1, 1Instituto Mexicano del Seguro Social, México D.F.,
México, 2Hospital Infantil de México Federico Gómez, Secretaría de Salud, México D.F., México
pg 86
PCV5COST-EFFECTIVENESS AND BUDGET IMPACT ANALYSIS OF RIVAROXABAN IN THE PREVENTION OF THROMBOEMBOLIC EVENTS IN PATIENTS
PERFORMING HIP AND KNEE ARTHROPLASTY IN COMPARISON WITH NO TREATMENT UNDER THE BRAZILIAN PRIVATE HEALTH CARE SYSTEM
PERSPECTIVE
Schiola A1, Silva AP2, Santoni NB2, Paladini L3, Teich V3, Pepe C3, Rocha MM3, 1Bayer de México, S.A. de C.V., México D.F., México, 2Bayer Brasil, São Paulo,
SP, Brazil, 3MedInsight Evidências, São Paulo, SP, Brazil
pg 86
PCV6COST-EFFECTIVENESS AND BUDGET IMPACT ANALYSIS OF RIVAROXABAN IN THE PREVENTION OF THROMBOEMBOLIC EVENTS IN PATIENTS
PERFORMING HIP AND KNEE ARTHROPLASTY IN COMPARISON WITH ENOXAPARIN UNDER THE BRAZILIAN PRIVATE HEALTH CARE SYSTEM
PERSPECTIVE
Schiola A1, Silva AP2, Santoni NB2, Paladini L3, Teich V3, Pepe C3, Rocha MM3, 1Bayer de México, S.A. de C.V., México D.F., México, 2Bayer Brasil, São Paulo,
SP, Brazil, 3MedInsight Evidências, São Paulo, SP, Brazil
pg 87
PCV7COST-EFFECTIVENESS OF PRASUGREL VERSUS CLOPIDOGREL IN PATIENTS WITH ACUTE CORONARY SYNDROMES UNDERGOING PERCUTANEOUS
CORONARY INTERVENTION IN THE PUBLIC HEALTH CARE SYSTEM IN MEXICO
Mondragon R1, Arrieta-Maturino E2, Vargas-Valencia JJ3, Martínez-Fonseca J3, Guzman-Sotelo M3, Galindo-Suarez RM2, Ramírez-Gámez J2
1
Hospital Central-Sur de Alta Especialidad PEMEX, México D.F., México, 2Eli Lilly and Company, México D.F., México, 3Econopharma Consulting S.A. de C.V.,
México D.F., México, 4Pfizer, Inc., México City, México
pg 87
PCV8COST-EFFECTIVENESS AND BUDGET IMPACT ANALYSIS OF RIVAROXABAN IN THE PREVENTION OF THROMBOEMBOLIC EVENTS IN PATIENTS
PERFORMING HIP AND KNEE ARTHROPLASTY IN COMPARISON WITH DABIGATRAN UNDER THE BRAZILIAN PRIVATE HEALTH CARE SYSTEM
PERSPECTIVE
Schiola A1, Silva AP2, Santoni NB2, Paladini L3, Teich V3, Pepe C3, Rocha MM3, 1Bayer de México, S.A. de C.V., México D.F., México, 2Bayer Brasil, São Paulo,
SP, Brazil, 3MedInsight Evidências, São Paulo, SP, Brazil
pg 87
PCV9COSTO–EFECTIVIDAD DE LOS ÁCIDOS GRASOS OMEGA 3 COMO COADYUVANTE DE LA SIMVASTATINA EN EL TRATAMIENTO DE LA
HIPERTRIGLICERIDEMIA
Rendon D, Ordoñez J, Orozco JJ, Universidad CES, Medellin, Colombia
Poster presentation topic codes are provided in Spanish on page 9 and English on page 37.
Page numbers shown to the left refer to the abstract location in this Program & Schedule of Events.
63
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
POSTER DISPLAY HOURS: FRIDAY, 9 SEPTEMBER: 8:30-20:00 & SATURDAY, 10 SEPTEMBER: 8:00-13:45
POSTER AUTHOR DISCUSSION HOUR: FRIDAY, 9 SEPTEMBER: 18:30-19:30
pg 87
PCV10UN ESTUDIO DE MINIMIZACION DE COSTOS PARA EVALUAR EL TRATAMIENTO CON METOPROLOL EN PACIENTES CON HIPERTENSION ARTERIAL EN
MÉXICO
Lopez JA1, Briones B2, 1Sandoz México, México D.F., México, 2Novartis Farmaceutica, México D.F., México
DIABETES/ENDOCRINE DISORDERS – Clinical Outcomes Studies
pg 88 PDB2 CALIDAD DE PRESCRIPCION DE HIPOGLUCEMIANTES ORALES EN UNA UNIDAD MEDICA FAMILIAR: CENTRO, TABASCO, MÉXICO, 2009
Zavala-González MA1, Posada-Arévalo SE2, Barrera-Olán L3, López-Mandujano C3, Mirón-Carrera MT3, Santiago-Naranjo P3, 1Asociación Latinoamericana de
Profesores de Medicina Familiar, A.C., Cárdenas, Tabasco, México, 2Universidad Nacional Autónoma de México, Villahermosa, Tabasco, México, 3Instituto
Mexicano del Seguro Social, Delegación Tabasco, Villahermosa, Tabasco, México
pg 88
PDB3PREVALENCE OF SEVERE OSTEOPOROSIS IN DAILY CONSULTATION OF RHEUMATOLOGY AND ENDOCRINOLOGY SERVICES, COSTS AND QUALITY OF LIFE
OF FRAGILITY FRACTURES IN MEXICO
Carlos F1, Clark P2, Chico G2, Ramírez E3, Franco F3, Jasqui-Romano S4, 1R A C Salud Consultores, S.A. de C.V., México D.F., México, 2Hospital Infantil de México
Federico Gómez, Secretaría de Salud, México, DF, México, 3Instituto Nacional de Rehabilitación, Secretaría de Salud, México D.F., México, 4Eli Lilly and
Company, México D.F., México
DIABETES/ENDOCRINE DISORDERS – Cost Studies
pg 88
PDB4GASTOS COM MEDICAMENTOS E CARACTERÍSTICAS DE INDIVÍDUOS COM HIPERTENSÃO E DIABETES MELLITUS, EM MUNICÍPIOS DA REDE FARMÁCIA
DE MINAS - MINAS GERAIS, BRASIL
Pereira VOM, Cherchiglia ML, Acurcio FA, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
pg 88
PDB5USE OF A DISCRETE EVENT SIMULATION MODEL TO ESTIMATE CLINICAL AND ECONOMIC OUTCOMES OF VARIOUS SELF-MONITORING OF BLOOD
GLUCOSE REGIMES PLUS CONVENTIONAL PHARMACOLOGIC TREATMENT ON TYPE-2 DIABETIC PATIENTS IN MEXICO
Zanela OO1, Cabra HA1, Muñoz DF2, 1Johnson & Johnson Medical, México D.F., México, 2Instituto Tecnológico Autónomo de México, México D.F., México
pg 89
PDB6EDUCATIONAL INTERVENTIONS IN PATIENTS WITH TYPE-2 DIABETES IMPROVE CLINICAL AND METABOLIC OUTCOMES AND OPTIMIZE THE USE OF
TREATMENT RESOURCES IN ARGENTINA: THE PRODIACOR STUDY
Caporale JE1, Elgart JF1, Gonzalez L1, Rucci E1, Lapertosa S2, Villagra M2, Gagliardino JJ1, 1CENEXA - Centro de Endocrinología Experimental y Aplicada (UNLPCONICET La Plata, Centro Colaborador OPS/OMS), La Plata, Buenos Aires, Argentina, 2Hospital, Corrientes, Corrientes, Argentina
pg 89 PDB7 COST-EFFECTIVENESS OF SAXAGLIPTIN TREATMENT IN THREE LATIN AMERICAN COUNTRIES
Elgart JF1, Caporale JE1, Aiello EC2, Waschbusch M2, Jotimliansky L2, Gagliardino JJ1, 1CENEXA - Centro de Endocrinología Experimental y Aplicada (UNLPCONICET La Plata, Centro Colaborador OPS/OMS), La Plata, Buenos Aires, Argentina, 2Bristol-Myers Squibb, Buenos Aires, Argentina
pg 89
PDB8COST-EFFECTIVENESS STUDY OF ORAL HYPOGLYCEMIC AGENTS IN OUTPATIENTS DIAGNOSED WITH TYPE-2 DIABETES ATTENDING A PRIMARY CARE
PUBLIC CLINIC IN MEXICO CITY
Diaz de León-Castañeda C, Altagracia-Martínez M, Kravzov-Jinich J, Cárdenas-Elizalde R, Martínez-Núñez JM, Universidad Autónoma Metropolitana Xochimilco, México D.F., México
pg 89
PDB9ANALISIS DE COSTO–EFECTIVIDAD DEL USO DE DETEMIR EN DIABETES TIPO 2 FRENTE AL RIESGO DE PRESENTAR EVENTOS CARDIOVASCULARES Y
MUERTE
Romero M1, Chavez D1, Karpf E1, Alvis N2, 1Fundación Salutia, Bogotá, Colombia, 2Universidad de Cartagena, Cartagena de Indias, Bolívar, Colombia
pg 90 PDB10 ECONOMIC EVALUATION OF DULOXETINE AS FIRST-LINE TREATMENT FOR PAINFUL DIABETIC PERIPHERAL NEUROPATHY IN MEXICO
Carlos F1, Ramírez-Gámez J2, Dueñas-Tentori H2, Ramos E1, 1R A C Salud Consultores, S.A. de C.V., México D.F., México, 2Eli Lilly and Company, México D.F.,
México
pg 90
PDB11ECONOMIC EVALUATION OF TERIPATIDE IN THE MANAGEMENT OF WOMEN WITH POSTMENOPAUSAL OSTEOPOROSIS AND HIGH RISK OF FRAGILITY
FRACTURES IN MEXICO
Carlos F1, Clark P2, Jasqui-Romano S3, 1R A C Salud Consultores, S.A. de C.V., México D.F., México, 2Hospital Infantil de México Federico Gómez, Secretaría de
Salud, México D.F., México, 3Eli Lilly and Company, México D.F., México
GASTROINTESTINAL DISORDERS – Cost Studies
pg 90 PGI1 RESOURCE UTILIZATION AND COST OF MANAGEMENT OF COMPLEX PERIANAL FISTULA IN CROHN’S DISEASE IN SPAIN
Badia X1, Lara N1, Garcia-Losa M2, Zanotti C3, Orofino J3, 1IMS Health, Barcelona, Spain, 2IMS Health, Madrid, Spain, 3Cellerix, SA, Tres Cantos, Spai
pg 90 PGI2 COST-EFFECTIVENESS ANALYSIS OF THE USE OF ADALIMUMAB FOR THE TREATMENT OF CROHN’S DISEASE (CD) IN MEXICO
Mayen-Herrera E1, Pozos JC2, Yang M3, Cortina D4, Abbott Laboratories de México, México, D.F. México
pg 91 PGI3 ADAPTACIÓN DE UN ANÁLISIS DE COSTO-EFECTIVIDAD DEL ENTECAVIR VS INTERFERÓN PEGILADO ALFA A VENEZUELA
Orozco JJ1, Valencia JE2, Aiello E3, Baquero E4, 1Universidad CES, Medellin, Colombia, 2Bristol-Myers Squibb, Bogotá, Colombia, 3Bristol-Myers Squibb,
Buenos Aires, Argentina, 4Bristol-Myers Squibb, Caracas, Venezuela
GASTROINTESTINAL DISORDERS – Patient-Reported Outcomes & Preference-Based Studies
pg 91
PGI4HEALTH-RELATED QUALITY OF LIFE IMPROVEMENTS IN PATIENTS WITH ACTIVE CROHN’S DISEASE FOLLOWING TREATMENT WITH CERTOLIZUMAB
PEGOL IN THE MUSIC STUDY (NCT00297648)
Hébuterne X1, †Lémann M2, Coteur G3, Ernault E3, Colombel JF4, 1Centre Hospitalier Universitaire de Nice, Nice, France, 2Hôpital Saint-Louis, Paris, France,
3
UCB, Braine l’Alleud, Belgium, 4Centre Hospitalier Universitaire (CHU) de Lille, Lille, France
Poster presentation topic codes are provided in Spanish on page 9 and English on page 37.
Page numbers shown to the left refer to the abstract location in this Program & Schedule of Events.
64
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
POSTER DISPLAY HOURS: FRIDAY, 9 SEPTEMBER: 8:30-20:00 & SATURDAY, 10 SEPTEMBER: 8:00-13:45
POSTER AUTHOR DISCUSSION HOUR: FRIDAY, 9 SEPTEMBER: 18:30-19:30
HEALTH CARE USE & POLICY STUDIES – Consumer Role in Health Care
pg 91 PHP1 KENYA’S VILLAGE AGING INSENSITIVITY TO AGING POLICIES
Nyabade G, Go Fishnet Youth Project, Kisumu, Nyanza, Kenya
HEALTH CARE USE & POLICY STUDIES – Disease Management
pg 91
PHP2DESCRIBING TRENDS AND DETERMINANTS OF NON-OPIOID ANALGESIC (NOA) PRESCRIBING IN CHRONIC NON-CANCER PAIN PATIENTS IN THE UNITED
STATES OUTPATIENT SETTINGS
Rasu R1, Fikru B1, Vouthy KK1, Rianon N2, Agbor Bawa W1, Knell M1, 1University of Missouri-Kansas City, Kansas City, MO, USA, 2University of Texas Health
Science Center-Houston, Houston, TX, USA
pg 92 PHP3 A REVIEW OF BREAST CANCER (BC) CARE AND OUTCOMES IN LATIN AMERICA & CARIBBEAN (LAC)
Justo N1, Wilking N2, Jönsson B3, 1i3 Innovus, Stockholm, Sweden, 2Karolinska Institutet, Stockholm, Sweden, 3Stockholm School of Economics, Stockholm,
Sweden
HEALTH CARE USE & POLICY STUDIES – Drug/Device/Diagnostic Use & Policy
pg 92 PHP4 SIGNIFICANT DECREASE IN THE HUNGARIAN HEALTH INSURANCE PHARMACEUTICAL BUDGET BETWEEN 2006-2009
Boncz I1, Donka-Verebes É2, Oberfrank F3, 1University of Pécs, Pécs, Hungary, 2Integra Consulting zRt., Budapest, Hungary, 3Institute of Experimental Medicine
(IEM)., Budapest, Hungary
pg 92 PHP5 MODELO TEORICO DE UN CONSUMIDOR: SELECCION ENTRE UN BIOSIMILAR Y UN BIOTECNOLOGICO DE PATENTE BASADO EN PREFERENCIAS
Lechuga D, ITAM, México, D.F., México
pg 92
PHP6CUADRO BÁSICO Y CATÁLOGO DE MEDICAMENTOS DEL SECTOR SALUD: ES ACTUALMENTE UN REFERENTE PARA LAS INSTITUCIONES PÚBLICAS Y/O
CUMPLE CON LOS OBJETIVOS DE SU CREACIÓN
Rivera-Peña G1, Vargas-Palacios A2, Barraza-Llorens M3, Gutierrez-Delgado C1, 1Economic Analysis Unit, México, D.F., México, 2The University of Sheffield,
Sheffield, Sheffield, UK, 3Instituto Mexicano del Seguro Social, México, D.F., México
pg 92 PHP7 IMPACT OF GLOBAL HEALTH CARE REFORMS ON PRICING, ACCESS AND HEALTH ECONOMICS AND OUTCOMES STRATEGY
Aggarwal S, PAREXEL Consulting, Bethesda, MD, USA
pg 93 PHP8 MEASURING ADHERENCE TO DRUG TREATMENT IN MEXICAN PATIENTS: A SYSTEMATIC REVIEW
Uc-Coyoc R, Pérez-Reynaud AG, Coello-Reyes LA, Rodriguez-Díaz Ponce MA, Instituto Mexicano del Seguro Social, México, D.F., México
pg 93 PHP9 PREDITORES DA QUANTIDADE DE MEDICAMENTOS TOMADOS EM PESSOAS COM DOENÇA CRÔNICA
Pais-Ribeiro J1, Silva I2, Meneses R2, Pedro L3, Cardoso H1, Abreu M1, Melo V1, Martins A1, Vilhena E1, Mendonça D1, Martins-da-Silva A1, 1Porto University,
Porto, Portugal, 2Fernando Pessoa University, Porto, Portugal, 3Polytechnic Institute, Lisboa, Portugal
pg 93 PHP10 MEDICATION USE EVALUATION OF EXPENSIVE AND BROAD-SPECTRUM ANTIBIOTICS IN SONGKHLA HOSPITAL
Thoedratanaphong OS, Preechavechakul P, Songkhla Hospital, Songkhla, Thailand
pg 93 PHP11 THE USE OF METHYLPHENIDATE IN A GROUP OF PATIENTS WITH ATTENTION DEFICIT AND HYPERACTIVITY DISORDER
Gomez-Galicia DL1, Rodriguez-Fragoso L1, Lopez Aymes G1, Sánchez-Alemán M2, Reyes-Esparza JA1, 1Universidad Autonoma del Estado de Morelos,
Cuernavaca, Morelos, México, 2Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
HEALTH CARE USE & POLICY STUDIES – Equity and Access
pg 94 PHP12 THE RATIO OF PUBLIC REIMBURSEMENT AND PATIENTS’ CO-PAYMENT IN THE FINANCING OF SPA SERVICES IN HUNGARY
Turcsanyi K1, Domján P1, Boncz I2, 1University of Pécs, Zalaegerszeg, Hungary, 2University of Pécs, Pécs, Hungary
pg 94 PHP13 GEOGRAPHICAL INEQUALITIES OF HOME CARE (NURSING) IN HUNGARY
Cs. Horváth Z1, Molics B1, Ágoston I1, Sebestyén A2, Boncz I1, 1University of Pécs, Pécs, Hungary, 2South-Trasdanubian Regional Health Insurance Fund
Administration, Pécs, Hungary
pg 94 PHP15 IMPLICATIONS OF LATIN AMERICAN PHARMACEUTICAL PRICING REFORM FOR THE UK NHS
Shankland BDT, Kirpekar S, Double Helix Consulting, London, UK
pg 94
PHP16WAITING TIME AND ITS IMPLICATIONS ON THE UTILIZATION OF ANTENATAL SERVICES IN A FREE SERVICE PROVISION SETTING IN THE ASANTE AKIM
NORTH MUNICIPAL, GHANA
Agyei-Baffour P, Nakua E, Agyemang P, Owusu-Dabo E, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ashanti, Ghana
HEALTH CARE USE & POLICY STUDIES – Formulary Development
pg 94 PHP17 MEXICO’S NATIONAL AND INSTITUTIONAL ESSENTIAL MEDICINE LISTS
Rivas R, CENETEC, México, D.F., México
HEALTH CARE USE & POLICY STUDIES – Health Care Costs & Management
pg 95 PHP18IMPACTO DE LA PARTICIPACION DEL FARMACEUTICO COMO PARTE DEL EQUIPO DE SALUD EN EL PRIMER NIVEL DE ATENCION, SOBRE LOS COSTOS
Mino-Leon D1, Contreras-Hernandez I2, Anaya P3, Reyes A4, 1Instituto de Geriatría, México, D.F., México, 2Instituto Mexicano del Seguro Social, México, D.F.,
México, 3GlaxoSmithKline México, México, D.F., México, 4Universidad de la Sierra Sur, Oaxaca, Miahuatlán de Po, México
Poster presentation topic codes are provided in Spanish on page 9 and English on page 37.
Page numbers shown to the left refer to the abstract location in this Program & Schedule of Events.
65
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
POSTER DISPLAY HOURS: FRIDAY, 9 SEPTEMBER: 8:30-20:00 & SATURDAY, 10 SEPTEMBER: 8:00-13:45
POSTER AUTHOR DISCUSSION HOUR: FRIDAY, 9 SEPTEMBER: 18:30-19:30
pg 95
PHP19INCREASED MARKET SHARE OF PRIVATE, FOR-PROFIT HEALTH CARE PROVIDERS FROM THE HUNGARIAN HEALTH INSURANCE BUDGET BETWEEN
2006-2009
Boncz I1, Endrei D1, Molics B1, Ágoston I1, Turcsanyi K2, Domján P2, Betlehem J1, Oláh A1, Sebestyén A3, 1University of Pécs, Pécs, Hungary, 2University of Pécs,
Zalaegerszeg, Hungary, 3South-Trasdanubian Regional Health Insurance Fund Administration, Pécs, Hungary
pg 95 PHP20 ECONOMIC EVALUATION OF POISON CONTROL CENTERS: A SYSTEMATIC REVIEW
Galvao TF1, Silva EN2, Silva MT2, Pereira MG3, 1Federal University of Amazonas, University of Brasilia, Brasilia, DF, Brazil, 2Brazilian Ministry of Health, Brasília,
DF, Brazil, 3University of Brasilia, Brasilia, DF, Brazil
pg 95 PHP21 MEDICAL SERVICES COST INFLUENCE ON THE RATIONALITY OF NEW MEDICAL TECHNOLOGY INTRODUCTION
Kozhanova I1, Romanova I1, Gavrilenko L1, Voitenkova L2, 1The Belarus State Medical University, Minsk, Belarus, 2Belarusian National Technical University,
Minsk, Belarus
pg 96
PHP22USE OF DECISION MODELING TO ESTIMATE THE NEGATIVE IMPACT OF TOBACCO USE ON HEALTH CARE COSTS AND HEALTH DISPARITIES IN PEOPLE
LIVING WITH HIV
Burbano-Levy X, Miguez MJ, Thompson M, Medina A, Quiros C, Malow R, Florida International University, Miami, FL, USA
pg 96 PHP23 LA ACEPTACION DE LAS VACUNAS EN LOS PROGRAMAS NACIONALES DE INMUNIZACION EN LATINA AMERICA: UN ESTUDIO COMPARATIVO
Jones K, PriceSpective Ltd., London, UK
pg 96 PHP24 COMPARAÇÃO DA QUALIDADE DE VIDA ENTRE PESSOAS COM DOENÇAS CRÔNICAS E PESSOAS DA COMUNIDADE SEM DOENÇA
Pais-Ribeiro J1, Silva I2, Pedro L3, Meneses R2, Cardoso H1, Abreu M1, Melo V1, Martins A1, Martins-da Silva A1, Vilhena E1, Mendonça D1, 1Porto University,
Porto, Portugal, 2Fernando Pessoa University, Porto, Portugal, 3Polytechnic Institute, Lisboa, Portugal
pg 96 PHP25 VALIDITY AND RELIABILITY OF INSTRUMENTS USED FOR MEASURING PATIENT SATISFACTION WITH PHARMACEUTICAL CARE SERVICES
Sakharkar PR1, Bounthavong M2, Law AV1, 1College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA, 2Veterans Affairs San Diego
Healthcare System, San Diego, CA, USA
pg 97 PHP26 A SATISFAÇÃO DOS PROFISSIONAIS DE SAÚDE VS A SATISFAÇÃO DOS UTENTES EM UNIDADES DE CUIDADOS CONTINUADOS
Anjos T1, Almeida A2, 1Santa Casa da Misericordia de Belmonte, Belmonte, Portugal, 2Universidade da Beira Interior, Covilhã, Portugal
pg 97
PHP27THE ECONOMIC BENEFITS OF IMPLEMENTING A UNIT DOSE DRUG DISPENSING SYSTEM AT THE HOSPITAL LEVEL IN THE MEXICAN INSTITUTE OF SOCIAL
SECURITY (IMSS)
Uc-Coyoc R, Pérez-Reynaud AG, Coello-Reyes LA, Rodriguez-Díaz Ponce MA, Instituto Mexicano del Seguro Social, México, D.F., México
pg 97
PHP28DECENTRALISATION OF HEALTH SERVICES PLANNING AND MANAGEMENT: THE VARYING PERSPECTIVES OF HEALTH WORKERS AND COMMUNITY
MEMBERS AT NANUMBA NORTH DISTRICT, GHANA
Agyei-Baffour P, Atta K, Nakua E, Owusu-Dabo E, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ashanti, Ghana
pg 97
PHP29PREDICTORS OF APPROPRIATE USE OF INSECTICIDE TREATED NETS IN AN URBAN COMMUNITY: THE CASE OF ASOKWA SUB-METROPOLITAN AREA,
KUMASI, ASHANTI, GHANA
Agyei-Baffour P, Mantey KG, Owusu-Dabo E, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ashanti, Ghana
pg 97 PHP31 ANALISIS COSTO EFECTIVIDAD SECTORIAL DE 45 INTERVENCIONES SANITARIAS EN CHILE
Vallejos C1, Castillo M2, Puebla S1, Orellana J1, Reveco R1, Valdés P1, Alarcón A1, Merino W1, 1Universidad de La Frontera, Temuco, Chile, 2Ministerio de Salud
de Chile, Santiago, Chile
HEALTH CARE USE & POLICY STUDIES – Health Care Research & Education
pg 98
PHP32LINEAMIENTOS DE UNA POLÍTICA DE INVESTIGACIÓN EN SALUD EN CHILE: ACUERDOS DE LA COMISIÓN TÉCNICA DE INVESTIGACIÓN SANITARIA PARA
EL PLAN NACIONAL DE SALUD 2011-2020
Espinoza MA1, Cabieses B2, Zitko P3, Castillo C3, Castillo M3, Jeria MM4, Valenzuela MT4, Delgado M3, Ramirez J3, 1Pontificia Universidad Católica de Chile,
Santiago, Chile, 2University of York, York, UK, 3Ministerio de Salud de Chile, Santiago, Chile, 4Instituto de Salud Pública de Chile, Santiago, Chile
pg 98
PHP33KNOWLEDGE, ATTITUDE, AND PRACTICES (KAP) OF FOOD PRACTITIONERS ON HAZARD ANALYSIS AND CRITICAL CONTROL POINT (HACCP) IN THE
KUMASI METROPOLIS, GHANA
Agyei-Baffour P, Boateng K, Nakua E, Otupiri E, Owusu-Dabo E, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ashanti, Ghana
pg 98
PHP34NECESIDADES DE INFORMACIÓN Y FORMACIÓN SOBRE FARMACOECONOMIA E INVESTIGACIÓN DE RESULTADOS PARA PROFESIONALES Y ESTUDIANTES
DE FARMACIA DEL ORIENTE VENEZOLANO
Adesso G, Bastardo Y, Universidad Central de Venezuela, Caracas, Venezuela
pg 98
PHP35PERCEPTIONS, KNOWLEDGE AND GAPS ABOUT HTA AND HEALTH ECONOMICS BY THE BRAZIIAN MARKET STAKEHOLDERS: ISPOR BRAZIL QUALITATIVE
RESEARCH
Araújo GTB1, Fonseca M1, Stefani SD2, 1Axia.Bio, São Paulo, SP, Brazil, 2Hospital Mãe de Deus, Porto Alegre, RS, Brazil
HEALTH CARE USE & POLICY STUDIES – Health Technology Assessment Programs
pg 99 PHP36 HISTORICAL AND FUTURE DRIVERS FOR HTA IN REIMBURSEMENT SYSTEMS IN MEXICO AND POLAND
Kirpekar S, Shankland B, Double Helix Consulting, London, UK
pg 99 PHP37 CROSS-CONTINENTAL COMPARISON OF HTA EVOLUTION IN EMERGING MARKETS: BRAZIL, INDIA AND POLAND
Kirpekar S, Shankland B, Dummett H, Double Helix Consulting, London, UK
Poster presentation topic codes are provided in Spanish on page 9 and English on page 37.
Page numbers shown to the left refer to the abstract location in this Program & Schedule of Events.
66
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
POSTER DISPLAY HOURS: FRIDAY, 9 SEPTEMBER: 8:30-20:00 & SATURDAY, 10 SEPTEMBER: 8:00-13:45
POSTER AUTHOR DISCUSSION HOUR: FRIDAY, 9 SEPTEMBER: 18:30-19:30
pg 99 PHP38 HEALTH TECHNOLOGY ASSESSMENT APPLIED TO MEDICAL DEVICES IN LATIN AMERICA: WHAT MUST BE ASSESSED
Gimenes F1, de O. Machado F2, Quiroz ME3, 1Medtronic, Sao Paulo, SP, Brazil, 2Medtronic, Doral, FL, USA, 3Medtronic, Colonia Juarez, DF, México
pg 99 PHP39 GAUGING THE ROLE OF HTA IN REIMBURSEMENT DECISION-MAKING ACROSS FIVE MARKETS IN LATIN AMERICA
Dummett H, Kirpekar S, Shankland B, Double Helix Consulting, London, UK
HEALTH CARE USE & POLICY STUDIES – Patient Registries & Post-Marketing Studies
pg 100 PHP40PROMOTING EFFICIENCY OF AVAILABLE CAPACITY IN A FRAGMENTED HEALTH SYSTEM: PATIENTS WITH DIFFERENT HEALTH INSURANCE SCHEMES
ATTENDED BY MOH, MEXICO 2006-2010
Gómez-Fraga S, Mexican Ministry of Health, México, D.F., México
pg 100 PHP41 MONITORING OF HPV VACCINATION EFFECTIVENESS WITHIN EUROPEAN UNION
Bielik J1, Marušáková E2, Glogowski C3, 1Trencin University, Trencin, Slovak Republic, 2GlaxoSmithKline Slovakia, Bratislava, Slovak Republic, 3GSK
Commercial Sp. z o.o., Warsaw, Poland
HEALTH CARE USE & POLICY STUDIES – Population Health
pg 100 PHP42 CALIDAD DE VIDA RELACIONADA CON LA SALUD Y APOYO SOCIAL EN ESTUDIANTES DE FARMACIA EN VENEZUELA
Parra G, Bastardo Y, Universidad Central de Venezuela, Caracas, Venezuela
pg 100 PHP43 EXPLORING SOCIAL DETERMINANTS OF THE HEALTH OF INTERNATIONAL IMMIGRANTS IN CHILE: THE GLOBAL HEALTH STATUS INDEX
Cabieses B, Tunstall H, Pickett K, Gutacker N, Espinoza M, University of York, York, UK
HEALTH CARE USE & POLICY STUDIES – Prescribing Behavior & Treatment Guidelines
pg 101 PHP44CHARACTERISTICS OF PATIENTS TREATED FOR FIBROMYALGIA IN PUERTO RICO AND THE UNITED STATES: BASELINE FINDINGS OF THE REFLECTIONS
STUDY (REAL WORLD EXAMINATION OF FIBROMYALGIA: LONGITUDINAL EVALUATION OF COSTS AND TREATMENTS)
Vazquez-Suarez JE1, Able SL2, Gatz JL2, Robinson RL2, 1Eli Lilly and Company, San Juan, PR, USA, 2Eli Lilly and Company, Indianapolis, IN, USA
pg 101 PHP46 PRÁCTICA CLÍNICA INSTITUCIONAL EN EL TRATAMIENTO DE LA DIABETES MELLITUS TIPO 2 EN MÉXICO
Juarez-Garcia A1, Vargas-Valencia J2, Martinez-Rivera G1, Sotelo-Guzmán M2, Elias-lópez JI1, Zamora-Barron M1, Rangel S1, 1Bristol-Myers Squibb, México
City, D.F., México, 2Econopharma Consulting S.A. de C.V., México, D.F., México
HEALTH CARE USE & POLICY STUDIES – Regulation of Health Care Sector
pg 101 PHP47AVALIAÇÃO DO MERCADO DE ANTIMICROBIANOS NO BRASIL: PASSO PARA IMPLANTAÇÃO DO MONITORAMENTO E CONTROLE SANITÁRIO EM
ESTABELECIMENTOS FARMACÊUTICOS
Mota DM, Araújo MAM, Santos AEG, Cunha TRP, Silva SF, Bovi RF, Alaver RT, Albo GC, Cunha JAF, Oliveira MG, Baptista FJDO, Bernardo PJB, Agência
Nacional de Vigilância Sanitária, Brasília, DF, Brazil
pg 101 PHP48 OS MOTIVOS QUE LEVAM O JUDICIÁRIO A DETERMINAR QUE OS PLANOS DE SAÚDE FORNEÇAM MEDICAÇÃO ORAL EM ONCOLOGIA
Stefani SD1, Fonseca JRL2, 1UNIMED, Porto Alegre, RS, Brazil, 2UNIDAS, Brasilia, DF, Brazil
HEALTH CARE USE & POLICY STUDIES – Risk Sharing/Performance-Based Agreements
pg 102 PHP49 DEVELOPING RISK SHARING ARRANGEMENTS – POTENTIAL FOR BRAZIL AND IMPLICATIONS
Shirk RC1, Godman B2, 1Fiocruz, Rio de Janeiro, RJ, Brazil, 2Karolinska Institutet, Stockholm, Sweden
HEALTH CARE USE & POLICY STUDIES – Conceptual Papers
pg 102 PHP50 THE VALUATION OF END-OF-LIFE HEALTH GAINS
Cairns J, London School of Hygiene and Tropical Medicine, London, UK
pg 102 PHP51 PATIENT-CENTERED CARE: CHALLENGES FOR BRAZIL, LESSONS FOR UNITED STATES
Freitas EL, Poplavska E, University of Minnesota, Minneapolis, MN, USA
INDIVIDUAL’S HEALTH – Cost Studies
pg 102 PIH1 IMPACTO PRESUPUESTAL DEL USO DE LEVONORGESTREL-UIS FRENTE A OTROS TRATAMIENTOS EN MENORRAGIA IDIOPATICA EN COLOMBIA
Romero M1, Karpf E1, Sanabria M1, Alvis N2, 1Fundación Salutia, Bogotá, Colombia, 2Universidad de Cartagena, Cartagena de Indias, Bolívar, Colombia
pg 103 PIH2ADDRESSING CHILDHOOD OBESITY IN MEXICO: SAVINGS ON HEALTH CARE EXPENDITURES FROM REGULATING FOOD AND BEVERAGE SALES IN BASIC
EDUCATION SCHOOLS
Guajardo-Barron VJ1, Gutierrez-Delgado MC1, Rivera-Peña G2, 1Mexican Ministry of Health, México, D.F., México, 2Economic Analysis Unit, México, D.F., México
pg 103 PIH3RESOURCE USE AND ASSOCIATED COSTS FOR THE TREATMENT OF HEAVY MENSTRUAL BLEEDING WITH LEVONORGESTREL RELEASING INTRAUTERINE
SYSTEM (LNG-IUS) VERSUS HYSTERECTOMY: THE BRAZILIAN PUBLIC HEALTH CARE SYSTEM (SUS) PERSPECTIVE
Bahamondes L1, Bahamondes V1, Schiola A2, Silva AP3, Santoni NB3, Moura M4, Salem J4, Clarck L4, Teich V4, 1University of Campinas, Campinas, SP, Brazil,
2
Bayer de México, S.A. de C.V., México, D.F, México, 3Bayer Brazil, São Paulo, SP, Brazil, 4MedInsight Evidências, São Paulo, SP, Brazil
pg 103 PIH4 ANALISIS DE COSTO-EFECTIVIDAD DEL USO DE LEVONORGESTREL-UIS FRENTE A OTROS TRATAMIENTOS EN MENORRAGIA IDIOPATICA
Romero M1, Arango C1, Espinel F2, Karpf E1, Sanabria M1, Alvis N3, 1Fundación Salutia, Bogotá, Colombia, 2Clínica de la Mujer, Bogotá, Colombia, 3Universidad
de Cartagena, Cartagena de Indias, Bolívar, Colombia
Poster presentation topic codes are provided in Spanish on page 9 and English on page 37.
Page numbers shown to the left refer to the abstract location in this Program & Schedule of Events.
67
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
POSTER DISPLAY HOURS: FRIDAY, 9 SEPTEMBER: 8:30-20:00 & SATURDAY, 10 SEPTEMBER: 8:00-13:45
POSTER AUTHOR DISCUSSION HOUR: FRIDAY, 9 SEPTEMBER: 18:30-19:30
pg 103 PIH5 REPLACING MMR BY MMRV IN MEXICO: ASSESSEMENT OF COST-EFFECTIVENESS BASED ON A DYNAMIC TRANSMISSION MODEL
Ouwens M1, Macias M2, Mascareñas De Los Santos AH3, Gomez JA4, Sauboin C5, Carreño Manjarrez R6, 1Mapi Values Netherlands, Houten, The Netherlands,
2
Instituto Nacional de Pediatría, Pediatric Infectious Diseases, México, D.F., México, 3Servicios médicos de la Universidad Autónoma, Monterrey -Nuevo
León, México, 4GlaxoSmithKline, Victoria, Buenos Aires, Argentina, 5GlaxoSmithKline Biologicals, Wavre, Belgium, 6GlaxoSmithKline, México, D.F. , México
INFECTION – Clinical Outcomes Studies
pg 104 PIN1 THE EPIDEMIOLOGIC BURDEN OF HEPATITIS C VIRUS INFECTION IN LATIN AMERICA
Szabo SM1, Donato BM2, Yuan Y3, Bibby M1, Jimenez-Mendez R4, Levy AR1, 1Oxford Outcomes Ltd., Vancouver, BC, Canada, 2Bristol-Myers Squibb, Wallingford,
CT, USA, 3Bristol-Myers Squibb, Plainsboro, NJ, USA, 4University of British Columbia, Vancouver, BC, Canada
INFECTION – Cost Studies
pg 104 PIN2
FACING CRITICAL HEALTH EVENTS: ECONOMIC IMPACT OF AH1N1 FLU EPIDEMIC IN THE MEXICAN HEALTH SECTOR, 2009-2010
Gutierrez-Delgado C, Gómez-Fraga S, Mexican Ministry of Health, México, D.F., México
pg 104 PIN3PURSUING FINANCIAL SUSTAINABILITY TO FULFILL THE MILLENIUM DEVELOPMENT GOAL SIX IN A FRAGMENTED SYSTEM. THE EXPERIENCE OF THE
UNIVERSAL ACCESS TO ANTIRETROVIRAL DRUGS IN MÉXICO 2007-2009
Rivera-Peña G, Rios-Arenas D, Gutierrez-Delgado C, Economic Analysis Unit, México, D.F., México
pg 104 PIN4 ECONOMIC IMPACT OF COMMUNITY ACQUIRED PNEUMONIA HOSPITALIZATIONS IN ADULTS IN SIX COUNTRIES IN LATIN AMERICA
Rosado-Buzzo A1, Garcia-Mollinedo L1, Camacho-Cordero L1, Roberts CS2, Mould-Quevedo JF2, Trejo-Martinez A1, Luna-Casas G1, 1Links & Links S.A, de C.V.,
México, D.F., México, 2Pfizer, Inc., New York, NY, USA
pg 105 PIN6 EVALUACION COSTO-EFECTIVIDAD DEL USO DE LINEZOLID EN EL TRATAMIENTO DE NEUMONIAS NOSOCOMIALES EN MÉXICO
Vargas-Valencia JJ1, Sotelo-Guzmán M1, Díaz-Ponce H2, Galindo-Suárez RM2, Muciño-Ortega E2, Mould-Quevedo JF3, 1Econopharma Consulting S.A. de C.V.,
México, D.F., México, 2Pfizer S.A. de C.V., México, D.F., México, 3Pfizer, Inc., New York, NY, USA
pg 105 PIN7 COST-EFFECTIVENESS ANALYSIS OF ANTI-PNEUMOCOCCAL VACCINES VERSUS NO VACCINATION IN EL SALVADOR
Dueñas MDL1, Lutz M2, Morales G2, Strutton DR3, Roberts C4, Cuesta G2, Farkouh RA3, 1Hospital Centro Pediátrico, San Salvador, El Salvador, 2Pfizer S.A., La
Aurora, Heredia, Costa Rica, 3Pfizer, Inc., Collegeville, PA, USA, 4Pfizer, Inc., New York, NY, USA
pg 105 PIN8EVALUACION ECONOMICA DE LA EXTENSION DE PROFILAXIS CONTRA CMV DE 100 A 200 DIAS EN RECEPTORES DE TRASPLANTE RENAL CON ALTO
RIESGO (D+ / R-)
Morales Buenrostro LE, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, México, DF, México
pg 105 PIN10EXCHANGE RATE OR POWER PURCHASE PARITY FOR ECONOMIC EVALUATION: ESTIMATING THE COSTS OF ROTAVIRUS VACCINATION IN A SIX-YEAR
PERIOD CONSIDERING DATA FROM MEXICAN CHILDREN
Granados-Garcia V1, Salinas-Escudero G2, Martinez-Valverde S2, 1National Institute of México for Social Security (IMSS), México, D.F., México, 2Hospital
Infantil de México Federico Gómez, Secretaría de Salud, México, D.F., México
pg 105 PIN11 EVALUACION ECONOMICA DE LAS VACUNAS CONJUGADAS DE PNEUMOCOCO PARA PERU
Tirado Caballero JC1, Navarro A2, Castrejon MM3, Gomez JA4, 1Complejo Hospitalario San Pablo, Lima, Peru, 2GlaxoSmithKline, Lima, Peru, 3GlaxoSmithKline,
Panama City, Panama, 4GlaxoSmithKline, Victoria, Buenos Aires, Argentina
pg 106 PIN12ANALISIS DE COSTO-EFECTIVIDAD DEL USO DE PROTEINA C ACTIVADA (PCA) EN ENFERMOS CON SEPSIS GRAVE Y CHOQUE SÉPTICO EN LA UNIDAD DE
CUIDADOS INTENSIVOS DEL HOSPITAL REGIONAL 1° DE OCTUBRE DEL ISSSTE
Villagómez A1, García S2, Carlos F3, Lemus A4, 1Hospital Regional 1° de Octubre del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado,
México, D.F., México, 2Centro Médico Nacional 20 de Noviembre del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, México, D.F.,
México, 3R A C Salud Consultores, S.A. de C.V., México, D.F., México, 4Universidad Anáhuac, México, D.F., México
MENTAL HEALTH – Clinical Outcomes Studies
pg 106 PMH1COMPARING THE EFFECTIVENESS OF PALIPERIDONE PALMITATE VERSUS OLANZAPINE PAMOATE FOR RELAPSE PREVENTION IN SCHIZOPHRENIA: POST
HOC INDIRECT ANALYSIS USING PUBLISHED PLACEBO-CONTROLLED STUDIES
Einarson T, University of Toronto, Toronto, ON, Canada
MENTAL HEALTH – Cost Studies
pg 106 PMH2 THE COST-EFFECTIVENESS OF PALIPERIDONE PALMITATE COMPARED TO OLANZAPINE PAMOATE IN THE TREATMENT OF SCHIZOPHRENIA IN SWEDEN
Pudas H1, Hemels M2, Mehnert A3, Druais S4, Martin M4, 1Janssen-Cilag Oy, Espoo, Finland, 2Janssen-Cilag AS, Birkerod, Denmark, 3Janssen Pharmaceutica
NV, Beerse, Belgium, 4i3 Innovus, Uxbridge, Middlesex, UK
pg 106 PMH3 COST-EFFECTIVENESS OF PALIPERIDONE PALMITATE FOR THE TREATMENT OF SCHIZOPHRENIA IN MÉXICO
Reyes-Lopez A1, Querol J2, 1Hospital Infantil de México Federico Gómez, Secretaría de Salud, México, D.F., México, 2Janssen de México, México, D.F., México
pg 107 PMH4 ECONOMIC ASSESSMENT OF MAJOR DEPRESSIVE DISORDER TREATMENT UNDER DIFFERENT THERAPEUTIC CLASSES AT ISSSTE
Ramírez-Gámez J, Dueñas-Tentori H, Eli Lilly and Company, México, D.F., México
pg 107 PMH5ANALISIS DE COSTO EFECTIVIDAD DEL MANEJO FARMACOLOGICO DE LA ESQUIZOFRENIA RECURRENTE EN PERU AJUSTADO POR LA ADHERENCIA AL
TRATAMIENTO
Izquierdo C, Janssen, Bogotá, Colombia
Poster presentation topic codes are provided in Spanish on page 9 and English on page 37.
Page numbers shown to the left refer to the abstract location in this Program & Schedule of Events.
68
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
POSTER DISPLAY HOURS: FRIDAY, 9 SEPTEMBER: 8:30-20:00 & SATURDAY, 10 SEPTEMBER: 8:00-13:45
POSTER AUTHOR DISCUSSION HOUR: FRIDAY, 9 SEPTEMBER: 18:30-19:30
MUSCULAR-SKELETAL DISORDERS – Clinical Outcomes Studies
pg 107 PMS1META-ANALISIS DE LA EFECTIVIDAD Y SEGURIDAD DEL USO DE CELECOXIB EN EL MANEJO DEL DOLOR CRONICO VS OTROS COX-2 EN PACIENTES CON
OSTEARTRITIS O ARTRITIS REUMATOIDE
Vargas-Valencia JJ1, Granados-Soto V2, Galindo-Suárez RM3, Mould-Quevedo J4, 1Econopharma Consulting S.A. de C.V., México, D.F., México, 2Centro de
Investigación y Estudios Avanzados, México, D.F., México, 3Pfizer S.A. de C.V., México, D.F., México, 4Pfizer, Inc., New York, NY, USA
pg 107 PMS2 OSTEOPOROSIS MEDICATION MIGHT HELP REDUCE THE INCIDENCE OF SECOND HIP FRACTURES?
Sebestyén A1, Sándor J2, Betlehem J3, Boncz I3, 1South-Trasdanubian Regional Health Insurance Fund Administration, Pécs, Hungary, 2University of Debrecen,
Debrecen, Hungary, 3University of Pécs, Pécs, Hungary
MUSCULAR-SKELETAL DISORDERS – Cost Studies
pg 108 PMS3 IMPACTO ECONOMICO DE LA OSTEOPOROSIS Y DE LAS FRACTURAS POR FRAGILIDAD EN EL INSTITUTO MEXICANO DEL SEGURO SOCIAL
Clark P1, Carlos F2, Chico G1, Galindo-Suarez RM3, 1Hospital Infantil de México Federico Gómez, Secretaría de Salud, México, D.F., México, 2R A C Salud
Consultores, S.A. de C.V., México, D.F., México, 3Pfizer, Inc., México, D.F., México
pg 108 PMS4ECONOMIC EVALUATION OF POST-OPERATION ORTHOPEDIC SURGERY OF ANTACID, ANTIHEMETIC AND ANALGESIC MEDICATION AFTER KETOPROPHENE,
KETOROLAC, PARECOXIB AND TENOXICAM IN BRAZILIAN PATIENTS
Fujii RK1, Mould-Quevedo JF2, 1Pfizer Pharmaceutics inc., São Paulo, SP, Brazil, 2Pfizer, Inc., New York, NY, USA
pg 108 PMS5ANALISIS DE COSTO-EFECTIVIDAD DE AGENTES BIOLOGICOS EN EL TRATAMIENTO DE PACIENTES CON ARTRITIS REUMATOIDE ACTIVA Y RESPUESTA
INSUFICIENTE A FARME TRADICIONALES DESDE LA PERSPECTIVA DEL SISTEMA PUBLICO DE SALUD EN MÉXICO
Carlos F1, Aguirre A1, Peláez-Ballestas I2, Ramos E1, 1R A C Salud Consultores, S.A. de C.V., México, D.F., México, 2Hospital Infantil de México Federico Gómez,
Secretaría de Salud, México, D.F., México
pg 108 PMS6 HEALTH CARE RESOURCE UTILIZATION OF THAI HIP FRACTURE PATIENTS IN PUBLIC HOSPITAL: COST OF ILLNESS ANALYSIS AT CHIANGRAI HOSPITAL
Srisawi K1, Thepnamwong J1, Sukwong DP1, Reungjarearnrung K3, 1Chaiangraiprachanukroh Hospital, Chiang Rai, Thailand, 3Bumrungrad Hospital, Wattana,
Bangkok, Thailand
pg 109 PMS7 DIRECT TREATMENT-COST OF PATIENTS WITH RHEUMATOID ARTHRITIS IN MEDELLIN, COLOMBIA
Montoya N1, Gómez L1, Vélez M1, Rosselli D2, 1Medicarte, Medellin, Colombia, 2Universidad Javeriana, Bogotá, Colombia
pg 109 PMS8COST-EFFECTIVENESS ANALYSIS OF ETANERCEPT VERSUS AVAILABLE ANTI-TNF AND IL-6 BLOCKERS FOR TREATING RHEUMATOID ARTHRITIS IN
GUATEMALA
Lutz M, Cuesta G, Morales G, Pfizer S.A., La Aurora, Heredia, Costa Rica
pg 109 PMS9 WHAT IS THE VALUE OF THE NEW KID ON THE BLOCK?: TOCILIZUMAB VERSUS ABATACEPT FOR RHEUMATOID ARTHRITIS IN COLOMBIA
Alfonso-Cristancho R1, Aiello EC2, Roa CN3, Valencia JE3, 1University of Washington, Seattle, WA, USA, 2Bristol-Myers Squibb, Buenos Aires, Argentina,
3
Bristol-Myers Squibb, Bogotá, Colombia
pg 109 PMS10COST-EFFECTIVENESS OF DULOXETINE COMPARED TO PREGABALINE IN PATIENTS WITH FIBROMYALGIA FROM THE PUBLIC HEALTH CARE SYSTEM
PERSPECTIVE IN MÉXICO
Ramírez-Gámez J, Dueñas-Tentori H, Eli Lilly and Company, México, D.F., México
pg 110 PMS11 REVIEW OF THE STUDIES ON ECONOMIC EVALUATION OF TREATMENT FOR POSTMENOPAUSAL OSTEOPOROSIS
Brandão CMR1, Acurcio FDA2, 1Universidade Federal de Minas Gerais, Contagem, Minas Gerais, Brazil, 2Universidade Federal de Minas Gerais, Belo
Horizonte, Minas Gerais, Brazil
pg 110 PMS12 EVALUACION ECONOMICA DE RITUXIMAB VERSUS ANTI-TNF EN PACIENTES CON ARTRITIS REUMATOIDE Y FALLA PREVIA A ANTI-TNF EN MÉXICO
Carlos F1, Clark P2, 1R A C Salud Consultores, S.A. de C.V., México, D.F., México, 2Hospital Infantil de México Federico Gómez, Secretaría de Salud, México,
D.F., México
pg 110 PMS13 ECONOMIC MODEL OF WORKPLACE IMPACTS OF ANTI-TNF THERAPY FOR RHEUMATOID ARTHRITIS IN BRAZIL
Teich V1, Chaves L2, Birnbaum H3, Pike C3, Waryas C3, Cifaldi M4, 1MedInsight Evidências, São Paulo, SP, Brazil, 2Abbott Laboratories, São Paulo, SP, Brazil,
3
Analysis Group, Inc., Boston, MA, USA, 4Abbott Laboratories, Abbott Park, IL, USA
NEUROLOGICAL DISORDERS – Cost Studies
pg 110 PND3 ESTIMACIÓN DEL PROCESO DE PROCURACIÓN DE ÓRGANOS DE PACIENTES CON MUERTE CEREBRAL EN MÉXICO 2009
Camacho Chairez A, Gutierrez C, Mexican Ministry of Health, México, D.F., México
pg 111 PND4EL IMPACTO ECONOMICO DEL TABAQUISMO EN EL DESARROLLO DE LA ENFERMEDAD VASCULAR CEREBRAL EN UN CENTRO NEUROLOGICO DE TERCER NIVEL
San-Juan D1, Quintana Carrillo R2, Arauz Góngora A1, López de Santiago I1, Aguire-Cruz L1, Corona T1, Reynales Shigematsu L3, 1Instituto Nacional de
Neurología y Neurocirugía, México, D.F, México, México, 2Instituto Nacional de Salud Pública, México, D.F., México, 3Instituto Nacional de Salud Pública,
Cuernavaca, Morelos, México
RESEARCH ON METHODS – Databases & Management Methods
pg 111 PRM2 EROS: A NEW SOFTWARE FOR EARLY STAGE OF SYSTEMATIC REVIEWS
Glujovsky D, Bardach A, García Martí S, Comandé D, Ciapponi A, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
Poster presentation topic codes are provided in Spanish on page 9 and English on page 37.
Page numbers shown to the left refer to the abstract location in this Program & Schedule of Events.
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
POSTER DISPLAY HOURS: FRIDAY, 9 SEPTEMBER: 8:30-20:00 & SATURDAY, 10 SEPTEMBER: 8:00-13:45
POSTER AUTHOR DISCUSSION HOUR: FRIDAY, 9 SEPTEMBER: 18:30-19:30
RESEARCH ON METHODS – Statistical Methods
pg 111 PRM3 DIMENSIONALITY OF COMORBIDITIES IN HEATH RELATED QUALITY OF LIFE COMORBIDITY INDEX
Ou HT1, Bagozzi RP2, Erickson S2, Mukherjee B2, Piette JD2, Balkrishnan R2, 1University of Michigan College of Pharmacy, Ann Arbor, MI, USA, 2University of
Michigan, Ann Arbor, MI, USA
pg 111 PRM4A MIXED-EFFECTS PIECEWISE LINEAR MODEL OF THE RATE OF LUNG FUNCTION DECLINE BEFORE AND AFTER INHALED CORTICOSTEROIDS IN AN
OBSERVATIONAL STUDY OF CHILDREN WITH CYSTIC FIBROSIS
Pasta DJ, Rasouliyan L, ICON Late Phase & Outcomes Research, San Francisco, CA, USA
RESEARCH ON METHODS – Conceptual Papers
pg 112 PRM5 INCORPORATING EQUITY INTO DEVELOPING AND IMPLEMENTING EVIDENCE-BASED CLINICAL PRACTICE GUIDELINES
Eslava-Schmalbach JH, Sandoval Vargas G, Mosquera PA, Universidad Nacional de Colombia, Bogotá, Colombia
pg 112 PRM6 TRANSLATION OF PATIENT-REPORTED OUTCOMES MEASURES TRANSLATABILITY REVIEW AND ITEM DEFINITION
Arnold BJ1, Correia H2, Pérez B1, Lent L1, 1FACITtrans, Elmhurst, IL, USA, 2Northwestern University, Chicago, IL, USA
RESPIRATORY-RELATED DISORDERS – Cost Studies
pg 112 PRS1 BUDGET IMPACT ANALYSIS OF FLUTICASONE FUROATE (FFNS) IN TREATMENT OF ALLERGIC RHINITIS PATIENTS IN MEXICO
Rely K1, Salinas GE2, Anaya P3, Alexandre PK4, 1CEAHealthTech, México, D.F., México, 2Hospital Infantil de México Federico Gómez, Secretaría de Salud,
México, D.F., México, 3GlaxoSmithKline México, México, D.F., México, 4Johns Hopkins University, Baltimore, MD, USA
pg 112 PRS2 COSTOS DE ATENCION MEDICA ATRIBUIBLES AL CONSUMO DE TABACO EN MÉXICO
Reynales-Shigematsu L1, Quintana Carrillo R2, 1Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México, 2Instituto Nacional de Salud Pública,
México, D.F., México
pg 113 PRS3 COSTOS DE ATENCION MEDICA DE LA ENFERMEDAD PULMONAR OBSTRUCTIVA CRONICA ATRIBUIBLES AL TABACO
Ramirez-Venegas A1, Quintana Carrillo R2, Sansores R1, Hernandez-Zenteno R1, Reynales Shigematsu L2, 1National Institute of Respiratory Diseases, México,
D.F., México, 2National Institute of Public Health, Cuernavaca, Morelos, México
pg 113 PRS4ECONOMIC EVALUATION OF THE USE OF PALIVIZUMAB AS PROPHYLACTIC TREATMENT FOR THE REDUCTION OF COMPLICATIONS ASSOCIATED WITH
RESPIRATORY SYNCYTIAL VIRUS IN PRE-TERM PATIENTS
Mayen-Herrera E1, Buesch K2, Cortina D3, Abbott Laboratories de México, México, D.F. México
pg 113 PRS5
COST-EFFECTIVENESS OF VARENICLINE VERSUS EXISTING SMOKING CESSATION STRATEGIES IN DOMINICAN REPUBLIC USING THE BENESCO MODEL
Lutz M, Morales G, Cuesta G, Pfizer S.A., La Aurora, Heredia, Costa Rica
pg 113 PRS6COST-EFFECTIVENESS OF FLUTICASONE FUROATE COMPARED WITH MOMETASONA FUROATE FOR THE PRIMARY TREATMENT OF ALLERGIC RHINITIS
PATIENTS
Rely K1, Alexandre PK2, Anaya P3, Salinas GE4, 1CEAHealthTech, México, D.F., México, 2Johns Hopkins University, Baltimore, MD, USA, 3GlaxoSmithKline
México, México, D.F., México, 4Hospital Infantil de México Federico Gómez, Secretaría de Salud, México, D.F., México
pg 113 PRS7ESTUDIO DE COSTO-EFECTIVIDAD DE BECLOMETASONA VERSUS CICLESONIDA COMO MEDICAMENTOS CONTROLADORES EN EL MANEJO DEL ASMA
EN PACIENTES QUE ASISTEN A CONSULTA EXTERNA DE NEUMOLOGÍA PEDIÁTRICA EN EL HOSPITAL UNIVERSITARIO CLÍNICA SAN RAFAEL DE BOGOTÁ
COLOMBIA, JULIO A DICIEMBRE 2010
Hinestrosa F1, Pedraza AM2, 1Grünenthal Colombiana S.A., Bogotá, Colombia, 2Hospital San Rafael, Bogotá, Colombia
pg 114 PRS8
COST-EFFECTIVENESS OF AN AMBULATORY PROGRAM OF PULMONARY REHABILITATION FOLLOWING ACUTE EXACERBATIONS OF COPD IN COLOMBIA
Giraldo LF, Brito KP, Rodriguez P, Universidad de La Sabana, Chia, Cundinamarca, Colombia
RESPIRATORY-RELATED DISORDERS – Patient-Reported Outcomes & Preference-Based Studies
pg 114 PRS9DISPONIBILIDAD A PAGAR POR UN METODO EFECTIVO PARA DEJAR DE FUMAR: EVIDENCIAS A PARTIR DE LA ENCUESTA GLOBAL DE TABAQUISMO EN
ADULTOS MÉXICO 2009
Heredia I, Serván E, Reynales LM, Bautista S, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
SENSORY SYSTEMS DISORDERS – Cost Studies
pg 114 PSS1EVALUACION ECONOMICA DE FOTOTERAPIA DE BANDA ANGOSTA O FOTOQUIMIOTERAPIA PARA EL TRATAMIENTO DE PSORIASIS DESDE LA
PERSPECTIVA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL
Carlos F1, Ramos E1, Llorens F2, Ruiz L2, 1R A C Salud Consultores, S.A. de C.V., México, D.F., México, 2Tecnologicos Dalup S. De R.L. De C.V., México, D.F.,
México
pg 114 PSS2ENCOURAGING THE EFFICIENCY OF THE NATIONAL TRANSPLANT PROGRAM: ESTIMATING THE COST OF CORNEAL TRANSPLANT TO BE FINANCED BY
PUBLIC INSTITUTIONS IN THE HEALTH SECTOR IN MEXICO
Camacho A, Gutierrez C, Mexican Ministry of Health, México, D.F. México
pg 115 PSS3
UN ESTUDIO DE COSTO-EFECTIVIDAD PARA EVALUAR EL TRATAMIENTO CON N-ACETIL CISTEÍNA EN PACIENTES CON ESCLEROSIS SISTÉMICA
Lopez JA1, Briones B2, 1Sandoz México, México, D.F., México, 2Novartis Farmaceutica, México, D.F., México
Poster presentation topic codes are provided in Spanish on page 9 and English on page 37.
Page numbers shown to the left refer to the abstract location in this Program & Schedule of Events.
70
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
POSTER DISPLAY HOURS: FRIDAY, 9 SEPTEMBER: 8:30-20:00 & SATURDAY, 10 SEPTEMBER: 8:00-13:45
POSTER AUTHOR DISCUSSION HOUR: FRIDAY, 9 SEPTEMBER: 18:30-19:30
SENSORY SYSTEMS DISORDERS – Patient-Reported Outcomes & Preference-Based Studies
pg 115 PSS4
DEVELOPMENT OF A QUESTIONNAIRE ASSESSING THE BURDEN OF ICHTHYOSIS IN INFANTS
Taieb C1, Dufresne H2, Bodemer C2, 1PFSA, Boulogne Billancourt, France, 2Hopital Necker, Paris, France
SYSTEMIC DISORDERS/CONDITIONS – Cost Studies
pg 115 PSY1 EPIDEMIOLOGY AND SOCIOECONOMIC BURDEN OF OVERWEIGHT AND OBESITY IN ARGENTINA
Elgart JF, Gonzalez L, Caporale JE, Pfirter G, Gagliardino JJ, CENEXA - Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET La Plata, Centro
Colaborador OPS/OMS), La Plata, Buenos Aires, Argentina
pg 115 PSY2
ESTIMACIÓN DEL IMPACTO FINANCIERO EN LA SALUD DE LA POBLACIÓN MEXICANA DERIVADO DE LA OBESIDAD Y EL SOBREPESO, 2000-2017
Guajardo-Barron VJ, Gutierrez-Delgado MC, Mexican Ministry of Health, México, D.F., México
pg 116 PSY3USE OF A DISCRETE EVENT SIMULATION MODEL TO ESTIMATE LONG TERM ECONOMIC OUTCOMES OF BARIATRIC SURGERY IN MORBIDLY-OBESE, TYPE-2
DIABETIC PATIENTS IN MEXICO
Zanela OO1, Cabra HA1, Anaya P2, Rodriguez S1, Melendez G2, Rupprecht F3, 1Johnson & Johnson Medical, México, D.F., México, 2Fundación Mexicana para la
Salud AC, México, México, 3Ethicon Endo-Surgery, Mission Viejo, CA, USA
pg 116 PSY4MODELO DE COSTO BENEFICIO DE LIDOCAINA EN PARCHE AL 5% VERSUS PREGABALINA 300 MG Y 600 MG AL DÍA PARA EL TRATAMIENTO DE LA
NEURALGIA POSTHERPÉTICA
Rojas LA1, Martinez JA2, 1Universidad de La Sabana, Chía, Cundinamarca, Colombia, 2Grünenthal Colombiana S.A., Bogotá, Colombia
pg 116 PSY5ESTUDIO COSTO-EFECTIVIDAD DEL PARCHE DE LIDOCAÍNA COMO TERAPIA ADYUVANTE A PREGABALINA Y GABAPENTINA EN EL MANEJO DEL DOLOR
NEUROPÁTICO PERIFÉRICO EN EL HOSPITAL SAN JOSÉ DE BOGOTÁ D.C. ENERO-DICIEMBRE 2010
Hinestrosa F1, Garzon L2, 1Grünenthal Colombiana S.A., Bogotá, Colombia, 2Hospital San José, Bogotá, Colombia
pg 116 PSY6ESTUDIO DE COSTO-EFECTIVIDAD DE BUPRENORFINA TRANSDÉRMICA VERSUS OXICODONA ORAL Y FENTANILO TRANSDÉRMICO EN EL MANEJO DEL
DOLOR CRÓNICO NO ONCOLÓGICO EN EL HOSPITAL SAN JOSÉ DE BOGOTÁ D.C. ENERO-DICIEMBRE 2010
Hinestrosa F1, Garzon L2, 1Grünenthal Colombiana S.A., Bogotá, Colombia, 2Hospital San José, Bogotá, Colombia
pg 117 PSY7COST OF MANAGING BLEEDING-RELATED EPISODES (BRE) FOR ROMIPLOSTIM VERSUS STANDARD OF CARE (SOC) IN PATIENTS WITH CHRONIC IMMUNE
THROMBOCYTOPENIA (ITP) IN MEXICO
Arocho R1, Northridge K2, Rivera Hurtado R3, Chavez JG4, 1Amgen, Inc., Barcelona, Spain, 2Outcomes Insights, Inc., Westlake Village, CA, USA, 3Amgen México,
México, D.F., México, 4National Institute of México for Social Security (IMSS), Tlalnepantla de Baz, Edo., México, D.F., México
pg 117 PSY8
TWO ANALGESIC TECHNIQUES AFTER CESAREAN DELIVERY: A COST-EFFECTIVENESS ANALYSIS STUDY
Farshchi A, Abdollahi Asl A, Tehran University of Medical Sciences, Tehran, Iran
pg 117 PSY9
EVALUACIÓN ECONÓMICA DE DIETA INMUNOREGULADORA (INMUNEX PLUS®) EN PACIENTES MEXICANOS
Soto Molina H, Iteliness SA de CV, México D.F., México
pg 117 PSY11EVALUACION ECONOMICA DEL USO PROFILACTICO DE PEGFILGASTRIM EN PACIENTES CON QUIMIOTERAPIA MILOABLATIVA PARA EVITAR LA
NEUTROPENIA FEBRIL
Morgan-Villela G, Instituto Mexicano del Seguro Social, Guadalajara, Jal, México
pg 118 PSY12 LAPAROSCOPY VERSUS OPEN ROUX-EN-Y GASTRIC BYPASS FOR MORBID OBESITY: COST-UTILITY ANALYSIS
Silva EN1, Silva MT1, Elias FTS1, Laranjeira FO1, Mottin CC2, 1Mexican Ministry of Health, Brasília, Brazil, 2Pontifical Catholic University of Rio Grande do Sul,
Porto Alegre, RS, Brazil
SYSTEMIC DISORDERS/CONDITIONS – Patient-Reported Outcomes & Preference-Based Studies
pg 118 PSY13 EFECTO DE UN PROGRAMA DE ATENCIÓN FARMACÉUTICA PARA PACIENTES CON SOBREPESO Y OBESOS
Alfonzo N1, Bastardo YM2, 1Proveeduria Farmaceutica IPP, Caracas, Venezuela, 2Universidad Central de Venezuela, Caracas, Venezuela
URINARY/KIDNEY DISORDERS – Cost Studies
pg 118 PUK1 COMPARISON OF DIRECT MEDICAL COST OF DIALYSIS IN A MEXICAN COHORT EITHER ON PERITONEAL OR HEMODIALYSIS
Mayen-Herrera E1, Cortes M1, Marx SE2, Sterz R2, 1Abbott Laboratories de México, México, D.F., México, 2 Abbott Laboratories, Abbott Park, IL, USA
pg 118 PUK2COST PER SUCCESSFUL RESPONSE OF STANDARD TREATMENT PLUS CINACALCET VERSUS STANDARD TREATMENT ALONE IN PATIENTS WITH
SECONDARY HYPERPARATHYROIDISM IN MEXICO
Arocho R1, Ianazzo S2, Rivera Hurtado R3, Paniagua Sierra JR4, 1Amgen, Inc., Barcelona, Spain, 2AdRes Health Economics & Outcomes Research, Torino, Italy,
3
Amgen México, México, D.F., México, 4National Institute of México for Social Security (IMSS), México, D.F., México
pg 118 PUK3 COST-EFFECTIVENESS OF ANEMIA TREATMENT IN DIALYSIS PATIENTS IN BRAZIL
Silva FHCV1, Vianna CMDM2, Silva FVC3, 1Agência Nacional de Saúde Suplementar, Rio de Janeiro, RJ, Brazil, 2Universidade do Estado do Rio de Janeiro, Rio
de Janeiro, RJ, Brazil, 3Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
pg 119 PUK4 COSTO-EFECTIVIDAD DE INTERVENCIONES PARA INSUFICIENCIA RENAL CRÓNICA TERMINAL EN MÉXICO
Arredondo A1, De icaza E2, 1Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México, 2Servicios de Salud del DF, México, D.F., México
Poster presentation topic codes are provided in Spanish on page 9 and English on page 37.
Page numbers shown to the left refer to the abstract location in this Program & Schedule of Events.
71
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
POSTER DISPLAY HOURS: FRIDAY, 9 SEPTEMBER: 8:30-20:00 & SATURDAY, 10 SEPTEMBER: 8:00-13:45
POSTER AUTHOR DISCUSSION HOUR: FRIDAY, 9 SEPTEMBER: 18:30-19:30
pg 119 PUK5ANÁLISIS COMPARATIVO DE COSTOS DEL TRATAMIENTO PARA LA ANEMIA RENAL CON METOXI POLIETILENGLICOL-ERITROPOYETINA BETA (MIRCERA®)
VS. ERITROPOYETINA ALFA
Medina Gómez JL, Instituto Mexicano del Seguro Social, Puebla, Puebla, México
HEALTH CARE DECISION-MAKER’S CASE STUDIES
pg 120 PCASE1 TOMA DE DECISIONES EN SALUD: UN MODELO DE GESTIÓN DE RECURSOS CON ÉNFASIS EN LA CALIDAD ASISTENCIAL. FONDO NACIONAL DE
RECURSOS, URUGUAY
Fernández G, Morales M, Lombide I, Fondo Nacional de Recursos, Montevideo, Uruguay
pg 120 PCASE2 A INSTITUCIONALIZAÇÃO DA AVALIAÇÃO DE TECNOLOGIAS EM SAÚDE NO BRASIL
Santos VCC, Louly P, Vidal A, Silva MT, Elias F, Ministry of Health of Brazil, Brasília, D.F., Brazil
pg 120 PCASE3 ESTRATÉGIAS DE FOMENTO DE ESTUDOS DE AVALIAÇÃO ECONÔMICA: SUBSÍDIO PARA TOMADA DE DECISÃO SOBRE INCORPORAÇÃO DE TECNOLOGIAS
NO BRASIL
Vidal ÁT, Santos VCC, Salomon FCR, Veloso NF, Elias FTS, Ministry of Health of Brazil, Brasilia, D.F., Brazil
Poster presentation topic codes are provided in Spanish on page 9 and English on page 37.
Page numbers shown to the left refer to the abstract location in this Program & Schedule of Events.
72
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research PoDIUM Abstracts
RESEARCH PODIUM ABSTRACTS – SESSION I
FRIDAY, 9 SEPTEMBER: 11:00-12:00
CARDIOVASCULAR DISORDERS OUTCOMES RESEARCH Don Americo
CV1: A COST-UTILITY ANALYSIS OF PROPHYLACTIC THERAPY FOR VENOUS
THROMBOEMBOLISM WITH DABIGATRAN ETEXILATE OR ENOXAPARIN
Burbano-Levy X1, Herrán S1, Sánchez G1, Mieth K2, Alfonso-Cristancho R3, 1RANDOM
Foundation, Bogotá, Colombia, 2Fundación Santa Fe de Bogotá - Banco de Huesos
y Tejidos de la Fundación Cosme y Damián, Bogotá, Colombia, 3University of
Washington, Seattle, WA, USA
OBJECTIVES: To conduct a cost-utility evaluation of dabigatran etexilate compared
with enoxaparin for the prevention of venous thromboembolism (VTE) after total
knee replacement (TKR) and total hip replacement (THR) in Colombia. METHODS:
An acute phase model, using decision analysis, and a long-term simulation Markov
model were developed to compare the clinical outcomes, utilities, and direct
medical costs of dabigatran 220 mg once daily and subcutaneous enoxaparin 40 mg
once daily for VTE prophylaxis after TKR or THR. Time frame for the acute inpatientphase was 14 days for TKR and 30 days for THR; adjustments for adverse events
and average length of hospital stay were performed. The long-term simulation was
performed using 6-months cycle transitions to eight health states for both TKR
and THR. Transition probabilities for VTE and bleeding events were derived from
Phase III studies comparing the two treatments. The probabilities of long-term
events were estimated using data from published longitudinal studies. The payer
perspective for a lifetime horizon was used. Sensitivity analyses were performed to
assess the model robustness. The annual discount rate was set at 3.0%. RESULTS:
During the acute phase, for TKR, patients with dabigatran had lower direct
medical costs than enoxaparin (US$1.005,83 vs. US$1.392,25), with 0.1 difference
in QALYs (0.9 vs.0.8 respectively). For THR, cost of dabigatran were US$868.73, and
US$1,007.55 for enoxaparin; no differences in QALYs were calculated. In the longterm follow-up, for both procedures, the costs associated with dabigatran were
US$115,433, compared to US$122,695 for enoxaparin, with differences in QALYs of
7.4 for dabigatran and 6.7 for enoxaparin. Life-term analyses reported a dominance
of dabigatran over enoxaparin. Results were robust across sensitivity analyses.
CONCLUSIONS: In Colombia, thromboprophylaxis with dabigatran was cost-saving
compared with enoxaparin in patients undergoing major joint replacement.
CV2: COST-EFFECTIVENESS OF PRASUGREL VERSUS CLOPIDOGREL IN PATIENTS
WITH ACUTE CORONARY SYNDROMES UNDERGOING PERCUTANEOUS
CORONARY INTERVENTION IN THE PRIVATE SECTOR IN MÉXICO
Mondragon R1, Arrieta-Maturino E2, Vargas-Valencia JJ3, Ramírez-Gámez J2,
Martínez-Fonseca J2, Guzman-Sotelo M2, 1Hospital Central-Sur de Alta Especialidad
PEMEX, México D.F., México, 2Eli Lilly and Company, México D.F., México,
3
Econopharma Consulting S. A. de C. V., México D.F., México
OBJECTIVES: To evaluate the cost-effectiveness of prasugrel versus clopidogrel in
patients with acute coronary syndromes (ACS) undergoing percutaneous coronary
intervention (PCI) from the private healthcare payer perspective in Mexico.
METHODS: The alternatives were prasugrel (loading dose 60 mg, maintenance
dose 10 mg daily) versus clopidogrel (loading dose 300 mg, maintenance dose 75
mg daily). A Markov model was developed. Only direct medical care costs were
considered for one year. The efficacy measure was a composite of the death from
cardiovascular causes, nonfatal myocardial infarction or nonfatal stroke, and
stent thrombosis reported in the trial directly comparing prasugrel and clopidogrel
(TRITON TIMI-38). Three types of populations were evaluated separately; overall,
patients with diabetes mellitus and the subset of diabetics treated with insulin. Care
costs were derived from medical records, and the costs of drugs were assumed to
be the same. Costs and the model were validated by experts. RESULTS: According
to the model, patients treated with prasugrel had fewer events in the three types
of populations evaluated over a 12 month time horizon. The number of events;
death from cardiovascular causes, nonfatal myocardial infarction-stroke and
stent thrombosis avoided by 10,000 patients were distributed as follows: overall
population, 15, 239 and 132, diabetics, 51, 667 and 175, diabetics on insulin, 87, 1041
and 496. The average cost per patient (2010 Mexican pesos) treated with prasugrel
was lower compared with clopidogrel, for the overall population (MXN$106,549
vs. MXN$108,991), diabetics (MXN$114,832 vs. MXN$130,872) and diabetics
treated with insulin (MXN$121,089 vs. MXN$157,502) CONCLUSIONS: Results from
the present analysis suggest that the use of prasugrel (instead of clopidogrel)
in patients with ACS undergoing PCI, represents a more effective strategy at a
lower cost (dominant strategy), a cost-saving alternative for institutions of private
healthcare in Mexico.
CV3: ANÁLISIS DE COSTO EFECTIVIDAD EN EL CIERRE DE LA COMUNICACIÓN
INTERATRIAL OSTIUM SECUNDUM: TÉCNICA PERCUTÁNEA VERSUS QUIRÚRGICA
Flores A1, Contreras I2, Alva E3, 1CMN 20 de Noviembre ISSSTE, México D.F.,
México, 2Instituto Mexicano del Seguro Social, México D.F., México, 3CMN SXXI,
México D.F., México
OBJECTIVOS: La comunicación interatrial (CIA) es la segunda cardiopatía
congénita en la infancia y la tercera en el adulto. Realizamos un análisis costoefectividad del cierre de la CIA con Técnica Percutánea (TP) con oclusor
Amplatzer septal occluter ASOÒ vs Técnica Quirúrgica (TQ), desde la perspectiva
del proveedor de servicios de salud. METODOLOGÍAS: Mediante una cohorte
prospectiva de pacientes con CIA atendidos en un hospital de tercer nivel del
Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado
(ISSSTE), se identificaron y compararon los costos y efectividades del cierre con
TP y con TQ, en ocho meses de seguimiento. La medida de efectividad fue el éxito
clínico en el cierre sin complicaciones mayores al final del seguimiento (ECSCM).
Se estimó el costo promedio por paciente y rango intercuartílico, mediante la
identificación y cuantificación de los recursos utilizados durante el seguimiento.
Los costos unitarios se obtuvieron de las bases de datos de la institución. Los
costos se expresaron en pesos mexicanos del 2010. Se definió un valor de p <
0.05 como estadísticamente significativo y se utilizaron las pruebas de U de Mann
Whitney y Chi cuadrada. RESULTADOS: Entre enero de 2008 y Diciembre de 2009
se estudiaron 89 pacientes con CIA; Un total de 51 fueron tratados con TQ y 38
con TP, la ECSCM con TQ fue 69% vs. 94% con TP (p<0.05). El costo promedio por
paciente en el grupo de TQ fue: $137,495.16 ($108,418.10-$146,661.60) vs. $99,850.96
($99,746.50-$102,008.90) con TP (p<0.05). El costo por paciente con ECSCM con
TQ fue $225,395.34 vs. $109,509.72 con TP. El costo-efectividad incremental del
tratamiento con TP vs TQ es de -$124,719.00. CONCLUSIONES: El cierre de la CIA,
en una institución de seguridad social mexicana mediante TP es costo-ahorradora
al compararse con la TQ, información que debe ser considerada por los tomadores
de decisiones. CV4: COST-EFFECTIVENESS OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR IN
PATIENTS WITH RISK FACTORS FOR SUDDEN DEATH IN ARGENTINA
Alcaraz A1, Gonzalez Zuelgaray J2, Augustovski F1, 1Institute for Clinical
Effectiveness and Health Policy, Buenos Aires, Argentina, 2PRONETAC, Buenos
Aires, Argentina
OBJECTIVES: To evaluate the cost-effectiveness and cost-utility of the implantable
cardioverter–defibrillator (ICD) among patients who are at risk for sudden death
in Argentina, from three insurance categories: public health, social security and
private. METHODS: We developed a Markov model to evaluate the survival, quality
of life and cost of the prophylactic implantation of an ICD, as compared with
pharmacological therapy, among three different target populations defined using
clinical trials selected through a systematic review. We measured effectiveness,
resource use and cost parameters. A healthcare system perspective was adopted
and a 3% discount rate was used. RESULTS: The use of an ICD was more costly
but more effective than control therapy. The cohort with the greatest benefits was
represented by the MADIT I study showing an incremental cost effectiveness
rate (ICER) of $8,539 (dollar 2009) for public, $9,371 for social security and $10,083
for private sector. ICERs for MADIT II population were $17,379, $18,574 and
$19,799, respectively. The secondary prevention cohort showed the worst results
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
RESEARCH PODIUM ABSTRACTS – SESSION I
with ICERs of $21,016, $22,520 and $24,012. The analysis was robust to different
deterministic and probabilistic sensitivity analyses, except for the cost of ICD and
for battery life. CONCLUSIONS: The results varied considerably depending on the
cohort and discretely according to the health system. ICD could be cost-effective in
Argentina, mainly in the MADIT I patients.
HEALTH CARE EXPENDITURE OR REIMBURSEMENT STUDIES Don Diego 3
EX2: HEALTH CARE RESOURCE USE AMONG PATIENTS WITH BIPOLAR DISORDER
FROM BRAZIL AND VENEZUELA: SUBGROUP ANALYSIS OF DATA FROM A LARGE
MULTINATIONAL LONGITUDINAL STUDY (WAVE-BD STUDY)
Vieta E1, Baptista T2, Bifano M3, Kerr-Corrêa F4, Grohs G5, de Oliveira I6, Vielma X7,
Montes C8, Beluche S8, 1Bipolar Disorders Programme University of Barcelona,
Hospital Clínic, IDIBAPS, CIBERSAM, Barcelona, Spain, 2Instituto Autónomo
Universidad de Los Andes, Departmento de Fisiología, Facultad de Medicina
Universidad de Los Andes, Mérida, Venezuela, 3Humana Docencia, Instituto de
Medicina Integral, Caracas, Venezuela, 4Universidade Estadual Paulista (UNESP),
Botucatu, Brazil, 5Instituto de Psiquiatria de Santa Catarina, Florianópolis, Brazil,
6
Sanatório São Paulo, Salvador, Brazil, 7Hospital General Dr. Miguel Pérez Carreño,
Caracas, Venezuela, 8Medical Department, AstraZeneca Pharmaceuticals, Caracas,
Venezuela
OBJECTIVES: WAVE-bd (International ambispective study of the clinical
management and burden of bipolar disorder [BD]) is ongoing to provide the
healthcare community with updated and representative longitudinal data on this
disease. As part of this study, healthcare utilization was assessed in a cohort
of Brazilian and Venezuelan BD patients. METHODS: Multinational, multicenter,
non-interventional, longitudinal study of patients diagnosed with BD with ≥1 mood
event in the preceding 12 months (retrospective data collection from index mood
event to enrollment, followed by a minimum of 9 months’ prospective follow-up).
Site and patient selection provided a representative sample of patients from both
countries, including private settings and hospitals. Data from Brazil and Venezuela
for the overall BD population (inclusive of BD type I and II) are presented. RESULTS:
In total, 397 patients were recruited from public hospitals and university hospitals
in Brazil [n=146 (88.0%) and n=20 (12.0%), respectively; N=166] and from private
practice and public and university hospitals in Venezuela [n=76 (32.9) and n=155
(67.1), respectively; N=231]. Planned visits to the psychiatrist were the most
frequently used resource (7.77 ± 7.02 [mean ± SD] visits/patient-year) and there
were also 0.48 ± 1.35 spontaneous visits to this specialist. The mean number of
visits to the psychologist was 0.99 ± 5.13 per patient-year. Hospitalization rates
since diagnosis and the index study event were 0.33 ± 0.54 and 0.18 ± 0.54 per
patient-year, respectively. Visits to group therapy sessions, general practitioners
and the emergency room since the index study event were 0.13 ± 1.82, 0.56 ± 0.71
and 0.15 ± 0.75 per patient-year, respectively. There were 140 ± 460 suicide attempts
per 1000 patient-years since diagnosis. CONCLUSIONS: Management of patients
with BD representative of everyday clinical practice involved considerable use of
resources in two Latin American countries. Study funded by AstraZeneca; Clinical
Trials Registry: NCT01062607.
EX3: INCREMENTAL COST OF IMPLEMENTING A CARE PROGRAM FOR PEOPLE
WITH TYPE 2 DIABETES IN ARGENTINA
Gonzalez L, Caporale JE, Elgart JF, Gagliardino JJ, CENEXA - Centro de
Endocrinología Experimental y Aplicada (UNLP-CONICET La Plata, Centro
Colaborador OPS/OMS), La Plata, Buenos Aires, Argentina
OBJECTIVES: To estimate the incremental cost of implementing a care program
for people with type 2 diabetes in Argentina. METHODS: ALAD guidelines were
used to identify resources necessary to implement a diabetes care program in two
Argentinean provinces with opposite socioeconomic characteristics (Cordoba
and Misiones). Microcosting techniques were employed to estimate this cost from
a public payer perspective, and considering a province without such diabetes
program. Probabilistic sensitivity analysis following Monte Carlo simulation
was used to determine the number of visits and practices, probability of insulin
treatment, combined drug therapy for hypertension, dislipidemia, annual number of
test strips for self-monitoring blood glucose (SMBG) and unit cost. RESULTS: The
SMBG represent in both provinces ~50% of the annual incremental cost per patient
followed by that of the treatment of hypertension, dyslipidemia and diabetes. The
74
lowest corresponded to human resources (<5%). The annual individual incremental
expenditure was 32% higher in Córdoba due to the pharmacological treatment of
diabetes (> 90%). Best statistical distribution comparison for incremental costs in
Córdoba and Misiones indicates that: a) Misiones has a 32% average incremental
cost lower than Córdoba; and b) the dispersion around the adjusted mean is
greater for Cordoba than for Misiones. The main determinants of incremental costs
variation associated to proposed treatment in Córdoba and Misiones were: a)
probability of insulin treatment; b) unitary cost of SMBG strips; c) number of HbA1c
determinations; and d) number of strips and lancets needed. The impact of each of
these variables would be different in each province. CONCLUSIONS: These data: a)
provide the first objective evaluation of the cost of a diabetes program in Argentina,
from a public payer perspective, and b) identify critical issues to consider when
planning the implementation of such a program in places with limited resources.
EX4: EFECTIVIDAD DE LOS INDICADORES DE CALIDAD DE LA PRESCRIPCIÓN
REGIONALES EN EL SNS ESPAÑOL
Garrido E1, Sabater FJ2, Hurtado P1, Espinós B1, Guarga L1, García Losa M2, Vieta
A1, Badia X1, 1IMS Health HEOR, Barcelona, Spain, 2IMS Health HEOR, Madrid, Spain
OBJECTIVOS: En el Sistema Nacional de Salud (SNS) español, las estatinas son
uno de los grupos terapéuticos de mayor gasto farmacéutico. Las 17 regiones
españolas gestionan su presupuesto sanitario mediante la implementación de
diferentes políticas farmacéuticas. Las regiones consideran a simvastatina la
estatina de elección y por ello algunas regiones fomentan su prescripción a través
de los indicadores de calidad de la prescripción (ICP). El objetivo de este estudio
fue analizar el efecto de la existencia de ICP de estatinas en la potenciación de
la prescripción de simvastatina respecto al resto de principios activos del grupo.
METODOLOGÍAS: Para identificar los ICP se ha realizado una búsqueda en los
sitios web de los servicios de salud de las regiones. Con las bases de datos de
IMS Health, se han analizado las cuotas de mercado de simvastatina vs el resto
de estatinas por región (unidades vendidas de enero a septiembre de 2010). Se ha
analizado la correlación bivariada no paramétricas entre la existencia de ICP de
estatinas vs la cuota de mercado de simvastatina. RESULTADOS: 6 regiones tenían
ICP en funcionamiento. Las cuotas de mercado de simvastatina oscilaron entre
el 24,3% (Valencia) y el 51,1% (Andalucía). La cuota de mercado de simvastatina
se correlacionó positivamente de manera estadísticamente significativa con la
existencia de ICP de estatinas en las regiones (r=0,660, p=0,014). La R2 reveló que
la existencia de ICP de estatinas explicaba un 41% de la variabilidad en la cuota
de mercado de simvastatina entre regiones. CONCLUSIONES: Parece ser que la
existencia de un ICP de estatinas se traduce en una relación significativa con las
ventas de simvastatina y, en concreto, con un aumento en la cuota de mercado
de simvastatina frente al resto de estatinas en las regiones. Los ICP se pueden
considerar como una política efectiva en el SNS Español.
EXAMINING THE QALY Don Diego 2
QA1: MEASURING THE BENEFITS OF HEALTH CARE: DALYS AND QALYS – DOES
THE CHOICE OF MEASURE MATTER? A CASE STUDY
Colantonio L1, Augustovski F1, Galante J1, Bardach A1, Caporale J1, Zarate V2,
Chuang LH3, Kind P2, 1IECS - Instituto de Efectividad Clinica y Sanitaria, Buenos
Aires, Argentina, 2University of York, York, UK, 3York Trials Unit, York, UK
OBJECTIVES: Health benefit measurement is key in economic evaluations.
Two main generic paradigms have been proposed, quality-adjusted life years
(QALYs) and disability-adjusted life years (DALYs). We explored, using two
previously published models, the differences in the estimation of benefits
through QALY or DALY, and whether these differences could lead to different
conclusions and decision making. METHODS: Two previously published preventive
models, developed in Excel and delivering outputs in QALYs, were adapted to
estimate DALYs: a Human Papilloma Virus (HPV) – a Markov model to compare
screening to vaccination in 12 year old girls - and a pneumococcal vaccination
model (PNEUMO)- a deterministic model which considers the occurrence of
pneumococcal diseases in a calendar year, across all age cohorts. We selected
Argentina, Chile and the UK as country examples as models were used in these
countries and EQ-5D social value weights wereavailable to provide as model inputs
for local QALYs weights. A primary study with descriptive vignettes was done
(n=73) to obtain descriptive EQ-5D data for all health states included in both models.
Several alternative scenario analyses were carried-out. RESULTS: In HPV, QALYs
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
RESEARCH PODIUM ABSTRACTS – SESSION I
gains were generally larger than DALYs avoided, which leads to more favorable
decisions using the former. Differences were larger in UK and smaller in Argentina.
The incorporation of discounting and age weighting increased differences in all
countries, where incremental DALYs avoided represented the 75%, 68% and 43%
of the QALYs gained in Argentina, Chile and UK respectively. Differences directly
influenced decision making using usual thresholds. In PNEUMO differences using
QALYs or DALYs were less consistent and sometimes in opposite directions. Chile
showed the largest gains using both metrics. CONCLUSIONS: This exploratory
analysis shows that using different benefit metrics in these case studies could
influence final results and decisions informed by cost-effectiveness thresholds.
QA2: ANALISIS DE COSTO-UTILIDAD DE RITUXIMAB POSTERIOR AL FALLO POR
ANTI-TNF EN ARTRITIS REUMATOIDE PARA COLOMBIA
Romero M1, Latorre M2, Alvarado C2, Karpf E1, Alvis N3, 1Fundación Salutia, Bogotá,
Colombia, 2Productos Roche Colombia, Bogotá, Colombia, 3Universidad de
Cartagena, Cartagena de Indias, Bolívar, Colombia
OBJECTIVOS: Evaluar la costo-utilidad de Rituximab en pacientes con artritis
reumatoide (AR) que fallaron al tratamiento con un anti-TNF-α. METODOLOGÍAS:
Se elaboró un modelo Markov para comparar Rituximab frente a anti-TNF
(Adalimumab, Infliximab y Etanercept) posterior al fallo por efectividad de otro
anti-TNF. La perspectiva fue del tercero pagador y el horizonte temporal de cinco
años. Se aplicó descuento del 3% a costos y desenlaces (Años de Vida Ajustados
por Calidad –QALY). Los costos de atención fueron tomados a precios del 2011. Las
probabilidades de transición se extrajeron de estudios clínicos según variaciones
en el nivel de enfermedad de acuerdo al Disease Activity Score (DAS-28). Las
utilidades fueron obtenidas de un estudio realizado en 300 pacientes colombianos,
mediante la aplicación del cuestionario Health Assesment Questionnaire (HAQ) y
según el nivel de DAS-28. Se realizó un análisis de sensibilidad tipo Montecarlo.
RESULTADOS: En un horizonte temporal de cinco años, el costo del brazo con
Rituximab fue de USD$2,305,891 frente a USD$2,046,357 con anti-TNF y una utilidad
de 213.54 y 99.33 QALY respectivamente. La razón costo utilidad incremental (ICUR)
fue de USD$2,009.27 USD/QALY´s. Cuando los análisis se hicieron en un horizonte
de tres años Rituximab mostró dominancia. Los resultados fueron robustos frente
al análisis de sensibilidad. CONCLUSIONES: Rituximab, desde la perspectiva del
tercer pagador, es costo-útil frente a otros anti-TNF´s para el tratamiento de
segunda línea de Artritis Reumatoide, ante falla en primera línea de los anti-TNF en
Colombia.
QA3: COSTO-EFECTIVIDAD DE DABIGATRAN VERSUS WARFARINA EN EL MANEJO
DE LA FIBRILACION AURICULAR EN COLOMBIA
Alfonso-Cristancho R1, Herran S2, Caicedo M2, Gomez E3, 1University of Washington,
Seattle, WA, USA, 2RANDOM Foundation, Bogotá, DC, Colombia, 3Clinica Shaio,
Bogotá, Colombia
OBJECTIVOS: Estimar la costo-efectividad de dabigatran o warfarina en fibrilación
auricular (FA) no complicada en Colombia. METODOLOGÍAS: Se creó un modelo de
Markov integrando las complicaciones asociadas a FA, permitiendo la transición
a ocho diferentes estados de salud, incluida la muerte. La utilización de recursos
para el manejo de la enfermedad fue derivada de las guías de la Sociedad de
Cardiología de Colombia y validada por expertos clínicos para ajustar a la práctica
usual. Los costos médicos directos fueron derivados de diferentes fuentes
(públicas y privadas). Las utilidades fueron calculadas a partir de la literatura.
La perspectiva del análisis fue la del pagador con un horizonte temporal de 20
años. Los valores máximos y mínimos de efectividad y del uso de recursos fueron
incluidos en los análisis de sensibilidad. Los resultados fueron descontados a
una tasa del 3% anual. RESULTADOS: Al cabo de 20 años de seguimiento, los
costos médicos directos promedio (descontados) ascendieron a US$69,972
para warfarina y US$80,173 para dabigatran; los años de vida estimados por el
modelo fueron mayores para dabigatran (9.5 vs. 9.2), al igual que los QALYs (8.6
vs. 8.2). La razón de costo-efectividad incremental calculada fue de US$25,122
por QALY adicional ganado con dabigatran comparado con warfarina. El mayor
impacto de los costos y uso de recursos asociados a la enfermedad se debió a
los eventos y complicaciones. El 77.1% de los costos asociados a la enfermedad
fueron consecuencia de los eventos y complicaciones en el grupo de warfarina
mientras que con dabigatran fue del 62.9%. CONCLUSIONES: En Colombia, el uso
de dabigatran para el manejo de FA no complicada comparado con warfarina
resulta en un incremento de años de vida y QALYs, a expensas de un aumento
de los costos del tratamiento pero con una reducción de eventos y costos de las
complicaciones.
QA4: COST-UTILITY OF SACRAL NEUROMODULATION VERSUS AUGMENTATION
CYSTOPLASTY FOR TREATMENT OF REFRACTORY URGE INCONTINENCE IN
MÉXICO
Oliva-Oropeza P1, Quiroz Angulo ME2, Marco Antonio AC3, 1Institute of Social and
Security Services for State Workers, México D.F., México, 2Medtronic México,
México D.F., México, 3V&M Servicios de Consultoria S.C., México D.F., México
OBJECTIVES: The purpose of this study was to conduct a cost-utility analysis
comparing sacral neuromodulation and augmentation cystoplasty for the
management of refractory urge urinary incontinence in Mexico. METHODS: Using
a health care provider perspective, a state transition model was developed to
compare costs (2011 Mexican pesos) and effectiveness (quality adjusted life-years,
QALYs) of sacral nerve stimulation and augmentation cystoplasty. Evaluated in a
Mexican hypothetical cohort, the primary outcome was the incremental cost-utility
ratio (ICUR) which was defined as (sacral nerve stimulation cost – augmentation
cystoplasty cost) / (sacral nerve stimulation QALYs – augmentation cystoplasty
QALYs). The clinical data were obtained from major clinical trials. Costs were
obtained from Diagnosis Related Groups database of the Mexican Social Security
Institute. The sensitivity analysis was performed to assess the impact of varying
efficacy, costs and adverse event rates over the range of reported values.
RESULTS: In the base case scenario, sacral nerve stimulation was more effective
(3.54 vs 1.64 QALYs) and more expensive ($191,825 vs. $107,912) than augmentation
cystoplasty at 5-years. The incremental cost-utility ratio was $44,164 per additional
QALY. Assuming a cost-effectiveness threshold of three times GDP per capita
established by the World Health Organization, the sacral nerve stimulation is
considered cost effective. In the sensitivity analyses, time horizon and cost of
medical device were the most important determinants of variability in costs and
clinical benefits. The ICUR remained cost-effective. Discount rate of 5% was
applied. CONCLUSIONS: The use of sacral neuromodulation for refractory UUI
treatment in Mexico will generate considerable quality of life improvements and it is
economically cost-effective when compared with augmentation cystoplasty. Future
cost-effectiveness studies should be made when botulinum toxin A injections
become available in the country for the management of refractory UUI and when
additional long-term efficacy and complications data become accessible.
HEALTH POLICY TREATMENT PATTERNS Don Diego 4
TP1: PREVALENCE OF LIPID ABNORMALITIES BEFORE AND AFTER INTRODUCTION
OF LIPID MODIFYING THERAPY AMONG MEXICAN PATIENTS
Aguilar-Salinas CA1, Rivera MDR2, Perez J2, Limon F3, Diggle A3, Ambegaonkar BM4,
1
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, México City,
DF, México, 2OMEESTADISTICOS, S.C., México D.F., México, 3MSD México, México
D.F., México, 4Merck and Co., Inc., Whitehouse Station, NJ, USA
OBJECTIVES: This study longitudinally examined the prevalence of lipid
abnormalities and utilization of lipid-modifying therapies (LMT) to determine
treatment gap in Mexican patients from regular clinical practice. METHODS: Using
standardized chart from The Instituto Nacional de Ciencias Medicas y Nutricion,
we identified patients ≥18 years of age, who initiated LMT between July 2001 and
September 2007, continued treatment for 1 year, and had a complete lipid panel
(LDL-C, HDL-C and triglycerides) one-year pre and post therapy. Patients with
history of coronary heart disease (CHD), diabetes and 10-year CHD risk>20% were
classified as high CV risk. Threshold levels for LDL-C, HDL-C and triglycerides were
specified as per NCEP ATPIII Guidelines. RESULTS: Among 332 patients, at baseline,
2% had complete lipid control while 74%, 44% and 82% experienced elevated
LDL-C, low HDL-C and elevated triglycerides respectively. Elevated LDL-C coupled
with low HDL-C and/or elevated triglycerides was prevalent among 61%. LMT was
introduced after one year with about 30% patients utilizing statin monotherapy and
statins in combination with fibrates while about one-third used fibrate monotherapy.
Post therapy, 71%, 47% and 77% continued to experience elevated LDL-C, low
HDL-C and elevated triglycerides respectively while elevated LDL-C coupled with
low HDL-C and/or elevated triglycerides persisted among 58%. A subset of high
risk patients (n=104) had similar results with no meaningful improvement in lipid
75
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
RESEARCH PODIUM ABSTRACTS – SESSION I
abnormalities pre and post therapy. CONCLUSIONS: In this longitudinal study of
Mexican patients, there were no meaningful improvements in proportion of patients
with controlled LDL, HDL-C, TG or multiple lipid abnormalities after initiation of LMT.
Prevalence of lipid abnormality pre and post treatment did not change notably
despite relatively high proportion of patients (over 60%) using fibrate therapy, either
alone or in combination with statins. Economic and social issues are most likely
contributing to poor goal attainment rates.
TP2: PATRONES DE TRATAMIENTO DE LA LEUCEMIA MIELOIDE CRÓNICA (LMC)
EN PACIENTES RESISTENTES O INTOLERANTES A IMATINIB EN INSTITUCIONES
DE SALUD PÚBLICA EN MÉXICO
Hernández-Rivera G1, Aguayo-González Á2, Cantu-Rodríguez OG3, Cervera E4,
Gomez-Almaguer D3, Gutiérrez-Aguirre CH3, Lopez-Hernández M5, Martínez-Baños
D6, Oropeza P7, Rico E8, Juarez-Garcia A1, Vargas-Valencia J9, 1Bristol-Myers
Squibb, México D.F., México, 2Instituto Nacional de Ciencias Médicas y Nutrición
Salvador, México D.F., México, 3Hospital Universitario Dr. José Eleuterio González,
Monterrey, México, 4Instituto Nacional de Cancerología, México D.F., México,
5
Centro Médico Nacional 20 de Noviembre ISSSTE, México City, DF, México,
6
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México D.F.,
México, 7Hospital General de Zona 8 IMSS, México D.F., México, 8Hospital General
Regional 110 IMSS, Guadalajara, México, 9Econopharma Consulting, México D.F.,
México
OBJECTIVOS: Identificar los patrones de tratamiento de la LMC en pacientes
resistentes o intolerantes a Imatinib en instituciones de salud pública en México.
METODOLOGÍAS: Se realizó una revisión retrospectiva de expedientes clínicos
en seis hospitales públicos en México. Se incluyeron 242 pacientes adultos con
LMC, en tratamiento con Imatinib durante al menos 12 meses. Se definieron
operacionalmente resistencia e intolerancia a imatinib, dada la naturaleza
retrospectiva del estudio, como un aumento o una disminución (incluida la
suspensión) de la dosis de imatinib, respectivamente. RESULTADOS: Se observa
una razón hombres-mujeres de 1:1.22, edad promedio de 49.4 años, el 94.24%
de los casos se encuentran en fase-crónica al momento del diagnóstico; faseacelerada 5.35%; y 0.41% en fase-blástica. El aspirado de médula ósea, la biopsia
y el PCR para BCR/ABL, son empleados como pruebas diagnósticas en el 32%, 2%
y 66% de los pacientes respectivamente. El 63.3% inician con 400mg de imatinib,
el 19.7% de 500-600mg, el 2% con 800mg, y el 14.9%<400mg, con una duración
media de 32.1 meses. El 57% reportan resistencia, el 15.7% intolerancia, y el 13%
reportan resistencia e intolerancia. El monitoreo incluye análisis citogenético
en el 82% de los casos, hibridación in situ en el 88% de los casos, PCR 24.8%,
análisis de mutaciones en el 9.1% de los casos. CONCLUSIONES: Los patrones de
tratamiento de la LMC son consistentes con las recomendaciones de las guías
clínicas, con incrementos en la dosis de Imatinib o cambio a un inhibidor de
tirocincinasa de segunda generación, en el caso de una respuesta no adecuada.
Sin embargo, las pruebas de diagnóstico y monitoreo no se realizan en el total de
pacientes o se realizan con frecuencias menores a las recomendadas en las guías
internacionales. La posible explicación a esto es la falta de acceso a las pruebas
de monitoreo en el sistema de salud.
TP3: PATRONES DE TRATAMIENTO Y COSTOS DE ATENCION EN PACIENTES CON
ARTRITIS REUMATOIDE, DESDE LA PERSPECTIVA DEL PROVEEDOR DE SERVICIOS
DE SALUD EN MÉXICO
Contreras I1, Juarez-Garcia A2, Martinez-Rivera G2, Vallejos Parás A3, Ojeda Méndez
J3, Villasis-Keever A2, Rangel S2, 1Instituto Mexicano del Seguro Social, México
D.F., México, 2Bristol-Myers Squibb, México D.F., México, 3Universidad Nacional
Autónoma de México, México D.F., México
OBJECTIVOS: La Artritis Reumatoide (AR) es una condición crónica, sistémica,
rápidamente progresiva, con perdida de la funcionalidad y disminución en calidad
de vida de quien la padece, con alto impacto económico a la sociedad. El objetivo
de este análisis fue identificar los esquemas de tratamiento para pacientes con
AR y estimar el costo de atención, desde la perspectiva del proveedor de servicios
de salud. METODOLOGÍAS: Estudio observacional, transversal y retrospectivo en
233 expedientes clínicos de pacientes con diagnóstico de AR, tratados durante 1
año, en el Instituto Mexicano del Seguro Social. Los esquemas de tratamiento se
clasificaron en: Anti-inflamatorios no esteroideos(AINEs); Fármacos Modificadores
de la Enfermedad (FARME); y terapia biológica. Se estimó el costo promedio por
76
paciente y el rango intercuartilíco en cada grupo de tratamiento. Se identificaron el
tipo y cantidad de medicamentos, consultas y paraclínicos registrados en archivos
clínicos. Los costos unitarios se obtuvieron de bases de datos institucionales. El
costo fue descrito en pesos mexicanos del año 2010. Se consideró valor de p
< 0.05 como estadísticamente significativo, mediante prueba de Kruskal-Wallis. RESULTADOS: El 90.1% de los pacientes fueron mujeres, el promedio de edad fue
50.9 años ± 15.1, el tiempo promedio de evolución de la enfermedad fue 9.5 años
± 8.9, el promedio de articulaciones dolorosas fueron 2.55 ± 1.16. La frecuencia
de los esquemas de tratamiento: AINEs 2%, FARME 34%, AINEs y FARME 54%,
FARME y Biológicos 6%, AINEs/FARME/Biológicos 3%. Costos del tratamiento:
AINEs $10,374.62 ($8,100.58-$11,250.26), FARME $12,615.82 ($8,624.20 - $14,176.42)
AINEs y FARME $13,243.99 ($8,726.04 - $14,678.25); FARME y Biológicos $170,028.85
($146,148.91 - $176,805.53), AINEs/FARME/Biológicos $194,472.09 ($161,478.45
- $202,562.02) (p<0.000). CONCLUSIONES: El esquema de tratamiento AINEs/
FARME fue el más utilizado. Sin embargo, el uso de biológicos comienza a ser una
alternativa factible y muy probablemente necesaria para la atención de AR en el
sistema de salud público.
VACCINE OUTCOMES RESEARCH Don Genaro
VA1: EVALUACION RÁPIDA DEL IMPACTO DE LA INTRODUCCION DE LA VACUNA
CONTRA EL ROTAVIRUS EN COLOMBIA
Rico Mendoza FA1, Porras A1, Alvis N2, De La Hoz F1, Cediel N1, Del Rio F2,
1
Universidad Nacional de Colombia, Bogotá, Colombia, 2Universidad de Cartagena,
Cartagena de Indias, Bolívar, Colombia
OBJECTIVOS: El presente estudio evaluó las coberturas de vacunación
antirotavírica en la cohorte de población colombiana menor de 2 años de edad que
ha sido vacunada desde el año 2008 y además, estimó la incidencia acumulada
de hospitalización por diarrea y la efectividad de la vacuna contra la enfermedad
diarreica severa. METODOLOGÍAS: Se realizó una encuesta poblacional en
hogares con niños mayores de dos meses y menores de 24 meses en 5 ciudades
de Colombia (Cali, Bogotá, Barranquilla, Cartagena y Riohacha). Los 3500 niños se
seleccionaron aleatoriamente, usando un muestreo por conglomerados bietápico,
de las zonas más vulnerables de las ciudades seleccionadas. RESULTADOS: Se
encontró una cobertura de vacunación del 87.3% contra rotavirus. El 43,2% (1453)
con un (IC95%: 36,8 – 66,7) niños menores de 24 meses reportaron haber tenido
al menos 1 episodio de EDA desde el nacimiento. Se encontró una incidencia
acumulada de hospitalización de 4,5% en los niños con dos dosis de vacuna a
diferencia de los niños sin vacuna que tuvieron 11,3% (OR 0,37; IC 95% 0,24-0,57).
Se encontró que una o dos dosis de vacuna contra rotavirus son protectoras
para hospitalización y esta diferencia es estadísticamente significativa (OR: 0,31
IC95%: 0,16 – 0,57). CONCLUSIONES: La efectividad de la vacuna (con el esquema
completo) para enfermedad severa (hospitalización) se mantiene en niveles muy
similares a los obtenidos en los estudios clínicos experimentales. Esto confirma la
validez de los estudios pre introducción que pese a la limitación de la información
epidemiológica que usaron, aparentemente mostraban la carga de enfermedad
real. Una o dos dosis de vacuna contra rotavirus protegen contra hospitalización
por EDA. Dado que este estudio se realizó en poblaciones de alta morbilidad y
mortalidad por diarrea y se encontró una protección adecuada de la vacuna
podríamos inferir que otras poblaciones de menor riesgo también se están viendo
beneficiadas.
VA2: COST EFFECTIVENESS ANALYSIS OF VACCINATION PROGRAMS WITH
10-VALENT (PCV10) AND 13-VALENT (PCV13) PNEUMOCOCCAL VACCINES IN
BOGOTÁ, COLOMBIA
Torres C1, Jaramillo J2, Coronell W3, Gutierrez MV4, Caceres HA4, 1Universidad
del Bosque, Bogotá, Colombia, 2Hospital Universitario del Valle, Universidad del
Valle - Centro IMBANACO, Cali, Colombia, 3Universidad de Cartagena, Hospital
Bocagrande, Cartagena, Colombia, 4Pfizer S.A., Bogotá, Colombia
OBJECTIVES: Pneumococcus was responsible for more than 50% of the
preventable deaths in infants under 5 years of age according to the Pan American
Health Organization before the introduction of conjugate vaccines. The objective
of this analysis is to evaluate the cost effectiveness of vaccinating the Bogota,
Colombia population younger than 2 years of age with 13- valent vaccine (PCV 13)
in comparison to the 10-valent or PHiD-CV vaccine (PCV 10) both in same schedule.
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
RESEARCH PODIUM ABSTRACTS – SESSION I
METHODS: In order to estimate the costs and the impact of the pneumococcal
disease, a Markov model simulating vaccination and outcomes of 10 annual
birth cohorts was adapted to the Colombian conditions from the Health System
perspective. The probabilities and the costs were extracted from a literature review
and tariff manuals applicable for Colombia for January 2011, with costs presented
in US$. The results in health are expressed as number of cases of diseases and
deaths prevented, as well as in terms of life years saved (LYs). Probabilistic
sensitivity analyses were done. RESULTS: Over a 10 year period, vaccinating with
PCV13 prevents 1,680 cases of invasive pneumococcal disease, 9,842 hospitalized
pneumonia, 805 non complicated pneumonia, 16,011 cases of acute Otitis media
and 473 deaths, saving 11,414 LY’s compared to PCV10. The total costs including
vaccination costs and medical costs are US$ 7,828,204 less for PCV13 compared
to PCV10 (US$ 215,750,926 vs. US$ 223,579,130). The model shows robustness in
the sensibility analysis. CONCLUSIONS: The analysis suggests that vaccinating
infants with PCV13 in Bogotá, Colombia is a cost-saving alternative in comparison
with PHiD-CV. The results in economic and disease burden are substantial and they
support the decision making in favor of PCV13 for its high impact in public health.
VA3: A COST-EFFECTIVENESS ANALYSIS OF A 10-VALENT PNEUMOCOCCAL
CONJUGATE VACCINE IN CHILDREN IN SIX LATIN AMERICAN COUNTRIES
García Martí S1, Colantonio L1, Bardach A1, Lopez A1, Caporale J1, Augustovski
F1, Pichon Riviere A1, Knerer G2, Gomez JA3, 1Institute for Clinical Effectiveness
and Health Policy, Buenos Aires, Argentina, 2GlaxoSmithKline Biologicals, Wavre,
Belgium, 3GlaxoSmithKline, Victoria, Buenos Aires, Argentina
BACKGROUND: A recently developed 10-valent pneumococcal non-typable H
influenzae protein D-conjugate vaccine (PHiD-CV) is expected to afford protection
against more than two thirds of isolates causing IPD in children in Latin America,
and also against acute otitis media caused by both Spn and NTHi. OBJECTIVES:
to assess the cost-effectiveness of PHiD-CV in comparison to non-vaccination
in children under 10 years of age in Argentina, Brazil, Chile, Colombia, Mexico
and Peru. METHODS: We used a static, deterministic, compartmental simulation
model. The dosing regimen considered included three vaccine doses (at 2 months,
4 months and 6 months) and a booster dose (at 13 months) (3 + 1 schedule). Model
outcomes included number of cases prevented, deaths averted, quality-adjusted
life- years (QALYs) gained and costs avoided. RESULTS: The largest effect in case
prevention was observed in pneumococcal meningitis (range 26% for Peru up to
47% for Colombia), neurologic sequelae after meningitis (range between 37% for
Peru and 65% for Brazil) and bacteremia (range 42% for Argentina up to 49% for
Colombia). The model showed a significant proportion of deaths averted annually
(range between 17% for Peru and 33% for Brazil). Overall, the health benefits
achieved with PHiD-CV vaccination resulted in a gain of QALYs (range 14% for Peru
up to 26% for Brazil). Compared to non-vaccination cost-effectiveness analysis
demonstrated significant health benefits in favor of 10-valent pneumococcal
vaccination implementation, with ICER values between -230 (Chile) and 7,088
(Brazil), $US dollars 2010 per QALY gained. In Chile, negative ICER value reflected
net cost savings. Indirect costs affected results more than herd immunity.
CONCLUSIONS: The incorporation of the 10-valent pneumococcal conjugate
vaccine into routine infant immunization programs in Latin American countries
could be a valid a strategy to optimize use of available resources improving both
health and quality of life for populations in the region.
VA4: COSTO-EFECTIVIDAD DE LA VACUNA CONTRA EL VPH SUBTIPOS 16 Y 18 EN
MÉXICO
Muciño-Ortega E1, Valencia-Mendoza A1, Flores-Leonard Y2, Bertozzi Kenefick SM1,
1
Instituto Nacional de Salud Pública, Cuernavaca, México, 2Instituto Mexicano del
Seguro Social, Cuernavaca, México
OBJECTIVOS: El cáncer cérvico-uterino (CaCU) permanece como una causa
importante de mortalidad en México. El objetivo de esta investigación fue estimar el
costo-efectividad de la vacunación contra virus del papiloma humano (VPH) 16 y 18
en niñas adolescentes desde la perspectiva de un proveedor público de servicios
de salud en México. METODOLOGÍAS: Se construyó un modelo de Markov de la
progresión de la infección por subtipos oncogénicos de VPH en mujeres a lo largo
de su vida (desde los 12 años), un brazo considera que son vacunadas con tres
dosis de la vacuna bivalente contra VPH, mientras que el otro no. Las mujeres son
susceptibles de someterse al programa de detección oportuna (PDDO) de CaCU
en ambos brazos del modelo. Se consideran los costos de vacunación, PDDO,
tratamiento de lesiones precancerosas y CaCU. Los resultados (descontados al
3%) fueron expresados como costo incremental por año de vida ganado (respecto
de sólo PDDO). Los parámetros de la infección, epidemiológicos, efectividad de
las intervenciones y los costos provienen de revisión de literatura. Se realizó
validación cruzada del modelo. Los resultados fueron obtenidos con simulaciones
Montecarlo y se derivó la curva de aceptabilidad. RESULTADOS: El costo
asociado al PDDO fue de MX$2,159.7 por mujer, menor en MX$1,885.4 al costo del
PDDO+vacunación. La efectividad del PDDO correspondió a 28.605 años de vida,
mientras que la de PDDO+vacunación fue de 28.630 años de vida. La razón de costo
efectividad incremental fue de MX$134,205.79/año de vida ganado. La vacunación
reduciría en 47% la morbi-mortalidad por CaCU. La curva de aceptabilidad muestra
que PDDO+vacunación presenta la mayor probabilidad de ser costo-efectivo a
partir de una disponibilidad a pagar de MX$84,000. CONCLUSIONES: La vacunación
contra VPH 16 y 18, aunada al PDDO de CaCU constituye una alternativa
potencialmente costo-efectiva para disminuir la morbi-mortalidad por CaCU en
México.
77
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
RESEARCH PODIUM ABSTRACTS – SESSION II
FRIDAY, 9 SEPTEMBER: 17:30-18:30
CANCER OUTCOMES RESEARCH Don Diego 4
CN1: COST-EFFECTIVENESS OF TRASTUZUMAB IN THE ADJUVANT TREATMENT
OF EARLY BREAST CANCER IN SIX LATIN AMERICAN COUNTRIES
Pichon-Riviere A1, Augustovski F1, Garay OU1, Buendia J2, Rodríguez A3, Vallejos
C4, Huayanay L5, Oliveira C6, 1Institute for Clinical Effectiveness and Health Policy,
Buenos Aires, Argentina, 2Universidad de Buenos Aires, Ciudad Autonoma de
Buenos Aires, Argentina, 3Fondo Nacional de Recursos, Montevideo, Uruguay,
4
Universidad de La Frontera, Temuco, Chile, 5Universidad Peruana Cayetano
Heredia, Lima, Peru, 6ANVISA, Brasilia, Brazil
OBJECTIVES: To evaluate the cost-effectiveness of adjuvant trastuzumab in six
Latin American (LA) countries (Argentina, Bolivia, Brazil, Chile, Perú and Uruguay)
in early HER2-positive breast cancer. METHODS: A Markov model was designed
to evaluate life years, quality adjusted life years (QALYs) and costs from a health
sector perspective. A systematic search on effectiveness, local epidemiology
and costs was undertaken to populate the model. Two face to face meetings of
countries teams were held to agree on model structure, required parameters, and
a costing template to use a common methodology. Two main transition probability
scenarios for the no-trastuzumab cohort were built and calibrated, one using trial
data (TD) and one using local/Globocan data (LD) in order to better fit local cancer
prognosis. The base case scenario was with 55-year-old women, and used a 5%
discount rate. Currency used was 2010 US dollars ($). RESULTS: Trastuzumab
benefits ranged from 0.9 to 1.1 QALY in the TD scenario, and between 1.5 to 2.6
QALY in the LD scenario. Incremental discounted costs of the trastuzumab strategy
ranged from $39,000 to $68,000 in the TD scenario, and $40,000 to $66,000 in the LD
scenario. Incremental cost-effectiveness ratios ranged from 39,000 to 60,000 $/
QALY in the TD scenario, and between 21,000 and 40,000 $/QALY in the LD scenario. CONCLUSIONS: Using the usually cited 3GDP threshold, these study results suggest
that adjuvant trastuzumab for early breast cancer may not be cost-effective in most
situations in the participant LA countries. Since trastuzumab was shown to be costeffective in many studies conducted in developed countries, our results highlight
the urgent need to evaluate many of the other new “biologic” treatments for cancer
and other diseases, as many of them are currently used in LA but have shown, in
other settings, much more unfavourable cost-effectiveness profiles than
trastuzumab.
CN2: CANCER DE PULMON Y TABACO, ANALISIS DEL COSTO DE ATENCION
MEDICA
Quintana Carrillo R1, Arrieta Rodríguez O2, Zinser Sierra J2, Correa Acevedo M2,
Mohar Betancurt A2, Reynales Shigematsu L3, 1Instituto Nacional de Salud Pública,
México D.F., México, 2Instituto Nacional de Cancerología, México D.F., México,
3
Instituto Nacional de Salud Pública, Cuernavaca, México
OBJECTIVOS: Estimar los costos directos de atención médica del Cáncer de
Pulmón (CP) atribuibles al consumo de tabaco, en el Instituto Nacional de
Cancerología (INCAN). METODOLOGÍAS: Durante el 2009 se estimaron los costos
directos de 290 pacientes con diagnóstico nuevo de CP en el Instituto. El análisis
de costos se hizo desde la perspectiva del proveedor de servicios, empleando la
metodología Cost of Illness (COI), basada en la prevalencia, así como la creación
de un panel de expertos multidisciplinario que clasificó la atención médica,
tomando en cuenta la gravedad de la enfermedad (CP I – CP IV): Ambulatoria,
Hospitalización, Quirófano, Unidad de Cuidados Intensivos, Quimioterapia,
Radioterapia y Cuidados Paliativos. Finalmente empleamos la fracción atribuible
por tabaco para estimar los costos por tabaquismo. Los costos están expresados
en pesos mexicanos ($) y en dólares americanos (USD) del 2009. RESULTADOS:
El costo promedio anual por paciente asociado al consumo de tabaco fue de
$1,105,250.9 (84,590.5 USD), independientemente de la gravedad de la enfermedad.
Los niveles de severidad III y IV del CP fueron los más costosos para el INCAN, con
un costo promedio anual por paciente de $862,398.9 (66,003.8 USD) y $1,174,011.5
(89,853.1 USD). El costo total anual del CP por tabaquismo en el INCAN fue de
$245,735,016.9 (18,807,354.8 USD), donde el CP IV explicó el 96 % de este costo
anual. CONCLUSIONES: Los resultados obtenidos confirman los altos costos del CP
atribuido al tabaquismo y presentan evidencia científica para apoyar las políticas
de salud orientadas al control del consumo de tabaco. El CP al ser una enfermedad
78
evitable, los recursos económicos destinados al tratamiento de la enfermedad
podrían asignarse en otras áreas de interés dentro del Instituto.
CN3: COST EFFECTIVENESS OF LIPOSOMAL DOXORUBICIN VERSUS PACLITAXEL
FOR THE TREATMENT OF AIDS-KS
Raimundo K1, Asche C2, 1University of Utah College of Pharmacy, Salt Lake City,
UT, USA, 2Center for Health Outcomes Research, University of Illinois College of
Medicine and University of Utah College of Pharmacy, Salt Lake City, UT, USA
OBJECTIVES: AIDS-Kaposi’s Sarcoma (KS) is a cancer that occurs among patients
infected with HIV/AIDS. To treat AIDS-KS, the FDA approved the chemotherapy
treatments: liposomal anthracyclines (doxorubicin and daunorubicin) and
paclitaxel. At present, there is no economic study evaluating the cost-effectiveness
of liposomal anthracyclines versus paclitaxel. This study aims to compare
liposomal doxorubicin to paclitaxel through a cost minimization analysis (CMA)
followed by a cost effectiveness analysis (CEA) METHODS: Available cost-studies
have indicated that liposomal doxorubicin is more cost effective than liposomal
daunorubicin thus removed from this analysis. For the CMA and CEA, total costs
were calculated based on the Average Wholesale Price (AWP) of 2010 minus 20%,
for a more realistic approach of acquisition cost. All costs associated with adverse
events were estimated based on a Cancer Institute in US dollars as of 2010. Clinical
outcomes were derived from the package insert and one phase III trial comparing
the two drugs. RESULTS: The CMA showed that the total treatment with liposomal
doxorubicin costs $14,819 compared to $15,135 for paclitaxel. After accounting for
response rate of 57% for paclitaxel and 46% for liposomal doxorubicin, the results
showed that paclitaxel costs $ 26,553 per response while liposomal doxorubicin
costs $ 32,215.One-way sensitivity analysis showed that our results hold true in a
wide range of cost values and the total cost of cycles have the biggest impact in
our analysis. Our model was highly sensitive to the response rate due to the small
difference in total treatment cost. CONCLUSIONS: In our scenario, paclitaxel is
more cost-effective than liposomal doxorubicin. After accounting for all the factors
that contribute to cost, and response rate, paclitaxel is more expensive and more
cost-effective than liposomal doxorubicin. Future research includes the use of other
sources of acquisition cost and a different scenario to validate or refute our results.
CN4: EVALUACION DE COSTOS DEL TRATAMIENTO DE PRIMERA LINEA PARA
CANCER COLORRECTAL METASTASICO (MCRC) CON ESQUEMAS BASADOS
EN: FOLFIRI, FOLFOX O XELOX MAS BEVACIZUMAB, EN CINCO INSTITUCIONES
MEXICANAS
Calderillo Ruiz G, Instituto Nacional de Cancerología, México D.F., México
OBJECTIVOS: Realizar una evaluación de costos del tratamiento de primera
línea para el Cáncer Colorrectal Metastásico (CCRm) con esquemas basados en:
FOLFIRI, FOLFOX o XELOX más Bevacizumab, en cinco instituciones mexicanas.
METODOLOGÍAS: Se desarrolló un análisis de costos del tratamiento del
CCRm, basado en los costos de los servicios de atención médica hospitalaria,
incluyendo los insumos utilizados para el proceso mismo de atención terapéutica.
Se utilizó la metodología de costeo con base en actividades, que se basa en el
microcosteo de procesos. Se revisaron 35 expedientes clínicos de pacientes
con diagnóstico de CCRm tratados con quimioterapia de combinación: FOLFOX
(oxaliplatino 170 mg/m2, fluorouracilo 1 g/m2 y ácido folínico 190 mg/m2), FOLFIRI
(irinotecan 200 mg/m2, fluorouracilo 2,780 mg/m2 y ácido polínico 190 mg/m2) o
XELOX (capecitabina y oxaliplatino 170 mg/m2), con bevacizumab 400 mg/kg. De
la revisión de expedientes se obtuvo información acerca de los procedimientos
efectuados para el diagnóstico y el tratamiento oncológico. Posteriormente se
realizó una comparación entre costos y efectividad expresada como costo por
meses libres de progresión ganados. Se utilizó como punto de referencia los
resultados obtenidos con el uso FOLFIRI Y FOLFOX en este grupo de pacientes
(práctica habitual en las instituciones de salud evaluadas). RESULTADOS: El total
de gastos esperados por diagnóstico asciende a 21,960; 10,110 por Biopsia y 11,850
por estudios. El tratamiento basado en FOLFIRI+Bevacizumab tiene un costo de
29,216 (19,283–34,988) y el basado en FOLFOX+Bevacizumab 22,262 (12,859–29,822).
Adicional a la Quimioterapia se incluyen los gatos por esquema de seguimiento
en cada ciclo, estos ascienden a 8249. El costo esperado total de la enfermedad
(diagnostico, tratamiento y seguimiento) asciende a 59,425. CONCLUSIONES: Este
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
RESEARCH PODIUM ABSTRACTS – SESSION II
análisis nos permite conocer el costo de atención del CCRm con la adición de un
medicamento biológico que incrementa su efectividad.
HEALTH SERVICES RESEARCH Don Americo
HS1: INTERCHANGEABILITY BETWEEN PNEUMOCOCCAL CONJUGATE VACCINES
AND SCHEMES
Ciapponi A, García Martí S, Rey-Ares L, Glujovsky D, Bardach A, Valanzasca P, Lee
A, Cafferata ML, Institute for Clinical Effectiveness and Health Policy, Buenos Aires,
Argentina
BACKGROUND: Streptococcus pneumoniae (pneumococcus) is a leading cause
of serious illness among children worldwide. Pneumococcal conjugate vaccines
that include 7, 9, 10, 11, 13, and 15 serotypes have been developed. OBJECTIVES:
Assess the comparative efficacy, cost-effectiveness, immunogenicity and safety
of interchangeability among Pneumococcal Conjugate Vaccines and Schemes.
METHODS: A systematic search was conducted in December 2010 on the main
electronic literature and regional databases, generic and academic Internet
search and meta-search engines, Cochrane Central Register of Controlled Trials.
Databases containing regional proceedings or congresses, annals and doctoral
theses were also searched. No language or temporal restriction was imposed. We
included all randomized controlled trials, economic evaluations, systematic reviews
and meta-analysis evaluating antibody response, cost-effectiveness and clinical
effectiveness of the interchangeability among Pneumococcal conjugated vaccines.
Pairs of reviewers independently selected and assessed the quality of the studies
and discrepancies were solved by consensus of the whole team. RESULTS: A total
of 21 out of 159 studies were included. There is currently no direct data available on
the interchangeability among PCV for primary series. Some studies demonstrated
noninferiority immunogenicity between PHiD-CV and PCV7. The tolerability profile
of PHiD-CV was similar to that of PCV7, when both vaccines were coadministered
with other routine pediatric vaccines. Regarding cost effectiveness profiles PhiDCV and PCV13 were consistently more costeffective than PCV7 at a constant price.
When PHiD-CV and PCV13 were compared against each other the results varied
according to price, indirect effects and indirect costs. CONCLUSIONS: In general,
PHiD-CV gains more QALYs due to the prevention of more frequent yet less severe
events such as otitis media; and PCV13 prevents less frequent events but more
costly as invasive diseases (meningitis or bacteremia). Although we found no direct
evidence, the two scientific recommendations identified in the search advise that
PCV13 and PHiD-CV could be interchanged with PCV7.
HS2: ANALISIS DE COSTOS DEL PROGRAMA AMPLIADO DE INMUNIZACIONES EN
COLOMBIA 2009
Romero M1, Arango C1, Chavez D1, Otero J1, Alvis N2, 1Fundación Salutia, Bogotá,
Colombia, 2Universidad de Cartagena, Cartagena de Indias, Bolívar, Colombia
OBJECTIVOS: Establecer costos de aplicación de los biológicos contenidos
en el Programa Ampliado de Inmunizaciones (PAI) en Colombia, que sirvan
en evaluaciones económicas posteriores. METODOLOGÍAS: Se combinaron
dos tipos de estudio: microcosteo tipo bottom up de centros vacunadores en
municipios, desde la perspectiva del tercer pagador, y una revisión presupuestal
de las asignaciones y gastos del PAI año 2009 en las direcciones territoriales de
salud. Para lograr representatividad nacional se seleccionaron 62 municipios
según nivel de pobreza distribuidos en 5 regiones, elegidos mediante un
muertreo probabilístico, estratificado, polietápico. Se recolectó información
por tipo de bilógico y por los diferentes elementos del costo. Se realizó análisis
de datos con medidas de tendencia central. Los datos fueron recolectados en
pesos colombianos (COP) y convertidos a dólares americanos (USD) del 2009. RESULTADOS: Los costos de aplicación de vacunas presentan diferencias por
tipo de biológico y región. Los mayores costos por dosis aplicada son neumococo
(30.21USD) y (30.07USD) polio inyectable (VIP), frente a los más bajos: (3.53USD)
polio oral (VOP) y toxoide tetánico (3.81USD). A nivel regional los costos más altos
corresponden a los de Orinoquia y Amazonia que son las de mas difícil acceso. Por categoría de municipios mostró que los biológicos son más costosos en los de
mayor pobreza. El recurso humano tiene un peso porcentual del 35.92% del total y
del 58% si se excluye el costo de los biológicos. La perdida de biológico significó
6.55% frente al costo, con variaciones según el biológico. CONCLUSIONES: La
mediana del costo total por aplicación de una dosis incluida en el PAI sería de
6.32USD. Si se excluyen los costos de desperdicio y el costo del biológico, la
mediana de aplicación sería de 3.92USD. Estos costos están influenciados por
el nivel de productividad de los centros y es similar al notificado por estudios
internacionales.
HS3: THE ECONOMIC BURDEN OF ROAD TRAFFIC INJURIES ON HEALTH SYSTEM
AND SOCIETY IN BELIZE
Heredia Pi IB1, Pérez Núñez R1, Hijar Medina M1, Jones S2, Silveira Rodrigues EM3,
1
National Institute of Public Health, Cuernavaca, México, 2Pan American Health
Organization/World Health Organization, Trinidad and Tobago, 3Pan American
Health Organization/World Health Organization, Washington, DC, USA
OBJECTIVES: To estimate the economic cost of road traffic injuries in Belize.
METHODS: A cross-sectional study was conducted using secondary cost data
and assuming the health system and social perspectives. Two major databases
were analyzed: the mortality database, containing all deaths during 2001-2007,
and the national hospital discharge database, containing all discharges during
2007. Additionally, a third database containing all emergency ambulance services
provided by BERT to persons involved in RTI in the Belize District during 2007 was
analyzed. A descriptive analysis was performed for all databases. Central tendency
and dispersion measures were calculated for the continuous variable (mean,
median, standard deviation, maximum and minimum value) as well as frequencies
and percentages for the categorical variables. Costing was done in 2007 Belize
Dollars after adjusting by inflation using the Belize National Consumer Price Index.
Costs were also discounted at an annual rate of 3% and 5%. Multi-way sensitivity
analysis was carried out in order to incorporate uncertainty in the estimations.
RESULTS: A total of 63 (or 61 if adjusted) people died as a consequence of RTI
during 2007 (a mortality rate of 20.72 deaths per 100,000 inhabitants), 338 were
hospitalized and a total of 565 slightly injured was estimated. A total of 2,501 Years
of Potential Life were Lost in Belize due to premature death. All this translated
in a total economic cost of BZ$31,966,045 due to RTI during 2007. This figure
represents 1.26% of Belizean GDP during 2007. The great majority of the cost is
for fatal injuries, specifically on indirect cost attributed to premature death. Direct
cost was estimated at BZ$491,549, of which 2.09% was spent on fatalities, 61.61%
on severely injured and 36.30% on slightly injured. CONCLUSIONS: The economic
cost estimations make clear the need to prevent RTI utilizing a strategic and
multisectoral approach that focuses on addressing the main problems identified. HS4: IMPACTO ECONOMICO EN LA ATENCION MEDICA DE ENFERMEDADES
ASOCIADAS AL TABAQUISMO EN UNA POBLACION MEXICANA
Pérez Zincer F1, Quintana Carrillo R2, Barrios Nanni R1, Chagoya Bello J1, Ramos
Reyna E1, Reynales Shigematsu L3, 1Hospital Central Militar, México D.F.,México,
2
Instituto Nacional de Salud Pública, México D.F., México, 3Instituto Nacional de
Salud Pública, Cuernavaca, México
OBJECTIVOS: Estimar la carga económica que representan las enfermedades
vinculadas al consumo de tabaco en el Hospital Central Militar (HCM), a través del
costo directo de atención médica (CDAM). METODOLOGÍAS: La estimación del
CDAM atribuible al consumo de tabaco fue realizada en pacientes con diagnóstico
de primera vez de las enfermedades: CP (20), IAM (123), EPOC (160) y EVC (288),
en 2009. El análisis de costos fue realizado desde la perspectiva del proveedor de
servicios, aplicando la metodología Cost of Illness (COI), basada en la prevalencia
así como la creación de un panel de expertos multidisciplinario, que clasificó la
atención médica: Ambulatoria, Urgencias, Hospitalización, Quirófano, Unidad
de Cuidados Intensivos, Quimioterapia y Radioterapia. Finalmente utilizamos
la fracción atribuible por tabaco para estimar los costos. Los costos fueron
reportados en pesos mexicanos ($) y en dólares (USD) del 2009. RESULTADOS:
Durante el 2009, el costo promedio anual por paciente sin importar la gravedad de
la enfermedad fue de $213,723.6 (16,357.4 USD) para el IAM, $130,901.8 (10,018.6
USD) para el ECV, $85,272.6 (6,526.3 USD) para el EPOC y $767,709.5 (58,756.7 USD)
para el CP; respectivamente. Para el mismo año, el costo total anual asociado
al tabaquismo fue de $21,159,968.2 (1,619,480.3 USD) para el IAM, $20,000,245.3
(1,530,720.8 USD) para el ECV, $15,652,522.9 (1,197,967.4 USD) para el EPOC y
$35,203,438.6 (2,694,298.2 USD) para el CP; respectivamente. El CP resultó más
costoso para el HCM. CONCLUSIONES: Los resultados obtenidos dimensionan
el enorme costo económico del problema de la atención de las enfermedades
asociadas al tabaquismo en el HCM y proveen información sólida para apoyar las
79
ISPOR 3rd Latin America Conference
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RESEARCH PODIUM ABSTRACTS – SESSION II
políticas de salud para el control del tabaco. Ya que las enfermedades asociadas al
tabaquismo son prevenibles, los recursos económicos destinados al tratamiento de
dichas enfermedades podrían dirigirse a otros programas prioritarios del HCM.
INFECTION OUTCOMES RESEARCH Don Diego 2
IN1: EVALUACION DE COSTO-EFECTIVIDAD CON EL USO DE LINEZOLID PARA EL
TRATAMIENTO DE INFECCIONES COMPLICADAS DE PIEL Y TEJIDOS BLANDOS
Vargas-Valencia JJ1, Sotelo-Guzmán M1, Díaz-Ponce H2, Galindo-Suárez RM2,
Muciño-Ortega E2, Mould-Quevedo J3, 1Econopharma Consulting S.A. de C.V.,
México D.F., México, 2Pfizer S.A. de C.V., México D.F., México, 3Pfizer, New York, NY,
USA
OBJECTIVOS: Las infecciones complicadas de piel y tejidos blandos (ICPTB)
son causa común de hospitalización, situación que representa un reto clínico
y económico para los prestadores de servicios de salud. El objetivo de esta
investigación fue estimar el costo-efectividad de linezolid en el tratamiento de
ICPTB vs vancomicina y teicoplanina, desde la perspectiva del Instituto Mexicano
del Seguro Social (IMSS). METODOLOGÍAS: Se construyó un árbol de decisiones
que evaluó la tasa de éxito microbiológico, los días de estancia hospitalaria (en
piso y unidad de cuidado intensivos, UCI) y los costos directos del tratamiento con
linezolid inyectable, seguido por linezolid oral (600mg dos veces/día), vancomicina
inyectable (1,000mg dos veces/día) y teicoplanina inyectable (400mg el primer día,
días subsecuentes: 200mg) en pacientes con ICPTB en un horizonte de 38 días. La
respuesta microbiológica se extrajó de literatura. La relación de insumos (estudios
de laboratorio, consultas y medicamentos) y procedimientos médicos, así como
el manejo hospitalario se extrajó de la literatura y se complementó con opinión de
expertos. Los costos corresponden al IMSS para el año 2010. Se realizó análisis
de sensibilidad probabilístico. RESULTADOS: La tasa de éxito microbiológico con
linezolid fue 93.1%, superior a la de vancomicina (88.2%, p=0.025) y teicoplanina
(44.1%, p<0.0001). Los días de estancia en UCI fueron 13.03, 17.53 y 21.82 con
linezolid, vancomicina y teicoplanina, respectivamente. El costo esperado por
evento para linezolid ($609,987) fue menor en comparación con el de vancomicina
($725,130) y teicoplanina ($930,172). El tratamiento con linezolid se asocia a una
menor estancia en UCI y a una baja en el costo del tratamiento debido al pasar de
la administración intravenosa a la oral. Las curvas de aceptabilidad muestran que
linezolid es una alternativa dominante. CONCLUSIONES: Linezolid constituye una
alternativa dominante sobre vancomicina y teicoplanina en el tratamiento de ICPTB
en el contexto del IMSS.
IN2: CHRONIC HEPATITIS C TREATMENT FOR GENOTYPE 2 OR 3: COSTEFFECTIVENESS ANALYSIS OF PEG AS FIRST LINE TREATMENT WITH THE
BRAZILIAN PROTOCOL
Blatt CR1, Storb BH1, Mühlberger N2, Wurm J2, Farias MR1, Siebert U2, 1Universidade
Federal de Santa Catarina / UNISUL /UMIT, Florianopolis, Santa Catarina, Brazil,
2
UMIT - University for Health Sciences, Medical Informatics and Technology /
ONCOTYROL, Hall i. T., Tirol, Austria
OBJECTIVES: The Brazilian protocol recommends that the first line treatment
for patients with chronic hepatitis C (CHC) and genotype 2 or 3 is interferon alfa
(IFN) plus ribavirin for 24 weeks. For those that do not respond to this treatment
the use of peginterferon alfa (PEG) plus ribavirin for 48 weeks is recommended.
Our objective was to compare the cost and effectiveness of first line treatment of
genotype 2 or 3 with peginterferon with the current Brazilian protocol. METHODS:
Target Population: CHC patients with genotype 2 or 3 in Brazil. Interventions:
PEG-SEC: interferon alfa (IFN) plus ribavirin (RBV) for 24 weeks for patients with
genotype 2/3; for nonresponders subsequently peginterferon (PEG) plus RBV for
48 weeks; PEG-FIRST: PEG+RBV for 48 weeks for all patients. Study Type: Costeffectiveness analysis. Data Sources: Effectiveness data from a meta-analysis
conducted with Brazilian studies. Treatment cost for antiviral drugs, secondary
drugs, diagnostic tests, outpatient visits to physicians and other professionals,
hospitalizations, nurse and pharmaceutical care from a micro-costing study
converted to 2010 USD. Perspective: Health care system. Outcome Measure:
Sustained Viral Response (SVR), direct costs and incremental cost effectiveness
ratio (ICER). RESULTS: With a SVR rate of 76.6% and costs of USD 6,943, PEG-SEC
was more effective and less costly than PEG-FIRST (SVR: 73.2%, costs: USD 11,297).
Sensitivity analyses: For PEG-SEC to remain dominant, the proportion of patients
80
undergoing second line treatment with PEG+RBV must be >88%. If only 0.5% of
patients undergo second line treatment with PEG+RBV, the ICER of PEG-FIRST is
USD 71,529 per additional SVR. CONCLUSIONS: In the Brazilian context, IFN for
genotype 2 or 3 as first line, and PEG+RBV for those who fail to achieve SVR is more
effective and less costly than PEG+RBV as first line treatment.
IN3: DENGUE MÁS QUE UN PROBLEMA DE SALUD PÚBLICA: ESTIMACIÓN DE LOS
COSTOS DIRECTOS DE LA EPIDEMIA DEL AÑO 2010 EN COLOMBIA
Bello SL1, Díaz E2, Malagon JN2, Romero M2, Salazar V2, 1Instituto Nacional de Salud
de Colombia, Bogotá, DC, Colombia, 2Fundación Salutia, Bogotá, DC, Colombia
OBJECTIVOS: Determinar los costos directos en atención de pacientes con Dengue
en Colombia durante la epidemia 2010. METODOLOGÍAS: La población a riesgo
fue calculada basada en los datos de morbilidad y mortalidad e indicadores de
salud nacionales entre 1999 y 2009 publicados por el Ministerio de la Protección
social. El consolidado de datos de casos de dengue y dengue grave (clasificación
revisada de dengue OMS 2009) del Sistema de Vigilancia Epidemiológica Nacional
reportados del 01 de enero al 31 de Diciembre de 2010 sirvieron para establecer la
historia natural de la enfermedad, con lo que se construyó un árbol de decisiones
que representa los desenlaces de los pacientes con dengue. Se consideraron
entre los costos directos: atención médica ambulatoria, urgencias, hospitalización
y asistencia en las unidades de cuidado intensivo. Los costos individuales fueron
estimados de las tarifas nacionales estandarizadas. RESULTADOS: Durante 2010
hubo 157,152 casos de Dengue, 94% (n=147,670) fueron de dengue y 6% (n=9482)
Dengue Grave. La tasa de letalidad fue de 2.28. Los costos directos ascendieron
a US$81.8 millones, de los cuales US$5.4 millones correspondieron a la atención
en los servicios ambulatorios y de urgencias. US$76 millones correspondieron a
gastos de hospitalización y UCI. El costo promedio por paciente fue de US$520.48.
Hubo un incremento del 12.14% en los costos durante la epidemia de un comparado
con un período previo no epidémico. CONCLUSIONES: El dengue representa
una patología de alto impacto económico en Colombia. No existen estudios
previos. Comparado con otros países, el costo de la atención de dengue es mayor.
Es necesario realizar estudios de costo efectividad de las intervenciones de control
regular y otras intervenciones del control vectorial en períodos inter epidémicos
para disminuir los costos directos en una futura epidemia. Estos resultados podrían
apoyar la evaluación de los costos de una vacuna contra dengue en el país.
IN4: MORBIDITY AND MORTALITY OF COMMUNITY ACQUIRED PNEUMONIA IN
ADULTS IN SIX COUNTRIES IN LATIN AMERICA
Rosado-Buzzo A1, Garcia-Mollinedo L1, Camacho-Cordero L1, Roberts CS2, MouldQuevedo JF2, Trejo-Martinez A1, Luna-Casas G1, 1Links & Links S.A, de C.V., México
D.F., México, 2Pfizer Inc, New York, NY, USA
OBJECTIVES: To estimate the morbidity and mortality of community acquired
pneumonia (CAP) in adults over 50 years of age in Argentina, Brazil, Chile,
Colombia, Mexico, and Venezuela. METHODS: Local data sources were used to
estimate the number of cases of hospitalized and outpatient pneumonia cases and
deaths in the year 2009. Pneumonia cases were queried in adults ≥50 years of age
using ICD-9 codes. CAP episodes were estimated from pneumonia proportionally
by age based on prior publications that compared ICD-9 coded hospitalizations
to confirmed CAP by chart review. Incidence rates were calculated as cases
per 100,000 population. Case-fatality rates (CFR%) associated with CAP requiring
inpatient care were based on hospital mortality rates reported for each country.
RESULTS: Cases of CAP hospitalization (incidence per 100,000 person years) in
adults ≥50 were: Argentina=21,619 (218.5); Brazil=123,033 (333.9); Chile=16,544
(401.4); Colombia=14,699 (178.1); Mexico=44,807 (224.7); Venezuela=17,205
(348.5). The number of hospital deaths (CFR%) were: Argentina=2,772 (13%);
Brazil=25,725 (21%); Chile=1,671 (10%); Colombia=1,622 (11%); Mexico=7,249
(16%); Venezuela=6,040 (35%). Cases of outpatient CAP (incidence) were:
Argentina=19,243 (194.5); Brazil=94,448 (256.5); Chile=12,010 (291.4); Colombia=10,039
(121.6); Mexico=30,635 (153.6); Venezuela=14,339 (290.4). The percent of episodes
treated as outpatient was 53% (range 45%-61%) among those aged 50-64 and
25% (range 4%-25%) among those ≥75. Across countries, 51% of hospitalizations
(range 42%-63%) and 69% of deaths (range 65%-72%) were in adults ≥75 years.
CONCLUSIONS: CAP is a common cause of hospitalization and mortality in adults in
Latin America. Incidence increases substantially with increasing age, as does the
likelihood of hospitalization.
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
RESEARCH PODIUM ABSTRACTS – SESSION II
PATIENT-REPORTED OUTCOMES STUDIES Don Genaro
PR1: RESPONSIVENESS OF THE COPD ASSESSMENT TEST (CAT) QUESTIONNAIRE
DURING EXACERBATIONS OF COPD
Agusti A1, Soler JJ2, Molina J3, Muñoz MJ4, Garcia-Losa M5, Roset M6, Jones
PW7, Badia X6, 11 Hospital Clínic IDIBAPS, Barcelona & CIBER Enfermedades
Respiratorias (Spain), Barcelona, Spain, 2Hospital de Requena, Requena (Valencia),
Spain, 3Centro de Salud Francia, Madrid, Spain, 4GlaxoSmithKline SA, Tres Cantos
(Madrid), Spain, 5IMS Health, Madrid, Spain, 6IMS Health, Barcelona, Spain, 7St
George’s, University of London, London, UK
OBJECTIVES: To assess the measurement properties and response to change
of the Spanish version of the CAT questionnaire during exacerbations of COPD
(ECOPD). METHODS: Observational, prospective study in 49 centers in Spain.
Patients hospitalized because of ECOPD (n=224) completed the CAT, the St.
George’s Respiratory Questionnaire-adapted for COPD (SGRQ-C) and the London
Chest Activities of Daily Living (LCADL) questionnaire during the first 48 hours of
admission and 4±1 weeks after hospital discharge. Another group of clinically
stable COPD patients (n=153) also completed the same questionnaires on two
occasions, at recruitment and 4±1 weeks later. RESULTS: Internal consistency
(Cronbach’s alpha) was 0.86. Test re-test reliability (Intraclass Correlation
Coefficient) was 0.83. CAT scores correlated with both the SGRQ (r=0.82; p<0.01)
and the LCADL (r=0.63; p<0.01). Change in CAT during ECOPD correlated well with
change in SGRQ (r=0.63, p<0.01).The CAT discriminated between stable and ECOPD
patients (15.8 vs 22.4, p <0.01), as well as between patients with different levels of
airflow limitation and dyspnea (MRC scale). The effect size in CAT scores for ECOPD
patients reporting their health state as “much better” after discharge was 0.90; for
“quite a lot better” 0.63, and for “slightly better” 0.59. CONCLUSIONS: The Spanish
version of CAT is sensitive to change during ECOPD and has similar properties to
those of the original English version. Funded by GlaxoSmithKline. PR2: THE BEAUTY OF MAPPING: NEED THE MEAN HEALTH-RELATED QUALITY OF
LIFE SCORE FOR A GROUP OF HIP PATIENTS AND DON’T HAVE EQ-5D? JUST USE
THE OXFORD HIP SCORE!
Pinedo Villanueva RA1, Turner D1, Judge A2, Raftery JP1, Arden NK2, 1University
of Southampton, Southampton, Hampshire, UK, 2University of Oxford, Oxford,
Oxfordshire, UK
OBJECTIVES: To assess different mapping methods for the estimation of a
group’s mean EQ-5D score based on responses to the Oxford Hip Score (OHS)
questionnaire. METHODS: Four models were considered: a) linear regression using
total OHS as a continuous regressor; b) linear regression employing responses
to the twelve OHS questions as categorical predictors, c) two-part approach
combining logistic and linear regression; and d) response mapping. The models
were internally validated on the estimation dataset, which included OHS and EQ-5D
scores for THR, both before and six months after procedure for 1,759 operations.
An external validation was also performed. RESULTS: All models estimated the
mean EQ-5D score within 0.005 of a utility, OLS continuous being the most accurate
(overestimation of 0.0005 at external validation) and OLS categorical the more
consistent (a maximum estimation error of 0.03 at calibration by deciles). Age,
gender and deprivation did not improve the models. More accurate estimations at
the individual level were achieved for higher scores of observed OHS and EQ-5D.
CONCLUSIONS: Based on these results, when EQ-5D scores are not available,
answers to the OHS questionnaire can be used to estimate a group’s mean EQ-5D
with a high degree of accuracy. The application of the response mapping approach
allows for the mapping of OHS onto EQ-5D to be undertaken in any country where a
value set is available to produce the single index EQ-5D summary score.
PR3: PRIMARY HEALTH CARE EVALUATION IN CHILE: PATIENTS’ PERSPECTIVE
Leisewitz T1, Nogueira L2, Peñaloza B1, Bastías G1, Villarroel L1, 1Pontificia
Universidad Católica de Chile, Santiago, RM, Chile, 2Harvard University, Boston,
MA, USA
BACKGROUND: Chile’s health indicators are good compared with other Latin
American countries with similar gross national product. Nonetheless, disparities in
health care services are not absent in Chile. OBJECTIVES: The aim of this study was
to evaluate satisfaction with primary health care and health-related Quality of Life
(hrQoL) between patients in urban and rural areas of Chile. METHODS: A nationalrepresentative sample of 1544 patients was surveyed at 38 primary care centers.
The “Encuesta de expectativas, percepcion y satisfaccion usuaria con modelo
de salud familiar” (survey of patient expectations, perception and satisfaction
with the family health model) and the EQ-5D questionnaire were administered to
assess patient satisfaction level, and self-evaluated health, respectively. Using
the Chilean social value for reported health states, a mathematic equation was
used to compute the average hrQoL. RESULTS: Patient satisfaction was 5.28 ±
0.30 (scale 1 to 7). There was a statistically significant difference between urban
and rural areas (5.45 ± 1.06 and 5.10 ± 1.28 points, respectively). The mean hrQoL
for the entire population was 0.77 ± 0.00 (scale 0 to 1), with a statistical significant
difference between rural and urban areas (0.78 ± 0.24 and 0.75 ± 0.25, respectively).
Using stepwise multivariate regression we were able to explain 25.4% (R2=0.254)
of the variability in patient satisfaction. Length of consultation with the health care
professional (Beta = 0.215, p value <0.001), patient education level (Beta = -0.115, p
value = 0.006), and year in which the center was founded (Beta = 0.089, p value =
0.025) were identified as explanatory variables. CONCLUSIONS: Despite evaluating
better-perceived quality of health services, urban patients rated lower their
self-assessed health. These results should motivate policy makers in looking for
innovative ways to diminish the gap in quality between urban and rural areas.
PR4: CALIDAD DE VIDA Y VICTIMIZACION EN ADOLESCENTES ESTUDIANTES DE
MÉXICO
Hidalgo CA, Jiménez G, 1Universidad de Guadalajara, Jalisco, México
OBJECTIVOS: Analizar la calidad de vida (CV) de adolescentes estudiantes de
secundaria de Jalisco México acorde a la percepción de ser víctima de alguna
agresión, intimidación o maltrato. METODOLOGÍAS: Estudio transversal analítico
llevado a cabo en 2010 con 570 adolescentes estudiantes de nueve secundarias de
Jalisco, México (11-17 años, media 13.3, 47.2% mujeres, 20% trabajaban, 1er grado
31%, 2do. 23.1%, 3ro. 44.3%), contestaron un instrumento en línea que incluyó el
módulo perceptual del Quality of Life Instrument-research (YQOL-R) en español,
4 ítems sobre violencia del Youth Risk Behavior Survey 2007 y un ítem del modulo
contextual del YQOL-R. Estadísticas: t de student, analizado con SPSS 17. Ética:
consentimiento informado, voluntario, privado y confidencial. RESULTADOS: Un
total de 17.1% no fueron a la escuela los pasados 30 días, por sentirse que podrían
estar inseguros en la escuela o en el camino para llegar a ella, a 12.4% los trató
de lastimar alguien con un arma en la escuela en los pasados 12 meses, 22.1% maltratados en la escuela, 22.6% maltratados electrónicamente (maltratados o
intimidados por email, chat, mensajes, páginas web) y 26.6% durante las últimas
4 semanas los hicieron sentirse rechazado/a por su apariencia, personas de su
edad. La CV fue significativamente menor para los que no fueron a la escuela
por sentirse inseguros (p‹0.001), en quienes trataron de lastimar con un arma en
la escuela (p=0.37), quienes fueron maltratados en la escuela (p‹0.001), quienes
fueron maltratados electrónicamente (p=0.047) y quienes se sintieron rechazados
por su apariencia (p‹0.001). CONCLUSIONES: En estudiantes de secundaria ser
víctima de maltrato y agresión está asociado con menor CV total. Es fundamental la
elaboración de programas de intervención en este nivel que garanticen escuelas
más seguras en su interior y alrededores para mejorar la CV de los adolescentes. RESEARCH ON METHODS Don Diego 3
RM1: COMPARING THE USE OF DYNAMIC AND STATIC INFECTIOUS DISEASE
MODELS IN LATIN AMERICA WITH NORTH AMERICA, EUROPE, ASIA AND OTHER
REGIONS.
Vargas-Palacios A1, Stevenson M1, Dueñas A2, Wailloo A1, 1The University of
Sheffield, Sheffield, South Yorkshire, UK, 2IÉSEG School of Management - LilleParis, Paris, France
OBJECTIVES: To establish whether there are differences in the type of methodology
(static or dynamic) used to assess the cost-effectiveness of vaccination
programmes between Latin America and other regions of the world. METHODS:
A systematic review from 1950 to 2010 of the cost-effectiveness of vaccine
interventions was performed. Modelling methodologies were categorised as static
where the number infected was not related to the number infectious, and where
herd immunity (an immunity that occurs when the vaccinated proportion of the
population provides protection to unprotected individuals) was not incorporated.
Models were categorised as dynamic otherwise. Static models were sub-classified
into Decision trees (DT) and static Markov models (sMM); dynamic models were
sub-classified into dynamic Markov models (dMM), System dynamics including
81
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
RESEARCH PODIUM ABSTRACTS – SESSION II
Susceptible, Exposed, Immune and Recovered models (SD), Discrete event
simulation (DES) and Agent-based models (ABM). RESULTS: A total of 310 relevant
studies were found. 251 (81%) adopted a static approach (131 sMM and 120 DT)
whilst 59 (19%) used a dynamic approach (52 SD, 3 DES, 3 ABM and 1 dMM). The
majority of papers were set in Europe (120, 39%) and North America (97, 31%),
with 26 (8%) in Latin America, 37 (12%) in Asia and 30 (10%) in other regions. The
proportion of models that were dynamic within Latin America (23%) compared
favourably with North America (15%), Europe (26%), Asia (8%) and the remaining
regions (15%). However, two of the six dynamic studies undertaken in Latin America
used modellers based in Europe or North America. CONCLUSIONS: Despite the
limitations associated with static models these are more prevalent than dynamic
methodologies when modelling the cost-effectiveness of vaccine interventions.
This conclusion was applicable to all regions, with the results for Latin America
comparable with other regions. This systematic review suggests that worldwide
education of researchers in the advantages of dynamic methodologies is needed.
RM2: APLICACION DE MODELOS DE REGRESION CON STATA PARA EL ESTUDIO
DEL CONSUMO DE RECURSOS EN UNIDADES DE CUIDADOS INTENSIVOS
NEONATALES
Reyes-Lopez A, Hospital Infantil de México Federico Gómez, México D.F., México
OBJECTIVOS: Mostrar la importancia de utilizar técnicas de regresión diseñadas
expresamente para modelar variables de conteo, así como describir las
herramientas disponibles en el programa estadístico Stata para esta clase de
modelos. METODOLOGÍAS: Los datos utilizados provienen de una muestra de 335
niños con peso bajo al nacimiento atendidos en un hospital pediátrico de tercer
nivel de la Ciudad de México, de los cuales se obtuvieron distintas variables
sobre consumo de recursos, así como variables demográficas y clínicas que se
emplearon como regresores. Primero se realizó la prueba de sobredispersión
para comprobar el cumplimiento del supuesto básico de la regresión poisson.
Posteriormente se compararon gráficamente las probabilidades estimadas con
cuatro diferentes modelos de regresión y se realizaron las pruebas de la razón
de verosimilitud y de Vuong para determinar el modelo con el que se obtiene el
mejor ajuste, utilizando para ello también los criterios de información de Akaike
y bayesiano. Una vez elegido el modelo más apropiado para cada variable de
resultado, se estimaron nuevamente los coeficientes de regresión y se obtuvo
el cambio porcentual en el valor esperado de la variable de conteo con el
comando ‘listcoef’ de Stata, que facilita a los usuarios la interpretación de los
efectos. RESULTADOS: El modelo de regresión binomial negativa resultó el más
apropiado para predecir los días de estancia hospitalaria, número de pruebas de
laboratorio y gabinete, y los días con antibioticoterapia. El modelo de regresión
binomial negativa con exceso de ceros fue el de mejor ajuste para los días con
nutrición parenteral, días con oxigenoterapia, número de transfusiones, días con
administración de aminas y días con ventilador. La variable que se ajustó a un
modelo de poisson fue el número de interconsultas. CONCLUSIONES: Los modelos
de regresión lineal aplicados a datos de conteo pueden producir estimaciones
ineficientes, inconsistentes y sesgadas. RM3: A COMPARISON BETWEEN MARKOV CHAINS AND SYSTEM DYNAMICS
MODELING FOR THE ESTIMATION OF METABOLIC SYNDROME COSTS IN A PUBLIC
HEALTH CARE DELIVERY ORGANIZATION IN MÉXICO
Olmedo-Bustillo C, Oliva-Oropeza P, Rivas-Oropeza I, Aranzeta-Ojeda F, Institute of
Social and Security Services for State Workers, México D.F., México
OBJECTIVES: The objective of this study was to compare life-time costs for a
population obtained through Markov chain (MC) and system dynamics (SD)
methodologies. While both methodologies are based on the concepts of state
and transition, the meanings of each differ. The importance of this study lies in
the fact that in some cases information is available for one type of model or the
other, and the possibility of using either tool for modeling a situation is of pragmatic
interest. METHODS: Models of increasing degrees of complexity were developed.
At each level of complexity, a MC model and a SD model were developed and the
differences in results obtained were compared. SD models were simulated with
Vensim software and MC models with TreeAge Pro software. Data were drawn from
an institutional survey and from literature. An important issue in this comparison
is that Markov models are based on transition probabilities while system dynamic
82
models rely on material flows. Also, simulation techniques differ in that Montecarlo
methods move a patient trough the model until it exits before including another
patient, while SD models treat all patients in the cohort simultaneously. Thus,
transformations for the set of mathematical expressions in each modeling
methodology may lead to similar numerical results while not being conceptually
equivalent. RESULTS: The simplest models led to equivalent aggregate numerical
results. In these cases, the probability of leaving state Sn (MC) is numerically
equivalent to inverse residence time (SD). More complex models required adapting
the structure of one to be equivalent to the other. CONCLUSIONS: Applications of
each methodology overlap at a certain aggregation level. When a long period is
studied and not much detail is required in each state, SD seems an appropriate tool.
When more precision is needed for individual patients, MC analysis seems a better
choice.
RM4: FACTORES PREDICTORES DE OBSTRUCCIONES CORONARIAS
SIGNIFICATIVAS EN PACIENTES ADULTOS CON CINEANGIOCORONARIOGRAFÍAS
REALIZADAS EN URUGUAY, FINANCIADAS POR EL FONDO NACIONAL DE
RECURSOS
Morales M, Perna A, Fernández G, Lombide I, Fondo Nacional de Recursos,
Montevideo, Uruguay
OBJECTIVOS: La realización de una cineangiocoronariografía (CACG) es el gold
standard para definir la anatomía coronaria. El porcentaje de lesiones coronarias
no significativas depende de la definición de “lesión significativa” variando según
la magnitud de obstrucción definida, siendo del 9 al 25 % cuando consideramos
lesiones menores al 50 %. Existen factores predictores como sexo masculino,
edad avanzada, diabetes, dislipemia y presentar un test de isquemia no invasivo
positivo. El Fondo Nacional de Recursos (FNR), financia, según normativas de
cobertura institucionales, prestaciones médicas altamente especializadas en
Uruguay, entre ellas las CACG de las cuales reúne un registro único nacional;
procedimientos costosos y no exentos de complicaciones. Objetivos:1) conocer
el porcentaje de CACG con lesiones coronarias significativas (mayores al 50 %)
realizados entre 1/12/2009 y 31/05/2010; 2) Identificar el tratamiento elegido luego
de la realización de la CACG; 3) describir en el proceso de decisión factores
predictores que permitan identificar pacientes con alto riesgo de tener lesiones
coronarias significativas. METODOLOGÍAS: Estudio retrospectivo de una cohorte
histórica de pacientes consecutivos mayores de 18 años, con CACG realizada en el
período establecido financiada por el FNR. De 2586 CACG realizadas se excluyeron
las solicitadas por enfermedad cardíaca no coronaria. RESULTADOS: Incluidas
2.326 CACG, 67,2% sexo masculino con media de edad 62,4 años (56 -75 años
P25-P75). El total de CACG realizadas con lesiones mayores al 50 % fueron 1.999
(85,9 %). En 541 (22,4 %) se optó por tratamiento médico. Las variables retenidas en
el modelo de regresión logística fueron: edad > 50 años, sexo masculino, prestador
privado, antecedentes de cardiopatía isquémica, diabetes, infarto trasmural
y tener un estudio funcional por imágenes realizado. El modelo mostró buena
discriminación (curva ROC 0.76). CONCLUSIONES: Este conocimiento podrá ser
utilizado para futuras decisiones sobre el financiamiento de los casos con mayor
riesgo de lesión coronaria significativa.
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
CANCER – Cost Studies
PCN1: SELECTING A MIX OF PREVENTION STRATEGIES AGAINST CERVICAL
CANCER FOR MAXIMUM EFFICIENCY WITH AN OPTIMISATION PROGRAM
Demarteau N1, Gomez JA2, Lorenzato F3, Standaert B1, 1GlaxoSmithKline Biologicals,
Wavre, Belgium, 2GlaxoSmithKline, Middlesex, UK, 3GlaxoSmithKline, Rio de
Janeiro, Brazil
BACKGROUND: Screening and vaccination against human papillomavirus (HPV)
can help protect against the development of cervical cancer (CC). Neither alone
can provide 100% protection against CC. Selecting the most efficient combination
of screening and vaccination to prevent CC is therefore an important question to
address. OBJECTIVES: To identify the mix of CC prevention strategies (screening
and/or vaccination against HPV) that minimize CC burden within a fixed budget in
Brazil. METHODS: The optimal mix of strategies for CC prevention was determined
using an optimisation program. The evaluation uses two models. One is a Markov
cohort model, adapted to the Brazilian setting, used as the evaluation model. It
estimates the costs and outcomes of 52 different prevention strategies combining
screening and vaccination. The other is an optimisation model in which the results
of each prevention strategy of the previous model are entered as input data. The
latter model determines the combination of prevention options to minimize CC
under budget, screening and vaccination coverage constraints. The base-case
constraints were current budget, screening of 50% women aged 18 to 65 every
3 years, and a maximum 80% vaccination coverage. Sensitivity analyses were
conducted on the optimization constraints. RESULTS: The base-case optimal
prevention strategy would be to have 30% vaccinated only at age 12, 50% both
vaccinated and screened with a screening interval extended to 5 years and 20%
without any prevention strategy. This would result in a 54% CC reduction from
pre-vaccination levels with no budget increase. A sharp reduction in CC is seen
when the vaccine coverage exceeds the maximum screening coverage, or when
screening coverage exceeds the maximum vaccine coverage, while maintaining
the budget. CONCLUSIONS: Our models predicted that implementation of
vaccination combined with adjusting the screening interval would optimize CC
prevention budget allocation to minimize the CC burden in Brazil.
PCN2: COST-EFFECTIVENESS AND BUDGET IMPACT ANALYSIS OF AN IMMEDIATE
CARE CENTER AT THE NATIONAL CANCER INSTITUTE, MEXICO
Nieves U1, Guajardo J1, Cerezo O1, Plancarte R1, Apodaca A1, Torres J1, Rodriguez F2
1
National Cancer Institute, México, Tlalpan, México, 2Universidad Nacional
Autónoma de México, México, Coyoacan, México
OBJECTIVES: To assess cost and clinical consequences (day of hospital stay
avoided), together with a budget impact analysis and assess frequency of
symptoms. METHODS: Evaluation of Immediate Care Center records during
September 2009. Data collected were: chief complaint, primary disease (oncologic),
semiology, requested studies, percentage of hospitalized patients, days of hospital
stay. We compared days of hospitalization related to the main symptoms cause
of consultation in 2009 versus 2005 getting hospitalization days and costs avoided
through a full economic study type analysis cost-effectiveness, retrospective,
analytical, longitudinal with a design before and after comparing the effectiveness
and efficiency of the implementation of a multidisciplinary service (medical
oncologist, surgical oncologist, algologist, internist). RESULTS: A total of 583
records were analyzed. Breast cancer was the most common diagnosis (28%),
pain as main symptom present (52%) and as a reason for consultation (31.82%). In
semiology the most frequent causes of hospitalization in 2009 (with immediate care
center) were: somatic pain, dyspnea and fever, these symptoms were compared
with patients who require hospitalization for the same reason in September of
2005 (without immediate care center) noting a reduction of 9.08, 3.28 and 3.12
respectively on “days of hospital stay avoided.” The percentage of patients
hospitalized for 2005 were 25.55% of 493 versus 10.46% of 583 patients during
September of 2009. The stratified ICER for somatic pain was $ - 1615 MXN, - $1513
MXN for dyspnea, and - $1169 MXN for fever. We estimated an average monthly
savings of $ 659,072.00 MXN pesos. CONCLUSIONS: The implementation of an
immediate care service for cancer patient management through a comprehensive
and multidisciplinary approach, results in a highly cost – effectiveness measure
in the resolution of symptoms, using timely and appropriate diagnostic and
therapeutic tools with consequent decrease in hospitalization rates, reflecting“days
of hospital stay avoided” adding an estimated annual budget impact of $ 7, 908,
860.00 MXN pesos.
PCN3: ESTIMACION DE LA CARGA DE LOS TUMORES NEUROENDOCRINOS EN
COLOMBIA
Ruiz A1, Alfonso-Cristancho R2, Mejia A1, Gonzalez D3, Maestre K4, Herran S1
1
RANDOM Foundation, Bogotá, Colombia, 2University of Washington, Seattle, WA,
USA, 3Fundación Santa Fe de Bogotá, Bogotá, Colombia, 4Novartis Pharma AG,
Bogotá, Colombia
OBJECTIVOS: Estimar el impacto en morbi-mortalidad, uso de recursos y costos
asociados a los tumores Neuroendocrinos (TNE) de intestino medio en fase
avanzada en Colombia. METODOLOGÍAS: Mediante un modelo de Markov se
estimaron desenlaces clínicos y uso de recursos asociados al manejo de TNE.
El modelo consta de 3 estadios: enfermedad estable, enfermedad progresiva y
muerte. Las probabilidades de transición entre estadios fueron calculadas a partir
de la literatura. Las variables de costos y su frecuencia de uso fueron validadas
con expertos clinicos. Los costos de los recursos asociados a la enfermedad se
extrajeron de instituciones públicas y privadas en Colombia. El horizonte temporal
fue de 10 años con una tasa de descuento del 3% anual. RESULTADOS: El modelo
nos permitió estimar que en grupo de pacientes con TNE, la progresión de la
enfermedad estaría presente en un 69,3% de los pacientes y un 24,2% adicional,
fallecería al cabo de diez años de seguimiento. En promedio, cada paciente
acumularía 3,4 años libres de progresión. Los costos médicos directos asociados
al manejo de la enfermedad estable es de aproximadamente US$3,738, mientras el
costo anual asciende a US$51,333 para la enfermedad progresiva. Después de diez
años, el costo promedio acumulado por paciente alcanzaría US$254,690. Según
los estimados de incidencia, en Colombia, se presentarían 176 nuevos casos por
año, y según la distribución de los pacientes y el nivel de progresión, los costos
médicos directos asociados a esta patología podrían superar US$ 1,400,000 al
año. CONCLUSIONES: El impacto financiero de los TNE en el sistema de salud en
Colombia es sustancial. Alternativas de tratamiento que extiendan el tiempo libre
de progresión de la enfermedad y reduzcan la mortalidad pueden tener un efecto
favorable para el sistema de salud colombiano.
PCN4: COSTO-EFECTIVIDAD DE OCTREOTIDE COMPARADO CON TERAPIA DE
SOPORTE USUAL PARA EL TRATAMIENTO DE TUMORES NEUROENDOCRINOS EN
COLOMBIA
Ruiz A1, Alfonso-Cristancho R2, Mejia A1, Gonzalez D3, Maestre K4, Herran S1
1
RANDOM Foundation, Bogotá, Colombia, 2University of Washington, Seattle, WA,
USA, 3Fundación Santa Fe de Bogotá, Bogotá, Colombia, 4Novartis Pharma AG,
Bogotá, Colombia
OBJECTIVOS: Estimar la costo-efectividad de octreotide LAR comparada con
terapia de soporte usual (TS) para el tratamiento de tumores neuroendocrinos
(TNE) avanzados de intestino medio en Colombia desde la perspectiva del pagador.
METODOLOGÍAS: En un modelo de Markov se simuló una cohorte de pacientes
con TNE asignándolos a tratamiento con TS o TS más octreotide. El modelo, que
comprende 3 estados de salud (enfermedad estable, enfermedad progresiva y
muerte), permite la estimación de desenlaces clínicos, uso de recursos y costos
asociados al manejo de la enfermedad. Las probabilidades de transición fueron
calculadas a partir de la literatura. Los costos médicos directos de los recursos
asociados a la enfermedad se obtuvieron de instituciones públicas y privadas en
Colombia, y fueron validados por expertos clínicos. El horizonte temporal fue de 10
años, aplicando una tasa de descuento del 3% anual a los costos y la efectividad.
RESULTADOS: Después de 10 años de seguimiento, 69.3% de los pacientes con
TNE habían progresado y 24.2% habían muerto con TS comparado con 57.5%
de progresión y 12.4% de mortalidad con octreotide. En promedio, los pacientes
con TS alcanzaron 3.2 años libres de progresión (LP) versus 5.2 LP con octretide.
Los costos médicos directos de TS en enfermedad estable alcanzaron US$
3,738, comparado con U$ 51,333 para enfermedad progresiva. Para el grupo con
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
octreotide, los costos alcanzaron US$ 20,739 y US$ 58,505, respectivamente. La
razón incremental de costo-efectividad por año de vida ganado libre de
progresión con octreotide es de US$ 16,062 (US$ 8,217-US$ 26,107). Los análisis de
sensibilidad para los costos y la efectividad demostraron la robustez del modelo.
CONCLUSIONES: En Colombia, la adición de octreotide a TS para el manejo de TNE
de intestino medio parece ser una alternativa costo-efectiva, aumentando el tiempo
libre de progresión y disminuyendo la mortalidad.
PCN5: EFECTIVIDAD CLÍNICA Y COSTO-EFECTIVIDAD DEL TRATAMIENTO DE
SEGUNDA LÍNEA PARA CARCINOMA METASTÁSICO DE CÉLULAS RENALES
Romero M, Díaz E, Malagon J, Fundación Salutia, Bogotá, Colombia
OBJECTIVOS: Revisar la literatura existente para determinar cuál es la mejor
alternativa desde efectividad y costos para el tratamiento de segunda línea para
Carcinoma Renal Metastásico (CCRm) en Colombia. METODOLOGÍAS: Se realizó
una revisión de la literatura científica publicada entre enero de 2000 y diciembre de
2010 en las bases de datos de Pubmed, EBSCO, BEST PRACTICE, LILACS, Cochrane
y Google Scholar, usando combinaciones de términos MESH. La calidad de los
artículos seleccionados fue evaluada usando los criterios Bobenrieth Astete por
dos investigadores independientes. Los costos de atención fueron estimados
tomando los costos unitarios de tratamiento establecidos de una media de precio
de mercado a precios de 2010 y a las dosis de manejo promedio identificadas en
la revisión de literatura. Al momento del estudio solo se encuentran disponibles
en Colombia Bevacizumab, Everolimus, Sorafenib y Sunitinib para tratamiento de
CCRm. RESULTADOS: Se seleccionaron 83 artículos entre guías de Práctica Clínica,
meta análisis, revisiones sistemáticas y estudios primarios. En segunda línea de
tratamiento, ante el fallo con antiangiogenicos y/o citoquinas, que son la primera
opción para primera línea, Everolimus mejora supervivencia libre de progresión
comparado contra placebo (4,9 meses vs. 1,9 meses). En el caso de fallo en la
terapia inicial con IL2, la terapia de elección son inhibidores de la tiroxina quinasa.
Sin embargo, esto corresponde menos del 5% de los casos. No se encontró
evidencia suficiente para soportar el uso de la terapia secuencial en CCRm. Los
costos de tratamiento promedio mensual con Everolimus fueron de US$ 660, menor
que la mayoría de tratamientos utilizados en primera línea. CONCLUSIONES: De
la información disponible, Everolimus es la mejor alternativa terapéutica para
segunda línea con mayor evidencia de efectividad y costos favorables para el
sistema de salud colombiano.
PCN6: EVALUACION ECONOMICA DEL DASATINIB EN EL TRATAMIENTO DE LA
LEUCEMIA MIELOIDE CRONICA EN PACIENTES RESISTENTES AL IMATINIB EN
CHILE
Orozco JJ1, Valencia JE2, Aiello E3, Caputo M4, 1Universidad CES, Medellin,
Colombia, 2Bristol-Myers Squibb, Bogotá, Colombia, 3Bristol-Myers Squibb, Buenos
Aires, Argentina, 4Bristol-Myers Squibb, Santiago de Chile, Chile
OBJECTIVOS: Dentro del tratamiento de la Leucemia Mieloide Crónica (LMC)
en Chile y con base en un modelo económico realizado previamente por el York
Health Economics Consortium, se compararon los costos y la relación de costoefectividad de 100 mg/día y 140 mg/día de dasatinib, de 800 mg/día de nilotinib y el
uso de dosis mayores de imatinib (800 mg/día), para cada fase de la enfermedad
(crónica, acelerada y blástica), en pacientes con resistencia o intolerancia a la
dosis habitual de imatinib. METODOLOGÍAS: Se utilizó un modelo de Markov, con
una cohorte hipotética de 10.000 pacientes con LMC en sus tres fases, durante
toda la vida y con una tasa de descuento del 3,5% para los costos y beneficios. Los
resultados incluyeron los costos de cada alternativa de tratamiento con dasatinib,
nilotinib o imatinib y los QALYs ganados. Los costos se expresan en Pesos Chilenos
del año 2010. RESULTADOS: En fase crónica dasatinib 100 mg/día produjo una
mayor cantidad de QALYs con 6,65 y la menor relación de costo-efectividad en
las tres fases. En relación con los otros tratamientos con 31.658.391, 42.056.630 y
70.436.294 CLP por QALY ganado. CONCLUSIONES: Dasatinib 100 mg/día mostró
mejores relaciones de costo-efectividad que nilotinib 800 mg/día y que imatinib 800
mg/día para el tratamiento de pacientes con resistencia o intolerancia a la dosis
habitual de imatinib en la fase crónica. Dasatinib 140 mg/día, mostró tener mejor
relación de costo efectividad que el imatinib 800 mg/día y que nilotinib 800 mg/
día en fase acelerada, y que imatinib 800 mg/día en fase blástica. Aunque hubo un
aumento de los costos en general, especialmente debido al dasatinib 140 mg/ día,
84
este hecho se explica por el aumento en años de vida ganados y, en consecuencia,
el mayor uso de medicamentos y recursos médicos.
PCN7: IMPACTO PRESUPUESTARIO DEL TRATAMIENTO EN PRIMERA LÍNEA PARA
CÁNCER COLORRECTAL METASTÁSICO BASADO EN XELOX + ANTI-VEGF O XELOX
+ ANTI-EGFR.
Gomez E, Torrecillas L, Cervantes L, Centro Médico Nacional 20 de Noviembre
ISSSTE, México, D.F., México
OBJECTIVOS: Realizar una evaluación de impacto presupuestario del tratamiento
en primera línea del cáncer colorrectal metastático (CCRm) tratado con
XELOX+anti-VEGF (Capecitabina+ Oxaliplatino+ anti-VEGF) o XELOX+anti-EGFR
(Capecitabina+ Oxaliplatino +Anti-EGFR) en el Centro Médico Nacional (CMN) 20
de Noviembre del ISSSTE en la Ciudad de México. METODOLOGÍAS: Se realizó
un análisis de impacto presupuestario de los pacientes con CCRm en el que se
incluyeron los costos directos (quimioterapia, biológico y premedicación) de cada
tratamiento. Se tomó en cuenta un escenario de 6 ciclos, con un intervalo de 21
días para cada uno. Los costos de los insumos se tomaron de las tarifas estimadas
del CMN ISSSTE 20 de Noviembre, utilizándose la metodología de microcosteo de
procesos. Los resultados de efectividad se adecuaron a la presencia o ausencia de
la mutación del gen KRAS. RESULTADOS: El costo por tratamiento de XELOX+antiVEGF fue de 283,963 MXP vs. 480,244 MXP para XELOX+anti-EGFR. Un análisis de
sensibilidad comprobó que el costo del biológico representa aproximadamente
80% del costo del tratamiento. Adicional a esto, la efectividad de XELOX+antiVEGF es superior que a la de XELOX+anti-EGFR para los casos de KRAS silvestre
y KRAS mutado. CONCLUSIONES: XELOX+anti-VEGF es un tratamiento más barato
y más efectivo que XELOX+anti-EGFR (+196,281). Por cada paciente tratado con
XELOX+anti-EGFR se pueden tratar 1.6 pacientes con XELOX+anti-VEGF y tener
mas probabilidad de éxito clínico dada la mayor eficacia sin importar si el gen
KRAS es silvestre o mutado. El enorme diferencial de costo (+98%) con respecto a
XELOX+anti-EGFR proviene del alto costo del biológico de la aplicación semanal (3
por ciclo) y la dosis de impregnación que el anti-EGFR requiere.
PCN8: COST-EFFECTIVENESS ANALYSIS OF AN OPIOID IN COMBINATION WITH
GABAPENTIN VERSUS MONOTHERAPY FOR THE TREATMENT OF NEUROPATHIC
PAIN
Galindo L1, Guajardo J1, Plancarte R1, Cerezo O2, Najera E3, Gonzalez I1, 1National
Cancer Institute, México, Tlalpan, México, 2Oncology National Institute, México
D.F., México, 3Universidad Nacional Autónoma de México, México, Coyoacan,
México
OBJECTIVES: This study aimed to compare the cost-effectiveness of gabapentin
combined with an opioid versus gabapentin monotherapy for the management of
neuropathic cancer pain. METHODS: Randomized controlled trial aimed to compare
monotherapy versus combined therapy to control neuropathic pain, in a subset of
cancer/HIV-AIDS/Chemotherapy/PHN/DN patients. Patients were randomized to
one of the following treatment protocols: 1) gabapentin and opioid combination
(GO group), and 2) Gabapentin monotherapy (GG group) both groups are titrated
according to pain response. Changes in pain intensity, DN-4, patient satisfaction
and analgesic drug consumption were evaluated at 0, 7, 30, 60 and 90 days. Side
effects were also recorded. We carried out an interim analysis in order to keep
recruit patients for the entire protocol. RESULTS: Fifty-four patients diagnosed with
neuropathic pain were included. Forty-nine patients completed the study. These
data suggest that GO treatment provides better relief of neuropathic pain in cancer
patients compared with monotherapy. Besides, the GO treatment is a very-high
cost-effectiveness alternative, cause in countries like Mexico the threshold falls
below 1 GDP per capita. CONCLUSIONS: Our preliminary clinical observation shows
that the addition of gabapentin to an opioid analgesic (tramadol + gabapentin) is
safe with fewer side effects and demonstrate greater effectiveness at lower cost
compared with gabapentin as monotherapy. Resulting in greater satisfaction and
better adherence to treatment.
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
PCN9: ECONOMIC EVALUATION OF PANITUMUMAB VS CETUXIMAB IN PATIENTS
WITH COLORECTAL CARCINOMA (CRCM) WITH NON-MUTATED (WILD-TYPE)
KRAS AFTER FAILURE OF CHEMOTHERAPY REGIMENS IN MEXICO
Arocho R1, Rivera Hurtado R2, 1Amgen, Inc., Barcelona, Spain, 2Amgen México,
México D.F., México
OBJECTIVES: Panitumumab, a fully human monoclonal antibody directed against
epidermal growth factor receptor (EGFR), is indicated as a monotherapy for the
treatment of patients with EGFR-expressing CRCm and non-mutated KRAS status.
The aim of this study was to conduct an economic evaluation of panitumumab vs
cetuximab in Mexican patients with CRCm. METHODS: A cost minimization analysis
(CMA) was performed from a Public Healthcare System perspective considering a
20-week timeframe. The analysis compared the treatment costs of CRCm patients
with panitumumab and cetuximab. Only direct medical costs were considered. Drug
cost for cetuximab was calculated according to Mexican Public Healthcare Sector
acquisition price list for 2010. Panitumumab price for the Mexican Public Healthcare
Sector was provided by Amgen Mexico ($94.36 MXP/mg). Recommended doses and
frequency were based on each product label and the number of cycles was based
on data from clinical trials. Anthropometric values were obtained from published
data in Mexican Public Healthcare Sector oncology (CRCm) patients. The cost of
administration was calculated from an official Mexican Public Healthcare Sector
price list for 2010. A probabilistic sensitivity analysis was performed considering
two scenarios: per vial of drug (assuming wastage of unused medication) and per
mg of drug (assuming no wastage). RESULTS: Panitumumab resulted in an overall
monthly cost savings of 20% (per vial scenario) and 12.4% (per mg sceanrio)
compared with cetuximab. When the analysis was restricted to the acquisition drug
costs, monthly savings of panitumumab compared with cetuximab were estimated
to be 19.1% and 11.2% in per vial and per mg scenarios, respectively. Regarding
the sensitivity analysis, 100% of iterations resulted cost-saving in both scenarios
(per vials and per mg). CONCLUSIONS: According to these results, panitumumab
represents a cost-saving strategy vs cetuximab for the treatment of patients with
CRCm in the Mexican setting.
PCN10: ANALISIS DE MINIMIZACION DE COSTOS ENTRE EL USO DE IOPROMIDE
MEDIANTE UN SISTEMA DE APLICACION EN CASCADA (SIAC) FRENTE AL USO DE
OTROS MEDIOS DE CONTRASTE CONVENCIONALES EN RADIOLOGIA INVASIVA
EN COLOMBIA
Romero M1, Karpf E1, Oyuela M2, 1Fundación Salutia, Bogotá, Colombia, 2Bayer
Colombia, Bogotá, Colombia
OBJECTIVOS: Realizar una evaluación económica del uso de Iopromide mediante
un sistema de aplicación en cascada (SIAC), frente a los demás medios de
contraste para radiología invasiva disponibles en Colombia e incluidos dentro
del plan de beneficios colombiano (POS). METODOLOGÍAS: Se realizó un análisis
de minimización de costos comparando SIAC frente al uso de otros medios de
contraste convencionales en radiología invasiva desde la perspectiva del hospital.
La efectividad y seguridad del uso de Iopromide es similar a la de los ya incluidos
en el POS según reportes de estudios clínicos. Los costos y frecuencias de uso
fueron obtenidos de tres hospitales en Colombia durante el primer trimestre del
2011. Se tomaron los costos promedios obtenidos de las diferentes observaciones.
No se incluyeron costos por eventos adversos, por cuanto son similares en
las diferentes opciones. RESULTADOS: El costo de utilizar SIAC en un paciente
promedio de 70 Kg fue de USD 35.57 frente a USD 39.44 cuando se utilizó otros
medios de contraste convencional. Lo que representa un ahorro de USD 3.90 por
paciente. La diferencia fundamental se debió a menor desperdicio de medio de
contraste y menor tiempo requerido. El análisis de sensibilidad no muestra cambios
en los resultados. El análisis de impacto presupuestario muestra el importante
ahorro que significaría para el país la conversión tecnológica pasando de utilizar
los medios actuales a la nueva tecnología que utiliza el sistema de aplicación SIAC
para un peso promedio de adultos en Colombia de 70 kg. CONCLUSIONES: El uso de
Iopromide mediante la aplicación de SIAC sería mejor que utilizar otros medios de
contraste por cuanto es menos costoso y utilizado de manera adecuada tendrían
igual efectividad a los otros medios de contraste comparados y de esta manera
incentiva la productividad al interior de las unidades de radiología.
CARDIOVASCULAR DISORDERS – Cost Studies
PCV1: COSTS, LENGTH OF STAY AND ALL-CAUSE MORTALITY IN RUPTURED
VERSUS UNRUPTURED CEREBRAL ANEURYSM AMONG INPATIENTS IN THE
UNITED STATES
Wallace KL, Hashemi L, Minshall ME, Covidien, Mansfield, MA, USA
OBJECTIVES: Cerebral aneurysms are pathological dilatations of the
cerebrovasculature that are prone to rupture. Risk of aneurysm rupture is
determined by size, location and patient co-morbidies, and five-year cumulative
rupture rates have been reported to be as high as 50% in giant aneurysms [1].
The current study was undertaken to assess the differences in overall hospital
discharge costs, length of stay (LOS) and all-cause mortality rates between
inpatients with ruptured vs. unruptured cerebral aneurysms. METHODS: All
inpatient discharges were selected from the Premier Perspective™ Database
that had a primary diagnosis code for a ruptured or unruptured aneurysm, AND
a primary procedure code for treatment of the aneurysm between 1/1/2008
and 6/30/2010 (index hospitalization). Costs, LOS and mortality were compared
between ruptured and unruptured aneurysm groups. To minimize differences in
baseline characteristics between groups, propensity adjustment was performed
for age, gender and severity of illness (based on the Patient Refined Diagnosis
Related Groups). RESULTS: A total of 2977 ruptured and 3836 unruptured
aneurysm discharges met the inclusion criteria for the study. After 1:1 propensity
matching, 1163 patients in each group were included in the analysis for outcome
comparisons. Mean total cost per discharge was significantly higher in the
ruptured group ($51,118, s.d. $33,790) than the unruptured group ($33,585, s.d.
$32,255). Mean LOS was also significantly higher in the ruptured group (13.6 days,
s.d. 12.7) versus the unruptured group (6.5 days, s.d. 11.2). The all-cause mortality
rate was significantly higher in ruptured (7.7%) versus unruptured (1.8%) cerebral
aneurysms. CONCLUSIONS: Preventing rupture in patients with cerebral aneurysms
would likely decrease burden to the health care system, and also improve survival
rates for patients. 1International Study of Unruptured Intracranial Aneurysms
Investigators. Unruptured Intracranial Aneurysms: Natural History, Clinical
Outcome, and Risks of Surgical and Endovascular Treatment. [1] (Lancet 2003; 362:
103-10).
PCV2: ESTIMATED COST OF ACUTE CORONARY SYNDROME FOR 2011: CASE OF
MEXICO
Ramirez MA1, Sanchez A1, Piha T2, Polanco AC1, Hernandez R3, De los Rios M4
1
AstraZeneca, México D.F., México, 2AstraZeneca, Cotia, São Paulo, SP, Brazil,
3
AstraZeneca, Miami, FL, USA, 4Centro para el Des. de la Medicina y de Asistencia
Medica Esp., Culiacan, Sinaloa, México
OBJECTIVES: To estimate the costs of acute coronary syndrome in Mexico and
its impact on the Mexican healthcare system, considering direct and indirect cost
under the public and private perspectives to support further HTA incorporation
METHODS: In this study we adopted the societal perspective, including the public
and private perspectives. Direct costs were retrieved from national databases and
only hospitalization period was considered. For indirect costs the Human Capital
Approach method was used with two major costs included in the analysis: loss
of productivity among patients that died of a MI or unstable angina event and the
loss of productivity of the period between the main event (MI or angina) and the
return to work (recovery time). For the study we assumed the age from 25 to 64
years old as active labor age (65 is the age of retirement in Mexico), a recovery
time of 3.4 months and the average income of the population to estimate the loss
of productivity for each working month lost RESULTS: The estimated direct costs
associated to Acute Coronary Syndrome for 2011 under the public perspective
is US$153,629,253 and for private it is US$179,725,285. The estimated indirect cost
for 2011 is US$918,239,181. So, the total estimated costs for ACS in Mexico for
2011 is US$1,251,593,719 CONCLUSIONS: Due the high impact of ACS costs for the
Mexican healthcare system (U$1,251,593,719), projected for the year of 2011, it is
very relevant to evaluate measures that can reduce such events beyond those
already in use.
85
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
PCV3: ESTIMATED COST OF ACUTE CORONARY SYNDROME FOR 2011: CASE OF
BRAZIL
Piha T1, Ramirez MA2, Sanchez A2, Mariz VO1, Neves JE3, Teich V4, Araujo DV4
1
AstraZeneca, Cotia, São Paulo, SP, Brazil, 2AstraZeneca, Ciudad del México,
México D.F., México, 3AstraZeneca, Miami, FL, USA, 4MedInsight Evidências, São
Paulo, SP, Brazil
OBJECTIVES: To estimate the costs of acute coronary syndrome in Brazil and its
impact on the Brazilian healthcare system, considering direct and indirect cost
under the public and private perspectives to support further HTA incorporation.
METHODS: In this study we adopted the societal perspective, including the public
(SUS) and supplementary (SHS) healthcare system perspectives. Direct costs
were retrieved from national databases [1] and only hospitalization period was
considered. For indirect costs the Human Capital Approach method was used with
two major costs included in the analysis: loss of productivity among patients that
died of a MI or unstable angina event and the loss of productivity of the period
between the main event (MI or angina) and the return to work (recovery time).
For the study we assumed the age from 25 to 64 years old as active labor age (65
is the age of retirement in Brazil), a recovery time of 3.4 months and the average
income of the population to estimate the loss of productivity for each working
month lost. RESULTS: The estimated direct costs associated to Acute Coronary
Syndrome for 2011 under the SUS perspective is US$ 314,080,370 and for SHS it is
US$ 309,781,809. The estimated indirect cost for 2011 is US$ 1,703,908,984. So, the
total estimated costs for ACS in Brazil for 2011 is US$ 2,327,771,163. CONCLUSIONS:
Due the high impact of ACS costs for the Brazilian healthcare system (U$
2,327,771,163.11), projected for the year of 2011, it is very relevant to evaluate
measures that can reduce such events beyond those already in use. PCV4: ANALISIS COSTO EFECTIVIDAD EN EL LARGO PLAZO DE LOS STENTS
LIBERADORES DE FARMACO VS STENTS CONVENCIONALES EN PACIENTES CON
CARDIOPATIA ISQUEMICA EN EL IMSS
Gonzalez-Diaz BE1, Salinas Escudero G2, Granados-Garcia V1, Contreras Hernández
I1, Calderón Abbo M1, 1Instituto Mexicano del Seguro Social, México D.F., México,
2
Hospital Infantil de México Federico Gómez, Secretaría de Salud, México D.F.,
México
OBJECTIVOS: Estimar la razón costo-efectividad (RCE) del uso de los stents
liberadores de fármaco (DES, drug eluting stent) comparado contra los stents
desnudos (BMS, bare metal stent) en una cohorte de pacientes con enfermedad
coronaria en el Instituto Mexicano del Seguro Social (IMSS). METODOLOGÍAS:
Análisis de costo-efectividad en una cohorte de pacientes isquémicos con
indicación de ICP (Intervención Coronaria Percutánea). La medida de efectividad
fue la tasa de éxitos clínicos sin eventos adversos cardiovasculares mayores a 3
años. El costo y la efectividad los tratamientos se obtuvo del seguimiento clínico
de la cohorte de n=230 pacientes en el Hospital de Cardiología del IMSS seguidos
por 3 años. Se utilizó la técnica de micro-costeo, los costos provienen de bases
de costos institucionales (2010). Los resultados están expresados en dólares
americanos (USD) del 2010 (tipo de cambio MX$12.63: $1 USD). Se empleó una tasa
de descuento del 5%. Además del modelo determinístico, se realizó un análisis de
sensibilidad probabilístico y se estimó la curva de aceptabilidad. RESULTADOS:
El 59.3% de los pacientes de la cohorte utilizó BMS y el 40.87% DES. El grupo con
DES mostró los mayores costos promedio por paciente USD$16,635 comparado
con BMS USD$13,432. Las efectividades DES encontradas fueron de 88% y las
de BMS 74%. La RCE fue de USD$15,263 en el caso de DES y de USD$22,480 con
BMS. El DES se ubicó como la alternativa costo-efectiva y dominante frente al
empleo del BMS. La curva de aceptabilidad muestra que el tratamiento de DES se
ubicó como la alternativa costo-efectiva independientemente de la Disponibilidad
a Pagar por parte de la institución. CONCLUSIONES: Los resultados del análisis
realizado sugieren que DES es una alternativa de tratamiento intervencionista de
revascularización con mejores resultados en salud, y que también representa una
alternativa costo ahorradora respecto a BMS.
86
PCV5: COST-EFFECTIVENESS AND BUDGET IMPACT ANALYSIS OF RIVAROXABAN
IN THE PREVENTION OF THROMBOEMBOLIC EVENTS IN PATIENTS PERFORMING
HIP AND KNEE ARTHROPLASTY IN COMPARISON WITH NO TREATMENT UNDER
THE BRAZILIAN PRIVATE HEALTH CARE SYSTEM PERSPECTIVE
Schiola A1, Silva AP2, Santoni NB2, Paladini L3, Teich V3, Pepe C3, Rocha MM3
1
Bayer de México, S.A. de C.V., México D.F., México, 2Bayer Brasil, São Paulo, SP,
Brazil, 3MedInsight Evidências, São Paulo, SP, Brazil
OBJECTIVES: To develop a cost-effectiveness and a budget impact analysis of
Rivaroxaban in the prevention of thromboembolic events in patients performing hip
and knee arthroplasty in comparison with no treatment under the Brazilian private
health care system perspective. METHODS: A decision tree analysis was developed
for the first 90 days, considering the occurrence of Deep Venous Thrombosis,
Pulmonary Embolism and thromboembolic events, followed by a Markov model,
for Post Thrombotic Syndrome and Thrombotic Pulmonary Hypertension. The
time horizon of the analysis was 5 year. The cycle duration was 1 year and the
corresponding epidemiological and efficacy data were obtained from a critical
appraisal of the scientific literature. Unit costs for drugs, procedures, materials and
daily hospital were obtained from Kairos Magazine (Maximum price consumers
18%ICMS), Hierarchical Brazilian Classification of Medical Procedures (CBHPM
5th edition), Simpro Magazine Maximum price consumers 18% ICMS) and search
UNIDAS 2008, respectively. A budget impact analysis was developed considering
an increase of 10% per year in market share of Rivaroxaban. RESULTS: Total costs
associated with Rivaroxaban and no treatment, considering the indication for
knee arthroplasty, were BRL363 (US$214) and BRL1040 (US$612), respectively. And
considering the indication for hip arthroplasty, were BRL332 (US$195) and BRL462
(US$272), respectively. Rivaroxaban reduces the number of all thromboembolic
events in 0.0793 and 0.0246, for knee and hip arthroplasty, respectively. Rivaroxaban
treatment is more effective and cheaper than no treatment in both indications
(dominant). The high cost associated with no treatment patient is due to the high
number of events in this group. The budget impact analysis estimated an economy
of BRL206,165 (US$121,274) and BRL104,351 (US$61,383) for knee and hip indication,
respectively, in 5 years. CONCLUSIONS: By this pharmacoeconomic analysis,
the treatment with Rivaroxaban, shown to reduce treatment costs and events
compared with no treatment.
PCV6: COST-EFFECTIVENESS AND BUDGET IMPACT ANALYSIS OF RIVAROXABAN
IN THE PREVENTION OF THROMBOEMBOLIC EVENTS IN PATIENTS PERFORMING
HIP AND KNEE ARTHROPLASTY IN COMPARISON WITH ENOXAPARIN UNDER THE
BRAZILIAN PRIVATE HEALTH CARE SYSTEM PERSPECTIVE
Schiola A1, Silva AP2, Santoni NB2, Paladini L3, Teich V3, Pepe C3, Rocha MM3
1
Bayer de México, S.A. de C.V., México D.F., México, 2Bayer Brasil, São Paulo, SP,
Brazil, 3MedInsight Evidências, São Paulo, SP, Brazil
OBJECTIVES: To develop a cost-effectiveness and a budget impact analysis of
Rivaroxaban in the prevention of thromboembolic events in patients performing
hip and knee arthroplasty in comparison with Enoxaparin under the Brazilian
private health care system perspective. METHODS: A decision tree analysis
was developed for the first 90 days, considering the occurrence of Deep Venous
Thrombosis, Pulmonary Embolism and thromboembolic events, followed by
a Markov model, for Post Thrombotic Syndrome and Thrombotic Pulmonary
Hypertension. The time horizon of the analysis was 5 year. The cycle duration was
1 year and corresponding epidemiological and efficacy data were obtained from a
critical appraisal of the scientific literature. The outcomes were expressed as the
incremental number of all thromboembolic events. The analysis considered only
direct medical costs. Unit costs for drugs, procedures, materials and daily hospital
were obtained from Kairos Magazine (Maximum price consumers 18% ICMS),
Hierarchical Brazilian Classification of Medical Procedures (CBHPM 5thedition),
Simpro Magazine (Maximum price consumers 18%ICMS) and UNIDAS 2008,
respectively. A budget impact analysis was developed considering an increase of
10% per year in market share of Rivaroxaban. RESULTS: Total costs associated
with Rivaroxaban and Enoxaparin, considering the indication for knee arthroplasty,
were BRL363 (US$214) and BRL632 (US$372), respectively. Rivaroxaban reduces
the number of all thromboembolic events in 0.0167. Rivaroxaban treatment is more
effective and cheaper than Enoxaparin treatment (dominant). Total costs associated
with Rivaroxaban and Enoxaparin, considering the indication for hip arthroplasty,
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
were BRL332 (US$195) and BRL468 (US$275), respectively. The number of all
thromboembolic events was the same. Rivaroxaban treatment is cheaper with
same efficacy. The budget impact analysis estimated an economy of BRL98,810
(US$58,124) and BRL184,630 (US$108,606) for knee and hip indication, respectively,
in 5 years. CONCLUSIONS: By this pharmacoeconomic analysis, the treatment
with Rivaroxaban, shown to reduce treatment costs and events compared with
Enoxaparin.
PCV7: COST-EFFECTIVENESS OF PRASUGREL VERSUS CLOPIDOGREL IN PATIENTS
WITH ACUTE CORONARY SYNDROMES UNDERGOING PERCUTANEOUS
CORONARY INTERVENTION IN THE PUBLIC HEALTH CARE SYSTEM IN MEXICO
Mondragon R1, Arrieta-Maturino E2, Vargas-Valencia JJ3, Martínez-Fonseca J3,
Guzman-Sotelo M3, Galindo-Suarez RM2, Ramírez-Gámez J2, 1Hospital Central-Sur
de Alta Especialidad PEMEX, México D.F., México, 2Eli Lilly and Company, México
D.F., México, 3Econopharma Consulting S.A. de C.V., México D.F., México, 4Pfizer,
Inc., México City, México
OBJECTIVES: To evaluate the cost-effectiveness of prasugrel versus clopidogrel
in patients with acute coronary syndromes (ACS) undergoing percutaneous
coronary intervention (PCI) from the public healthcare payer perspective in Mexico.
METHODS: The alternatives were prasugrel (loading dose 60 mg, maintenance
dose 10 mg daily) versus clopidogrel (loading dose 300 mg, maintenance dose
75 mg daily). A Markov model was developed. Only direct medical care costs
were considered for one year. The efficacy measure was a composite of the
death from cardiovascular causes, nonfatal myocardial infarction or nonfatal
stroke and stent thrombosis reported in the trial directly comparing prasugrel
and clopidogrel (TRITON TIMI-38). Three types of populations were evaluated
separately; overall, patients with diabetes mellitus, and the subset of diabetics
treated with insulin. Care costs were derived from medical records, and the costs
of drugs were assumed to be the same. Costs and the model were validated by
experts. RESULTS: According to the model prasugrel had fewer events in the
three types of populations evaluated over a 12 month time horizon. The number of
events; death from cardiovascular causes, nonfatal myocardial infarction-stroke
and stent thrombosis avoided by 10,000 patients were distributed as follows: overall
population, 31, 650 and 147, diabetics, 92, 1363 and 203, diabetics on insulin, 174,
2531 and 499. The average cost per patient (2010 Mexican pesos) treated with
prasugrel was lower compared with clopidogrel, for the overall population (MXN$
69,972 vs. MXN$ 82,991), diabetics (MXN$79,971 vs. MXN$ 105,756) and diabetics
treated with insulin (MXN$ 85,750 vs. MXN$ 137,144) CONCLUSIONS: Results from
the present analysis suggest that the use of prasugrel (instead of clopidogrel)
in patients with ACS undergoing PCI represents a more effective strategy at a
lower cost (dominant strategy), a cost-saving alternative for institutions of public
healthcare in Mexico.
PCV8: COST-EFFECTIVENESS AND BUDGET IMPACT ANALYSIS OF RIVAROXABAN
IN THE PREVENTION OF THROMBOEMBOLIC EVENTS IN PATIENTS PERFORMING
HIP AND KNEE ARTHROPLASTY IN COMPARISON WITH DABIGATRAN UNDER THE
BRAZILIAN PRIVATE HEALTH CARE SYSTEM PERSPECTIVE
Schiola A1, Silva AP2, Santoni NB2, Paladini L3, Teich V3, Pepe C3, Rocha MM3, 1Bayer
de México, S.A. de C.V., México D.F., México, 2Bayer Brasil, São Paulo, SP, Brazil,
3
MedInsight Evidências, São Paulo, SP, Brazil
OBJECTIVES: To develop a cost-effectiveness and a budget impact analysis of
Rivaroxaban in the prevention of thromboembolic events in patients performing
hip and knee arthroplasty in comparison with Dabigatran under the Brazilian
private health care system perspective. METHODS: A decision tree analysis
was developed for the first 90 days, considering the occurrence of Deep Venous
Thrombosis, Pulmonary Embolism and thromboembolic events, followed by
a Markov model, for Post Thrombotic Syndrome and Thrombotic Pulmonary
Hypertension. The time horizon of the analysis was 5 year. The cycle duration was
1 year and corresponding epidemiological and efficacy data were obtained from a
critical appraisal of the scientific literature. The outcomes were expressed as the
incremental number of all thromboembolic events. The analysis considered only
direct medical costs. Unit costs for drugs, procedures, materials and daily hospital
were obtained from Kairos Magazine (Maximum price consumers 18%ICMS),
Hierarchical Brazilian Classification of Medical Procedures (CBHPM 5thedition),
Simpro Magazine (Maximum price consumers 18%ICMS) and UNIDAS 2008,
respectively. A budget impact analysis was developed considering an increase
of 10% per year in market share of Rivaroxaban. RESULTS: Total costs associated
with Rivaroxaban and Dabigatran, considering the indication for knee arthroplasty,
were BRL363 (US$214) and BRL371 (US$218), respectively. The number of all
thromboembolic events was the same. Rivaroxaban treatment is cheaper with same
efficacy. Total costs associated with Rivaroxaban and Dabigatran, considering
the indication for hip arthroplasty, were BRL332 (US$195) and BRL485 (US$285),
respectively. Rivaroxaban reduces the number of all thromboembolic events in
0.0140. Rivaroxaban treatment is more effective and cheaper than Dabigatran
treatment (dominant). The budget impact analysis estimated an economy of
BRL3,894 (US$2,291) and BRL150,642 (US$88,613) for knee and hip indication,
respectively, in 5 years. CONCLUSIONS: By this pharmacoeconomic analysis,
the treatment with Rivaroxaban, shown to reduce treatment costs and events
compared with Dabigatran
PCV9: COSTO–EFECTIVIDAD DE LOS ÁCIDOS GRASOS OMEGA 3 COMO
COADYUVANTE DE LA SIMVASTATINA EN EL TRATAMIENTO DE LA
HIPERTRIGLICERIDEMIA
Rendon D, Ordoñez J, Orozco JJ, Universidad CES, Medellin, Colombia
OBJECTIVOS: Evaluar la relación costo-efectividad del omega-3 como coadyuvante
de segunda línea en los pacientes con hipertrigliceridemia, que vienen utilizando
simvastatina versus simvastatina sola. METODOLOGÍAS: Para la búsqueda de
las eficacias se realizó una búsqueda sistemática de la literatura de acuerdo a
unos criterios establecidos previamente. Los costos monetarios fueron evaluados
de acuerdo al mercado interno farmacéutico. Se tomó el valor de la mediana y
se utilizaron los valores extremos para el análisis de sensibilidad. RESULTADOS:
El tratamiento con simvastatina 40 mg + 4 gr/día de ácidos grasos del aceite de
pescado Omega 3 tuvó una mejor relación de costo-efectividad en comapración
con el tratamiento tradicional de solo simvastatina 40 mg/día, en pacientes con
hipertrigliceridemia. Las efectividades fueron determinadas como el porcentaje
de disminución de los niveles de triglicéridos respecto de los valores iniciales.
El estudio seleccionado en la revisión sistemática determinó la efectividad del
primer tratamiento en un 29.5% frente a un 6.3% del segundo. La relación de
costo-efectividad a las 8 semanas, fue de 7,971 pesos por unidad porcentual de
disminución los triglicéridos para el tratamiento con Omega-3, versus 17,938 pesos
para la simvastatina sola. El análisis incremental mostró un costo de 5264 pesos
por unidad porcentual adicional de disminución de los triglicéridos por encima de
la opción de simvastatina sola. CONCLUSIONES: El tratamiento con simvastatina 40
mg mas 4 gr/dia de ácidos grasos del aceite de pescado Omega 3, tiene una mejor
relación de costo- efectividad que el tratamiento tradicional de simvastatina 40
mg sola, tanto cuando se consideró un horizonte de 8 semanas como para las 52
semanas. Esto es importante para el diseño de nuevos programas de promoción y
prevención en el marco del sistema general de seguridad social en Colombia.
PCV10: UN ESTUDIO DE MINIMIZACION DE COSTOS PARA EVALUAR EL
TRATAMIENTO CON METOPROLOL EN PACIENTES CON HIPERTENSION ARTERIAL
EN MÉXICO
Lopez JA1, Briones B2, 1Sandoz México, México D.F., México, 2Novartis
Farmaceutica, México D.F., México
OBJECTIVOS: El objetivo de este análisis es comprobar la relación costoefectividad de dos alternativas de metoprolol, un beta-bloqueador de liberación
prolongada con amplia experiencia clínica en su uso para el manejo de la
hipertensión arterial, para el manejo de pacientes hipertensos en México.
METODOLOGÍAS: Este es un estudio de minimización de costos desde la
perspectiva institucional del Instituto de Seguridad Social del Estado de México y
Municipios (ISSEMYM). Se evaluaron dos alternativas de metoprolol para el
manejo de hipertensión arterial: el metoprolol genérico actualmente disponible
en el cuadro básico de medicamentos institucional (metoprolol genérico actual),
y el metoprolol genérico de marca Lopresor R® (metoprolol genérico de marca).
La medición de eficacia se igualó a una constante, debido a que los estudios de
bioequivalencia, avalados por la autoridad sanitaria, corroboran que el metoprolol
genérico de marca es bioequivalente al metoprolol genérico actual. Los costos
fueron obtenidos de la institución; están expresados en Pesos Mexicanos y son
vigentes para el 2011. El horizonte temporal fue de 12 meses, por lo cual no se
utilizó tasa de descuento. Una vez obtenido el resultado, se procedió a un análisis
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de impacto presupuestal para la institución. RESULTADOS: El análisis reveló un
costo anual de $2,190.00 para metoprolol genérico de marca, en comparación con
un costo anual de $2,754.11 para metoprolol genérico actual, dando como resultado
un decremento en el costo anual de $564.11 por cada paciente tratado. El análisis
de impacto presupuestal reveló que cada 1000 pacientes tratados con el metoprolol
genérico de marca, en contraposición al metoprolol genérico actual, representan
un ahorro anual para la institución de $564,107.50. CONCLUSIONES: La sustitución
de metoprolol genérico actual por metoprolol genérico de marca representa, para
la institución, un ahorro anual potencial de $564.11 por cada paciente tratado, y un
ahorro anual potencial de $564,107.5 por cada 1000 pacientes tratados.
DIABETES/ENDOCRINE DISORDERS – Clinical Outcomes Studies
PDB2: CALIDAD DE PRESCRIPCION DE HIPOGLUCEMIANTES ORALES EN UNA
UNIDAD MEDICA FAMILIAR: CENTRO, TABASCO, MÉXICO, 2009
Zavala-González MA1, Posada-Arévalo SE2, Barrera-Olán L3, López-Mandujano
C3, Mirón-Carrera MT3, Santiago-Naranjo P3, 1Asociación Latinoamericana de
Profesores de Medicina Familiar, A.C., Cárdenas, Tabasco, México, 2Universidad
Nacional Autónoma de México, Villahermosa, Tabasco, México, 3Instituto Mexicano
del Seguro Social, Delegación Tabasco, Villahermosa, Tabasco, México
OBJECTIVOS: Determinar la calidad de la prescripción de hipoglucemiantes
orales en pacientes con Diabetes Mellitus No Insulinodependiente (DMNID)
derechohabientes usuarios de la Unidad de Medicina Familiar (UMF) No. 43
del Instituto Mexicano del Seguro Social (IMSS), en Villahermosa, Centro,
Tabasco, México, durante el año 2009. METODOLOGÍAS: Diseño: observacional,
retrospectivo, transversal, descriptivo. Universo: 2678 expedientes de pacientes
con DMNID atendidos en la UMF No. 43 del IMSS, en Villahermosa, Centro,
Tabasco, México, durante el año 2009. Muestra: probabilística simple, 254
expedientes (N=2,678, p=0.76, q=0.24, d=0.05, Z=1.96). Muestreo: aleatorizado,
técnica de números aleatorios. Criterios de selección: expedientes clínicos
completos. Variables: edad, sexo, obesidad, tiempo de evolución de la Diabetes
Mellitus, esquema terapéutico, calidad de la prescripción y error de prescripción.
Fuentes de información: expedientes completos. Procedimientos: se sistematizó la
información de los esquemas terapéuticos de hipoglucemiantes orales prescritos
a los pacientes, y se compararon contra las guías de prescripción, considerando
adecuadas las prescripciones realizadas de acuerdo a las guías. Análisis:
estadística descriptiva. Software: STATSTM 2.0, Epi InfoTM 3.3.2. RESULTADOS: Un
total de 254 expedientes clínicos: excluidos 34.3%, incluidos 65.7%. Expedientes
clínicos estudiados: 167. Media de hipoglucemiantes orales prescritos 2±1,
intervalo 1-3, moda 2. Esquema terapéutico más frecuentes: Glibenclamida y
Metformina 58.1%. Calidad de la prescripción: 81% inadecuada, 19% adecuada.
Error de prescripción más frecuente: intervalo inadecuado 61%. CONCLUSIONES:
La calidad de la prescripción de hipoglucemiantes orales observada en esta
serie es predominantemente inadecuada, en proporción mayor a la media estatal
(23.7%). Se requiere educación continua y medidas gerenciales para corregir el
problema.
PDB3: PREVALENCE OF SEVERE OSTEOPOROSIS IN DAILY CONSULTATION OF
RHEUMATOLOGY AND ENDOCRINOLOGY SERVICES, COSTS AND QUALITY OF LIFE
OF FRAGILITY FRACTURES IN MEXICO
Carlos F1, Clark P2, Chico G2, Ramírez E3, Franco F3, Jasqui-Romano S4, 1R A C
Salud Consultores, S.A. de C.V., México D.F., México, 2Hospital Infantil de México
Federico Gómez, Secretaría de Salud, México, DF, México, 3Instituto Nacional de
Rehabilitación, Secretaría de Salud, México D.F., México, 4Eli Lilly and Company,
México D.F., México
OBJECTIVES: Osteoporosis (OP) and its fragility fractures (FF) impose a large
burden on health system and the impact is growing due to population ageing.
Severe or established OP defines a T-score < -2.5 in presence of a fragility
fracture. We aimed to estimate the prevalence of severe OP in daily consultation
of rheumatology and endocrinology services in hospitals of IMSS and ISSSTE
and to assess the costs and quality of life (QoL) associated with FF in Mexico.
METHODS: A prospective study was performed in 11 specialty (6 rheumatology and
5 endocrinology) services from 9 hospitals of IMSS and ISSSTE through March 1
to April 27, 2010. Data of adults attending to outpatient consultation was collected
in a clinical report form. The analysis was done following a frequentist statistical
approach. We also conducted a systematic review of published and non-published
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data of direct medical costs (acute attention, physical therapy and outpatient
visits) and QoL related with major FF in Mexico. Expert opinion was used when
local information was not available. All costs were updated to December 2010 and
figures are expressed in Mexican pesos. RESULTS: During the period of study, 84
out of the 3527 medical consultations were given to patients diagnosed with severe
OP, comprising a 2.4% of the total consultations in these services. Prevalence
of severe OP was slightly higher in rheumatology (2.6%) than in endocrinology
(2.2%) services. First-year total cost per patient with hip, vertebral, forearm and
humerus FF were estimated at $82631, $53332, $39006 and $41942, respectively.
FF significantly reduced QoL, with hip and vertebral fractures affecting the most.
CONCLUSIONS: This study shows that severe OP is common in rheumatology and
endocrinology services. Since a prior fracture increases the risk of future fractures,
patients with severe OP entail a high economic burden to the health system.
DIABETES/ENDOCRINE DISORDERS – Cost Studies
PDB4: GASTOS COM MEDICAMENTOS E CARACTERÍSTICAS DE INDIVÍDUOS COM
HIPERTENSÃO E DIABETES MELLITUS, EM MUNICÍPIOS DA REDE FARMÁCIA DE
MINAS - MINAS GERAIS, BRASIL
Pereira VOM, Cherchiglia ML, Acurcio FA, Universidade Federal de Minas Gerais,
Belo Horizonte, Minas Gerais, Brazil
OBJETIVOS: Descrever características sociais, demográficas, além dos gastos
mensais com medicamentos por indivíduos com hipertensão arterial e/ou diabetes
mellitus, em municípios selecionados da Rede Farmácia de Minas. MÉTODOS: A
estratégia geral de delineamento foi a de um estudo epidemiológico seccional
(inquérito) sobre a utilização de medicamentos, realizado por meio de seleção
aleatória em 32 dos 67 municípios participantes do Programa Farmácia de Minas.
Esse programa, implementado no estado de Minas Gerais, visa garantir o acesso a
medicamentos por meio da estruturação da rede pública estadual de assistência
farmacêutica. A população alvo foi constituída por pacientes hipertensos e/
ou diabéticos, residentes nos referidos municípios. Foram entrevistados 4815
indivíduos, no período de 18 de janeiro a 22 de fevereiro de 2010. Os gastos mensais
com medicamentos foram expressos em unidade monetária brasileira, Real (R$),
e também foram descritos em proporções do salário mínimo vigente no período
de realização das entrevistas. RESULTADOS: Observou-se que os indivíduos
entrevistados possuíam em média 61,2 anos (mediana=62). Dentre eles, a maior
parte (68,7%) era do sexo feminino e 64,6% possuíam primeiro grau incompleto
ou nunca haviam estudado. Cerca de 41% dos entrevistados apresentaram algum
gasto para a aquisição de medicamentos nos 30 dias anteriores à realização das
entrevistas. O gasto médio mensal foi de R$ 103,80, e o mediano, de R$60,00. Esses
valores de gastos com medicamentos equivalem, respectivamente, a 20% e a
12% do valor do salário mínimo vigente à época da realização das entrevistas. Os
gastos também foram caracterizados pela concentração. Os dez indivíduos com
os maiores gastos foram responsáveis por 8,8% dos gastos totais. CONCLUSÕES:
Os resultados deste trabalho poderão ser úteis para direcionar o planejamento de
novas análises, sobre o perfil de utilização de medicamentos por indivíduos com
hipertensão e/ou diabetes mellitus, em municípios da Rede Farmácia de Minas.
PDB5: USE OF A DISCRETE EVENT SIMULATION MODEL TO ESTIMATE CLINICAL
AND ECONOMIC OUTCOMES OF VARIOUS SELF-MONITORING OF BLOOD
GLUCOSE REGIMES PLUS CONVENTIONAL PHARMACOLOGIC TREATMENT ON
TYPE-2 DIABETIC PATIENTS IN MEXICO
Zanela OO1, Cabra HA1, Muñoz DF2, 1Johnson & Johnson Medical, México D.F.,
México, 2Instituto Tecnológico Autónomo de México, México D.F., México
OBJECTIVES: Estimate the effects on glycosylated hemoglobin (HbA1c) and the
accumulated cost of treatment of the use and provision of various self-monitoring
of blood glucose (SMBG) regimes plus conventional pharmacologic treatment on
type-2 diabetic (T2D) patients from the Mexican public health system perspective.
METHODS: The individual experience of a T2D patient was simulated using a
discrete event simulation (Arena™). Patients were created with unique, randomly
assigned baseline characteristics, cloned three times and sent to each of the
considered SMBG regimes (0, 1, 2 and 3 times daily). T2D- and complication-related
pharmacologic treatment & resource utilization, and treatment algorithms and
goals were based on published clinical guidelines. Treatment therapies included
lifestyle modifications alone, oral antidiabetics (OADs) and insulin use. HbA1c
ISPOR 3rd Latin America Conference
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Research Poster Abstracts
was the main driver of disease progression, determining initial state, clinical
evolution and drug/insulin dosages. Complication and acute event development
for each SMBG regime was assessed through published local relative risk studies.
Considered OADs and insulin types were assumed equally effective. Clinical and
cost data were obtained from published literature. Mortality was assessed by
disease duration. Simulation was run with 250,000 patients for 10 years using a 4.5%
annual discount rate. Average per-patient costs are shown in inflation-adjusted
2011 MXP. RESULTS: More intensive SMBG regimes resulted in lower final average
HbA1c levels; 1, 2 and 3 times daily SMBG regimes resulted in lesser costs than no
SMBG after years 3, 3 and 4, respectively. Year-10 accumulated costs for the former
were $598,189, $590,616 and $589,008, and $614,162 for no SMBG. Savings are due
to fewer complications and slower disease progression under any SMBG regime.
CONCLUSIONS: As more intensive SMBG regimes result in lower HbA1c levels and
treatment costs, glycemic control should be an objective of every T2D integral
treatment strategy, potentially reducing the social and economic burden imposed
by the disease.
were obtained from local studies. Costs were expressed in US dollars (2009), with
an annual 3.5% discount. The time horizon was 20 years. RESULTS: In all countries,
the number of non-fatal events was lower in the SAXA+MET group than in the
SULF+MET group. The model also predicted a lower number of fatal macrovascular
and microvascular events for the SAXA+MET-treated group. In Argentina and Perú,
the total cost of the SAXA+MET cohort was higher than that of the SULF+MET
cohort (14% and 3%, respectively), while in Chile the total cost of the SAXA+MET
cohort was 3% lower than that of the SULF+MET. Treatment with SAXA+MET
resulted in a higher number of QALYs (Argentina: 9,392 vs. 9,172; Chile: 9,794 vs.
9,594; Peru: 9,796 vs. 9,597) and LYGs (Argentina: 20,898 vs. 20,797; Chile: 23,068 vs.
23,019; Peru: 23,079 vs. 23,028) as compared with SULF+MET. The additional cost
per QALY was U$S6,691, U$S2,446 and -U$S2,243 for Argentina, Peru and Chile,
respectively. CONCLUSIONS: Considering the GDP per capita in Argentina and
Peru, the addition of SAXA instead of SU to MET therapy would result in acceptable
cost-effectiveness ratios in T2DM patients, being this combination cost-saving
(dominant cost-effectiveness ratio) in Chile.
PDB6: EDUCATIONAL INTERVENTIONS IN PATIENTS WITH TYPE-2 DIABETES
IMPROVE CLINICAL AND METABOLIC OUTCOMES AND OPTIMIZE THE USE OF
TREATMENT RESOURCES IN ARGENTINA: THE PRODIACOR STUDY
Caporale JE1, Elgart JF1, Gonzalez L1, Rucci E1, Lapertosa S2, Villagra M2, Gagliardino
JJ1, 1CENEXA - Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET
La Plata, Centro Colaborador OPS/OMS), La Plata, Buenos Aires, Argentina,
2
Hospital, Corrientes, Corrientes, Argentina
OBJECTIVES: To evaluate the efficacy of educational interventions in the
PRODIACOR study and estimate pharmacological treatment costs. METHODS:
PRODIACOR is a 3-year prospective and randomized controlled trial, aimed
at improving the quality of care of people with type 2 diabetes, preventing
complications and optimizing resource use. It includes 4 groups (control, educated
patients, educated physicians and educated patients and physicians) with 9
physicians and 117 patients each. Clinical and metabolic changes were recorded
in ad-hoc forms (annual and semiannual). Costs and utilization rates were obtained
from the administrative dataset of the coverage institutions involved. We verified
differences in means and proportions using ANOVA and Chi2. RESULTS: After the
3-year follow up we recorded significant improvements (p<0.001) in all groups in
systolic blood pressure (142±17 vs. 134±15 mmHg), HbA1c (7.8±1.5 vs. 7.1±0.8%) and
total cholesterol (4.7±0.9 vs. 4.4±0.7 mmol/L). All these changes were significantly
larger in the intervention groups. The percentage of patients at target for all these
parameters was significantly larger (p<0.01) in these groups. In the educated
groups, we also recorded a significant increment in combined against oral
monotheraphy (42 vs. 30%) and insulin use (15 vs. 9%). Drug consumption and strips
for blood glucose represented 64 and 83% of the total care cost at baseline and
3-year follow up, respectively. This cost increased (113%) in the control group while
it significantly decreased (11 to 20%) in the intervention groups, particularly in the
patient/physician educated group. The cost to decrease HbA1c by 1% or SBP by 10
mmHg in the patient/physician educated group was lower than in the control group
($161 vs. $547, $16 vs. $77, respectively). CONCLUSIONS: Educational interventions
implemented at primary care level improved the clinical and metabolic outcomes of
people with Type 2 diabetes and optimized the use of resources.
PDB8: COST-EFFECTIVENESS STUDY OF ORAL HYPOGLYCEMIC AGENTS IN
OUTPATIENTS DIAGNOSED WITH TYPE-2 DIABETES ATTENDING A PRIMARY
CARE PUBLIC CLINIC IN MEXICO CITY
Diaz de León-Castañeda C, Altagracia-Martínez M, Kravzov-Jinich J, CárdenasElizalde R, Martínez-Núñez JM, Universidad Autónoma Metropolitana - Xochimilco,
México D.F., México
OBJECTIVES: To assess the cost-effectiveness (CE) ratios of oral hypoglycemic
agents (OHA’s) most used (acarbose, metformin and glyburide) on the initial
pharmacologic therapy of outpatients diagnosed with type 2 diabetes in a primary
care public clinic in Mexico City. METHODS: We conducted a cost-effectiveness
study based on a Markov model during a time horizon of one year and from
the perspective of the Mexican society. The model designed included two
health states (HbA1c ≤ 7% and HbA1c > 7%) and 6 months for the evaluation of
monotherapy with OHA’s and 6 months for the addition of a second OHA in case
of failure of the first (metformin - glyburide dual therapy) were considered. We
assessed the total monthly costs of the treatments with the OHA’s through a
structured questionnaire applied to 27 outpatients recently diagnosed with type
2 diabetes in treatment in a primary care public clinic in Mexico City during 2009. The efficacies (treatments success probabilities if HbA1c ≤ 7% was reached) as
well adverse events frequencies were assessed through a systematic review of
published randomized clinical trials and meta-analysis of selected studies based
on structured inclusion criteria. We used a commercial computational program to
perform the cost-effectiveness analysis for a hypothetical cohort of 10,000
patients through a Monte Carlo simulation and an univariate sensibility analysis
was performed. RESULTS: The CE ratios found were glyburide US$ 272.63/
QALY, metformin US$ 246.48/QUALY and acarbose US$ 409.86/QALY. Acarbose
and metformin showed high frequency of gastrointestinal adverse events (78%
and 54% respectively), and glyburide showed mainly hypoglycemia (31%). The
sensitivity analysis did not show changes for the most CE therapy when the
success probabilities or the treatment costs were modified. CONCLUSIONS: Initial
monotherapy with glyburide offers the best cost-effectiveness ratio.
PDB7: COST-EFFECTIVENESS OF SAXAGLIPTIN TREATMENT IN THREE LATIN
AMERICAN COUNTRIES
Elgart JF1, Caporale JE1, Aiello EC2, Waschbusch M2, Jotimliansky L2, Gagliardino
JJ1, 1CENEXA - Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET
La Plata, Centro Colaborador OPS/OMS), La Plata, Buenos Aires, Argentina,
2
Bristol-Myers Squibb, Buenos Aires, Argentina
OBJECTIVES: To evaluate the economic consequences of saxagliptin (SAXA)
versus sulfonylurea (SU) administration in combination with metformin (MET) after
failure of MET monotherapy treatment, in patients with type 2 diabetes (T2DM).
METHODS: A discrete event simulation model (Cardiff Long term cost-utility model)
based on UKPDS 68 with a fixed time increase was used to simulate disease
progression and to obtain an estimate of the treatment’s economic and health
consequences in patients with T2DM from Argentina, Chile and Peru. The clinical
efficacy parameters for SAXA were obtained from the literature; drug acquisition
costs, adverse effects (AEs) and microvascular and macrovascular complications
PDB9: ANALISIS DE COSTO–EFECTIVIDAD DEL USO DE DETEMIR EN DIABETES
TIPO 2 FRENTE AL RIESGO DE PRESENTAR EVENTOS CARDIOVASCULARES Y
MUERTE
Romero M1, Chavez D1, Karpf E1, Alvis N2, 1Fundación Salutia, Bogotá, Colombia,
2
Universidad de Cartagena, Cartagena de Indias, Bolívar, Colombia
OBJECTIVOS: Analizar la relación costo-efectividad del uso de Detemir frente a
otras insulinas (Glargine e insulina NPH) para tratamiento de diabetes tipo 2 en
Colombia. METODOLOGÍAS: Mediante un modelo probabilístico de Markov se
realizó un análisis de costo-efectividad, desde la perspectiva del tercero pagador,
en un horizonte temporal de 5 años en una cohorte de 10,000 personas con edad
media de 45 años. Como desenlaces se evaluaron eventos cardiovasculares y
muertes evitadas, relacionadas con eventos de hipoglicemia severa y Años de
Vida Salvados (AVS). Se utilizaron los IC de las probabilidades de los desenlaces
evaluados obtenidas de la revisión de estudios clínicos. Los costos se extrajeron
de bases de datos de prestadores de servicios de salud en Colombia, a precios
2010. Se utilizó una tasa de descuento del 3% para costos y resultados. Se realizó
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un análisis de sensibilidad tipo montecarlo con 1000 iteraciones para probar la
solidez de los resultados. RESULTADOS: En un horizonte temporal de 5 años el
Detemir presentó un menor número de eventos de hipoglicemia severa (730)
frente a Glargine y NPH (1910 y 2140) respectivamente, a su vez menor número de
eventos macrovasculares (1052) y microvasculares (1019) frente a Glargine (1115,
1040) y NPH (1130 y 1042). Detemir evitó 112 y 131 muertes frente a Glargine y NPH
equivalentes a 3935 y 3363 AVS respectivamente. Luego del descuento el ICER por
AVS con Detemir frente a Glargine fue de 1043 USD y frente a NPH 8795.5 USD.
En el análisis de sensibilidad Detemir se mantiene costo-efectivo en el 100% de
los casos por debajo del umbral de costo efectividad frente a los comparadores,
tomando como umbral lo propuesto por la OMS. CONCLUSIONES: Detemir, desde
la perspectiva del tercer pagador, es costo-efectivo frente a Glargine y NPH para
tratamiento de diabetes tipo 2 en Colombia.
teriparatide. We analyzed acquisition costs of teriparatide and medical care costs
due to FF. Frequency and location of fractures avoided and quality adjusted life years
(QALYs) were estimated. All costs are expressed in 2010 USD (1USD:12.50MXN
Pesos) RESULTS: Teriparatide avoided 324 FF per a thousand patients (hip: 43;
vertebral: 164; humerus: 35; forearm: 82). The number needed to treat (NNT) to
prevent one FF was 3.09. Teriparatide was slightly more expensive ($20,052 vs. $22,209 USD) but more effective, with net gains of 87 QALYs per a thousand patients.
The cost per additional QALY gained with teriparatide was $24,925 (below the upper
limit of 3 times the gross domestic product per capita in Mexico). Teriparatide
was found to be cost-effective therapy in 80% of the simulations performed in the
probabilistic sensitivity analysis. CONCLUSIONS: Teriparatide is a cost-effective
intervention in women with PMOP and high risk of FF.
PDB10: ECONOMIC EVALUATION OF DULOXETINE AS FIRST-LINE TREATMENT FOR
PAINFUL DIABETIC PERIPHERAL NEUROPATHY IN MEXICO
Carlos F1, Ramírez-Gámez J2, Dueñas-Tentori H2, Ramos E1, 1R A C Salud
Consultores, S.A. de C.V., México D.F., México, 2Eli Lilly and Company, México D.F.,
México
OBJECTIVES: To perform an economic evaluation of duloxetine, pregabalin and
(either branded or generic) gabapentin for managing pain in patients with painful
diabetic peripheral neuropathy (PDPN) in Mexico. METHODS: The analysis was
conducted using a three-month decision model, which compares duloxetine 60mg
once daily (DUL), pregabalin 150mg twice daily (PGB) and gabapentin 600mg threetimes daily (GBP) for patients with PDPN and moderate-to-severe pain, under the
perspective of the Mexican public health care system. We performed a systemic
review and calculated placebo-adjusted risk ratios for achieving good pain relief
(GPR), any adverse event (AE) and withdrawal owing to intolerable AE. Direct
medical costs included drug acquisition and additional visits due to lack of efficacy
(poor pain relief) or intolerable AE. Unit costs were taken from local sources.
Adherence rates (based in number of daily doses needed) were used to estimate
the expected drug costs. All costs are expressed in 2010 USD (1USD:12.50MXN
Pesos). Utility values drawn from published literature were applied to health
states. Proportion of patients with GPR and quality-adjusted life years (QALY)
were assessed. RESULTS: Branded-GBP was dominated by all the other options.
PGB was more costly and less effective than DUL. Compared with branded-GBP
and PGB, DUL led to savings of $80,080 and $85,920 (per 1000 patients) USD. The
incremental cost per QALY gained with DUL used instead of generic-GBP was
$8,194. This amount is slightly lower than the estimated gross domestic product
per capita in Mexico for 2010. During a second-order Monte Carlo simulation, DUL
had the highest probability of being cost-effective (61%), followed by generic-GBP
(25%) and PGB (14%). CONCLUSIONS: This study suggests that DUL provides
overall savings and better health outcomes compared with branded-GBP and PGB.
Administering DUL rather than generic-GBP is a highly cost-effective intervention
to manage PDPN in Mexico.
GASTROINTESTINAL DISORDERS – Cost Studies
PDB11: ECONOMIC EVALUATION OF TERIPATIDE IN THE MANAGEMENT OF
WOMEN WITH POSTMENOPAUSAL OSTEOPOROSIS AND HIGH RISK OF FRAGILITY
FRACTURES IN MEXICO
Carlos F1, Clark P2, Jasqui-Romano S3, 1R A C Salud Consultores, S.A. de C.V.,
México D.F., México, 2Hospital Infantil de México Federico Gómez, Secretaría de
Salud, México D.F., México, 3Eli Lilly and Company, México D.F., México
OBJECTIVES: Fragility fractures (FF) are associated with increased mortality,
deterioration in health-related quality of life and high costs. Teriparatide stimulates
bone remodeling. The aim of this study was to assess the cost and health effects
of teriparatide in women with postmenopausal osteoporosis (PMOP) and high
risk of FF from the perspective of public healthcare system in Mexico. METHODS:
Target population was women aged 70 years, with PMOP, T-score -4.0 and three
clinical risk factors, with a recent vertebral fracture not candidates to receive
bisphosphonates. Competing alternatives were: 1) daily subcutaneous injection
of teriparatide 20mcg for 18 months, and 2) no therapy. A Markov microsimulation
model was developed with a 30 years time horizon divided into 6-month cycles and
is composed by 5 health states: hip, vertebral, forearm and humerus fracture and
death. The incidence of FF was obtained from the FRAX® algorithms for Mexican
women. Efficacy data was gathered from placebo-controlled clinical trials of
90
PGI1: RESOURCE UTILIZATION AND COST OF MANAGEMENT OF COMPLEX
PERIANAL FISTULA IN CROHN’S DISEASE IN SPAIN
Badia X1, Lara N1, Garcia-Losa M2, Zanotti C3, Orofino J3, 1IMS Health, Barcelona,
Spain, 2IMS Health, Madrid, Spain, 3Cellerix, SA, Tres Cantos, Spain
OBJECTIVES: : To assess health care resources use and costs associated with
management of complex perianal fistula in Crohn’s disease (CPCD) in Spain.
METHODS: : Multicenter, retrospective and observational study conducted by 13
gastroenterologists from 11 hospitals in the Autonomous Community of Madrid,
Spain. Direct healthcare resources consumption (pharmacological treatments,
laboratory/diagnostic tests, visits to specialists, emergency department visits and
hospitalizations/surgical procedures) were recorded for 97 adult patients with
CPCD active at some time between January 1, 2005 and study data collection
(4.2±1.5 years). RESULTS: : 527 treatments were recorded: 73.1% pharmacological
(32.3% antibiotics, 20.5% immunomodulators, 20.3% biological therapies) and
26.9% surgical. Mean per patient-year global cost was 7821.4. Percentage cost per
treatment type and [mean per patient-year cost] breakdown was 78.7% [5773.5]
pharmacological cost, 11.12% [1027.4] hospitalizations/surgical procedures,
6.5% [€640] specialists visits, 3.4 [350] laboratory/diagnostic tests, and 0.2%, [30.4]
emergency department visits. Mean per patient-year cost per pharmacological
treatment type was: 12.5 antibiotics, 1050.6 immunomodulators, and 4710.4
biological therapies. CONCLUSIONS: : Pharmacological treatments are the main
cost driver of CPCD management in Spain, being biological therapies the main
component. Study funded by Cellerix, S.A. (Spain)
PGI2: COST-EFFECTIVENESS ANALYSIS OF THE USE OF ADALIMUMAB FOR THE
TREATMENT OF CROHN’S DISEASE (CD) IN MEXICO
Mayen-Herrera E1, Pozos JC2, Yang M3, Cortina D4, Abbott Laboratories de México,
México, D.F. México
OBJECTIVES: To estimate the cost-effectiveness of adalimumab CD treatment
versus standard care and infliximab for patients with severe active CD. METHODS:
The model combines clinical, utility, and cost data. Four disease states (remission;
moderate; severe; very severe) based on the Crohn’s Disease Activity Index range
are used as measures of patient disease status. For the adalimumab arm, a cohort
for the proposed adalimumab regimen using actual observations from the EOW arm
in a randomized controlled clinical trial (CHARM) is used. For the standard care
arm, the model simulates patient disease states based on randomized controlled
trial data (CLASSIC I and CHARM) and calculates the probability of individuals
being in each disease state. The base-case model analyzes lifetime patient clinical
status. Hospitalization costs are estimated from the hospitalization unit cost and
a regression model based on CHARM trial data. Disease state specific nonhospitalization, non-anti TNF costs are summarized over time for each patient to
include other direct medical costs. For the adalimumab vs. infliximab model, the
adalimumab regimen is compared to infliximab 5mg/kg maintenance therapy. The
percentage of patients in remission over time is used as the measure of clinical
efficacy. Indirect costs are estimated based on hospitalization stays and posthospitalization recovery times. Costs are reported in Mexican Peso. RESULTS:
Compared to standard care, adalimumab is dominant for patients with severe
CD (cost difference -$16,825, gain in QALYs 0.1045). Adalimumab is dominant,
with lower costs and higher efficacy compared with infliximab when treating
patients with severe disease based on a societal perspective. Cost difference
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
(adalimumab–infliximab) were -$19,784, and including infliximab “overdosing”, the
costs accounted for -$42,356. Sensitivity analyses confirm the results obtained in
the cost-effectiveness analysis. CONCLUSIONS: Adalimumab maintenance therapy
is dominant over standard care. The adalimumab regimen is cost-saving over
infliximab 5mg/kg maintenance therapy.
PGI3: ADAPTACIÓN DE UN ANÁLISIS DE COSTO-EFECTIVIDAD DEL ENTECAVIR VS
INTERFERÓN PEGILADO ALFA A VENEZUELA
Orozco JJ1, Valencia JE2, Aiello E3, Baquero E4, 1Universidad CES, Medellin,
Colombia, 2Bristol-Myers Squibb, Bogotá, Colombia, 3Bristol-Myers Squibb, Buenos
Aires, Argentina, 4Bristol-Myers Squibb, Caracas, Venezuela
OBJECTIVOS: Mediante la adaptación a la realidad de Venezuela de un modelo
realizado por Spackman y Veenstra y previo análisis de transferibilidad, se
realizó un análisis de costo-efectividad del uso de 0.5 mg/día de entecavir
versus interferón pegilado en la supresión de la replicación viral y la calidad de
vida relacionada con la salud en términos de QALYs en pacientes con Hepatitis
B Crónica. METODOLOGÍAS: Para la construcción de la cohorte hipotética,
Spackman y Veenstra asumieron los datos de las eficacias así como las
características de los pacientes reportadas en estudios clínicos recientes. Para
el análisis de transferibilidad se siguieron los criterios de transferibilidad de la
Task Force on Good Research Practices on Transferability of Economic Data de la
ISPOR. En la adaptación del modelo se asumieron las probabilidades de cambio
entre estados reportadas en el estudio original. Los costos médicos directos y de
los medicamentos fueron tomados directamente del entorno local. Adicionalmente
se tomaron las tablas de expectativa de vida del observatorio de salud global de
la Organización Mundial de la Salud para Venezuela actualizadas al año 2008.
Los resultados incluyeron los costos de cada alternativa de tratamiento tanto con
entecavir como con interferón pegilado, así como los años de vida ajustados a
calidad ganados. RESULTADOS: El entecavir 0.5 mg/día produjo 18,25 QALYs y una
relación de costo efectividad media de 5.257 BsF por QALY, en comparación con el
interferón pegilado (marketshare) que produjo 18,12 QALYs y una relación de costo
efectividad media de 7.055 BsF por QALY. CONCLUSIONES: El entecavir a dosis de
0.5 mg/día mostró índices más bajos de costo-efectividad media con respecto al
interferón pegilado en la supresión viral en pacientes con infección por el virus de
la hepatitis B. En Venezuela, al igual que muchos países latinoamericanos, no están
establecidos umbrales de costo efectividad.
GASTROINTESTINAL DISORDERS –
Patient-Reported Outcomes & Preference-Based Studies
PGI4: HEALTH-RELATED QUALITY OF LIFE IMPROVEMENTS IN PATIENTS WITH
ACTIVE CROHN’S DISEASE FOLLOWING TREATMENT WITH CERTOLIZUMAB
PEGOL IN THE MUSIC STUDY (NCT00297648)
Hébuterne X1, †Lémann M2, Coteur G3, Ernault E3, Colombel JF4, 1Centre Hospitalier
Universitaire de Nice, Nice, France, 2Hôpital Saint-Louis, Paris, France, 3UCB,
Braine l’Alleud, Belgium, 4Centre Hospitalier Universitaire (CHU) de Lille, Lille,
France
OBJECTIVES: MUSIC, an open-label, 1-year study of certolizumab pegol (CZP),
evaluated the efficacy of CZP in improving pathological changes in the intestinal
mucosa of patients with active moderate-to-severe Crohn’s disease (CD). The
purpose of this posthoc study was to examine the relationship between CZPmediated endoscopic improvement and changes in HRQoL in patients with CD.
METHODS: Patients with active CD (CD Activity Index score >225 to <450) were
treated with open-label CZP, 400 mg subcutaneously every 2 weeks for 3 doses
(induction) then 400 mg every 4 weeks for up to 54 weeks (maintenance). Patients
completed the Inflammatory Bowel Disease Questionnaire (IBDQ) at baseline,
Week 10, and Week 54 to assess HRQoL. An exploratory analysis of the correlation
between IBDQ remission (total score ≥170 points) and endoscopic remission
(measured by a CD Endoscopic Index of Severity score of <6 points) was performed.
RESULTS: Of 89 patients entering the study, 78 patients at Week 10 and 50 patients
at Week 54 completed the IBDQ. At baseline, mean IBDQ total score was 120.2. At
Week 10, mean change in IBDQ total score was 43.8 and the IBDQ remission rate
was 43.8%. At Week 54, mean change in IBDQ total score was 44.1 and the IBDQ
remission rate was 29.2%. In patients with endoscopic remission at Week 10, the
IBDQ remission rate was 69.7% compared with 33.3% in patients not reaching
endoscopic remission. Similar results were observed at Week 54. CONCLUSIONS:
Treatment with CZP at the recommended dose resulted in substantial improvement
in HRQoL at 10 and 54 weeks of therapy, measured by the IBDQ. Higher rates
of IBDQ remission were associated with endoscopic remission compared with
nonremission, warranting further evaluation of CZP therapy on HRQoL in CD. †Dr
Lémann died on August 26, 2010. We mourn the loss of our esteemed colleague.
HEALTH CARE USE & POLICY STUDIES – Consumer Role in Health Care
PHP1: KENYA’S VILLAGE AGING INSENSITIVITY TO AGING POLICIES
Nyabade G, Go Fishnet Youth Project, Kisumu, Nyanza, Kenya
OBJECTIVES: Since independence in Kenya in 1963, there has been great
challenges on policy making with regards to the village elderly and ageing. Inspite
of our current advocacies, sensitization and awareness programmes being carried
out by local non governmental humanitarian bodies and faith based entities, Kenyan
elderly and ageing men and women lack government concern, services and new
policies on especially the ageing village vulnerable ill-health policy and services
in their life insurance The aim and purpose of my paper is to highlight worthy
approaches and to identify areas of need as a priority in overcoming the impasse in
Kenyan policy on ageing and health. METHODS: We conducted a village research
on a door to door basis on policy and health development through Questionare as
part of a research project on dimensions and actions of health in old age in rural
communities in western Kenya and its policy implications. RESULTS: Five very
sensitive areas of evidence of lack of awareness and government lack of action
to the aged and ageing groups were highlighted. And required to 1) sensitize
and give strength to the case on why action on old age-related health should
be pursued, and 2) what action be taken to bring to light the uncertainties of the
aged and ageing groups in Kenyas most forgotten rural insensitive communities.
CONCLUSIONS: A continued formal research system on the five areas is essential
to promote awareness of policies on aged and ageing groups in the insensitive
villages and advocacy towards their ignorance and plight on matters related to
their life insurance, policy making and advancement towards scientific debate on
ageing and their health in the global community.
HEALTH CARE USE & POLICY STUDIES – Disease Management
PHP2: DESCRIBING TRENDS AND DETERMINANTS OF NON-OPIOID ANALGESIC
(NOA) PRESCRIBING IN CHRONIC NON-CANCER PAIN PATIENTS IN THE UNITED
STATES OUTPATIENT SETTINGS
Rasu R1, Fikru B1, Vouthy KK1, Rianon N2, Agbor Bawa W1, Knell M1, 1University of
Missouri-Kansas City, Kansas City, MO, USA, 2University of Texas Health Science
Center-Houston, Houston, TX, USA
OBJECTIVES: Cost of prescriptions is a large portion of the nation’s health care
expenditure. In 2007, the Kaiser Family Foundation estimated total prescription
costs to be $202 billion, demonstrating a large burden to the US economy. This
study evaluates determinates of non-opioid analgesic (NOA) prescribing patterns
in the USA from the National Ambulatory Medical Care Survey (NAMCS) from
2002-2007. METHODS: NOA prescribing trends were determined using drug codes
from NAMCS data. The data was collected on patients greater than 18 years, with
ICD-9-CM codes for chronic-non-cancer pain as reasons for office visits. The study
used cross-sectional analysis. A logistic model reported determinants of NOA
in the study population. RESULTS: A total of 22,967 analgesic prescriptions were
prescribed from 2002-2007 for men (37%) and women (63%) 18 years or older. Men
were 1.46 times more likely (p<0.05) to receive NOA than Women. Medicare and
Medicaid patients were 42% (p<0.01) and 44% (p<0.01) more likely to receive NOA
than patients with other insurance types. Patients seen by primary care physicians
(PCPs) were 56% (p<0.05) more likely to receive NOA than by non-PCPs. Low back
pain (LBP) patients were 60% more likely to get NOA prescribed than patients with
non-LBP. Geographical location was a statistically insignificant factor relating to the
likelihood of a being prescribed NOAs. Socio-economic, education, lifestyle, diet,
age group, ethnicity, and mental health status were also found to be insignificant.
CONCLUSIONS: Men, patients with Medicare, Medicaid, and LBP were more likely
to receive prescriptions for NOA. Physicians managing patients at risk of receiving
NOA, reported in our results, may benefit from seeking evidence based policy for
maximizing pain control in a cost-effective way.
91
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
PHP3: A REVIEW OF BREAST CANCER (BC) CARE AND OUTCOMES IN LATIN
AMERICA & CARIBBEAN (LAC)
Justo N1, Wilking N2, Jönsson B3, 1i3 Innovus, Stockholm, Sweden, 2Karolinska
Institutet, Stockholm, Sweden, 3Stockholm School of Economics, Stockholm,
Sweden
OBJECTIVES: Provide an overview of the burden of BC and of BC care and
outcomes in LAC. METHODS: Review of literature (PubMed, LILACS, SCIELO),
public databases (Globocan 2002 & 2008, CEPALSTAT, DIRAC, PAHO, WHOSYS,
etc) and conference presentations (ASCO, ISPOR). Latin-American experts and
patient organizations were surveyed. RESULTS: A total of 114,900 women present
with and 37,000 die of BC annually in LAC. BC exhibits the highest incidence and
mortality of all cancers, is steadily increasing and is expected to double by 2030.
Age is the principal risk factor. High incidence in Argentina and Uruguay (ASR
74-91/100,000) and younger age at diagnosis and death (mean 57y) in Peru, Mexico,
Colombia and Brazil translate into a heavy burden. LAC’s low 5-year survival
(~70-75%) is partly because ~30-40% patients are diagnosed in metastatic phases
III and IV. However, BC mortality-to-incidence ratios (MIR) improvements are
noticeable when comparing MIR2002 vs. MIR2008. Best MIRs are registered in
Argentina, Uruguay and Chile. Costa Rica shows the most progress; Brazil, Mexico
and Panama have not improved significantly. Suboptimal prevention policies; vast
inequalities in access to diagnosis and treatment, a fragmented organisation and
management of BC care, and poor uptake of evidence-based best practices were
observed. Universal healthcare coverage is not the rule in LAC and, even in those
countries where access to BC health services is guaranteed by law; resources
are insufficient. Availability of BC-specialized surgeons, waiting times, node
clearance policy and access to breast reconstruction vary greatly across countries
and between public and private settings. Radiotherapy equipment is insufficient
(except Uruguay, Chile, Venezuela). All modern systemic therapies are available
but some not widely diffused for cost considerations. Palliative care is developing
but, despite great efforts, many problems persist. CONCLUSIONS: Women go
undiagnosed, uncared for or treated with suboptimal therapies; which results in
high morbidity and associated societal costs.
HEALTH CARE USE & POLICY STUDIES – Drug/Device/Diagnostic Use & Policy
PHP4: SIGNIFICANT DECREASE IN THE HUNGARIAN HEALTH INSURANCE
PHARMACEUTICAL BUDGET BETWEEN 2006-2009
Boncz I1, Donka-Verebes É2, Oberfrank F3, 1University of Pécs, Pécs, Hungary,
2
Integra Consulting zRt., Budapest, Hungary, 3Institute of Experimental Medicine
(IEM)., Budapest, Hungary
OBJECTIVES: At the end of 2006, there was an important reform in the Hungarian
pharmaceutical market, including serious changes in the health insurance
reimbursement of medicines. The aim of our study is to analyze the changes in the
Hungarian health insurance pharmaceutical budget between 2006-2009. METHODS:
Data were derived from the nationwide administrative dataset of the National
Health Insurance Fund Administration (OEP), the only health care financing agency
in Hungary. We analyzed the changes of the pharmaceutical budget between
2006-2009. Results are given in Hungarian Forint (HUF), US dollars (USD) and Euro
(EUR). The annual average currency exchange rates were applied according to
the data of the Central Bank of Hungary. RESULTS: In the first year, the Hungarian
pharmaceutical budget decreased from 388.7 billion HUF (2006) to 323.6 billion
HUF (2007) by 65.1 billion HUF (16.7 %). This decrease was a bit moderate both
in Euro (0.18 billion EUR, 12.4 %) and in USD dollar (0.1 billion USD, 4.7 %) due to
the stronger Hungarian currency. For 2009, the pharmaceutical budget slightly
increased compared to 2007 up to 343.2 billion HUF which resulted in a decrease
from 2006 to 2009 by 45.5 billion HUF (11.7 %). The decrease between 2006-2009
was more significant both in Euro (0.25 billion EUR, 16.8 %) and in USD dollar (0.15
billion USD, 8.1 %) due to the weakened Hungarian currency. CONCLUSIONS: Due
to the reform of the whole Hungarian pharmaceutical market, the Hungarian health
insurance pharmaceutical budget significantly decreased between 2006-2009.
This decrease was moderate in EUR or USD between 2006-2007, however between
2006-2009 it became higher as the Hungarian currency weakened compared to EUR
or USD during the world economic crisis.
92
PHP5: MODELO TEORICO DE UN CONSUMIDOR: SELECCION ENTRE UN
BIOSIMILAR Y UN BIOTECNOLOGICO DE PATENTE BASADO EN PREFERENCIAS
Lechuga D, ITAM, México, D.F., México
OBJECTIVOS: Realizar un análisis teórico de las preferencias del paciente derivado
de la elección entre dos bienes: un medicamento biotecnológico de patente y un
medicamento biosimilar. METODOLOGÍAS: Suponemos que son bienes sustitutos
perfectos, pues el paciente no puede consumir los dos bienes al mismo tiempo,
debe elegir entre uno u otro. Definimos la función de utilidad del paciente como
U(BT,BS)=aBT+bBS. Donde, BT es el Biotecnológico de patente, BS Biosimilar,
a es la seguridad y eficacia del medicamento BT y b seguridad y eficacia del
medicamento BS. Entre más seguro y eficaz sea el medicamento el paciente lo
prefiere más. Entre mayor sea U su estado de salud es mejor. Suponemos que BT
tiene estudios clínicos confiables que demuestran su seguridad y eficacia y que
BS no presenta estudios clínicos y no se sabe su seguridad y eficacia real, por lo
tanto BT es preferido, es decir a>b. El paciente posee una restricción presupuestal
determinada por la ecuación y=PBTBT+PBSBS. Derivado de las inversiones en
estudios clínicos suponemos que PBT>PBS. La tasa marginal de sustitución está
determinada por la pendiente -a/b, es decir que el paciente sacrificará una
unidad de BT por b/a unidades del bien BS. Dada la restricción presupuestal, la
pendiente y tasa de sustitución objetivo es -PBT/PBS. RESULTADOS: De acuerdo a
las preferencias del consumidor, su consumo óptimo se determinan de acuerdo a
lo siguiente, si PBT/PBS<a/b solo consumirá BT, si PBT/PBS>a/b entonces el paciente
solo consumirá BS, y si PBT/PBS=a/b el paciente está indiferente entre consumir BT
o BS. CONCLUSIONES: Podemos concluir que las preferencias del paciente son
sensibles al precio y a la seguridad y eficacia del medicamento. Entre más seguro y
eficaz sea BT el paciente lo prefiere y estará dispuesto a pagar más.
PHP6: CUADRO BÁSICO Y CATÁLOGO DE MEDICAMENTOS DEL SECTOR SALUD:
ES ACTUALMENTE UN REFERENTE PARA LAS INSTITUCIONES PÚBLICAS Y/O
CUMPLE CON LOS OBJETIVOS DE SU CREACIÓN
Rivera-Peña G1, Vargas-Palacios A2, Barraza-Llorens M3, Gutierrez-Delgado
C1, 1Economic Analysis Unit, México, D.F., México, 2The University of Sheffield,
Sheffield, Sheffield, UK, 3Instituto Mexicano del Seguro Social, México, D.F., México
OBJECTIVOS: Analizar las actualizaciones hechas al cuadro Básico y Catálogo
de Medicamentos (CBM) del Sector Salud en el periodo 2006-2010. Analizar
el grado de apego al CBM en las compras de medicamentos realizadas por
diferentes instituciones del sector público de salud en el periodo 2006-2009.
METODOLOGÍAS: Se identificaron en el Diario Oficial de la Federación las
actualizaciones (inclusiones, modificaciones y exclusiones) realizadas al
CBM en el periodo de 2006-2010. Se analizó información de compra pública de
medicamentos para el periodo 2006-2009. Para el procesamiento de la información
se construyó una base de datos con la información en el programa estadístico
Stata. RESULTADOS: En el periodo 2006-2010 se han realizado 24 actualizaciones
al CBM. En total se realizaron 359 cambios de los cuales el 39% corresponden a
inclusiones, 53% actualizaciones y un 8% a exclusiones. El 78% de los cambios
fueron realizados al Cuadro Básico de Insumos para el primer nivel de atención y
el 22% restante al Catálogo de Insumos para el segundo y tercer nivel. Se identificó
que aproximadamente sólo se compró el 80% del total de medicamentos listados
en el CBM además de que se identificaron medicamentos cuyas presentaciones
y/o sustancias activas no se encuentran listados en el CBM. CONCLUSIONES: La
creación del CBM siguió tres objetivos fundamentales: promover la presentación
uniforme para los medicamentos que adquiera el sector público; servir como
instrumento de orientación para una prescripción adecuada así como evitar la
dispersión de criterios institucionales; y servir como guía para la adquisición
correcta de medicamentos. Los resultados encontrados dan evidencia de que estos
objetivos no se están cumpliendo por lo que es necesario reordenar y analizar el
contenido y uso que se da al CBM en las instituciones del sector público.
PHP7: IMPACT OF GLOBAL HEALTH CARE REFORMS ON PRICING, ACCESS AND
HEALTH ECONOMICS AND OUTCOMES STRATEGY
Aggarwal S, PAREXEL Consulting, Bethesda, MD, USA
OBJECTIVES: During 2009-2010 major health care reforms were proposed and
implemented in a number of nations, for example, Affordable Care Act in the
US, AMNOG in Germany, HSPT in France, KVG in Switzerland and NHS proposed
reform in the UK. These reforms have major implications on pricing, market access
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
and HEOR strategy for drug and device products. METHODS: To understand the
implications of these trends, we analyzed 2009-2010 reform bills and proposed
changes worldwide. Additionally, we interviewed public and private payers, key
opinion leaders and payer-influencers to understand implications of these reforms
on drug and device manufacturers. RESULTS: The global healthcare landscape is
expected to undergo significant change during 2011-2015. In the US, government
will play increased role as a single payer, especially with―Medicare, Medicaid
and CHIP programs― which will cover 114 million Americans, at a cost of $784
billion. In Germany, AMNOG bill marked the end of free drug pricing and would
lead to increased insurance premiums (now 15.5% of wages). In the UK, NHS has
proposed to replace PCTs with 500-1000 GP-led consortia and use value-based
pricing for expensive drugs and devices. Overall, payers view that in the future,
health economic assessments would play critical role in pricing, coverage and
reimbursement of branded products. CONCLUSIONS: This analysis shows that
global healthcare landscape is expected to undergo significant change during
2011-2015. Discussions with payers, KOLs and payer-influencers highlights
increased importance of HEOR data in the future.
PHP8: MEASURING ADHERENCE TO DRUG TREATMENT IN MEXICAN PATIENTS: A
SYSTEMATIC REVIEW
Uc-Coyoc R, Pérez-Reynaud AG, Coello-Reyes LA, Rodriguez-Díaz Ponce MA,
Instituto Mexicano del Seguro Social, México, D.F., México
OBJECTIVES: Measuring the level of adherence to drugs is relevant to assess the
clinical benefits of prescribed treatments. Adherence can be defined as the extent
to which a patient intake of medicines coincides with the medical prescription. The
purpose of this study is to review the degree of adherence to drugs among Mexican
patients as part of the overall medical therapy. METHODS: A systematic review
was performed to retrieve information on quantity measures of drug adherence
to medical treatments in Mexico. Key words such as “treatment and patient
adherence,” “drug compliance” and “drug utilization” were searched in Pub Med,
Medline, Embase, Medic Latina, and the Cochrane Library of Systematic Reviews
from 1998 to 2010. RESULTS: Few published studies in Mexico quantify the extent of
adherence to drugs among Mexican patients. Most of these studies measured drug
adherence in three chronic diseases: diabetes, HIV/AIDS, and rheumatoid arthritis.
These were carried out at the regional level with patients from public health
institutions. The main methods used were pill-count, questionnaires, and interviews
with patients. Adherence to diabetes medication reported frequencies in the range
of 17.2%- 54.2%, while in antiretroviral treatment for HIV/AIDS, the range was from
42% to 85.3%. One study reported adherence to disease-modifying antirheumatic
drugs in stable patients with early rheumatoid arthritis of 50.5%, with an increased
risk of non-adherence as the drug treatment scales-up. CONCLUSIONS: The range
of frequencies for drug adherence among diabetic and HIV/AIDS patients varies
widely. This can be attributed to the different methods used to measure adherence
and the lack of a standardized measuring technique. Adherence results are derived
from regional studies; therefore, further research is needed in order to obtain
estimates with national representation. This is important for the design of drug
policies aimed at enhancing drug adherence to maximize the health benefits from
treatments.
PHP9: PREDITORES DA QUANTIDADE DE MEDICAMENTOS TOMADOS EM
PESSOAS COM DOENÇA CRÓNICA
Pais-Ribeiro J1, Silva I2, Meneses R2, Pedro L3, Cardoso H1, Abreu M1, Melo V1,
Martins A1, Vilhena E1, Mendonça D1, Martins-da-Silva A1, 1Porto University, Porto,
Portugal, 2Fernando Pessoa University, Porto, Portugal, 3Polytechnic Institute,
Lisboa, Portugal
OBJETIVOS: O objetivo do presente estudo é identificar os principais preditores
da quantidade de medicamentos tomados por indivíduos com doenças crónicas,
de entre diferentes variáveis demográficas, de doença, personalidade, qualidade
de vida e psicossomáticos. MÉTODOS: Participantes são 603 indivíduos, com
41,19 anos de idade média, escolaridades média de 9,87 anos, 72,5% mulheres,
portadores de uma das seguintes doenças crónicas: epilepsia, diabetes tipo
1 e 2, cancro, miastenia gravis, esclerose múltipla, obesidade mórbida, com
diagnóstico há mais de três anos. As variáveis avaliadas foram, o número de
medicamentos que o indivíduo toma como variável dependente, e como variáveis
independentes, variáveis psicossociais, tais como, personalidade (neuroticismo
e extroversão), afecto positivo e negativo, componentes mental e físico do SF-36,
sintomas psicossomáticos (dimensões, sistema nervoso, muscular e digestivo),
variáveis demográficas (idade e escolaridade), e variáveis de doença (numero
de anos de diagnóstico, número de internamentos no último ano, percepção da
gravidade da doença). Recorreu-se à regressão linear hierárquica que incluía o
número de medicamentos tomados como variável dependente e como variáveis
independentes, no primeiro passo as variáveis demográficas, no segundo passo,
as variáveis de doença, e no terceiro as variáveis psicossociais. RESULTADOS: A
solução explica 20,6% da variância da variável dependente. Cada bloco acrescenta
valores estatisticamente significativos à solução. Os resultados sugerem que um
quinto da variância na quantidade de medicamentos tomados é explicada pelas
variáveis psicossociais em que, no modelo final, as variáveis demográficas e de
doença são excluídas da solução. Das variáveis independentes, os principais
preditores são, o neuroticismo (t=5,62) os componentes físico e mental do SF-36,
(t=5,45, e t=5,03) e o sistema nervoso da variável psicossomática (t=5,45) todos com
um nível de significância p<0,0001. CONCLUSÕES: Um programa de intervenção
que melhore a qualidade de vida é passível de contribuir para a redução na tomada
de medicação não essencial
PHP10: MEDICATION USE EVALUATION OF EXPENSIVE AND BROAD-SPECTRUM
ANTIBIOTICS IN SONGKHLA HOSPITAL
Thoedratanaphong OS, Preechavechakul P, Songkhla Hospital, Songkhla, Thailand
OBJECTIVES: To evaluate expensive and broad-spectrum antimicrobials usage
in Songkhla hospital. METHODS: A prospective, chart review was performed
on all inpatients initiated with Levofloxacin, Meropenem, Imipenem/ Cilastatin,
Piperacillin/ Tazobactam and Cefoperazone/ Sulbactam from March to December
2010. Pharmacist interventions were made when medication use evaluation
(MUE) criterias were not met and/or drug related problems (DRPs) were detected.
RESULTS: Overall, 347 patients received 412 courses with these antibiotics.
Percentage of empiric therapy was 80 % and specific therapy was 20 %. Pneumonia and sepsis/septic shock were leading indications of these antibiotic
uses. Cefoperazone/Sulbactam was the most frequently used. The appropriate
use of Levofloxacin, Meropenem, Imipenem/Cilastatin, Piperacilin/Tazobactam
and Cefoperazone/Sulbactam was 46%, 40%, 46% 70% and 53% respectively. No
indication and incorrect drug dosage especially in patients with renal impairment
were the most common misuse of these antibiotics. Acceptance of interventions
from physician was 86% (25/29). The cost of inappropriate use of these antibiotics
was 28,789 USD. CONCLUSIONS: MUE program should be continuously performed
for effective use of antibacterial drug, safety and most benefit.
PHP11: THE USE OF METHYLPHENIDATE IN A GROUP OF PATIENTS WITH
ATTENTION DEFICIT AND HYPERACTIVITY DISORDER
Gomez-Galicia DL1, Rodriguez-Fragoso L1, Lopez Aymes G1, Sánchez-Alemán M2,
Reyes-Esparza JA1, 1Universidad Autonoma del Estado de Morelos, Cuernavaca,
Morelos, México, 2Instituto Nacional de Salud Pública, Cuernavaca, Morelos,
México
OBJECTIVES: to describe the use of stimulants in a group of Mexican children
with ADHD in order to know some pharmacoepidemiological data METHODS: An
observational and descriptive study in pediatrics patients based on a survey in a
one year period (June 2009-June 2010) was done. Survey was answered by children
parents who signed an informed consent. Patients with diagnosis of ADHD and/
or received stimulant treatment with and without co-morbidity were considering.
RESULTS: Of 124 surveys, 85 were selected according to inclusion criteria. 61.2% of
patients received pharmacologic treatment; the drug most use among them was the
stimulant methylphenidate (94%). The mean age of stimulant users was 7.94 years
(4-13 years), 81.2% were male, 76.5% were in a primary school and 94% had a nonpharmacologic treatment. The average daily dose was 13.95mg. Immediate release
was the most prescribed form in three different commercial presentations, and 8%
received the long term release. Children with seven years old were who received
more methylphenidate prescription. The age and having a comorbidity increased
the probability (p<0.005) for receiving methylphenidate treatment. The most frequent
side effect reported was loss of appetite. CONCLUSIONS: Methylphenidate in an
immediate action form was the most prescribed stimulant drug in seven years old
children with ADHD in the population studied. High percentage of children received
methylphenidate treatment.
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HEALTH CARE USE & POLICY STUDIES – Equity and Access
PHP12: THE RATIO OF PUBLIC REIMBURSEMENT AND PATIENTS’ CO-PAYMENT IN
THE FINANCING OF SPA SERVICES IN HUNGARY
Turcsanyi K1, Domján P1, Boncz I2, 1University of Pécs, Zalaegerszeg, Hungary,
2
University of Pécs, Pécs, Hungary
OBJECTIVES: Hungary has long and strong traditions in providing spa services.
The reimbursement of spa services includes both public health insurance scheme
and patient co-payment. The aim of our study is to explore the ratio of public
reimbursement and patients’ co-payment in financing of spa services in Hungary.
METHODS: Data were derived from the nationwide administrative dataset of
the National Health Insurance Fund Administration (OEP), the only health care
financing agency in Hungary covering the year 2007. We calculated within the total
spa spending the annual health insurance reimbursement and the patients’ copayment at county and regional level. Hunmgary is devided into 7 regions and 20
counties. RESULTS: On nationwide level, the average ratio of patients’ co-payment
was 28.0 %, while the remaining 72.0 % was reimbursed by the National Health
Insurance Fund Administration (OEP). At regional level, the ratio of patients’ copayment varied between 22.7 % (in the Northern-Great Plane region) and 35.4 % (in
the Western-Transdanubian region). At county level, we found the lowest ratio of
patients’ co-payment in county Csongrád (19.8 %), Hajdú-Bihar (21.3 %) and Békés
(23.1 %), while the highest ratio of patients’ co-payment was observed in county
Zala (53.4 %), Veszprém (46.6 %) and Somogy (33.3 %). CONCLUSIONS: In financing
of spa services in Hungary, patient co-payment has a significant role: 28.0 % of total
expenditures. There are important inequalities in the ratio of patient co-payment at
both regional and county level.
PHP13: GEOGRAPHICAL INEQUALITIES OF HOME CARE (NURSING) IN HUNGARY
Cs. Horváth Z1, Molics B1, Ágoston I1, Sebestyén A2, Boncz I1, 1University of
Pécs, Pécs, Hungary, 2South-Trasdanubian Regional Health Insurance Fund
Administration, Pécs, Hungary
OBJECTIVES: Home care (nursing) was introduced into the Hungarian basic health
insurance package in 1996. The aim of our study is to analyze the geographical
inequalities in home care (nursing) in Hungary. METHODS: Data were derived
from the nationwide administrative dataset of the National Health Insurance
Fund Administration (OEP), the only health care financing agency in Hungary. The
utilization of home care (nursing) services was measured by the number of patients
and the number of visits. The geographical inequalities were calculated for county
level. Both indicator was calculated to 10.000 population. RESULTS: The average
number of patients in the Hungarian home care system was 50 / 10.000 population.
We found the highest utilization in the following counties: Zala (65), Baranya (65),
Jász-Nagykun-Szolnok (64), Vas (59), Csongrád (54), Borsod-Abaúj-Zemplén (54)
and Győr-Moson-Sopron counties. The lowest utilization rate was measured in
Komárom-Esztergom (43), Fejér (43), Nógrád (38) and Szabolcs-Szatmár-Bereg (26)
counties (all are for 10.000 population). The average number of home care visits
was 1188 visits/10.000 population at national level. The number of home visits was
the highest in Fejér (1342), Komárom-Esztergom (1333), Jász-Nagykun-Szolnok
(1327), Nógrád (1310), Győr-Moson-Sopron (1285) counties. The lowest home visit
rate was measured in Budapest (1162), Somogy (1142) and Szabolcs-Szatmár-Bereg
(614) counties (all are for 10.000 population). CONCLUSIONS: We found significant
inequalities in the utilization of home care (nursing) in Hungary measured both by
the number of patients and the number of visits per 10.000 population.
PHP15: IMPLICATIONS OF LATIN AMERICAN PHARMACEUTICAL PRICING REFORM
FOR THE UK NHS
Shankland BDT, Kirpekar S, Double Helix Consulting, London, UK
OBJECTIVES: Mexico and Brazil have well-developed pharmaceutical pricing
systems, with an increasing trend towards use of Health Technology Assessment
in access decisions. However, there are significant differences in the prices of
innovative medicines in the two countries. The object of the study is to clarify to
what extent local decision making criteria can account for these discrepancies
and therefore which evaluation mechanisms may have international relevance.
METHODS: Secondary research was carried out to identify prices in Brazil and
Mexico for 5 patented oncology medicines. A rating scale was then devised with
the following decision domains for pricing and reimbursement: international
referencing; cost-plus analysis; economic evaluation and budget impact;
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innovation; unmet needs; therapeutic referencing; negotiated agreements; demand
side controls; and societal benefit. In primary research 4 senior stakeholders in
Brazil and Mexico were asked to rate the importance of these domains in access
decisions, and provide a rationale. RESULTS: Decision criteria in Mexico and
Brazil reflect the historical origins of their respective health systems, but recent
developments reflect a centralising trend in decision-making in both countries.
This suggests that economic evaluation will increasingly determine access
in both countries but pricing criteria will remain different, notably due to the
greater role of price negotiation in Mexico. CONCLUSIONS: The mix of empirical
and context-based decision criteria in Brazil and Mexico represent valuable
alternative models for other countries, such as the UK National Health Service
(NHS), which is currently contemplating a move towards “value-based pricing” for
pharmaceuticals. In particular, Mexican and Brazilian evaluation mechanisms may
inform future considerations of therapeutic innovation in the UK.
PHP16: WAITING TIME AND ITS IMPLICATIONS ON THE UTILIZATION OF
ANTENATAL SERVICES IN A FREE SERVICE PROVISION SETTING IN THE ASANTE
AKIM NORTH MUNICIPAL, GHANA
Agyei-Baffour P, Nakua E, Agyemang P, Owusu-Dabo E, Kwame Nkrumah
University of Science and Technology (KNUST), Kumasi, Ashanti, Ghana
OBJECTIVES: The study sought to estimate the waiting time and assess its
implications on the utilization of antenatal services in the Asante Akim North
Municipal, Ghana. METHODS: The study was a cross sectional descriptive
type using both qualitative and quantitative methods. In all 200 pregnant
women presenting at the Konongo Odumasi Government Hospital and the
Agogo Presbyterian Hospital were randomly selected for the study. Structured
questionnaires were used to obtain data from respondents. Key informant and
household heads interviews were also conducted and used to augment the
information obtained. Descriptive and inferential statistics were used in the data
analysis; statistical differences were set at 0.05 or less and at 95% confidence
interval. RESULTS: Of the 200 respondents 35.5% (71) made four visits and 64.5%
(129) made one or more visits. Pregnant mothers had to forego GH¢ 31(US$ 22.14)
and GH¢ 15(US$10.17) as their incomes whenever they attended ANC. Significant
differences existed between national health insurance policy holders and antennal
clinic (ANC) visits (p=0.022), trimester of pregnancy and ANC visits (p<0.001), and
place of residence (indicating distance to health facility and ANC visits (p=0.017).
CONCLUSIONS: Long waiting is associated with high opportunity cost and are likely
to reduce utilisation of ANC services in a free services provision setting. Further
studies on feasibility of creating of separate pharmacy, laboratory and records units
for antenatal clinic users and effects of waiting time on service utilization may be
helpful to improve utilization of ANC services and reduction in pregnancy related
maternal mortality.
HEALTH CARE USE & POLICY STUDIES – Formulary Development
PHP17: MEXICO’S NATIONAL AND INSTITUTIONAL ESSENTIAL MEDICINE LISTS
Rivas R, CENETEC, México, D.F., México
BACKGROUND: Essential medicines are those that satisfy the priority health
care needs of the population. They are selected with due regard to public health
relevance, evidence on efficacy and safety, and comparative cost-effectiveness.
To be selected, medicines must be available through health systems, in suitable
amounts and dosage forms. The Essential Medicines List can help countries
rationalize the purchasing and distribution of medicines, thereby reducing costs
to the health system. Most countries have national lists and some have provincial,
state or institutional lists as well. Mexican Health System has 2 main institutions
who provide healthcare services to population: IMSS and ISSSTE; each of them
have an institutional list and also there is a National essential medicine list.
OBJECTIVES: To compare the National essential medicine list with the institutional
lists of IMSS and ISSSTE. METHODS: The National essential medicine list (2009
version) and the latest web versions available for the essential list of each
institution where analyzed to compare by product key and by generic name for
each of the 23 therapeutic groups excluding the groups referring to vaccines,
nutrimental components and electrolytic solutions. RESULTS: There were a wide
difference between the national essential list and the institutional list especially
in the group for treating endocrinology, oncology and infectius conditions. Also
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there were big differences for more than 50% of the therapeutic groups examined
between the institutions. CONCLUSIONS: There remains, significant opportunity for
improvement of the national and institutional essential medicines list because don´t
seem to be uniform criteria to selection.
HEALTH CARE USE & POLICY STUDIES – Health Care Costs & Management
PHP18: IMPACTO DE LA PARTICIPACION DEL FARMACEUTICO COMO PARTE DEL
EQUIPO DE SALUD EN EL PRIMER NIVEL DE ATENCION SOBRE LOS COSTOS
Mino-Leon D1, Contreras-Hernandez I2, Anaya P3, Reyes A4, 1Instituto de Geriatría,
México, D.F., México, 2Instituto Mexicano del Seguro Social, México, D.F., México,
3
GlaxoSmithKline México, México, D.F., México, 4Universidad de la Sierra Sur,
Oaxaca, Miahuatlán de Po, México
OBJECTIVOS: Analizar el ahorro en costos por la intervención del farmacéutico
sobre errores de prescripción, desde la perspectiva del proveedor de servicios de
salud. METODOLOGÍAS: Análisis de costo-efectividad, tipo árbol de decisiones.
Se estimaron costos y efectividades de incluir en las decisiones médicas un
farmacéutico y corregir prescripciones de antihipertensivos e hipoglucemiantes
combinados con analgésicos e hipolipemiantes. La medida de efectividad fue
la probabilidad de otorgar prescripciones farmacológicas sin eventos adversos
graves (EAG), con horizonte temporal de 30 días. La probabilidad de corrección por
la intervención del farmacéutico se obtuvo a través de un ensayo clínico (EC) y la
probabilidad de la ocurrencia de EAG (hemorragia gastrointestinal, rabdoimiolisis,
enfermedad vascular cerebral y fractura de cadera) como consecuencia de la
no corrección se obtuvo de la literatura publicada. Se estimaron los costos de
la atención médica con y sin farmacéutico del EC y los costos esperados de los
EAG de publicaciones de costos nacionales. Los costos son expresados en pesos
mexicanos del 2010. RESULTADOS: Costo promedio por paciente esperado sin la
intervención del farmacéutico durante el horizonte temporal fue de $12,481.60 y el
costo promedio por paciente con la intervención fue de $9,127.97, lo que significó
disminución en el costo por paciente de 27%. El número de prescripciones que
evitaron interacciones riesgosas fue superior con la presencia del farmacéutico
y la posibilidad de que un paciente no presentara alguno de los desenlaces
evaluados por efecto de la intervención de manera oportuna aumentó en 11%.
El costo por paciente sin EAG de manera habitual fue de $16,981.77 mientras que
con la intervención del farmacéutico fue de $11,158.89. La razón costo efectividad
incremental demostró que por cada paciente adicional sin EAG el sistema de salud
ahorra $40,405.18. CONCLUSIONES: La inclusión del farmacéutico en el equipo de
atención fue costo-ahorradora.
PHP19: INCREASED MARKET SHARE OF PRIVATE, FOR-PROFIT HEALTH CARE
PROVIDERS FROM THE HUNGARIAN HEALTH INSURANCE BUDGET BETWEEN
2006-2009
Boncz I1, Endrei D1, Molics B1, Ágoston I1, Turcsanyi K2, Domján P2, Betlehem J1,
Oláh A1, Sebestyén A3, 1University of Pécs, Pécs, Hungary, 2University of Pécs,
Zalaegerszeg, Hungary, 3South-Trasdanubian Regional Health Insurance Fund
Administration, Pécs, Hungary
OBJECTIVES: The potential role of private health care providers and privatization
has been under heavy discussion in many countries. In the Hungarian health
care, there was a clearly supporting health policy regarding the increasing role
of private health care providers. The aim of the study is to analyze the market
share of for-profit private sector from the public health insurance expenditures on
medical services. METHODS: Data were derived from the nationwide administrative
dataset of the National Health Insurance Fund Administration (OEP), the only
health care financing agency in Hungary, covering the period 2006-2009. The
analysis includes the medical provisions (primary care, health visitors, dental care,
out- and inpatient care, home care, kidney dialysis, CT-MRI). We calculated the
health insurance reimbursement according to the following categories of health
care providers’ ownership status: local authorities, central government, for-profit
companies and non-profit providers. RESULTS: In 2006 only 15.8 % (112.8 billion
Hungarian Forint, HUF) of total expenditure for medical services went to for-profit
private providers, 53.9 % to local authorities, 24.7 % to central government and 5.6
% to non-profit sector. For 2009, the market share of private for-profit health care
providers increased to 30.9 % (222.3 billion HUF), the local authorities had 43.8 %,
the central government 22.7 % and the non-profit sector 2.5 % market share. We
found the largest increase of private for-profit health care providers in acute (from
0.8 % in 2006 to 14.3 in 2009) and chronic care (from 1.1 % in 2006 to 20.6 % in 2009).
CONCLUSIONS: In line with the health policy objectives between 2006-2009, we
found a significant increase of private for-profit companies from health insurance
financing: they doubled their market share from 15.8 % (2006) to 30.9 % (2009). This
increase was attributed to the “functional” privatization of acute and chronic care
hospitals.
PHP20: ECONOMIC EVALUATION OF POISON CONTROL CENTERS: A SYSTEMATIC
REVIEW
Galvao TF1, Silva EN2, Silva MT2, Pereira MG3, 1Federal University of Amazonas,
University of Brasilia, Brasilia, DF, Brazil, 2Brazilian Ministry of Health, Brasília, DF,
Brazil, 3University of Brasilia, Brasilia, DF, Brazil
OBJECTIVES: The aim of this review is to systematically summarize and assess
the existing economic evaluations of poison control centers (PCCs). METHODS:
A literature search was performed to identify complete economic evaluations
regardless of language or publication status by searching the following databases:
Medline (via Pubmed), Embase, Centre for Reviews and Dissemination Databases,
Cochrane Library, Cochrane Central, metaRegister of Clinical Trials, LILACS, SciELO,
ProQuest, Capes (Brazilian theses register) databases and abstracts at toxicology
congresses., Two reviewers assessed abstracts for inclusion and extracted the
data. Two experts assessed studies’ quality with a standardized tool (Drummond
2005). RESULTS: A total of 365 non-duplicated reports were identified, but only
nine met eligibility criteria. Five studies were published in the 1990s, and four were
published in the following decade. PCCs were compared to a scenario in which
they did not exist. Benefits were measured as potentially avoided healthcare
charges. Eight studies used cost-benefit analyses, and the other one used a
cost-effectiveness approach. Only two studies did not meet at least seven of 10
quality criteria. Cost-benefit ratios ranged from 0.76 to 7.67, what means that each
dollar spent on poison centers saves almost US$ 8 in other medical spending.
Incremental cost-effectiveness ratios were US$ -12,000 for morbidity and -56,000 for
mortality. These results indicate that a significant cost savings is realized with each
successful outcome achieved by a poison center: US$ 12,000 in case of morbidity
and US$ 56,000 in case of mortality. CONCLUSIONS: Investment in PCCs appears
to be a rational public health policy. They could improve health care expenditure
efficiency and contribute to the sustainability of the health system. However, the
number of PCCs is decreasing in many countries.
PHP21: MEDICAL SERVICES COST INFLUENCE ON THE RATIONALITY OF NEW
MEDICAL TECHNOLOGY INTRODUCTION
Kozhanova I1, Romanova I1, Gavrilenko L1, Voitenkova L2, 1The Belarus State Medical
University, Minsk, Belarus, 2Belarusian National Technical University, Minsk,
Belarus
OBJECTIVES: To define the value medical services cost while conducting
pharmacoeconomic analysis. METHODS: A review of pharmacoeconomic
researches of 5-alpha reductase inhibitors (5-ARI) application for treatment benign
prostatic hyperplasia (BPH) has been conducted. The average prices for medical
services for care and treatment of BPH patients have been defined. The prices
analysis of the medical services Belarusian market in a “urology” specialty has
been made. The average prices comparison (in US dollars) of the actual medical
services and prices taken from medical literature has been done. RESULTS:
The foreign medical literature review of using the 5-ARI for BPH patients shows
the considerable economic expenses because of an acute urinary retention
hospitalization and surgical treatment necessity. The medical services cost in
Belarus is considerably cheaper to compare with the costs given by foreign
researchers’ reviews. We have specified three procedures giving the significant
contribution to the above-stated discrepancies: the urologist examination cost
in the USA 9 times exceeds the similar procedure in our country (47,9$ vs. 5$),
transurethral resection (TURP) performance is 5 times (793$ vs. 159$) and 1 day
hospitalization cost without operative interventions and anesthesia is 364 times
(4809$ vs. 13,2$) more. CONCLUSIONS: Hospital services and the medical staff
work high cost in western countries allows proving economically out-patient
application of expensive treatment methods. The end-points choice of the
events demanding hospitalizations is not optimum at making pharmacoeconomic
researches in Belarus because of the low contribution in hospital expenses vs
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Research Poster Abstracts
the drug therapy cost. A complex approach with integration of several economic
analyses is required to introduce new expensive innovative drugs on the Belarusian
pharmaceutical market.
PHP22: USE OF DECISION MODELING TO ESTIMATE THE NEGATIVE IMPACT OF
TOBACCO USE ON HEALTH CARE COSTS AND HEALTH DISPARITIES IN PEOPLE
LIVING WITH HIV
Burbano-Levy X, Miguez MJ, Thompson M, Medina A, Quiros C, Malow R, Florida
International University, Miami, FL, USA
OBJECTIVES: After people living with HIV (PLWH) start on highly active
antiretroviral therapy (HAART), rates of hospitalization for PLWH’s declined, but
continued still occurred at high levels. The increased prevalence of tobacco
use among PLWH and paucity of current data provide the rationale to study
if tobacco use might affect cost and clinical benefits of HAART among PLWH.
METHODS: A decision-tree model guided our assessment of the impact of
tobacco on costs and effectiveness of HAART by race/ethnicity. Using a payer
perspective, the probabilities related with smoke habit for racial group (AfricanAmericans, Caribbeans, Hispanics, Caucasians) were extracted from our prior
tobacco study (n=560) along with the number of hospitalizations. This information
along with hospital bed/day costs, provided by Jackson Memorial Hospital’s
patient accounting system, was used to estimate the impact of the tobacco with
a 1-year time frame. Results were express as cost per hospitalizations related
to smoking diseases (HRSD) RESULTS: Among patients receiving antiretroviral
therapy, our data indicated that smoking contributed a $480,029 additional cost/
year, with an average of $6,234/HRSD and an incremental cost of $ 4,750 compared
to non-smokers in the same treatment group. In the Non-HAART Group, the
incremental cost for smokers was $2,064,469, with an average of $8,054/HRSD
and an incremental cost of $7,486. When racial group were evaluated for smoking
habit, the average costs for Hispanics receiving HAART was $10,975/HRSD. African
Americans despite the high cost reported for the total group had an average cost
of $8011/HRSD. CONCLUSIONS: In PLWH receiving HAART, our analysis indicated
that the benefits of HAART were negatively impacted by tobacco use and costs
are increased in the smokers in both the HAART and Non-HAART groups. The data
also indicated that focusing tobacco prevention efforts on minorities may maximize
effectiveness in terms of disease prevention and cost reduction
PHP23: LA ACEPTACION DE LAS VACUNAS EN LOS PROGRAMAS NACIONALES DE
INMUNIZACION EN LATINA AMERICA: UN ESTUDIO COMPARATIVO
Jones K, PriceSpective Ltd., London, UK
OBJECTIVOS: A un con un precio alto, la vacuna de VPH se ha asegura do
una rápida inclusión en los programas nacionales de inmunización (PNI) en
economías avanzadas y emergentes. Por el contrario, otras vacunas nuevas, han
encontrado una aceptación más lenta en economías emergentes. El objetivo de
esta investigación es comparar el acceso al mercado de esta vacuna con los de
las vacunas contra el neumococo y la del Hib, con el fin de entender los criterios
subyacentes en la exitosa aceptación de una vacuna. METODOLOGÍAS: Cinco
países de Latina América fueron considerados en este estudio. Todos los países
participaron en un debate nacional de al menos dos de las vacunas sobre la
inclusión en el PNI. Se recopilaron los siguientes datos: fecha de autorización
comercial y de inclusión en el PNI, precio, restricciones de acceso y fuentes
de financiación. Se llevó a cabo una revisión cualitativa de la literatura y de las
publicaciones de los Ministerios de Salud de estos países para hacer un estudio
comparativo de las tres vacunas. RESULTADOS: Nuestro análisis muestra en
todos los países una clara diferencia entre la financiación del VPH y de las
otras vacunas, con poca consistencia en el razonamiento económico y político.
Por ejemplo, los altos costos se citan como barrera al acceso, sin embargo las
poblaciones incluidas en los programas de vacunación del VPN son más grandes
que en los países industrializados. CONCLUSIONES: Los factores adicionales que
influyen en la aceptación de una vacuna varían dependiendo de los actores
principales del debate nacional. Políticamente, las voces de los activistas contra
el cáncer pueden aumentar la percepción del valor social de una vacuna en
particular. Estos factores son muy importantes y van más allá de la evaluación
económica del proceso de inclusión de vacunas en los PNIs.
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PHP24: COMPARAÇÃO DA QUALIDADE DE VIDA ENTRE PESSOAS COM DOENÇAS
CRÓNICAS E PESSOAS DA COMUNIDADE SEM DOENÇA
Pais-Ribeiro J1, Silva I2, Pedro L3, Meneses R2, Cardoso H1, Abreu M1, Melo V1,
Martins A1, Martins-da Silva A1, Vilhena E1, Mendonça D1, 1Porto University, Porto,
Portugal, 2Fernando Pessoa University, Porto, Portugal, 3Polytechnic Institute,
Lisboa, Portugal
OBJETIVOS: O objetivo da investigação é comparar a qualidade de vida (QOL) de
pessoas portadoras de doenças crónicas com diagnóstico superior a três anos,
com pessoas da comunidade sem doença, do mesmo grupo etário e género.
MÉTODOS: Participam 603 indivíduos com 41,19 anos de idade média, escolaridade
média de 9,87 anos, 72,5% mulheres, portadores de uma das seguintes doenças
crónicas: epilepsia, diabetes tipo 1 e 2, cancro, miastenia gravis, esclerose
múltipla, obesidade mórbida, com diagnóstico há mais de 3 anos. Depois de
satisfazer as exigências éticas expressas nos códigos e na lei, avaliámos as
seguintes variáveis: componentes, mental e físico, do MOS SF-36. O procedimento
consistiu em subtrair o valor de cada componente da população sem doença ao da
população com doença. RESULTADOS: No total, 28% da população com doença
reportava qualidade de vida superior à dos seus contrapartes sem doença. Estes
valores variavam de modo estatisticamente significativo entre doenças (χ2=0,002)
com, respectivamente 10% dos participantes com miastenia gravis reportando
QOL superior, 35,8% no cancro, 23,4% na obesidade mórbida, 43% na epilepsia,
22% na esclerose múltipla, 20% na diabetes tipo 2 e 32,5% na diabetes tipo 1.
CONCLUSÕES: Os resultados mostram que uma percentagem significativa de
pessoas com doenças crónicas, controladas e estabilizadas, vive com QOL superior
à dos seus pares sem doença, embora esses valores variem substancialmente com
a doença. A idade não se correlaciona de modo estatisticamente significativo com
a diferença entre os grupos, para a componente mental e de modo estatisticamente
significativo embora baixo (r=0, 14) para o componente físico: os grupos com idade
mais jovem como a diabetes tipo 1 e epilepsia mostram uma maior percentagem de
pessoas com melhor QOL, mas os com cancro exibem uma média de idade média
mais elevada e a esclerose múltipla idade mais baixa
PHP25: VALIDITY AND RELIABILITY OF INSTRUMENTS USED FOR MEASURING
PATIENT SATISFACTION WITH PHARMACEUTICAL CARE SERVICES
Sakharkar PR1, Bounthavong M2, Law AV1, 1College of Pharmacy, Western
University of Health Sciences, Pomona, CA, USA, 2Veterans Affairs San Diego
Healthcare System, San Diego, CA, USA
OBJECTIVES: Patient satisfaction is an important patient reported outcome (PRO)
that is being used to document the impact of pharmacists’ clinical services,
especially in managing patients with chronic conditions. The purpose of this study
was to review literature on the validity and reliability of published instruments
that have been used to measure patient satisfaction with pharmaceutical care
in the community setting. METHODS: A structured search was conducted in
five databases (PUBMED, EMBASE, MEDLINE, PsycINFO, and OVID (1998–Feb.
2011) using keywords to identify studies that measured patient satisfaction with
pharmaceutical care using survey instruments. Studies conducted outside United
States, those which used non-English language questionnaire; abstracts from
conferences, reviews, letters or notes were excluded. Studies reporting patient
satisfaction results and/or psychometric properties were included. RESULTS: A
total of 21 studies were identified that met the selection criteria. The pharmacy
practice setting, sample size, study design in evaluating patient satisfaction varied
greatly. The survey instruments differed in number of items, response scale and
mode of administration. Majority of survey instrument were administered by mail.
The response rate varied from relatively low to very high. Patient satisfaction
was a secondary outcome in most of these studies. Majority of the studies used
self developed, non-validated or modified instrument with items from preexisting
instruments. Only few studies reported psychometric properties of the instrument
used. Inconsistency in use of instrument measuring patient satisfaction was
observed. In general, studies reviewed showed greater degree of overall patient
satisfaction with the services. CONCLUSIONS: In majority of studies patient
satisfaction was measured using non-validated instruments. There is a lack of
comprehensive, valid and reliable instrument for assessing patient satisfaction with
pharmaceutical care services in community setting. Use of a standardized survey
instrument, sampling and study design will provide valuable insight into patient
evaluation of pharmacist services. ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
PHP26: A SATISFAÇÃO DOS PROFISSIONAIS DE SAÚDE VS A SATISFAÇÃO DOS
UTENTES EM UNIDADES DE CUIDADOS CONTINUADOS
Anjos T1, Almeida A2, 1Santa Casa da Misericordia de Belmonte, Belmonte,
Portugal, 2Universidade da Beira Interior, Covilhã, Portugal
OBJETIVOS: Esta investigação teve como objectivo identificar o nível de satisfação
dos profissionais e dos utentes de unidades de cuidados continuados, a sua
diferença, avaliar e identificar a influência de algumas variáveis. MÉTODOS: A
metodologia utilizada foi quantitativa, descritiva e exploratória. O questionário
foi composto por duas partes, questionário de Luís Graça e EORTC IN-PATSAT32,
respectivamente. RESULTADOS: A amostra foi constituída por 41 profissionais
e 30 utentes. Os resultados encontrados mostraram a consistência de 7 das
18 hipóteses formuladas. Os profissionais estavam mais satisfeitos com as
dimensões “geral” e “condições de trabalho”, apresentando menor nível de
satisfação profissional com a dimensão “salário”. Ao nível de satisfação dos
utentes/clientes, estes estavam mais satisfeitos com a dimensão “satisfação
com os enfermeiros”, apresentando menor nível de satisfação com a dimensão
“satisfação com os médicos”. CONCLUSÕES: Os dados confirmam a existência de
correlação entre as dimensões salário, tipo de vínculo, actividade profissional e
estado civil com a satisfação profissional relativamente aos profissionais de saúde,
relativamente aos utentes/clientes os dados confirmam a existência de correlação
entre as dimensões “organização do serviço e cuidados”, “enfermeiros” e
“serviço hospitalar de onde teve alta” com a satisfação dos utentes/clientes, no
que respeita ao serviço hospitalar de onde teve alta, esta avaliação é algo de
inovador. Salienta-se o facto de os utentes/clientes e os profissionais de saúde se
encontrarem na sua maioria satisfeitos, a satisfação profissional, ao contrário da
satisfação dos utentes/clientes, varia em função da instituição. Será recomendável
que as administrações monitorizem frequentemente a satisfação, quer dos
profissionais, quer dos utentes, no sentido de ter um constante feedback, tendo
conhecimento das dimensões em que há uma maior satisfação ou insatisfação,
tendo assim a possibilidade de apurar/estudar alternativas para intervir no
sentido de proporcionar uma maior satisfação, uma vez que a satisfação é um dos
principais pontos para o sucesso de uma organização.
PHP27: THE ECONOMIC BENEFITS OF IMPLEMENTING A UNIT DOSE DRUG
DISPENSING SYSTEM AT THE HOSPITAL LEVEL IN THE MEXICAN INSTITUTE OF
SOCIAL SECURITY (IMSS)
Uc-Coyoc R, Pérez-Reynaud AG, Coello-Reyes LA, Rodriguez-Díaz Ponce MA,
Instituto Mexicano del Seguro Social, México, D.F., México
OBJECTIVES: In Mexico, two pilot studies in public hospitals assessed the
economic benefit of changing from a traditional, or ward stock, drug dispensing
system to a unit dose drug dispensing system. The aim of this study is to estimate
the total drug savings derived from implementing a unit dose system among
hospitals at IMSS. METHODS: Total and average hospital drug expenditures were
estimated based on hospital drug prescriptions data base for 2009. Statistical
analysis was performed to test for expenditure differences among levels of health
care. The percentages of economic savings derived from previous studies were
used to construct three economic benefit scenarios. These were applied to the
total hospital drug expenditure. The baseline scenario was obtained from studies in
Mexico that reported economic savings of 40%. A minimum and maximum scenario
of 14.4% and 67.7% were obtained from international studies. The exchange rate
was of $12.10 pesos per dollar. RESULTS: The total hospital drug expenditure was of
USD $499.3 millions. Most of the expenditure was derived from hospitals of general
and specialized level of care. Average expenditure and drug prescription dispensed
were statistically higher in the specialized compared to general hospitals (p=0.0002
and p=0.00009, respectively). The total economic drug savings from the baseline
scenario considering all hospitals was of USD$199.7 millions. In the maximum
and minimum scenarios, the economic savings were of USD$334.5 millions and
USD$71.9 millions respectively. On average savings were higher on specialized
than in general hospitals. CONCLUSIONS: The estimated economic benefits,
derived from implementing a unit drug dispensing system in hospitals at IMSS, was
equivalent to 7.9% of the 2009 institutional budget expenditure for medical related
spending in the baseline scenario. This suggests that this system can contribute to
the containment of costs and the rational use of medicines on behalf of the patients
and institutions.
PHP28: DECENTRALISATION OF HEALTH SERVICES PLANNING AND
MANAGEMENT: THE VARYING PERSPECTIVES OF HEALTH WORKERS AND
COMMUNITY MEMBERS AT NANUMBA NORTH DISTRICT, GHANA
Agyei-Baffour P, Atta K, Nakua E, Owusu-Dabo E, Kwame Nkrumah University of
Science and Technology (KNUST), Kumasi, Ashanti, Ghana
OBJECTIVES: To assesses the extent of varying perspectives between health
workers and community members’ perception of decentralization and how
such variation in views could affect the effective health services planning and
management in the Nanumba North District, Ghana. METHODS: A descriptive
analytical cross sectional survey with randomly selected community members
aged 18 or more years and health staff was undertaken from May – September
2009. Data collection was done with the use of questionnaire and interview guide
administered by university trained research assistants to 186 respondents; 120
community members, 66 health staff who had stayed or worked in the district for the
past 6-12months. Data was analysed into descriptive statistics using the Statistical
Package for Social Sciences (SPSS) version 15.0. The significance or otherwise of
the differences in perspectives was ascertained using chi-square or fishers exact
test with p-values of 0.05 or less and at 95% confidence interval. The study had
ethical clearance and Informed consent was sought from respondents. RESULTS:
A majority of health workers were females 74.2%, and young with average of
31.5yrs (SD, 9.3) and had worked for <5yrs, 56.1%. Community members, 47.5%,
were equally quite young but slightly older, mean years 34.8, (SD 8.4), than health
staff, and had lived in the community for <5yrs. There was significant differences
in perception between health staff of whether or not the district management team
(DHMT) was decentralised, p<0.05, and in perception regarding health planning
process and management of finances between health staff and community
members, p<0.05. CONCLUSIONS: Differences in perception between health staff
and community members partly account for low community involvement in health
planning and management, health activities and utilisation of health service. A
study involving many DHMTs will be needed to make a case for policy change as
the study focused on only one district.
PHP29: PREDICTORS OF APPROPRIATE USE OF INSECTICIDE TREATED NETS IN
AN URBAN COMMUNITY: THE CASE OF ASOKWA SUB-METROPOLITAN AREA,
KUMASI, ASHANTI, GHANA
Agyei-Baffour P, Mantey KG, Owusu-Dabo E, Kwame Nkrumah University of
Science and Technology (KNUST), Kumasi, Ashanti, Ghana
OBJECTIVES: To assesses the predictors of appropriate use of insecticides treated
nets (ITNs) in the Asokwa Sub-Metropolitan Area of Kumasi, Ashanti, Ghana.
METHODS: The research was conducted in five communities in the Asokwa Submetropolitan area of Kumasi, Ghana, with randomly selected 500 mothers and
caregivers, interviewed with questionnaire administration in their homes and in
the health facilities. The study was conducted from May – September, 2010. The
study had ethical clearance. Informed consenting processes were strictly followed.
Data was analysed using descriptive statistics and logistic regression to examine
the predictors of appropriate use of ITNs among children under five years at
95% confidence interval. Data was analysed into descriptive statistics using the
Statistical STATA version 11 software. RESULTS: The study found that 50% of the
participants owned ITNs, and of this only 67% used it the night before the study.
Meanwhile, 21% of those who owned the nets used them occasionally. Also 39% of
the total population did not own any ITN at all. The predictors of appropriate use of
ITNs were found to be income levels, health seeking behaviour of caregivers and
the room structure of participants. CONCLUSIONS: Appropriate ITN use in the study
area is determined by incomes of participants, room structures, and health seeking
behaviour of users. A comparative study between urban and rural communities
could be useful for nationwide intervention to improve current situation
PHP31: ANALISIS COSTO EFECTIVIDAD SECTORIAL DE 45 INTERVENCIONES
SANITARIAS EN CHILE
Vallejos C1, Castillo M2, Puebla S1, Orellana J1, Reveco R1, Valdés P1, Alarcón A1,
Merino W1, 1Universidad de La Frontera, Temuco, Chile, 2Ministerio de Salud de
Chile, Santiago, Chile
OBJECTIVOS: Apoyar la priorización de problemas de salud a ser incorporados
en las Garantías Explicitas en Salud, a partir del análisis costo-efectividad
de 45 intervenciones destinadas a reducir la mortalidad o discapacidad.
97
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
METODOLOGÍAS: Análisis Costo-Efectividad Sectorial. Se definieron los procesos
productivos para cada intervención (diagnóstico, tratamiento y seguimiento). Se
costearon 309 prestaciones, en base a una muestra de establecimientos públicos.
Los costos están expresados en moneda chilena a Junio 2009. La eficacia de cada
intervención se determinó por revisión sistemática. Se construyó un modelo de
historia natural (sin intervención) para cada enfermedad, y se contrastó con un
modelo que incorpora la intervención. El resultado de eficacia obtenido se ponderó
por adherencia, cumplimiento de prestadores, y cobertura, obteniendo así el
indicador de efectividad por caso incidente tratado. Los resultados de efectividad
se expresan en Disability Adjusted Life Years (DALY) evitados. Se aplica tasa de
descuento (6%) para costos y resultados. El horizonte temporal se define por
la expectativa de vida mediana para la cohorte de pacientes. RESULTADOS: Se
obtiene la razón costo-efectividad de cada intervención, y se construye un ranking
de costo-efectividad, identificando aquellas muy costo-efectivas, potencialmente
costo-efectivas, y no costo-efectivas. Se propone un umbral de pago por DALY
evitado: una intervención es muy costo-efectiva si previene 1 DALY a costo igual o
inferior a 1 PIB (producto interno bruto) per cápita: potencialmente costo-efectiva
si previene 1 DALY a un costo entre 1 y 3 PIB per cápita; y no costo-efectiva si el
resultado es mayor. CONCLUSIONES: Se proporciona una metodología y resultados
concretos que apoyan el proceso de toma de decisiones sanitarias en Chile. Al día
de hoy, varias de las intervenciones costo-efectivas han sido incorporadas a la Ley
de Garantías Explícitas. Se sugiere un umbral de pago por DALY evitado en el país
para futuras decisiones.
HEALTH CARE USE & POLICY STUDIES – Health Care Research & Education
PHP32: LINEAMIENTOS DE UNA POLÍTICA DE INVESTIGACIÓN EN SALUD EN
CHILE: ACUERDOS DE LA COMISIÓN TÉCNICA DE INVESTIGACIÓN SANITARIA
PARA EL PLAN NACIONAL DE SALUD 2011-2020
Espinoza MA1, Cabieses B2, Zitko P3, Castillo C3, Castillo M3, Jeria MM4, Valenzuela
MT4, Delgado M3, Ramirez J3, 1Pontificia Universidad Católica de Chile, Santiago,
Chile, 2University of York, York, UK, 3Ministerio de Salud de Chile, Santiago, Chile,
4
Instituto de Salud Pública de Chile, Santiago, Chile
OBJECTIVOS: Chile ha avanzado en el desarrollo de investigación en salud (IS).
Sin embargo, aún falta definir un marco conceptual que de soporte a una política
de IS de largo plazo. El nuevo Plan Nacional de Salud 2011-2020 (PNS) ha incluido,
por primera vez, como objetivo el desarrollo de IS en Chile. El presente reporte
presenta los lineamientos directrices de la política de IS en Chile para el nuevo
PNS. METODOLOGÍAS: El Ministerio de Salud convocó a un sub-comité de
profesionales vinculados a salud para desarrollar aspectos a considerar en una
política de IS. Se realizó una revisión de situación de IS en Chile, identificando
elementos teóricos y empíricos centrales para fortalecer su desarrollo. A partir
de múltiples encuentros de discusión temática, se definieron metas de IS al año
2020 y estrategias para su cumplimiento. RESULTADOS: El comité definió los
siguientes cinco lineamientos: 1) La inversión en IS-aplicada debe ser consistente
con objetivos de salud definidos por PNS; 2) IS se justifica desde el presupuesto
de salud si permite resolver incertidumbre de la autoridad sanitaria, reduciendo
el costo-esperado de decisiones incorrectas; 3) Se adopta el marco teórico de
investigación traslacional que incluye distintos niveles/tipos de IS, alineados con
necesidades/prioridades de la autoridad; 4) Se deben explicitar los tópicos de
IS y establecer mecanismos transparentes para su priorización (priority-settingmethodology); dichos tópicos deben articularse con la evaluación de nuevas
intervenciones y considerar la colaboración con sociedades-científicas; and
5) Se debe potenciar la vinculación pública-académica-privada en la ejecución y
financiamiento de proyectos. A partir de estos lineamientos, se definieron las metas
y estrategias para IS en PNS, conforme a necesidades, restricciones y desafíos
actuales del país. CONCLUSIONES: Este reporte destaca las bases conceptuales y
lineamientos del desarrollo de una política de IS en Chile. Las metas y estrategias
para el nuevo PNS son definidas a partir de esta iniciativa.
98
PHP33: KNOWLEDGE, ATTITUDE, AND PRACTICES (KAP) OF FOOD PRACTITIONERS
ON HAZARD ANALYSIS AND CRITICAL CONTROL POINT (HACCP) IN THE KUMASI
METROPOLIS, GHANA
Agyei-Baffour P, Boateng K, Nakua E, Otupiri E, Owusu-Dabo E, Kwame Nkrumah
University of Science and Technology (KNUST), Kumasi, Ashanti, Ghana
OBJECTIVES: To assess knowledge, attitude, and practices (KAP) of food
practitioners on hazard analysis and critical control point (HACCP) in the Kumasi
Metropolis, Ashanti, METHODS: A descriptive cross sectional survey with randomly
selected 450 food practitioners and 50 key informants was conducted from May
– September 2009. Data collection was done with the use of questionnaire and
interview guide administered by university trained research assistants. Data
was analysed into descriptive statistics using the Statistical Package for Social
Sciences (SPSS) version 15.0. The data analysis was done at 95% confidence
interval with significance level 0.05 or less and at 95% confidence interval. The
study had ethical clearance and Informed consent was sought from respondents.
RESULTS: The knowledge level of food practitioners on HACCP was extremely
low, only 25% knew it. HACCP has not been widely used, less than one-third,
24%, of food practitioners’ use it. Little use of HACCP has negative impact on the
general knowledge level and food handling practices of food practitioners, p=0.031.
Majority have not even heard about it and therefore shows no positive signs of
adherence and effort to practice. More than 85% of the respondents did not attend
any educational course on food hygiene and food borne disease. CONCLUSIONS:
There is poor knowledge on hazard analysis and critical control point among
food services staff. Studies involving the use of both qualitative and quantitative
research methods and environmental exposures will be helpful to design
interventions to improve food hygiene.
PHP34: NECESIDADES DE INFORMACIÓN Y FORMACIÓN SOBRE
FARMACOECONOMIA E INVESTIGACIÓN DE RESULTADOS PARA PROFESIONALES
Y ESTUDIANTES DE FARMACIA DEL ORIENTE VENEZOLANO
Adesso G, Bastardo Y, Universidad Central de Venezuela, Caracas, Venezuela
OBJECTIVOS: Describir la necesidades sobre información y formación en
Farmacoeconomia e Investigaciones de Resultados de profesionales y estudiantes
de Farmacia asentados en el oriente de Venezuela. METODOLOGÍAS: Estudio
descriptivo transversal realizado a la población asistente de la 14ª reunión anual
de la Federación Farmacéutica de Venezuela celebrada en el estado Anzoátegui
en el mes de marzo de 2011, mediante el cuestionario desarrollado por los
Consorcios de Asia y America Latina de ISPOR y, disponible en la pagina web
de ISPOR para evaluar la necesidad para la investigación de farmacoeconomia
e investigación de resultados. RESULTADOS: Del total de encuestados (N: 74),
el 53 % son profesionales farmacéuticos en ejercicio y el resto estudiantes de
Farmacia del núcleo de oriente de la Universidad Santa Maria. La mayoría de los
profesionales (66%) trabaja en establecimientos de Farmacia para la comunidad.
El 83 % de los encuestados señala no haber recibido actividades educativas o
de formación en Farmacoeconomia e Investigación de Resultados. El análisis
de costos y los estudios de costo beneficio concentran los métodos percibidos
que usualmente se utilizan (41%). Un 56% de los encuestados considera que las
autoridades no toma en cuenta los resultados de los estudios llevados a cabo, y un
59% se preocupa por la falta de conocimiento de los temas farmacoeconomicos
en el país. Así mismo, 91% quisiera más formación educativa y aplicaciones
prácticas de la disciplina. El 77% nunca ha escuchado de la existencia de ISPOR,
y un 55% de los mismos estarían interesados en ser miembros del capitulo
local del ISPOR. CONCLUSIONES: Los resultados de este estudio sugieren la
necesidad de que ISPOR Venezuela siga profundizando los esfuerzos para
promover la farmacoeconomia y la investigación de resultados en Venezuela y,
específicamente, con los Farmacéuticos y estudiantes de Farmacia de la zona
oriental del país.
PHP35: PERCEPTIONS, KNOWLEDGE AND GAPS ABOUT HTA AND HEALTH
ECONOMICS BY THE BRAZIIAN MARKET STAKEHOLDERS: ISPOR BRAZIL
QUALITATIVE RESEARCH
Araújo GTB1, Fonseca M1, Stefani SD2, 1Axia.Bio, São Paulo, SP, Brazil, 2Hospital
Mãe de Deus, Porto Alegre, RS, Brazil
OBJECTIVES: Understand the Brazilian set needs about HTA and Health economics
METHODS: In deep interview, based on a structured questionnaire, with decision
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
makers from the public and private set, Prescriptors, Patients group and
Manufacturers. RESULTS: A total of 131 interviews was conducted: 60 decision
makers, 50 Prescriptors, 10 patients groups and 11 manufacturers. For the decision
makers and Manufacturers, HTA and Health economics its’ a main issue and,
despite several methodological mistakes, takes an important role on the decision
and business. Patient groups and prescirptors are not very well awarned about the
issues in analysis, but consider that a better knowledge about is important and can
be very useful for the prescriptor and patients. For all the stakeholders, education
and access to clear information was a main issue of need. CONCLUSIONS:
Considering the rich database that this research provides and the knowledge about
the needs and points to enforce, ISPOR Brazil will be able to act with more focus.
HEALTH CARE USE & POLICY STUDIES – Health Technology Assessment Programs
PHP36: HISTORICAL AND FUTURE DRIVERS FOR HTA IN REIMBURSEMENT
SYSTEMS IN MEXICO AND POLAND
Kirpekar S, Shankland B, Double Helix Consulting, London, UK
OBJECTIVES: Although HTA is well established in healthcare systems like the
England & Wales National Health Service (NHS), it is increasingly used more
formally in developing countries such as Poland and Mexico. The objectives of this
research were to understand the drivers of decision-making and future trends in
these HTA systems in relation to market access for pharmaceuticals. METHODS:
Secondary research and structured telephone interviews with 12 key stakeholders
in Poland and Mexico was carried out. The research evaluated trends in the
following aspects of the systems: impact of HTA in final reimbursement decisions,
positioning of HTA in the healthcare system and future trends. A comparison of the
impact of HTA in Mexico and Poland was then made on a rating scale devised to
account for these influencing factors. RESULTS: HTA in Mexico is positioned within
a highly decentralised healthcare system, although its Federal Cuadro Básico is
important in determining price and access for pharmaceuticals. HTA appraisals
although mostly conducted by IMSS (60% of reimbursement) are also used by the
other reimbursing institutions. The Polish HTA body, AHTAPol, works closely with
the reimbursement process at the central level, but its ultimate influence on price
and reimbursement is moderate; the majority of respondents (n=8) regarded HTA as
more of a negotiating tool, as decision-making balances multiple diverse interests.
CONCLUSIONS: HTA is seen to impact the Polish system, despite being centralised
to a lesser extent than Mexico, which has a decentralised health system and a
significant private sector. In addition to HTA, historical development of the health
care system, external influences and financial resources are equally important
drivers of access decisions.
PHP37: CROSS-CONTINENTAL COMPARISON OF HTA EVOLUTION IN EMERGING
MARKETS: BRAZIL, INDIA AND POLAND
Kirpekar S, Shankland B, Dummett H, Double Helix Consulting, London, UK
OBJECTIVES: Despite universal healthcare being the common motto, healthcare
systems in developing economies around the world have developed to varying
extents. HTA as a concept has evolved particularly in Western European markets
to ensure equity and equality of healthcare provision. Understanding the status of
HTA evolution and impact on reimbursement decisions is expected to have lessons
to be learnt for countries like India where non-evolution of HTA is seen. METHODS:
Secondary research to understand the reimbursement systems publicly available
information about recent reimbursement decisions was done. Primary research
involved discussions with decision makers in important reimbursement bodies.
Eight in-depth interviews were conducted covering individuals from a variety of
backgrounds. Information was collected under headings covering current drivers,
historical influences, existing issues, reasons for evolution / non-evolution of
HTA and expected changes. Data was analysed qualitatively to develop results.
RESULTS: Broadly, HTA was seen to be non-evolved in India. Majority of the market
being out-of-pocket is considered the key driver where both industry and doctors
are thought to generally oppose any formal technology appraisals (n=6). At the
other end of the spectrum, despite having a multi-payer reimbursement system,
Brazil was seen to be using HTA as a tool for reimbursement decisions widely
(n=6). Poland however, despite having a well-developed HTA system was seen
to use HTA more as a negotiation tool than for reimbursement decisions (n=4).
CONCLUSIONS: A tri-directional comparison of HTA systems and their involvement
in the reimbursement system showed that the reasons behind the varying level of
HTA influence can be attributed somewhat to the history of the healthcare systems.
There are lessons to be learned for Poland, which is a centralised system from
other centralised systems like England and for India from Brazil. In-depth research
involving lessons from Brazil for India is warranted.
PHP38: HEALTH TECHNOLOGY ASSESSMENT APPLIED TO MEDICAL DEVICES IN
LATIN AMERICA: WHAT MUST BE ASSESSED
Gimenes F1, de O. Machado F2, Quiroz ME3, 1Medtronic, Sao Paulo, SP, Brazil,
2
Medtronic, Doral, FL, USA, 3Medtronic, Colonia Juarez, DF, México
OBJECTIVES: Analyze the health technology assessment (HTA) scenario
and process to Medical Devices (MD) in Latin American and discuss the
appropriateness of the present process METHODS: search in Latin American
and Caribbean Health Sciences Literature (LILACS), PubMed, gray literature
and internet search. RESULTS: MD and drugs differ from their concept to usage,
therefore it is important to note that is not always possible to apply the same
HTA processes to both categories. In the research, we found in Latin America
12 countries with significant HTA initiatives and the majority emerged in the past
decade. In total, 4 countries with published economic evaluation guidelines, 17 HTA
committees and groups, 6 ISPOR chapters, the Pan American Health Organization
(PAHO) HTA initiative and Mercosur HT special group. The expertise with HTA
applied to drugs seems to be higher than HTA applied to MD across Latin America
and this was observed in appraisals published by the main HTA agencies. Important
to note the almost non existence of specific HTA guidelines to MD among HTA
agencies, groups and committees. CONCLUSIONS: The methodological validity
should consider a broader source of evidence to evaluate the efficacy of certain
MD or for certain clinical indications or settings. Patient and/or investigator
blinding is impractical or impossible for many MD and most surgical procedures.
Observational studies should be considered as a relevant source of data for HTA,
often randomized clinical trials do not provide real life data and are not always
feasible technically and ethically for devices. MD has a shorter life cycle and it
is not compatible with HTA cycles which can vary from 6 months to 4 years for
a sound assessment. HTA agencies, committees and groups in Latin America
must recognize the medical devices specificities and its market dynamics and
incorporate to existing guidelines a process adequate to this category.
PHP39: GAUGING THE ROLE OF HTA IN REIMBURSEMENT DECISION-MAKING
ACROSS FIVE MARKETS IN LATIN AMERICA
Dummett H, Kirpekar S, Shankland B, Double Helix Consulting, London, UK
OBJECTIVES: HTA is at different stages of development across Latin America,
from Brazil’s highly developed system at one extreme to Venezuela at the other,
despite the existence of substantial local expertise. This study attempts to
explain these disparities. METHODS: A total of 20 HTA reviewers and academic
health economists were interviewed across Brazil, Argentina, Mexico, Chile
and Venezuela to understand the parameters of the HTA system, the importance
of different stakeholders within the process and the decisions influenced by
HTA. RESULTS: HTA systems within Latin America exist at all stages of the HTA
development continuum, although they are better developed than in many other
developing countries. At one end sits a multi-payer, universal health system Brazil
in which demonstration of cost-effectiveness is considered highly important
for central funding decisions. At the other extreme sit Chile and Venezuela in
which no formal role for HTA yet exists, although the speed and direction of HTA
development in these two countries is likely to differ. In between sits Argentina,
where HTA capability is advanced but operating within a fragmented health system. CONCLUSIONS: HTA is developing rapidly within the markets surveyed suggesting
that private actors would be rational to invest in local expertise. However, despite
formalisation, cost-effectiveness may remain only one of many decision factors.
Understanding the nuances of where HTA sits in the reimbursement system and
how it is applied in practice in each market is essential for maximising favourable
outcomes for suppliers and providers alike.
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HEALTH CARE USE & POLICY STUDIES –
Patient Registries & Post-Marketing Studies
PHP40: PROMOTING EFFICIENCY OF AVAILABLE CAPACITY IN A FRAGMENTED
HEALTH SYSTEM: PATIENTS WITH DIFFERENT HEALTH INSURANCE SCHEMES
ATTENDED BY MOH, MEXICO 2006-2010
Gómez-Fraga S, Mexican Ministry of Health, México, D.F., México
OBJECTIVES: In order to implement strategies that promote an efficient use of
public health services and grant more access opportunities to the population,
irrespective of their insurance status, estimate the volume and type of hospital
care services provided by the Ministry of Health (MoH) to patients who have
social security or private health insurance. METHODS: The exercise was made
though an analysis by ICD-10 of the Hospital Discharge Automated System, which
concentrates hospital activity from over 600 hospitals belonging to MoH, between
January 2006 and August 2010. Patients having a social security scheme (IMSS,
ISSSTE, PEMEX, SEDENA y SEMAR) or private health insurance were analyzed.
RESULTS: A total of 11.9 million of attentions were recorded in the analyzed period,
2.2 on average per year, of which, 40 thousand (1.7%) corresponded to patients
who belong to a social security institution or private health insurance. Among the
institutions of origin, IMSS led the list with 45% of the total, followed by ISSSTE with
26% and private insurances with 20%. By ICD-10 chapter, Pregnancy, childbirth and
puerperium (O00-O99) was the most demanded, with 24.5% of the total attentions.
In the analysis by state, about 50% of cases came from five to seven states; in 2010
the state of Jalisco led the list with 14.5% of the total, followed by the states of
Tamaulipas and Mexico, with about 7% each. Considering all the analyzed period,
the most common intervention was Single spontaneous delivery (O80), (41% in
2010). CONCLUSIONS: Quantifying the MoH health care demand coming from
social and private insured population and its evolution will permit the definition
of better exchange planning strategies and guarantee its appropriate financial
compensation. Besides analyze the exchange volume and their characteristics;
establishing fees and agreements is needed to implement reimbursement systems
between public sector institutions.
PHP41: MONITORING OF HPV VACCINATION EFFECTIVENESS WITHIN EUROPEAN
UNION
Bielik J1, Marušáková E2, Glogowski C3, 1Trencin University, Trencin, Slovak
Republic, 2GlaxoSmithKline Slovakia, Bratislava, Slovak Republic, 3GSK Commercial
Sp. z o.o., Warsaw, Poland
OBJECTIVES: The study evaluated recent data related to real impact measurement
of HPV prevention or cervical oncologic diseases related to HPV infection
available from publications in the EU member states. The main idea was to find out
whether there is any prerequisite to evaluate the effectiveness of the preventive
HPV vaccination based on the existing data and standard approaches within the
EU in the future in an observational study. The second goal was to define these
prerequisites in order to use them for “good practice.” METHODS: The systematic
review of PUBMED, EMBASE and CENTRAL extended to official websites of public
health institutions officially published data was used. The goal was to find all
papers on HPV/cervical cancer epidemiology, screening, and prevention published
in years 2009- 2011, related to EU member states. Only studies related to countries
from the European Union were taken into account. All relevant data were extracted
and compared. Population size was derived from Eurostat. Based on this data we
created the principles for evaluation of HPV screening and monitoring of quality
indicators. RESULTS: Out of 27 EU countries, only 2 countries (Denmark and United
Kingdom) received the highest value for screening and monitoring of quality
indicators. The data retrieved from their standard approaches in screening could
be a baseline for the comparison between the modelling of effectiveness data and
real data. New data required were defined as the condition to formulate an optimal
design for valued surveillance of the effectiveness of HPV vaccination in general
population. CONCLUSIONS: Some harmonization of screening and monitoring of
active surveillance would be necessary within the EU member states in order to
increase the reliability of real world data effectiveness. The proposal for defined
criteria is needed for valuable evaluation the real effectiveness of HPV vaccination
in general population in prospective studies.
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HEALTH CARE USE & POLICY STUDIES – Population Health
PHP42: CALIDAD DE VIDA RELACIONADA CON LA SALUD Y APOYO SOCIAL EN
ESTUDIANTES DE FARMACIA EN VENEZUELA
Parra G, Bastardo Y, Universidad Central de Venezuela, Caracas, Venezuela
OBJECTIVOS: Describir la calidad de vida relacionada con la salud (CVRS) de
los estudiantes de farmacia y explorar su relación con el apoyo social percibido
(AS). METODOLOGÍAS: Una muestra al azar, de 71 estudiantes de Farmacia de la
Universidad Central de Venezuela se entrevistó usando un cuestionario escrito. La
CVRS fue determinada usando los cuestionarios de salud: Forma Corta 36 (SF-36)
y EQ-5D. El AS se evaluó usando la Lista de Evaluación de Apoyo Interpersonal
(ISEL). Estadísticos descriptivos fueron calculados para todas las variables. La
asociación entre CVRS y AS se estimó mediante coeficiente de correlación de
Pearson. RESULTADOS: La muestra estuvo formada por 53 mujeres y 18 hombres
con edad promedio de 19.31 años. Los promedios obtenidos para el ISEL fueron:
Emocional=76.97, Información=80.32 y Tangible=78.13. Los promedios obtenidos
para el SF-36 fueron: Función Física=90.34, Rol Físico=57.75, Dolor Corporal=70.28,
Salud General=68.59, Vitalidad=49.85, Función Social=67.96, Rol Emocional=50.70 y
Salud Mental=62.93. Los valores obtenidos para el EQ-5D fueron: Movilidad: 87.7%
sin problemas y 11.3% tiene problemas moderados; Cuidado Personal: 90.1% sin
problemas y 9.9% tiene problemas moderados; Actividades Cotidianas: 64.8%
sin problemas y 35.2% tiene problemas moderados; Dolor: 52.1% sin problemas y
47.9% tiene problemas moderados; Ansiedad: 53.5% sin problemas, 40.8% tienen
problemas moderados y 5.6% problemas severos. Para la EQ-VAS se obtuvo
un promedio de 75.48. La EQ-VAS se encontró estar asociada en forma positiva
como todas las dimensiones del ISEL. CONCLUSIONES: Pese a limitaciones en generalizabilidad de los resultados y diseño transversal, el estudio encontró que
la CVRS de los estudiantes de farmacia es buena. Los principales problemas
detectados corresponden a Rol Emocional, Vitalidad, Ansiedad y Dolor. Esto
resalta necesidades de atención en esta población de jóvenes universitarios. El
apoyo psicosocial puede ser una opción de atención.
PHP43: EXPLORING SOCIAL DETERMINANTS OF THE HEALTH OF INTERNATIONAL
IMMIGRANTS IN CHILE: THE GLOBAL HEALTH STATUS INDEX
Cabieses B, Tunstall H, Pickett K, Gutacker N, Espinoza M, University of York, York,
UK
OBJECTIVES: Variations in immigrants’ health-status have been observed in the
past, depending on the indicator considered. This study analyzes the association
between a new linear variable “Global Health-Status Index” (GHSI) generated
from Exploratory Factor Analysis (EFA), and different social determinants of health
(SDH) in the international immigrant population (IIP) in Chile. METHODS: Crosssectional Chilean survey (CASEN-2006). From 268,873 participants, one percent
were immigrants (n=1.877). Main-outcome-measure: GHSI, constructed using
EFA (range=-0.82-+4.25; the higher the index, the worse the health-status). This
was a linear combination of: 1)number of medical consultations, 2)number of
mental consultations, and 3)number of other health care consultations. Before
EFA, Reliability-coefficient (cronbach´s-alpha=0.74), constructs-validity/samplingadequacy (Kaiser–Mayer–Olkin=0.56, Bartlett’s-Sphericity-Test p-value<0.001),
Minimum-loadings (above=0.30) and loadings-uniqueness (below=0.80) were
assessed. They all suggested EFA was moderately suitable in the IIP. Explanatory
variables: SDH: demographics (age/sex/marital-status/geographic-location),
socioeconomic-status (low/medium/high), and material standards (overcrowding/
sanitary-conditions/housing-quality). Analysis: Given the skewness of GHSI,
weighted Generalized Linear Models (with log-link and gamma-variance function)
were estimated (STATA-10.0). RESULTS: Age showed a positive association with
GHSI in the IIP [coeff.=0.02(SE=0.003)]. Female immigrants showed a lower chance
of impairing their health status [coeff.=-0.31(SE=0.07)] compared to men and this
association was consistent across different SDH. Immigrants in rural settings were
more likely to have a poor global health-status [coeff.=1.00(SE=0.11)]. Immigrants
belonging to a minority ethnic group had a higher chance of experiencing health
impairment [coeff.=1.32(SE=1.06)]. EFA was a valuable first-step towards a
combined measure of health status among immigrants. GLM with log-link and
gamma-variance function have been used in the past and prove useful to deal
with highly skewed outcomes without requiring transformation-retransformation
techniques. CONCLUSIONS: The Global Health-Status Index is a useful indicator
ISPOR 3rd Latin America Conference
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Research Poster Abstracts
of health status to study different SDH in the IIP. Demographic determinants were
strongly associated with GHSI, even after controlling for socioeconomic and
material SDH, and should be further addressed in Chile.
HEALTH CARE USE & POLICY STUDIES –
Prescribing Behavior & Treatment Guidelines
PHP44: CHARACTERISTICS OF PATIENTS TREATED FOR FIBROMYALGIA IN PUERTO
RICO AND THE UNITED STATES: BASELINE FINDINGS OF THE REFLECTIONS
STUDY (REAL WORLD EXAMINATION OF FIBROMYALGIA: LONGITUDINAL
EVALUATION OF COSTS AND TREATMENTS)
Vazquez-Suarez JE1, Able SL2, Gatz JL2, Robinson RL2, 1Eli Lilly and Company, San
Juan, PR, USA, 2Eli Lilly and Company, Indianapolis, IN, USA
OBJECTIVES: This secondary analysis of REFLECTIONS, a prospective
observational study of patients initiating on medications for fibromyalgia, compared
patient, clinical, and treatment characteristics between United States (US) and
Puerto Rico (PR). METHODS: Baseline data were collected from July 2008 through
May 2010 via physician surveys, office visit forms, and telephone interviews in 58
care settings in the US and PR. RESULTS: Study patients included 1539 (90.5%)
treated in the US and 161 (9.5%) in PR. Patient characteristics differed for mean
age in years (53.8 PR vs. 50.0 US, p<.001), body mass index (30.4 PR vs. 31.4 US,
p=.049) and race/ethnicity (98.1% Hispanic PR vs. 91.4% Caucasian US). Patients
in PR versus the US were more likely to have a lower category of economic status
and less likely to be privately insured. PR patients had more total concomitant
diseases including back pain and depression (all p<.001). Times to first symptom,
diagnosis, and prescription were shorter in PR than US (all p<.01). Patients in PR
also reported more severe pain, pain interference, and greater disease impact via
the Brief Pain Inventory and the Fibromyalgia Impact Questionnaire (all p<0.001).
Treatment patterns also differed with US patients more likely to be prescribed
opioids (5.6% PR vs. 26.2% US) and exercise (81.4% PR vs. 90.3% US), but less likely
to be prescribed NSAIDS (55.9% PR vs. 23.6% US), (all p<0.001). Despite the strong
evidence for efficacy, cognitive behavioral therapy was prescribed infrequently
(3.1% PR vs. 4.7% US, p=0.36). CONCLUSIONS: To the best of our knowledge, this
is the first study to describe patient and treatment characteristics for patients with
fibromyalgia in PR. Patient, clinical, and treatment characteristics of REFLECTIONS
patients in PR differed in several respects from the US cohort. It is unknown
whether these findings are generalizable to all fibromyalgia patients in the US and
PR.
PHP46: PRÁCTICA CLÍNICA INSTITUCIONAL EN EL TRATAMIENTO DE LA DIABETES
MELLITUS TIPO 2 EN MÉXICO
Juarez-Garcia A1, Vargas-Valencia J2, Martinez-Rivera G1, Sotelo-Guzmán M2, Eliaslópez JI1, Zamora-Barron M1, Rangel S1, 1Bristol-Myers Squibb, México City, D.F.,
México, 2Econopharma Consulting S.A. de C.V., México, D.F., México
OBJECTIVOS: Realizar un análisis de la práctica médica institucional en el
tratamiento de la diabetes mellitus tipo 2 (DM2) en México. METODOLOGÍAS:
Estudio transversal sobre los esquemas de manejo de la DM2, la recolección se
realizó mediante un cuestionario estructurado en entrevista directa a 54 médicos
en instituciones de salud pública (56% IMSS, 15% ISSSTE, 4% PEMEX y 26% SSA),
de los cuales 37% son médico generales, 4% familiares, 15% endocrinólogos y
44% internistas, con 14.4 años IC95%(10.7-18.3) de experiencia. El 41% atiende
un volumen ≤60 pacientes/año, 30%≤100 pacientes/año y el 29% >100 pacientes/
año. Se reporta estadística descriptiva de los tratamientos y características
poblacionales. RESULTADOS: Al diagnóstico, la edad promedio es de 47.7 años
IC95%(43.7-51.7), 43% hombres y 57% mujeres. El 56% presenta IMC>25, 36%
IMC>30, 53% hipertensión y 28% tabaquismo. Valores promedio de glucosa sérica
en ayuno 205.8mg/dL, tolerancia oral a la glucosa 233.9mg/dl, Hb1Ac 9.3%, glucosa
postprandial 242mg/dL, microalbuminuria 161.7mg/dL, LDL 162.5mg/dL, HDL 30mg/
dL, triglicéridos 280mg/dL, colesterol 253.3md/dL y creatinina sérica 1.7mg/dL. Con
un tiempo de evolución <1año 11%, de 3-5 años el 45% y >5 años el 44%. El 48%
de los pacientes no presenta complicaciones, 25.8% una complicación, 13.1% dos
complicaciones y 13.1% ≥3 complicaciones. Se observa una preponderancia de
la monoterapia en el 86% de los pacientes con niveles <7% HbA1c, principalmente
metformina en el 68%; con respecto al uso de insulina, el 62% de los médicos
consideran niveles ≥8.75% de HbA1c IC95%(7.92-9.58%) como criterio para indicar
su uso. CONCLUSIONES: El diagnóstico de la diabetes en México suele ser tardío.
De acuerdo a lo reportado por los médicos el 89% de sus pacientes presentan
una evolución de más de 3 años y al menos una complicación el 52% de los casos.
Además, el estudio sugiere una relación importante entre los niveles de HBA1c y la
elección del tratamiento farmacológico.
HEALTH CARE USE & POLICY STUDIES – Regulation of Health Care Sector
PHP47: AVALIAÇÃO DO MERCADO DE ANTIMICROBIANOS NO BRASIL: PASSO
PARA IMPLANTAÇÃO DO MONITORAMENTO E CONTROLE SANITÁRIO EM
ESTABELECIMENTOS FARMACÊUTICOS
Mota DM, Araújo MAM, Santos AEG, Cunha TRP, Silva SF, Bovi RF, Alaver RT, Albo
GC, Cunha JAF, Oliveira MG, Baptista FJDO, Bernardo PJB, Agência Nacional de
Vigilância Sanitária, Brasília, DF, Brazil
OBJETIVOS: Avaliar o mercado de antimicrobianos no Brasil, em 2009, subsidiando
a Agência Nacional de Vigilância Sanitária na implantação do monitoramento e
controle do consumo desses medicamentos em farmácias e drogarias privadas.
MÉTODOS: Estudo descritivo que congrega as áreas do conhecimento em
vigilância sanitária e economia do medicamento. A seleção dos antimicrobianos
foi definida a partir da lista anexa da norma regulatória (RDC nº 44/2010, atualizada
pela RDC nº 61/2010). Essa norma determinou o controle sanitário por meio da
retenção de receita médica nos estabelecimentos farmacêuticos e escrituração
eletrônica no Sistema Nacional de Gerenciamento de Produtos Controlados
(SNGPC). No Brasil, existia uma cultura de dispensação dos antimicrobianos sob
prescrição médica sem a apresentação de receita médica. Foi analisado o total
e quantidade de apresentações farmacêuticas comercializadas, participação
dos antimicrobianos no mercado total de medicamentos, os antimicrobianos
mais vendidos no país e o custo habitante dia (CHD). RESULTADOS: Na norma
foram definidos 119 antimicrobianos sob prescrição médica, resultando em
mais de duas mil apresentações farmacêuticas vendidas no país, das quais
251 são de uso restrito aos hospitais. A quantidade comercializada ultrapassou
mais de 270 milhões de unidades físicas. A participação do mercado de
antimicrobianos, em termos de quantidades vendidas, foi de 9,1%. A amoxicilina
(14,6%), azitromicina (8,8%) e cefalexina (7,6%) foram os antimicrobianos mais
vendidos no país. O CHD foi de R$ 36,25, ou seja, para cada 1000 habitantes foram
gastos de R$ 36,25 em antimicrobianos diariamente. CONCLUSÕES: A análise do
mercado de antimicrobianos no país sinaliza para um grande volume de dados
a serem escriturados no SNGPC, cuja principal finalidade é o monitoramento
sanitário e farmacoepidemiológico do consumo desses medicamentos no
Brasil. Essa estratégia visa ao fortalecimento da política de medicamentos e
assistência farmacêutica no país, no que diz respeito ao uso seguro e racional de
medicamentos no país.
PHP48: OS MOTIVOS QUE LEVAM O JUDICIÁRIO A DETERMINAR QUE OS PLANOS
DE SAÚDE FORNEÇAM MEDICAÇÃO ORAL EM ONCOLOGIA
Stefani SD1, Fonseca JRL2, 1UNIMED, Porto Alegre, RS, Brazil, 2UNIDAS, Brasilia,
DF, Brazil
OBJETIVOS: Levantar as principais causas e motivos que justificaram o
deferimento das liminares uma vez que, no Brasil, o fornecimento de medicação
oral oncológica (QT oral) não constitui obrigatoriedade para os planos de saúde. No
entanto, o Poder Judiciário tem sido acionado para demandas para o fornecimento
desse tipo de terapia. MÉTODOS: A partir dos levantamentos realizados em
decisões judiciais proferidas nos Estados de SP, MG e RJ, foram selecionadas
as motivações que levaram o Magistrado à determinar o fornecimento de QT
oral. Os fundamentos de cada decisão foram organizados e estratificados para
análise qualitativa. RESULTADOS: Um total de 71 ações envolveram QT oral. Todas
obtiveram (100%) de ganho de causa em favor dos pacientes. Foram identificados
mais que uma justificativa em alguns casos, conforme descrito: 32 casos de
deferimento por cláusulas abusivas; 07 casos onde os serviços de saúde não
apresentaram cobertura securitária, incluindo drogas inovadora utilizadas
anteriormente com sucesso em tratamento oncológico; 13 casos por restringir
cobertura as obrigações do Rol ANS; 23 casos para Assegurar a continuidade
de vida e saúde; 03 casos por descabimento e/ou interferencia de empresa de
serviço na conduta médica; 01 caso de ilegitimidade passiva da operadora; 11
casos por aplicação de Jurisprudência STJ pelo fato dos Quimioterapicos, mesmo
oral, fazer parte do tratamento; 01 caso por Inexistência que exclui expressamente
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Research Poster Abstracts
a medicação requerida; 1 caso por Exclusão que contraria a função social.
CONCLUSÕES: Quando acionado, o judiciário determina fornecimento de QT oral
em todos casos, mesmo que os instrumentos legais ou contratos das operadoras
de saúde tentem limitar tal prática. É necessária reflexão no processo de tomada
de decisão dos gestores sobre esse tema, bem como a urgência de implementação
de uma política racional de fornecimento QT oral, que evite instrumento judicial.
HEALTH CARE USE & POLICY STUDIES –
Risk Sharing/Performance-Based Agreements
PHP49: DEVELOPING RISK SHARING ARRANGEMENTS – POTENTIAL FOR BRAZIL
AND IMPLICATIONS
Shirk RC1, Godman B2, 1Fiocruz, Rio de Janeiro, RJ, Brazil, 2Karolinska Institutet,
Stockholm, Sweden
The number of risk sharing arrangements between pharmaceutical companies,
regional and national governments has been growing in recent years as authorities
strive to enhance efficiency given the uncertainty of outcomes and appreciable
resource implications with many new drugs. These arrangements are just
being considered in Brazil. OBJECTIVES: Analyse risk sharing arrangements
in other countries including concerns to develop a basis for future activities in
Brazil. METHODS: Joint activities are planned including a) literature search of
published papers in Europe, US, and Australia using key words including risk
sharing, coverage with evidence,price volume agreements, value-based pricing,
pharmaceuticals, no cure no pay, pay back schemes, health impact guaranteeto
document existing schemes and definitions including concerns, b) an assessment
of the potential legal approaches in Brazil (if different to other countries), and
c) an assessment of the potential implications of such agreements to Brazilian
public health/ Ministry of Health acknowledging growing resource pressures and
the need to fund new products approved by the Ministry. RESULTS: The initial
research uncovered potential definitions as well as an appreciable number of
risk sharing arrangements in operation across Canada, US, Europe and Australia.
These are currently being reviewed for applicability to Brazil. The findings will
be discussed in more detail during the presentation as the search progresses.
CONCLUSIONS: There is an appreciable number of risk sharing arrangements
globally. However, there is confusion regarding their terminology, legal status,
administration costs, benefits andransparency. These issues will be discussed in
relation to Brazil to help stimulate the debate among Latin American countries and
whether they should develop such schemes.
HEALTH CARE USE & POLICY STUDIES – Conceptual Papers
PHP50: THE VALUATION OF END-OF-LIFE HEALTH GAINS
Cairns J, London School of Hygiene and Tropical Medicine, London, UK
There has been a tradition in health economics to regard all QALYs as being of
the same significance and value. One example of this is the practice in economic
evaluation when estimating incremental cost-effectiveness of adding together the
QALYs of the entire patient group and ignoring that some patients accrue more
QALYs than others and their identity. Another example concerns the use of a
common cost-effectiveness threshold when making a series of recommendations
across a range of clinical areas. A significant departure from this conventional
approach has recently been introduced by the National Institute for Health
and Clinical Excellence (NICE) in England when Appraisal Committees were
instructed to treat life-extending, end of life treatments differently from other health
technologies. This paper first discusses the criteria that must be fulfilled in order
to qualify as an end-of-life treatment. It then reviews the ways the instruction to
weight end-of-life health gains could be and has been interpreted. A key issue at
the heart of the challenges of implementing this policy is whether it is the entire
QALY gain or just the life extension that is to be weighted more highly. Another
issue is how inappropriate double-counting of health benefits is to be avoided. The experience to date of implementing this policy with respect to about thirty
drug treatments is reviewed and the implied valuation of end-of-life health gains
is identified. The paper closes with an appraisal of the success of this policy
innovation and discussion as to how it might be further developed and refined.
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PHP51: PATIENT-CENTERED CARE: CHALLENGES FOR BRAZIL, LESSONS FOR
UNITED STATES
Freitas EL, Poplavska E, University of Minnesota, Minneapolis, MN, USA
Patient-centered care is a key factor to ensure quality in the healthcare system.
The USA has been struggling for a long time with its (in)ability to translate the
scientific knowledge into practice and to apply the abundant technology safely and
appropriately. While main issues discussed now by the USA refer to the shortage
of primary care providers and needed reform that ensures appropriate reward for
this practice, certainly the Brazilian Unified Health System have some experience
to share, after 20 years focusing on the primary care as the chief of its healthcare
system. The objective of this concept paper is to critically analyze the issues
emerging from the literature related to the patient-centered care in both countries.
The Patient Centered Medical Home (PCMH) in the USA and the Family Health
Strategy (FHS) in Brazil claim equally to be patient-centered models of practice.
However, our analysis revealed different patterns of ‘patient-centeredness’. Most
of the discussions around PCMH address issues of payment and organization of
the healthcare providers’ team that is heavily influenced by the historical structure
of healthcare system; but few address, in sufficient deepness, how to improve
the service that is ultimately being delivered to the patient. The FHS, by its turn,
nowadays is deeply involved in discussions about humanization of care and how
to articulate community participation in the policy development of healthcare
strategies. In conclusion, political and budget issues are relevant in both countries,
but the focus must remain on patient autonomy and participation as a way to
expand the quality of a health care system truly committed to the social welfare.
Furthermore, each society poses unique health care challenges. In confronting this
complex and sensitive issue, it is essential to reflect on the experiences of both
countries and to use the lessons learned for optimizing patient care.
INDIVDUAL’S HEALTH – Cost Studies
PIH1: IMPACTO PRESUPUESTAL DEL USO DE LEVONORGESTREL-UIS FRENTE A
OTROS TRATAMIENTOS EN MENORRAGIA IDIOPATICA EN COLOMBIA
Romero M1, Karpf E1, Sanabria M1, Alvis N2, 1Fundación Salutia, Bogotá, Colombia,
2
Universidad de Cartagena, Cartagena de Indias, Bolívar, Colombia
OBJECTIVOS: Realizar un análisis de impacto presupuestal del uso de
Levonorgestrel-UIS (LNG-UIS) como primera opción de tratamiento en Menorragia
idiopática en Colombia. METODOLOGÍAS: Se realizó un análisis de impacto
presupuestal del uso de LNG-UIS para la población de mujeres en edad fértil para
Colombia con cortes anuales. La prevalencia de la enfermedad fue obtenida de
estudios clínicos. Se utilizó como base la población reportada por el Departamento
Nacional de Estadística para 2010. La distribución de uso actual de LNG-UIS,
Anticonceptivo Oral Combinado, Acido Tranexámico, Acido Mefenámico y
Naproxeno fue establecida mediante una encuesta y posterior comité de expertos. Se modeló que las preferencias por LNG-UIS aumentarían a un 50% en los primeros
2 años y 70% en los años siguientes. Para el cálculo de costos se utilizó un modelo
de Markov basado en la historia natural de la enfermedad. Los datos fueron
estimados en pesos colombianos (COP) y convertidos a dólares americanos 2010
(USD) según tasa representativa media del mercado. RESULTADOS: Los casos
esperados en un año de Menorragia idiopática serían 61,334 en mujeres en edad
fértil y según los cambios en intención de uso de LNG-UIS definidos para el primer
año del análisis se tendría un mayor costo de 6,4 millones de USD. A partir del
segundo año el ahorro sería de 8,8 millones de USD lo que significaría un ahorro
acumulado de 2,4 millones de USD. El ahorro sigue incrementándose a partir
del segundo año a pesar de estimarse el incremento de población anualmente.
El análisis del ahorro acumulado al final del 5 año sería 37,5 millones de USD.
CONCLUSIONES: El uso de LNG-UIS como primera opción de tratamiento en
mujeres con menorragia idiopática generaría ahorro para el Sistema General de
Seguridad Social en Salud colombiano en un horizonte de análisis de cinco años.
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
PIH2: ADDRESSING CHILDHOOD OBESITY IN MEXICO: SAVINGS ON HEALTH
CARE EXPENDITURES FROM REGULATING FOOD AND BEVERAGE SALES IN BASIC
EDUCATION SCHOOLS
Guajardo-Barron VJ1, Gutierrez-Delgado MC1, Rivera-Peña G2, 1Mexican Ministry of
Health, México, D.F., México, 2Economic Analysis Unit, México, D.F., México
OBJECTIVES: Estimate potential direct savings for the Mexican Healthcare System
generated by the operation of the “Technical Guidelines for distribution of food
and beverages in establishments of basic education” targeting population of 6 to
14 years of age. METHODS: The authors use the micro-simulation model “Chronic
Disease Prevention (CDP)” developed by the OECD-WHO for projecting health
gains and costs of treatment in a period of 100 years. The model was adjusted to
accommodate the range of ages stated in the Guidelines and uses information of
incidence, prevalence, mortality, population at risk, annual unit costs and relative
risk of selected chronic diseases (diabetes mellitus type 2, hypertension, cardioand cerebro-vascular, hypercholesterolemia) attributable to obesity as well as the
treatment of obesity as disease itself for the Mexican context. Sensitivity analyses
were developed for most variables used in the model. RESULTS: Under the base
case scenario present value of potential savings in total spending on medical care
associated with the implementation of the Guidelines amount to USD$1,052.2 million
in 2008. Most savings are derived from averted cases of hypertension (32.7%),
obesity-overweight (28.6%) and diabetes mellitus type II (17.8%). Results are robust
to changes in all parameters analyzed. Amounts obtained are an underestimation
of potential savings as neither expensive complications as renal failure nor other
chronic diseases attributable to obesity as arthritis, colorectal or breast cancer
were included. CONCLUSIONS: The Guidelines, developed by both Ministry of
Public Education and Ministry of Health, represent a good example of cooperation
among different sectors to solve a complex public health problem. Results shows
the importance of implementing preventive interventions aimed at reducing the
prevalence of chronic diseases related to poor eating habits, inadequate physical
activity and obesity in Mexico. The implementation of the Guidelines involves
significant direct savings that can be assigned to other health needs of the Mexican
population.
PIH3: RESOURCE USE AND ASSOCIATED COSTS FOR THE TREATMENT OF HEAVY
MENSTRUAL BLEEDING WITH LEVONORGESTREL RELEASING INTRAUTERINE
SYSTEM (LNG-IUS) VERSUS HYSTERECTOMY: THE BRAZILIAN PUBLIC
HEALTHCARE SYSTEM (SUS) PERSPECTIVE
Bahamondes L1, Bahamondes V1, Schiola A2, Silva AP3, Santoni NB3, Moura M4,
Salem J4, Clarck L4, Teich V4, 1University of Campinas, Campinas, SP, Brazil, 2Bayer
de México, S.A. de C.V., México, D.F, México, 3Bayer Brazil, São Paulo, SP, Brazil,
4
MedInsight Evidências, São Paulo, SP, Brazil
OBJECTIVES: To describe the resource utilization and the costs related to heavy
menstrual bleeding (HMB) control with either an LNG-IUS or hysterectomy in the
Brazilian Public Health System (SUS) on patients treated at the Department of
Obstetrics and Gynecology, School of Medical Sciences, University of Campinas,
Brazil. METHODS: We performed an observational retrospective descriptive study
with costs evaluation and budgetary impact calculation from data extracted from
medical files of patients diagnosed with HMB treated either with the LNG-IUS
or hysterectomy. The measured outcomes were HMB control, LNG-IUS induced
complications (expulsion, uterine perforation, pelvic inflammatory disease), LNGIUS continuation rate and hospital costs after one year, as well as, the budgetary
impact of the use of LNG-IUS in the treatment of HMB vs. hysterectomy. RESULTS:
Two hundred sixty-seven medical files were initially retrieved for analysis. A total
of 246 patients were included in this study, 122 received the LNG-IUS and 124 were
treated with hysterectomy. The mean age was 39.7 years in the LNG-IUS group
and 47.9 in the surgery group. Mean duration of HMB in the hysterectomy group
was 3.2 years, twice that of the LNG-IUS group (1.5 years) (p<0.01). Of the patients
treated with LNG-IUS, 88.7% maintained the device for over one year and 83.1%
had success in bleeding control with this method. Fourteen patients had to have
the LNG-IUS removed prior to 12 months; however, only 1.6% because of failure in
bleeding control. Costs for the LNG-IUS insertion in a one-year time horizon were
R$ 762.64 versus R$ 870.03 for the hysterectomy procedure. CONCLUSIONS: When
applied to the eligible population in SUS the budgetary impact of the LNG-IUS
adoption was an economy of almost R$ 3.6 million.
PIH4: ANALISIS DE COSTO-EFECTIVIDAD DEL USO DE LEVONORGESTREL-UIS
FRENTE A OTROS TRATAMIENTOS EN MENORRAGIA IDIOPATICA
Romero M1, Arango C1, Espinel F2, Karpf E1, Sanabria M1, Alvis N3, 1Fundación
Salutia, Bogotá, Colombia, 2Clínica de la Mujer, Bogotá, Colombia, 3Universidad de
Cartagena, Cartagena de Indias, Bolívar, Colombia
OBJECTIVOS: Establecer la Costo-efectividad de levonorgestrel-UIS (LNG-UIS)
en el tratamiento de Menorragia Idiopática comparado con otras opciones
de tratamiento (Anticonceptivo Oral Combinado, Acido Tranexámico, Acido
Mefenámico y Naproxeno). METODOLOGÍAS: Se realizo un análisis de costoefectividad desde la perspectiva del tercero pagador evaluando como desenlace
el tiempo libre de sintomatologías ganado y el número de histerectomías evitadas.
Las probabilidades de transición fueron obtenidas de estudios clínicos. Se tomaron
los costos directos de atención a precios del 2010. No se incluyó la Ablación
endometrial por no ser de uso en Colombia Se aplico un descuento del 3% anual
para costos y desenlaces. Se realizó un análisis de sensibilidad tipo Montecarlo
con 2000 iteraciones y un análisis univariado tipo tornado. RESULTADOS: Para
una cohorte hipotética de 100 mujeres y un horizonte temporal de 5 años el costo
del brazo con LNG-UIS fue de 100,993 USD frente a 116,726 USD, 127,513 USD,
103,497 y 125,330 USD (Anticonceptivo Oral Combinado, Acido Tranexámico, Acido
Mefenámico y Naproxeno respectivamente). Con LNG-UIS se lograron 5.413 meses
sin sintomatología frente a 5.110, 4.975, 5.028 y 4791 respectivamente. Con LNG-UIS
se evitaron, 77 Histerectomías frente a 58, 74,75 Y 65 respectivamente. LNG-UIS fue
dominante frente a los demás comparadores para los desenlaces analizados. El
análisis de sensibilidad tipo Montecarlo mantuvo dominancia del LNG-UIS en más
del 99%. CONCLUSIONES: El uso de LNG-UIS como primera opción de tratamiento
en mujeres con menorragia idiopática es la mejor alternativa por cuanto es menos
costoso y más efectiva desde la perspectiva del tercero pagador en Colombia.
PIH5: REPLACING MMR BY MMRV IN MEXICO: ASSESSEMENT OF COSTEFFECTIVENESS BASED ON A DYNAMIC TRANSMISSION MODEL
Ouwens M1, Macias M2, Mascareñas De Los Santos AH3, Gomez JA4, Sauboin
C5, Carreño Manjarrez R6, 1Mapi Values Netherlands, Houten, The Netherlands,
2
Instituto Nacional de Pediatría, Pediatric Infectious Diseases, México, D.F.,
México, 3Servicios médicos de la Universidad Autónoma, Monterrey -Nuevo León,
México, 4GlaxoSmithKline, Victoria, Buenos Aires, Argentina, 5GlaxoSmithKline
Biologicals, Wavre, Belgium, 6GlaxoSmithKline, México, D.F. , México
OBJECTIVES: To predict the cost-effectiveness of vaccination with measles,
mumps, rubella, and varicella (MMRV) versus MMR in Mexico. METHODS: A
dynamic mathematical model was used to reproduce the age-related incidence of
varicella and zoster. The impact of introducing varicella vaccination was predicted
at population-level including costs and quality of life. Empirical age-specific
contact rates between individuals were used. Vaccine efficacy against varicella
was assumed to be 95% after two doses (1y and 6y). We assessed the impact of
vaccination in a base-case (coverage dose1: 90%; dose2: 80%) and in an optimal
scenario (higher coverage dose1:95%; dose2:90% and catch-up programme); and
the cost-effectiveness of replacing MMR with MMRV using 1.5% and 3% discount
rates for benefits and costs. RESULTS: In the long-term, MMRV vaccination is
predicted to result in a ~90% decrease in varicella incidence (with short-term
epidemics due to rebound effect) and a ~90% decrease in zoster cases (with a
temporary increase due to the assumption on exogenous boosting). At 1, 5, 30,
and 80 years, MMRV versus MMR is predicted to result in: - more QALYs saved
(31, 209, 925, and 1306); - more complications avoided (2, 6, 132, 1864); and - less
deaths in the long-term (though more in the short-term) (0, -5, -105, 279). Despite
increased vaccine costs vs MMR, MMRV was cost saving at all time points in terms
of GP/outpatient, hospital, indirect, and total ($7.9, $56.5, $226.9, and $331.2 million,
respectively) costs. Cost-effectiveness planes for direct and total costs indicate
that MMRV would provide more QALYs than MMR, and is cost saving. These results
are for the base-case scenario. For optimal scenario, results were similar or even
better. CONCLUSIONS: MMRV vaccination should result in significant reduction in
varicella and zoster cases in the long-term. We predict the replacement of MMR by
MMRV to be dominant under both scenarios.
103
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
INFECTION – Clinical Outcomes Studies
PIN1: THE EPIDEMIOLOGIC BURDEN OF HEPATITIS C VIRUS INFECTION IN LATIN
AMERICA
Szabo SM1, Donato BM2, Yuan Y3, Bibby M1, Jimenez-Mendez R4, Levy AR1, 1Oxford
Outcomes Ltd., Vancouver, BC, Canada, 2Bristol-Myers Squibb, Wallingford, CT,
USA, 3Bristol-Myers Squibb, Plainsboro, NJ, USA, 4University of British Columbia,
Vancouver, BC, Canada
OBJECTIVES: Chronic infection with hepatitis C virus (HCV) is a major and
growing public health concern in many, if not all, Latin American countries.
With more efficacious therapies becoming available, decision-makers require
accurate estimates of disease prevalence to assess the cost-benefit ratio of new
treatments for HCV infection. These estimates are challenging to derive because
HCV infection often remains asymptomatic – and therefore undetected – until the
liver has been seriously damaged. The objective of the study was to synthesize
estimates of the epidemiologic burden of HCV from Latin America. METHODS: A
systematic review was conducted in Medline and EMBASE by two reviewers to
identify population-based estimates of HCV prevalence from Argentina, Brazil,
Colombia, Mexico, Peru, and Venezuela since 2000. Studies were only included
if they were considered methodologically adequate, and randomly sampled
representative members of the general population. Counts and rates of positive
HCV tests from national blood bank networks were also synthesized. RESULTS:
Only one methodologically adequate Latin American population-based survey,
from Mexico, was identified; the estimated HCV prevalence was 1.4% (1.1%-1.6%).
Estimates of HCV prevalence among blood donors were: 0.66% (Argentina, 2008),
0.53% (Brazil, 2007), 0.57% (Colombia, 2006), 0.66% (Mexico, 2007), 0.81% (Peru,
2007), and 0.37% (Venezuela, 2005). CONCLUSIONS: Based on the review, Mexico
is the only Latin American country with robust estimates of HCV prevalence; the
potential societal burden is enormous as about 1.5% of the population is infected. Rates from blood donors underestimate true HCV prevalence; and the differences
between population-based and blood donor estimates for Mexico help frame the
extent of that underestimate. These population-based prevalence estimates, and
the prevalence estimates from blood donors, may be useful for inclusion in disease
models. Discrepancies between estimates from the different sources underscore
the need for methodologically-rigorous epidemiologic studies to maximally inform
decision-makers in Latin America.
INFECTION – Cost Studies
PIN2: FACING CRITICAL HEALTH EVENTS: ECONOMIC IMPACT OF AH1N1 FLU
EPIDEMIC IN THE MEXICAN HEALTH SECTOR, 2009-2010
Gutierrez-Delgado C, Gómez-Fraga S, Mexican Ministry of Health, México, D.F.,
México
OBJECTIVES: Analyze the economic impact of the A-H1N1 flu epidemic for the
health sector in Mexico in the 2009-2010 period, that resulted in the first pandemic
of the XXI century, in order to plan the resources provision and review policies
aimed to deal with similar future events. METHODS: The exercise had several
stages. First, a collect of the expenditures incurred by the health sector at federal
level between April 2009 and August 2010 was made. Second, the collected
information was classified into two areas of analysis: a) health care expenditures,
and b) additional costs from purchasing and application of vaccines, medical
equipment, drugs and health products, federal support to states, and national media
campaigns. Third, health care expenditure and expenditure by area of analysis was
estimated by aggregating all costs. RESULTS: Total federal expenditure related to
addressing the epidemic in the health sector was estimated in USD$ 733.3 million,
32% linked to health care and 93.7% exercised in 2009, corresponding to 11.2% of
the total health expenditure budget for this year. This expenditure involved medical
attention of 368 thousands patients, purchasing and application of 6.8 million of
anti-flu seasonal vaccines and 30 million of anti-AH1N1flu vaccines. For health
care, a total expenditure of USD$ 216.7 million was estimated, 80% exercised in
2009, that involves medical attention of 330 thousand patients. A total expenditure of
USD$ 516.3 million was estimated for additional costs, more than 99% exercised in
2009. The main component of this area was the purchase and application of A-H1N1
flu vaccine (USD$ 228.8 million). CONCLUSIONS: The exercise allows knowing the
mayor spending areas and generates evidence to strengthen the financial and
104
operational planning processes to face similar health events, such as the need
to anticipate resources and contingency funds in addition to administrative and
operational processes.
PIN3: PURSUING FINANCIAL SUSTAINABILITY TO FULFILL THE MILLENIUM
DEVELOPMENT GOAL SIX IN A FRAGMENTED SYSTEM. THE EXPERIENCE OF THE
UNIVERSAL ACCESS TO ANTIRETROVIRAL DRUGS IN MÉXICO 2007-2009
Rivera-Peña G, Rios-Arenas D, Gutierrez-Delgado C, Economic Analysis Unit,
México, D.F., México
OBJECTIVES: To calculate the average annual cost per ART in IMSS, ISSSTE and
MoH. To analyze the financial requirements for the provision of ART through the
Universal Access Program to Antiretroviral Drugs (PAUMA) lead for the MoH and
its implications for drug procurement policies at national level in the short and
medium terms.
METHODS: We obtained data about patients under ART in 2007 for the three
main institutions mentioned and in 2009 only for MoH. Information was analyzed
to identify ART prescriptions according to official recommendations. Average
annual cost of ART per patient and institution was estimated for 2007 and 2009.
Projections of the financial requirements to ensure the provision of ART through
the PAUMA for the period 2010-2017 were estimated. Analysis was developed
in STATA 9.2. RESULTS: In 2007 average annual cost of ART for the three main
institutions was MXP$64,800; per institution were as follow: ISSSTE MXP$74,300;
IMSS MXP$67,600 and MoH MXP$61,600. Information for the MoH indicates
that average annual cost of ART decreased between 2007 and 2009 by around
10.2% (in 2009 was MXP$55,300). First 20 ART options are prescribed to 80% of
the patients and represent around 73% of the total costs in 2009. Projections
for PAUMA in the period 2010-2017 indicate that on average annually 7,000 new
patients require ART and 5,000 deaths will occurred. Assuming new cases, deaths
and prices of antiretroviral drugs remain constant the average annual increase in
financial requirements for PAUMA to ensure ART in the period studied will be 5.6%.
CONCLUSIONS: Results generate evidence to strengthen the decision making,
monitoring, containment costs, and purchase of antiretroviral drugs processes.
It also provides information to allow policy makers optimize the use of limited
public resources to support the demand for ART through the financial armor that
contributes to maintain universal coverage, allowing the fulfillment of Goal 6 of the
Millennium Development Goals.
PIN4: ECONOMIC IMPACT OF COMMUNITY ACQUIRED PNEUMONIA
HOSPITALIZATIONS IN ADULTS IN SIX COUNTRIES IN LATIN AMERICA
Rosado-Buzzo A1, Garcia-Mollinedo L1, Camacho-Cordero L1, Roberts CS2, MouldQuevedo JF2, Trejo-Martinez A1, Luna-Casas G1, 1Links & Links S.A, de C.V., México,
D.F., México, 2Pfizer, Inc., New York, NY, USA
OBJECTIVES: To estimate the economic impact of community acquired pneumonia
(CAP) in adults over 50 years of age in Argentina, Brazil, Chile, Colombia, Mexico,
and Venezuela. METHODS: Local data sources were used to estimate the number of
cases of hospitalized pneumonia cases from ICD-9 codes in the year 2009 in adults
≥50 years of age. CAP episodes were estimated from pneumonia proportionally
by age based on prior publications that compared ICD-9 coded hospitalizations
to confirmed CAP by chart review. Resource use was estimated from treatment
guidelines and expert opinion and multiplied by local unit costs to derive total
costs. Indirect costs to patients and caregivers were estimated by average wages
times participation rate by age. Mortality cost was estimated by discounted life
expectancy times wage rates and participation rates by age group. Costs were
converted to USD by exchange rates to facilitate comparison. RESULTS: The
average cost of CAP hospitalizations in adults was (USD): Argentina=$32,241;
Brazil=$29,457; Chile=$26,936; Colombia=$23,656; Mexico=$21,018;
Venezuela=$22,536. In adults <65 years old, indirect costs comprised 1.5% of cost
associated with hospitalizations (range: 0.2% - 2.5%) and mortality costs comprised
16% (range: 3% - 24%). In adults ≥65 direct costs were over 95% of episode costs. The total cost of CAP hospitalizations in adults was (USD$Mil): Argentina=$697;
Brazil=$3,624; Chile=$445; Colombia=$347; Mexico=$941; Venezuela=$387. As a
proportion of the total population, CAP hospitalizations cost approximately $74 per
person ≥50 years old per year (range $42-$108) and $148 per person over 65 per
year (range $95-$235). CONCLUSIONS: CAP hospitalizations represent a significant
economic burden in adults across Latin America countries. Nearly one quarter
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
of the cost burden among adults <65 includes indirect costs, while the economic
burden among older patients is driven by direct costs and high incidence.
PIN6: EVALUACION COSTO-EFECTIVIDAD DEL USO DE LINEZOLID EN EL
TRATAMIENTO DE NEUMONIAS NOSOCOMIALES EN MÉXICO
Vargas-Valencia JJ1, Sotelo-Guzmán M1, Díaz-Ponce H2, Galindo-Suárez RM2,
Muciño-Ortega E2, Mould-Quevedo JF3, 1Econopharma Consulting S.A. de C.V.,
México, D.F., México, 2Pfizer S.A. de C.V., México, D.F., México, 3Pfizer, Inc., New
York, NY, USA
OBJECTIVOS: La neumonía nosocomial (NN) es la segunda causa más frecuente de
infección intrahospitalaria, la infección más frecuentemente adquirida en la unidad
de cuidados intensivos (UCI) y la primera causa de mortalidad por infecciones
intrahospitalarias. El objetivo de esta investigación fue estimar el costo-efectividad
del uso de linezolid en el tratamiento de la NN en comparación con el uso de
vancomicina y teicoplanina, desde la perspectiva del Instituto Mexicano del
Seguro Social (IMSS). METODOLOGÍAS: Se construyó un árbol de decisiones que
compara el uso de linezolid inyectable, seguido por linezolid oral (600mg dos veces/
día), vancomicina inyectable (1000mg dos veces/día) y teicoplanina inyectable
(400mg dos veces el primer día, días subsecuentes: 400mg) en el tratamiento de
NN (horizonte temporal: 38 días). Se evalúan la tasa de éxito microbiológico, los
días de estancia hospitalaria (en piso y UCI) y los costos médicos directos. Se
realizó una revisión de literatura para extraer la tasa de respuesta. La relación de
insumos (laboratorios, consultas y medicamentos) y procedimientos, así como el
manejo hospitalario se extrajó de la literatura y se complementó con opinión de
expertos. Los costos corresponden al IMSS para el año 2010. Se realizó análisis
de sensibilidad probabilístico. RESULTADOS: La tasa de éxito microbiológico del
tratamiento con linezolid fue de 64%, 59.5% con vancomicina (p=0.336) y 44.1% con
teicoplanina (p<0.001). Esto se refleja en una menor estancia en UCI, con 17.4 días
para linezolid, 21.26 días con vancomicina y 21.82 días para teicoplanina. El costo
total de tratamiento con linezolid fue $777,873.14, siendo menor respecto del de
vancomicina ($865,186.96) y teicoplanina ($931,983.09). Las curvas de aceptabilidad
muestran que linezolid es costo ahorrador con respecto a vancomicina o
teicoplanina. CONCLUSIONES: En el tratamiento de las NN en el contexto del IMSS,
linezolid presenta dominacia débil sobre vancomicina y dominancia absoluta sobre
teicoplanina.
PIN7: COST-EFFECTIVENESS ANALYSIS OF ANTI-PNEUMOCOCCAL VACCINES
VERSUS NO VACCINATION IN EL SALVADOR
Dueñas MDL1, Lutz M2, Morales G2, Strutton DR3, Roberts C4, Cuesta G2, Farkouh RA3
1
Hospital Centro Pediátrico, San Salvador, El Salvador, 2Pfizer S.A., La Aurora,
Heredia, Costa Rica, 3Pfizer, Inc., Collegeville, PA, USA, 4Pfizer, Inc., New York, NY,
USA
OBJECTIVES: . In 2009, it was estimated that there were 12.000 to 28.000 deaths
in Latin America related to Streptococcus pneumonia infections in pediatric
population under 5 years old. Currently, in El Salvador, Prevenar 7 (PCV-7) is the
anti-pneumococcal vaccine used. The aim of this study was to estimate the costeffectiveness and cost-utility of immunization strategies based on pneumococcal
conjugated vaccines (PCVs) in El Salvador, from an institutional perspective. METHODS: . A decision tree model was used to asses economic and health
impact of PCVs in children under 2 years old. The alternatives compared were: no
vaccination (comparator), PCV-7, PCV-10 and PCV-13. The effectiveness measures
were: child illness avoided, life years gained (LYs) and quality-adjusted life years
(QALYs) gained. Effectiveness and utilities were obtained from literature. Local
costs (expressed in 2009 $US) and epidemiology (data from 2009) were obtained
from El Salvador´s Ministry of Health database. The model included vaccine
dosage schedules approved in WHO prequalification and/or El Salvador MoH
calendar at the time of data collection (dec-2010). Univariate sensitivity analysis
was performed. The time horizon was one year and the discount rate was 3%. RESULTS: . Results show that immunization is cost-saving against no-vaccination. PCV-13 gained the highest number of QALYs (898) against PCV-10 (637) and PCV-7
(460). PCV-13 prevented 359 illnesses and gained 998 LYs. PCV-10 and PCV-7
prevented 257 and 228 illnesses and gained 707 and 511 LY´s, respectively. These
results were robust to variations in herd immunity and impact adjustments of PCV10
immunogenicity. CONCLUSIONS: . In El Salvador, immunization strategies based on
7, 10 and 13-valent PCV´s would be cost-saving interventions. Health outcomes and
savings of PCV-13 are greater than those estimated for 7 and 10-valent PCV´s.
PIN8: EVALUACION ECONOMICA DE LA EXTENSION DE PROFILAXIS CONTRA CMV
DE 100 A 200 DIAS EN RECEPTORES DE TRASPLANTE RENAL CON ALTO RIESGO
(D+ / R-)
Morales Buenrostro LE, Instituto Nacional de Ciencias Médicas y Nutrición
Salvador Zubiran, México, DF, México
OBJECTIVOS: Traducir los beneficios clínicos de extender el período de profilaxis
con Valganciclovir de 100 a 200 días en un análisis de costo-efectividad de largo
plazo en la etapa postrasplante en pacientes con alto riesgo de enfermedad por
Citomegalovirus (CMV) (D+ / R-). METODOLOGÍAS: Se utilizó un Modelo Markov
para simular los costos de los diferentes estadios de la enfermedad. Los horizontes
temporales evaluados son: menor a un año, un año, cinco años y diez años. La
población modelada son pacientes receptores de trasplante renal (RTR) con
alto riesgo de contraer CMV. Se compararon dos esquemas de profilaxis con
Valganciclovir 100 vs. 200 días. Tasa de descuento para un horizonte temporal
mayor a 1 año: 3% (Aplica para costos y utilidades). Los costos médicos directos
asociados con los diferentes estadios, se obtuvieron del listado de costos unitarios
para el IMSS, publicados en el Diario Oficial de la Federación 2010 y el portal de
compras gubernamentales Compranet. RESULTADOS: En el caso de receptores
con alto riesgo, extender profilaxis con Valganciclovir a 200 días, muestra una
notable mejoría en los resultados de salud y una baja en los costos asociados a las
complicaciones por enfermedad del CMV. De una cohorte de 100 pacientes, dentro
de los 2 siguientes años, se evitará la infección por CMV en 18 pacientes, adicional
a esto se redujeron en un 53% el riesgo de rechazo agudo, un 28% la pérdida
de la función del injerto y un 23% la probabilidad de muerte. CONCLUSIONES:
La reducción y/o retraso de infecciones por CMV en RTR resultará en una
reducción de los costos en el largo plazo. En el corto plazo se observarán menos
complicaciones por la enfermedad del CMV en pacientes inmunosuprimidos y en
el largo plazo se reducirá la incidencia de fallas del injerto y la probabilidad de
muerte.
PIN10: EXCHANGE RATE OR POWER PURCHASE PARITY FOR ECONOMIC
EVALUATION: ESTIMATING THE COSTS OF ROTAVIRUS VACCINATION IN A SIXYEAR PERIOD CONSIDERING DATA FROM MEXICAN CHILDREN
Granados-Garcia V1, Salinas-Escudero G2, Martinez-Valverde S2, 1National Institute
of México for Social Security (IMSS), México, D.F., México, 2Hospital Infantil de
México Federico Gómez, Secretaría de Salud, México, D.F., México
OBJECTIVES: To undertake a comparison of cost effectiveness estimates in
different currencies for the program of vaccination to prevent rotavirus diarrhea
for children less than five years of age. METHODS: Cost effectiveness estimates
were conducted considering yearly cohorts of children from 0 to 5 years of age
for a period of 6 years (2001-2006). We used two alternatives for presenting the
values of costs when transforming the Mexican pesos to dollars. In one alternative
we present the costs and cost effectiveness results in US dollars (with yearly
average exchange rates) and the second was the purchase power-parity factors.
We compare the results obtained considering the exchange rates and PPP factors
for each one year. Costs data and cost effectiveness ratios were expressed in
2006 prices. RESULTS: We found that the cost per DALY in base case estimate was
estimated at US$3640 per DALY ranging between US$2692 and 4502. The variations
of the estimates using PPP were between 48-59% larger than estimates using US
dollars CONCLUSIONS: Estimates of cost effectiveness using US dollars or PPP did
not change the conclusion which suggest that the vaccine is cost effective by using
of the rule of three times GDP per capita of the country as a threshold of the cost
per DALY in low and middle-income countries
PIN11: EVALUACION ECONOMICA DE LAS VACUNAS CONJUGADAS DE
PNEUMOCOCO PARA PERU
Tirado Caballero JC1, Navarro A2, Castrejon MM3, Gomez JA4, 1Complejo
Hospitalario San Pablo, Lima, Peru, 2GlaxoSmithKline, Lima, Peru, 3GlaxoSmithKline,
Panama City, Panama, 4GlaxoSmithKline, Victoria, Buenos Aires, Argentina
OBJECTIVOS: Evaluar los beneficios potenciales de la vacuna conjugada
10-valente de neumococo & proteína D de Haemophilus influenzae no tipificable
(HiNT) (PHiD-CV) y la vacuna conjugada 13 valente de neumococo (PCV-13) para
Perú. METODOLOGÍAS: Se utilizó un modelo Markov de cohorte. El modelo simula
el impacto de la enfermedad por neumococo y HiNT (enfermedad invasiva (EI),
neumonía adquirida en comunidad (NAC), y otitis media aguda (OMA)) en una
cohorte peruana seguida toda la vida. La epidemiología, el manejo de enfermedad
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y los costos utilizados fueron específicos de Perú. El escenario base incluyó
asunciones mínimas sobre las tasas de infección por HiNT. Se utilizó un esquema
de vacunación 3+1, una cobertura del 95% y precios por dosis de la Organización
Panamericana de la Salud (PHiD-CV: 14,85 dólares, y PCV13: 20,00 dólares). Se
presentan resultados de años de vida ganados ajustados por calidad (AVACs)
y costos utilizando un descuento del 3,5%, desde la perspectiva del pagador.
RESULTADOS: El modelo estimó resultados comparables sobre mortalidad por
EI y NAC para las dos vacunas, en el escenario base. Predice que las vacunas
reducirían 51,5 muertes (PCV13) y 50,0 muertes (PHiD-CV) por cada 100,000
niños vacunados. PHiD-CV prevendría 364 más miringotomías y 4.403 más OMAs
cada 100,000 niños vacunados versus PCV-13. Los costos médicos evitados (sin
descuento) por EI y NAC prevenidas, son similares para las dos vacunas. En
cambio, PHiD-CV ahorraría 1,9 veces más costos médicos por OMAs que PCV13.
Ambas vacunas son costo efectivas, pero PHiD-CV generaría más AVACs ganados
(378 AVACs adicionales) y sería costo ahorrativa (requiere 10 millones de dólares
menos) comparado con PCV13. CONCLUSIONES: Ambas vacunas reducirían
significativamente la enfermedad neumocóccica invasiva y la NAC siendo PHiDCV la que generaría más AVACs ganados siendo costo ahorrativa con respecto a
PCV-13, al presentar mayores efectos sobre OMA.
PIN12: ANALISIS DE COSTO-EFECTIVIDAD DEL USO DE PROTEINA C ACTIVADA
(PCA) EN ENFERMOS CON SEPSIS GRAVE Y CHOQUE SÉPTICO EN LA UNIDAD DE
CUIDADOS INTENSIVOS DEL HOSPITAL REGIONAL 1° DE OCTUBRE DEL ISSSTE
Villagómez A1, García S2, Carlos F3, Lemus A4, 1Hospital Regional 1° de Octubre del
Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, México,
D.F., México, 2Centro Médico Nacional 20 de Noviembre del Instituto de Seguridad
y Servicios Sociales de los Trabajadores del Estado, México, D.F., México, 3R A
C Salud Consultores, S.A. de C.V., México, D.F., México, 4Universidad Anáhuac,
México, D.F., México
OBJECTIVOS: La sepsis y el choque séptico representan una de las principales
causas mundiales de morbilidad y mortalidad, generando un impacto económico
considerable. El objetivo fue evaluar los costos y el beneficio por reducción
de mortalidad asociados con el uso de proteína C activada (PCA) en pacientes
con sepsis grave o choque séptico (SGoCS) desde la perspectiva del Instituto
de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE). METODOLOGÍAS: Se realizó un estudio transversal, comparativo, abierto, analítico
y retrospectivo con 200 pacientes adultos con SGoCS atendidos en la Unidad
de Cuidados Intensivos (UCI) del Hospital Regional 1° de Octubre del ISSSTE.
La inclusión fue no aleatoria y consecutiva de enero de 2007 a diciembre de
2009. El tratamiento estándar se otorgó conforme a guías internacionales. PCA
fue administrada en forma intravenosa (24 µg/kg/h) con duración total de 96
horas. Se analizó la mortalidad a 28 días de inicio del tratamiento en cada grupo.
Utilizando las proyecciones del Consejo Nacional de Población y el factor de
Quartin se estimó la expectativa de vida restante en los sobrevivientes (tasa de
descuento=5%). Se contemplaron los costos de adquisición de PCA y estancia
hospitalaria en UCI. Todos los costos se expresan en pesos mexicanos (MXN) 2010.
RESULTADOS: Ambos grupos eran comparables: edad media 60 años, 57% mujeres,
puntuación APACHE II (23.3 Vs. 24.0 en PCA y tratamiento estándar), número de
órganos con disfunción (3.8 y 3.6 en PCA y tratamiento estándar). Menos muertes
ocurrieron en el grupo PCA (52 Vs. 57): riesgo relativo=0.91 (IC95%=0.71-1.18). El
costo por salvar una vida adicional con PCA fue $1,159,591. Los costos por año
de vida ganado y por año de vida ajustado por calidad (AVAC) adicional con PCA
fueron $163,324 y $272,207 respectivamente. CONCLUSIONES: El uso de PCA en
pacientes con SGoCS constituye una estrategia costo-efectiva.
MENTAL HEALTH – Clinical Outcomes Studies
PMH1: COMPARING THE EFFECTIVENESS OF PALIPERIDONE PALMITATE VERSUS
OLANZAPINE PAMOATE FOR RELAPSE PREVENTION IN SCHIZOPHRENIA: POST
HOC INDIRECT ANALYSIS USING PUBLISHED PLACEBO-CONTROLLED STUDIES
Einarson T, University of Toronto, Toronto, ON, Canada
OBJECTIVES: Presently, no published studies compare head-to-head long-acting
injectable (LAI) antipsychotics paliperidone palmitate (PP) and olanzapine pamoate
(OLANZ) for schizophrenia; therefore, this indirect analysis was undertaken to
examine long-term relapse rates. METHODS: A priori criteria included: Patients:
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adults ≥18 with DSM diagnosis of schizophrenia, non-suicidal outpatients with
stable disease, taking minimal other medications; Designs: placebo-controlled,
double-blind, stabilized on LAIs and treated long-term; Outcome was relapse rate;
Definitions: must have defined relapse and stabilization. We compared between
LAI and placebo within studies using risk ratios (RR) for relapse rates derived
from Kaplan-Meier curves. Bucher’s method was used to compare indirectly
between LAIs. RESULTS: We identified two similar trials, one for each LAI. At
randomization, patients had similar mean±SD age (PP=39.1±11.1, OLANZ=38.9±11.2),
BMI (PP=27.3±5.8, OLANZ=26.9±5.0), and PANSS-Total scores (PP=52.6±11.8,
OLANZ=55.8±15.2). Research designs and definitions were also comparable. For a
valid comparison, outcomes at 24 weeks were analyzed. In the PP trial (Hough; Trial
PSY-3001), 206 patients received PP (50 or 100 mg Eq, which could be adjusted to 25,
50 or 100 mg Eq; average dose: 82.8 mg/4 weeks; 1.18 daily-defined-doses[DDDs]),
204 received placebo. In the OLANZ trial (Kane; Trial HGKA), 599 patients were
randomized to receive OLANZ (150 mg/2 weeks, 405 mg/4 weeks, or 300 mg/2
weeks; average dose: 426 mg/4 weeks; 1.52 DDDs) and 144 received pseudoplacebo (45 mg/month), a very low clinically sub-therapeutic dose assumed to be
comparable to placebo. PP had significantly fewer relapses than placebo (RR=0.31;
CI95%:0.22-0.44) as did OLANZ (RR=0.33, CI95%:0.24-0.46). The indirect RR of OLANZ
versus PP was 1.06 (CI95%:0.65-1.72). However, the monthly dose was 29% higher
for OLANZ (426 mg, 1.52 DDDs) than for PP (82.8 mg, 1.18 DDDs). CONCLUSIONS:
No differences were found in 6-month relapse rates between LAIs; however,
OLANZ required higher DDDs. These findings could impact outcomes from costeffectiveness analyses.
MENTAL HEALTH – Cost Studies
PMH2: THE COST-EFFECTIVENESS OF PALIPERIDONE PALMITATE COMPARED TO
OLANZAPINE PAMOATE IN THE TREATMENT OF SCHIZOPHRENIA IN SWEDEN
Pudas H1, Hemels M2, Mehnert A3, Druais S4, Martin M4, 1Janssen-Cilag Oy, Espoo,
Finland, 2Janssen-Cilag AS, Birkerod, Denmark, 3Janssen Pharmaceutica NV,
Beerse, Belgium, 4i3 Innovus, Uxbridge, Middlesex, UK
OBJECTIVES: To compare from the Swedish societal perspective the costeffectiveness of paliperidone palmitate administered monthly (75mg eq every
month) (PP) with olanzapine pamoate (150mg every 2 weeks or 300mg every
4 weeks) (OP). METHODS: A Markov decision analytic model was developed
simulating a cohort of stable schizophrenia patients transitioning monthly through
different health states over a lifetime (55 years). Probability of relapse, level of
adherence, side-effects (extrapyramidal symptoms, tardive dyskinesia, weight gain
and diabetes) and treatment discontinuation (switch) were derived from long-term
observational data. Productivity losses were included in the analysis. Costs were
expressed in 2011 Swedish Kronor (1 SEK ≈ 0,159 US dollar) with costs and benefits
discounted at 3%. Drug costs were derived from the Swedish Pharmaceutical
Benefits agency (TLV). Primary cost-effectiveness measures were the cost / QALY
gained and cost / relapse avoided. RESULTS: Compared to OP, PP is dominant:
an increased effectiveness (additional QALYs = 2.097) and fewer relapses (0.395)
at reduced costs (SEK 26 719) over a lifetime horizon. Results were robust when
tested in 33 deterministic (DSA) and probabilistic sensitivity analyses (PSA) using 12
parameters with predefined distributions. The model was most sensitive to change
in the risk ratio of relapse and the proportion of patients changing medication.
PP dominated OP in 99 % of cases in QALYs gained and in 92 % of cases in
relapses avoided. CONCLUSIONS: This cost-effectiveness analysis indicates that
paliperidone palmitate has both economic (reduced costs) and clinical advantages
(more QALYs, fewer relapses) compared with olanzapine pamoate in the long-term
treatment of schizophrenia in Sweden.
PMH3: COST-EFFECTIVENESS OF PALIPERIDONE PALMITATE FOR THE TREATMENT
OF SCHIZOPHRENIA IN MÉXICO
Reyes-Lopez A1, Querol J2, 1Hospital Infantil de México Federico Gómez, Secretaría
de Salud, México, D.F., México, 2Janssen de México, México, D.F., México
OBJECTIVES: Perform a cost-effectiveness analysis of paliperidone palmitate,
for the treatment of patients with schizophrenia in Mexico, from the perspective
of public health care providers METHODS: A Markov model with monthly cycles
was developed based on the natural history of disease, to simulate cohorts of
patients treated with paliperidone palmitate (PP), risperidone long-acting injectable
ISPOR 3rd Latin America Conference
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Research Poster Abstracts
(RIS) or oral olanzapine (OLZ), over a ten year horizon. The model captured
clinical and cost parameters including adherence levels, relapse risks, treatment
switch reasons, adverse events and direct medical care costs. Deterministic and
probabilistic sensitivity analyses were conducted to assess the robustness of the
model RESULTS: Compared with RIS, PP resulted more effective and less costly,
while when compared with OLZ, PP was more costly but more effective with an
incremental cost-effectiveness ratio of US$ 980 per relapse avoided. When plotting
an acceptability curve, PP showed a 0.90 probability of being cost-effective if a
decision maker is willing to pay US$ 3775 at present value to avoid an additional
relapse over a 10 year horizon. There was also a 0.32 probability of PP being
considered cost-saving. Both probability results were derived from the comparison
with OLZ CONCLUSIONS: Since it is possible to avoid more relapses at a reasonable
cost when compared with OLZ, PP represents good value-for-money for Mexican
healthcare providers. On the other hand, PP is a dominant treatment alternative
over RIS.
PMH4: ECONOMIC ASSESSMENT OF MAJOR DEPRESSIVE DISORDER TREATMENT
UNDER DIFFERENT THERAPEUTIC CLASSES AT ISSSTE
Ramírez-Gámez J, Dueñas-Tentori H, Eli Lilly and Company, México, D.F., México
OBJECTIVES: The objective of the present study is to determine the costeffectiveness associated with three therapeutic classes for treating major
depressive disorder (MDD) from the public health care payer perspective in
Mexico. METHODS: To evaluate health and cost outcomes, a previously published
decision model was adapted in order to reflect the usual treatment practice of
MDD at the Institute for Social Security and Services for State Workers in Mexico
(ISSSTE) during a 3-months time horizon. The three therapeutic classes included
in the present analysis are: Selective Serotonin Reuptake Inhibitors (SSRI),
Tricyclics (TCA) and Serotonin-Norepinephrine Reuptake Inhibitors (SSRI). Only
direct medical costs were considered either generics or branded antidepressants
with patent protection. All costs are presented in 2010 US dollars (Exchange Rate
1 US:12.50 MXN pesos) RESULTS: Within the three therapeutic classes assessed,
the expected value for one patient with each 3 options was distributed as follows:
$5 001, $4 215 $4 078 for group SSRI, TCA, and SNRI, respectively. The alternative
with a greater expected remission rate was the SNRI class. For every thousand
patients treated with SNRI, TCA, and SSRI, 725, 718, and 665 patients are expected
to accomplish remission. For each thousand patients treated with SNRI instead of
TCA, there will be $68272 cost savings over a period of 3 months. Likewise, when
compared against SSRI, the savings generated by SNRI is more than $367437 for
each thousand treated patients. CONCLUSIONS: The results of the present analysis
suggest that the SNRI as a therapeutic class in the treatment of MDD represent a
dominant strategy.
PMH5: ANALISIS DE COSTO EFECTIVIDAD DEL MANEJO FARMACOLOGICO DE
LA ESQUIZOFRENIA RECURRENTE EN PERU AJUSTADO POR LA ADHERENCIA AL
TRATAMIENTO
Izquierdo C, Janssen, Bogotá, Colombia
OBJECTIVOS: Comparar los resultados de costo-efectividad del tratamiento
de la esquizofrenia en adultos entre los antipsicoticos orales atípicos (APOA)
vs. antipsicoticos de depósito convencionales (DEPOT) vs. risperidona de
acción prolongada inyectable (RAPI) entre escenarios según adherencia.
METODOLOGÍAS: Se desarrolla un modelo en Excel con variables de uso y
frecuencia de los medicamentos y recursos hospitalarios, los eventos adversos
más relevantes y el subsidio por incapacidad entre las alternativas disponibles
para el tratamiento de la esquizofrenia. El modelo contempla switch de medicación
por risperidona de acción prolongada cuando ha iniciado con antipsicoticos de
depósito convencionales u orales atípicos y haloperidol o flufenazina para el caso
de risperidona de acción prolongada inyectable. Horizonte temporal: dos años
(un año para cada escenario), Perspectiva del tercero pagador. Indicadores de
efectividad: días libres de crisis y días evitados de hospitalización. RESULTADOS:
El modelo proyecta un porcentaje de adherencia de 89.6% para RAPI; 79.6% para
DEPOT; y 69.5% para APOA. El incremento de efectividad de RAPI teniendo en
cuenta los dos escenarios comparado con la opción menos costosa (risperidona
oral) es de de 65 días libres de crisis y 15 días libres de hospitalizacion con un ICER
en el primer caso de $65.47 y en el segundo caso de ICER de $261.67 en dos años.
CONCLUSIONES: Risperidona de acción prolongada como primer medicamento
o como switch en esquizofrenia recurrente teniendo en cuenta un primer año de
mala adherencia y un segundo año con mejoría de la adherencia es una alternativa
que ahorra costos en recursos hospitalarios y costo efectiva con un umbral a
pagar aceptable comparándolo con el costo de un día de hospitalizacion ($300).
El análisis de sensibilidad muestra robustez después de tres días en promedio
de hospitalizacion en caso de recaída. (1 Dólar Americano: 2.84 Nuevos Soles
Peruanos).
MUSCULAR-SKELETAL DISORDERS – Clinical Outcomes Studies
PMS1: META-ANALISIS DE LA EFECTIVIDAD Y SEGURIDAD DEL USO DE
CELECOXIB EN EL MANEJO DEL DOLOR CRONICO VS OTROS COX-2 EN PACIENTES
CON OSTEARTRITIS O ARTRITIS REUMATOIDE
Vargas-Valencia JJ1, Granados-Soto V2, Galindo-Suárez RM3, Mould-Quevedo
J4, 1Econopharma Consulting S.A. de C.V., México, D.F., México, 2Centro de
Investigación y Estudios Avanzados, México, D.F., México, 3Pfizer S.A. de C.V.,
México, D.F., México, 4Pfizer, Inc., New York, NY, USA
OBJECTIVOS: Los inhibidores de la ciclooxigenasa-2 (COX-2) constituyen una
alternativa para tratar el dolor asociado a artritis reumatoide u osteoartritis.
El objetivo de esta investigación fue identificar las diferencias en efectividad
y seguridad de celecoxib vs otros inhibidores de la COX-2 al tratar el dolor en
pacientes con osteoartritis o artritis reumatoide. METODOLOGÍAS: Se realizó una
búsqueda de literatura publicada de enero 2000 a diciembre 2010. Se incluyeron
ensayos aleatorizados, doble ciegos y placebo-controlados, que especifican
la evaluación de la intensidad del dolor mediante escala visual análoga (EVA)
e incidencia de eventos adversos (EA) gastrointestinales y cardiovasculares
(hipertensión, edema y cardiopatía congestiva), en pacientes con clase funcional
I-III, con dolor ≥40EVA y 3 meses previos con sintomatología. Se excluyeron
aquellos que investigaron dosis de inhibidores de la COX-2 diferentes a las
terapéuticas (Celecoxib 200mg/día, Etoricoxib 30-90mg/día y Lumiracoxib
100-200mg/día). Para la cuantificación del efecto de los inhibidores de la COX-2, se
definió la diferencia media en la reducción en la calificación de EVA con respecto
a placebo y se evaluó mediante análisis de varianza. La razón de momios para
estimar el incremento en riesgo de presentar EA’s, se estimó mediante la prueba
Mantel-Haenszel. Se consideró el modelo de efectos aleatorios y pruebas de
heterogeneidad. RESULTADOS: La reducción absoluta en la escala del dolor a 12
semanas con respecto a placebo fue 14.18% IC95% [10.48-17.87] con Celecoxib
(P<0.00001); 12.70% IC95% [7.67-17.73] con Etoricoxib (P<0.00001) y 9.47% IC95%
[7.17-11.77] con Lumiracoxib (P<0.00001). Celecoxib redujo el dolor crónico en 4.71%
IC95% [0.36,9.06] (P=0.03) respecto a Lumiracoxib. La diferencia con Etoricoxib
no fue significativa (P=0.64). La diferencia en la incidencia de EA’s entre los
inhibidores de la COX-2 y placebo no fue significativa. CONCLUSIONES: Celecoxib
constituye una alternativa farmacológica segura para el manejo del dolor crónico
asociado a osteoartritis o artritis reumatoide y ofrece mayor reducción del dolor vs
Lumiracoxib.
PMS2: OSTEOPOROSIS MEDICATION MIGHT HELP REDUCE THE INCIDENCE OF
SECOND HIP FRACTURES?
Sebestyén A1, Sándor J2, Betlehem J3, Boncz I3, 1South-Trasdanubian Regional
Health Insurance Fund Administration, Pécs, Hungary, 2University of Debrecen,
Debrecen, Hungary, 3University of Pécs, Pécs, Hungary
OBJECTIVES: The aim of the study is to evaluate, that the pharmacologic treatment
for osteoporosis after primary hip fracture can reduce the risk of subsequent
femoral neck fracture in patients aged over 60 years? METHODS: In this
retrospective study the data derive from the financial database of the Hungarian
National Health Insurance Fund Administration. The study includes patients over 60
years following primary treatment of femoral neck fracture (S7200) discharged from
inpatient care institutions in 2000. Pathologic hip fractures, fractures that emerged
from high-energy trauma, fractures that happened in hospitals, and patients who
died within ½ years after primary hip fracture were excluded from the analysis.
The follow up period was 8 years. We evaluated data according to sex, age, type of
living place, type of hospital treated the primary fracture, type of primary femoral
neck fracture, absence or presence of accompanying diseases, type of surgical
intervention for primary fracture, and antiosteoporotic pharmacologic treatment
after primary fracture. The effects of prognostic factors were evaluated by Cox
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proportional hazard regression analysis (HR, 95 % CI, p) RESULTS: The 2778 patients
were observed for 13,488.92 person-years. During the observation period 320
second hip fracture (11.5 %) were identified, giving an overall incidence of 0.024
per person-year. The significant predictors (0.05>p) are presented: Gender: female/
male HR:1.5289; Age: 80-89y/60-69y HR:1.4910; Residence: capital/village HR:1.4980;
Type of surgical intervention: arthroplasty/osteosynthesis HR:1.4136; Osteoporosis
medication: duration<2years/none HR:0.5100, duration>2 years/none HR:0.5261.
The references is marked with underline. CONCLUSIONS: The risk of second hip
fracture was the highest in female, in older age-group, in patient after arthroplasty,
in patient with capital residence and in patient without pharmacologic treatment
for osteoporosis. In addition the osteoporosis medication can reduce the risk of
subsequent femoral neck fracture.
MUSCULAR-SKELETAL DISORDERS – Cost Studies
PMS3: IMPACTO ECONOMICO DE LA OSTEOPOROSIS Y DE LAS FRACTURAS POR
FRAGILIDAD EN EL INSTITUTO MEXICANO DEL SEGURO SOCIAL
Clark P1, Carlos F2, Chico G1, Galindo-Suarez RM3, 1Hospital Infantil de México
Federico Gómez, Secretaría de Salud, México, D.F., México, 2R A C Salud
Consultores, S.A. de C.V., México, D.F., México, 3Pfizer, Inc., México, D.F., México
OBJECTIVOS: La osteoporosis (OP) y fracturas por fragilidad (FF) aumentarán
considerablemente en los próximos años. El objetivo fue identificar los costos
directos médicos asociados al tratamiento de estas condiciones en personas
de 50-99 años del Instituto Mexicano del Seguro Social (IMSS) durante 2010.
METODOLOGÍAS: La prevalencia de OP fue estimada con base en literatura
publicada y datos nacionales de población y cobertura del IMSS. La herramienta
FRAX® se utilizó para estimar la probabilidad de presentar alguna de las
principales FF (cadera, columna, antebrazo y húmero) en población mexicana con
diagnóstico de OP (T-score promedio=-3.0) y ningún factor clínico de riesgo. En el
portal de transparencia IMSS se consultaron los gastos en bisfosfonatos, calcio,
calcitriol y calcitonina. Mediante una búsqueda bibliográfica se identificaron
datos publicados sobre costos de atención aguda de FF en el IMSS, cifras que
fueron actualizadas a diciembre de 2010 aplicando la inflación acumulada en el
periodo correspondiente (2007-2010). Se consideraron los costos potenciales de
diagnóstico así como el seguimiento durante un año en pacientes con OP y los
generados por sesiones de rehabilitación y consultas externas para las FF tomando
en cuenta la literatura disponible, entrevista a expertos y costos unitarios del
IMSS. RESULTADOS: Un total de 659,182 (17.4%) mujeres y 188,196 hombres (6.0%)
conformaron la prevalencia de OP en derechohabientes de 50-99 años. El gasto
en atención no farmacológica para OP superó 616 millones de pesos mexicanos
(MXN). El gasto en adquisición de medicamentos para OP fue estimado en 72.8
millones MXN. Los costos totales de las 9488 FF ascendieron a 513 millones
MXN. Así, el impacto económico de la OP y las FF en el IMSS para el año 2010
fue de 1202.30 millones MXN, equivalente al 0.4% de los ingresos del instituto.
CONCLUSIONES: La OP y FF imponen un elevado costo económico al IMSS. PMS4: ECONOMIC EVALUATION OF POST-OPERATION ORTHOPEDIC SURGERY OF
ANTACID, ANTIHEMETIC AND ANALGESIC MEDICATION AFTER KETOPROPHENE,
KETOROLAC, PARECOXIB AND TENOXICAM IN BRAZILIAN PATIENTS
Fujii RK1, Mould-Quevedo JF2, 1Pfizer Pharmaceutics inc., São Paulo, SP, Brazil,
2
Pfizer, Inc., New York, NY, USA
OBJECTIVES: To evaluate the use of ‘antacid, antihemetic and adjuvant analgesic
opiates and non-opiates’ (AAA) after using intravenous ketoprophene (100mg/
day), ketorolac (90mg/day), parecoxib (40mg/day) or tenoxicam (40mg/day) in postoperative orthopedic surgery at five Brazilian private hospitals. METHODS: Medical
charts were accessed and selected based on the use of ketoprophene, ketorolac,
parecoxib or tenoxicam at the immediate post-operative period and based on the
existence of hospital’s billing information. 400 medical charts from November 2010
were evaluated and 121 cases were recruited. Data regarding the regular use of
AAA was gathered and grouped by age, sex, length of stay (LOS) at nursing ward
and intensive care unit, and number of hours at the immediate post-operative
observation room. Ketoprophene, ketorolac, parecoxib and tenoxicam groups were
compared using unpaired t-tests with 95% confidence interval. RESULTS: Average
age was 51.1 (±13.1)yrs and 60% were female. Average LOS at nursing ward, ICU
and immediate post-operative rooms were 3.7 (±2.8) days, 0.8 (±1.1)days, and 95
108
(±36)min, respectively. Ketoprophene, ketorolac, parecoxib and tenoxicam for
overall users represented 39.7%, 28.9%, 19.0% and 12.4% respectively. Ketorolac
group exhibited to use more adjuvant non-opiate analgesics than parecoxib
and tenoxicam groups(p<0.05). Only parecoxib was found to have significantly
less use of antacid and antihemetic medications when compared to others
treatments(p<0.004). Other parameters didn’t present meaningful differences. Total
mean treatment daily costs considering drug equipment resulted in US$28.2; US$
34.3; US$27.1 and US$32.9 corresponding to ketoprophene, ketorolac, parecoxib
and tenoxicam, respectively. Mean AAA daily estimates costs were US$9.0 (±4.8);
US$11.0 (±5.7); US$5.3 (±4.1) and US$7.5 (±4.9) respectively. Potential cost savings
per patient regarding the reduction of AAA by replacing all alternatives with
parecoxib was estimated in US$37.2. CONCLUSIONS: Parecoxib users undergoing
orthopedic surgeries showed the least use of antacid and antihemetic medications
generating savings in the Brazilian private setting.
PMS5: ANALISIS DE COSTO-EFECTIVIDAD DE AGENTES BIOLOGICOS EN EL
TRATAMIENTO DE PACIENTES CON ARTRITIS REUMATOIDE ACTIVA Y RESPUESTA
INSUFICIENTE A FARME TRADICIONALES DESDE LA PERSPECTIVA DEL SISTEMA
PUBLICO DE SALUD EN MÉXICO
Carlos F1, Aguirre A1, Peláez-Ballestas I2, Ramos E1, 1R A C Salud Consultores,
S.A. de C.V., México, D.F., México, 2Hospital Infantil de México Federico Gómez,
Secretaría de Salud, México, D.F., México
OBJECTIVOS: Un número importante de pacientes con artritis reumatoide (AR)
presenta respuesta insuficiente a fármacos antirreumáticos modificadores del
curso de la enfermedad (FARME) tradicionales. El objetivo fue comparar los
costos y la efectividad de utilizar FARME biológicos en esta población, desde la
perspectiva del sistema público de salud en México. METODOLOGÍAS: Se realizó
una búsqueda sistemática, identificándose 23 estudios clínicos controlados,
con asignación aleatoria y a doble-ciego que evaluaron el uso de tocilizumab,
infliximab, etanercept, adalimumab y abatacept en dosis recomendadas para la
población objetivo. El horizonte temporal fue seis meses. La medida de efectividad
consistió en la proporción de pacientes con mejora de 70% en la respuesta, según
criterios del Colegio Americano de Reumatología (ACR70), parámetro considerado
proxy de remisión. Mediante una comparación indirecta se calcularon las tasas
ajustadas de ACR70 para cada agente biológico. Únicamente se analizaron costos
de adquisición y administración de FARME biológicos con base en la duración
de los ensayos. Los costos de infliximab, etanercept y adalimumab, además del
costo unitario por infusión fueron obtenidos de fuentes oficiales; Roche México
proporcionó los precios de tocilizumab y se estimó que el costo de abatacept en
instituciones de gobierno es 40% más bajo que en el sector privado. Todos los
costos se expresan en pesos mexicanos (MXN) 2010. RESULTADOS: El costo
fue más bajo con tocilizumab ($57,420) que con etanercept ($62,354), infliximab
($65,527), adalimumab ($73,359) y abatacept ($74,925). La mayor proporción ajustada
de pacientes con respuesta ACR70 se obtuvo con tocilizumab (30.74%), seguida de
adalimumab (22.05%), abatacept (14.84%), etanercept (14.79%) e infliximab (12.80%).
El costo por lograr un ACR70 fue notablemente más bajo con tocilizumab ($186,783)
que con el resto de las alternativas (rango: $332,699 a $511,820). CONCLUSIONES:
Tocilizumab representa una estrategia dominante para el tratamiento de pacientes
adultos con AR y respuesta insuficiente a FARME tradicionales.
PMS6: HEALTH CARE RESOURCE UTILIZATION OF THAI HIP FRACTURE PATIENTS
IN PUBLIC HOSPITAL: COST OF ILLNESS ANALYSIS AT CHIANGRAI HOSPITAL
Srisawi K1, Thepnamwong J1, Sukwong DP1, Reungjarearnrung K3,
1
Chaiangraiprachanukroh Hospital, Chiang Rai, Thailand, 3Bumrungrad Hospital,
Wattana, Bangkok, Thailand
OBJECTIVES: Hip fracture incidence in Thailand is rising and triggers an increased
healthcare resource demand. This research is to examine hip fracture incidence at
Chiangraiprachanukroh hospital and associated hospital costs. METHODS: Patients
with hip fracture coded S720-S722 (ICD-10) aged 50 or older, were recruited from
January to December 2009 together with co-morbidities, type of hip fracture and
management (surgical & nonsurgical discharge) and a follow-up over one year.
All direct hospital costs at provider’s perspective were retrieved from hospital
database. Statistical analysis employed unpaired t-test, Mann-Whitney U test for
comparison of costs and their associations to type of fracture and management.
RESULTS: A total of 121 patients with hip fracture were screened. Patients’ mean
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
age (SD) was 77.0 (11.6) years and 57% were male. (N=68). The mean days followup (SD) and mean hospitalization (SD) was 90.7 (15.1) and 7.3 (7.9) respectively. At
screening, 56% of patients had co-morbidities (N=67). The average hospitalization
costs were 20,936 THB. The cost of all type of drugs was below 11% of total cost of
illness. It ranged from 2.5% to 10.7% for surgical and non-surgical discharge and
from 4.8% to 9.6% for inter-trochanteric and femoral neck fracture respectively.
Patients with femoral neck fracture (N=33, 27%) and inter-trochanteric fracture
(N=88, 73%) had similar mean age (p=0.612) and hospitalization length (p=0.480).
The associated mean hospital costs were 34,397 THB and 15,887 THB respectively.
Patients with surgical discharge (N=34, 28%) and non-surgical discharge (N=87,
72%) had similar hospitalization length (p=0.490). The associated mean hospital
costs were 55,268 THB and 7,273 THB respectively. Overall hospital costs ranges
from less than 10,000 to 156,529 THB with median of 7,260 THB per patient/year.
CONCLUSIONS: Patients admitted for hip fracture, femoral fracture and surgical
management increase hospital costs over short-term in public hospital. Regardless
of context, cost of drugs was marginal among hospital costs of hip fracture.
PMS7: DIRECT TREATMENT-COST OF PATIENTS WITH RHEUMATOID ARTHRITIS IN
MEDELLIN, COLOMBIA
Montoya N1, Gómez L1, Vélez M1, Rosselli D2, 1Medicarte, Medellin, Colombia,
2
Universidad Javeriana, Bogotá, Colombia
OBJECTIVES: To analyze clinical variables and direct costs of a sample of patients
with rheumatoid arthritis from a specialized pharmacotherapeutic management
center in Medellin, Colombia. METHODS: We reviewed 408 clinical files of
the period 2007-2009 collecting clinical information and direct costs from the
perspective of a local private health insurer. RESULTS: 337 women (82.6%),
average age 49.8 (range 4-91). Almost one half of the patients (183, 44.8%) in
this sample received biological therapy during this period. Overall, average
monthly cost increased from Col$1.31 million (around US$650) in 2007, to Col$1.71
million (~US$850) in 2008, and Col$1.99 million (~US$1000) in 2009; 87.9% of this
cost is represented by pharmaceuticals. CONCLUSIONS: Costs of treatment
are increasing, despite the implementation of cost-containing strategies;
pharmaceuticals represent an important proportion of total cost.
PMS8: COST-EFFECTIVENESS ANALYSIS OF ETANERCEPT VERSUS AVAILABLE
ANTI-TNF AND IL-6 BLOCKERS FOR TREATING RHEUMATOID ARTHRITIS IN
GUATEMALA
Lutz M, Cuesta G, Morales G, Pfizer S.A., La Aurora, Heredia, Costa Rica
OBJECTIVES: Rheumatoid Arthritis (RA) affects approximately 0.4% of the Latin
American population over 16 years old. Due to its chronic and progressive
condition, RA has an important economic and social impact. The aim is to assess
the cost-effectiveness of etanercept in the treatment for moderate to severe
RA, with previous antirheumatic drugs (DMARDs) failure, in comparison with
the rest of anti-TNF and IL-6 blockers products available in Guatemala, from the
healthcare payer’s perspective. METHODS: A decision tree model was used
to compare the costs and effectiveness of the alternatives, all in combination
with methotrexate, in the treatment of RA in adult population of Guatemala. The
alternatives included were: etanercept (comparator), adalimumab, infliximab and
tocilizumab. The effectiveness measures were: American College of Rheumatology
(ACR) Response Criteria ACR<20 and ACR<70. Quality utilities were obtained from
Health Assessment Questionnaire (HAQ). Local costs (2011 US$) were obtained
from Guatemala´s Ministry of Health databases. The outcomes were express in
costs of success with ACR20 and ACR70 and QALYs gained. Univariate sensitivity
analysis was performed. The time horizon was 2 years. Discount rate was 5% for
costs and health outcomes. RESULTS: Results showed that etanercept gained
the highest number of QALYs (1.5423) in comparison with adalimumab (1.5048),
infliximab (1.4299) and tocilizumab (1.4955). Etanercept appeared as the least
expensive alternative at both ACR<20 ($69,410.32) and ACR<70 ($176,178.43). The
highest costs were obtained by infliximab, ACR<20 ($139,291.80) and ACR<70
($612,236.06). Cost-effectiveness analyses exhibited etanercept as the dominant
strategy. Acceptability curves showed that at the willingness-to-pay of US$8,000/
QALY, the probability that etanercept is cost-effective met 100%. PSA results
support the robustness of these findings. CONCLUSIONS: Etanercept is the most
cost-effective alternative for treating RA against other anti-TNF and IL-6 blockers. According to <3 GDP per capita ($5,200; 2010) threshold of Guatemala, etanercept is
a cost-effective treatment for RA.
PMS9: WHAT IS THE VALUE OF THE NEW KID ON THE BLOCK?: TOCILIZUMAB
VERSUS ABATACEPT FOR RHEUMATOID ARTHRITIS IN COLOMBIA
Alfonso-Cristancho R1, Aiello EC2, Roa CN3, Valencia JE3, 1University of Washington,
Seattle, WA, USA, 2Bristol-Myers Squibb, Buenos Aires, Argentina, 3Bristol-Myers
Squibb, Bogotá, Colombia
OBJECTIVES: Determine the cost-effectiveness of abatacept or tocilizumab in
patients with rheumatoid arthritis (RA) with inadequate response to methotrexate
(IR-MTX) in Colombia. METHODS: A patient-level simulation based on the
Birmingham Rheumatoid Arthritis Model was adapted to the clinical practice
patterns and demographic characteristics of the patients and validated by clinical
experts in Colombia. The functional disability was assessed using the Health
Assessment Questionnaire (HAQ); the mean scores and the distribution were
derived from subjects screened to participate in clinical trials in Latin America. The
effect of biologic therapy was assessed using changes in HAQ scores for the first
6 months based on a mixed treatment comparison and then projected over time.
Direct medical costs were calculated from private and public providers, and the
information system of the Ministry of Social Protection (SISMED). A 20-year time
horizon and the payer’s perspective were assumed. Costs and health outcomes
were discounted at 3% annually. Sensitivity analyses were performed to the main
parameters of the model. RESULTS: A hypothetical cohort of 1,000 patients with
RA - IR MTX followed for 20 years or until death, the mean direct medical costs
per patient for abatacept were U$132,654 (129,198-145,203), compared to U$283,753
(275,809-315,551) for tocilizumab. For the group of subjects treated with abatacept,
84% of these costs were associated with the drug; for tocilizumab, 93% of the
costs are associated with the drug. The mean number of life years were 29.27
(28.45-30.15) and 29.25 (28.43-30.13) for abatacept and tolicizumab respectively.
The mean number of QALYs (discounted) by abatacept, and tocilizumab were:
7.21 (7.02-7.42), and 7.15 (6.96-7.37) respectively. Using abatacept as the reference
treatment, tolicizumab provided less utility at a higher cost, being dominated
by abatacept CONCLUSIONS: For the treatment of RA in patients with IR MTX
in Colombia, the use of abatacept, as the reference treatment, is dominant
over tocilizumab.
PMS10: COST-EFFECTIVENESS OF DULOXETINE COMPARED TO PREGABALINE
IN PATIENTS WITH FIBROMYALGIA FROM THE PUBLIC HEALTH CARE SYSTEM
PERSPECTIVE IN MÉXICO
Ramírez-Gámez J, Dueñas-Tentori H, Eli Lilly and Company, México, D.F., México
OBJECTIVES: Fibromyalgia (FM) is a disease with a great economic impact not
only related to the costs associated but also to the loss of productivity. Effective
treatment options in the Mexican market are few. The objective of the present
analysis is to assess the cost-effectiveness of duloxetine in the treatment of
patients with FM versus pregabalin. METHODS: Alternatives to compare were: (1)
duloxetine 60 mg / day and 120 mg / day and (2) pregabalin 300 mg / day and 450
mg / day. A decision tree model was developed with a 12 weeks time horizon in
which patients maintained response, lost response or dropped out. Relative rates
of response for other comparators over placebo were extracted from a systematic
review of published randomized controlled studies for achieving a reduction of
30% in the Brief Pain Inventory average pain severity score or a “much improved”
or “very much improved” rate in the Patient Global Impression of Improvement
(PGI). Resource use associated with fibromyalgia management was estimated from
published studies and costs were estimated from the Mexican Public Healthcare
Payer perspective at 2010 USD prices. RESULTS: In the base case duloxetine 60
mg/day versus the two indications of pregabalin were compared considering the
price per milligram for the 14 and 28 tablets of 75 mg presentations of pregabalin.
In this case, duloxetine is a dominant strategy versus pregabalin in 3 out of four
scenarios and highly cost-effective when compared duloxetine 120mg/day versus
pregabalin 300mg/day. Further analysis (considering presentation 14/28 tablets of
150 mg of pregabalin), shows that duloxetine is a highly cost-effective alternative
with cost-effectiveness ratios of $34-405 USD range per one additional response.
CONCLUSIONS: Results suggest duloxetine is a dominant and highly cost-effective
alternative compared with pregabalin at therapeutic doses published in studies of
comparable design in patients with FM.
109
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
PMS11: REVIEW OF THE STUDIES ON ECONOMIC EVALUATION OF TREATMENT
FOR POSTMENOPAUSAL OSTEOPOROSIS
Brandão CMR1, Acurcio FDA2, 1Universidade Federal de Minas Gerais, Contagem,
Minas Gerais, Brazil, 2Universidade Federal de Minas Gerais, Belo Horizonte, Minas
Gerais, Brazil
OBJECTIVES: The use of economic evaluation studies has been increasingly
common, especially in the field of osteoporosis, in which there is wide a variation
in effectiveness and costs of therapeutic strategies. Aiming to identify relevant
studies, there was a complete review of the economic evaluations, conducted
in Brazil and abroad, focusing on the treatment of postmenopausal osteoporosis
to support decision-making on health policies in Brazil and Latin America.
METHODS: There was a search on PubMed and the national scientific journals
until February 2011. We used the keywords {osteoporosis} and {postmenopausal
or post-menopausal} and {cost effectiveness or cost benefit or cost utility or
Economic Evaluation}. RESULTS: 147 titles and abstracts were found. After careful
selection, 29 articles remained for analysis. We found great variability in the
methods of studies related to the specific issues of each country (demographic and
epidemiological factors), associated with the perspective adopted, the prices, the
valuation of health states by population (utility) and according to factors inherent
to economic modeling. Most studies that compared treatment strategies with no
treatment at all, found a reasonable incremental cost-effectiveness ratio (ICER),
according to the willingness to pay of each country. The interventions have become
more cost-effective with increasing age, decreasing bone mineral density and the
presence of previous fractures. In general, bisphosphonates were the strategies
that were evaluated the most and they showed better results in ICER’s. Teriparatide
was not cost-effective. Studies evaluating hormone replacement therapy found
good ICER, but call attention to the increased risk of breast cancer. Vitamin
supplementation, strontium ranelate, raloxifene, and denosumab were evaluated
and showed variable results depending on the perspective, of the country and the
assumptions. CONCLUSIONS: It was not possible to extrapolate any of the results
to the population of Brazil or countries of Latin America, limiting its use to decision
makers in yours different locations.
PMS13: ECONOMIC MODEL OF WORKPLACE IMPACTS OF ANTI-TNF THERAPY FOR
RHEUMATOID ARTHRITIS IN BRAZIL
Teich V1, Chaves L2, Birnbaum H3, Pike C3, Waryas C3, Cifaldi M4, 1MedInsight
Evidências, São Paulo, SP, Brazil, 2Abbott Laboratories, São Paulo, SP, Brazil,
3
Analysis Group, Inc., Boston, MA, USA, 4Abbott Laboratories, Abbott Park, IL, USA
OBJECTIVES: To estimate employer productivity offset costs when using Tumor
Necrosis Factor inhibitors (TNF-i) therapies for treatment of Rheumatoid Arthritis
(RA) using an economic model that encompasses a broad set of workplace costs
from RA. METHODS: A customizable model of the workplace impacts of alternative
RA treatments was calibrated with Brazilian specific parameters based on data
from literature, clinical trials, and government sources. The workplace model
included employment sector wages to allow for comparisons across industries.
Costs of medical leave absenteeism/disability, reduced productivity, job turnover,
and work-equipment adaptations were calculated for RA employees on the TNF-i
versus other traditional DMARDs RA treatments. Employer costs of RA workers on
TNF-i versus traditional DMARDs were compared. RESULTS: Across all industries in
Brazil, the annual workplace cost of employees with RA was R$4,839 for employees
on adalimumab (23% of wages) versus R$8,679 for employees on traditional
DMARDs therapies (42% of wages). The R$3,839 offset reduction in employer costs
for RA workers on adalimumab included reduced medical leave (R$764) and RArelated job turnover (R$1,076), and higher productivity (R$1,999). Savings per RA
worker on adalimumab ranged from R$2,597 (19% of wages) in the waste treatment
sector to R$26,312 (19% of wages) in the petroleum product manufacturing sector.
CONCLUSIONS: RA imposes a large financial burden on employers in Brazil.
This burden is substantially less for employees treated with adalimumab than for
employees treated with traditional DMARDs as a result of the higher productivity,
lower turnover, and lower absenteeism associated with adalimumab use. Employer
savings from adalimumab use varies across industries in Brazil. High-wage sectors,
such as the petroleum industry, have both larger absolute costs associated with RA
and larger absolute savings from adalimumab use than do low-wage sectors, such
as waste treatment.
PMS12: EVALUACION ECONOMICA DE RITUXIMAB VERSUS ANTI-TNF EN
PACIENTES CON ARTRITIS REUMATOIDE Y FALLA PREVIA A ANTI-TNF EN MÉXICO
Carlos F1, Clark P2, 1R A C Salud Consultores, S.A. de C.V., México, D.F., México,
2
Hospital Infantil de México Federico Gómez, Secretaría de Salud, México, D.F.,
México
OBJECTIVOS: Aproximadamente 30% de los pacientes con artritis reumatoide (AR)
tratados con inhibidores del factor de necrosis tumoral (anti-TNF) no alcanzan una
mejora de al menos 20% en los criterios del Colegio Americano de Reumatología
(ACR). El objetivo fue determinar la relación costo-utilidad de diferentes opciones
de tratamiento en pacientes con AR y falla a anti-TNF, desde la perspectiva del
sistema público de salud en México. METODOLOGÍAS: Se utilizó un modelo de
microsimulación (horizonte temporal de por vida) para comparar 12 diferentes
secuencias de tratamiento en un millón de pacientes (edad: 40 años, 70% mujeres,
peso corporal 66.67kg). En las secuencias, rituximab (2 infusiones de 1g por
curso, administrados cada 9 meses) podía ser utilizado inmediatamente tras
la falla de un anti-TFN (infliximab, etanercept o adalimumab) o hasta después
de agotar los 3 anti-TNF. Mediante una comparación indirecta de 23 ensayos
clínicos, se determinaron las respuestas ACR ajustadas para cada agente. Un
panel integrado por diez expertos y literatura publicada sirvió para determinar el
consumo de recursos. Se consultaron costos unitarios oficiales. Analizamos los
costos de adquisición e infusión de medicamentos (incluyendo metotrexato), el
costo ambulatorio por respuesta ACR y el costo hospitalario según puntaje HAQ
(Health Assessment Questionnaire). RESULTADOS: Los costos acumulados de
por vida (descontados a una tasa anual de 3%) fueron más bajos para todas las
secuencias en las que rituximab fue administrado como primera opción ante una
respuesta insuficiente al tratamiento con un anti-TNF. Los ahorros oscilaron entre
$6904 y $16,411 pesos mexicanos por paciente. Las mayores diferencias en calidad
de vida a favor de iniciar con rituximab se obtuvieron cuando se comparó contra
iniciar con infliximab. CONCLUSIONES: Este estudio sugiere que iniciar terapia con
rituximab inmediatamente después de la primer falla a anti-TNF es una estrategia
costo-efectiva en lugar de continuar con otro agente anti-TFN. NEUROLOGICAL DISORDERS – Cost Studies
110
PND3: ESTIMACIÓN DEL PROCESO DE PROCURACIÓN DE ÓRGANOS DE
PACIENTES CON MUERTE CEREBRAL EN MÉXICO 2009
Camacho Chairez A, Gutierrez C, Mexican Ministry of Health, México, D.F., México
OBJECTIVOS: Estimar el costo del proceso de procuración de órganos de
pacientes con muerte cerebral dentro de las instituciones públicas del Sector
Salud en México para identificar los costos en que incurren los hospitales
involucrados (donador y receptor). Lo anterior debido a que el Centro Nacional
de Trasplantes (CENATRA) ha identificado que la falta de incentivos económicos
para los hospitales donadores, disminuye la posibilidad de obtener órganos de
aquéllos pacientes que presentan muerte cerebral. METODOLOGÍAS: El costo
del proceso de procuración de órganos se estimó tomando como referencia el
protocolo técnico del CENATRA de México. Los costos de baterías de laboratorio,
de gabinete y de operación durante el proceso se obtuvieron de fuentes de
información tanto de instituciones públicas del Sector Salud, como de empresas
privadas proveedoras de servicios al Sector. Los supuestos básicos son: todas las
actividades del proceso se enfocan a una procuración multiórganica (6 órganos)
y que el tiempo estimado del proceso es de 36 horas. RESULTADOS: El costo total
del proceso de procuración multiorgánica es de $47,572.50 pesos mexicanos (PM).
Por órgano el costo es de $7928 PM, del cual el 77.67% es incurrido por el hospital
donador ($6159 PM), mientras que el 22.33% restante por el hospital receptor ($1770
PM). Los rubros que implican más del 80% del costo del proceso son el día terapia
intensiva y de hospitalización (59.65%), mientras que el 22.15% es representado por
el gasto en viáticos y alimentación para el personal médico necesario dentro del
proceso. CONCLUSIONES: Los resultados permiten identificar los costos en que
incurre cada una de las partes que intervienen dentro del proceso de procuración
de órganos, a considerarse en la implementación de políticas públicas que
incentiven el proceso a nivel nacional. ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
PND4: EL IMPACTO ECONOMICO DEL TABAQUISMO EN EL DESARROLLO DE LA
ENFERMEDAD VASCULAR CEREBRAL EN UN CENTRO NEUROLOGICO DE TERCER
NIVEL
San-Juan D1, Quintana Carrillo R2, Arauz Góngora A1, López de Santiago I1, AguireCruz L1, Corona T1, Reynales Shigematsu L3, 1Instituto Nacional de Neurología y
Neurocirugía, México, D.F, México, México, 2Instituto Nacional de Salud Pública,
México, D.F., México, 3Instituto Nacional de Salud Pública, Cuernavaca, Morelos,
México
OBJECTIVOS: Estimar los costos directos de atención médica de la enfermedad
vascular cerebral (EVC) atribuidos al tabaquismo en un centro neurológico de
tercer nivel. METODOLOGÍAS: Se estimaron los costos de salud directos por ictus
atribuidos al tabaquismo en 297 pacientes atendidos en el Instituto Nacional
de Neurología y Neurocirugía (INNN) en 2009. Metodología: Cost of Illness y
microcosteo. Perspectiva de costeo: proveedor. La utilización se estimó con base
en los procedimientos médicos registrados en el expediente clínico. Se utilizó la
fracción atribuible al tabaco de la EVC para estimar los costos del tabaquismo. Los
costos están expresados en pesos mexicanos ($) y en dólares americanos (USD)
del 2009. RESULTADOS: El costo total de la EVC atribuible al tabaco durante el 2009
fue de $13,995,388.8 (1,071,123.2 USD). La hemorragia subaracnoidea fue la más
costosa. El costo promedio anual por paciente relacionado con el tabaquismo de
las hemorragias intracerebral y subaracnoidea fue, respectivamente, $35,396.2
(2,709.2 USD) y $66,890.5 (5,119.5 USD). El costo promedio anual asociado al
tabaquismo de la EVC de un paciente en el INNN fue de $45,242.6 (3,462.6 USD).
CONCLUSIONES: Este es el primer estudio que evalúa y confirma los altos costos
directos de la atención médica de los pacientes con EVC atribuidos al tabaco. Si
de los 297 pacientes atendidos en el INNN durante 2009, 149 no hubieran fumado,
el Instituto podría haber asignado en su mejor uso alternativo los $13,995,188.8
(1,071,123.2 USD). La metodología empleada nos provee un gran nivel de
especificidad de los datos relacionados con los servicios médicos y financieros
utilizados por el paciente con EVC durante el año analizado.
RESEARCH ON METHODS – Databases & Management Methods
PRM2: EROS: A NEW SOFTWARE FOR EARLY STAGE OF SYSTEMATIC REVIEWS
Glujovsky D, Bardach A, García Martí S, Comandé D, Ciapponi A, Institute for
Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
OBJECTIVES: The workload of the initial phases of the process of developing
a systematic review (SR) is often underestimated. The screening and quality
assessment of studies, usually done by pairs of independent reviewers, is not
only time-consuming, but it also is complicated, tiresome, and prone to mistakes.
A computer-software designed to cope with the initial phases of a SR would be
of great help. There is a generalized lack of development in this regard, and the
available options are not very accessible or affordable. The objective of this study
is to show the advances in the development of EROS (Early Review Organizing
Software), a web-based software for the initial phases of a SR process. METHODS:
We developed an online software that helps in performing the first stages of a
SR: importation of citation from a reference manager software or directly after a
search in several medical electronic databases (PubMed, EMBASE, LILACS, etc),
screening by title/abstract, first agreement, uploading of full-text, screening by fulltext (tracking exclusion reasons), quality assessment (second and third agreement
respectively), and distribution of full-text for data collection. RESULTS: EROS is
currently being used in the simultaneous conduction of more than 20 systematic
reviews. Its main characteristics are: a) ability to manage multiple projects; b)
differentiation of roles assigned to reviewers, administrators and librarians; c)
multi-language environment in each review; d) adequate, equitable and timely
delivery of full-texts for evaluation and data abstraction; e) real-time tracking of the
whole process for each role; f) building the study flowchart; g) possibility to work
simultaneously in different SR’s stages; and h) configurable inclusion/exclusion
criteria and other relevant features. CONCLUSIONS: A computerized SR tool in the
initial phases like EROS saves time, reduces workload for each involved role, and
probably enhances SR’s methodological quality.
RESEARCH ON METHODS – Statistical Methods
PRM3: DIMENSIONALITY OF COMORBIDITIES IN HEATH RELATED QUALITY OF
LIFE COMORBIDITY INDEX
Ou HT1, Bagozzi RP2, Erickson S2, Mukherjee B2, Piette JD2, Balkrishnan R2,
1
University of Michigan College of Pharmacy, Ann Arbor, MI, USA, 2University of
Michigan, Ann Arbor, MI, USA
OBJECTIVES: To assess comorbidity patterns among 25 comorbidity candidates
in the Health-related Quality of Life Comorbidity Index METHODS: Using the
MarketScanTM Medicaid database from 2003 to 2007, type 2 diabetes patients were
targeted. Patterns of comorbidities were analyzed via confirmatory factor analyses
for four subgroups: male, female, black and white. Three models were compared:
a uni-dimensional model, a 2-dimensional model in which 15 and 10 disorders
represented physical and mental domains of comorbidities, respectively, a multidimensional model in which the dimensions were formed based on tetrachoric
correlation matrices. Predictive performances of three comorbidity structures
were assessed using regression analyses for four types of outcomes: physician
adherence to diabetes care guideline, patient adherence to oral antidiabetic
medication, health care utilization and costs. The STATA™ and LISREL™ software
were utilized. RESULTS: 9,830 patients were included and majority of them was
female (73%) and white (62%). A 7-factor (category) structure was noticeable in
the correlations among comorbidity candidates across subgroups. Arrhythmias,
heart failure, and ischemic heart disease formed a heart disease category; asthma
and obstructive pulmonary disease formed a lung disease category; rheumatoid
arthritis, osteoarthritis and nontraumatic joint disorders formed a rheumatic
disease category, degenerative neurologic disorders and headaches formed a
neurologic disease category, esophageal disorders, gastric and duodenal ulcer
formed a gastric disease category, hepatitis, biliary and liver disorders formed a
liver disease category, anxiety, depression, affective disorders, schizophrenia,
other psychoses formed a mental disease category. The 7-category model provided
best model fit across subgroups and better predictive performance across different
healthcare outcomes. Based on a 7- category model, individual comorbidity
categories demonstrated differential impacts for a given outcome. CONCLUSIONS:
Instead of one composite comorbidity score, using comorbidity categories had
better risk adjustment and provided insightful information about differential impacts
of different features of comorbidities for further developing efficient comorbidity
management strategies.
PRM4: A MIXED-EFFECTS PIECEWISE LINEAR MODEL OF THE RATE OF LUNG
FUNCTION DECLINE BEFORE AND AFTER INHALED CORTICOSTEROIDS IN AN
OBSERVATIONAL STUDY OF CHILDREN WITH CYSTIC FIBROSIS
Pasta DJ, Rasouliyan L, ICON Late Phase & Outcomes Research, San Francisco,
CA, USA
OBJECTIVES: To evaluate the change in the rate of lung function decline before
and after initiation of inhaled corticosteroids (ICS) in children enrolled in the
Epidemiologic Study of Cystic Fibrosis (ESCF) through a multivariable mixed-effects
piecewise linear model. METHODS: The primary outcome measure was the longterm rate of change in percent predicted forced expiratory volume in 1 second (pp
FEV1). Patients aged 6-17 years who had been enrolled in ESCF for 2 years, when
initially treated with ICS therapy, were selected if they remained on treatment for at
least 80% of their visits during the following 2 years. A comparator group included
patients aged 6-17 who did not receive ICS for 4 consecutive years. The index date
was defined as date of ICS initiation (ICS group) or the patient’s even-numbered
(8th-16th) birthday (comparator group). For each patient we estimated the annual
rate of decline in pp FEV1 before and after index using a mixed-effects piecewise
linear model adjusted for age, gender, pulmonary exacerbations, routine therapies,
and nutritional supplements. Model results were used to draw comparisons within
and between study groups. RESULTS: Before initiation of ICS, mean FEV1 decline
was -1.52 pp/year (95% CI: -1.96, -1.08 pp/year). After initiation of ICS therapy,
mean FEV1 decline was -0.44 pp/year (95% CI: -0.85, -0.03 pp/year), which was a
significant change (p=0.002). In contrast to our observations in the ICS group,
patients in the comparator group had a mean FEV1 decline of -1.01 pp/year (95%
CI: -1.27, -0.75 pp/year) before index, which marginally worsened (p=0.046) after
index to -1.44 pp/year (95% CI: -1.70 to -1.19 pp/year). CONCLUSIONS: Initiation of
ICS was associated with a significantly slower subsequent rate of FEV1 decline in
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
children with cystic fibrosis. Mixed-effects piecewise linear models are valuable
for analyzing observational studies by demonstrating changes in key disease
measures corresponding to the times of interventions. RESEARCH ON METHODS – Conceptual Papers
PRM5: INCORPORATING EQUITY INTO DEVELOPING AND IMPLEMENTING
EVIDENCE-BASED CLINICAL PRACTICE GUIDELINES
Eslava-Schmalbach JH, Sandoval Vargas G, Mosquera PA, Universidad Nacional
de Colombia, Bogotá, Colombia
BACKGROUND: Clinical practice guidelines (CPG) are useful tools for clinical
decision making, processes standardization and quality of care improvements.
The current General Social Security and Health System (GSSHS) in Colombia is
promoting the initiative of developing and implementing CPG based on evidence
in order to improve efficiency and quality of care. The reduction of inequalities
in health should be an objective of the GSSHS. OBJECTIVES: The main propose
of this analysis is to argue why it is necessary to consider the incorporation of
equity considerations in the development and implementation of clinical practice
guidelines based on the evidence. METHODS: A series of reflections were made.
Narrative description was used for showing the arguments that support the main
findings. RESULTS: Among the main findings are: 1) Differential effectiveness
by social groups of interventions could diminish final effectiveness of CPG in the
GSSHS; 2) To not consider geographical, ethnic, socioeconomic, cultural and
access diversity issues within the CPG could have a potential negative impacts
of the CPG; 3) Overall effectiveness of GPC could be better if equity issues are
included in the quality verification checklist of the guideline questions; and
4) Incorporating equity issues in the process of developing CPG could be cost
effective, because improve overall effectiveness of CPG. CONCLUSIONS: To
include equity issues in CPG and can help in achieving more equitable health
outcomes. From this point of view CPG could be key tools to promote equity in care
and health outcomes. Keywords: health inequalities, clinical practice guidelines,
essay (Source: MeSH, NLM)
PRM6: TRANSLATION OF PATIENT-REPORTED OUTCOMES MEASURES
TRANSLATABILITY REVIEW AND ITEM DEFINITION
Arnold BJ1, Correia H2, Pérez B1, Lent L1, 1FACITtrans, Elmhurst, IL, USA,
2
Northwestern University, Chicago, IL, USA
Translatability Review and Item Definition documents are key components to
any successful Patient Reported Outcome (PRO) translation and are especially
relevant in item banking initiatives. Translatability review helps to ensure concepts,
constructs and phrasing in the source language are appropriate for translation into
other languages and for multicultural contexts. Identifying potential issues during
item development can result in improvement of the source item. When modification
of the source is not possible or necessary, translatability review can be seen as a
first step towards identifying acceptable translation alternatives which can be used
by linguists. The assessment of item translatability before the translation process
begins also facilitates the creation of item definitions, a critical tool for increasing
translation accuracy. The Item Definition document refers to the identification and
clarification of concepts the items are trying to measure. The development of item
definitions is an iterative process combining efforts by translation coordinators
and item/questionnaire developers as well as input from linguists. These steps
are especially essential in item banking initiatives in which items are frequently
made available by different developers and sources on behalf of varying patient
populations, with disparate answer categories. As translation of PRO measures is
much more than just a literal, word for word translation process, these steps are
fundamental in furthering the equivalence, comparability and data poolability of
translated language versions. This presentation will provide information regarding
when to carry out these steps, how to carry them out and who should be involved
in them. Linguistic issues such as, but not limited to, sentence structure, register
and ambiguity will be discussed. Examples from National Institutes of Health
Spanish translation projects Patient-Reported Outcomes version of the Common
Terminology Criteria for Adverse Events (PRO-CTCAE) and The Patient-Reported
Outcomes Measurement Information System (PROMIS) will be highlighted.
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RESPIRATORY-RELATED DISORDERS – Cost Studies
PRS1: BUDGET IMPACT ANALYSIS OF FLUTICASONE FUROATE (FFNS) IN
TREATMENT OF ALLERGIC RHINITIS PATIENTS IN MEXICO
Rely K1, Salinas GE2, Anaya P3, Alexandre PK4, 1CEAHealthTech, México, D.F.,
México, 2Hospital Infantil de México Federico Gómez, Secretaría de Salud, México,
D.F., México, 3GlaxoSmithKline México, México, D.F., México, 4Johns Hopkins
University, Baltimore, MD, USA
OBJECTIVES: To estimate the 5-year projected impact on the annual pharmacy
budget for allergic rhinitis (AR) patients in Mexico METHODS: Mexican prevalence
and treatment data for AR patients were obtained from published and nonpublished
sources. The model considered 2 scenarios—without (pre) and with (post) FFNS.
Market share data for corticosteroid treatment options for AR pre- FFNS and in the
first year post-FFNS were obtained from nonpublished, real-world drug utilization
data collected by GSK. Market shares for the second until fifth years post- FFNS
were forecasted by the study authors. Drug costs were based on the Mexican
Social Security Institute (IMSS). Wholesale Acquisition Cost was accessed on
March 2010. The results for each indication were analyzed individually and summed
to reflect the total impact of FFNS. Results were also considered on a per member
per month (PMPM) basis to examine the relative impact on the plan. Sensitivity
analyses were performed by varying several model input parameters RESULTS:
The estimated prevalence of AR in 2010 was 10%. In the year after its introduction,
60% of the AR population filled a prescription for FFNS. The estimated total cost
for AR treatment prior to introduction of FFNS was $ 552 million and (532 to $ 384
million post FFNS. The incremental decrease in pharmacy benefit cost was ($ 20
to $ 84 millions) in 2010 dollars. These reductions translated to a medical care
cost saving of $ 266 millions over 5 years. CONCLUSIONS: Model results suggest
that increasing the use of fluticasone furoate decreases total budget costs due to
decreased acquisition drug costs.
PRS2: COSTOS DE ATENCION MEDICA ATRIBUIBLES AL CONSUMO DE TABACO
EN MÉXICO
Reynales-Shigematsu L1, Quintana Carrillo R2, 1Instituto Nacional de Salud Pública,
Cuernavaca, Morelos, México, 2Instituto Nacional de Salud Pública, México, D.F.,
México
OBJECTIVOS: Estimar la carga económica, en términos de costos de atención
médica que las enfermedades atribuibles al consumo de tabaco representan para
el sistema de salud Mexicano. METODOLOGÍAS: La estimación del costo directo
de atención médica atribuible al tabaquismo se realizó con las enfermedades:
CP, IAM, EPOC y EVC, en 2009. Instituciones de salud participantes: institutos
nacionales (INNN, INCAN, INER e INCAR), Hospital Central Militar (HCM), Instituto
de Seguridad y Servicios Sociales de los Trabajadores del Estado (sólo incluye al
CMN “20 de Noviembre” y al HRZ “1º. de Octubre” del ISSSTE) e Instituto Mexicano
del Seguro Social (IMSS). El análisis de costos fue realizado desde la perspectiva
del proveedor de servicios, utilizando la metodología Cost of Illness, basada en
la prevalencia así como la creación de un panel de expertos multidisciplinario,
que clasificó la atención médica: Ambulatoria, Urgencias, Hospitalización,
Quirófano, Unidad de Cuidados Intensivos, Quimioterapia, Cuidados Paliativos y
Radioterapia. Finalmente empleamos la fracción atribuible por tabaco para estimar
dichos costos. Los costos están expresados en pesos mexicanos ($) y en dólares
americanos (USD) del 2009. RESULTADOS: Los costos institucionales de atención
médica por tabaquismo ascendieron a $459,026,446.2 (35,131,636.3 USD); Institutos
Nacionales, $92,016,175.0 (7,042,467.4 USD); HCM, $103,483,466.1 (7,920,117.7 USD);
ISSSTE y $9,564,089,959.0 (731,988,608.4 USD); IMSS, respectivamente. Los costos
nacionales por tabaquismo oscilaron entre $30,213,184,046.5 (2,312,369,147.7 USD)
y $44,484,500,278.1 (3,404,625,802.9 USD). El IAM y el CP fueron los más caros.
CONCLUSIONES: Nuestros resultados muestran la elevada carga económica que
representan para el sistema de salud mexicano el tabaquismo y son evidencia
científica sobre la magnitud del problema. Como las enfermedades asociadas al
tabaquismo son prevenibles, una adecuada política de salud para el control del
tabaco, produciría una reasignación de los recursos económicos que actualmente
se destinan al tratamiento de las enfermedades provocadas por el tabaco hacia
otros programas institucionales.
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
PRS3: COSTOS DE ATENCION MEDICA DE LA ENFERMEDAD PULMONAR
OBSTRUCTIVA CRONICA ATRIBUIBLES AL TABACO
Ramirez-Venegas A1, Quintana Carrillo R2, Sansores R1, Hernandez-Zenteno R1,
Reynales Shigematsu L2, 1National Institute of Respiratory Diseases, México, D.F.,
México, 2National Institute of Public Health, Cuernavaca, Morelos, México
OBJECTIVOS: Estimar los costos directos de atención médica de la Enfermedad
Pulmonar Obstructiva Crónica (EPOC) asociados al consumo de tabaco, en el
Instituto Nacional de Enfermedades Respiratorias. METODOLOGÍAS: Durante
el 2009 se estimaron los costos directos de la EPOC de los pacientes que fueron
atendidos en el año 2008 en el Instituto. El análisis de costos se hizo desde la
perspectiva del proveedor de servicios, considerando el enfoque de la metodología
Cost of Illness (COI), basada en la prevalencia así como la creación de un panel
de expertos multidisciplinario, que clasificó la atención médica en 4 eventos:
Ambulatoria, Urgencias, Hospitalización y Unidad de Cuidados Intensivos.
Finalmente empleamos la fracción atribuible por tabaco para estimar los costos
por consumo de tabaco. El costo además se estimo de acuerdo a la gravedad
de la enfermedad con los criterios GOLD. RESULTADOS: El costo anual de la
EPOC atribuible al tabaco fue de $36 millones. El costo promedio por paciente, de
acuerdo a GOLD fue de $30 mil; estadio I, $37 mil; estadio II, $84 mil; estadio III y
$288 mil; estadio IV. Entre más grave fue la enfermedad, (III y IV) mayores costos
resultaron. CONCLUSIONES: La evaluación económica de los costos directos que
ocasiona el EPOC debido al tabaquismo, confirma la gran carga económica que
representan estos pacientes para el presupuesto del INER y del sistema de salud
mexicano. Estos resultados proveen suficiente evidencia científica para apoyar la
implementación de políticas del sector salud relacionadas con el tabaco.
PRS4: ECONOMIC EVALUATION OF THE USE OF PALIVIZUMAB AS PROPHYLACTIC
TREATMENT FOR THE REDUCTION OF COMPLICATIONS ASSOCIATED WITH
RESPIRATORY SYNCYTIAL VIRUS IN PRE-TERM PATIENTS
Mayen-Herrera E1, Buesch K2, Cortina D3, Abbott Laboratories de México, México,
D.F. México
OBJECTIVES: To determine the incremental cost-effectiveness ratio (ICER) of the
use of palivizumab as prophylaxis for the reduction of complications associated
with respiratory syncytial virus (RSV) in pre-term patients <29 weeks of gestational
age (WGA) under the Mexican public health sector perspective. METHODS: A
cost-utility model was developed based on a decision tree that evaluated both
scenarios of prophylaxis and no-prophylaxis. Epidemiological and cost data were
obtained from different Mexican sources such as the Mexican Institute of Social
Security (IMSS) by analysing birth rates. Clinical effectiveness was obtained from
the international literature (Cardiac Synagis Study Group, The IMpact-RSV Study
Group MEDI-493 Study Group). Prophylaxis therapy consisted of 5 applications of
palivizumab during the winter season in Mexico. The dose scheme considered was
15 mg/kg. The effectiveness outcomes were quality adjusted life years (QALYs).
Since the study was conducted under the public health perspective, only direct
medical costs associated with the RSV treatment were evaluated (hospitalization,
emergency room, drugs, and prophylaxis). For resource utilisation purposes, an
expert panel of paediatricians with experience in RSV infection was convened.
Drug and medical attention costs were discounted by using a 3% discount rate and
are reported in local currency. Acceptability curves of the probability of palivizumab
to be cost effective were calculated. The threshold included in the study for costeffectiveness comparisons, is the proposed by the World Health Organisation (3
times the gross domestic product per capita). RESULTS: The ICER per QALY for the
study group was MXN $219,150. The acceptability curves showed a 75% probability
of palivizumab to be cost effective when employing a 3 times GDP threshold.
CONCLUSIONS: The use of palivizumab represents a cost-effective alternative for
the prophylaxis of complications associated with RSV infection, under the public
health perspective in Mexico for patients <29 WGA.
PRS5: COST-EFFECTIVENESS OF VARENICLINE VS EXISTING SMOKING CESSATION
STRATEGIES IN DOMINICAN REPUBLIC USING THE BENESCO MODEL
Lutz M, Morales G, Cuesta G, Pfizer S.A., La Aurora, Heredia, Costa Rica
OBJECTIVES: In Dominican Republic, the economic burden of tobacco has not
been assessed. The aim of this study was to evaluate the cost-effectiveness of
varenicline compared to other existing strategies for smoking cessation within a
5-year time horizon in an adult population cohort from Dominican Republic using the
healthcare payer’s perspective. METHODS: The Benefits of Smoking Cessation on
Outcomes (BENESCO) simulation model was used for an adult cohort in Dominican
Republic (n=6,528,125). Smoking cessation therapies compared were: varenicline
(0.5 – 2 mg/day) versus bupropion (300 mg/day); nicotine replacement treatment
(NRT) (5-10 mg/day) and unaided cessation. Effectiveness measures were: LifeYear gained (LYG) and quality-adjusted life-year gained (QALY’s). Resource use and
costs data were obtained from Dominican Republic’s Ministry of Health and Social
Security databases (2009). The model used a 3% discount rate for costs (expressed
in 2009 US dollars) and health outcomes. Probabilistic sensitivity analyses (PSA)
were conducted and acceptability curves were constructed. RESULTS: Varenicline
reduced smoking-related morbidity, mortality and healthcare costs. After 5 years,
mortality in the varenicline arm was reduced by 67, 86 and 163 deaths compared
with bupropion, NRT and unaided cessation, respectively. The net average cost
per additional quitter showed that varenicline was cost-saving against competing
alternatives. Varenicline exhibited 145, 188 and 355 more QALYs against Bupropion,
NRT and unaided cessation, respectively. Cost-effectiveness analyses showed
that varenicline was the dominant strategy. At a willingness-to-pay of US$8,000/
QALY, the probability that varenicline is cost-effective met 100%. PSA results
support the robustness of the findings. CONCLUSIONS: Smoking cessation therapy
with varenicline is cost-saving in Dominican Republic. These results could help to
reduce the tobacco related disease burden and align cost-containment policies.
PRS6: COST-EFFECTIVENESS OF FLUTICASONE FUROATE COMPARED WITH
MOMETASONA FUROATE FOR THE PRIMARY TREATMENT OF ALLERGIC RHINITIS
PATIENTS
Rely K1, Alexandre PK2, Anaya P3, Salinas GE4, 1CEAHealthTech, México, D.F.,
México, 2Johns Hopkins University, Baltimore, MD, USA, 3GlaxoSmithKline México,
México, D.F., México, 4Hospital Infantil de México Federico Gómez, Secretaría de
Salud, México, D.F., México
OBJECTIVES: To evaluate the cost-effectiveness of fluticasone furoate vs.
mometasone furoate in the treatment of ocular symptoms in allergic rhinitis patients
in Mexico. METHODS: A decision-analytic model was developed to estimate the
cost-effectiveness of fluticasone furoate versus mometasone furoate. Patients
initiated on treatment either completed initial therapy or switched to second
line therapy due to non-response. Probability of a switch and resource use was
based on expert panel and literature. Costs were based on local drug acquisition
costs, local cost estimates for outpatient and hospitalization. Effectiveness
was defined as the net improvement in Total Ocular Symptom Score (TOSS)
at 12 weeks from Keith PK. 2009 study. The analysis was carried out from the
perspective of the Mexican health care system and all costs are reported in 2010
US dollars. RESULTS: The corresponding health effects were 0.47 net improvement
TOSS for fluticaone furoate and 0.31 for mometasone furoate regimen. The mean
total cost of the fluticaone furoate regimen was $ 627 compared with $ 827 for the
furoate mometasone regimen. Treatment with fluticasone furoate compared to
treatment with mometasone furoate was less costly and resulted in a greater net
improvement of TOSS. Probabilistic sensitivity analyses demonstrated that the cost
savings observed were maintained over a wide range of alternative values for costs
and resource utilization. CONCLUSIONS: Cost-effectiveness analysis indicated the
dominance of fluticasone furoate over mometasone furoate because of both lower
costs and greater efficacy. Cost savings with fluticasone furoate were attributable
to lower drug acquisition costs. In addition, a net improvement in ocular symptoms
may be expected in allergic rhinitis patients.
PRS7: ESTUDIO DE COSTO-EFECTIVIDAD DE BECLOMETASONA VS CICLESONIDA
COMO MEDICAMENTOS CONTROLADORES EN EL MANEJO DEL ASMA EN
PACIENTES QUE ASISTEN A CONSULTA EXTERNA DE NEUMOLOGÍA PEDIÁTRICA
EN EL HOSPITAL UNIVERSITARIO CLÍNICA SAN RAFAEL DE BOGOTÁ COLOMBIA,
JULIO A DICIEMBRE 2010
Hinestrosa F1, Pedraza AM2, 1Grünenthal Colombiana S.A., Bogotá, Colombia,
2
Hospital San Rafael, Bogotá, Colombia
OBJECTIVOS: Desarrollar un estudio de costo-efectividad que compare Ciclesonida
con Beclometasona en el control del asma. METODOLOGÍAS: Estudio CostoEfectividad, de cohortes, observacional, analítico, con información recolectada
prospectivamente, realizado desde la perspectiva institucional, incluyó pacientes
pediátricos con diagnóstico de asma no controlada admitidos durante Julio de
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Research Poster Abstracts
2010 los que recibieron Ciclesonida o Beclometasona como único medicamento
controlador. Se realizó seguimiento por 6 meses, basados en datos reportados
por la literatura se utilizó el porcentaje de pacientes libres de crisis asmáticas
como variable para el cálculo del tamaño muestral, la muestra necesaria fué de
20 pacientes por cada alternativa, se incluyeron 94 pacientes con edades entre
los 1 y 15 años, 47 recibieron Beclometasona y 47 Ciclesonida. La asignación
fue de manera aleatoria. La variable primaria de efectividad fue definida como
el porcentaje de pacientes libres de crisis durante el periodo de estudio, se
definieron como variables generadoras de costo uso de medicamentos y estancia
hospitalaria. Se calculó la razón costo-efectividad incremental y se realizó un
modelo mediante un árbol de decisión RESULTADOS: 17 pacientes estuvieron libres
de crisis en el grupo de Beclometasona, los costos de utilización de medicamentos
en este grupo fueron de $7255.564 pesos colombianos, los costos de hospitalización
se calcularon en $38,568.200, los costos totales ascendieron a $45,823.764
($25,188.67 dólares). En el grupo de Ciclesonida, 45 pacientes estuvieron libres de
crisis, los costos por utilización de medicamentos fueron de $14,982.172, los costos
derivados de hospitalización se calcularon en $92,200, los costos totales alcanzaron los $15,074.372 ($8291.73 dólares). La razón costo-efectividad incremental de
Beclometasona versus Ciclesonida fue de -1’098.192 CONCLUSIONES: Al utilizar
Ciclesonida el hospital encuentra ahorros de $1098.192 pesos por cada paciente
libre de crisis, desde la perspectiva del hospital, el manejar un paciente con
Beclometasona representa un costo adicional de $1,098.192 que se podrían ahorrar
si el paciente fuese manejado con Ciclesonida.
participaron en la Encuesta Global de Tabaquismo en Adultos, México 2009. Se
realizó un análisis descriptivo y de asociación estadística que permitió caracterizar
a los fumadores y su DAP con base en variables socioeconómicas, demográficas,
de su historia de tabaquismo y de su entorno. RESULTADOS: El 74.4% de los
fumadores eran del sexo masculino, 51.4% consumía cigarrillos con una frecuencia
diaria. Los fumadores tenían más de 15 años fumando, 58.6% había realizado
intentos previos de cesación y alrededor del 10% conocía de la existencia de
centros de ayuda para dejar de fumar. En promedio, la DAP por un método efectivo
de cesación fue $2573 pesos mexicanos. En los hombres, la DAP fue 2056 pesos
menor que en las mujeres. A mayor educación y mayor nivel socioeconómico
(NSE), la DAP de los fumadores aumentó en todos los modelos estimados.
CONCLUSIONES: Las estimaciones del presente estudio sugieren que los
fumadores mexicanos que desean dejar de fumar revelan, en términos monetarios,
una alta valoración por un método de cesación efectivo. Los fumadores del sexo
masculino muestran un comportamiento más “egoísta” que las mujeres fumadoras.
En México, se requiere de la implementación de un mayor número de acciones
encaminadas a apoyar a los fumadores en su intento por abandonar la adicción al
tabaco, fortaleciendo y ampliando la oferta de programas de cesación, así como
el acceso a los tratamientos farmacológicos logrando una cobertura universal
mediante la incorporación de las diferentes alternativas farmacológicas al cuadro
básico de medicamentos del sector salud.
PRS8: COST-EFFECTIVENESS OF AN AMBULATORY PROGRAM OF PULMONARY
REHABILITATION FOLLOWING ACUTE EXACERBATIONS OF COPD IN COLOMBIA
Giraldo LF, Brito KP, Rodriguez P, Universidad de La Sabana, Chia, Cundinamarca,
Colombia
OBJECTIVES: To evaluate the economic benefits of an 8 week Ambulatory
Pulmonary Rehabilitation Program (PR) plus GOLD based standard treatment
(ST) vs. ST without PR of COPD patients after an acute exacerbation of the
disease in the Colombian Health Care System (CHCS). METHODS: Direct costs
of ST and of PR were calculated according to tertiary level university hospital’s
registries during one year and CHCS’s drugs prices; these costs and QALY
were estimated for one year by a Markov chain model based on Seymour’s
study (Thorax, 2010) findings of health care utilization and probability of death.
Univariate sensitivity and probabilistic analysis were performed by Monte
Carlo method. RESULTS: Following acute exacerbation of COPD the annual
cost of PR plus ST was COL$ 4,594,407,00 (US$ 2,483.46) vs. an annual cost of
ST without PR of COL$ 9,124,326.00 (US$ 4,932.07). QALY of PR plus ST patients:
0.86577; QALY of ST without PR: 0.852979. Mean cost-effectiveness of PR plus
ST: COL$5,306,729.00 (US$ 2,868.50) per QALY, cost-effectiveness of ST without
PR:$10,697,014.00 (US$ 5,782.17) per QALY. There was absolute dominance of
PR plus ST vs. ST without PR in all scenarios. In the sensitivity analysis the
absolute dominance is maintained for any cost of PR program < COL$ 5,302,428.00
(US$ 2.866,18). CONCLUSIONS: Global costs of Pulmonary Rehabilitation plus
Standard Treatment are much lower than Standard Treatment without Pulmonary
Rehabilitation for patients after an acute exacerbation of COPD. Pulmonary
Rehabilitation is a highly cost-effective treatment for these patients in the CHCS
and probably in many other countries with similar socio-economic level, specially
of Latin America.
PSS1: EVALUACION ECONOMICA DE FOTOTERAPIA DE BANDA ANGOSTA
O FOTOQUIMIOTERAPIA PARA EL TRATAMIENTO DE PSORIASIS DESDE LA
PERSPECTIVA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL
Carlos F1, Ramos E1, Llorens F2, Ruiz L2, 1R A C Salud Consultores, S.A. de C.V.,
México, D.F., México, 2Tecnologicos Dalup S. De R.L. De C.V., México, D.F., México
OBJECTIVOS: La psoriasis es una enfermedad cutánea que en sus formas
moderadas-graves afecta la expectativa y calidad de vida. El objetivo fue evaluar
costos y desenlaces en salud de diversas modalidades de tratamiento de psoriasis
de grado moderado-severo desde la perspectiva del Instituto Mexicano del
Seguro Social (IMSS). METODOLOGÍAS: En un modelo Markov se compararon:
fototerapia de luz ultravioleta de banda angosta (UVB-NB); fotoquimioterapia
PUVA; metotrexato (MTX); ciclosporina (CsA); infliximab (INF); etanercept
(ETA); adalimumab (ADA). Se contemplaron dos horizontes temporales: período
de evaluación (12-16 semanas) seguido de un período de 10 años donde los
respondedores continúan tratamiento. Cada ciclo anual los pacientes enfrentan
riesgo de muerte y de abandono por pérdida de eficacia o por eventos adversos.
Se analizaron los costos de adquisición y administración de terapias, monitoreo de
pacientes y costo adicional por falla terapéutica. Mediante revisión sistemática se
identificó el cambio en el puntaje PASI (Psoriasis Area Severity Index) asociado
con cada estrategia y su efecto en calidad de vida. Los costos se expresan en
pesos mexicanos (MXN) 2010. RESULTADOS: El costo total acumulado por paciente
es más bajo cuando se utiliza PUVA ($589,636); MTX ($602,045) o UVB-NB ($602,749)
que cuando se emplea CsA ($644,268) o algún agente biológico: $919,292 (ETA);
$1,048,781 (ADA) y $1,190,837 (INF). La mejor respuesta se obtuvo con ADA e INF.
El costo más bajo por categoría de respuesta (moderada o buena) se encontró con
PUVA, seguido de UVB-NB, MTX y CsA. En todos los casos, los agentes biológicos
condujeron a un costo por respuesta notablemente más elevado. UVB-NB y PUVA
fueron dominantes (menos costosos y con más años de vida ajustados por calidad)
con relación a MTX, CsA y ETA. CONCLUSIONES: UVB-NB y PUVA representan
las alternativas más costo-efectivas y potencialmente costo-ahorradoras al
compararse con otras modalidades de tratamiento utilizadas actualmente en IMSS. RESPIRATORY-RELATED DISORDERS –
Patient-Reported Outcomes & Preference-Based Studies
PRS9: DISPONIBILIDAD A PAGAR POR UN METODO EFECTIVO PARA DEJAR DE
FUMAR: EVIDENCIAS A PARTIR DE LA ENCUESTA GLOBAL DE TABAQUISMO EN
ADULTOS MÉXICO 2009
Heredia I, Serván E, Reynales LM, Bautista S, Instituto Nacional de Salud Pública,
Cuernavaca, Morelos, México
OBJECTIVOS: Estimar la máxima disponibilidad a pagar (DAP) por un tratamiento
efectivo de cesación tabáquica entre fumadores mexicanos e identificar los
factores sociodemográficos, de la historia de fumador y de su entorno asociados
a esta valoración. METODOLOGÍAS: Se realizó un estudio observacional de tipo
transversal. La muestra de análisis estuvo constituida por 777 fumadores que
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SENSORY SYSTEMS DISORDERS – Cost Studies
PSS2: ENCOURAGING THE EFFICIENCY OF THE NATIONAL TRANSPLANT
PROGRAM: ESTIMATING THE COST OF CORNEAL TRANSPLANT TO BE FINANCED
BY PUBLIC INSTITUTIONS IN THE HEALTH SECTOR IN MEXICO
Camacho A, Gutierrez C, Mexican Ministry of Health, México, D.F. México
OBJECTIVES: Estimate the cost of procurement-surgery-follow up for corneal
transplant to be covered by public institutions in Mexico, in the context of the
National Transplant Program. The estimation is important, because according
to economic evaluation studies in Mexico, corneal transplant is considered a
very cost effective intervention. However, there is a considerable list of patients
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
awaiting corneal transplant. This situation urges forward the Ministry of Health
to analyze the various aspects involved in the corneal procurement-transplant
process. METHODS: A micro-costing was developed considering the clinical
treatment protocol developed by the collegiate body of the General Health Council
of Mexico. The protocol includes three phases: preoperative, surgery and followup. Each phase requires a number of studies, medical supplies, medicines and
medical staff. The unit cost of required inputs are obtained from the public health
sector. RESULTS: The total cost of the procurement-surgery-follow up of corneal
transplant, was US$2037. The phase that represents the lowest percentage of total
cost is the preoperative (13.4%), the greatest cost comes in the stage of surgery
with US$1042 (46.4%). This stage includes the most expensive supply (trephine)
as well as the cost of the procurement process. Finally, the follow up phase
amounts to US$722 which represents the cost of medical visits and drug therapy
for one year. CONCLUSIONS: The results allow estimating the total cost of corneal
transplant in the context of public institutions in Mexico. This estimate provides vital
information for the decision making process of developing sustainable strategies
for the abatement of the list of patients waiting for corneal transplantation.
PSS3: UN ESTUDIO DE COSTO-EFECTIVIDAD PARA EVALUAR EL TRATAMIENTO
CON N-ACETIL CISTEÍNA EN PACIENTES CON ESCLEROSIS SISTÉMICA
Lopez JA1, Briones B2, 1Sandoz México, México, D.F., México, 2Novartis
Farmaceutica, México, D.F., México
OBJECTIVOS: La terapia con N-Acetil Cisteína ha demostrado ser eficaz y
segura en pacientes con Esclerosis Sistémica (ES). El objetivo de este análisis es
comprobar la costo-efectividad de la adición de N-Acetil Cisteína al tratamiento
estándar para ES. METODOLOGÍAS: Este es un estudio de costo-efectividad desde
la perspectiva institucional del Instituto Mexicano del Seguro Social (IMSS).
Se evaluó el tratamiento estándar a base de prednisona 10 mg/d y penicilamina
300 mg/d en comparación con el mismo tratamiento más la adición de N-Acetil
Cisteína 1.8 g/d durante seis meses. La medición de eficacia utilizada fue la
mejora en capacidad vital (CV), medida por espirometría; los datos de eficacia
fueron obtenidos de estudios publicados. Los costos y la utilización de recursos
fueron obtenidos de la institución; todos los costos están expresados en Pesos
Mexicanos y son vigentes para el 2010. El horizonte temporal fue de 6 meses, por
lo cual no se utilizó tasa de descuento. Se realizó un análisis probabilístico de
sensibilidad a través de una simulación de Monte Carlo con 100,000 iteraciones
para corroborar la robustez del modelo. RESULTADOS: El análisis reveló un índice
de costo-efectividad de $9898.74 para el grupo que recibió el tratamiento estándar
más la adición de N-Acetil Cisteína, en comparación con un índice de $7158.09 para
el grupo que sólo recibió el tratamiento estándar, lo cual nos da como resultado
un índice incremental de costo-efectividad de $2740.65, que es el costo por cada
unidad adicional de eficacia con la adición del tratamiento de N-Acetil Cisteína.
CONCLUSIONES: La adición de N-Acetil Cisteína al manejo de pacientes con
ES supone un incremento en la eficacia y una mejora en la capacidad vital, que
conlleva un costo adicional de $2740.65 por cada unidad adicional de eficacia,
convirtiendo a N-Acetil Cisteína en un tratamiento costo-efectivo.
SENSORY SYSTEMS DISORDERS –
Patient-Reported Outcomes & Preference-Based Studies
PSS4: DEVELOPMENT OF A QUESTIONNAIRE ASSESSING THE BURDEN OF
ICHTHYOSIS IN INFANTS
Taieb C1, Dufresne H2, Bodemer C2, 1PFSA, Boulogne Billancourt, France, 2Hopital
Necker, Paris, France
OBJECTIVES: To explore the handicap, in the largest sense, generated by
ichthyosis using a questionnaire to express the burden of the illness on the daily
life of patients and their family, in order to anticipate and treat it more effectively.
METHODS: The questionnaire was developed following a strict methodological
process involving a multidisciplinary team incorporating various players (doctors,
nurses, social workers) who are involved in the treatment of patients and caring
for their families in order to guarantee its credibility and reliability. A review of the
literature and discussions with the children and their families were conducted
in order to identify the concepts related to the pathology. RESULTS: Exploratory
assessments showed that the concept of burden could be structured around 5
components: feeling of pain, daily life, family and personal relationships, work and
psychological impact. 96 preliminary items were identified at the end of the first
discussion. A first analysis managed to reduce these items to 40 whilst conserving
the 5 components but making it easier to use the analysis. The creation of a “child
module” aimed at children who are able to provide answers independently proved
necessary CONCLUSIONS: Chronic pathologies such as ichthyosis, which remains
a rare and incapacitating illness, are difficult to assess by clinical or quality of
life aspects alone as their impact can be multidimensional. Although there is
no specific quality of life questionnaire, several existing questionnaires attempt
to assess one or other of these components; our questionnaire entitled “Family
Burden Ichthyosis” takes them all into consideration in order to explain every angle
of the handicap generated.
SYSTEMIC DISORDERS/CONDITIONS – Cost Studies
PSY1: EPIDEMIOLOGY AND SOCIOECONOMIC BURDEN OF OVERWEIGHT AND
OBESITY IN ARGENTINA
Elgart JF, Gonzalez L, Caporale JE, Pfirter G, Gagliardino JJ
CENEXA - Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET La
Plata, Centro Colaborador OPS/OMS), La Plata, Buenos Aires, Argentina
OBJECTIVES: Obesity is a global epidemic with a heavy socio-economic burden.
This study estimates such burden in Argentina and provides useful evidence
to design prevention, control and treatment strategies for obesity and other
cardiovascular risk factors (CVRFs). METHODS: Descriptive statistical analyses
of the National Survey of Risk Factors (2005) to identify associations between
overweight/obesity (classified according to BMI values and WHO criteria) and
demographic/epidemiological characteristics. It estimates fatal events, cost of
premature deaths (human capital approach) and loss of healthy life years due to
overweight and obesity. Differences in means and proportions were verified using
Student’s t test, ANOVA and Chi2. RESULTS: The national prevalence of overweight
and obesity was 34.8% and 14.8%, respectively; age range of the adult overweight/
obesity population was 35-64 years; obese people were older than normal
weight and overweight (49.4 vs. 38.7 and 47.3, respectively); 16.2% of the obese
people had unsatisfied basic needs (15.1% in overweight people). Prevalence of
obesity (15.2%) was lower than that of overweight (21.6%) in university students.
Obesity was frequently associated with other CVRFs, being hypertension the most
frequent one (48.1%). The association with two o more CVRFs was greater in obese
than in overweight people (23.3% vs. 16.6%), with 14.776 deaths due to overweight/
obesity. The statistical value of life in Argentina was $39,174. The cost attributable
to premature deaths due to obesity/overweight was $190.5 millions (70% due
to overweight). We estimate 596.704 lost healthy life years due to overweight/
obesity. CONCLUSIONS: Implementation of effective strategies for the prevention
and treatment of overweight and obesity is necessary to decrease their high
socioeconomic costs and their negative impact upon lost healthy life years.
PSY2: ESTIMACIÓN DEL IMPACTO FINANCIERO EN LA SALUD DE LA POBLACIÓN
MEXICANA DERIVADO DE LA OBESIDAD Y EL SOBREPESO, 2000-2017
Guajardo-Barron VJ, Gutierrez-Delgado MC, Mexican Ministry of Health, México,
D.F., México
OBJECTIVOS: Estimar el impacto financiero de la obesidad y el sobrepeso en
los aspectos de muerte prematura y gasto total de la atención médica en el
contexto mexicano para el periodo 2000-2017. METODOLOGÍAS: Se desarrollan
diversos escenarios en un modelo de proyección que emplea información de
incidencia, prevalencia, población expuesta al riesgo, costo anual unitario y
fracción de enfermos y muertes atribuibles a obesidad y sobrepeso, esperanza
de vida e ingresos promedios. RESULTADOS: El ingreso perdido por muerte
prematura asociada a cuatro enfermedades seleccionadas atribuibles a obesidad
y sobrepeso se estimó en 25,099 millones de pesos en 2008 afectando a 45,504
familias. La estimación para 2017 fluctúa entre 30,394 millones y 101,086 millones
de pesos afectando a 68,471 familias. El gasto total anual en la atención médica de
cuatro enfermedades seleccionadas atribuibles a obesidad y sobrepeso en 2008
asciende a $42,246 millones. Este monto representa el 33.2% del gasto público
federal en atención médica presupuestado en ese año. En 2017 se estima que
dicho gasto fluctúe entre $77,909 millones y $101,281 millones en pesos de 2008
que representarían entre el 61.2% y 79.5% del gasto público federal en atención
médica del presupuesto 2008. Nótese que el gasto total en atención médica esta
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ISPOR 3rd Latin America Conference
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Research Poster Abstracts
subestimado en al menos 6433 millones de pesos al no incluir complicaciones
derivadas de las enfermedades seleccionadas. Además no incluye el gasto en
la atención médica de la obesidad y el sobrepeso como enfermedad, estimado
en alrededor de 19,688 millones de pesos. CONCLUSIONES: De los resultados se
evidencia la necesidad de definir e implementar una serie de políticas preventivas
encaminadas a reducir la incidencia de obesidad y sobrepeso en la población
mexicana. Asimismo se requiere un seguimiento integral de la población enferma
para controlar la aparición de complicaciones que implique un ahorro potencial al
sistema mexicano de salud.
PSY3: USE OF A DISCRETE EVENT SIMULATION MODEL TO ESTIMATE LONG TERM
ECONOMIC OUTCOMES OF BARIATRIC SURGERY IN MORBIDLY-OBESE, TYPE-2
DIABETIC PATIENTS IN MEXICO
Zanela OO1, Cabra HA1, Anaya P2, Rodriguez S1, Melendez G2, Rupprecht F3,
1
Johnson & Johnson Medical, México, D.F., México, 2Fundación Mexicana para la
Salud AC, México, México, 3Ethicon Endo-Surgery, Mission Viejo, CA, USA
OBJECTIVES: Estimate return of investment (ROI) time for bariatric surgery as
treatment for morbidly obese, type-2 diabetic (T2D) patients versus conventional,
non-surgical approach from a Mexican third level public hospital perspective.
METHODS: The individual experience of a morbidly-obese patient was assessed
using a discrete event simulation model built in Arena™. Patients were created
with unique, randomly assigned baseline characteristics, cloned and sent to
either bariatric surgery (BS) or conventional treatment – pharmacologic treatment
of associated comorbidities and lifestyle modifications (control arm). The only
comorbidity considered was T2D. Preoperative prevalence and up to year 2
recovery rates were taken from a published meta-analysis. Prevalences for
years 2-10 were assumed constant, as literature suggests T2D does not relapse
after year 2 post surgery. Patients in control arm were not allowed to experience
comorbidity recovery. Additional assumptions include infrastructure restrictions,
no perioperative complications and short term mortality; 5% of patients in control
group were allowed to have bariatric surgery after year 5. Considered costs
included the bariatric procedure and T2D pharmacologic treatment, taken from
public institution’s DRG list. Simulation was run with 150 patients for 10 years and
10 iterations using a 4.5% annual discount rate. Results are shown in years and
2011 inflation-adjusted MXP; 95% confidence intervals were estimated. RESULTS:
Average 10-year accumulated costs were $108,744 ($108,302 – $ 109,186) for a
BS patient and $222,555 ($222,062 - $223,048) for a control patient. ROI on BS
was achieved on year 4.55 (4.52 – 4.58). Cost differences are due to the reduced
resource utilization after BS resulting from T2D resolution. CONCLUSIONS:
Investment in BS offsets its cost and is recouped within a reasonable time, thus
allowing institutions to reduce the burden imposed by T2D morbidly obese patients.
Long-term data for other associated comorbidities is needed, as their inclusion in
the analysis could modify ROI time.
PSY4: MODELO DE COSTO BENEFICIO DE LIDOCAINA EN PARCHE AL 5%
VERSUS PREGABALINA 300 MG Y 600 MG AL DÍA PARA EL TRATAMIENTO DE LA
NEURALGIA POSTHERPÉTICA
Rojas LA1, Martinez JA2, 1Universidad de La Sabana, Chía, Cundinamarca, Colombia,
2
Grünenthal Colombiana S.A., Bogotá, Colombia
OBJECTIVOS: Estimar el costo-beneficio (CB) de usar lidocaína parche 5% para
el tratamiento de la Neuralgia Post-Herpética (NPH) comparado con pregabalina
cápsulas de 300mg y 600mg al día desde la perspectiva del pagador en el sistema
de salud de Colombia. METODOLOGÍAS: Se construyó un modelo teórico de análisis
de decisión con base en el costo-beneficio de usar lidocaína en parche 5% y
pregabalina 300mg/día y 600mg/día para el tratamiento de la NPH, simulando 1000
pacientes adultos en un horizonte temporal de un mes, utilizando el software DPL
v7; tomando como variable de desempeño el costo total del tratamiento (costo
del medicamento para la enfermedad + costo de tratamientos complementarios
+ costo de tratamiento de reacciones adversas). El criterio de decisión será
el medicamento que produzca menos efectos adversos relacionados con el
tratamiento y que genere menores costos totales. Como análisis de sensibilidad
se empleará una simulación de Montecarlo, modificando la variable de costo
de tratamiento. RESULTADOS: Los costos totales del tratamiento mensual en
moneda local fueron: lidocaína 5% 1 parche/día $386.809,48; lidocaína 5% ½
parche/día $196.553,62; pregabalina 150 mg bid fue $232.700,19 y pregabalina 300
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mg bid $326.912. Desde la perspectiva de costo integral, la alternativa menos
costosa fue pregabalina 150 mg dos veces al día. Simulando en DPL, el uso de
medio parche de lidocaina 5% presenta mejor relación costo/beneficio frente a
pregabalina. CONCLUSIONES: Según el modelo de costo-beneficio, para la NPH se
recomienda iniciar tratamiento con pregabalina 150mg via oral cada 12 horas. En
caso de presentarse reacción adversa, iniciar medio parche o parche completo de
lidocaína al 5%, si no hay alivio usar pregabalina 300mg al día, dosis con la que es
necesario evaluar el perfil de seguridad. Este trabajo puede ser el fundamento de
establecer si Lidocaina 5% en parche puede favorecer la calidad de vida de los
pacientes que requieran tratamiento para la NPH.
PSY5: ESTUDIO COSTO-EFECTIVIDAD DEL PARCHE DE LIDOCAÍNA COMO TERAPIA
ADYUVANTE A PREGABALINA Y GABAPENTINA EN EL MANEJO DEL DOLOR
NEUROPÁTICO PERIFÉRICO EN EL HOSPITAL SAN JOSÉ DE BOGOTÁ D.C. ENERODICIEMBRE 2010
Hinestrosa F1, Garzon L2, 1Grünenthal Colombiana S.A., Bogotá, Colombia, 2Hospital
San José, Bogotá, Colombia
OBJECTIVOS: Desarrollar un estudio costo-efectividad que compare Pregabalina
y Gabapentina con y sin la terapia adyuvante del parche de Lidocaína en dolor
neuropático periférico. METODOLOGÍAS: Estudio costo-efectividad, observacional,
descriptivo, con recolección retrospectiva de información, desde la perspectiva
institucional, incluyó historias clínicas de pacientes con dolor neuropático
periférico que utilizaron bien sea Pregabalina ó Gabapentina para el control
del dolor con y sin el parche de Lidocaína como medicamento adyuvante y que
asistieron a clínica de dolor entre Enero y Diciembre de 2010.La variable primaria
de efectividad fue definida como el número de pacientes que presentaron mejoría
significativa del dolor en el periodo de estudio, previamente definido como alivio
de tres o más puntos en la escala visual análoga, se definieron como variables
generadoras de costo el uso de medicamentos, estancia hospitalaria y atención
por profesionales de la salud. Se calculó la razón costo-efectividad incremental
para cada alternativa, el análisis de sensibilidad se hizo al variar 20% el costo
más relevante, se realizó análisis de decisiones mediante un modelo de Markov.
RESULTADOS: Se encontró que 49 pacientes utilizaron Gabapentina, 52 Lidocaína +
Gabapentina, 57 Pregabalina y 59 Lidocaína + Pregabalina. Un total de 23 pacientes
presentaron mejoría significativa en el grupo de Gabapentina, 43 con Lidocaína +
Gabapentina, 38 con Pregabalina y 55 con Lidocaina + Pregabalina . Los costos
totales ascendieron a $315.846.279 pesos con Gabapentina, $302.547.985 con
Lidocaína+Gabapentina, $310.729.129 con Pregabalina y $292.478.627 con Lidocaína
+ Pregabalina, La razón costo-efectividad incremental de Gabapentina versus
Lidocaína + Gabapentina fue de -664.914. la de Pregabalina versus Lidocaina +
Pregabalina -1.073.558. CONCLUSIONES: La adición del parche de lidocaína a la
terapia regular con gabapentina y pregabalina demostró una relación de costo
efectividad favorable en ambas situaciones, se encontró que al comparar entre la
terapia adyuvante a gabapentina y pregabalina fue la adición a pregabalina la que
reflejo mayores beneficios.
PSY6: ESTUDIO DE COSTO-EFECTIVIDAD DE BUPRENORFINA TRANSDÉRMICA
VERSUS OXICODONA ORAL Y FENTANILO TRANSDÉRMICO EN EL MANEJO DEL
DOLOR CRÓNICO NO ONCOLÓGICO EN EL HOSPITAL SAN JOSÉ DE BOGOTÁ D.C.
ENERO-DICIEMBRE 2010
Hinestrosa F1, Garzon L2, 1Grünenthal Colombiana S.A., Bogotá, Colombia, 2Hospital
San José, Bogotá, Colombia
OBJECTIVOS: Desarrollar un estudio de costo-efectividad que compare
Buprenorfina transdérmica con Fentanilo transdérmico y Oxicodona oral en el
manejo del dolor crónico no maligno. METODOLOGÍAS: Estudio costo-efectividad,
observacional, descriptivo, con recolección retrospectiva de la información,
realizado desde la perspectiva institucional, incluyó historias clínicas de pacientes
con dolor crónico no maligno que utilizaron bien sea Fentanilo ó Buprenorfina
ó Oxicodona para el control del dolor y que asistieron a clínica de dolor entre Enero y Diciembre de 2010.La variable primaria de efectividad fue definida como
el número de pacientes que presentaron mejoría significativa del dolor en el
periodo de estudio, previamente definido como alivio de tres o más puntos en la
escala visual análoga, se definieron como variables generadoras de costo el uso
de medicamentos, la estancia hospitalaria y la atención por profesionales de la
salud. Se calculó la razón costo-efectividad incremental para cada alternativa,
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
el análisis de sensibilidad se hizo al variar en un 20% el costo más relevante, se
realizó análisis de decisiones mediante un modelo de Markov. RESULTADOS: Se
encontró que 147 pacientes utilizaron Oxicodona, 121 Fentanilo transdérmico y
132 Buprenorfina transdérmica. Un total de 115 pacientes presentaron mejoría
significativa en el grupo de Oxicodona, 104 en el grupo de Fentanilo y 117
en el de Buprenorfina. Los costos totales ascendieron a $400.224.615 pesos
colombianos en el grupo de Oxicodona, $398.902.388 en el grupo de Fentanilo y
$396.875.234 en el grupo de Buprenorfina. La razón costo-efectividad incremental
de Oxicodona versus Buprenorfina fue de -1’013.577. La de Oxicodona versus
Fentanilo -120.202 y la de Fentanilo versus Buprenorfina -257.644. CONCLUSIONES:
El Fentanilo y la Buprenorfina se asociaron a valores favorables al compararse con
Oxicodona, ambas alternativas se mostraron costo-efectividad significativa en el
escenario estudiado, el desempeño de Buprenorfina transdérmica fue ligeramente
superior al de Fentanilo transdérmico.
PSY7: COST OF MANAGING BLEEDING-RELATED EPISODES (BRE) FOR
ROMIPLOSTIM VERSUS STANDARD OF CARE (SOC) IN PATIENTS WITH CHRONIC
IMMUNE THROMBOCYTOPENIA (ITP) IN MEXICO
Arocho R1, Northridge K2, Rivera Hurtado R3, Chavez JG4, 1Amgen, Inc., Barcelona,
Spain, 2Outcomes Insights, Inc., Westlake Village, CA, USA, 3Amgen México,
México, D.F., México, 4National Institute of México for Social Security (IMSS),
Tlalnepantla de Baz, Edo., México, D.F., México
OBJECTIVES: ITP, an autoimmune disorder characterized by isolated
thrombocytopenia, puts patients at risk of BRE, the management of which can pose
a high economic burden. The novel TPO-mimetic romiplostim is recommended
for treatment of adult patients with chronic ITP. We compared BRE rates, and the
costs of managing BRE in Mexico, for romiplostim versus SOC in adult patients
with chronic ITP. METHODS: BRE rates were obtained from two randomized
placebo-controlled trials in splenectomized and non-splenectomized patients.
BRE were categorized as: outpatient minor bleed, bleed requiring immunoglobulin
treatment, or bleeding-related hospitalizations. BRE costs were calculated by
splenectomy status and treatment group, with unit costs obtained from the 2010
Official Price List of the Public Healthcare System in Mexico. The frequency of
each BRE was multiplied by its managing cost and this total cost divided by the
total number of patient-weeks in each treatment arm to obtain an average cost per
patient per week. The average cost per patient per week was then extrapolated
to the treatment duration of 52 weeks. RESULTS: The analysis included 62 nonsplenectomized (41 romiplostim, 21 SOC) and 63 splenectomized patients (42
romiplostim, 21 SOC), with a total of 2,715 patient-weeks on study. Romiplostim
yielded a 55% reduction in all BRE (95% CI: 41% to 65%) and an 88% (95% CI 80%
to 93%) reduction in those requiring immunoglobulin treatment. The estimated
yearly BRE management cost per non-splenectomized patient was MXP$33,103 for
romiplostim and MXP$162,720 for SOC. The estimated yearly BRE management cost
per splenectomized patient was MXP$31,328 for romiplostim and MXP$283,246 for
SOC. CONCLUSIONS: Romiplostim is an important therapeutic alternative for adult
patients with chronic ITP which reduces the incidence of BREs compared to SOC,
and lowers BRE management costs for the Mexican Public Healthcare system.
PSY8: TWO ANALGESIC TECHNIQUES AFTER CESAREAN DELIVERY: A COSTEFFECTIVENESS ANALYSIS STUDY
Farshchi A, Abdollahi Asl A, Tehran University of Medical Sciences, Tehran, Iran
OBJECTIVES: The study was designed to compare two analgesic regimens
administered after cesarean delivery in a routine hospital setting with respect to
patients’ perceptions of their pain relief and the impact of analgesic technique on
hospital costs. METHODS: This study was undertaken based on our previous paper
that evaluated postoperative pain in a double-blinded, randomized, single-dose
comparison of the monoaminergic and µ-opioid agonist tramadol, 100 mg (Group
T) and piroxicam 20 mg (Group P) given IM alone- single dose in 150 patients
who had elective cesarean delivery. All patients were assessed at 0, 6, 12 and
24 hours post operation for pain degree (by Visual Analogue Score: VAS 1-10),
nausea and vomiting. Our outcomes were the power of drug to reduce pain and
our costs came from drug prices. Incremental Cost-Effectiveness Ratio (ICER) was
calculated. RESULTS: There was no significant difference between the efficacy
of tramadol and piroxicam injections (P>0.05). Side effects were similarly minimal
with all treatments. Total costs in P group were $16.33 and in T group were $47.52.
CONCLUSIONS: In this study, ICER showed that analgesic effect of piroxicam is
more cost-effective than tramadol.
PSY9: EVALUACIÓN ECONÓMICA DE DIETA INMUNOREGULADORA (INMUNEX
PLUS®) EN PACIENTES MEXICANOS
Soto Molina H, Iteliness SA de CV, México D.F., México
OBJECTIVOS: Realizar un análisis costo efectividad del uso de una dieta
Inmunoreguladora (DI) con aporte de antioxidantes y glutamina, Arginina,
Nucleótidos y Ácidos grasos omega 3, en dosis terapéuticas; utilizado como
apoyo nutricional enteral en pacientes críticos en comparación con el
tratamiento sin apoyo nutricio inmunogénico (NDI), desde la perspectiva del
IMSS. METODOLOGÍAS: Se realizó un análisis de costo-efectividad, para ello,
se construyó un árbol de decisiones. Se realizó una revisión sistemática para
determinar la eficacia (porcentaje de pacientes libres de complicaciones) y los
días de estancia hospitalaria. Se midieron costos médicos directos por medio
de un panel de expertos. En la valuación de costos se utilizaron tarifas vigentes
aplicables a los servicios médicos proporcionados por el IMSS. Todos los
costos están expresados en pesos mexicanos de 2010. Se realizó un análisis de
costo efectividad incremental, análisis de sensibilidad y un análisis de impacto
presupuestal. RESULTADOS: Los pacientes con DI tienen una mayor eficacia
promedio (68.76% versus 57.80%, p <0.001) y un menor costo promedio por paciente
( $490,602 PMX versus $504,876.54) que los pacientes NDI, este menor costo se
debe a una reducción 3.3 días de estancia hospitalaria que tienen los pacientes con
DI versus pacientes con NDI. Los ahorros en el presupuesto para el IMSS, al utilizar
la dieta inmunogénica en el tratamiento de 100 pacientes sería $1,427,436.35. El
análisis de sensibilidad corroboró la validez del modelo. CONCLUSIONES: La dieta
Inmunoreguladora produce una reducción significativa de complicaciones mayores
(infecciones nosocomiales, falla multi-orgánica, abscesos intra-abdominales,
dehiscencia de anastomosis, entre otros). Al usarla se obtiene una disminución
significativa de los costos totales y días totales de estancia hospitalaria, por lo cual
es una opción eficiente en este tipo de pacientes mexicanos.
PSY11: EVALUACION ECONOMICA DEL USO PROFILACTICO DE PEGFILGASTRIM
EN PACIENTES CON QUIMIOTERAPIA MILOABLATIVA PARA EVITAR LA
NEUTROPENIA FEBRIL
Morgan-Villela G, Instituto Mexicano del Seguro Social, Guadalajara, Jal, México
OBJECTIVOS: Evaluar si el uso profiláctico de Pegfilgastrim ofrece mejores
resultados en términos de salud y gasto asociado a la incidencia de la neutropenia
febril (NF) asociada a la quimioterapia mielosupresora con respecto a Filgastrim
y a no usar profilaxis. METODOLOGÍAS: Análisis de minimización de costos
basado en un árbol de decisiones de tres alternativas profilácticas: Pegfilgastrim,
Filgastrim y no-profilaxis. La medida de efectividad fue la incidencia de NF en
pacientes que reciben quimioterapia. Pegfilgastrim de acuerdo a literatura, reduce
el riesgo relativo de desarrollar nuetropenia febril en un 90% y Filgastrim la reduce
en un 39%. Se consideraron los siguientes costos médicos directos: costos de
medicamentos, consultas, estudios clínicos, hospitalización y procedimientos.
Dichos costos se tomaron de las tarifas vigentes para 2010 aplicables a los
servicios médicos proporcionados por el IMSS. RESULTADOS: Tomando en cuenta
un total de 1000 pacientes hipotéticos con un riesgo del 20% de desarrollar NF, si
dividimos equitativamente los pacientes (33% Pegfilgrastim, 33% Filgrastim, 33%
sin Profilaxis), el uso de Pegfilgastrim hace que sólo 7 pacientes presenten NF, y
se incurrirá en un costo total de $5.6 Mio MXP; mientras que el uso de Filgrastim
hace que 40 pacientes presenten NF y 66 pacientes desarrollan NF cuando no
se usa profilaxis, con costos totales de $7.8 y $10.5 Mio MXP. CONCLUSIONES:
En conclusión, podemos afirmar que el uso de Pegfilgatrim en forma profiláctica
disminuyen los costos de atención de los pacientes con cáncer que reciben
quimioterapia mieloablativa en nuestro país, además de ser una molécula que
incurre en menores costos para las instituciones, y claramente presenta un
beneficio para los pacientes. El uso de Pegfilgastrim es un medicamento dominante
comparado con Filgastrim y el no uso de profilaxis.
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
PSY12: LAPAROSCOPY VERSUS OPEN ROUX-EN-Y GASTRIC BYPASS FOR MORBID
OBESITY: COST-UTILITY ANALYSIS
Silva EN1, Silva MT1, Elias FTS1, Laranjeira FO1, Mottin CC2, 1Mexican Ministry of
Health, Brasília, Brazil, 2Pontifical Catholic University of Rio Grande do Sul, Porto
Alegre, RS, Brazil
OBJECTIVES: To estimate the incremental cost-utility ratio (ICUR) of laparoscopy
versus open Roux-en-Y gastric bypass for morbid obesity in the Brazilian Public
Health System (SUS) perspective. METHODS: We performed a cost-utility
model using a decision tree for the SUS perspective as the payer of the health
services, with a one-year follow-up. The cost and complication rates information
were obtained from a retrospective cohort (n> 1000) at a Brazilian center that is
renowned for bariatric surgery, and from the SUS database. More specifically,
we used an adjustment factor to convert the average value charged in private
health plans due to the absence of actual costs for laparoscopic surgery in the
SUS (unlisted). The mortality data, conversion probability (for video to open) and
years with quality-adjusted life year (QALY) were from literature. A tornado diagram
was created, which encouraged univariate and bivariate analyses to explore
sensitivity. RESULTS: The ICUR was R$ 84.678/QALY. The QALY and the costs of
laparoscopic or open surgery were the variables most sensitive to the model.
CONCLUSIONES: Compared with open surgery, the laparoscopic approach does
not appear cost-effective within the SUS perspective, assuming the cost-utility
threshold recommended by WHO (R$ 49,242.90). From the bivariate sensitivity
analysis related to quality of life, the laparoscopic approach becomes costeffective
if there is a favorable difference in quality of life of at least 20%, keeping the other
variables constant. Moreover, in the bivariate sensitivity analysis related to costs,
laparoscopy would be cost-effective if its cost to the SUS were reduced by R$
8,100.00, keeping other variables constant.
SYSTEMIC DISORDERS/CONDITIONS –
Patient-Reported Outcomes & Preference-Based Studies
PSY13: EFECTO DE UN PROGRAMA DE ATENCIÓN FARMACÉUTICA PARA
PACIENTES CON SOBREPESO Y OBESOS
Alfonzo N1, Bastardo YM2, 1Proveeduria Farmaceutica IPP, Caracas, Venezuela,
2
Universidad Central de Venezuela, Caracas, Venezuela
OBJECTIVOS: El propósito de este estudio es describir los efectos de un programa
de Atención Farmacéutica para pacientes con sobrepeso y obesos que asisten a
la Proveeduría Farmacéutica IPP-UCV en términos de perdida de peso y calidad
de vida relacionada con la salud (CVRS). METODOLOGÍAS: Pacientes adultos
con sobrepeso y obesos recibieron Atención Farmacéutica por un periodo de 6
meses en la Farmacia Comunitaria ubicada dentro del Campus de la Universidad
Central de Venezuela. El cuestionario de salud EQ-5D que comprende un sistema
descriptivo de cinco dimensiones y una escala visual analógica (EQ VAS) fue
utilizado para medir la CVRS. RESULTADOS: Un total de 83 pacientes (68 mujeres
y 15 hombres) con una edad promedio de 49.86 años (DE= 15.73) completaron el
cuestionario durante el periodo de la intervención. El peso, diámetro de cintura
y las puntuaciones obtenidas en la EQ-5D antes y después de la intervención
fueron comparados. Una mejora en calidad de vida fue observada en todas
las dimensiones del EQ-5D y en la EQ-VAS. Una diferencia estadísticamente
significativa en peso (-5.44 kg) y diámetro de cintura (-5.48 cm) fue observada al
final de la intervención. CONCLUSIONES: Un programa de Atención Farmacéutica
permite alcanzar una mejora en la calidad de vida relacionada con la salud y en los
resultados clínicos en pacientes con sobrepeso y obesos. URINARY/KIDNEY DISORDERS – Cost Studies
PUK1: COMPARISON OF DIRECT MEDICAL COST OF DIALYSIS IN A MEXICAN
COHORT EITHER ON PERITONEAL OR HEMODIALYSIS
Mayen-Herrera E1, Cortes M1, Marx SE2, Sterz R2, 1Abbott Laboratories de México,
México, D.F., México, 2 Abbott Laboratories, Abbott Park, IL, USA
OBJECTIVES: End-stage renal disease (ESRD) poses a high medical and economic
burden on healthcare systems. Information on direct medical costs for dialysis
patients in Mexico is comparatively sparse. METHODS: Data was collected
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retrospectively on 40 patients on automated peritoneal dialysis (APD) and 40
patients on hemodialysis (HD) from institutional databases of two hospitals of
the Mexican Institute of Social Security (IMSS). Patient follow up ranged from
3 months up to 67 months. Resources captured in the study were: medications,
dialysis procedures, laboratory and diagnostic tests, hospitalizations and medical
consultations, blood and hemoderivatives and catheter procedures. Drug and
medical services costs were calculated using information from the Mexican
Government website (http://web.compranet.gob.mx ) based on 2010 fees. All
costs were converted into US dollars (1USD= 12.54 Mexican pesos ). RESULTS:
Forty patients on peritoneal dialysis (APD, age 50 ± 15.6, 40% female) and 40
patients on hemodialysis ( HD , age 47 ± 17.3 years , 42,5 % female). Total annual
costs were: US$12,589 (APD), US$7541 (PD). Dialysis: US$1058 (APD) , US$13,739
(HD). Hospitalization: US$6212 (APD), US$6128 (HD). Medication: US$5043
(APD), US$7580 (HD). Costs for complications: US$5586 (APD) and US$3943 (HD). CONCLUSIONS: Dialysis patients either on peritoneal or hemodialysis present a
high cost burden to the Mexican Health system. Medication and hospitalization
costs constitute a major part of the total costs. Further investigations are needed to
understand how to optimize care to avoid some of these costs. PUK2: COST PER SUCCESSFUL RESPONSE OF STANDARD TREATMENT PLUS
CINACALCET VERSUS STANDARD TREATMENT ALONE IN PATIENTS WITH
SECONDARY HYPERPARATHYROIDISM IN MEXICO
Arocho R1, Ianazzo S2, Rivera Hurtado R3, Paniagua Sierra JR4, 1Amgen, Inc.,
Barcelona, Spain, 2AdRes Health Economics & Outcomes Research, Torino, Italy,
3
Amgen México, México, D.F., México, 4National Institute of México for Social
Security (IMSS), México, D.F., México
OBJECTIVES: Secondary Hyperparathyroidism (SHPT) is a common complication
of chronic kidney disease. Abnormal levels of Parathyroid Hormone (PTH), Calcium
(Ca) and Phosphorus (P) are associated with an increased risk of cardiovascular
death and fracture. The aim of the study was to assess the cost per successful
response with standard treatment (ST)+Cinacalcet versus ST alone (vitamin D
sterols and chelated phosphates) in patients with SHPT in Mexico. METHODS:
A decision analytic model was developed to calculate and compare the costs
per successful response with Cinacalcet in adult patients with SHPT to whom a
specific scheme of ST has been prescribed. The successful response was defined
as the balance (normal levels) in all target parameters: PTH, Ca, P and Ca x P.
ST was defined as one of the following combinations: Paricalcitol IV + Chelated
Phosphate (PCP), Chelated Phosphate + Calcitriol (CPC) and Paricalcitol + Calcium
Carbonate (PCC). Unit costs were gathered from the 2010 Official Price List of the
Public Healthcare System in Mexico. RESULTS: According to the literature, 16%
of patients achieve the targets in all parameters when ST is given. The addition of
Cinacalcet increases this proportion up to 60%. Considering PCP as the ST, the cost
per response was MXP$32,750 vs MXP$16,945 with Cinacalcet+PCP; CPC showed a
cost per response of MXP$22,156 vs MXP$15,509 with Cinacalcet+CPC; finally, PCC
reflected a cost per response of MXP$14,850 vs. MXP$12,091 with Cinacalcet+PCC.
CONCLUSIONS: The addition of Cinacalcet to any ST combination represents a
strategy which results to lower cost per responder principally due to two factors:
the reduction of 50% in ST concomitant drugs and the higher response rates in
achieving targets for all biochemical parameters.
PUK3: COST-EFFECTIVENESS OF ANEMIA TREATMENT IN DIALYSIS PATIENTS IN
BRAZIL
Silva FHCV1, Vianna CMDM2, Silva FVC3, 1Agência Nacional de Saúde Suplementar,
Rio de Janeiro, RJ, Brazil, 2Universidade do Estado do Rio de Janeiro, Rio de
Janeiro, RJ, Brazil, 3Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ,
Brazil
OBJECTIVES: This study sought to determine the cost-effectiveness of anemia
treatment in dialysis patients for Brazilian Public Health System. Two alternatives
were compared: a new drug, the Continuous Erythropoietin Receptor Activator,
CERA, recently registred in Brazil, and another one, provided nowadays by the
National Health System, Epo-rHu (Recombinant Human Eythropoietin). METHODS:
A Markov cohort of dialysis patients treated with CERA and Epo-rHu for four years
was used to perform the base case analysis. The model outputs were QALYs and
costs. The quality of life associated with each drug was measured by interviews
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Research Poster Abstracts
applied to health care professionals. These interviews were previously submitted
and approved by the local ethics committee. A sensitivity analysis was applied
to the model to test it, varying the values of drugs dosage, costs, discount rate
and effectiveness. RESULTS: The average quality of life assigned by health care
professionals to the patients treated with Epo-rHu, CERA and to kidney transplant
receptors were respectively 6,3, 7,8 and 9,3. The model showed that Epo-rHu
treatment was more cost-effective than CERA treatment. The cost-effectiveness
ratio of Epo-rHu therapy was R$ 21.052,00. In addition, the cost per QALY gained
of CERA therapy was R$ 72.974,00. CONCLUSIONS: Anemia treatment with CERA
is associated with improvement in quality of life compared to Epo-rHu therapy.
However, the new drug is not more cost-effective than the drug provided by the
Brazilian Public Health System. PUK4: COSTO-EFECTIVIDAD DE INTERVENCIONES PARA INSUFICIENCIA RENAL
CRÓNICA TERMINAL EN MÉXICO
Arredondo A1, De icaza E2, 1Instituto Nacional de Salud Pública, Cuernavaca,
Morelos, México, 2Servicios de Salud del DF, México, D.F., México
OBJECTIVOS: Análisis de costo-efectividad en intervenciones para pacientes con
insuficiencia renal crónica terminal (IRCT) en términos de los costos económicos
de cada intervención, los años de vida ganados y la calidad de vida que generan
tres alternativas comparables y mutualmente excluyentes: diálisis peritoneal
continua ambulatoria (DPCA), la hemodiálisis (HD) y el trasplante renal (TR).
METODOLOGÍAS: El diseño del estudio fue de tipo longitudinal. Los costos de cada
intervención se determinaron mediante la técnica de manejo de caso promedio. Las
medidas para evaluar los criterios de efectividad elegidos fueron la probabilidad
de sobrevida y el Año de Vida Ajustado por Calidad (QALY, Quality-Adjusted Life
Year) medido por el Indice de Rosser. RESULTADOS: Los costos de manejo anual de
caso en US $ fueron: diálisis peritoneal $470.00, hemodiálisis $802.00 y trasplante
$231,00. En cuanto a la efectividad, la sobrevida del injerto de trasplante renal
resultó de 89,9% y 79,6% a uno y tres años respectivamente, mientras que los
pacientes sometidos a DPCA tienen una sobrevida de 86,2% y 66,9% a un año y
a tres años respectivamente. En cuanto a los QUALY’s, los resultados para cada
intervención fueron: DPCA 0,879; HD 0,864; y para el TR 0,978. CONCLUSIONES:
La intervención más costo-efectiva resultó el trasplante renal con un coeficiente
de 3088,69, seguido de la DPCA y la hemodiálisis, cuyos coeficientes fueron de
6416.95 y 11.147,68 respectivamente. Por lo tanto se recomienda promover y utilizar
el trasplante renal como la intervención más costo-efectiva para pacientes con
IRCT. Los resultados del coeficiente costo-efectividad identificado desde una
perspectiva clínica y económica, constituyen un aporte relevante para la búsqueda
y el logro de la eficiencia de los recursos que se asignan para producir servicios de
salud para pacientes con IRCT, cuyas demandas están en competencia con otras
enfermedades crónicas e infecto-contagiosas.
PUK5: ANÁLISIS COMPARATIVO DE COSTOS DEL TRATAMIENTO PARA LA ANEMIA
RENAL CON METOXI POLIETILENGLICOL-ERITROPOYETINA BETA (MIRCERA®) VS.
ERITROPOYETINA ALFA
Medina Gómez JL, Instituto Mexicano del Seguro Social, Puebla, México
OBJECTIVOS: Evaluar si el uso de Metoxi polietilenglicol-eritropoyetina beta
(MPG-beta) ofrece mejores resultados en salud y gasto con respecto a la
eritropoyetina alfa. METODOLOGÍAS: Análisis de costo-efectividad incremental
basado en un árbol de decisiones para simular los costos del tratamiento, con
un horizonte temporal de 12 meses (costos en valor nominal). La dosis mensual
de agentes estimulantes de la eritropoyesis se ajustó de acuerdo con los
niveles de hemoglobina; sí la concentración es mayor a 12 g/dl 20,000 UI/mes de
Eritropoyetina alfa o 0.6 mcg/kg/mes de MPG-beta, para 11-12 g/dl 26,00 0UI/mes
de Eritropoyetina alfa o 1.2 mcg/kg/mes de MPG-beta y para concentraciones
menores a 11 g/dl 32,000 UI/mes de Eritropoyetina alfa o 1.5 mcg/kg/mes de MPGbeta. Cada escenario tiene un costo basado en la atención habitual de estos
pacientes. Los costos de los insumos se tomaron de las tarifas vigentes para 2010
aplicables a los servicios médicos proporcionados por el IMSS. Se evaluaron los
riesgos de no estar en un intervalo ideal de Hemoglobina (11-12.5 g/dl), también
conocido como excursiones de la hemoglobina y su costo asociado. RESULTADOS:
MPG-beta mantiene en forma más estable la concentración de hemoglobina al
compararse con Eritropoyetina alfa, de tal forma que a los 6 meses de tratamiento
permanecen en el intervalo ideal 94% vs. 5% con Eritropoyetina alfa. Con el uso
de Eritropoyetina alfa hay mayor riesgo de tener excursiones, y por consecuencia
se incurre en mayores costos anuales (67,612 vs. 63,931). El análisis costoefectividad incremental muestra un incremento de 83% en efectividad y un ahorro
por paciente de 3,681 utilizando MPG-beta en comparación con Eritropoyetina
alfa, esto derivado de la estabilidad de la hemoglobina. El ICER es de -12,901
unidades. CONCLUSIONES: Estos resultados demuestran que MPG-beta ofrece
mejores resultados en salud y costos posesionándose como un tratamiento costoahorrador.
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
HEALTH CARE DECISION-MAKER’S CASE STUDy ABSTRACTS
HEALTH CARE DECISION-MAKER’S CASE STUDY POSTER SESSION
Friday, 9 September 2011: 8:30-20:00 & SATURDAY, 10 SEPTEMBER 2011: 8:00-13:45 Don Diego 1
PCASE1: TOMA DE DECISIONES EN SALUD: UN MODELO DE GESTIÓN DE
RECURSOS CON ÉNFASIS EN LA CALIDAD ASISTENCIAL. FONDO NACIONAL DE
RECURSOS, URUGUAY
Fernández G, Morales M, Lombide I, Fondo Nacional de Recursos, Montevideo,
Uruguay
ORGANIZACIÓN: El Fondo Nacional de Recursos (FNR) es un organismo público
no estatal creado por ley en Uruguay en 1980. Gestiona un seguro obligatorio para
toda la población financiando y controlando el resultado de procedimientos de
medicina altamente especializada y medicamentos de alto costo. En el año 2010
se financiaron 10.776 procedimientos cardiovasculares invasivos, 3352 cirugías
traumatológicas, 438 ingresos a hemodiálisis y 55 ingresos a diálisis peritoneal, 211
trasplantes, 183 grandes quemados, 15 implantes cocleares y 2268 nuevos
tratamientos de alto costo. PROBLEMA O ASUNTO ECONTRADO: Durante los
años 90, sufrió un desfinanciamiento creciente comprometiéndose seriamente su
viabilidad a expensas de un aumento de prestaciones no explicado por la situación
demo-epidemiológica del país. METAS: Expondremos un proceso de reingeniería
institucional tanto en términos administrativos como de toma de decisiones
médicas que ha permitido revertir esta situación. MEDIDAS USADAS EN LA
DECISIÓN: Desde el 2000, fueron implementadas múltiples estrategias de gestión
tendientes a la racionalización del gasto manteniendo el objetivo de elevar la
calidad asistencial. ESTRATEGIA DE IMPLEMENTACIÓN: Por un lado la institución
fortaleció su condición de negociador directo con proveedores realizando
licitaciones para compra de dispositivos y medicamentos creando competencia
entre proveedores y aplicando un criterio de escala lográndose descenso
significativo de costos. Los dispositivos se comenzaron a pagar directamente a
los proveedores permitiendo negociaciones independientes de las realizadas
por los actos médicos. Se implementaron estrategias económico-financieras
para responder a voluminosas deudas contraídas. Surgieron listas de espera con
cupos mensuales para cirugías traumatológicas racionalizándose este gasto.
Se rediseñó el sistema informático lográndose una historia informatizada con
todas las intervenciones realizadas a los pacientes. Esto permite acceso a datos
epidemiológicos muy importantes a nivel país, centralizados en una base única. A
nivel médico, se diseñan estrategias tendientes a fortalecer el proceso de toma
de decisiones. Se crearon normativas de cobertura financiera estableciéndose
precisamente las situaciones en las que se garantiza el financiamiento de técnicas
o medicamentos; elaboradas con información de guías médicas internacionales y
asesoramiento de expertos locales e internacionales apuntando al mejor resultado
costo efectividad. Son revisadas periódicamente, auditadas y eventualmente
cambiadas si la evidencia así lo justifica. En función de ellas se analiza cada
solicitud. Se estableció un sistema de segunda opinión por el cual médicos
externos al FNR evalúan a los pacientes con actos solicitados, emitiendo un juicio
sobre su pertinencia que es tomado como insumo por los médicos de la institución
para tomar una decisión. Se crean instancias de análisis de casos complejos
con equipos de expertos locales e internacionales. Se diseña un programa de
seguimiento de paciente con sustitución de función renal. RESULTADOS: Estas
medidas, contribuyeron a consolidar la mejoría económica de la institución cuyo
patrimonio crecientemente negativo hasta el año 2005 ($-5.283.027.432 en 2001), se
positiviza y mantiene así hasta la fecha ($472.688.138 en 2010, datos expresados
en moneda constante). Los actos financiados, disminuyeron significativamente
(19.928 en 2001 a 16.978 en 2008) a expensas de disminución de las solicitudes y no
de aumento de actos negados (1329 en 2001 y 1401 en 2008). A partir de 2008 esta
tendencia cambia, lo que se produce dentro del contexto de una reforma sanitaria
en el país que probablemente ha llevado a mejorar el acceso de la población
a intervenciones sanitaria con el consiguiente aumento de requerimientos de
medicina altamente especializada. Paralelamente, en los últimos dos años, se han
incorporado nuevas prestaciones. En términos sanitarios se aprecia un descenso
sostenido de mortalidad de causa cardiovascular del país en igual período
(314/100.000 en 2001 a 283/100.000 en 2008). Con un fuerte énfasis en la optimización
de la calidad asistencial, hay un constante vínculo con las instituciones
prestadoras realizando controles tanto de aspectos edilicios, de infraestructura,
de recursos humanos y materiales y de procesos asistenciales así como una
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evaluación periódica de resultados en las diferentes técnicas. Se implementan
programas de prevención secundaria cardiovascular para pacientes con actos
financiados por la institución, de salud renal, cesación de tabaquismo, control de
obesidad. Paralelamente la institución ha realizado un fuerte inversión en recursos
humanos calificados y estimulando la alta dedicación horaria de sus funcionarios.
LECCIONES APRENDIDAS: El FNR ha generado la experiencia necesaria como
para ser ejemplo de cómo repercute una política de gestión en los diferentes
proveedores y de cómo se puede regular, ordenar y controlar proponiendo a la vez
un modelo de calidad asistencial. Hablar de medicina sustentable obliga a basarse
en indicaciones precisas de eficacia demostrada y con límites establecidos para
mejorar la accesibilidad y cumplir el principio de justicia distributiva. Se trata,
entonces, de establecer la “ética del ahorro”.
PCASE2: A INSTITUCIONALIZAÇÃO DA AVALIAÇÃO DE TECNOLOGIAS EM SAÚDE
NO BRASIL
Santos VCC, Louly P, Vidal A, Silva MT, Elias F, Ministry of Health of Brazil, Brasília,
D.F., Brazil
ORGANIZAÇÃO: Coordenação de Avaliação de Tecnologias em Saúde (CGATS) do
Ministério da Saúde do Brasil (MS). PROBLEMA ECONTRADO: Criada em 2005, as
ações da CGATS são pautadas pela Política Nacional de Ciência, Tecnologia
e Inovação em Saúde (PNCTIS) e Política Nacional de Gestão de Tecnologias
em Saúde (PNGTS). A partir da PNCTIS foi pactuada uma agenda nacional de
prioridades de pesquisa com atores estratégicos do cenário brasileiro. Esta agenda
possui 24 subagendas, dentre elas a de “Avaliação de Tecnologias e Economia
da Saúde”. Em 2009, após ampla consulta à sociedade o MS publicou a PNGTS.
Esta política é o instrumento norteador para os atores envolvidos na gestão dos
processos de avaliação, incorporação, difusão, gerenciamento da utilização e
retirada de tecnologias no sistema de saúde brasileiro, o Sistema Único de Saúde
(SUS). METAS: Avaliar a atuação da CGATS no processo de institucionalização da
ATS no Brasil. A coordenação tem uma equipe de 22 profissionais e 2 consultores
externos (médicos). MEDIDAS USADAS NA DECISIÇÃO: Até o final de 2010, 503
estudos de ATS foram fomentados pela CGATS totalizando R$45 milhões (US$25
milhões), sendo que 256 foram desenvolvidos pela equipe e 247 por pesquisadores
externos que ganharam editais do MS. Do total de estudos, 52 foram de custoefetividade e 5 análises de impacto orçamentário (AIO). Estes estudos têm como
principal objetivo apoiar a decisão sobre a incorporação de novas tecnologias
no SUS que é feita pela Comissão de Incorporação de Tecnologias do Ministério
da Saúde (CITEC). A coordenação também vem investindo maciçamente na
capacitação em ATS para técnicos e gestores do SUS. Foram financiados: 5
Mestrados e 2 Especializações para 150 profissionais; curso a distância de ATS
para 90 gestores e técnicos do SUS; oficinas para elaboração de Pareceres
Técnico-Científicos para 250 profissionais do MS, Secretarias Estaduais e
Municipais e Núcleos de ATS (NATS); 4 Bolsas de pós-doutorado para estudos
de custo-efetividade/utilidade; e curso a distância para 5 técnicos da equipe da
CGATS em AvE do Instituto de Efectividad Clinica y Sanitaria (IECS) da Argentina.
Dentre as diretrizes metodológicas elaboradas, destaca-se a Diretriz para Estudos
de Avaliação Econômica de Tecnologias em Saúde, publicada em 2009, que visa
contribuir para a padronização dos estudos de custo-efetividade demandados
pelo MS, permitindo uma maior transparência dos estudos a serem apresentados
e a possibilidade de sua revisão e reprodução. Mesmo antes de sua publicação,
desde 2007, todos os estudos de AvE financiados pelo MS já seguiam esta
diretriz, ou seja, 36 estudos. Em fase final de elaboração, se encontra a diretriz
de AIO. Esta diretriz já foi validada pela Rebrats (Rede Brasileira de Avaliação de
Tecnologias em Saúde) e 25 técnicos do MS foram capacitados para utilização
da ferramenta. ESTRATÉGIA DE IMPLEMENTAÇÃO: A estratégia de disseminação
da ATS no Brasil está calcada em três pilares: i). o SISREBRATS, que é um banco
de dados que disponibiliza estudos de ATS e ACEs para a sociedade; ii). os NATS,
núcleos de ATS em hospitais de ensino, que totalizam 24, em todas as regiões do
Brasil, e têm a missão de institucionalizar a ATS nestes serviços; e iii). o apoio a
eventos da área de ATS, dentre eles o Ispor Brazil Regional Chapter. No campo
da cooperação nacional, a principal estratégia é a Rebrats, que é uma rede que
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
HEALTH CARE DECISION-MAKER’S CASE STUDy ABSTRACTS
congrega 44 instituições envolvidas com a ATS no Brasil, e visa estabelecer a
ponte entre pesquisa, política e gestão. Ressalta-se, ainda, o Boletim Brasileiro
de ATS (BRATS) que é um boletim eletrônico trimestral feito por meio de parceria
da ANVISA, ANS e a CGATS. No âmbito internacional, a coordenação de ATS é
membro da INAHTA desde 2006. Além disso, está organizando o Health Technology
Assessment International (HTAi) 2011 (8th Annual Meeting), de 25 a 29 de junho de
2011 no Rio de Janeiro. O Mercosul também tem um grupo de trabalho que atua na
área da ATS e que dentre as atividades desenvolvidas, está a criação de diretriz
de AvE comum para os 4 países baseada na diretriz brasileira e a capacitação de
40 técnicos dos 4 países no curso de ATS a distância do IECS. RESULTADOS: Em
5 anos de atuação da CGATS, muito já foi realizado no sentido de institucionalizar
a ATS no Brasil. Pode-se concluir que a CGATS atuou semelhante a outras
instituições de ATS no mundo em 5 eixos: i). elaboração de estudos; ii). capacitação
na área; iii). desenvolvimento de diretrizes metodológicas; iv). disseminação da ATS
e ; v). cooperação nacional e internacional. LIÇÕES APRENDIDAS: Os próximos
passos devem se concentrar na intensificação destas atividades e na expansão
do fomento e utilização de técnicas de racionalização dos gastos, como a AvE, na
tomada de decisão.
do desenvolvimento de um modelo de Markov para a história natural da doença no
Brasil – a decisão sobre a incorporação da vacina para prevenção do HPV ainda
não foi tomada, mas estes estudos foram elaborados para subsidiar a decisão. É
importante ressaltar que ainda há uma dificuldade de conciliar o tempo da tomada
de decisão com o tempo de elaboração dos estudos de avaliação econômica, mas
pode-se dizer que o Brasil já avançou bastante nesta questão, primeiro por estar
direcionando as decisões de incorporação a partir de evidências científicas de boa
qualidade e segundo por fomentar estudos de centros de pesquisa de excelência
por meio da REBRATS.
PCASE3: ESTRATÉGIAS DE FOMENTO DE ESTUDOS DE AVALIAÇÃO ECONÔMICA:
SUBSÍDIO PARA TOMADA DE DECISÃO SOBRE INCORPORAÇÃO DE TECNOLOGIAS
NO BRASIL
Vidal ÁT, Santos VCC, Salomon FCR, Veloso NF, Elias FTS, Ministry of Health of
Brazil, Brasilia, D.F., Brazil
ORGANIZAÇÃO: A Rede Brasileira de Avaliação de Tecnologias em Saúde
(REBRATS), coordenada pelo Ministério da Saúde, tem como objetivo fomentar e
disseminar estudos de Avaliação de Tecnologias em Saúde do Brasil para apoiar
a tomada de decisão dos gestores do sistema de saúde brasileiro (Sistema Único
de Saúde – SUS). PROBLEMA ECONTRADO: Tendo em vista a demanda pela
incorporação de tecnologias de alto custo e a estruturação de uma Comissão
de Incorporação de Tecnologias em Saúde (CITEC), a necessidade de estudos
de avaliação econômica que respaldem a incorporação tecnológica é de
fundamental importância para a sustentabilidade do sistema de saúde brasileiro.
METAS: Analisar os estudos de Avaliação Econômica que foram financiados pelo
Ministério da Saúde através da REBRATS e suas repercussões na incorporação de
tecnologias em saúde. MEDIDAS USADAS NA DECISIÇÃO: Quantidade de estudos
de avaliação econômica financiados pelo Ministério da Saúde e o apoio destes
nas decisões de incorporação de tecnologias. ESTRATÉGIA DE IMPLEMENTAÇÃO:
Para financiar estudos de avaliação econômica de interesse para o SUS foram
realizados anualmente (desde 2005) editais de fomento a pesquisas de interesse
para o SUS relacionados à gestão de tecnologias em saúde. RESULTADOS: O
Ministério da Saúde financiou 52 estudos de avaliação econômica desde 2005,
através destes editais. A maior concentração foi no ano de 2009 (19 estudos), pelo
fato de neste ano ter sido disponibilizada uma maior concentração de recursos
financeiros, como consequência de uma estratégia da REBRATS em que foram
abertos editais específicos para a área de avaliação de tecnologias em saúde
(incluindo estudos de avaliação econômica). Atualmente, na base de dados da
REBRATS, dos 52 estudos 35 estão disponibilizados para a sociedade. LIÇÕES
APRENDIDAS: Destes estudos pode-se ressaltar a relevância dos estudos de : 1)
Avaliação econômica dos medicamentos análogos de nucleosídeos/nucleotídeos –
adefovir, dipivoxil, entecavir e telbivudina - no tratamento da hepatite viral crônica
B e; Avaliação do tenofovir para o tratamento da hepatite B crônica e do interferon
peguilado comparado ao interferon convencional para o tratamento das hepatites
B – estes estudos respaldaram a decisão (inédita) do Ministério da Saúde de
autorizar a indicação do medicamento Tenofovir, até então registrado pela indústria
farmacêutica no Brasil somente para AIDS, também para o tratamento de hepatite
B. Esta medida inclusive alterou o protocolo para tratamento da forma crônica da
hepatite B. 2) Estudos de custo-efetividade da incorporação de novas vacinas à
rotina do Programa Nacional de Imunizações (PNI): rotavírus e meningocócica C
conjugada – estes estudos subsidiaram a decisão de incorporação destas vacinas
no calendário básico de vacinação da criança. 3) Avaliação tecnológica de vacinas
para a prevenção de infecção por papilomavírus humano (HPV): estudo de custoefetividade e; Custo-efetividade no rastreamento do câncer cérvico-uterino a partir
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
conference REVIEW COMMITTEE MEMBERS
Please see pages 8 (Spanish) and 36 (English) for Conference Program Committee Chairs.
The following individuals were volunteer reviewers for this Conference.
RESEARCH REVIEW COMMITTEE
José María Abad, Department of Health and Consumer Affairs of the Government of Aragon.
D.G. Planning and Assurance, Zaragoza, Spain
Ismail Abbas, Universitat Politècnica de Catalunya, Barcelona, Catalunya, Spain
Urko Aguirre, Biostatistician, Hospital Galdakao-Usansolo, Galdakao, Vizcaya, Spain
Araceli Aguirre, UCB, México, D.F., México
Felipe Aizpuru, Hospital of Txagorritxu, Vitoria, Álava, Spain
Andrea Alcaraz
Rafael Alfonso, PhD Student, University of Washington, Seattle, WA, USA
Alejandro Allepuz, IMS Health, Barcelona, Spain
Anabela Almeida, Universidade da Beira Interior, Covilhã, Portugal
Juan Carlos Alva Pinto, Assistant Physician, Hospital Nacional Edgardo Rebagliati Martins,
Lima, Peru
Nelson Alvis Guzmán, Professor, Universidad de Cartagena, Cartagena, Colombia
Pablo Anaya, AstraZeneca, México, D.F., México
Sofia Andrade
Enrique Anton de las Heras, Manager, Medtronic Iberica, Madrid, Spain
Salvador Arlandis-Guzmán, Department of Urology, Hospital Universitario La Fe, Valencia, Spain
Armando Arredondo
Leonardo Arriagada, Hospital Clínico de la Universidad de Chile, Santiago, Chile
Javier Arrieta, Hospital de Basurto, Bilbao, Spain
Elio Asano, Pharmacoeconomics Coordinator, Bristol-Myers Squibb, São Paulo, Brazil
Luz-Ma-Adriana Balderas-Peña, Medical Researcher, Instituto Mexicano del Seguro Social,
Guadalajara, Jalisco, Mexico
Javier Ballesteros, University of the Basque Country, UPV-EHU, Leioa, Vizcaya, Spain
Javier Bautista, Director of Pharmacy Plan, Andalusian Health Ministry, Sevilla, Spain
Yara Baxter, Director, Novartis Oncology, São Paulo, Brazil
Henry Alberto Becerra Ramírez, Universidad Nacional de Colombia, Bogotá, Colombia
Gaizka Benguria-Arrate, Technician, OSTEBA - Basque Office for Health Technology Assessment, Gasteiz, Spain
Elizabeth Benito-Garcia, Executive Director, Bioepi Clinical and Translational Resarch Center,
Oeiras, Portugal
Juan Blackburn, Health Economics Manager - Latin America, Baxter Export Corporation, Fort
Lauderdale, FL, USA
Juan Antonio Blasco, Chief of Unit, Agencia Laín Entralgo, Madrid, Spain
Josep M. Borras, Catalan Institute of Oncology, Hospitalet, Barcelona, Spain
Alexandra Brentani, Executive Director, Western Region Project, Faculdade de Medicina da
USP, São Paulo, Brazil
Bernardo Briones, Medical Advisor, Novartis, Mexico City, Mexico
David Bruhn, Eli Lilly & Company, Indianapolis, IN, USA
Jefferson Buendia
Jennifer Milena Bueno Rocha
Baltica Cabieses
Daniel Callejo, Agencia Lain Entralgo, Madrid, Spain
Oscar Cañon, Research, Salud y Equidad, Bogotá, Colombia
Alexander Carreño, Bogotá, Colombia
Armando Carvalho
Alfonso Jaime Casado Collado, Dynamic Solutions, Madrid, Spain
Juan Sebastian Castillo
Julio Simon Castro Mendez, Professor, Institute of Tropical Medicine Central University of
Venezuela, Caracas, Venezuela
Mariangela Cherchiglia, Universidade Federal De Minas Gerais, Brazil
Liliana Chicaiza
Agustín Ciapponi, MD, Coordinator, Argentine Cochrane Centre IECS (Institute for Clinical
Effectiveness and Health Policy), Iberoamerican Cochrane Network, and Family and Community
Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
Katia Coelho Ortega
Eduardo Collantes Estevez
Massimo Colombini-Netto, Axismed Gestão Preventiva da Saúde, São Paulo, Brazil
Iris Contreras-Hernández, Centro Médico Nacional Siglo XXI, México D.F, México
María Crojethovic, Center for the Study of State and Society, Buenos Aires, Argentina
122
Jhony Albert De La Cruz Vargas
Pedro de Pablos-Velasco, Dr Negrin Hospital, Las Palmas University, Las Palmas de Gran
Canaria, Spain
Tatiana Dilla, Lilly, S.A., Alcobendas, Madrid, Spain
Margarida Domingos
Bonnie M. Donato, Bristol-Myers Squibb, Wallingford, CT, USA
Margareth Eira, Infectologist - Clinical research and Education, Instituto de Infectologia Emílio
Ribas, São Paulo, Brazil
Jorge Elgart, CENEXA, La Plata, Argentina
Octavio Escobedo, Mexican Social Security Institute, México, D.F, México
Javier Eslava-Schmalbach, Associate Professor, Universidad Nacional de Colombia, Bogotá,
Colombia
Manuel Espinoza
Eneas Faleiros
Sara Farinha, Reimbursement Analyst, Medtronic, Lisbon, Portugal
Lara Ferreira, University of The Algarve, Faro, Portugal
Andre Luis Ferreira Da Silva, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre,
Brazil
Antonio Ferreras, Zaragoza, Spain
Ester Filinger, Buenos Aires, Argentina
Patricia Fujita, Federal University of Parana, Curitiba, Parana, Brazil
Taís Freire Galvão, Getúlio Vargas University Hospital/Federal University of Amazonas, Manaus,
AM, Brazil
Oscar Gamboa, Specialist Physician, Instituto Nacional de Cancerología, Bogotá D.C, Colombia
Osvaldo Ulises Garay
Fernando Garcia
Carlos Grande García, H. U. 12 de Octubre, Madrid, Spain
Graciela García Mahias, Santiago, Chile
Oscar Armando Garcia Vega, Professor Asociado, Universidad Nacional de Colombia, Bogotá,
Colombia
Manuel García-Goñi, Universidad Complutense de Madrid, Pozuelo de Alarcón, Madrid, Spain
Antonio J Garcia-Ruiz, University of Málaga, Spain
Oscar Gianneo, Coordinator of the Cochrane Collaborative Center, National Resources Fund,
Uruguayan National Agency For Highly Specialized Medical Procedures, Montevideo, Uruguay
Pilar Giraldo, Hospital Universitario Miguel Servet, Zaragoza, Spain
Demian Glujovsky
Marcia Regina Godoy, Professor & Researcher, UFRGS - Federal University of Rio Grande do
Sul, São Paulo - SP, Brazil
Maria del Carmen Gomez
Jorge Alberto Gomez, GlaxoSmithKline, Victoria, Buenos Aires, Argentina
Diana L Gomez-Galicia, Universidad Autonoma del Estado de Morelos, México
Francisco Gonsãlves
Paloma González, Medtronic Iberia, Madrid, Spain
Beatriz Gonzalez Lopez-Valcarcel, Professor, University of Las Palmas De Gran Canaria, Las
Palmas, Spain
Luis Gonzalez Michaca, Health Access Manager, Roche, Mexico City, Mexico
Silvia Gorban de Lapertosa, National University of La Plata, La Plata, Buenos Aires, Argentina
Enrique Grande
Rocio Guillen
Fernando Gusmao-filho, Health Risk Manager, IMIP - Instituto Materno-Infantil Prof. Fernando
Figueira, Recife, Brazil
Cesar Homero Gutierrez-Aguirre, Hospital Universitario Dr. José Eleuterio González, Monterrey,
NL, Mexico
Ileana Heredia
Luis Hernández, United BioSource Corporation, Bogotá, Colombia
Carmen Herrera Espiñeira, Researcher, Hospital Virgen de las Nieves, Granada, Spain
Nora Ibargoyen-Roteta, Basque Office for Health Technology Assessment (Osteba), VitoriaGasteiz, Araba, Spain
Teresa Juárez-Cedillo, Instituto Mexicano del Seguro Social, México, D.F., México
Juang Jyh, Hospital Municipal Tatuape, São Paulo, Brazil
Thomas Leisewitz, Professor, Pontificia Universidad Católica de Chile, Santiago, Chile
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
review committee members
Luis Lizan, Director, Outcomes, Castellon, Spain
Felipe Lorenzato
Setefilla Luengo-matos, Agencia De Evaluacion De Tecnologias Sanitarias, Madrid, Spain
Márcio Machado, Pharmacoeconomics Manager, GlaxoSmithKline Brazil, Rio de Janeiro, Brazil
Pedro Magalhães, Porto Alegre, RS, Brazil
Daniel Savignon Marinho, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
Ignacio Mariscal-Ramírez, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, Mexico
Jairo Andres Martinez, Bogotá D.C., Colombia
Elena Martínez
Céu Mateus, Lecturer, National School Public Health - UNL, Lisboa, Portugal
Alessandra Kimie Matsuno
Jorge Maurino
Esteban Medina, AstraZeneca Farmacéutica Spain S.A., Madrid, Spain
Maria Eugenia Mendoza Flores, Research Department in Public Health, Mexico City, Mexico
Rodolfo Milani, Universidade de São Paulo, Brazil
Dolores Mino León, Research, Instituto Mexicano del Seguro Social, México, D. F., México
Arthur Moellmann-Coelho, Instituto Nacional de Cancer (INCA), Rio de Janeiro, Brazil
Antonio Moreira
Daniel Mota
Joaquin Mould
Emilio Muciño
Vitor Nasciben, Pharmacoeconomics Manager, Boehringer Ingelheim, São Paulo, Brazil
Armando Nevárez Sida, Mexican Institute of Social Security, México, D.F., México
Javier Nuevo Rivero, Biostatistician, AstraZeneca, Madrid, Spain
John Jairo Orozco Giraldo, Universidad CES Medellín, Medellín, Colombia
Joseph Ortega, Central University of Venezuela, Caracas, Venezuela
Martha Edith Oyuela, Docente, Cordinadora De Servicio, Universidad El Bosque, Instituto De
Ortopedia Roosevelt, Bogotá, Colombia
Jose Pais-Ribeiro, R.Dr. Manuel Pereira da Silva, Porto, 4200-392, Portugal
Angel Paternina-Caicedo, Universidad de Cartagena, Cartagena de Indias, Bolívar, Colombia
Lucinda Paz Valiñas, Axencia De Avaliación De Tecnoloxías Sanitarias De Galicia, Avalia-t,
Santiago De Compostela (a Coruña), Spain
Luis Pereira, University of the Algarve, Faro, Portugal
Carmen Phang Romero Casas, Researcher, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
Ana Cecilia Polanco, AstraZeneca, Naucalpan, Mexico
Carlos Polanco, Health Economics, Merck Serono, Madrid, Spain
Alexandra Porras, Epidemiologist, Universidad Nacional de Colombia, Bogotá, Colombia
Jesús Porta-Etessam, Neurologist, Hospital Clinico San Carlos, Madrid, Spain
Mireia Raluy Callado, Research Associate II, United BioSource Corporation, London, UK
Antonio Ramirez de Arellano
Carina Guedes Ramos, Universidade Federal do Rio Grande do Sol, Porto Alegre, Brazil
Mario Enrique Rendón-Masías, Instituto Mexicano del Seguro Social, Mexico City, Mexico
Jesus Reviriego Fernandez
Alfonso Reyes-Lopez, Mexican Children Hospital, Mexico City, Mexico
Ruth Rivas, Pharmaceutical Engineer, CENETEC, Mexico
Rodolfo Rivas-Ruiz, Associate Investigator, Social Security Mexican Institute, Mexico City,
Mexico
Fernanda d’ Athayde Rodrigues, Federal University of Rio Grande do Sul, Santa Maria, Rio
Grande do Su, Brazil
Lourdes Rodriguez
Susana Rodríguez, Johnson & Johnson Medical, Mexico City, Mexico
Diego Rosselli, Professor, Universidad Jorge Tadeo Lozano, Bogotá, Colombia
Inés Ruíz, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago, Chile
Sergio Sánchez-García, Instituto Mexicano del Seguro Social, México, D.F., México
Iván Sánchez-Iglesias
Ana Santos
Cristina Sarasqueta, Hospital of Donostia, San Sebastián, Guipuzkoa, Spain
Zuleika Saz-Parkinson, Instituto de Salud Carlos III, Madrid, Spain
Antoni Serrano
Vicky Serra-Sutton, Agència d’Informació, Avaluació i Qualitat en Salut, Barcelona, Spain
Edson Servan, National Institute of Public Health, Cuernavaca, Mexico
Grazielle Silva, Servidora Pública, Secretaria Estadual de Saúde, Belo Horizonte, Brazil
Marcus Tolentino Silva, Ministry of Health of Brazil, Brasilia, Brazil
Nuno Miguel Silverio, Pricing & Access Manager, Pfizer, Lisbon, Portugal
Suely Siqueira, Health Economics Manager, Aventis Pharma - Brazil, São Paulo, Brazil
Enrique Soriano, Hospital Italiano de Buenos Aires, Argentina
Herman Soto, Pharmacoeconomic Director, CCESALUD, Mexico City, Mexico
Fabiano Souza, ICESP, São Paulo, Brazil
Fabiano Souza, Clinical oncology, ICESP, São Paulo, Brazil
Carla Spinillo, Federal University of Parana, Curitiba, Parana, Brazil
Cristian Tebé, Agència d’Informació, Avaluació i Qualitat en Salut, Barcelona, Spain
Ana Clara M Tolentino, ANOVA - Knowledge Translation, Rio de Janeiro, Brazil
Juan Valencia, Associate Health Economics and Outcomes Research Manager - Colombia and
Ven, Bristol-Myers Squibb, Bogotá, Colombia
Ata Valencia Mendoza
Paulina Valenzuela, Consultora datavoz/statcom, Santiago, RM, Chile
Leonor Varela Lema, Axencia De Avaliación De Tecnoloxías Sanitarias De Galicia, Avalia-T,
Santiago De Compostela (A Coruña), Spain
Armando Vargas Palacios, rac, Salud Consultores, SA de CV, Ciudad de Mexico, Distrito Federal,
Mexico
Julio E. Vazquez
Luis Vera Benavides, Medical Assistant, Quality and Safety Department, Ministry of Health, Chile
Monica Vinhas de Souza, PhD student, Universidade Federal do Rio Grande do Sul, Porto
Alegre-RS, Brazil
Vicente Zanon-Moreno, Biology, Hospital Dr. Peset, Valencia, Spain
WORKSHOP REVIEW COMMITTEE
Giustino Adesso, Caracas, Venezuela
Marcos Brioschi
Carlos Camps, Head of Medical Oncology Departament, Hospital General Universitario de
Valencia, Spain
Adriana Cortes, México, D.F., México
Beatriz de Cuenca, Hospital Infanta Cristina, Madrid, Spain
Sandra Flores, Director, AETSA, Sevilla, Spain
Valter Duro Garcia, Casa Santa de Misericordia, Porto Alegre, Brazil
Sebastian Gonzalez McQuire, Global Health Outcomes Manager, GlaxoSmithKline, Stockley
Park, UK
Felipe Guzmán, Fundación Santa Fe de Bogotá, Bogotá, DC, Colombia
Federico Micheli, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
Claudia Morales, Directora Red de servicios de salud, Asociación Mutual Ser ESS EPS-S,
Cartagena, Colombia
Mércia Pandolfo Provin, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
Rodolfo Soto, Centro Medico Imbanaco, Cali, Colombia
Maira LS Takemoto, ANOVA - Knowledge Translation, Rio de Janeiro, Brazil
Nelson Teich, President, Medinsight, Rio de Janeiro, Brazil
Juan Torres
Mirta Villagra, National University of La Plata, Buenos Aires, Argentina
ISSUE PANEL REVIEW COMMITTEE
Maria Beatriz Coutinho, Health Economics Manager, Abbott Laboratories, São Paulo - SP, Brazil
Erwin De Cock, Senior Research Associate, United BioSource Corporation, Barcelona, Spain
Pamela De La Rosa, Committee Leader for the Development of Guidelines, Ministry of Health,
Guatemala
Rosa Maria Galindo-Suarez, Outcomes Research Manager, Pfizer, Mexico
Iñaki Gutierrez-ibarluzea, Basque Government, Vitoria-gasteiz, ALAVA, Spain
Arely Lemus, Sanofi-Aventis, Mexico City, Mexico
Antonio Torres Lana
DECISION-MAKER CASE STUDY REVIEW COMMITTEE
Luis Avila Lachica, Servicio Andaluz de Salud, Malaga, Spain
Hernán Bustamante, Hospital Clínico De La Fuerza Aérea De Chile, Santiago, Region Metropoli,
Chile
Maria Gabriela Fernandez, Pharmacist, Garrahan Pediatric Hospital, Ciudad de Buenos Aires,
Argentina
Janaina Gonçalves, Medical Manager, São Paulo, Brazil
Jorge Guajardo-Rosas, Oncology National Institute, Mexico
Cesar Felix Enrique Longaray Chau, MD, Cardiologist, Navy Hospital, Lima, Peru
Cuauhtémoc Olmedo-Bustillo, Institute of Social and Security Services for State Workers,
Mexico City, Mexico
Alarico Rodríguez, Medical Technician Assistant Manager, National Resource Fund, Loans,
Montevideo, Uruguay
Stephen Stefani, CAPESESP/CAPESAUDE, Rio de Janeiro, RJ, Brazil
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
exhibitING ORGANIZATIONS
Table-top displays will be on view in the Don Diego Foyer
Friday, 9 September: 8.30-20.00 and Saturday, 10 September: 8:00-13:45
Adis a Wolters Kluwer business
BJHE - Brazilian Journal of Health Economics
FACITtrans
GUIA MARK
IMS Consulting Group
ISPOR Mexico Regional Chapter
OptumInsight*
PAREXEL Consulting
Verisk Health
*Exhibitor who is also an Event Supporter
EXHIBITOR
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EXHIBITOR
EXHIBITOR
EXHIBITOR
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Please visit representatives
of the
ISPOR Mexico Regional Chapter
to learn more about
Mexico and
Chapter activities.
EXHIBITOR
EVENT
SUPPORTER
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EXHIBITOR
ISPOR thanks our exhibitors
for their participation in the
ISPOR 3rd Latin America Conference
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SUPPORTER
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SUPPORTER
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
ISPOR
Leadership
Directory
129
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
2011-2012 ispor organization
130
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
ISPOR Board of Directors
President (2011-2012)
Mark J. Sculpher, MSc, PhD
Professor of Health Economics
Centre for Health Economics
University of York
York, UK President-elect (2011-2012)
Deborah Marshall, PhD, MHSA
Associate Professor
University of Calgary & University of McMaster
Director, HTA, Alberta Bone and Joint Health
Institute Canada
Research Chair Health Services & Systems
Research Center
Calgary, Canada
Past President (2010-2011)
Scott D. Ramsey, MD, PhD
Member, Fred Hutchinson Cancer
Research Center
Professor, School of Pharmacy School of Medicine
Institute for Public Health Genetics
University of Washington
Seattle, Washington, USA
Director (2010-2012)
Bong-Min Yang, PhD
Professor, Health Economics
School of Public Health
Seoul National University
Seoul, South Korea
Director (2011-2013)
Donald L. Patrick, PhD, MSPH
Director, Seattle Quality of Life Group and
Biobehavioral Cancer Prevention and Control Training
Program
University of Washington
Seattle, Washington
Director (2010-2012)
Federico Augustovski MD, MSc, PhD
Director, Economic Evaluations and HTA Department,
Institute for Clinical Effectiveness and Health Policy
(IECS)
Professor of Public Health University of Buenos Aires
Family and Community Medicine Division Hospital
Italiano of Buenos Aires
Buenos Aires, Argentina
Director (2011-2013)
Finn Børlum Kristensen, MD, PhD
Professor, Health Services Research
& Health Technology Assessment (HTA)
University of Southern Denmark
Director, EUnetHTA
National Board of Denmark
Copenhagen, Denmark
Director (2010-2012)
J.L. (Hans) Severens, PhD
Professor, Evaluation in Health Care Institute of
Health Policy and Management Erasmus University
Rotterdam
Rotterdam, The Netherlands
Director (2010-2012)
Kati Copley-Merriman MS, MBA
Vice-President, Regulatory and Outcomes Strategy/
Market Access
RTI
Ann Arbor, MI, USA
Director (2011-2013)
Newell McElwee, PharmD, MSPH, PhD
Executive Director
Merck
North Wales, PA, USA
Treasurer (2010-2013)
Karen L. Rascati RPh, PhD
Eckerd/Turley Centennial Endowed Professor of
Pharmacy Administration and Faculty Member
Center for Pharmacoeconomic Studies College of
Pharmacy
University of Texas
Austin, TX, USA
Founding Executive Director
Marilyn Dix Smith RPh, PhD
Founding Executive Director
ISPOR
Lawrenceville, NJ, USA
131
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Latin America Consortium ORGANIZATIONAL CHART
Latin America Consortium Executive Committee
132
EXECUTIVE COMMITTEE CHAIR
Guillermo Meléndez, MD, MSc
Scientific Coordinator, Nutrition Nestlé Fund
Mexican Health Foundation (FUNSALUD)
Mexico City, Mexico
ADVISORY COMMITTEE CHAIR
Márcio Machado, PhD, PharmD
Pharmacoeconomics Manager
GlaxoSmithKline Brazil
Rio de Janeiro, Brazil
CHAIR-ELECT
Gabriela Tannus Araújo MBA, MSc
Heath Economics Director
Axia.Bio Consulting
São Paulo, Brazil
BIENNIAL LATIN AMERICA CONFERENCE
PROGRAM COMMITTEE CO-CHAIRS
Antonio Caso Marasco, MD, MEd
Postgraduate Hematology Professor &
Distance Learning Coordinator
Subdivision of Continuing Medical Education
Postgraduate Division, Faculty of Medicine
National Independent University of Mexico, and
President, Mexican College for Pharmacoeconomics
Mexico City, Mexico
PAST-CHAIR AND ISPOR BOARD OF DIRECTORS
MEMBER
Federico Augustovski, MD, MSc, PhD
Director, Health Economic Evaluation and Technology
Assessment
Professor of Public Health, University of Buenos Aires
Institute for Clinical Effectiveness and Health Policy (IECS)
Staff Physician, Family and Community Medicine Division,
Italian Hospital of Buenos Aires
Buenos Aires, Argentina
Guillermo Meléndez, MD, MSc
Scientific Coordinator, Nutrition Nestlé Fund
Mexican Health Foundation (FUNSALUD)
Mexico City, Mexico
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
Latin America Consortium Executive Committee
EDUCATION COMMITTEE CHAIR
Nelson Alvis Guzmán, PhD, MD, MPH
Professor & Research and Director
Health Economics Research Group
School of Economic Sciences
University of Cartagena
Cartagena, Colombia
PUBLICATION COMMITTEE CHAIR
Jorge Gómez, MS, PhD
Senior Project Manager, Health Economics for
Vaccines-Latin America & Caribbean
GlaxoSmithKline Biologicals
Latin America & Caribbean
Buenos Aires, Argentina
HEALTH TECHNOLOGY PRODUCERS
(INDUSTRY) COMMITTEE CHAIR
Diego Fernando Guarín García, MD, MPH, MA
Director, Market Access Latin America
Merck Sharp & Dohme
Mexico City, Mexico
HEALTH SERVICE PROVIDERS COMMITTEE
CHAIR
Oscar Cerezo Camacho, MD, MSc
Medical Sciences Researcher
Oncology National Institute
Mexico City, Mexico
HEALTH TECHNOLOGY ASSESSMENT
AGENCIES COMMITTEE CHAIR
Iris Contreras, MD, MSc
Clinical Researcher
Mexican Institute of Social Security
Mexico City, Mexico
HEALTH CARE POLICYMAKERS & PAYERS
COMMITTEE CHAIR
Stephen Doral Stefani, MD
Medical Auditor, Head of Oncology Unit, and
Professor, UNIMED
Porto Alegre, Brazil
LATIN AMERICA REGIONAL CHAPTER
REPRESENTATIVES
ARGENTINA CHAPTER
Adriano Castronuovo, MD
Market Access Head
Novartis Argentina
Buenos Aires, Argentina
BRAZIL CHAPTER
Gabriela Tannus Araújo, MBA, MSc
Heath Economics Director
Axia.Bio Consulting
São Paulo, Brazil
CENTRAL AMERICA &
THE CARIBBEAN CHAPTER
TBD
CHILE CHAPTER
Manuel Antonio Espinoza, MD, MSc
Health Economist, Department of Public Health
School of Medicine – Papal University of Chile & Center
for Health Economics at the University of York
Heslington, York, UK
COLOMBIA CHAPTER
Heidy Alexandra Cáceres R., MD, MSc
Market Access Manager
Biopas Laboratories
Bogotá, Colombia
ECUADOR CHAPTER
Patricia Unamuno, PharmD
Clinical Research & HEOR Manager
Abbott International
Quito, Ecuador
HONDURAS CHAPTER
Mayely Álvarez, MBA
General Manager
Tecnofarme
Tegucigalpa, Honduras
MEXICO CHAPTER
Edith Arely Lemus, DrPH
Health Economics Manager
Novartis Pharma Mexico
Mexico City, Mexico
PERU CHAPTER
Pablo Best Bandenay, MSc, MHE
Associate Professor
Cayetano Heredia Peruvian University
School of Public Health and Administration
San Martín de Porres, Lima, Peru
PUERTO RICO CHAPTER
Julio E. Vázquez Suárez, RPh, PharmD
Consultant Outcomes Liaison
Eli Lilly Export P.R.
Dorado, Puerto Rico
VENEZUELA CHAPTER
Marino J. González, PhD, MSc, MD
Professor of Public Policy and Health Policy
Unit of Public Policy
Simon Bolivar University
Caracas, Venezuela
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ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
ISPOR LATIN AMERICA CONSORTIUM 2010-2012 LEADERSHIP DIRECTORY
ISPOR LATIN AMERICA CONSORTIUM
EXECUTIVE COMMITTEE
EXECUTIVE COMMITTEE CHAIR
Guillermo Meléndez, MD, MSc, Scientific Coordinator,
Nutrition Nestlé Fund, Mexican Health Foundation
(FUNSALUD), Mexico City, Mexico
CHAIR-ELECT
Gabriela Tannus Araújo, MBA, MSc, Heath Economics
Director, Axia.Bio Consulting, São Paulo, Brazil
PAST-CHAIR AND ISPOR BOARD OF
DIRECTORS MEMBER
Federico Augustovski, MD, MSc, Director, Health
Economic Evaluation and Technology Assessment,
Institute for Clinical Effectiveness and Health Policy
(IECS); Professor of Public Health, University of
Buenos Aires, Staff Physician, Family and Community
Medicine Division, Italian Hospital of Buenos Aires,
Buenos Aires, Argentina
ADVISORY COMMITTEE CHAIR
Márcio Machado, PhD, PharmD, Pharmacoeconomics
Manager, GlaxoSmithKline Brazil, Rio de Janeiro, Brazil
BIENNIAL LATIN AMERICA CONFERENCE
PROGRAM COMMITTEE CO-CHAIRS
Antonio Caso Marasco, MD, MEd, Postgraduate
Hematology Professor & Distance Learning
Coordinator, Subdivision of Continuing Medical
Education, Postgraduate Division, Faculty of Medicine,
National Independent University of Mexico, and
President, Mexican College for Pharmacoeconomics,
Mexico City, Mexico
Guillermo Meléndez, MD, MSc, Scientific Coordinator,
Nutrition Nestlé Fund, Mexican Health Foundation
(FUNSALUD), Mexico City, Mexico
EDUCATION COMMITTEE CHAIR
Nelson Alvis Guzmán, PhD, MD, MPH, Professor &
Research and Director, Health Economics Research
Group, School of Economic Sciences, University of
Cartagena
PUBLICATION COMMITTEE CHAIR
Jorge Gómez, MS, PhD, Senior Project Manager,
Health Economics for Vaccines-Latin America &
Caribbean, GlaxoSmithKline Biologicals, Latin America
& Caribbean, Buenos Aires, Argentina
HEALTH CARE POLICYMAKERS & PAYERS
COMMITTEE CHAIR
Stephen Doral Stefani, MD, Medical Auditor, Head of
Oncology Unit, and Professor, UNIMED, Porto Alegre,
Brazil
LATIN AMERICA REGIONAL CHAPTER
REPRESENTATIVES
ARGENTINA CHAPTER
Adriano Castronuovo, MD, Market Access Head,
Novartis Argentina, Buenos Aires, Argentina
BRAZIL CHAPTER
Gabriela Tannus Araújo, MBA, MSc, Heath Economics
Director, Axia.Bio Consulting, São Paulo, Brazil
CENTRAL AMERICA & THE CARRIBEAN CHAPTER
TBD
CHILE CHAPTER
Manuel Antonio Espinoza, MD, MSc, Health
Economist, Department of Public Health, School of
Medicine – Papal University of Chile and Center for
Health Economics at the University of York, Heslington,
York, UK
COLOMBIA CHAPTER
Heidy Alexandra Cáceres R., MD, MSc, Market
Access Manager, Biopas Laboratories, Bogotá,
Colombia
ECUADOR CHAPTER
Patricia Unamuno, PharmD, Clinical Research & HEOR
Manager, Abbott International, Quito, Ecuador
HONDURAS CHAPTER
Mayely Álvarez, MBA, General Manager,
Tecnofarme, Tegucigalpa, Honduras
MEXICO CHAPTER
Arely Lemus Carmona, DrPH, Health Economics
Manager, Novartis Pharma Mexico, Mexico City,
Mexico
PERU CHAPTER
Pablo Best Bandenay, MSc, MHE, Associate
Professor, Cayetano Heredia Peruvian University,
School of Public Health and Administration, San
Martín de Porres, Lima, Peru
PUERTO RICO CHAPTER
Julio E. Vázquez Suárez, RPh, PharmD, Consultant
Outcomes Liaison, Eli Lilly Export P.R., Dorado, Puerto
Rico
HEALTH TECHNOLOGY PRODUCERS
(INDUSTRY) COMMITTEE CHAIR
Diego Fernando Guarín García, MD, MPH, MA,
Director, Market Access Latin America, Merck Sharp
& Dohme, Mexico City, Mexico
VENEZUELA CHAPTER
Marino J. González, PhD, MSc, MD, Professor of
Public Policy and Health Policy, Unit of Public Policy,
Simon Bolivar University, Caracas, Venezuela
HEALTH SERVICE PROVIDERS COMMITTEE
CHAIR
Oscar Cerezo Camacho, MD, MSc, Medical Sciences
Researcher, Oncology National Institute, Mexico City,
Mexico
ISPOR LATIN AMERICA CONSORTIUM
ADVISORY COMMITTEE CHAIRS
HEALTH TECHNOLOGY ASSESSMENT
AGENCIES COMMITTEE CHAIR
Iris Contreras, MD, MSc, Clinical Researcher, Mexican
Institute of Social Security, Mexico City, Mexico
134
ADVISORY COMMITTEE CHAIR
Márcio Machado, PhD, PharmD, Pharmacoeconomics
Manager, GlaxoSmithKline Brazil, Rio de Janeiro,
Brazil
CHAIR-ELECT
Rafael Alfonso, MD, MSc, Pharmaceutical Outcomes
Research & Policy Program, University of Washington,
Seattle, WA, USA
ISPOR LATIN AMERICA CONFERENCE
PROGRAM COMMITTEE CHAIRS
2011 ISPOR 3RD LATIN AMERICA
CONFERENCE PROGRAM COMMITTEE
PROGRAM COMMITTEE CO-CHAIRS
Antonio Caso Marasco, MD, MEd, Postgraduate
Hematology Professor & Distance Learning
Coordinator, Subdivision of Continuing Medical
Education, Postgraduate Division, Faculty of Medicine,
National Independent University of Mexico, and
President, Mexican College for Pharmacoeconomics,
Mexico City, Mexico
Guillermo Meléndez, MD, MSc, Scientific Coordinator,
Nutrition Nestlé Fund, Mexican Health Foundation
(FUNSALUD), Mexico City, Mexico
RESEARCH REVIEW COMMITTEE CO-CHAIRS
Yajaira Bastardo, PhD, Administrative Director and
Professor, School of Pharmacy, Central University of
Venezuela, Caracas, Venezuela
Iris Contreras, MD, MSc, Clinical Researcher, Mexican
Institute of Social Security, Mexico City, Mexico
WORKSHOP REVIEW COMMITTEE COCHAIRS
Carlos Andrés Castañeda Orjuela, MD, MSc,
Researcher, Epidemiologic Group and Public Health
Evaluation, National University of Colombia, Bogotá,
Colombia
Gerardo Machnicki, MSc, Director, Global HE&OR,
Novartis Argentina, Buenos Aires, Argentina
ISSUE PANEL REVIEW COMMITTEE COCHAIRS
Joaquín Federico Mould-Quevedo, PhD, MBA, MSc,
HE & OR Director for Latin America and Primary Care,
Pfizer Laboratories, New York, NY, USA
Gabriela Tannus Araújo, MBA, MSc, Heath Economics
Director, Axia.Bio Consulting, São Paulo, Brazil
HEALTH CARE DECISION-MAKER CASE
STUDY REVIEW COMMITTEE CO-CHAIRS
Carlos Cruz, Director, Public Health Institute, Central
University of Ecuador, Quito, Ecuador
Alfonso Reyes López, PhD, Senior Researcher,
Federico Gómez Mexican Children’s Hospital, Mexico
City, Mexico
ISPOR EDUCATION COMMITTEE CHAIRS
CHAIR
Nelson Alvis Guzmán, PhD, MD, MPH, Professor &
Research and Director, Health Economics Research
Group, School of Economic Sciences, University of
Cartagena, Cartagena, Colombia
CHAIR-ELECT
Alarico Rodríguez, MD, Medical Benefits Manager,
Uruguayan National Agency for Highly Specialized
Medical Procedures, Montevideo, Uruguay
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
ISPOR LATIN AMERICA CONSORTIUM 2010-2012 LEADERSHIP DIRECTORY
BIENNIAL LATIN AMERICA CONFERENCE
SHORT COURSE SUBCOMMITTEE CHAIR
Yajaira Bastardo, PhD, Administrative Director and
Professor, School of Pharmacy, Central University of
Venezuela, Caracas, Venezuela
CHAIR-ELECT
Diego Rosselli, MD, MEd, MHP, Associate Professor
of Health Economics, Javeriana Papal University,
Bogotá, Colombia
DISTANCE LEARNING AND ON-SITE
TRAINING SUBCOMMITTEE CHAIR
Rafael Alfonso, MD, MSc, Pharmaceutical Outcomes
Research & Policy Program, University of Washington,
Seattle, WA, USA
CHAIR-ELECT
Marcelo Fonseca, MD, MSc, Professor, Health
Technology Assessment and Clinical Research,
Federal University of São Paulo (UNIFESP), Director,
Axia.Bio, and Pediatrician, Private Practice &
Assistant Physician, Pediatric Intensive Care Unit,
University of São Paulo Faculty of Medicine Clinics
Hospital, São Paulo, Brazil
ISPOR PUBLICATION COMMITTEE
CHAIRS
CHAIR
Jorge Gómez, MS, PhD, Senior Project Manager,
Health Economics for Vaccines-Latin America &
Caribbean, GlaxoSmithKline Biologicals, Latin America
& Caribbean, Buenos Aires, Argentina
CHAIR–ELECT
Guillermo Meléndez, MD, MSc, Scientific Coordinator,
Nutrition Nestlé Fund, Mexican Health Foundation
(FUNSALUD), Mexico City, Mexico
VALUE IN HEALTH SPECIAL ISSUE COEDITORS
Federico Augustovski, MD, MSc, PhD, Director, Health
Economic Evaluation and Technology Assessment,
Institute for Clinical Effectiveness and Health Policy
(IECS), Staff Physician, Family and Community
Medicine Division, Italian Hospital of Buenos Aires,
Buenos Aires, Argentina
Marcos Bosi Ferraz, MD, PhD, Associate Professor,
Department of Medicine, Federal University of São
Paulo (UNIFESP), Director of the São Paulo Center for
Health Economics (CPES), FAP UNIFESP, and Director
of Medical Economics of the Brazilian Medical
Association, São Paulo, Brazil
VALUE IN HEALTH SPECIAL ISSUE REVIEW
BOARD CHAIR
Marcelo Fonseca, MD, MSc, Professor, Health
Technology Assessment and Clinical Research,
Federal University of São Paulo (UNIFESP), Director,
Axia.Bio, and Pediatrician, Private Practice &
Assistant Physician, Pediatric Intensive Care Unit,
University of São Paulo Faculty of Medicine Clinics
Hospital, São Paulo, Brazil
ISPOR GOOD OUTCOMES RESEARCH
PRACTICES & PUBLICATIONS
SUBCOMMITTEE CHAIR (2011-2014)
Pedro Oliva Oropeza, MD, MSc, Director, Economic
Health Studies Department, Assistant Manager of
Health Insurance, Finance Management, Social
Security Services Institute for State Employees,
Mexico City, Mexico
ISPOR HEALTH TECNOLOGY
PRODUCERS (INDUSTRY) COMMITTEE
CHAIRS
CHAIR
Diego Fernando Guarín García, MD, MPH, MA,
Director, Market Access Latin America, Merck Sharp
& Dohme, Mexico City, Mexico
CHAIR-ELECT
Joaquín Federico Mould-Quevedo, PhD, MBA, MSc,
HE & OR Director for Latin America and Primary Care,
Pfizer Laboratories, New York, NY, USA
PHARMACEUTIALS & BIOLOGICS
SUBCOMMITTEE CHAIR (2011-2014)
Juan Carlos Alandete, MD, MPh, Health Economics
Manager, Janssen-Cilag, Bogotá, Colombia
CHAIR-ELECT
Emilio Muciño Ortega, MSc, Pharmacoeconomic
Coordinator, Pfizer S.A. de C.V., Mexico City, Mexico
MEDICAL DEVICES & DIAGNOSTICS
SUBCOMMITTEE CHAIR (2011-2014)
Pablo Anaya, MHA, Health Economics Manager,
GlaxoSmithKline, Bosque Real, Edo. de México,
Mexico City, Mexico,
CHAIR-ELECT
Hermilo Arturo Cabra Gómez, Health Economics
and Reimbursement Manager, Johnson & Johnson
Medical Mexico, Mexico City, Mexico
ISPOR HEALTH CARE POLICYMAKERS &
PAYERS COMMITTEE CHAIRS
CHAIR
Stephen Doral Stefani, MD, Medical Auditor, Head of
Oncology Unit, and Professor, UNIMED, Porto Alegre,
Brazil
CHAIR-ELECT
José Luis Aguilar Garza, PhD, Medical Administration
Assistant Director, VITAMÉDICA, Mexico City, Mexico
ISPOR LATIN AMERICA REGIONAL
CHAPTER PRESIDENTS
ARGENTINA CHAPTER
Eleonora C. Aiello, MBA, MHE, Regional Health
Economics & Outcomes Research Manager, BristolMyers Squibb, Buenos Aires, Argentina
BRAZIL CHAPTER
Stephen Doral Stefani, MD, Medical Auditor, Head of
Oncology Unit, and Professor, UNIMED, Porto Alegre,
Brazil
CENTRAL AMERICA & THE CARIBBEAN
CHAPTER
Manfred Lutz, MD, Outcomes Research Specialist
& Product Physician, Pfizer Central America &
Caribbean, La Aurora, Costa Rica
CHILE CHAPTER
Rony Lenz Alcayaga, Head Consultant, Lenz
Consulting, and Professor, School of Public Health,
University of Chile, Providencia Santiago, Chile
COLOMBIA CHAPTER
Nicolás Vargas Zea, Business Development Manager,
IMS Health Colombia, Bogotá, Colombia
ECUADOR CHAPTER
Patricia Unamuno, PharmD, Clinical Research & HEOR
Manager, Abbott International, Quito, Ecuador
ISPOR HEALTH SERVICE PROVIDERS
(CLINICIANS) COMMITTEE CHAIRS
HONDURAS CHAPTER
Mayely Álvarez, General Manager, Tecnofarme,
Francisco Morazán, Honduras
CHAIR
Oscar Cerezo Camacho, MD, MSc, Medical Sciences
Researcher, Oncology National Institute, Mexico City,
Mexico
MEXICO CHAPTER
Herman Soto, MSc, Health Economics & Outcomes
Research Consultant, Itelines Consultants SA De CV,
Mexico City, Mexico
CHAIR-ELECT
José Luis Aguilar Garza, PhD, Medical Administration
Assistant Director, VITAMÉDICA, Mexico City, Mexico
PERU CHAPTER
Pablo Best Bandenay, MSc, MHE, Associate
Professor, Cayetano Heredia Peruvian University,
Lima, Peru
ISPOR HEALTH TECHNOLOGY
ASSESSMENT AGENCIES COMMITTEE
CHAIRS
PUERTO RICO CHAPTER
Julio E. Vázquez Suárez, RPh, PharmD, Consultant,
Outcomes Liaison, Eli Lilly Export P.R., Dorado, Puerto
Rico
CHAIR
Iris Contreras, MD, MSc, Clinical Researcher, Mexican
Institute of Social Security, Mexico City, Mexico
CHAIR-ELECT
Emilio Santelices Cuevas, MD, MBA, Chief,
Department of Strategic Development, Ministry of
Cabinet Ministry of Health, Santiago, Chile
VENEZUELA CHAPTER
Marino J. González, PhD, MSc, MD, Professor of
Public Policy and Health Policy, Unit of Public Policy,
Simon Bolivar University, Caracas, Venezuela
135
ISPOR 3rd Latin America Conference
8-10 September 2011 • Hilton MExico City Reforma • MExico City, MExico
ispor past presidents
2009-2010
2004-2005
1999-2000
Michael Barry, MD, PhD, FRCPI, Clinical Director,
National Centre for Pharmacoeconomics, St.
James’s Hospital and Senior Lecturer in Clinical
Pharmacology, Trinity College, Dublin, Ireland
Lieven Annemans, PhD, MSc, Mman, Professor
of Health Economics, Ghent University & Brussels
University, Meise, Belgium
Bryan R. Luce, PhD, MBA, Senior Vice President,
Science Policy, United BioSource Corporation,
Bethesda, MD, USA
2008-2009
2003-2004
1998-1999
Sean D. Sullivan, PhD, MSc, Professor and Director,
Pharmaceutical Outcomes Research and Policy
Program and Associate Dean for Research, School of
Pharmacy, University of Washington, Seattle,
WA, USA
Robert S. Epstein, MD, MS, Chief Medical Officer,
Senior Vice President Medical Affairs, Medco Health,
Franklin Lakes, NJ, USA
Chris L. Pashos, PhD, Vice President, United
BioSource, Corporation, Lexington, MA, USA
2007-2008
Diana Brixner, RPh, PhD, Professor and Chair,
Department of Pharmacotherapy and Executive
Director, Pharmacotherapy Outcomes Research
Center, University of Utah, Salt Lake City, UT, USA
2006-2007
Michael Drummond, MCom, DPhil, Professor of
Health Economics, Centre for Health Economics,
University of York, Heslington, York, UK
2005-2006
Peter J. Neumann, ScD, Director, Center for the
Evaluation of Value and Risk in Health, Institute
for Clinical Research and Health Policy Studies;
Professor of Medicine, Tufts University School of
Medicine, Tufts Medical Center, Boston, MA, USA
1997-1998
James Smeeding, RPh, MBA, President, JestaRx
Group, Dallas, TX, USA
2002-2003
Peter Davey, MD, FRCP, Professor in
Pharmacoeconomics, Division of Community and
Population Sciences and Education, The University of
Dundee, Dundee, Scotland
1996-1997
Jean Paul Gagnon, PhD, Health Policy Consultant,
Pittstown, NJ, USA
2001-2002
1995-1996
Eva Lydick, PhD, Chief Research Officer, Epidemiology
and Applied Health Economics, Lovelace Clinic
Foundation, Albuquerque, NM, USA
William McGhan, PharmD, PhD, Professor of
Pharmacy and Health Policy, University of the
Sciences in Philadelphia, Philadelphia, PA, USA
2000-2001
Jon Clouse, RPh, MS, Executive Vice-President,
Ingenix, Inc., United Health Group, Denver, CO, USA
ispor STAFF
Marilyn Dix Smith, RPh, PhD
Executive Director
Email: [email protected]
Felicia Davis Alvin
Assistant Manager, Latin America Development
Telephone Extension: 31; Email: [email protected]
Valerie Anderson
Manager, Meetings
Telephone Extension: 28; Email: [email protected]
Sue Capon
Senior Director, Meetings
Telephone Extension: 21; Email: [email protected]
Jennifer Casillas
Director, Meetings and Member Services
Telephone Extension: 10; Email: [email protected]
Rebecca Corey
Senior Manager, Member Services
Telephone Extension: 22; Email: [email protected]
Randa Eldessouki, MD, DrPH
Director, ISPOR Scientific Initiatives
Telephone Extension: 33; Email: [email protected]
Nancy Garcia
Coordinator, Meetings
Telephone Extension: 34; Email: [email protected]
David Goldstein
Assistant Manager, Member Services
Telephone Extension: 15; Email: [email protected]
136
Jerusha Harvey
Director, International Development (Americas) and
Education Services
Telephone Extension: 13; Email: [email protected]
Pamela Joyce
Manager, Operations
Telephone Extension: 14; Email: [email protected]
Malgorzata (Gosia) Juszczak-Punwaney, MA
Manager, International Development and Meetings
Telephone Extension: 18; Email: [email protected]
Xing Li, MA
Manager, International Development (Asia-Pacific)
and ISPOR Initiatives
Telephone Extension: 27; Email: [email protected]
Nadia Maldonado
Executive Assistant
Telephone Extension: 32; Email: [email protected]
Elizabeth Molsen, RN
Director, ISPOR Initiatives
Telephone Extension: 26; Email: [email protected]
Danielle Mroz
Manager, Publications
Telephone Extension: 12; Email: [email protected]
Nadia Naaman
Senior Director, Health Technology Assessment and
ISPOR Initiatives
Telephone Extension: 11; Email: [email protected]
Dorothy Novilus
Manager, Education Services
Telephone Extension: 29; Email: [email protected]
Stephen Priori
Director, Publications
Telephone Extension: 16; Email: [email protected]
Nancy Sun
Coordinator, Asia Development & Meetings
Telephone Extension: 20; Email: [email protected]
Steve Tuckerson
Senior Manager, Meetings
Telephone Extension: 23; Email: [email protected]
Zandra Zhijing Yin, MA, MPA
Director, International Development
(Asia, Pacific, Africa, Europe)
Telephone Extension: 19; Email: [email protected]
GLOBAL COMMUNICATION
ISPOR Regional Chapters
ISPOR has over 5,900 active members from 92
countries. In addition, ISPOR Regional Chapters
have more than 4,500 members, extending
ISPOR’s outreach to over 10,400 active and
regional members.
TOOLS FOR RESEARCHERS & DECISION MAKERS
TOOLS FOR OUTCOMES RESEARCHERS
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Tools For HEALTH CARE Decision Makers
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ISPOR Good Outcomes
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Outcomes
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www.ispor.org
137
Future ISPOR Meetings
Latin America Conferences
ISPOR 4th
Latin America Conference
ISPOR 5th
Latin America Conference
12-14 September 2013
Buenos Aires, Argentina
September 2015
Santiago, Chile
Abstract Submission Deadline: 21 March 2013
Early Registration Deadline: 23 July 2013
Abstract Submission Deadline: 19 March 2015
Early Registration Deadline: 21 July 2015
European Congresses
ISPOR 14th Annual
European Congress
5-8 November 2011
Madrid, Spain
22% increase in abstract submissions!
Early Registration Deadline: 20 September 2011
ISPOR 16th Annual
European Congress
2-6 November 2013
Dublin, Ireland
ISPOR 15th Annual
European Congress
3-7 November 2012
Berlin, Germany
Abstract Submission Deadline: 26 June 2012
Early Registration Deadline: 18 September 2012
Abstract Submission Deadline: 25 June 2013
Early Registration Deadline: 17 September 2013
North American Meetings
ISPOR 17th Annual
International Meeting
June 2-6, 2012
Washington, DC, USA
Abstract Submission Deadline: January 19, 2012
Early Registration Deadline: April 17, 2012
ISPOR 18th Annual
International Meeting
May 18-22, 2013
New Orleans, LA, USA
Abstract Submission Deadline: January 17, 2013
Early Registration Deadline: April 9, 2013
Asia-Pacific Conferences
ISPOR 5th Asia-Pacific
Conference
2-4 September 2012
Taipei, Taiwan
Abstract Submission Deadline: 22 March 2012
Early Registration Deadline: 24 July 2012
ISPOR 6th Asia-Pacific
Conference
September 2014
Beijing, China
Abstract Submission Deadline: 20 March 2014
Early Registration Deadline: 22 July 2014
ISPOR
Tel: 1-609-219-0773 - Toll Free: 1-800-992-0643 - Fax: 1-609-219-0774
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Email: [email protected] - Website: www.ispor.org