Evaluación socioeconómica del tratamiento de la diabetes tipo 2 en la Argentina : Un análisis de costo-efectividad

Uno de los instrumentos de política sanitaria más utilizados en la evaluación de tratamientos de salud son los análisis de costo-efectividad (ACE). Éstos permiten analizar objetivamente la implementación de un nuevo tratamiento y/o programa o la modificación de uno existente, para alguna enfermedad en particular o para un conjunto de ellas. Concretamente permite conocer los costos y beneficios marginales de optar por distintos tratamientos dilucidando las necesidades financieras que garanticen una correcta prestación. Así, colabora en las decisiones que deben tomar no sólo los gobiernos sino también otros actores con diferentes responsabilidades en las funciones de financiar, proveer y regular los servicios de salud. En este sentido, este trabajo de tesis brinda un aporte metodológico y a la vez genera evidencias concretas para el caso de la diabetes tipo 2 en nuestro país. Así, se estimará la relación incremental de costo-efectividad del tratamiento de la diabetes tipo 2 derivado de la utilización de guías clínicas recomendadas a nivel internacional a partir del estudio UKPDS. El patrón de comparación es el tratamiento a nivel provincial en nuestro país para el año 2005. Debido a la disponibilidad de información necesaria, se considerarán las provincias de Córdoba y Misiones, la primera representante de la región Centro y la segunda de la región del Noreste. Estas regiones detentan el menor y mayor porcentaje de hogares con Necesidades Básicas Insatisfechas (NBI), respectivamente. A su vez, la región Noreste presenta la menor tasa de actividad y empleo del país y la región Centro una de las más altas para el primer semestre del 2005, según la Encuesta Permanente de Hogares (EPH).Departamento de Economí

Diabetes in Argentina: Cost and management of diabetes and its complications and challenges for health policy

Background: Diabetes is an expensive disease in Argentina as well as worldwide, and its prevalence is continuously rising affecting the quality of life of people with the disease and their life expectancy. It also imposes a heavy burden to the national health care budget and on the economy in the form of productivity losses.Aims: To review and discuss a) the reported evidence on diabetes prevalence, the degree of control, the cost of care and outcomes, b) available strategies to decrease the health and economic disease burden, and c) how the disease fits in the Argentinian health care system and policy. Finally, to propose evidence-based policy options to reduce the burden of diabetes, both from an epidemiological as well as an economic perspective, on the Argentinian society. The evidence presented is expected to help the local authorities to develop and implement effective diabetes care programmes.Methodology: A comprehensive literature review was performed using databases such as MEDLINE, EMBASE and LILACS (Latin American and Caribbean Health Sciences). Literature published from 1980 to 2011 was included. This information was complemented with grey literature, including data from national and provincial official sources, personal communications and contacts with health authorities and diabetes experts in Argentina.Results: Overall diabetes prevalence increased from 8.4% in 2005 to 9.6% 2009 at national level. In 2009, diabetes was the seventh leading cause of death with a mortality rate of 19.2 per 100,000 inhabitants, and it accounted for 1,328,802 DALYs lost in the adult population, mainly affecting women aged over fifty. The per capita hospitalisation cost for people with diabetes was significantly higher than for people without the disease, US$1,628 vs. US$ 833 in 2004. Evidence shows that implementation of combined educative interventions improved quality of care and outcomes, decreased treatment costs and optimised the use of economic resources.Conclusions: Based on the evidence reviewed, we believe that the implementation of structured health care programmes including diabetes education at every level, could improve quality of care as well as its clinical, metabolic and economic outcomes. If implemented across the country, these programmes could decrease the disease burden and optimise the use of human and economic resources.Centro de Endocrinología Experimental y Aplicad

The burden of diabetes in Argentina

OBJECTIVE: To measure the economic burden of diabetes in Argentina by age, gender and region for the year 2005, in disability-adjusted life years (DALYs).METHODS: DALYs were estimated by the sum of years of life lost due to premature death (YLL) and years of life lived with disability (YLD).RESULTS: In the population studied (20 to 85 years), the burden of diabetes without complications was 1.3 million DALYs, 85% of which were caused by disabilities. Whereas mortality rates (YLL) increased as a function of age, YLD showed the opposite relationship. Women had higher burden of disease values, represented by 51 and 61% of YLL and YLD, respectively, independently of age.CONCLUSIONS: Our results demonstrate that disabilities are a key component of diabetes burden; its regular and systematic estimation would allow to design effective prevention strategies, to assess the impact of their implementation and to optimize resource allocation based on objective evidence.Centro de Endocrinología Experimental y Aplicad

Diabetes in Argentina: Cost and management of diabetes and its complications and challenges for health policy

Background: Diabetes is an expensive disease in Argentina as well as worldwide, and its prevalence is continuously rising affecting the quality of life of people with the disease and their life expectancy. It also imposes a heavy burden to the national health care budget and on the economy in the form of productivity losses.Aims: To review and discuss a) the reported evidence on diabetes prevalence, the degree of control, the cost of care and outcomes, b) available strategies to decrease the health and economic disease burden, and c) how the disease fits in the Argentinian health care system and policy. Finally, to propose evidence-based policy options to reduce the burden of diabetes, both from an epidemiological as well as an economic perspective, on the Argentinian society. The evidence presented is expected to help the local authorities to develop and implement effective diabetes care programmes.Methodology: A comprehensive literature review was performed using databases such as MEDLINE, EMBASE and LILACS (Latin American and Caribbean Health Sciences). Literature published from 1980 to 2011 was included. This information was complemented with grey literature, including data from national and provincial official sources, personal communications and contacts with health authorities and diabetes experts in Argentina.Results: Overall diabetes prevalence increased from 8.4% in 2005 to 9.6% 2009 at national level. In 2009, diabetes was the seventh leading cause of death with a mortality rate of 19.2 per 100,000 inhabitants, and it accounted for 1,328,802 DALYs lost in the adult population, mainly affecting women aged over fifty. The per capita hospitalisation cost for people with diabetes was significantly higher than for people without the disease, US$1,628 vs. US$ 833 in 2004. Evidence shows that implementation of combined educative interventions improved quality of care and outcomes, decreased treatment costs and optimised the use of economic resources.Conclusions: Based on the evidence reviewed, we believe that the implementation of structured health care programmes including diabetes education at every level, could improve quality of care as well as its clinical, metabolic and economic outcomes. If implemented across the country, these programmes could decrease the disease burden and optimise the use of human and economic resources.Centro de Endocrinología Experimental y Aplicad

Enfermedades crónicas no transmisibles y sus factores de riesgo en Argentina: prevalencia y prevención

Este trabajo se concentra en las enfermedades crónicas no transmisibles (EC), sus factores de riesgo evitables (FR) y las medidas preventivas que se aplican en la Argentina. En particular se persiguen tres objetivos: (1) analizar las características y determinantes de las EC y sus FR, (2) identificar a nivel teórico cuáles son las estrategias de prevención primaria y secundaria costo-efectivas, y (3) evaluar la cobertura de tales estrategias en el caso argentino. Como principales fuentes de información se emplean la Encuesta Nacional de Factores de Riesgo 2005 y los Registros de Estadísticas Vitales.Centro de Estudios Distributivos, Laborales y Sociales (CEDLAS

Treatment of type 2 diabetes with saxagliptin: a pharmacoeconomic evaluation in Argentina

Background: The increasing prevalence of diabetes and its inadequate management results in a heavy burden of the disease for the patients, the health and the productive system and the overall community. Consequently, it is necessary to have new effective drugs to treat people with diabetes to decrease such burden. DPP-4 inhibitors can help to cope with this demand, but its usage is challenged by its apparent high cost. The aim of the current study was to compare a simulated cost-effectiveness ratio of metformin (MET) plus one drug of the DPP-4 inhibitors family, saxagliptin (SAXA) or sulfonylurea (SU) treatment during a 20-year period, from the perspective of the social security system, in a cohort of people with Type 2 diabetes (T2DM) who did not attain glycosylated hemoglobin treatment target values only with MET. Methods: A discrete event simulation model (Cardiff diabetes model) based on UKPDS 68 was used to simulate disease progression and to estimate the economic and health treatment consequences in people with T2DM. The clinical efficacy parameters for SAXA administration were obtained from the literature; local standard costs were considered for drug acquisition, adverse events (AEs), and micro/macrovascular complications. Costs were expressed in US dollars (2009) with an annual 3.5% discount and a 20-year time horizon. Results: The SAXA + MET treated group had a lower number of non-fatal events than the SU + MET treated group. The model also predicted a lower number of fatal macrovascular events for the SAXA + MET group (149.6 vs. 152.8). The total cost of the SAXA + MET cohort was 15% higher than that of the SU + MET cohort. Treatment with SAXA + MET resulted in a higher number of quality-adjusted life years (QALYs) (9.54 vs. 9.32) and life-years gained (LYGs) (20.84 vs. 20.76) compared to those treated with SU + MET. The incremental cost per QALY and LYG gained was $7,374 and$20,490, respectively. Conclusions: According to the criteria proposed by the Commission on Macroeconomics and Health, the use of the combination SAXA+ MET is highly cost-effective in Argentina.Centro de Endocrinología Experimental y Aplicad

The burden of diabetes in Argentina

OBJECTIVE: To measure the economic burden of diabetes in Argentina by age, gender and region for the year 2005, in disability-adjusted life years (DALYs).METHODS: DALYs were estimated by the sum of years of life lost due to premature death (YLL) and years of life lived with disability (YLD).RESULTS: In the population studied (20 to 85 years), the burden of diabetes without complications was 1.3 million DALYs, 85% of which were caused by disabilities. Whereas mortality rates (YLL) increased as a function of age, YLD showed the opposite relationship. Women had higher burden of disease values, represented by 51 and 61% of YLL and YLD, respectively, independently of age.CONCLUSIONS: Our results demonstrate that disabilities are a key component of diabetes burden; its regular and systematic estimation would allow to design effective prevention strategies, to assess the impact of their implementation and to optimize resource allocation based on objective evidence.Centro de Endocrinología Experimental y Aplicad

Hospitalization costs for heart failure in people with type 2 diabetes: Cost-effectiveness of its prevention measured by a simulated preventive treatment

Objectives: To estimate the cost-consequence of interventions to prevent hospitalizations for heart failure (HF) in people with type 2 diabetes. Methods: In HF events (63) from type 2 diabetes-related hospitalizations (N = 462) recorded in an Argentine hospital (March 2004April 2005), we verified 1) the presence of one metabolic HF predictor (glycosylated hemoglobin [HbA1c] value) before hospitalization; and 2) in a simulation model, the resources needed for its prevention controlling such predictor during 6 months before and after the event. Sensitivity analysis of HF risk reduction, hospitalization cost, and cost of different treatments to achieve HbA1c 7% or less was performed with a Monte Carlo simulation (10,000 iterations). Results: HF represented 14% of hospitalizations, with a 44% rehospitalization rate for the same cause. Due to the total estimated cost for an HF hospitalization event was $437.31, the prevention attained using our simulated treatment was$2326.51. The number needed to treat to prevent an HF event under any of the proposed alternatives to reduce HbA1c would be 3.57 (95% confidence interval 2.0016.67). The additional cost of the simulated treatment versus the real one oscillates between $6423.91 and$8455.68. Conclusions: HbA1c control to reduce the number of HF events would be economically beneficial for health care payers.Centro de Endocrinología Experimental y Aplicad

Hospitalization costs for heart failure in people with type 2 diabetes: Cost-effectiveness of its prevention measured by a simulated preventive treatment

Objectives: To estimate the cost-consequence of interventions to prevent hospitalizations for heart failure (HF) in people with type 2 diabetes. Methods: In HF events (63) from type 2 diabetes-related hospitalizations (N = 462) recorded in an Argentine hospital (March 2004April 2005), we verified 1) the presence of one metabolic HF predictor (glycosylated hemoglobin [HbA1c] value) before hospitalization; and 2) in a simulation model, the resources needed for its prevention controlling such predictor during 6 months before and after the event. Sensitivity analysis of HF risk reduction, hospitalization cost, and cost of different treatments to achieve HbA1c 7% or less was performed with a Monte Carlo simulation (10,000 iterations). Results: HF represented 14% of hospitalizations, with a 44% rehospitalization rate for the same cause. Due to the total estimated cost for an HF hospitalization event was $437.31, the prevention attained using our simulated treatment was$2326.51. The number needed to treat to prevent an HF event under any of the proposed alternatives to reduce HbA1c would be 3.57 (95% confidence interval 2.0016.67). The additional cost of the simulated treatment versus the real one oscillates between $6423.91 and$8455.68. Conclusions: HbA1c control to reduce the number of HF events would be economically beneficial for health care payers.Centro de Endocrinología Experimental y Aplicad

Treatment of type 2 diabetes with saxagliptin: a pharmacoeconomic evaluation in Argentina

Background: The increasing prevalence of diabetes and its inadequate management results in a heavy burden of the disease for the patients, the health and the productive system and the overall community. Consequently, it is necessary to have new effective drugs to treat people with diabetes to decrease such burden. DPP-4 inhibitors can help to cope with this demand, but its usage is challenged by its apparent high cost. The aim of the current study was to compare a simulated cost-effectiveness ratio of metformin (MET) plus one drug of the DPP-4 inhibitors family, saxagliptin (SAXA) or sulfonylurea (SU) treatment during a 20-year period, from the perspective of the social security system, in a cohort of people with Type 2 diabetes (T2DM) who did not attain glycosylated hemoglobin treatment target values only with MET. Methods: A discrete event simulation model (Cardiff diabetes model) based on UKPDS 68 was used to simulate disease progression and to estimate the economic and health treatment consequences in people with T2DM. The clinical efficacy parameters for SAXA administration were obtained from the literature; local standard costs were considered for drug acquisition, adverse events (AEs), and micro/macrovascular complications. Costs were expressed in US dollars (2009) with an annual 3.5% discount and a 20-year time horizon. Results: The SAXA + MET treated group had a lower number of non-fatal events than the SU + MET treated group. The model also predicted a lower number of fatal macrovascular events for the SAXA + MET group (149.6 vs. 152.8). The total cost of the SAXA + MET cohort was 15% higher than that of the SU + MET cohort. Treatment with SAXA + MET resulted in a higher number of quality-adjusted life years (QALYs) (9.54 vs. 9.32) and life-years gained (LYGs) (20.84 vs. 20.76) compared to those treated with SU + MET. The incremental cost per QALY and LYG gained was $7,374 and$20,490, respectively. Conclusions: According to the criteria proposed by the Commission on Macroeconomics and Health, the use of the combination SAXA+ MET is highly cost-effective in Argentina.Centro de Endocrinología Experimental y Aplicad