Demand Price Elasticity and Taxes on the Consumption of Sugar Sweetened Beverages in Argentina

Background: Currently there is an important debate in Argentina about the health and economic burden associated with chronic non-communicable diseases, and the potential impact associated with the high consumption of sugar-sweetened beverages (SSB) in children and adults. The objective of this study is to assess the consumption of SSB in Argentina, to estimate the own price, cross-price and income elasticity of the demand for each type of beverage, and to simulate the effect of a price increase via taxes on the quantities consumed. Methods: Household micro-data was used to determine expenditure, purchased quantities, and implicit prices of different types of beverages (sodas, flavored waters, juices, etc.). This information was taken from the National Household Expenditure Survey (ENGHo) 2004/2005 and 2012/2013. Own price, cross price and income elasticity were estimated using the Almost Ideal Demand System (AIDS). Results: The own price elasticity of SSB presented values ranged between -1.10 and -1.15 (depending on the household income quintile). Therefore, if price increases of 10% via taxes, the quantity consumed of these beverages would be reduced between 11.0 and 11.5%. The income elasticity of the demand for SSB was estimated between 0.95 and 0.99, which implies that with an increase of 10% of household income, the quantity demanded increases between 9.5 and 9.9% (depending on the household income quintile). Conclusions: The consumption of SSB is sensitive to the increase in prices in Argentina. From a public health perspective, this suggests that a tax policy for these beverages would have a positive and effective effect in reducing their consumption

Epidemiología, uso de recursos y costos de la artritis reumatoidea en Argentina

La presente revisión tiene como objetivo identi car información sobre parámetros epidemiológicos y estimar el costo de la artritis reumatoidea (AR) moderada a severa. Se llevó a cabo una búsqueda de la literatura en las principales bases de datos. Se recurrió a un consenso de expertos locales en reumatología para encontrar los parámetros más realistas, utilizando un método Delphi modi cado. Se estimaron los costos médicos directos, utilizando información recopilada en la base de datos de costos unitarios del Instituto de Efectividad Clínica y Sanitaria de Argentina. Los costos indirectos se estimaron a través del enfoque del capital humano. Los costos se expresaron en dólares estadounidenses (USD) a noviembre de 2017. La prevalencia reportada de AR en Argentina fue 0,94% (IC95%: 0,86 a 1,02), con una tasa de incidencia anual de 19 cada 100 000 personas (IC95%: 17 a 20). El costo anual de las drogas modi ca- doras de la enfermedad fue de USD 33 936,10 por paciente. El costo atribuido a las infecciones serias fue de USD 2474,6. El costo del reemplazo bilateral de rodillas por paciente fue de USD 5276,8, y el del reemplazo total de cadera, de USD 9196,4. El costo por paciente por año de días de hospitalización y los costos indirectos de la AR se acrecentaron al aumentar el puntaje de discapacidad. La revisión reporta información útil acerca de parámetros epidemiológicos y de costos de la AR moderada a severa en la era de los agentes biológicos, con el n de resultar de utilidad para la conducción de evaluaciones económi- cas de salud en Argentina.This review aims to identify information on epidemiological parameters and estimate the cost of moderate to severe rheumatoid arthritis (RA). A search for related literature was carried out in major databases. A consensus of local rheumatology experts was used to find the most realistic parameters, using a modified Delphi method. Direct medical costs were estimated, using information collected from the cost per unit database of the Instituto de Efectividad Clínica y Sanitaria de Argentina. Indirect costs were estimated using the human resources approach. Costs were expressed in US dollars (USD) as of November 2017. The reported prevalence of RA in Argentina was 0.94% (95%CI: 0.86 to 1.02), with an annual incidence rate of 19 per 100,000 people (95%CI: 17 to 20). The annual cost of disease-modifying drugs was 33,936.10 USD per patient. The cost attributed to serious infections was 2,474.6 USD. The cost of bilateral knee replacement per patient was $5,276.8 USD; and the cost for total hip replacement was$9,196.4. Both, the cost of hospitalization days per patient per year, and the indirect costs of RA increased as the disability score increased. This review reports useful information on epidemiological and cost parameters of moderate to severe RA, in the era of biological agents, in order to be useful for conducting economic evaluations regarding health in Argentina.Fil: Secco, Anastasia. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Alfie, Verónica. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Espinola, Natalia Micaela. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Bardach, Ariel Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentin

The estimated benefits of increasing cigarette prices through taxation on the burden of disease and economic burden of smoking in Nigeria: A modeling study

Background Globally, tobacco consumption continues to cause a considerable burden of preventable diseases. Although the smoking prevalence in Nigeria may be declining over the last years, the absolute number of active smokers remains one of the highest in Africa. Little is known about the disease burden and economic costs of cigarette smoking in Nigeria. Consequently, there is an evidence gap to inform the design and implementation of an effective policy for tobacco control. Methods We applied a microsimulation model to estimate the burden attributable to smoking in terms of morbidity, mortality, disability-adjusted life-years (DALYs), and direct medical costs and indirect costs (e.g., productivity loss costs, informal caregivers´ costs). We also modeled the health and economic impact of different scenarios of tobacco price increases through taxes. Results We estimated that smoking is responsible for approximately 29,000 annual deaths in Nigeria. This burden corresponds to 816,230 DALYs per year. In 2019, the total economic burden attributable to tobacco was estimated at 634 billion annually (approximately U$D 2.07 billion). If tobacco cigarettes´ prices were to be raised by 50% through taxes, more than 30,000 deaths from smoking-attributable diseases would be averted in 10 years, with subsequent savings on direct and indirect costs of 597 billion and increased tax revenue collection of 369 billion. Conclusion In Nigeria, tobacco is responsible for substantial health and economic burden. Increasing tobacco taxes could reduce this burden and produce net economic benefits.Fil: Bardach, Ariel Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Casarini, Agustin. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Rodriguez Cairoli, Federico. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Adeniran, Adedeji. No especifíca;Fil: Castradori, Marco. No especifíca;Fil: Akanonu, Precious. No especifíca;Fil: Onyekwena, Chukwuka. No especifíca;Fil: Espinola, Natalia Micaela. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Pichón-riviere, Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Palacios, Alfredo. Instituto de Efectividad Clínica y Sanitaria; Argentin

Impacto de las políticas de restricción de publicidad, promoción y patrocinio de bebidas azucaradas. Revisión Sistemática

Objective.  To assess the impact of the implementation of a ban on advertising, promotion and sponsorship (PPP) of sugar-sweetened beverages (SSBs) in terms of reducing consumption, advertising exposure and relevant clinical outcomes. Material and methods A systematic review of studies published between 2001 and 2021 was conducted using the in PubMed, Embase and LILACS databases. Experimental, observational studies and economic models written in English, Portuguese or Spanish were included. Results. Sixteen studies out of 840 identified were selected. Due to outcomes heterogeneity, a meta-analysis was not possible. The interventions included comprehensive policies, general SSBs PPP restriction policies,TV advertising, promotional, point-of-sale, and school restrictions. Clinical outcomes (such as obesity, cardiovascular disease, diabetes, and cancer), economic outcomes (such as purchase, sale, cost-effectiveness, and other economic outcomes), changes in exposure, consumption, and other measures of effectiveness were assessed. Most effect measures showed decreases following the interventions. Conclusions. Policies that include PPP restrictions on SSBs can be effective in reducing consumption, especially among children and adolescents, and have a positive impact on their health.Objetivo.  Evaluar el impacto de la implementación de la prohibición de la publicidad, promoción y patrocinio (PPP) de las bebidas azucaradas (BA) en términos de disminución de consumo, exposición publicitaria y desenlaces clínicos relevantes. Material y métodos. Revisión sistemática de estudios publicados entre 2001-2021 en bases de datos PubMed, Embase y LILACS escritos en inglés, portugués o español. Se incluyeron estudios experimentales, observacionales y modelos económicos. Resultados. Se seleccionaron 16 de 840 estudios identificados. Debido a la heterogeneidad en los desenlaces no fue posible realizar un meta-análisis. Las intervenciones incluidas correspondieron a una política integral, medidas generales de restricción de PPP de BA, restricciones de publicidad televisiva, de promociones, en punto de venta y en escuelas. Se hallaron desenlaces clínicos (obesidad, enfermedad cardiovascular, diabetes, cáncer), económicos (compra, venta, costo-efectividad, otros desenlaces económicos), cambios en la exposición, en el consumo y en otras medidas de efectividad.  La mayoría de las medidas de efecto evaluadas registraron disminuciones a partir de las intervenciones. Conclusiones. Las políticas que incluyen una restricción de la PPP de las BA resultarían efectivas, sobre todo para disminuir su consumo en NNyA, impactando positivamente en su salud

Detección inmunohistoquímica del virus de Epstein-Barr en pacientes con linfoma

El virus de Epstein-Barr es un gammaherpes virus que infecta principalmente a linfocitos B permaneciendo en un estado de latencia en el interior del mismo, pudiendo también infectar a linfocitos T y células epiteliales. La persistencia de la infección viral inmortaliza a los linfocitos y favorece el desarrollo de procesos linfoproliferativos malignos como linfomas. Si bien se conoce que la relación entre la infección crónica del virus y el desarrollo de linfoma, varía de acuerdo al tipo histológico, se incrementa en pacientes inmunocomprometidos y de edad avanzada, la evidencia científica indica no sólo la importancia de este virus como agente infeccioso asociado con la etiología de esta neoplasia, sino también como un marcador asociado a respuesta refractaria y peor supervivencia. El objetivo de este estudio observacional descriptivo, fue detectar la presencia del Epstein-Barr virus por técnicas de inmunohistoquímica empleando anticuerpos monoclonales anti antígeno viral proteína latente de membrana en 86 pacientes con linfoma. La positividad para proteína en el total de pacientes con linfoma fue del 44%, correspondiendo el 20% a pacientes con linfoma de Hodgkin y el 24% a pacientes con linfoma no Hodgkin. La detección del virus en estas enfermedades, contribuye al manejo clínico de las mismas ya que el virus no sólo tiene un rol etiológico, sino además es un marcador pronóstico importante, incluso de interés terapéutico

Making visible the cost of informal caregivers’ time in Latin America : a case study for major cardiovascular, cancer and respiratory diseases in eight countries

BACKGROUND: Informal care is a key element of health care and well-being for society, yet it is scarcely visible and rarely studied in health economic evaluations. This study aims to estimate the time use and cost associated with informal care for cardiovascular diseases, pneumonia and ten different cancers in eight Latin American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico and Peru). METHODS: We carried out an exhaustive literature review on informal caregivers' time use, focusing on the selected diseases. We developed a survey for professional caregivers and conducted expert interviews to validate this data in the local context. We used an indirect estimate through the interpolation of the available data, for those cases in which we do not found reliable information. We used the proxy good method to estimate the monetary value of the use of time of informal care. National household surveys databases were processed to obtain the average wage per hour of a proxy of informal caregiver. Estimates were expressed in 2020 US dollars. RESULTS: The study estimated approximately 1,900 million hours of informal care annually and $ 4,300 million per year in average informal care time cost for these fifteen diseases and eight countries analyzed. Cardiovascular diseases accounted for an informal care burden that ranged from 374 to 555 h per year, while cancers varied from 512 to 1,825 h per year. The informal care time cost share on GDP varied from 0.26% (Mexico) to 1.38% (Brazil), with an average of 0.82% in the studied American countries. Informal care time cost represents between 16 and 44% of the total economic cost (direct medical and informal care cost) associated with health conditions. CONCLUSIONS: The study shows that there is a significant informal care economic burden -frequently overlooked- in different chronic and acute diseases in Latin American countries; and highlights the relevance of including the economic value of informal care in economic evaluations of healthcare

The health, economic and social burden of smoking in Argentina, and the impact of increasing tobacco taxes in a context of illicit trade

Tobacco tax increases, the most cost-effective measure in reducing consumption, remain underutilized in low and middle-income countries. This study estimates the health and economic burden of smoking in Argentina and forecasts the benefits of tobacco tax hikes, accounting for the potential effects of illicit trade. Using a probabilistic Markov microsimulation model, this study quantifies smoking-related deaths, health events, and societal costs. The model also estimates the health and economic benefits of different increases in the price of cigarettes through taxes. Annually, smoking causes 45,000 deaths and 221,000 health events in Argentina, costing USD 2782 million in direct medical expenses, USD 1470 million in labor productivity loss costs, and USD 1069 million in informal care costs-totaling 1.2% of the national gross domestic product. Even in a scenario that considers illicit trade of tobacco products, a 50% cigarette price increase through taxes could yield USD 8292 million in total economic benefits accumulated over a decade. Consequently, raising tobacco taxes could significantly reduce the health and economic burdens of smoking in Argentina while increasing fiscal revenue

Carga de enfermedad y económica atribuible al consumo de bebidas azucaradas en El Salvador

OBJECTIVE: To estimate the burden of disease and economic burden attributable to the consumption of sugar-sweetened beverages in El Salvador. METHODS: A comparative risk model was used to estimate the effects on deaths, health events, disability-adjusted life years (DALYs), and direct medical costs attributable to the consumption of sugar-sweetened beverages. RESULTS: A total of 520 deaths (8 per 100 000 individuals), 214 082 health events (3 220 per 100 000 individuals) and 16 643 DALYs could be attributable to the consumption of sugar-sweetened beverages in El Salvador, representing US$69.35 million in direct medical costs for the year 2020. In particular, type 2 diabetes (T2DM) events attributable to the consumption of sugar-sweetened beverages could represent more than 20% of total T2DM cases in the country. CONCLUSION: A high number of deaths, events, and costs could be attributed to the consumption of sugar-sweetened beverages in El Salvador

Budget Impact analysis of venetoclax for management of acute myeloid leukemia from the perspective of the social security and the private sector in Argentina

OBJECTIVE: This study aimed to estimate the budget impact of the incorporation of venetoclax for the treatment of patients with Acute Myeloid Leukemia (AML) over 75 years of age or those with comorbidities and contraindications for the use of intensive chemotherapy, from the perspective of the social security and the private third-party payers in Argentina. METHODS: A budget impact model was adapted to estimate the cost difference between the current scenario (azacitidine, decitabine and low doses of cytarabine) and the new scenario (incorporation of venetoclax) for a third-party payer over a time horizon of three years. Input parameters were obtained from a literature review, validated or complemented by expert opinion using a modified Panel Delphi approach. All direct medical costs were estimated by the micro-costing approach and were expressed in US dollars (USD) as of September 2020 (1 USD = 76.18 Argentine pesos). RESULTS: For a third-party payer with a cohort of 1,000,000 individuals covered, incorporating venetoclax was associated with an average budget impact per-member per-month (PMPM) of $0.11 USD for the social security sector and$0.07 USD for the private sector. The duration of treatment with venetoclax was the most influential parameter in the budget impact results. CONCLUSION: The introduction of venetoclax was associated with a positive and slight budget impact. These findings are informative to support policy decisions aimed to expand the current treatment landscape of AML