Provision of Health Care Services in Canada: Challenges and Opportunities

The Canadian health care system provides comprehensive coverage of hospital and outpatient care, including therapeutic, diagnostic and preventive services. The level of coverage of services varies across the country. This study examines the key characteristics of the Canadian health and long-term care systems; presents a structured analysis of the insurance, financing and provision of health and long-term care services in Canada; describes the main challenges of the Canadian health and long-term care systems; and concludes with feasible opportunities for the Canadian health policy. Main challenges to the Canadian system are related to population ageing; prevalence of avoidable diseases caused by poor health habits; coverage and financing of long-term care services; financing of expensive new technologies and pharmaceuticals; and the shortage and unbalanced geographic distribution of health care professionals. Opportunities for the Canadian health policy are: strengthening public health policy, continuing shifting care to the ambulatory level; improving the coordination between primary care and specialist services; implementing a system-wide national human resources planning; and integrating home-based care as part of overall primary health care

BIOSIMILAR MEDICINE PRICE ANALYSIS IN BRAZIL: THE ANTIRHEUMATIC CASE

Objective: The introduction of biosimilar medicines in markets can bring savings to health systems, expanding the population’s access to various treatments. This study aims to analyze the price competition of biological agents and their biosimilars in Brazil within the scope of rheumatoid arthritis. Methods: Prices for 14 presentations of original and biosimilar medicines were analyzed from January 2003 to October 2019 in Brazil. Prices were taken from official lists and were noted since launch and during the later trading period. Prices were converted to United States dollars and adjusted for inflation for the 2003 base year. Results: In Brazil, during this review period, prices of biopharmaceuticals decreased in real values, reaching up to a 50% reduction. The introduction of biosimilars did not affect the price sharing of biological medicines. Conclusion: Biosimilar antirheumatics do not yet have a significant impact on the price of biologics marketed in Brazil. A change in this scenario is expected in the medium and long term

Economic Analyses of Respiratory Tract Infection Diagnostics:A Systematic Review

BACKGROUND: Diagnostic testing for respiratory tract infections is a tool to manage the current COVID-19 pandemic, as well as the rising incidence of antimicrobial resistance. At the same time, new European regulations for market entry of in vitro diagnostics, in the form of the in vitro diagnostic regulation, may lead to more clinical evidence supporting health-economic analyses. OBJECTIVE: The objective of this systematic review was to review the methods used in economic evaluations of applied diagnostic techniques, for all patients seeking care for infectious diseases of the respiratory tract (such as pneumonia, pulmonary tuberculosis, influenza, sinusitis, pharyngitis, sore throats and general respiratory tract infections). METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles from three large databases of scientific literature were included (Scopus, Web of Science and PubMed) for the period January 2000 to May 2020. RESULTS: A total of 70 economic analyses are included, most of which use decision tree modelling for diagnostic testing for respiratory tract infections in the community-care setting. Many studies do not incorporate a generally comparable clinical outcome in their cost-effectiveness analysis: fewer than half the studies (33/70) used generalisable outcomes such as quality-adjusted life-years. Other papers consider outcomes related to the accuracy of the test or outcomes related to the prescribed treatment. The time horizons of the studies generally are limited. CONCLUSIONS: The methods to economically assess diagnostic tests for respiratory tract infections vary and would benefit from clear recommendations from policy makers on the assessed time horizon and outcomes used. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40273-021-01054-1

Produtividade perdida atribuída a infecções respiratórias agudas na América do Sul: breve revisão da literatura / Productivity lost attributed to acute respiratory infections in South America: a brief literature review

As infecções agudas do trato respiratório (IATR) têm elevada morbimortalidade mundial, com importante perda de produtividade em países da América Latina e Caribe (ALC) e, em particular, da América do Sul (AS). Esta revisão não sistemática da literatura objetiva organizar os estudos sobre a estimativa da produtividade perdida devido a mortalidade por IATR em países da AS. Levantou-se publicações de 2012 a 2022 presentes no PubMed, Portal Regional da Biblioteca Virtual em Saúde (BVS) e no Science Direct. Identificou-se 10 estudos envolvendo custos das IATR em países da AL, que inclui o subcontinente sul-americano. Duas revisões sistemáticas foram recuperadas. Pneumonia, Influenza e outras infecções do trato superior e inferior foram abordadas em estudos que usaram modelos de simulação, Markov, e dados primários e secundários para o cálculo de custos diretos e indiretos relacionados a produtividade perdida. Outros desfechos encontrados relacionavam-se a dados epidemiológicos e clínicos, como duração da doença. São necessários mais estudos de qualidade sobre a temática, a fim de apoiar decisões sobre a alocação de recursos destinados ao planejamento de políticas e intervenções sanitárias, para sua prevenção

Health-Economic Analyses of Diagnostics:Guidance on Design and Reporting

Cost-effectiveness analyses (CEAs) can be used to assess the value of diagnostics in clinical practice. Due to the introduction of the European in vitro diagnostic and medical devices regulations, more clinical data on new diagnostics may become available, which may improve the interest and feasibility of performing CEAs. We present eight recommendations on the reporting and design of CEAs of diagnostics. The symptoms patients experience, the clinical setting, locations of test sampling and analysis, and diagnostic algorithms should be clearly reported. The used time horizon should reflect the time horizon used to model the treatment after the diagnostic pathway. Quality-adjusted life-years (QALYs) or disability-adjusted life-years (DALYs) should be used as the clinical outcomes but may be combined with other relevant outcomes, such as real options value. If the number of tests using the same equipment can vary, the economy of scale should be considered. An understandable graphical representation of the various diagnostic algorithms should be provided to understand the results, such as an efficiency frontier. Finally, the budget impact and affordability should be considered. These recommendations can be used in addition to other, more general, recommendations, such as the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) or the reference case for economic evaluation by the international decision support initiative

Situación actual y perspectiva futura de los estudios de farmacoeconomía e investigación de resultados en salud en España

Situación actual y perspectiva futura de los estudios de farmacoeconomía e investigación de resultados en salud en España

La evaluación económica en España: el camino recorrido

El objetivo de este artículo es analizar la evolución de los estudios de evaluación económica aplicados al sector sanitario realizados en España. Después de enmarcar la evaluación de proyectos sanitarios dentro de la evaluación de tecnologías sanitarias en general, se repasan los instrumentos de evaluación económica habitualmente empleados en el sector sanitario y se clasifican los treinta estudios realizados durante los últimos diez años. Finalmente, se apuntan algunas tendencias en la evoluación de este conjunto de técnicas instrumentales y de sus formas concretas de utilizació