In a context of finite economic resources and multiple health demands that must be addressed, how to identify the best medications, vaccines, diagnostic procedures, and biomedical devices? How do you know what a fair price is so that patients can access these innovations?
To help the health systems of 174 countries respond to this question in a more efficient and equitable way, researchers from CONICET and the Institute of Clinical and Health Effectiveness (IECS) formulated and presented the first equation in The Lancet Global Health. based on data available in most countries, which offers decision makers a critical parameter to guide the appropriate allocation of health resources.
“This equation allows for better decision-making, as health systems can focus their efforts and resources on those interventions and technologies that are truly worthwhile. In other words, it helps produce more health with the same budget ,” says Andrés Pichon-Riviere , CONICET researcher at the Center for Research in Epidemiology and Public Health (CIESP, CONICET-IECS), first author of the work and general director. of the IECS.
Also participating in the study were Michael Drummond , professor of Health Economics at the University of York (United Kingdom) and international leader in health economics, and CONICET researchers at CIESP Federico Augustovski and Sebastián García Martí , respectively director and coordinator of the Department. of Health Technology Assessment and Health Economics of the IECS, and economist Alfredo Palacios , who is currently a research fellow at the Center for Health Economics at the University of York.
The tool, which has already begun to be used by governments of countries in the region, “is also an incentive to lower the prices of technologies that do not offer great benefits,” adds Pichon-Riviere.
When health systems choose which technologies to incorporate, they take into account different elements, such as, for example, what level of benefit it produces in patients, their safety or the quality of the scientific evidence that supports their use. One of these elements is the cost-effectiveness of the technology, which measures the relationship between the benefits it produces and the costs it implies.
The new equation allows us to calculate the “threshold” or limit that technologies must not exceed to be worth incorporating into the health system.
Until now, most countries calculated this cost-effectiveness threshold based on a rough rule of thumb proposed by the World Health Organization (WHO) 20 years ago, which postulated that an intervention was cost-effective when the cost per disability-adjusted life years or DALYs (a measure of the loss of 100% healthy years due to premature death or disability) was less than 3 gross domestic products (GDP). And “very” cost-effective when that same result cost less than 1 GDP. However, the same body later questioned the validity of that formula, admitting that it could lead to an overestimation of the figure.
With the application of the new proposed equation, Pichon-Riviere and his collaborators confirmed that presumption: the “real” cost-effectiveness thresholds are substantially lower than those estimated by most countries , especially low- and middle-income ones. “This implies that countries could be ’losing’ health when they decide to cover certain technologies, that is, the health gained is less than that lost by not using those resources in other interventions. That is to say, there are things that were being left out of coverage due to implicit rationing,” explains the CONICET researcher and director of the IECS.
“The new equation allows resources to be distributed equitably and gives clear rules for health systems and for the technology-producing industry regarding the prices that can be covered,” says Pichon-Riviere, adding that countries can adjust the results and lower or raise cost-effectiveness thresholds based on more ambitious health investment goals or current situations.
Until now, only a few countries had been able to approximately estimate their cost-effectiveness thresholds , because the methods were very complex and required a quantity and quality of information usually not available, especially in lower-income countries. One of the greatest contributions of this work is that it not only provides a novel method for estimating thresholds, but also does so in a surprisingly simple way and with easily accessible data in most countries, including those with low and middle income.
Although the main results are now being published, the team in charge of Pichon-Riviere has been working for years on this project that had already generated very important reports and advances, partially presented since 2015 at specialty conferences held in Rome (Italy). ), Tokyo (Japan) and Sao Paulo (Brazil). In fact, the Brazilian government incorporated this tool since August 31 for its calculation of the cost-effectiveness threshold, and it also serves as a reference input in Peru and Argentina.
