Marcelo Eidi Nita, MD, MSc, PhD MAPESolutions, Brazil
Bruno Salgado Riveros, PharmD, MSc, PhD, NATS Federal University of Paraná, Brazil
In recent years, it has been observed that there is an unrestrained increase in health costs not necessarily accompanied by improvement in the healthcare delivery. In fact, the overall perception of society is that healthcare services are getting worse, more restrictive and with limited access to important services and products. Hospitals and ambulatories are more crowded, therefore, impairing directly the quality of healthcare assistance. The most widespread model for pricing products and services in healthcare, fee for service (FFS), is being increasingly discredited. On one hand, if it encourages using all available resources to treat patients, on the other, it stimulates unnecessary procedures and services. The consensus among specialists is that a new healthcare delivery model is necessary in order to promote sustainability over the health systems.
Along these lines, we had the opportunity to attend the ISPOR 2018 meeting with the theme “Real-World Evidence, Digital Health, and the New Landscape for Health Decision Making”. Colleagues from the Latin America were gathered to discuss the hot topics and challenges for progress in our field and the organization as a whole.
Indeed, Health Technology Assessment (HTA) is now a very well established discipline in some countries of our region, becoming more and more influential in the decision-making process for new technologies such as immune-oncologic drugs or medical devices. While some HTA agencies (such as NICE in England or PBAC in Australia) in most cases concentrated their assessment on the ICER (Incremental Cost Effectiveness Ratio), other agencies (such as IQWIG in Germany and HAS in France) have moved toward some form of Comparative Effectiveness Research (CER), hence mirroring the US movement toward CER. In Latin America, many HTA agencies (such as CONITEC in Brazil) are focusing on the clinical and budgetary impact of new technologies, but are increasingly demanding local adaptation of economic evaluation with Real-World Evidence. RedETSA is the network of HTA bodies of the Americas (Red de Evaluación de Technologías en Salud de las Américas). More than 25 HTA bodies from most of the countries in the region are members of RedETSA. It publishes the “Base Regional de Informes de Evaluación de Tecnologías en Salud de Las Américas” (BRISA), which facilitates the creation of a repository of HTA studies with local data. The ISPOR Latin America Consortium Publications Committee is discussing the necessity to consolidate the practices that our region has gathered in the last years to identify possible lessons learned and points to develop. What are other hot topics related to this matter?
Value-Based Healthcare (VBHC) can be understood as a healthcare delivery model where the value promoted by the patient is the central point. (At FSS, the number of procedures delivered is the central point.) In turn, value is interpreted as the number of benefits promoted to the patient per each monetary unit spent. The Center for Medicare and Medicaid (CMS) has been implementing many flavors of VBHC in the United States, inspiring many other countries to evolve their own Healthcare System toward a more sustainable practice. Where VBHC is embraced by healthcare practitioners and hospital administrators due to its focus on patient value over the entire care pathway instead of single intervention, it lacks an operational definition of value in relation to cost. What are the other key questions that our region is facing to implement a more sustainable and patient-oriented management practice?
Soon, the Publications Committee will launch a survey where we intend to suggest topics that can be developed within the region during the next months. We invite you to propose additional topics of interest for consideration. With the collaboration of many experts, the Publications Committee can develop a robust evidence of advances and discuss the challenges that our region should be working on during the next few years.
We welcome all those interested in joining us to collaborate on the development of proposed topics for the Publications Committee. Together with Herman Soto Molina, 2018-2018 Publications Committee Chair-Elect, and the support from the ISPOR Global Networks – Latin America team, field of work will continue to evolve to meet the challenges that our healthcare systems face.
Thank you all in advance.
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