STATUS UPDATE OF THE REIMBURSEMENT REVIEW ENVIRONMENT ACROSS LATIN AMERICA GENERAL PICTURE, ARGENTINA

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1 Educational Symposium STATUS UPDATE OF THE REIMBURSEMENT REVIEW ENVIRONMENT ACROSS LATIN AMERICA GENERAL PICTURE, ARGENTINA Prof. Dr. Federico Augustovski MD MSc PhD Director, Instituto de Efectividad Clínica y Sanitaria 3rd ISPOR Latin America September 2011 México City, México

2 Latin America Area 21,069,501 km² Countries 21 Population 569 Million Aprox. 10% of world population and 10% of world GDP GDP Largest Urban Agglomerations [2][3] $3.33 Trillion (exchange rate) $5.62 Trillion (ppp) 1. Mexico City 2. São Paulo 3. Buenos Aires 4. Rio de Janeiro 5. Lima 6. Bogotá 7. Santiago 8. Belo Horizonte 9. Caracas 10. Porto Alegre Source: Wikipedia Social security and Public Sectors represent the largest financer and providers of health care Most have a compulsory package of basic benefits Prof. Federico Augustovski

3 HTA in Latinamerica CENETEC Mexico INAHTA Agencies IECS - Argentina DECIT - Brazil MoH - Chile CENETEC- Mexico DECIT and ANVISA Brazil MoH Chile Institute for Clinical Effectiveness and Health Policy IECS - Argentina

4 HTA in Latinamerica INAHTA Agencies IECS - Argentina DECIT - Brazil MoH - Chile CENETEC- Mexico HTA groups at MoHs and Academia Argentina: UCEETS MoH Bolivia: HTA group - MoH Brasil: ANVISA Brasil: IATS&P Allegre,Rio, S. Paulo Univers Chile: HTA Unit MoH Chile: CIGES Univ. de la Frontera Colombia: GIES Univ. de Cartagena Colombia: MoH Cuba: ENSAP Esc. Nac. de S. Pública Ecuador: HTA group - Proceso de Ciencia y Tecnología- MoH Mexico: INSP - Instituto Nacional de Salud Pública Paraguay: HTA unit - MoH Perú: HTA Unit MoH Perú: Clin. Epidemiology Unit, UPCH Uruguay: HTA Department MoH Uruguay: FNR Venezuela: HTA Unit - MoH

5 ISPOR Chapters and LA Consortium Andres Pichon-Riviere MD MSc PhD, IECS Argentina

6 Other examples of the growing interest in HTA in the region 2011 HTAi Annual Meeting Rio de Janeiro - Brazil June PAHO Regional HTA network Buenos Aires Argentina October 21-23, 2010 HTAi regional metting

7 Red de ETS de las Américas Tema prioritario para países miembros Articulación de ministerios de salud y centros de referencia regional Desarrollo de capacidades, cooperación, compartir información y actividades comunes Dar visibilidad política a nivel regional de la importancia del tema Plan de trabajo en elaboración con perspectiva de la reunión de Rio.

8 HEE methodological guidelines in Latin America Countries with HEE guidelines Brazil, Colombia, Cuba and Mexico MERCOSUR: Argentina, Brazil, Paraguay and Uruguay Grupo Andino: Bolivia, Chile, Colombia, Ecuador, Peru, Venezuela HEE Guidelines under development

9 Key accomplishments of the HTA Sub-Commission HTA-Methodology Guídeline (Resolution GMC Nº 18/05) HTA application form (Resolution GMC Nº 12/08) HTA-Reports Guídeline (Resolution GMC Nº 52/08)

10 Bolivia Chile Colombia Ecuador Perú Venezuela

11 The Argentine Health system is highly fragmented. Total population: Private Sector More than 300 HMOs and Prepaid health plans Private Sector 10% Social Security 47% PAMI 8% Social Security Public Sector 35% 300 different organizations PAMI Insurance for the elderly Public Sector A federal system: each of the 24 provinces has it own HealthCare system.

12 UCEETS Compuesta por representantes de 12 áreas pertenecientes al Ministerio de Salud de la Nación que tienen responsabilidades en la aprobación, regulación, monitoreo y evaluación de tecnologías sanitarias Prof. Federico Augustovski

13 DIRECCION NACIONAL DE ECONOMIA DE LA SALUD DIRECCION DE CALIDAD DE LOS SERVICIOS DE SALUD DIRECCION NACIONAL DE REGULACION Y CALIDAD EN LOS SERVICIOS DE SALUD ANMAT ANLIS SPRI UCEETS HOSPITALES "Dr. Alejandro POSADAS" y de Pediatría "Prof. Dr. Juan P. GARRAHAN" COMISION NACIONAL SALUD INVESTIGA SUPERINTENDENCIA DE SERVICIOS DE SALUD PAMI APE INCUCAI Prof. Federico Augustovski

14 tacion-uceets2.pdf Prof. Federico Augustovski

15 More than 250 HTA reports produced since 2003 and indexed in the CRD (Centre for Review and Dissemination University of York) Intervention Procedures Osteochondral grafting Uterine Artery Embolization Prosthetic intervertebral disc Ceramic hip prosthesis Outpatient BiPAP Myopia surgery Radiofrequency ablation Ozone therapy Surgical treatments for obesity Photodynamic Therapy Deep brain stimulation Percutaneous vertebroplasty 0 Reportes de Evaluación de Tecnologías Sanitarias Publicados Drugs Ximelagatran Interferon Bevacizumab Capecitabina Glargine Insulin Cetuximab Liposomal Amphotericine Bortezomib Sunitinib Trastuzumab Etanercept Sevelamer Letrozole Gefitinib Drotrecogin Alfa LMW Heparins Growth Hormones Dx Technologies Multislice computed tomography PET- Otoacoustic emissions Hip arthroscopy - Functional MRI Video capsule endoscopy Wavefront analysis 3D and 4D ultrasound Expanded newborn screening IECS s HTA reports

16 Final Words Clear trend reflecting the importance that LA healthcare systems pay to the concept of incorporating new technologies that are good value for money. HTA was and is formally used to shape benefit packages in several countries. Four LA countries have published Pharmacoeconomic guidelines for the local regulatory levels and Common Country Unions are also in it The region needs to increase drug access, but also intensify cost-containment measures.

17 Thank you! Federico Augustovski, MD MSc PhD Institute for Clinical Effectiveness and Health Policy (IECS), Argentina