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EDITORIAL

Brief Latin American Update: One More ViHRI AnnualIssue, and Another Exciting Biennial ISPOR Conference

It is our pleasure to present a new annual issue of Value in HealthRegional Issues from the Latin American (LA) region, and a goodopportunity to provide our readership with fresh news about theISPOR 5th LA Conference recently held in Chile. Let us start withthe latter, and then get to the former.

ISPOR LA meetings started 8 years ago, with nearly 300 peoplegathering in Cartagena. In Santiago, there were 940 attendeesfrom 51 countries, reflecting the growing momentum and interestfor this field in our region. There were 6 short courses, 38research podiums, 15 workshops, 10 issue panels, and 392posters. The two plenaries were aligned with the meeting’soverarching theme, “Increasing Access to Health Care in LatinAmerica: Making Better Decisions for Greater Equity,” andfocused on how to improve access to health technologies inLatin America on the basis of methods that are transparent andfairly representative of all stakeholders’ perspectives [1].

The first plenary, “Is HTA [health technology assessment] fair?Analyzing the HTA process in Latin America & its implications foraccess to health care,” was focused on high-level system objec-tives (such as efficiency and equity) and principles (transparency,or appeal mechanisms). Stimulating presentations by worldexperts (Anthony Culyer and Norman Daniels) provided someinsights that challenged mainstream ideas such as the one thatstates that efficiency and equity cannot be both improved, andthat there is always a trade-off. They also argued how decisionscan be made fairly and represent all stakeholders, while balan-cing the requirements of a rigorous scientific method to evaluatethe usefulness of drugs and devices for their populations [2].

The second plenary was “Access to high-cost drugs in LatinAmerica: Who goes first?” This is an important emerging topic inthe region that has been addressed in several developed coun-tries through the creation of specialized programs that estab-lished processes that balance equity and efficiency principlesaccording to local jurisdictions. In Latin America, Mexico hasimplemented coverage for a number of high-cost drugs for whichprices are negotiated independently by a special commissioncreated by presidential agreement. However, it represents ahazard that could allow external pressure to play a role in thedecision-making process, threatening the rational allocation ofresources. In the case of Colombia, multiple health policies havebeen implemented to face the challenge of financing high-costdrugs, including the creation of an independent body to centrallymanage funds across all health care subsystems and the devel-opment of legislation and tools to regulate drug prices. Chile hasrecently tackled the issue of access to high-cost drugs through itspublic health insurer, the National Health Fund (Fondo Nacional

de Salud (FONASA)). This institution implemented a specificprogram in 2007 to fund drugs for certain rare diseases and otherhealth conditions that require expensive medications, such asbreast cancer and rheumatoid arthritis, which have been pro-vided to the population on the basis of restricted patient quotas.In 2015, a law that establishes a new universal fund to coverhigh-cost drugs has been enacted. Nonetheless, the organizationsand mechanisms involved in this task are yet to agree on theprocedures and rules that will regulate in practice the provisionof these services in the country, which plan to formally incorpo-rate HTA tools and principles [3].

Other regional collaborations strengthening outcome researchand HTA are also rather active: some examples are the XIVIberoamerican Cochrane Network meeting held during May ofthis year in Uruguay [4]; REDETSA’s (regional HTA network) latestannual meeting held in Chile after the ISPOR regional meeting;and the first upcoming LA HTAi policy forum to be held nextApril [5].

In this issue (volume 8, the fourth issue devoted to LA), we canhave an overview of the significant progress our field is making inour region. There are studies from the northern to the southernparts of LA, with several studies from Mexico [6,7] and two fromChile [8,9]. Researchers from Brazil [10–12] and Colombia [13–17]continue to produce several articles, but we also find articles fromGuatemala [18] and Uruguay [19]. Three of the studies deal withregional topics and do not deal specifically with a country-specific issue [20–22]. We are publishing not only traditionalcost-effectiveness analysis comparing several technologies, thesite of administration of the treatment (at home vs at hospitalmanagement of pneumonia) [9], or an image archiving metho-dology, but also a budget impact analysis [11], a systematicreview [22], and a multicenter study using chart reviews [12].One study examines epidemiological aspects of malaria in ourregion, whereas another examines how to estimate dengue-related costs [21]. The scope of topics being evaluated isreally interesting: some examples are avoidable mortality [13],inclusion of new drugs into a national benefit package [16],implementation of patient-reported outcomes [20], consequencesof chemotherapy wastage [23], equity in access to oncologicaldrugs [19], and unexplained variation in cesarean deliveries [17].One article focuses on children younger than 5 years [14]. Insummary, we have a very rich 2015 issue, and we definitely thinkour readers will have a lot to enjoy.

And, last but not the least, some other issues: 1) we are in thequeue for National Library of Medicine PubMed/Medline, to bereviewed in the fall of 2015, for a decision approximately in the

Conflict of interest: The authors have indicated that they have no conflicts of interest with regard to the content of this article.Source of financial support: The authors have no other financial relationships to disclose.

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spring of 2016. We hope we succeed, and this will make ourjournal much more visible and attractive for researchers; 2) thisyear we are launching the first Value in Health Regional IssuesExcellent Article Award for each region, for articles published inthe previous 2 years. This award will be given to the best articlepublished in ViHRI from each region biennially; and 3) our journaloutreach is steadily increasing in our rather young existence of3.5 years. Some metrics are the more than 1600 monthly full-textdownloads, or the nearly 2300 monthly page views in 2015.

Hope that you enjoy the current issue and the buoyant life ofour field in LA, aiming to contribute to the use of sound societalprinciples for decision making in our region (public and trans-parent grounds for decisions, relevant reasons, revision mechan-isms, and enforcement of the previous three) [24].

Acknowledgments

We thank Maria Cook, ViHRI regional manager, Jerusha Harvey,the ISPOR key person for our region, and Steve Priori, the ISPORsenior staff for its publications.

Federico Augustovski, MD, MSc, PhDInstitute for Clinical Effectiveness and Health Policy (IECS), NationalScientific and Technical Research Council (CONICET), University of

Buenos Aires, Buenos Aires, Argentina

Victor Zárate, MD, MSc, PhDChilean Ministry of Health, Santiago, Chile

Jaime Caro, MDCM, FRCPC, FACPEvidera, McGill University, Lexington, MA, USA

Marcos Bossi Ferraz, MD, MSc, PhDFederal University of São Paulo, São Paulo, Brazil

2212-1099/$36.00 – see front matter Copyright & 2015,International Society for Pharmacoeconomics and Outcomes

Research (ISPOR). Published by Elsevier Inc.http://dx.doi.org/10.1016/j.vhri.2015.10.005

R E F E R E N C E S

[1] LA meeting Web page. Available from: http://www.ispor.org/event/index/2015santiago. [Accessed October 05, 2015].

[2] Garrison L, Culyer A, Daniels N. Is HTA fair? Analyzing the HTA process inLatin America & its implications for access to health care. First PlenarySession. Available from: http://www.ispor.org/Event/ProgramList/2015Santiago?type=Plenary#ProgramItemMon. [Accessed October 05, 2015].

[3] Lenz Alcayaga R, Acuña Merchán L, González Rétiz ML, Vega Morales J.Access to high cost drugs in Latin America: Who goes first? Second PlenarySession. Available from: http://www.ispor.org/Event/ProgramList/

2015Santiago?type=Plenary#ProgramItemTue. [Accessed October 05,2015].

[4] Reunión anual de la red Cochrane. Available from: http://www.fnr.gub.uy/?q=evento_cochrane. [Accessed October 05, 2015].

[5] Available from: http://www.htai.org/htai/advisory-committees/policy-forum.html. [Accessed October 05, 2015].

[6] Neslusan C, Teschemaker A, Johansen P, et al. Cost-effectiveness ofcanagliflozin versus sitagliptin as add-on to metformin in patients withtype 2 diabetes mellitus in Mexico. Value Health Regional 2015;8:8–19.

[7] Hunt B, Aguilar Garza JL, Enríquez Vázquez CJ, et al. Evaluating thelong-term health economic implications of improving the proportion ofpatients with type 2 diabetes meeting treatment targets in Mexico.Value Health Regional 2015;8:20–7.

[8] Balmaceda C, Espinoza MA. Impacto de una política de equivalenciaterapéutica en el precio de medicamentos en Chile. Value HealthRegional 2015;8:43–8.

[9] Carvajal Macaya M, Hernández Ridulfo A, Ramírez-Santana M.Comparación de costos y resultados sanitarios en usuarios conneumonia adquirida en comunidad atendidos en domicilio o enhospitalización tradicional: estudio exploratorio de 40 casos. ValueHealth Regional 2015;8:112–5.

[10] Ribeiro de Souza CP, Santoni NB, Melo TG, et al. Cost-effectiveness andcost-utility analyses of dabigatran compared with warfarin in patientswith nonvalvular atrial fibrillation and risk factors for stroke andsystemic embolism within Brazilian private and public healthcaresystems perspectives. Value Health Regional 2015;8:37–42.

[11] Aparecido Nunes A, Marques de Mello L, Barbosa Coelho E, et al.Analyses of budget impact considering the use of the picture archivingand communication system (PACS). Value Health Regional 2015;8:62–8.

[12] de Bitencourt FH, Vieira TA, Steiner CE, et al. Medical costs related toenzyme replacement therapy for mucopolysaccharidosis types I, II andVI in Brazil: a multicenter study. Value Health Regional 2015;8:99–106.

[13] Diaz-Jimenez D, Castañeda-Orjuela C, Castillo-Rodríguez L, De la Hoz-Restrepo F. Economic costs analysis of the avoidable mortality inColombia 1998–2011. Value Health Regional 2015;8:129–35.

[14] Atehortúa S, Florez ID, Ceballos M, et al. Análisis de costo efectividad deondansetrón para el tratamiento del vómito en niños menores de cincoaños con gastroenteritis en Colombia. Value Health Regional2015;8:1–7.

[15] Castro JC, Daza AM, Misas JD. Cost-effectiveness analysis ofviscosupplementation vs. conventional supportive therapy for kneeosteoarthritis in Colombia. Value Health Regional 2015;8:56–61.

[16] Machado-Alba JE, Torres D, Potilla A, Arias AF. Results of the inclusionof new medications in the obligatory health system plan in Colombia,2012-2013. Value Health Regional 2015;8:28–35.

[17] Vecino Ortiz AI, Bardey D, Castano Yepes RA. Hospital variation incesarean delivery: a multilevel analysis. Value Health Regional2015;8:116–21.

[18] Cruz Rodriguez JB, Leal S, Calvimontes SG, Hutton D. Cost-effectivenessof radiofrequency ablation for supraventricular tachycardia inGuatemala. Value Health Regional 2015;8:92–8.

[19] González-Vacarezza N, Poggi M, Arroyo G. Equidad en el acceso a losmedicamentos oncológicos de alto costo en Uruguay. Value HealthRegional 2015;8:122–8.

[20] Winnette R, Zárate V, Machnicki G. Patient-reported outcomes in LatinAmerica: implementation in research and role in emerging HTAsystems. Value Health Regional 2015;8:49–55.

[21] Constenla D, Armien B, Arredondo J, et al. Costing dengue fever casesand outbreaks: recommendations from a costing dengue workinggroup in the Americas. Value Health Regional 2015;8:80–91.

[22] Bardach AE, Ciapponi A, Rey-Ares L. Epidemiology of malaria in LatinAmerica and the Caribbean from 1990 to 2009: systematic review andmeta-analysis. Value Health Regional 2015;8:69–79.

[23] Hyeda A, da Costa ESM. Uma análise preliminar do desperdício dequimioterapia no tratamento do câncer. Value Health Regional2015;8:107–11.

[24] Daniels N, Sabin JE. Accountability for reasonableness: an update. BMJ2008;337:a1850.

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