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Are economic evaluations and health technology assessments increasingly demanded in times of rationing health services? The case of the Argentine financial crisis

Published online by Cambridge University Press:  01 April 2007

Adolfo Rubinstein ,
María Belizán  and
Vilda Discacciati
Adolfo Rubinstein
Affiliation:
Institute for Clinical Effectiveness and Health Policy and Hospital Italiano
María Belizán
Affiliation:
Institute for Clinical Effectiveness and Health Policy
Vilda Discacciati
Affiliation:
Hospital Italiano
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Abstract

Objectives: After 4 years of deepening recession, Argentina's economy plummeted after default in 2002. This crisis critically affected health expenditures and triggered acute rationing. Our objective was to explore health decision-makers' knowledge and attitudes about economic evaluations (EE) and whether health technology assessment (HTA) were increasingly used for decision making.

Methods: A qualitative design based on semistructured interviews and focus groups was used to explore how decision makers belonging to different health sectors implement resource allocation decisions.

Results: Informants were mostly unaware of EE. The most important criteria mentioned to adopt a treatment were evidence of effectiveness, social/stakeholder demand, or resource availability. Despite general positive attitudes about EE, knowledge was rather limited. Although cost considerations were widely accepted by purchasers and managers, clinicians argued about these issues as interfering with the doctor–patient relationship. Other important perceived barriers to HTA use were lack of confidence in the transferability of studies conducted in developed countries and institutional fragmentation of the Argentine healthcare system. The new macroeconomic context was cited as a justification of implicit rationing measures. Although explicit priority setting was implemented by many purchasers and managers, HTA was not used to improve technical and/or allocative efficiency.

Conclusions: The crisis seems to be a strong incentive to extend the use of HTA in Argentina, provided decision makers are aware as well as involved in the generation of local studies.

Keywords

Economic evaluationResource allocationHealth technology assessmentFinancial crisis in Argentina
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 2 , April 2007 , pp. 169 - 176
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

1.Costa, J, Rovira, J.A short practical guide to the focus group approach in analysing the role of economic evaluation on decision making in the health care system. Rovira, J., Personal communication. February, 1998.Google Scholar
2.Coyle, D. Increasing the impact of economic evaluation on health care decision making. Discussion paper N 108. University of York: Center for Health Economics; 1993.Google Scholar
3.Drummond, M, Cooke, J, Walley, T. Economic evaluation under managed competition: Evidence from the UK. Soc Sci Med. 1997; 45: 583–595.CrossRefGoogle Scholar
4.Drummond, M, Sculpher, M, Torrance, G et al. Methods for the economic evaluation of health care programs. 3rd ed.. New York: Oxford University Press; 2005.CrossRefGoogle Scholar
5.Evans, DE, Tan-Torres, Edejer T, Adam, T, Lim, SL, for the WHO Choosing Interventions that are Cost Effective (CHOICE). Methods to assess the costs and health effects of interventions for improving health in developing countries. BMJ. 2005; 331: 1137–1140.CrossRefGoogle ScholarPubMed
6.Ezzati, M, Lopez, AD, Rodgers, A, Vander, Hoorn S, Murray, CJL, and the Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet. 2002; 360: 1347–1360.CrossRefGoogle ScholarPubMed
7.Harris, A, Buxton, M, O'Brien, B, Rutten, F, Drummond, M. Using economic evidence in reimbursement decision for health technologies: Experiences of 4 countries. Expert Rev Pharmacoeconomic Outcome Res. 2001; 1: 7–12.CrossRefGoogle ScholarPubMed
8.Hoffmann, C, Graf, von der Schulenburg JM, on, behalf of the Euromet group. The influence of economic evaluation studies on Decision making: a European Survey. Health Policy. 2000; 52: 179–192.CrossRefGoogle ScholarPubMed
9.Hutubessy, R, Chisholm, D, Torres, Edejer TT, and WHO CHOICE. Cost-effectiveness and resource allocation. Geneva: WHO; 2003; 1:8.Google Scholar
10.Iglesias, CP, Drummond, MF, Rovira, J, NEVALAT, Pro- ject Group. Health-care decision-making processes in Latin America: problems and prospects for the use of economic evaluation. Int J Technol Assess Health Care. 2005; 21: 1–14.CrossRefGoogle ScholarPubMed
11.Sloan, FA, Whetten-Goldstein, K, Wilson, A. Hospital pharmacy decisions, cost-containment and their use of cost-effectiveness analysis. Soc Sci Med. 1997; 45: 525–533.CrossRefGoogle ScholarPubMed
12.Taylor, RS, Drummond, MF, Salkeld, G, Sullivan, SD. Inclusion of cost effectiveness in licensing requirements of new drugs: the fourth hurdle. BMJ. 2004; 29: 972–975.CrossRefGoogle Scholar
13.Williams, AH, Cookson, RA. Equity-efficiency trade-offs in health technology assessment. Int J Technol Assess Health Care. 2006; 22: 1–9.CrossRefGoogle ScholarPubMed