Two points discussed both at ISPOR and at the Network's annual meeting were about the difficulties in fixing a payment limit in Latin America, and what are the possible ways to estimate it.
At ISPOR, Professor Federico Augustovski, MD, MSc PhD, representative of IECS commented that the limit can be estimated empirically, based on the costs and productivity of health systems, or based on willingness to pay (WTP). two interested parties (“stakeholders”); It is possible to use local recommendations or even the WHO recommendations. The same point of view was defended by Sebastián García Martí, MD, MSc (representative of the IECS at the RedETSA meeting).
The IECS prepared a study to be presented at ISPOR Milan, where it was verified that most two countries in Latin America, even without a specific predetermined limit, will incorporate technologies with costs in the range of 0.5 to 1 GDP per QALY. In this work, Prof. Federico presents a proposed model for determining the limit based on a formula based on the life expectancy of the country, at birth, and how much the government intends to invest (% increase in per capita spending), being This is a variable dependent on these factors.
We emphasize that limiting is useful in the area of decision-making, based on economic evaluations, that there are different ways to determine it, and that local consensus is important. Recent studies suggest that the values used in the studies are overestimated and do not incorporate other criteria that could be relevant.
In Chile, in its economic assessment guide, it adopted a conservative decision in the face of lack of evidence of a higher limit, recommending the use of the reference of 1 GDP per capita per QALY gained or DALY avoided. Marianela Castillo Riquelme, MSc ETESA-DESAL, Ministry of Health of CHILE, highlights the difficulties in establishing it empirically or limiting it, due to: years of diverse theoretical models; Various technologies cover two possible values assigned to the validations; patient policy presses; cases of judicialization; among others. It is also emphasized that incorporation decisions in this country are not based on cost-effectiveness studies and that this limited reference is used as a reference for very high prices.
The National Technology Incorporation Commission (CONITEC) in the Brazilian Health System (SUS) decided not to establish a limit, according to Vania Canuto, Government Manager and Substitute Director of CONITEC. The question is the adoption of a single limit for a variety of health conditions such as chronic diseases, rare diseases, end of life, salvage conditions; judicialization and others. CONITEC is supporting the discussions on the topic together with REDETSA, aiming to advance this issue.
 
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