Highlights of the 5th ISPOR Latin American Conference and RedETSA Annual Meeting – Payment Threshold
One of the points discussed at both ISPOR and the annual meeting of the Network was the question of the difficulties in setting a payment threshold in Latin America, and the possible ways of estimating it.
In ISPOR, Professor Federico Augustovski, MD, MSc PhD, representative of the IECS commented that the threshold can be estimated empirically, based on costs and productivity of health systems, or on willingness to pay (WTP) of stakeholders; And you can use local recommendations or the WHO recommendation. The same point of view was defended by Sebastián García Martí, MD, MSc (IECS representative at the RedETSA meeting).
The IECS prepared a study to be presented at ISPOR Milan, where it was found that most countries in Latin America, even without a specific predetermined threshold, incorporated technologies with costs in the range of 0.5 to 1 GDP per QALY. In this work, Prof. Federico presents a model proposal for determining the threshold based on a formula based on the country's life expectancy at birth, and how much the government proposes to invest (% of increase in per capita spending), which is a dependent variable of these factors.
I have stressed that the threshold is useful in decision-making, based on economic assessments, that there are different ways of determining it, and what matters is local consensus. Recent studies suggest that the values ​​used in the studies are overestimated and do not incorporate other criteria that could be relevant.
Chile, in its guide to economic evaluations, adopted a conservative decision regarding the lack of evidence of a higher threshold, recommending the use of the referential of 1 GDP per capita per QALY gain or DALY avoided. Marianela Castillo Riquelme, MSc ETESA-DESAL, Ministry of Health of CHILE, highlights the difficulties in establishing the threshold empirically due to: various theoretical models; Various technologies covered above the possible values ​​​​adopted in the evaluations; Patient political pressures; Cases of judicialization; among others. It should be noted that the incorporation decisions in this country are not based on cost-effectiveness studies and that this reference threshold has served as a brake for very high prices.
The National Commission for the Merger of Technologies (CONITEC) in Brazil's Unified Health System (SUS) decided not to establish a threshold yet, according to Vania Canuto, Government Manager and Deputy Director of CONITEC. It is questioned the adoption of a single threshold for a diversity of health conditions such as chronic diseases, rare, end of life, rescue rules; Judicialization and others. CONITEC is supporting the discussions on this issue with REDETSA, aiming to make progress on this issue.