ABSTRACT
Abstract According to the World Health Organization, coronary heart disease (CHD)-caused deaths accounted for one-fifth of the total deaths in Mexico in 2017. Researches done in the past have confirmed the association between dietary trans-fatty acids (TFA) and CHD. Dietary TFA are mostly derived from industrial-hydrogenated oils, milk products, and meat fats. This paper is a build on of a policy paper done on international policies for TFA in low-to-middle income countries, using Mexico as the case study. This write up, however, aims to critically analyse the TFA regulation policy process in Mexico, evaluating the strength of evidence proposed and identifying the barriers preventing the usage of the evidence for a TFA regulation policy implementation. Although evidence abounds for TFA regulation policy, lack of effective collaboration and communication among the major actors (researchers, policymakers, and consumers) in Mexico remains a major setback in its implementation.
Resumen Según la Organización Mundial de la Salud, las muertes causadas por enfermedades coronarias (EC) representaron una quinta parte del total de muertes en México en 2017. Investigaciones realizadas en el pasado han confirmado la asociación entre los ácidos grasos trans (AGT) en la dieta y las EC. Los AGT de la dieta se derivan principalmente de aceites hidrogenados industriales, productos lácteos y grasas cárnicas. Este trabajo tiene como base un documento de política pública acerca de las políticas internacionales para AGT en países de ingresos bajos a medianos, utilizando a México como estudio de caso. Sin embargo, esta reelaboración tiene como objetivo analizar críticamente el proceso de políticas de regulación de AGT en México, mediante la evaluación de la solidez de la evidencia propuesta y la identificación de las barreras que impiden el uso de la misma para la implementación de una política de regulación de AGT. Aunque abundan las evidencias para fundamentar políticas de regulación de los AGT, la falta de colaboración y comunicación efectivas entre los principales actores (investigadores, formuladores de políticas y consumidores) en México sigue siendo un gran obstáculo en su implementación.
ABSTRACT
Background: Nigeria ranks third just behind India and China in the global disease burden of pneumococcal disease. The current sustainability approach for an affordable pneumococcal conjugate vaccine (PCV) for the national immunization program from 2014 till 2025 involves a cost sharing plan funded with a 75% financial support from GAVI and a subsidy from Pfizer pharmaceuticals. There is a strong need to generate evidence on the cost-effectiveness of the national PCV program in Nigeria from 2014-2025 and beyond 2025.Methods: The following parameters (demography, disease burden, health services utilization and costs, vaccination coverage, vaccine efficacy, and vaccination costs) were used in a static cohort model to estimate the total cost, health and economic benefit, and cost-effectiveness of the implementation of PCV vaccination program, compared with no PCV vaccination among under-five children in Nigeria from 2014-2025 and from 2026-2033. A sensitivity analysis was conducted to evaluate the robustness of the data used.Results: The national PCV vaccination program would have an approximated 31.4% and 30% reduction of the total burden of pneumococcal diseases over the period of 2014-2025 and 2026-2033 respectively. One-way sensitivity analysis reveals vaccine efficacy as most sensitive parameter followed by disease incidence rate and treatment cost. Removal and addition of DTP3 and 3+1 (measles vaccine) dose respectively resulted to a similar ICER from both.Conclusions: The estimated ICER suggests that the national PCV program in Nigeria will be cost-effective post 2025 era. In addition, it is recommended for policy-makers adoption considering the budget and equity impact of the intervention in Nigeria.