Health technology assessment in an argentinean province: adapting existing tools.

OBJECTIVES: This study reports on the development of a critical process for health technologies incorporation concerning an Argentinean Provincial Ministry of Health (MOH) in collaboration with the University of Lanús from 2008 to 2010. METHODS: We describe the approach developed to adapt selected international experiences to provincial scenario. Bibliographic review, regulations examination, key informants interviews and iterative adjustments after various stages of consultation and consensus building with main local players, contribution from foreign experts, and piloting of process and instruments for ultimate fine-tuning are described. We examine final proposal in the light of new updated studies. RESULTS: Analysis of regulations revealed that rules governing the provincial system were historically linked to administrative resolutions in relation to procurement with poor consideration to clinical, epidemiological, organizational, and health policy aspects. Key informants from hospitals, MOH, and other governmental agencies agreed on the lack of a process capable of guaranteeing a decision about health technology incorporation based on a transparent use of the best available information, ready to deal with competitive pressures. This adaptation provided a structured and explicit process (introduction, implementation, and development) as well as essential and supporting tools. CONCLUSIONS: MOH adopted the proposal for its progressive implementation while institutional evaluation capacity develops. Further studies are needed on the value placed on health technology assessment-based processes and recommendations by clinicians, managers, policy makers, and patients.

A 'polypill' aimed at preventing cardiovascular disease could prove highly cost-effective for use in Latin America.

We evaluated the cost-effectiveness of administering a daily "polypill" consisting of three antihypertensive drugs, a statin, and aspirin to prevent cardiovascular disease among high-risk patients in Latin America. We found that the lifetime risk of cardiovascular disease could be reduced by 15 percent in women and by 21 percent in men if the polypill were used by people with a risk of cardiovascular disease equal to or greater than 15 percent over ten years. Attaining this goal would require treating 26 percent of the population at a cost of $34-$36 per quality-adjusted life-year. Offering the polypill to women at high risk and to men age fifty-five or older would be the best approach and would yield acceptable incremental cost-effectiveness ratios. The polypill would be very cost-effective even in the country with the lowest gross national income in our study. However, policy makers must weigh the value of intervention with the polypill against other interventions, as well as their country's willingness and ability to pay for the intervention.

Adaptación de guías de práctica clínica: validación de un método a partir de la producción de guías para la atención de la anemia ferropénica en niños y embarazadas / Adaptation of clinical practice guides: validation of the method from the guides production for attention of the iron deficiency anemia in children and pregnant woman

El objetivo de este estudio ha sido validar una metodología de adaptación para ser utilizada en la producción de guías de práctica clínica de alta calidad en la Argentina, mediante su aplicación en el desarrollo de guías sobre la anemia ferropénica en niños y embarazadas. La metodología propuesta fue producto de la búsqueda y valoración de la evidencia internacional sobre adaptación de guías y revisión de documentos técnicos de los principales productores de guías. Su implementación, a través de un riguroso protocolo, permitió la validación empírica de dicha metodología. Como resultado de este proceso, se adaptaron dos guías sobre prevención, diagnóstico y tratamiento de la anemia ferropénica, lográndose generar recomendaciones sobre ciertos aspectos fundamentales del manejo de esta condición, basadas en evidencia de alta calidad y potencialmente aplicables. El proceso sistemático empleado y su documentación contribuyeron a generar conocimiento técnico útil y transferible sobre la adaptación de guías basadas en la evidencia, método que se presenta como una alternativa más acotada a la elaboración de novo, proceso de mayor complejidad y demanda de recursos. La metodología validada durante el estudio fue compilada en una guía para la adaptación de guías.

The objective of this study was to validate an adaptation methodology for the production of high quality clinical guidelines in Argentina through its implementation in the development of a guideline for the management of ferropenic anemia in children and pregnant women. The proposed methodology was the result of the searching and critical review of scientific evidence about guidelines adaptation, as well as technical documents provided by the main guidelines developers. Its implementation through a rigorous research protocol allowed the empiric validation of the above-mentioned methodology. As a result of this process, two guidelines about prevention, diagnosis and treatment of ferropenic anemia were adapted; and a set of high-quality evidence based and applicable recommendations for certain issues were produced. The used systematic process and its documentation contributed to generate useful and transferable technical knowledge about evidence-based guidelines adaptation; this method is proposed as a simplified altemative to “de novo elaboration”, which is of mayor complexity and demands important resources. This validated methodology was compiled into a guide for guidelines adaptation.