Estimating cost-effectiveness thresholds under a managed healthcare system: experiences from Colombia

Oscar Espinosa; Paul Rodríguez-Lesmes; Luis Orozco; Diego Ávila; Hernán Enríquez; Giancarlo Romano; Mateo Ceballos

doi:10.1093/heapol/czab146

Estimating cost-effectiveness thresholds under a managed healthcare system: experiences from Colombia

Título traducido de la contribución: Estimación de umbrales de costo-efectividad bajo un sistema de salud administrado : Experiencia para Colombia

Oscar Espinosa
, Paul Rodríguez-Lesmes
, Luis Orozco
, Diego Ávila
, Hernán Enríquez
, Giancarlo Romano
, Mateo Ceballos

Producción científica: Contribución a revista › Artículo de Investigación › revisión exhaustiva

61 Citas (Scopus)

Resumen

Al igual que la mayor parte del mundo, los países de ingresos bajos y medios se enfrentan a una creciente demanda de nuevas tecnologías sanitarias y a mayores restricciones presupuestarias. Es necesario disponer de instrumentos técnicos para tomar decisiones basadas en pruebas del mundo real que permitan maximizar la salud de la población con un presupuesto limitado. Estimamos la elasticidad coste-efectividad basada en la oferta, que luego se utilizó para determinar el umbral de coste-efectividad para el sistema de salud de Colombia, un país de renta media en el que múltiples aseguradoras, pagadas bajo reglas de capitación, gestionan las aportaciones obligatorias de los ciudadanos y los subsidios del gobierno. Utilizando datos administrativos, exploramos la variación del gasto sanitario y los resultados a nivel de aseguradora, región geográfica, grupo de diagnóstico y año. Para hacer frente a la endogeneidad en un modelo de efectos fijos de dos vías, instrumentamos los gastos sanitarios utilizando características del sistema de salud como la regulación de los precios de los medicamentos. Estimamos que el umbral es de 4.487,5 dólares por años de vida evitados [14,7 millones de pesos colombianos (COP) a precios de 2019] y 5.180,8 dólares por años de vida ajustados por calidad ganados (17 millones de COP a precios de 2019), alrededor de una vez el PIB per cápita del producto interno bruto. Hasta donde sabemos, esta es la primera estimación de la elasticidad del umbral de coste-efectividad basada en la oferta en un país de ingresos medios con un sistema sanitario gestionado.

Traducción realizada con la versión gratuita del traductor www.DeepL.com/Translator

Título traducido de la contribución	Estimación de umbrales de costo-efectividad bajo un sistema de salud administrado : Experiencia para Colombia
Idioma original	Inglés estadounidense
Páginas (desde-hasta)	359-368
Número de páginas	10
Publicación	Health Policy and Planning
Volumen	37
N.º	3
DOI	https://doi.org/10.1093/heapol/czab146
Estado	Publicada - mar 4 2022

ODS de las Naciones Unidas

Este resultado contribuye a los siguientes Objetivos de Desarrollo Sostenible

ODS 3: Salud y bienestar

Áreas temáticas de ASJC Scopus

Políticas sanitarias

Acceder al documento

10.1093/heapol/czab146

Otros archivos y enlaces

Citar esto

@article{30fd16f4f2e74b2aa975a00a244e69d7,

title = "Estimating cost-effectiveness thresholds under a managed healthcare system: experiences from Colombia",

abstract = "Like most of the world, low- and middle-income countries have faced a growing demand for new health technologies and higher budget constraints. It is necessary to have technical instruments to make decisions based on real-world evidence that allows maximization of the population's health with a limited budget. We estimated the supply-based cost-effectiveness elasticity, which was then used to determine the cost-effectiveness threshold for the healthcare system of Colombia, a middle-income country where multiple insurers, paid under capitation rules, manage the compulsory contributions of the citizens and government subsidies. Using administrative data, we explored the variation of health expenditures and outcomes at the insurer, geographical region, diagnosis group and year levels. To deal with endogeneity in a two-way fixed-effects model, we instrumented health expenditures using characteristics of the health system such as drug-price regulation. We estimated the threshold to be US\$4487.5 per years of life lost avoided [14.7 million Colombian pesos (COP) at 2019 prices] and US\$5180.8 per quality-adjusted life-years gained (17 million COP at 2019 prices), around one times the gross domestic product GDP per capita. To the best of our knowledge, this is the first estimation of the cost-effectiveness threshold elasticity supply-based in a middle-income country with a managed healthcare system.",

author = "Oscar Espinosa and Paul Rodr{\'i}guez-Lesmes and Luis Orozco and Diego {\'A}vila and Hern{\'a}n Enr{\'i}quez and Giancarlo Romano and Mateo Ceballos",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2021. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: [email protected].",

year = "2022",

month = mar,

day = "4",

doi = "10.1093/heapol/czab146",

language = "English (US)",

volume = "37",

pages = "359--368",

journal = "Health Policy and Planning",

issn = "0268-1080",

publisher = "Oxford University Press",

number = "3",

}

TY - JOUR

T1 - Estimating cost-effectiveness thresholds under a managed healthcare system

T2 - experiences from Colombia

AU - Espinosa, Oscar

AU - Rodríguez-Lesmes, Paul

AU - Orozco, Luis

AU - Ávila, Diego

AU - Enríquez, Hernán

AU - Romano, Giancarlo

AU - Ceballos, Mateo

N1 - Publisher Copyright: © The Author(s) 2021. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: [email protected].

PY - 2022/3/4

Y1 - 2022/3/4

N2 - Like most of the world, low- and middle-income countries have faced a growing demand for new health technologies and higher budget constraints. It is necessary to have technical instruments to make decisions based on real-world evidence that allows maximization of the population's health with a limited budget. We estimated the supply-based cost-effectiveness elasticity, which was then used to determine the cost-effectiveness threshold for the healthcare system of Colombia, a middle-income country where multiple insurers, paid under capitation rules, manage the compulsory contributions of the citizens and government subsidies. Using administrative data, we explored the variation of health expenditures and outcomes at the insurer, geographical region, diagnosis group and year levels. To deal with endogeneity in a two-way fixed-effects model, we instrumented health expenditures using characteristics of the health system such as drug-price regulation. We estimated the threshold to be US$4487.5 per years of life lost avoided [14.7 million Colombian pesos (COP) at 2019 prices] and US$5180.8 per quality-adjusted life-years gained (17 million COP at 2019 prices), around one times the gross domestic product GDP per capita. To the best of our knowledge, this is the first estimation of the cost-effectiveness threshold elasticity supply-based in a middle-income country with a managed healthcare system.

AB - Like most of the world, low- and middle-income countries have faced a growing demand for new health technologies and higher budget constraints. It is necessary to have technical instruments to make decisions based on real-world evidence that allows maximization of the population's health with a limited budget. We estimated the supply-based cost-effectiveness elasticity, which was then used to determine the cost-effectiveness threshold for the healthcare system of Colombia, a middle-income country where multiple insurers, paid under capitation rules, manage the compulsory contributions of the citizens and government subsidies. Using administrative data, we explored the variation of health expenditures and outcomes at the insurer, geographical region, diagnosis group and year levels. To deal with endogeneity in a two-way fixed-effects model, we instrumented health expenditures using characteristics of the health system such as drug-price regulation. We estimated the threshold to be US$4487.5 per years of life lost avoided [14.7 million Colombian pesos (COP) at 2019 prices] and US$5180.8 per quality-adjusted life-years gained (17 million COP at 2019 prices), around one times the gross domestic product GDP per capita. To the best of our knowledge, this is the first estimation of the cost-effectiveness threshold elasticity supply-based in a middle-income country with a managed healthcare system.

UR - https://www.scopus.com/pages/publications/85125882361

UR - https://www.scopus.com/pages/publications/85125882361#tab=citedBy

U2 - 10.1093/heapol/czab146

DO - 10.1093/heapol/czab146

M3 - Research Article

C2 - 34875689

AN - SCOPUS:85125882361

SN - 0268-1080

VL - 37

SP - 359

EP - 368

JO - Health Policy and Planning

JF - Health Policy and Planning

IS - 3

ER -

Estimating cost-effectiveness thresholds under a managed healthcare system: experiences from Colombia

Resumen

ODS de las Naciones Unidas

Áreas temáticas de ASJC Scopus

Acceder al documento

Otros archivos y enlaces

Huella

Citar esto