[Show abstract][Hide abstract] ABSTRACT: Despite advances in medicine, health systems in Latin America are not coping with the challenges of chronic diseases. Incidence of disease and the economic burdens as a consequence have both increased in recent years. We have chosen Type 2 diabetes as an example to highlight the challenges posed by chronic diseases, in terms of the epidemiological transition and the economic burden of the demand for services to treat such problems.
BMC Medicine 08/2014; 12(1):136. · 7.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
In many low-income to middle-income countries where there are limited economic resources, willingness to spend money is low. There is a need for analysis of the effects of small changes in willingness to pay (WTP) for health care to inform decision making in drug selection. Our goal in this study was to analyse the cost-effectiveness of oral hypoglycaemic agents (OHAs) for the initial treatment of non-obese outpatients diagnosed with type 2 diabetes in a resource-poor setting.Methods
We performed a probabilistic sensitivity analysis to analyse the cost-effectiveness of three OHAs: metformin, glibenclamide, and acarbose. We used specialised software for programming a Markov model designed for a horizon time of 1 year considering 6 months for monotherapy and 6 months for combined oral dual therapy. Meta-analysis techniques were performed for the study of effectiveness and surveys for costs estimations. For the probabilistic sensitivity analysis we used distributions of probabilities as beta distributions and monthly costs as lognormal distributions of therapeutic alternatives. We performed a Monte Carlo simulation for a cohort of 10 000 patients for each treatment option.FindingsThe results of the Monte Carlo simulations were very close for metformin and glibenclamide, showing their strong dominance over acarbose. In the acceptability curve generated, for a WTP equal to 0 the probabilities of the therapies to be cost effective were 49·5%, 43·0%, and 7·5% for glibenclamide, metformin, and acarbose, respectively. In the glibenclamide versus metformin incremental cost-effectiveness analysis, the change of the WTP from 0 to 1 gross domestic product per capita by quality-adjusted life-year, the proportion of cost-effective iterations favouring glibenclamide increased from 53·4% to 59·7%.InterpretationThe initial drug therapies with glibenclamide or metformin are dominant over therapy with acarbose. Glibenclamide is slightly more cost effective than metformin in the treatment of non-obese outpatients diagnosed with type 2 diabetes. This kind of analysis is important for drug selection in low-income to middle-income countries.FundingNational Commission for Science and Technology supported a grant for the first author.
The Lancet 06/2013; 381:S38. · 39.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Mexico has been experiencing some of the most rapid shifts ever recorded in dietary and physical activity patterns leading to obesity. Diabetes mellitus has played a crucial role causing nearly 14% of all deaths. We wanted to make a comprehensive study of the role of diabetes in terms of burden of disease, prevalence, cost of diabetes, cost of complications and health policy. METHOD: In this paper we review the quantitative data that provides evidence of the extent to which the Mexican health economy is affected by the disease and its complications. We then discuss the current situation of diabetes in Mexico with experts in the field. RESULTS: There was a significant increase in the prevalence of diabetes from 1994 to 2006 with rising direct costs (2006: outpatient USD$ 717,764,787, inpatient USD$ 223,581,099) and indirect costs (2005: USD$ 177,220,390), and rising costs of complications (2010: Retinopathy USD$ 10,323,421; Cardiovascular disease USD$ 12,843,134; Nephropathy USD$ 81,814,501; Neuropathy USD$ 2,760,271; Peripheral vascular disease USD$ 2,042,601). The health policy focused on screening and the creation of self-support groups across the country. CONCLUSIONS: The increasing diabetes mortality and lack of control among diagnosed patients make quality of treatment a major concern in Mexico. The growing prevalence of childhood and adult obesity and the metabolic syndrome suggest that the situation could be even worse in the coming years. The government has reacted strongly with national actions to address the growing burden posed by diabetes. However our research suggests that the prevalence and mortality of diabetes will continue to rise in the future.
Globalization and Health 02/2013; 9(1):3. · 1.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The rapid growth of diabetes in middle-income countries is generating disparities in global health. In this context we conducted a study to quantify the health disparities from the economic burden of diabetes in México. Evaluative research based on a longitudinal design, using cost methodology by instrumentation. For the estimation of epidemiological changes during the 2010-2012 period, several probabilistic models were developed using the Box-Jenkins technique. The financial requirements were obtained from expected case management costs by disease and the application of an econometric adjustment factor to control the effects of inflation. Comparing the economic impact in 2010 versus 2012 (p<0.05), there was a 33% increase in financial requirements. The total amount for diabetes in 2011 (US dollars) was $7.7 billion. It includes $3.4 billion in direct costs and $4.3 in indirect costs. The total direct costs were $.4 billion to the Ministry of Health (SSA), serving the uninsured population; $1.2 to the institutions serving the insured population (Mexican Institute for Social Security-IMSS-, and Institute for Social Security and Services for State Workers-ISSSTE-); $1.8 to users; and $.1 to Private Health Insurance (PHI). If the risk factors and the different health care models remain as they currently are in the analyzed institutions, health disparities in terms of financial implications will have the greatest impact on users' pockets. In middle-income countries, health disparities generated by the economic burden of diabetes is one of the main reasons for catastrophic health expenditure. Health disparities generated by the economic burden of diabetes suggests the need to design and review the current organization of health systems and the relevance of moving from biomedical models and curative health care to preventive and socio-medical models to meet expected challenges from diseases like diabetes in middle-income countries.
PLoS ONE 01/2013; 8(7):e68443. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective. To identify policies that increase access to health care for undocumented Mexican immigrants. Materials and methods. Four focus groups (n=34 participants) were conducted with uninsured Mexican immigrants in Los Angeles, California. The feasibility and desirability of different policy proposals for increasing access were discussed by each group. Results. Respondents raised significant problems with policies including binational health insurance, expanded employer-provided health insurance, and telemedicine. The only solution with a consensus that the change would be feasible, result in improved access, and they had confidence in was expanded access to community health centers (CHC's). Conclusions. Given the limited access to most specialists at CHC's and the continued barriers to hospital care for those without health insurance, the most effective way of improving the complete range of health services to undocumented immigrants is through immigration reform that will bring these workers under the other health care reform provisions.
Salud publica de Mexico 12/2012; 55:s508-s514. · 0.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to assess the costs and financial consequences of epidemiological changes in hypertension in Mexico. The cost evaluation method to estimate costs was based on instrumentation techniques. To estimate the epidemiological changes and expected cases of hypertension in 2010-2012, three probabilistic models were constructed according to the Box-Jenkins technique. Comparing the economic impact, from 2010 to 2012 there will be a 24% increase in financial requirements (p < 0.05). The total cost of hypertension in 2011 will be US$ 5,733,350,291, including US$ 2,718,280,941 in direct costs and US$ 3,015,069,350 in indirect costs. If the risk factors and various healthcare models remain unaltered in the institutions analyzed here, the financial consequences will have a major impact on users' pockets, followed by social security providers and public healthcare providers. The authors suggest a revision in the planning, organization, and allocation of resources, particularly programs for health promotion and prevention of hypertension.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 03/2012; 28(3):497-502. · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To assess the impact of a workplace leisure physical activity program on healthcare expenditures for type 2 diabetes and hypertension treatment. MATERIAL AND METHODS: We assessed a workplace program's potential to reduce costs by multiplying the annual healthcare costs of patients with type 2 diabetes and hypertension by the population attributable risk fraction of non-recommended physical activity levels. Feasibility of a physical activity program was assessed among 425 employees of a public university in Mexico. RESULTS: If 400 sedentary employees engaged in a physical activity program to decrease their risk of diabetes and hypertension, the potential annual healthcare cost reduction would be 138 880 US dollars. Each dollar invested in physical activity could reduce treatment costs of both diseases by 5.3 dollars. CONCLUSIONS: This research meets the call to use health economics methods to re-appraise health priorities, and devise strategies for optimal allocation of financial resources in the health sector.
Salud publica de Mexico 02/2012; 54(1):20-27. · 0.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the impact of a workplace leisure physical activity program on healthcare expenditures for type 2 diabetes and hypertension treatment.
We assessed a workplace program's potential to reduce costs by multiplying the annual healthcare costs of patients with type 2 diabetes and hypertension by the population attributable risk fraction of non-recommended physical activity levels. Feasibility of a physical activity program was assessed among 425 employees of a public university in Mexico.
If 400 sedentary employees engaged in a physical activity program to decrease their risk of diabetes and hypertension, the potential annual healthcare cost reduction would be 138 880 US dollars. Each dollar invested in physical activity could reduce treatment costs of both diseases by 5.3 dollars.
This research meets the call to use health economics methods to re-appraise health priorities, and devise strategies for optimal allocation of financial resources in the health sector.
Salud publica de Mexico 01/2012; 54(1):20-7. · 0.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article aims to identify opportunities, barriers and challenges in Mexico's policy networks for the development of healthcare programs for undocumented migrants in the USA and their families.
We used policy analysis, in-depth interviews and a case study. Key stakeholders at the federal, state and municipal levels in one major migrant-sending state were interviewed. We also conducted an in-depth case study of one community to obtain the perceptions of local health workers, migrant families and local nongovernmental organizations.
Findings identified opportunities and barriers involving the stakeholders, institutions, social interactions and types of relationships necessary for further progress on binational policies. There was wide interest in creating binational health insurance with different degrees of potential involvement by political actors and variation in local actors' willingness to be covered by some type of health insurance scheme.
The use of the opportunities to overcome barriers depends on the identification of high, medium or low interaction among key stakeholders, integration of coalitions and negotiating skills of all stakeholders involved.
International Journal of Health Planning and Management 08/2011; 27(1):50-62. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The main objective was to identify economic burden from epidemiological changes and expected demand for health care services for diabetes in México. The cost evaluation method to estimate direct and indirect costs was based on instrumentation and consensus techniques. To estimate the epidemiological changes for 2009-2011, three probabilistic models were constructed according to the Box-Jenkins technique. Comparing the economic impact in 2009 versus 2011 (p
Value in Health 07/2011; 14(5). · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The World Health Organization estimates that the expense of attending mental illness problems in developed countries amounts to 34% out of the total GDP. The public expense for hospitalization of patients diagnosed with schizophrenia was three times higher in patients who decide to leave the treatment than those who continue with it; ambulatory patients amount to almost the same figures in public expenses whether they decide to continue the treatment or not.
[Show abstract][Hide abstract] ABSTRACT: This article includes the results of a multi-level conceptual approach review, considering four models of analysis, delving into the determinants and the explanatory factors in the process of search and use of health services. Such models are: psychosocial, epidemiological, sociological, and socio-economic. The implications, determinants, and characteristics of utilization of health care services have been subject to scrutiny since the eighties. Research on this matter has not been independent of the process of reform, which has been carried out simultaneously in virtually every country in the world. In fact, establishing adequate health services for patients who need them most has become a generally accepted priority.
[Show abstract][Hide abstract] ABSTRACT: The diagnosis of pancreatic cancer (PC) is most frequently established in advanced stages. The aim of this study is to estimate the likelihood ratios (LRs) of diagnostic data with regards to PC that could be used to approach an earlier diagnosis.
A case-control study of 300 patients - 150 histological diagnosed cases of PC and 150 age-matched controls hospitalized for study of jaundice, abdominal pain, weight loss and/or chronic pancreatitis - was conducted. Bayesian probabilities in the form of LRs were estimated for PC predictions.
Probability of PC was associated with jaundice [odds ratio (OR) 2.89; confidence interval (CI) 1.71-4.85], glycemic disturbance (OR 5.64; CI 2.36-13.46), tobacco index >20 (OR 2.11; CI 1.08-4.09) and tumour marker CA 19-9 (OR 9.33; CI 1.36-63.95). Computed tomography showed the highest test performance with regards to PC when comparing with other diagnostic tests. LRs for variables relevant to PC were estimated, among the most relevant: jaundice LR + 1.92, CA 19-9 LR + 5.36 and computed tomography LR + 4.15. The prediction model with an endoscopic retrograde cholangiopancreatography at a tertiary referral hospital determined a 67% probability of detecting PC.
Through a Bayesian approach we can combine clinical, laboratory and imaging data to approximate to an earlier diagnosis of PC.
Journal of Evaluation in Clinical Practice 03/2009; 15(1):62-8. · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study analyzes the results of a cross-sectional survey which set out to determine the costs to patients of searching for and receiving health care in public and private institutions. The information analyzed was obtained from the study population of the Mexican National Health Survey. The dependent variable was the out-of-pocket users' costs and the independent variables were the insurance conditions, type of institution and income. The empirical findings suggest that there is a need for a more detailed analysis of user costs in middle income countries in general, where the health system is based on social security, public assistance and private institutions. This study shows that the out of pocket costs faced by users are inequitable and fall disproportionately upon socially and economically marginalized populations.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 01/2009; 24(12):2819-26. · 0.83 Impact Factor