7 results
Search Results
2. Water Expansions in Shantytowns: Health and Savings.
- Author
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GALIANI, SEBASTIAN, GONZALEZ-ROZADA, MARTIN, and SCHARGRODSKY, ERNESTO
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WATER supply ,WATER resources development ,ECONOMIC development projects ,ECONOMIC development ,ECONOMIC expansion ,ECONOMIC activity ,SUSTAINABLE development ,PUBLIC utilities ,COST effectiveness - Abstract
This paper examines the effects of the expansion of the water network in urban shantytowns in Argentina. We find large reductions in the presence, frequency and severity of diarrhoea episodes among children reached by network expansions relative to a control group. Moreover, expanded connections induce savings in water expenditures, as these families are able to substitute piped water for more expensive and distant sources of water provision. These health and savings effects are also important for households that previously had clandestine self-connections to the water network, which were free but of low quality. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
3. Cost-effectiveness of COVID-19 vaccination in Latin America and the Caribbean: an analysis in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru.
- Author
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Federico, Augustovski, Ariel, Bardach, Adrián, Santoro, Federico, Rodriguez-Cairoli, Alejandro, López-Osornio, Fernando, Argento, Maissa, Havela, Alejandro, Blumenfeld, Jamile, Ballivian, Germán, Solioz, Analía, Capula, Analía, López, Cintia, Cejas, William, Savedoff, Alfredo, Palacios, Adolfo, Rubinstein, and Andrés, Pichon-Riviere
- Subjects
COVID-19 vaccines ,COST control ,COST effectiveness ,RESOURCE allocation ,RESEARCH funding ,HEALTH planning - Abstract
Objective: Our study analyzes the cost-effectiveness of the COVID-19 vaccination campaigns in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. Methods: Using a previously published SVEIR model, we analyzed the impact of a vaccination campaign (2021) from a national healthcare perspective. The primary outcomes were quality adjusted life years (QALYs) lost and total costs. Other outcomes included COVID-19 cases, hospitalizations, deaths, and life years. We applied a discount rate of 3% for health outcomes. We modeled a realistic vaccination campaign in each country (the realistic country-specific campaign). Additionally, we assessed a standard campaign (similar, "typical" for all countries), and an optimized campaign (similar in all countries with higher but plausible population coverage). One-way deterministic sensitivity analyses were performed. Findings: Vaccination was health improving as well as cost-saving in almost all countries and scenarios. Our analysis shows that vaccination in this group of countries prevented 573,141 deaths (508,826 standard; 685,442 optimized) and gained 5.07 million QALYs (4.53 standard; 6.03 optimized). Despite the incremental costs of vaccination campaigns, they had a total net cost saving to the health system of US$16.29 billion (US$16.47 standard; US$18.58 optimized). The realistic (base case) vaccination campaign in Chile was the only scenario, which was not cost saving, but it was still highly cost-effective with an ICER of US$22 per QALY gained. Main findings were robust in the sensitivity analyses. Interpretation: The COVID-19 vaccination campaign in seven Latin American and Caribbean countries -that comprise nearly 80% of the region- was beneficial for population health and was also cost-saving or highly cost-effective. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
4. Cost-effectiveness in unstable economies: the case of sacubitril/valsartan in heart failure with reduced ejection fraction in Argentina.
- Author
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Giorgi, Mariano A., Boissonnet, Carlos P., Luque, Paula Soledad, Piastrella, Jimena, Porley, Carlos, Ditata, Fernanda, and Volman, Sergio
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ENTRESTO ,VENTRICULAR ejection fraction ,VALSARTAN ,COST effectiveness ,HEART failure - Abstract
Background: Sacubitril/valsartan (an Angiotensin receptor-neprilysin inhibitor—ARNI) is one of the cornerstones in the management of patients with heart failure with reduced ejection fraction (HFrEF) having demonstrated significant reductions in both mortality and hospitalisations as compared with enalapril. It proved to be a cost-effective treatment in many countries with stable economies. In Argentina, a country with chronic financial instability and a fragmented health care system, the estimation of its cost-effectiveness requires to consider local financial data. Objectives: To estimate the cost-effectiveness of sacubitril/valsartan in HFrEF in Argentina. Methods: We populated an Excel-based cost-effectiveness model, previously validated, using inputs from the pivotal phase-3 PARADIGM-HF trial and from local sources. As the main problem to consider was the financial instability, we adopted a differential approach to cost discounting based on the opportunity cost of capital. Thus, a discount rate for costs were set at 31.6%, using the BADLAR rate published by the Central Bank of Argentina. Discount for effects were set at 5% as is the current practice. Costs were expressed in Argentinian pesos (ARS). We used the perspective for both the social security and private payers at a 30-year horizon. The primary analysis was the incremental cost-effectiveness ratio (ICER) versus enalapril, the previous standard of care. Alternative scenarios performed included a 5% cost discount rate and 3 a 5-year horizon (as is usually used). Results: In Argentina the cost-per quality adjusted life-year (QALY) gained for sacubitril/valsartan versus enalapril was 391,158 ARS and 376,665 ARS for a social security and a private payer, respectively, at a 30- year horizon. These ICERs were under the cost- effectiveness threshold of 520,405.79 ARS (1 Gross domestic product (GDP) per capita) suggested by Argentinian health technology assessment bodies. Probabilistic sensitivity analysis showed an acceptability of sacubitril/valsartan as a cost-effective alternative of 86.40% and 88.25% for social security and private payers, respectively. Conclusion: Sacubitril/valsartan is a cost-effective treatment in HFrEF using local inputs that considered the financial instability. For both payers considered the cost per QALY gained are under the cost-effectiveness threshold considered. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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- View/download PDF
5. Comparing Strategies for Lipid Lowering in Argentina: An Analysis from the CVD Policy Model-Argentina.
- Author
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Konfino, Jonatan, Fernandez, Alicia, Penko, Joanne, Mason, Antoinette, Martinez, Eugenio, Coxson, Pamela, Heller, David, Moran, Andrew, Bibbins-Domingo, Kirsten, Pérez-Stable, Eliseo, Mejía, Raul, and Pérez-Stable, Eliseo J
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CARDIOVASCULAR disease prevention ,HEALTH policy ,STATINS (Cardiovascular agents) ,PUBLIC health ,MEDICAL care ,ANTILIPEMIC agents ,CARDIOVASCULAR diseases ,COMPARATIVE studies ,COST effectiveness ,HIGH density lipoproteins ,LOW density lipoproteins ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL protocols ,PREVENTIVE health services ,RESEARCH ,RESEARCH funding ,EVALUATION research ,ECONOMICS - Abstract
Introduction: In Argentina, the national guidelines for lipid control emphasize the use of relatively inexpensive low- or moderate-potency statins by patients at high risk (>20 %) of a cardiovascular event. The objective of this study was to compare the impact and costs of the current national CVD prevention guidelines with regard to morbidity and mortality in Argentina with the impact and costs of three strategies that incorporate high-potency statins.Methods: We used the CVD Policy Model-Argentina to model the proposed interventions. This model is a national-scale, state-transition (Markov) computer simulation model of the CVD incidence, prevalence, mortality, and costs in adults 35-84 years of age. We modeled three scenarios: scenario 1 lowers the risk threshold for treatment to >10 % according the Framingham Risk Score (FRS); scenario 2 intensifies statin potency under current treatment thresholds; and scenario 3 combines both scenarios by lowering the treatment threshold to ≥10 % FRS and intensifying statin potency.Results: Scenario 1 would translate into 1400 fewer MIs and 500 fewer CHD deaths every year, a 3 % and 2 % reduction, respectively. Scenario 2 would lead to 2000 fewer MIs and 1000 fewer CHD deaths every year. Scenario 3 would result in the greatest reduction in MIs and CHD deaths, with 3400 fewer MIs and 1400 fewer CHD deaths every year, which translates to a 7 % and 6 % reduction, respectively. All scenarios were cost-effective if the cost of a high-potency statin pill was under US$0.25.Conclusion: Incorporating those individuals with greater than 10 % cardiovascular risk and the use of high-potency statins into Argentina's national lipid guidelines could result in fewer CHD deaths and events at a reasonable cost. [ABSTRACT FROM AUTHOR]- Published
- 2017
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6. A multimodal intervention to improve hand hygiene in ICUs in Buenos Aires, Argentina: a stepped wedge trial.
- Author
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RODRIGUEZ, VIVIANA, GIUFFRE, CAROLINA, VILLA, SILVIA, ALMADA, GRISELDA, PRASOPA-PLAIZIER, NITTITA, GOGNA, MONICA, GIBBONS, LUZ, ELORRIO, EZEQUIEL GARCÍA, GarcÍa Elorrio, Ezequiel, Argentinian Group Hand Hygiene Improvement, and García Elorrio, Ezequiel
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INTENSIVE care units ,COST effectiveness ,MEDICAL care ,COMBINED modality therapy ,CROSS infection prevention ,PREVENTION of communicable diseases ,COMPARATIVE studies ,HAND washing ,HEALTH facility employees ,LEADERSHIP ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL protocols ,RESEARCH ,RESEARCH funding ,EVALUATION research ,RANDOMIZED controlled trials - Abstract
Copyright of International Journal for Quality in Health Care is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2015
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7. Generalized cost-effectiveness analysis of a package of interventions to reduce cardiovascular disease in Buenos Aires, Argentina.
- Author
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Rubinstein, Adolfo, García Martí, Sebastián, Souto, Alberto, Ferrante, Daniel, and Augustovski, Federico
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COST effectiveness ,CARDIOVASCULAR diseases ,CHRONIC diseases ,SMOKING cessation ,HYPERTENSION ,HYPERCHOLESTEREMIA - Abstract
Background: Chronic diseases, represented mainly by cardiovascular disease (CVD) and cancer, are increasing in developing countries and account for 53% of chronic diseases in Argentina. There is strong evidence that a reduction of 50% of the deaths due to CVD can be attributed to a reduction in smoking, hypertension and hypercholesterolemia. Generalized cost-effectiveness analysis (GCE) is a methodology designed by WHO to inform decision makers about the extent to which current or new interventions represent an efficient use of resources. We aimed to use GCE analysis to identify the most efficient interventions to decrease CVD. Methods: Six individual interventions (treatment of hypertension, hypercholesterolemia, smoking cessation and combined clinical strategies to reduce the 10 year CVD Risk) and two population-based interventions (cooperation between government, consumer associations and bakery chambers to reduce salt in bread, and mass education strategies to reduce hypertension, hypercholesterolemia and obesity) were selected for analysis. Estimates of effectiveness were entered into age and sex specific models to predict their impact in terms of age-weighted and discounted DALYs saved (disability-adjusted life years). To translate the age- and sex-adjusted incidence of CVD events into health changes, we used risk model software developed by WHO (PopMod). Costs of services were measured in Argentine pesos, and discounted at an annual rate of 3%. Different budgetary impact scenarios were explored. Results: The average cost-effectiveness ratio in argentine pesos (ARS$) per DALY for the different interventions were: (i) less salt in bread $151; (ii) mass media campaign $547; (iii) combination drug therapy provided to subjects with a 20%, 10% and 5% global CVD risk, $3,599, $4,113 and $4,533, respectively; (iv) high blood pressure (HBP) lowering therapy $7,716; (v) tobacco cessation with bupropion $ 33,563; and (iv) high-cholesterol lowering therapy with statins $ 70,994. Conclusion: Against a threshold of average per capita income in Argentina, the two selected populationbased interventions (lowering salt intake and health education through mass-media campaigns) plus the modified polypill strategy targeting people with a 20% or greater risk were cost-effective. Use of this methodology in developing countries can make resource-allocation decisions less intuitive and more driven by evidence. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
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