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Evidence-Informed Update of Argentina’s Health Benefit Package: Application of a Rapid Review Methodology

Part of: Special Collection - Methods

Published online by Cambridge University Press:  11 March 2022

Andrea Alcaraz Open the ORCID record for Andrea Alcaraz [Opens in a new window] ,
Verónica Alfie Open the ORCID record for Verónica Alfie [Opens in a new window] ,
Lucas Gonzalez ,
Sacha Virgilio ,
Sebastián Garcia-Marti ,
Federico Augustovski  and
Andrés Pichon-Riviere Open the ORCID record for Andrés Pichon-Riviere [Opens in a new window]
Andrea Alcaraz*
Affiliation:
Department of Health Technology Assessment and Economic Evaluation Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
Verónica Alfie
Affiliation:
Department of Health Technology Assessment and Economic Evaluation Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
Lucas Gonzalez
Affiliation:
Department of Health Technology Assessment and Economic Evaluation Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
Sacha Virgilio
Affiliation:
Department of Health Technology Assessment and Economic Evaluation Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
Sebastián Garcia-Marti
Affiliation:
Department of Health Technology Assessment and Economic Evaluation Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
Federico Augustovski
Affiliation:
Department of Health Technology Assessment and Economic Evaluation Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
Andrés Pichon-Riviere
Affiliation:
Department of Health Technology Assessment and Economic Evaluation Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
*
*Author for correspondence: Andrea Alcaraz, E-mail: [email protected]
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Abstract

Objectives

Argentina has a fragmented healthcare system with social security covering almost two thirds of the population. Its benefit package—called compulsory medical program (PMO; by its Spanish acronym Programa Médico Obligatorio)—has not been formally and widely updated since 2005. However, laws, clinical practice guidelines (CPGs), and a high-cost technology reimbursement fund complement it. Our objective was to comprehensively review such a PMO and propose an update considering the corresponding complementary sources.

Methods

We followed four steps: (i) identification of health technologies from the current PMO and complementary sources, (ii) prioritization, (iii) assessment through rapid health technology assessment (HTA), and (iv) appraisal and recommendations. We evaluated three value domains: quality of evidence, net benefit, and economics, which were summarized in a five-category recommendation traffic-light scale ranging from a strong recommendation in favor of inclusion to a strong recommendation for exclusion.

Results

Eight hundred fifty technologies were identified; 164 of those, considered as high priority, were assessed through rapid HTAs. Those technologies mentioned in laws and CPGs were mostly outpatient essential medicines, whereas those from the reimbursement system were mostly high-cost drugs; of these 101 technologies, 50 percent were recommended to be kept in the PMO. The other 63 (identified by the Superintendence of Health Services, technology producers, and patients) were mostly medical procedures and high-cost drugs; only 25 percent of those resulted in a favorable recommendation.

Conclusions

A methodology based on four clearly identified steps was used to carry out a comprehensive review of an outdated and fragmented benefit package. The use of rapid HTAs and a traffic-light recommendation framework facilitated the deliberative evidence-based update.

Keywords

Technology assessment healthHealth benefit packageDecision makingResource allocation
Type
Method
Information
International Journal of Technology Assessment in Health Care , Volume 38 , Issue 1 , 2022 , e24
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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Footnotes

We would like to thank researchers Cecilia Mengarelli, MD, and Silvana Cesaroni, MD, Daniel Comande, and Mónica Soria for their work as documentalists and Miss Gabriela Rodriguez for her administrative support. We would also like to thank Edgardo Von Ew and Eduardo Walter Salewsky (ISALUD University), Constantino Touloupas, MD, and Guadalupe Soulages, PharmD, for their research and technical cooperation during this project.

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