Institute for Clinical Effectiveness and Health Policy

Buenos Aires, Argentina

Institute for Clinical Effectiveness and Health Policy

Buenos Aires, Argentina
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Pattinson R.,University of Pretoria | Kerber K.,Saving Newborn Lives Save the Children | Buchmann E.,University of Witwatersrand | Belizan M.,University of Pretoria | And 9 more authors.
The Lancet | Year: 2011

The causes of stillbirths are inseparable from the causes of maternal and neonatal deaths. This report focuses on prevention of stillbirths by scale-up of care for mothers and babies at the health-system level, with consideration for effects and cost. In countries with high mortality rates, emergency obstetric care has the greatest effect on maternal and neonatal deaths, and on stillbirths. Syphilis detection and treatment is of moderate effect but of lower cost and is highly feasible. Advanced antenatal care, including induction for post-term pregnancies, and detection and management of hypertensive disease, fetal growth restriction, and gestational diabetes, will further reduce mortality, but at higher cost. These interventions are best packaged and provided through linked service delivery methods tailored to suit existing health-care systems. If 99 coverage is reached in 68 priority countries by 2015, up to 1·1 million (45) third-trimester stillbirths, 201 000 (54) maternal deaths, and 1·4 million (43) neonatal deaths could be saved per year at an additional total cost of US$10·9 billion or $2·32 per person, which is in the range of $0·96- 2·32 for other ingredients-based intervention packages with only recurrent costs. © 2011 Elsevier Ltd.


Mazzoni A.,Institute for Clinical Effectiveness and Health Policy | Althabe F.,Institute for Clinical Effectiveness and Health Policy | Liu N.H.,University of Nebraska - Lincoln | Bonotti A.M.,Maternal and Child Health Program | And 3 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2011

Background The striking increase in caesarean section rates in middle- and high-income countries has been partly attributed to maternal request. We conducted a systematic review and meta-analysis of women's preferences for caesarean section. Objectives To review the published literature on women's preferences for caesarean section. Search strategy A systematic search of MEDLINE, EMBASE, LILACS and PsychINFO was performed. References of all included articles were examined. Selection criteria We included studies that quantitatively evaluated women's preferences for caesarean section in any country. We excluded articles assessing health providers' preferences and qualitative studies. Data collection and analysis Two reviewers independently screened abstracts of all identified citations, selected potentially eligible studies, and assessed their full-text versions. We conducted a meta-analysis of proportions, and a meta-regression analysis to determine variables significantly associated with caesarean section preference. Main results Thirty-eight studies were included (n = 19 403). The overall pooled preference for caesarean section was 15.6% (95% CI 12.5-18.9). Higher preference for caesarean section was reported in women with a previous caesarean section versus women without a previous caesarean section (29.4%; 95% CI 24.4-34.8 versus 10.1%; 95% CI 7.5-13.1), and those living in a middle-income country versus a high-income country (22.1%; 95% CI 17.6-26.9 versus 11.8%; 95% CI 8.9-15.1). Authors' conclusions Only a minority of women in a wide variety of countries expressed a preference for caesarean delivery. Further research is needed to better estimate the contribution of women's demand to the rising caesarean section rates. © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.


Talbird S.E.,RTI Health Solutions | Taylor T.N.,Wayne State University | Knoll S.,Glaxosmithkline | Frostad C.R.,Glaxosmithkline | Marti S.G.,Institute for Clinical Effectiveness and Health Policy
Vaccine | Year: 2010

This study estimated the impact of routine vaccination of infants with a new 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on health outcomes and costs across the entire population in Canada, Germany, Mexico, and Norway. A compartmental, static model with a 1-year time period for a steady-state population that allowed for the incorporation of direct and indirect (i.e., herd immunity and serotype replacement) vaccine effects across all age groups was used. Cases of disease prevented, deaths prevented, life-years gained, quality-adjusted life-years gained, and incremental costs in the steady-state year were calculated for PHiD-CV compared with 7-valent pneumococcal conjugate vaccine (PCV-7). A short-term analysis was also conducted to estimate the incremental difference in disease and cost outcomes for the two vaccines within the first 10 years. All costs were in 2008 local currency. In all four countries, the model estimated that PHiD-CV prevented more cases of disease, prevented more deaths, and resulted in more life-years and quality-adjusted life-years compared with PCV-7 in both the short term and the steady-state year. Assuming price parity for the vaccines, the model projected that routine vaccination with PHiD-CV resulted in lower costs compared with PCV-7 in both the short term and the steady-state year. Scenario analysis showed the incremental cost savings for PHiD-CV compared with PCV-7 in the steady-state year were sensitive to assumptions regarding duration of vaccine efficacy. © 2010 Elsevier Ltd.


Goldenberg R.L.,Drexel University | McClure E.M.,University of North Carolina at Chapel Hill | Bhutta Z.A.,Aga Khan University | Belizan J.M.,Institute for Clinical Effectiveness and Health Policy | And 6 more authors.
The Lancet | Year: 2011

Stillbirth is a common adverse pregnancy outcome, with nearly 3 million third-trimester stillbirths occurring worldwide each year. 98 occur in low-income and middle-income countries, and more than 1 million stillbirths occur in the intrapartum period, despite many being preventable. Nevertheless, stillbirth is practically unrecognised as a public health issue and few data are reported. In this final paper in the Stillbirths Series, we call for inclusion of stillbirth as a recognised outcome in all relevant international health reports and initiatives. We ask every country to develop and implement a plan to improve maternal and neonatal health that includes a reduction in stillbirths, and to count stillbirths in their vital statistics and other health outcome surveillance systems. We also ask for increased investment in stillbirth-related research, and especially research aimed at identifying and addressing barriers to the aversion of stillbirths within the maternal and neonatal health systems of low-income and middle-income countries. Finally, we ask all those interested in reducing stillbirths to join with advocates for the improvement of other pregnancy-related outcomes, for mothers and their offspring, so that a united front for improved pregnancy and neonatal care for all will become a reality. © 2011 Elsevier Ltd.


Beratarrechea A.,Institute for Clinical Effectiveness and Health Policy | Lee A.G.,Fogarty International Center | Willner J.M.,Fogarty International Center | Jahangir E.,Fogarty International Center | And 2 more authors.
Telemedicine and e-Health | Year: 2014

Introduction: Rates of chronic diseases will continue to rise in developing countries unless effective and cost-effective interventions are implemented. This review aims to discuss the impact of mobile health (m-health) on chronic disease outcomes in low-and middle-income countries (LMIC). Materials and Methods: Systematic literature searches were performed using CENTRAL, MEDLINE, EMBASE, and LILACS databases and gray literature. Scientific literature was searched to identify controlled studies evaluating cell phone voice and text message interventions to address chronic diseases in adults in low-or middle-income countries. Outcomes measured included morbidity, mortality, hospitalization rates, behavioral or lifestyle changes, process of care improvements, clinical outcomes, costs, patient-provider satisfaction, compliance, and health-related quality of life (HRQoL). Results: From the 1,709 abstracts retrieved, 163 articles were selected for full text review, including 9 randomized controlled trials with 4,604 participants. Most of the studies addressed more than one outcome. Of the articles selected, six studied clinical outcomes, six studied processes of care, three examined healthcare costs, and two examined HRQoL. M-health positively impacted on chronic disease outcomes, improving attendance rates, clinical outcomes, and HRQoL, and was cost-effective. Conclusions: M-health is emerging as a promising tool to address access, coverage, and equity gaps in developing countries and low-resource settings. The results for m-health interventions showed a positive impact on chronic diseases in LMIC. However, a limiting factor of this review was the relatively small number of studies and patients enrolled, highlighting the need for more rigorous research in this area in developing countries. © 2014, Mary Ann Liebert, Inc.


Belizan J.M.,Institute for Clinical Effectiveness and Health Policy | Mumford S.,National Health Research Institute
Reproductive Health | Year: 2015

The editors of Reproductive Health would like to extend a sincere thank you to all our valued reviewers listed below who contributed to the journal in Volume 11 (2014). The journal has grown 63% in submissions and 43% in publications compared to 2013 and therefore the co-operation and dedicated time of peer reviewers is increasingly essential in order to move these manuscripts through the submission system so high quality research does not remain static and unpublished. We are very pleased to have a diverse range of reviewers from high, middle and low income countries, contributing to the dissemination of research findings in an open access journal. Please accept our sincerest and deepest thanks for your knowledge, time and continuing efforts. © 2015 Belizán et al.; licensee BioMed Central.


Sullivan S.D.,University of Washington | Mauskopf J.A.,RTI Health Solutions | Augustovski F.,Institute for Clinical Effectiveness and Health Policy | Jaime Caro J.,Evidera | And 7 more authors.
Value in Health | Year: 2014

Background Budget impact analyses (BIAs) are an essential part of a comprehensive economic assessment of a health care intervention and are increasingly required by reimbursement authorities as part of a listing or reimbursement submission. Objectives The objective of this report was to present updated guidance on methods for those undertaking such analyses or for those reviewing the results of such analyses. This update was needed, in part, because of developments in BIA methods as well as a growing interest, particularly in emerging markets, in matters related to affordability and population health impacts of health care interventions. Methods The Task Force was approved by the International Society for Pharmacoeconomics and Outcomes Research Health Sciences Policy Council and appointed by its Board of Directors. Members were experienced developers or users of BIAs; worked in academia and industry and as advisors to governments; and came from several countries in North America and South America, Oceania, Asia, and Europe. The Task Force solicited comments on the drafts from a core group of external reviewers and, more broadly, from the membership of the International Society for Pharmacoeconomics and Outcomes Research. Results The Task Force recommends that the design of a BIA for a new health care intervention should take into account relevant features of the health care system, possible access restrictions, the anticipated uptake of the new intervention, and the use and effects of the current and new interventions. The key elements of a BIA include estimating the size of the eligible population, the current mix of treatments and the expected mix after the introduction of the new intervention, the cost of the treatment mixes, and any changes expected in condition-related costs. Where possible, the BIA calculations should be performed by using a simple cost calculator approach because of its ease of use for budget holders. In instances, however, in which the changes in eligible population size, disease severity mix, or treatment patterns cannot be credibly captured by using the cost calculator approach, a cohort or patient-level condition-specific model may be used to estimate the budget impact of the new intervention, accounting appropriately for those entering and leaving the eligible population over time. In either case, the BIA should use data that reflect values specific to a particular decision maker's population. Sensitivity analysis should be of alternative scenarios chosen from the perspective of the decision maker. The validation of the model should include at least face validity with decision makers and verification of the calculations. Data sources for the BIA should include published clinical trial estimates and comparator studies for the efficacy and safety of the current and new interventions as well as the decision maker's own population for the other parameter estimates, where possible. Other data sources include the use of published data, well-recognized local or national statistical information, and, in special circumstances, expert opinion. Reporting of the BIA should provide detailed information about the input parameter values and calculations at a level of detail that would allow another modeler to replicate the analysis. The outcomes of the BIA should be presented in the format of interest to health care decision makers. In a computer program, options should be provided for different categories of costs to be included or excluded from the analysis. Conclusions We recommend a framework for the BIA, provide guidance on the acquisition and use of data, and offer a common reporting format that will promote standardization and transparency. Adherence to these good research practice principles would not necessarily supersede jurisdiction-specific BIA guidelines but may support and enhance local recommendations or serve as a starting point for payers wishing to promulgate methodology guidelines. © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR).


Jahangir E.,Institute for Clinical Effectiveness and Health Policy | Jahangir E.,Vanderbilt University | Irazola V.,Institute for Clinical Effectiveness and Health Policy | Rubinstein A.,Institute for Clinical Effectiveness and Health Policy
PLoS ONE | Year: 2012

Introduction: Health care utilization is an important step to disease management, providing opportunities for prevention and treatment. Anderson's Health Behavior Model has defined utilization by need, predisposing, and enabling determinants. We hypothesize that need, predisposing, and enabling, highlighting behavioral factors are associated with utilization in Argentina. Methods: We performed a logistic regression analysis of the 2005 and 2009 Argentinean Survey of Risk Factors, a cohort of 41,392 and 34,732 individuals, to explore the association between need, enabling, predisposing, and behavioral factors to blood pressure measurement in the last year. Results: In the 2005 cohort, blood pressure measurement was associated with perception of health, insurance coverage, basic needs met, and income. Additionally, female sex, civil state, household type, older age groups, education, and alcohol use were associated with utilization. The 2009 cohort showed similar associations with only minor differences between the models. Conclusions: We explored the association between utilization of clinical preventive services with need, enabling, predisposing, and behavioral factors. While predisposing and need determinants are associated with utilization, enabling factors such as insurance coverage provides an area for public intervention. These are important findings where policies should be focused to improve utilization of preventive services in Argentina. © 2012 Jahangir et al.


Requejo J.H.,Institute for International Programs | Belizan J.M.,Institute for Clinical Effectiveness and Health Policy
Reproductive Health | Year: 2013

The last innovation in operative vaginal delivery happened centuries ago with the invention of the forceps and the vacuum extractor. The World Health Organization Odon Device Research Group recently published a protocol for a feasibility and safety study for a new device (Odon device) which aims to revolutionize assisted vaginal delivery. This editorial discusses the device and its pathway to global use. Although preliminary results look promising, the rigorous three-phased WHO protocol needs completion before the device can be determined, based on the evidence, to be safe and effective. © 2013 Requejo and Belizán; licensee BioMed Central Ltd.


Ciapponi A.,Institute for Clinical Effectiveness and Health Policy | Alison L.,Institute Efectividad Clinica y Sanitaria | Agustina M.,Institute for Clinical Effectiveness and Health Policy | Demian G.,Institute for Clinical Effectiveness and Health Policy | And 2 more authors.
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2014

Background: In the developing world, COPD continues to be an under studied, diagnosed and treated disorder. In the present study, we analyzed the prevalence, mortality and resource utilization of COPD in Latin America and the Caribbean (LAC) in order to guide future research and public policies. Methods: A systematic review and meta-analysis was performed following MOOSE and PRISMA guidance. We searched CENTRAL, MEDLINE, EMBASE, LILACS, countries' Ministries of Health, proceedings, and doctoral theses from January 1990 to October 2012. We included studies with a validated definition of COPD that assessed the incidence, prevalence, use of health care resources or costs since 1985. Using EROS, a web-based software, pairs of reviewers independently selected, performed quality assessment (using a STROBE-based checklist) and extracted the study data. Discrepancies were resolved by consensus. Arcsine transformations and random-effects model were used for proportion meta-analyses. Results: 26 articles met entry criteria. The pooled COPD prevalence defined by GOLD criteria (11 cities, 6 countries) was 13.4% (95%CI, 10.1-17.1). Most patients suffer mild or moderate COPD and were undertreated according to international guidelines. The prevalence increased by age and was 1.75 times higher in men than women. 35 of every 1,000 hospitalizations were due to COPD, most of high economic cost, and the COPD in-hospital mortality ranged from 6.7% to 29.5%. Conclusions: COPD burden in LAC is high, especially for men and older persons; however few persons had severe disease. COPD patients often received inappropriate treatment and had high exacerbation and hospitalization rates leading to high economic costs. © 2014 Informa Healthcare USA, Inc.

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