Natalia Espinola

Atopic dermatitis (AD) is a chronic inflammatory skin condition with a multidimensional burden. This study aimed to estimate the socioeconomic burden of the pediatric and adult population with AD in Argentina and explore the health system's response to their needs. We employed a mixed-methods approach, combining a cross-sectional cost-of-illness analysis with a qualitative component to comprehensively assess the social and economic impact of atopic dermatitis in Argentina. We collected data from a survey, focus group and in-depth interviews conducted in Argentina between May 2023 and September 2023. We recruited adult patients and caregivers of children with AD below 18 years of age. We used multivariable ordinal regression to assess associations between sociodemographic and clinical characteristics and burden associated with AD. 1471 subjects participated in the pediatric analysis, and 1412 in the adult analysis. The average annual per capita cost was USD 2639 for adults with AD and USD 8682 for children with AD. Costs increased significantly with disease severity in both groups and were strongly associated with patients' quality of life. Patients and caregivers highlighted the poor response of the health system in terms of adequate and timely access, as well as comprehensive care of the disease. Patients and caregivers suffer from a significant economic burden and quality of life impact associated with AD, which requires urgent attention and comprehensive support from the healthcare system to improve their lives.

Background: Influenza imposes a substantial burden on Argentina, particularly among adults aged 50–64 with comorbidities and those aged ≥65. The adjuvanted trivalent influenza vaccine (aTIV) has shown superior effectiveness compared with non-adjuvanted vaccines; however, its cost-effectiveness and budget impact in the 50–64 high-risk population have not been assessed nationally. This study evaluates the cost-effectiveness and budget impact of introducing aTIV for high-risk adults aged 50–64, alongside its use in adults aged ≥65, compared with standard-dose trivalent influenza vaccine (SD-TIV) from the Argentine health care system perspective. Methods: A decision-analytic static model was used to compare aTIV with SD-TIV over a single influenza season. In addition, a 5-year budget impact analysis (BIA) was conducted under scenarios of progressive uptake. Model inputs were derived from international literature, local data, and expert opinion. Deterministic and probabilistic sensitivity analyses were performed. Results: Compared with SD-TIV, aTIV yielded a lifetime gain of 1489 quality-adjusted life-years (QALYs) at an incremental cost of USD 8.34 million, resulting in an incremental cost-effectiveness ratio (ICER) of USD 5599 per QALY gained—well below Argentina’s cost-effectiveness threshold (USD 11,059/QALY). Higher vaccine acquisition costs were largely offset by reductions in outpatient visits and hospitalizations. The BIA showed a modest average annual per-member-per-month increase of USD 0.0025, remaining below the estimated budget impact threshold (USD 0.0065). Conclusions: Implementing aTIV in adults aged ≥50 with risk factors would be cost-effective and affordable in Argentina. These findings support the consolidation and potential expansion of current vaccination strategies to reduce influenza burden.

Some immunosuppressive disorders have shown substantially lower protection after COVID-19 vaccination against severe outcomes. Therefore, pre-exposure prop

Este estudo buscou estimar a carga da doença, social e econômica do tabagismo no Brasil em 2022 e prever os benefícios do aumento de impostos, com a inclusão dos efeitos do mercado ilegal. Aplicou-se um modelo de microsimulação probabilística de Markov no qual indivíduos a partir de 35 anos foram acompanhados em coortes hipotéticas, quantificando as mortes, os eventos de saúde, o custo direto da assistência médica e o custo indireto por perda de produtividade. Foi desenvolvido um modelo para estimar os ganhos em termos de saúde e econômicos a partir de cenários de aumento de impostos em dez anos. Obteve-se os dados de prevalência do tabagismo, da estrutura demográfica brasileira, de mortalidade e morbidade em bases de dados oficiais e na literatura. Os recursos de saúde utilizados foram obtidos por meio da literatura e de consultas a especialistas. O tabagismo causou 174 mil mortes e 5,7 milhões de anos de vida perdidos por morte prematura e por incapacidade. A carga econômica foi de R$ 153 bilhões, sendo R$ 67 bilhões atribuídos ao custo direto e R$ 45 bilhões ao custo indireto. O custo do cuidador informal alcançou R$ 41 bilhões. No cenário com o mercado ilegal de produtos do tabaco, um aumento de 50% no preço dos cigarros tem o potencial de gerar benefícios econômicos de R$ 161 bilhões em dez anos. A Reforma Tributária atualmente em curso é oportuna para que o país possua uma política de preços e impostos permanente.

Objectives. To estimate the economic burden and disease burden associated with tobacco use in Peru and the projected effect of strengthening specific tobacco control measures. Materials and methods. We used a Markov microsimulation model to assess smoking-attributable mortality, disease events, economic costs, and projected benefits over ten years, considering the implementation of measures such as plain packaging, full enforcement of smoke-free laws, a complete ban on tobacco advertising, promotion, and sponsorship, and increased cigarette taxes. Results. Each year in Peru, approximately 22,350 deaths and 126,000 disease events are attributable to tobacco use, accounting for 19% of all deaths from heart disease, 18% of deaths from stroke, and 515,768 years of life lost. In addition, approximately 1.28% of gross domestic product is lost annually due to smoking. Over ten years, the implementation of plain packaging could prevent 6,218 deaths, 31,700 events, and save 576 million USD. Full compliance with smoke-free places would prevent 4,982 deaths, 25,400 events, and save 461 million USD. Banning advertising, promotion, and sponsorship could prevent 8,767 deaths, 44,700 events, and save 812 million USD. Increasing cigarette prices by 50% could prevent 20,400 deaths, 658,400 healthy life years lost, and an economic benefit of more than 3.3 billion USD. Conclusions. The economic and disease burden of tobacco use in Peru is significant. Greater efforts to control tobacco would significantly reduce this burden.

The COVID-19 pandemic imposed a substantial burden on healthcare systems worldwide, yet reliable data on COVID-19 morbidity, mortality, and healthcare costs in Latin America remain limited. This study explored the disease and economic burden of COVID-19 in Argentina, Brazil, Chile, Colombia, Mexico, and Peru during the pre-vaccination period. Using national databases and a systematic review of the literature, we analyzed data on adults aged 18 and older, reporting cases, death rates, years of life lost, excess mortality, and direct medical costs. Before vaccination programs began, the average COVID-19 incidence rate was 6741 per 100,000 adults. Of these, 91% were mild cases, 7% moderate/severe, and 2% critical. Among 2,201,816 hospitalizations, 27.8% required intensive care, and 17.5% required mechanical ventilation. Excess mortality ranged from 76 to 557 per 100,000, and years of life lost spanned 241,089 to 3,312,346. Direct medical costs ranged from USD 258 million to USD 10,437 million, representing 2–5% of national health expenditures. The findings highlight significant variability across countries and provide crucial insights to help policymakers to make informed decisions and allocate resources effectively to improve national strategies around surveillance, preventive and treatment strategies to control the spread of COVID-19 disease in the future.

Objetivos. Sintetizar la evidencia sobre el impacto de la implementación de la prohibición de publicidad, promoción y patrocinio (PPP) de bebidas azucaradas (BA) en términos de disminución de consumo, exposición publicitaria y desenlaces clínicos relevantes. Materiales y métodos. Revisión sistemática de estudios publicados entre 2001-2021 en las bases de datos PubMed, Embase, Global Health, CINAHL y LILACS escritos en inglés, portugués o español. Se incluyeronestudios experimentales, observacionales y modelos económicos. Se evaluó el riesgo de sesgo mediante RoB2, Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group y Consolidated Health Economic Evaluation Reporting Standards 2022. Se realizó una síntesis descriptiva de los estudios. Resultados. Se seleccionaron 11 de 1146 estudios identificados. Debido a la heterogeneidad en los desenlaces no fue posible realizar un meta-análisis. Las intervenciones incluidas correspondieron a una política integral; restricciones de publicidad televisiva, de promociones, en punto de venta y en escuelas. Se hallaron cambios en desenlaces clínicos (obesidad, enfermedad cardiovascular, diabetes, cáncer), de índole económica (compra, venta, costo-efectividad, otros desenlaces económicos), en exposición y en consumo. La mayoría de las medidas de efecto evaluadas registraron disminuciones a partir de las intervenciones. Aún hacen falta más estudios sobre políticas efectivamente implementadas. Los resultados de los trabajos incluidos deben ser interpretados contemplando sus limitaciones metodológicas. Conclusiones. Las políticas de restricción de la PPP de las BA pueden resultar efectivas, sobre todo para disminuir su consumo en niños, niñas y adolescentes, impactando positivamente en su salud.

Lung cancer (LC) is a leading cause of cancer mortality in Argentina. Low-dose computed tomography (LDCT) had demonstrated higher efficacy than chest radiography as a screening method for early detection and reducing LC mortality. This study estimates the Budget Impact of implementing annual LDCT screening for individuals aged 55-74 with at least 30 pack-years of smoking in Argentina. A budgetary impact model for a dynamic cohort was developed from the Argentine health system's perspective, accounting for LC incidents, prevalents and death probability, distinguishing by disease stage and survival years. Model parameters were sourced from literature and official databases, with costs expressed in 2023 USD. In Argentina, 726,420 individuals were eligible for annual LC screening. The average annual budget was USD 196,611,452 in the current scenario and USD 207,439,560 in the projected scenario, leading to a 5.20% incremental cost due to more false positives in LDCT and screening costs. The budget impact per member per month was USD 0.019, slightly above the estimated threshold of USD 0.015. The introduction of LDCT for LC screening increased the health system budget in Argentina but improved early disease detection.

Introduction and objective: The COVID-19 pandemic had a significant disease burden on the healthcare system worldwide. There is limited reliable national data on COVID-19 associated morbidity, mortality, and healthcare costs in Latin America. This study explored the COVID-19 disease and economic burden in Argentina, Brazil, Chile, Colombia, Mexico, and Peru in the pre-vaccination period. Methods: We analyzed national databases and conducted a systematic review of the published literature on COVID-19 in adults aged 18 years and above. We reported cases, death rates, years of life lost, and excess mortality associated with COVID-19 in pre-vaccination period. In addition, we used a cost of illness analysis to estimate the direct medical costs associated with COVID-19. All costs are reported in US dollars as of 2023. Results: Before the national COVID vaccination program rollout, the average incidence rate of COVID-19 in adults aged 18 and above was 6,741 per 100,000 persons. Approximately 91% of the cases were mild, 7% were moderate/severe, and 2% were critical. Among 2,201,816 hospitalized cases, 27.8% were in intensive care, and 17.5% required mechanical ventilation. The country-specific data varied greatly across Latin American countries, with hospitalization admission: 469-18,096 per 100,000, excess mortality: 76-557 per 100,000, and years of life lost: 241,089-3,312,346. Direct medical costs ranged from US$258 million to US$10,437 million, representing approximately 2%-5% of national health expenditure. Conclusion: COVID-19 imposed a substantial public health and economic burden on Latin American countries during the pre-vaccination period. The findings should help policymakers to make informed decisions and allocate resources effectively to improve national strategies around surveillance, preventive and treatment strategies to control the spread of COVID-19 disease in the future.