Economic dimensions of selected NCDs in Latin America and the Caribbean: characterization of studies based on a systematic search Carla Castillo-Laborde Pablo Villalobos-Dintrans

Background The importance of NCDs Demographic and epidemiological transition Life style and risk factors High prevalence High burden of disease (worldwide) – 2004: 48% of total DALY (WHO, 2008) – 2010: 54% of total DALY (Murray et al., 2012) 11,8% cardiovascular and circulatory 7,6% cancer CDs 7% in countries with advanced demographic and epidemiological transition 67-71% Sub Saharan Africa

Background High economic burden Productivity Working days lost Premature death Health system – Direct costs – Health expenditure – Financial coverage Cost effectiveness Individuals – Out-of-pocket spending

Objective The main objective of this research is contributing to identify information gaps on the economic dimensions associated to NCDs in Latin America and the Caribbean during the period

Methods A systematic search of articles available at the Virtual Library in Health (BVS) was conducted ( ). The review of articles considered the following criteria (previously established): – Period – Focus on Latin America and the Caribbean – Economic studies – Prioritized NCDs Cancer Diabetes Cardiovascular diseases Respiratory diseases Risk factors

Methods The final selection and review included articles regarding: – Costs – Economic impact (mainly macro) – Economic evaluations – Socioeconomic analysis …on the four prioritized NCDs (cancer, respiratory diseases, cardiovascular diseases, and diabetes) and their risk factors. The selected articles were characterized considering the country under analysis, year of publication, type of NCD, specific disease under analysis and type of study among others.

Results: selection Original search: 2,678 Repeated articles: 2,246 (433 eliminated) Titles review: 456 (1,790 eliminated) Abstracts review: 285 (170 eliminated) *LAC, Economics, NCDs

Results: by country

Results: by NCDs

Results: by economic study

Results: by year of publication

Results: affiliation Some of the most frequently mentioned institutions: Fundación Osvaldo Cruz, Brasil Hospital Italiano, Buenos Aires, Argentina Instituto Mexicano del Seguro Social (IMSS), México Instituto Nacional de Salud Pública, Cuernavaca, México Instituto de Efectividad Clínica y Sanitaria (IECS), Argentina Secretaria de Salud, México Universidad de Chile, Chile Universidad de Puerto Rico, Puerto Rico Universidade de Saao Paulo, Brasil Universidade Federal do Rio Grande do Sul, Brasil Universidade Federal do Sao Paulo, Brasil Universidad Nacional de Colombia, Colombia University of the West Indies, Jamaica *Some institutions from non LAC countries were identified, for instance: Harvard University, John Hopkins University, LSHTM

Results: funding Most frequently: Councils of Science and Technology (CNPq in Brasil, CONACyT in Mexico, Colciencias in Colombia); Ministries and Departments of Health; the pharmaceutical industry.

Results: NCDs by country

Results: type of study by country

Results: NCDs by year

Results: economic study and year

Results: economic study and NCDs Otros incluye: Aspergilosis invasora en pacientes oncológicos pediátricos, carcinoma hepatocelular, enfermedad ósea metastásica, esófago, faringe, laringe, mieloma múltiple, neutropenia febril, próstata, tumores y vesícula.

Results: economic study and cancer *Others include: invasive aspergilosis in pediatric oncology patients, hepatocellular carcinoma, metastatic bone disease, esophageal, pharyngeal, laryngeal, multiple myeloma, febrile neutropenia, prostatic, tumors and gallbladder.

Results: economic study and risk factor

Results: economic study an respiratory diseases *Others include: severe chronic hypoxemic, lung hidatidosis, rhinosinusitis, rhinitis, respiratotory disease in general.

Results: economic study and cardiovascular disease *Others include: cardiovascular diseases in general, high cardiovascular risk, mediastinitis, ostium secundum atrial septal defects, coronary artery disease, prevention, coronary lesions, risk for sudden death, supraventricular tachycardia, valvular heart disease.

Discussion The study represents a general overview regarding the economic research on NCDs in Latin America and the Caribbean – What has been studied? How? When? Where? There is a growing trend in the number of studies since the year 2000, more than tripling the number of publications between 2000 and Most of the studies are based on Brazil, Mexico, Colombia and Argentina. Among the reviewed articles, the most studied NCD was cancer, specifically cervical and breast cancer. One condition that also presented a high number of studies was asthma, as well as the risk factors like tobacco consume and obesity and/or nutritional status. About 90% of the studies use a cost (30%), economic gradient (30%), and economic evaluation approach. The remaining 10% correspond to analyses using an economic impact framework.

Discussion Is it enough? – Despite the importance of NCDs in terms of their sanitary and economic burden, it seems that the number of related studies in LAC is still limited and highly concentrated in four countries. – What about the other countries? Is it possible to transfer results? What other information do we need in order to properly inform health decisions and planning at the regional and national level? – In order to support the decision making process in the health policy area it urges to promote these kind of studies in the region. – It is required a structured planning on the research conducted in this area, in order to close the existing information gaps (in terms of the countries and the diseases analyzed, and in terms of the methodological approaches). – The Pan-American Health Organization, as the coordinator of the health policies in the region, plays a key role in this endeavor. Limitations – Mental and behavioral disorders not included – Just BVS indexed publications International organizations Other ‘grey literature’ – Systematic review (methodologies and results)