Presentation (CTI)

OBJECTIVES: In Argentina, the use of clinical practice guidelines is not mandatory to define coverage policies for medicinal products. This has led to substantial variability in prescribing patterns, particularly in high-cost areas such as oncology and oncohematology. To ensure rational resource use, healthcare providers have implemented Case-Management Programmes to assess the added value of each prescription and its alignment with national or international guidelines. We present the experience of the Value Assessment Committee of the Case-Management Programme (VAC-CMP) of a Social Security Provider covering 650,000 people.
METHODS: VAC-CMP integrates assessments of clinicians, HTA experts and administrators. We systematically reviewed Committee decisions using guidelines from the Argentinian Society of Hematology, the Argentinian Association of Clinical Oncology, ASCO, and ESMO as references. Each prescription was assessed regardless of cost considerations.
RESULTS: Between March 2021 and March 2025, 785 high-cost drug submissions were evaluated. Of these, 93 were for oncohematology and 152 for oncology, totaling 245 (31.2%). The rejection rate based on clinical value was 17.6% overall, 23.1% in oncology, and 8.6% in oncohematology. In 11% of cases, incomplete clinical information prevented proper assessment and in 39.5% of the cases the prescription was incorrect.
CONCLUSIONS: In our experience, the absence of a mandatory framework for guideline use resulted in the need for a time- and resource-intensive approval process. Almost one in five prescriptions reviewed lacked demonstrated added value. The use of a VA-CMP provided us a suitable strategy to deal with this statu quo. These cases raise concerns about the equity of healthcare resource allocation and highlight the importance of aligning prescribing practices with evidence-based guidelines to optimize therapeutic value and sustainability.