Presentation (CTI)

OBJECTIVES: A value framework's cost categories determine which technologies it can value. Mexico's Consejo de Salubridad General (CSG) guide scopes admissible costs to use of the input, excluding caregiver direct medical costs and other foreseeable downstream costs. We examined whether this exclusion recurrently undervalues preventive technologies across two disease types: a degenerative condition and the sequelae of an acute event.
METHODS: We combined a documentary analysis of the CSG evaluation guide (GEI, January 2023), the binding framework for formulary inclusion, with qualitative care-pathway evidence from two conditions: Alzheimer's disease (14 interviews) and post-stroke spasticity (a separate interview series with patients, caregivers, neurologists, and orthopedists). We traced how excluded cost categories map to undervalued technologies and to concrete pathway consequences.
RESULTS: In both conditions, a foreseeable cost accruing to the same public payer fell outside the guide's input-linked categories. In Alzheimer's disease, caregiver health was unrecognized, so technologies improving caregiver health could register no benefit; because caregivers sustain the pathway, their untreated collapse accelerated and returned costs to the same payer. In post-stroke spasticity, caregiver burden and downstream complications such as ulcers and infections accrued to the same payer, yet sat outside admissible categories, so spasticity-reducing care was undervalued. The cost accumulated through slow progression in one case and through complications of an acute event in the other, yet the exclusion was identical: the guide ties cost scoping to input use, leaving foreseeable consequences uncounted.
CONCLUSIONS:

The same exclusion held across a degenerative condition and an acute-event sequela, placing the gap in the framework itself. Its cost categorization excluded costs the payer ultimately bears, undervaluing technologies that would prevent them. Because the guide already permits a complementary social perspective, findings point to consequence-linked cost categories that admit caregiver direct medical and other foreseeable same-payer costs, so assessment reflects costs the payer already incurs.