OBJECTIVES

Argentina has a fragmented healthcare system with social security being the largest (63,5% of the total population). Its benefits package -called Compulsory Medical Program (CMP)- was created in 2002 since then not formally updated. However, laws, clinical practice guidelines (CPG) and high-cost technologies reimbursement fund complement or interact with the CMP. Our objective was to comprehensively review and propose an update of the CMP; and to harmonize it with these other sources.

METHODS

We followed four steps, 1-Identification of health technologies from the current CMP and complementary sources; 2-Prioritization for formal evaluation, 3-Assessment through rapid health technology assessment reports on high priority technologies; and 4-Appraisal and preliminary recommendation to decision makers.

The information was presented weighting three domains: quality of the evidence, net benefit and economics, graphically summarized through a traffic-light scale that classified the technologies into five categories, from a strong inclusion recommendation to a strong exclusion recommendation.

RESULTS

850 technology-indication pairs were identified, 164 were identified as high priority; and seventy-five rapid review reports encompassing them were written for their assessment.

We split the technologies in two lists. The main list included technologies from laws, CPG and other mandatory sources that actually de facto modify the CMP. It included 101 technologies, of which 50% resulted with a favorable recommendation to keep in the benefits package. The complementary list was made with technologies identified from representatives from the superintendence of health services, industry and patient groups, and included 64 technologies; 75% had a non-favorable recommendation for their inclusion in the benefits package.

CONCLUSIONS

A methodology based on four clearly identified steps could be applied to carry out a comprehensive review of an outdated and fragmented benefits package.

The use of rapid-HTAs and a traffic light system recommendation supported decision makers in a useful way.