the economic burden of cardiovascular disease in mexico

HOW DO WE DEAL WITH The economic burden of

CV disease in MexicoACC CHICAGO 2016

Dr. Fernando Petersen-Aranguren, F.A.C.C.

AGENDA

• Mexico´s numeralia and health system

• Principal causes of death• Obesity• Hypertension and CV diseases• Diabetes• INITIATIVES• Final remarks

Some Data from MexicoTotal population (2010) 112,336,538

Life expectancy at birth m/f (years) 72/78

Gross domestic income per capita (2011) $16,588

Probability of dying under 5 years (per 1,000 live births) 16

Probability of dying between 15 and 60 years m/f (per 1,000 population)

177/95

Total expenditure on health per capita (2010) $959

Total expenditure on health as GDP (2010) 6.3

Population covered by social security 64.5%

Source: INEGI

Distribution of causes of Death in Mexico, 1955-2030

Communicable diseases, reproductive and malnutrition

Non communicable diseases

Injuries Source: INEGI

Rising prevalence of diabetes mellitus and risk factors in Mexico

Perspectives in Public Health published online 27 November 2013

Epidemiological transition in Mexico (1955-2005)

Source: INEGI

Theoretical values in (US$/DALY) for cost-effectiveness based on the “three times GDP per capita” approach proposed in the WHO Report (2002)

* 1 GDP

** DALY (Disability-Adjusted Life-Year)

Source: World Bank, 2011

Mortality from cardiovascular diseases (age-standarised rates per 100 000 pop.)

MEXICO MEDIA OECD RANGE

2012 2000 2012 2000

272.9 298.1 296.4 428.5 14 out of 34

Salud pública de México / vol.44, no.1, enero-febrero de 2002

Out-of-pocket payments for health care (% health expenditure)

MEXICO MEDIA OECD RANGE

2012 2000 2012 2000

45.2 50.9 19.0 20.5 1 out of 34

Salud pública de México / vol.44, no.1, enero-febrero de 2002

HYPERTENSION

Salud pública de México / vol.44, no.1, enero-febrero de 2002

HYPERTENSION IN MEXICO

Total Annual Expenditure

Percentage of health spending

Percentage of Gross domestic product (GDP)

$17 953 908 480 13.95% 0.71%

$65 854 802 752 51.17% 2.61%

Average Scenario

Xtreme Scenario

HYPERTENSION• The annual cost per patient with hypertension was:

$1,067 in the standard scenario $3,913 in the extreme scenario.

• The annual expenditures from hypertension corresponded to 13.95% of the budget allocated to health care and to 0.71%, of Mexico’s GDP.

• These figures changed to 51.17% and 2.61% in the extreme scenario, respectively.

Salud pública de México / vol.44, no.1, enero-febrero de 2002

MEXICO’S CONTEXT IN DIABETES•Every 2 hours die 5 persons with Diabetes (premature mortality)

•From every 100 diabetics, 14 develop renal failure

•30% of diabetic foot end up in amputation

•10% will develop neuropathy

•2 out of 5 diabetcs will develop blindness

•From 13-18% of all gross expenditure in the health system will be devoted to Diabetes

•30-35% of diabetics do not know of their disease

Countries that spend more in diabetes

1.- USA2.- Germany3.-Japan4.-France5.-Canada6.-Italy7.- Great Britain8.- Spain9.- China10.- México

Ping Zhang et al, Diabetes Res & Clin Practice, 2010.

FindingDulcinea The Librarian for the Internet Age

“An abundance of information yields a poverty of attention.” Herb Simon

Direct, indirect, and total costs attributable to diabetes in three main public institutions of the Mexican health care system (in U.S. dollars, year of estimation 2005).

Armando Arredondo, and Alexis Zúñiga Dia Care 2004;27:104-109

©2004 by American Diabetes Association

Financial requirements to satisfy health care service demand by type of institution, comparing diabetes versus hypertension.

Armando Arredondo, and Alexis Zúñiga Dia Care 2004;27:104-109

©2004 by American Diabetes Association

FOR EVERY $100 PESOS SPENT IN DIABETES IN MEXICO

52 PESOS ARE PAID BY THE PATIENT OR FAMILY

30 PESOS BY THE SOCIAL SECURITY SERVICE

11 PESOS BY THE DEPARTMENT OF HEALTH

7 PESOS BY THE HEALTH SERVICE FOR THE GOVERMENT EMPLOYEES

COMPARING COST BY HOSPITAL VS AMBULATORY

•92 PESOS ARE PAID FOR HOSPITAL MANAGEMENT

•8 PESOS ARE FOR AMBULATORY CARE

Arredondo A et al, INSP-CONACYT-IDRC,2012

In México diabetes cost 778 millions 427,475 dólares, just in 2010, according to Dr Armando Arredondo, principal investigator and author of the study Costs for Diabetes in Latin America. Published in  Value in Health (vol 14, junio 2011). 

Every patient with Diabetes in Mexico costs 708 dóllars a year The health system spents 15% of its total budget to combat diabetes and is expected to be rising progresively.

www.cnnmexico.com

Mortality Rates for Mexico and Its Regions

Mexico’s regions

Comparison withother countries

Ca, cancers; Cir, liver cirrhosis; Com, communicable; CVD, cardiovascular; DM, diabetes; Inj, injuries; Mat, maternal, perinatal, and nutritional; NCom, other noncommunicable; NP, neuropsychiatric.

www.plosmedicine.org

Leading Causes of Death in Mexico by Disease

www.plosmedicine.org

Leading Causes of Death in Mexico by Risk Factor

www.plosmedicine.org

Mexico’s Health System

Salud pública de méxico / vol. 53, suplemento 2 de 2011

Mexico’s Health System

Salud pública de méxico / vol. 53, suplemento 2 de 2011

CASALUD: an innovative healthcare system to control and prevent non-communicable diseases in Mexico

Perspectives in Public Health published online 27 November 2013

CASALUD

Perspectives in Public Health published online 27 November 2013

De los países registrados en la OCDE, México se queda atrás en cuanto a los recursos destinados en salud; en promedio, los países invierten 8.9% de su PIB en salud. España invierte casi el 10% de su PIB en materia de salud, México sólo un rezagado 6.2%.

OECD Health Statistics 2015

OECD Health Statistics 2015

OECD Health Statistics 2015

OECD Health Statistics 2015

OECD Health Statistics 2015

OECD Health Statistics 2015

www.codigoinfarto.mx

Protocol

Protocols FOR HELP

Phone call reception “ call center” to CECOMMedical guidelines for NSTEAMIMedical guidelines for STEMIGuidelines for chest pain Fast acting team, intervention.Triptic for chest pain

www.codigoinfarto.mx

PREVEN

www.imss.gob.mx

CONCLUSION• The economic burden of CV disease in Mexico is nowadays

shared by the Public and Private sectors.• The investment of represents around 7% of the GIP• As non comunnicable diseases increase, the capability of the

established health system will collapse• A very important economic evaluation and private-public

participation is needed to cope with the very obscure foresight