CERGAS Seminar "A Microsimulation-Based Distributional Cost-Effectiveness Analysis of Pharmacological Strategies for Type 2 Diabetes Mellitus Refractory to Metformin in Chile."
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Type 2 diabetes mellitus (T2DM) constitutes a growing public health and economic challenge in Chile, particularly among patient's refractory to first-line Metformin therapy. This study develops a de-novo Distributional Cost-Effectiveness Analysis (DCEA) to evaluate alternative pharmacological strategies, integrating both efficiency and equity dimensions in resource allocation. While aggregate DCEA applications have recently been reported in Chile, this work represents—to our knowledge—the first microsimulation-based DCEA in the country, modelling individual-level disease trajectories to capture heterogeneity in risk, outcomes, and socioeconomic gradients in health.
A discrete-event simulation model was constructed to represent the progression of T2DM, drawing on UKPDS risk equations for event probabilities and calibrating baseline risk using data from the Chilean National Health Survey (NHS). The model quantifies the current economic burden of diabetes and conducts a comparative cost-effectiveness assessment of 14 pharmacological interventions available in Chile, including SGLT-2 inhibitors, GLP-1 receptor agonists, and sulfonylureas, against the reference regimen of Metformin plus Glibenclamide.
The DCEA framework extends the analysis by estimating the baseline social distribution of health, measured as quality-adjusted life expectancy (QALE) by sex and income quintile, and by modelling how alternative therapies modify this distribution through incremental health gains. Social welfare and dominance criteria are applied to identify strategies that jointly optimise efficiency and equity.
This work introduces an individual-level, equity-sensitive modelling framework for Chile, providing an analytical foundation for fairer and more transparent pharmaceutical reimbursement decisions in chronic disease management.
Speaker:
Carlos Balmaceda is a Health Economist and Postdoctoral Fellow at CeRGAS SDA Bocconi, working to the EU/EDCTP3-funded REACH-OUT project. He holds an MPhil in Health Economics from the Centre for Health Economics (CHE), University of York (UK) and an MSc in Epidemiology from Pontificia Universidad Católica de Chile. Before joining Bocconi, he founded and led Epsilon Research Consulting and served as senior researcher of the HTA Unit at Pontificia Universidad Católica de Chile. He has also worked as a consultant to the Inter-American Development Bank (IADB). His research interests centre on the development and application of advanced modelling methods—particularly microsimulation, value of heterogeneity, and distributional cost-effectiveness analysis (DCEA)—to support evidence-based and equity-oriented health policy decisions.
Link zoom:
Meeting ID:
945 8423 2291
Passcode:
403506
Lunch at the end of the meeting: for those willing to participate in person, click here before the 15th of October.