CÉSAR SANABRIA

@unmsm.edu.pe

Economista - Facultad de Ciencias Económicas
Universidad Nacional Mayor de San Marcos

Economist, Master, and Doctor in Economics from the Universidad Nacional Mayor de San Marcos. Principal Professor of the Faculty of Economic Sciences and Member of the Institute of Economic Research of the UNMSM. He held management positions in the Public Sector: Social Security, Municipalities, and University. He has extensive experience consulting and researching social projects and policies and health economics. In addition, he teaches at the postgraduate level in public and private universities in the country and abroad. He has publications on topics of his specialization and extensive participation in academic events.

EDUCATION

Economics at Universidad Nacional Mayor de San Marcos
Master in Economics at Universidad Nacional Mayor de San Marcos
PhD in Economics from Universidad Nacional Mayor de San Marcos

RESEARCH INTERESTS

Health economics
Outcomes research
Social political

FUTURE PROJECTS

Scopus Publications

222

Scholar Citations

Scholar h-index

Scholar i10-index

Scopus Publications

Cost-effectiveness of ceftazidime/avibactam for infections due to carbapenem-resistant bacteria in Peru
Rafael Bolaños-Díaz, Eddie Angles-Yanqui, Giancarlo Pérez-Lazo, and César Sanabria-Montañez
Oxford University Press (OUP)
Abstract Objectives The objective of this study was to analyse the cost-effectiveness (C-E) of ceftazidime/avibactam (CAZ/AVI)-based therapy versus colistin (COL)-based therapy for pneumonia and bacteraemia caused by carbapenem-resistant enterobacteria (CRE) adjusted to Peruvian context. Methods A Markov decision model was extrapolated from literature to evaluate the clinical and economic consequences of CAZ/AVI-based therapy compared to COL-based therapy for a hypothetical cohort of patients with CRE pneumonia or bacteraemia according to Peruvian context. It was adopted a 5-year time horizon and a Markov-cycle length of 1 year. All patients in the model were assigned to CRE pneumonia or bacteraemia state and may transit through four different health states: home-care, long-term care without dialysis, long-term care with dialysis or death. Key findings Intervention with CAZ/AVI becomes progressively more cost-effective from a threshold of S/ 24,000 or US$ 6666 (equivalent to 1 Gross Domestic Product-per cápita [GDP-pc]). The model simulation allowed to calculate an average total cost of S/ 2’971,582 (US$ 825,440) for CAZ/AVI against S/2’056,488 (US$ 571.247) for COL treatment, yielding an incremental cost of S/ 915,094 (US$ 254,193). The cost/QALY for CAZ/AVI treatment against COL therapy approaches to S/23,154 (US$ 6432), something less than 1 annual GDP-pc. There were additional benefits associated with CAZ/AVI in the 5-year horizon, such as: 21 deaths avoided, 86 hospital days avoided, 1 CRF5 avoided and a NMB of S/6649 (US$ 1847). Conclusions The present transferability model demonstrates the C-E of CAZ/AVI over COL for the treatment of bacteraemia and CRE pneumonia according to peruvian payment thresholds.

Cost patterns of care for patients with ischemic heart disease at the Instituto Nacional Cardiovascular, 2019
César Sanabria-Montañez, Jorge Cabrejos Polo, Adriel Raúl Olortegui Yzu, Herminio San Juan Lezama, Manuel Antonio Lama More, and Ricardo Villamonte Blas
Universidad Nacional Mayor de San Marcos, Vicerectorado de Investigacion
Introducción. La enfermedad isquémica del corazón (EIC) es actualmente un problema de salud pública en el Perú, y su tratamiento tiende a ser muy costoso para el sistema de salud. Objetivo. Establecer los patrones de costos de atención de las EIC en el Instituto Nacional Cardiovascular (INCOR) de la Seguridad Social en Salud del Perú (EsSalud). Métodos. Se utilizaron las bases de datos de atenciones, cirugías, egresos y valor bruto de la producción del INCOR de la población diagnosticada y atendida con EIC en el año 2019 (879 pacientes). Se estimaron los costos de las atenciones mediante costeo basado en actividad; se utilizó un modelo econométrico para establecer los determinantes de los costos, y con el método de distancia euclidiana se formaron “clústeres” con características similares para establecer patrones de costos. Resultados. El costo de atención de EIC más alto fue de 148 567 soles (US$ 44 830) para un paciente con 40 días de estancia. Fueron principales determinantes del costo de la atención la estancia hospitalaria y el número de ingresos al establecimiento. Se identificó que los “clúster” que tuvieron un costo mayor, fueron pacientes con edad de 70 y 72 años como mediana, con altos número de días de estancia y con alguna cirugía de alta complejidad. Conclusión. Los patrones de costos de la atención de la EIC estuvieron asociados a la estancia y los reingresos al establecimiento de salud. Los “clústers” con mayor costo estuvieron relacionados a la edad y complejidad de la cirugía.

Cost-effectiveness of interferon therapy for multiple sclerosis in Peru: impact of treatment adherence
Rafael Bolaños-Díaz, César Sanabria-Montañez, and Nilton Custodio-Capuñay
Oxford University Press (OUP)
Abstract Objective To analyse the cost-effectiveness (C-E) of interferon therapy for MS and the impact of adherence associated with a patient support programme (PSP). Methods Markov model was structured based on systematic review of the evidence and the opinion of local experts. The model has three health states: (1) Baseline treatment (BT), (2) Interferon-β (IFN) with patient support programme (PSP) and (3) IFN without PSP. Annual cycles were considered, with a time horizon of 30 years. The analysis perspective was based on the Ministry of Health (MoH). Key findings Interferon-β + PSP dominates the treatment of IFN without PSP. The incremental C-E rate (ICER) for IFN + PSP was estimated at S/. 26 408 per Quality Adjusted Life Year (QALY) in relation to BT. IFN without PSP was dominated by the IFN + PSP treatment. The cost per QALY of IFN + PSP was below the payment threshold in almost 100% of the model simulations. The acceptability curves show that the treatment with PSP + IFN is probabilistically more cost effective from a payment threshold of 1.25 annual Gross Domestic Product per capita (GDP-pc). The Tornado analysis for the ICER between IFN + PSP and BT shows that the most sensitive variables of the model are the relative risk (RR) for treatment adherence and the cost of IFN + PSP treatment. Conclusion The addition of a PSP had a significant effect on adherence and C-E of the intervention. The ICER for IFN + PSP was below 1.5 annual GDP-pc of payment threshold with an incremental cost near to 3 GDP-pc. IFN without PSP was dominated by the IFN + PSP.

Cost-effectiveness of Cetuximab as a treatment strategy for metastatic colon cancer in Peru: chemotherapy/Cetuximab versus chemotherapy alone
Rafael Bolaños-Díaz, César Sanabria-Montañez, Carlos Farfán-Tello, and María Calderón-Cahua
Oxford University Press (OUP)
To evaluate cost‐effectiveness – from a local perspective – of cetuximab when it is added to conventional chemotherapy for the treatment of metastatic colon cancer.

The process of health sector reform in Peru
Pedro Jesús Mendoza-Arana, Germán Rivera-Del Río, César Gutiérrez-Villafuerte, and César Sanabria-Montáñez
Pan American Health Organization
Objective To characterize the process of health sector reform (HSR) in Peru (launched publicly in 2013), identifying the principal advances in its implementation and the pending challenges from the perspective of the participating actors. Methods This study systematizes experiences through semi-structured interviews conducted with 21 key informants, including three ex-ministers of health, using the decade 2005-2015 as the time frame. Official databases were analyzed to verify variations in health indicators. Results The proposed reform was based on expanding insurance coverage (predominantly public health insurance), following the structured pluralism model, with clear separation between the functions of delivery, financing, regulation, and governance. The main progress in HSR identified by this study involves: having transcended the poverty criterion for public insurance, strengthening investments in infrastructure and human resources, strengthening the National Health Authority with a focus on the rights of users, and reinforcing the public health role of the Ministry of Health. The main challenges involve providing non-poverty-related insurance coverage for the population, having sufficient specialized human resources, and reducing out-of-pocket expenditure. Conclusions In the 10 years under analysis, HSR is a process that builds on the progress made in prior years; a process that consolidates an insurance model aimed at universal coverage based on public health insurance and that has led to a demonstrable increase in public spending and population coverage. However, progress has been limited mainly due to insufficient provision of specialized human resources and out-of-pocket expenditure, which remains very high.

Cost-effectiveness of two antiviral therapies for chronic hepatitis B in Peru: Entecavir and tenofovir
Rafael Bolaños-Díaz, Romina A. Tejada, César Sanabria, and Seimer Escobedo-Palza
Instituto Nacional de Salud (Peru)
Objetives. To compare in terms of cost-effectiveness to entecavir (ETV) and tenofovir (TDF) in the treatment of hepatitis B virus (HBV) in public hospitals in Peru. Materials and methods. We structured a Markov model. We define effectiveness adjusted life years for quality (QALY). We include the direct costs of treatment in soles from the perspective of the Ministry of Health of Peru. We estimate the relationship between cost and effectiveness ratios (ICER). We performed sensitivity analyzes considering a range of willingness to pay (WTP) from one to three times the Gross Domestic Product (GDP) per capita, and a tornado analysis regarding Monetary Net Profit (BMN) or ICER. Results. Treatment with TDF is more effective and less expensive than ETV. The ETV had a cost per QALY of PEN 4482, and PEN 1526 TDF. The PTO maintains a progressively larger with increasing WTP BMN. The discount rate was the only variable with a significant effect on model uncertainty. Conclusion: Treatment with TDF is more cost-effective than ETV in public hospitals in Peru.

Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children
Edward Mezones-Holguín, Rafael Bolaños-Díaz, Víctor Fiestas, César Sanabria, Alfonso Gutiérrez-Aguado, Fabián Fiestas, Víctor J Suárez, Alfonso J. Rodriguez-Morales, and Adrián V Hernández
Journal of Infection in Developing Countries
Introduction: Pneumococcal pneumonia (PP) has a high burden of morbimortality in children. Use of pneumococcal conjugate vaccines (PCVs) is an effective preventive measure. After PCV 7-valent (PCV7) withdrawal, PCV 10-valent (PCV10) and PCV 13-valent (PCV13) are the alternatives in Peru. This study aimed to evaluate cost effectiveness of these vaccines in preventing PP in Peruvian children <5 years-old. Methodology: A cost-effectiveness analysis was developed in three phases: a systematic evidence search for calculating effectiveness; a cost analysis for vaccine strategies and outcome management; and an economic model based on decision tree analysis, including deterministic and probabilistic sensitivity analysis using acceptability curves, tornado diagram, and Monte Carlo simulation. A hypothetic 100 vaccinated children/vaccine cohort was built. An incremental cost-effectiveness ratio (ICER) was calculated. Results: The isolation probability for all serotypes in each vaccine was estimated: 38% for PCV7, 41% PCV10, and 17% PCV13. Avoided hospitalization was found to be the best effectiveness model measure. Estimated costs for PCV7, PCV10, and PCV13 cohorts were USD13,761, 11,895, and 12,499, respectively. Costs per avoided hospitalization were USD718 for PCV7, USD333 for PCV10, andUSD 162 for PCV13. At ICER, PCV7 was dominated by the other PCVs. Eliminating PCV7, PCV13 was more cost effective than PCV10 (confirmed in sensitivity analysis). Conclusions: PCV10 and PCV13 are more cost effective than PCV7 in prevention of pneumonia in children <5 years-old in Peru. PCV13 prevents more hospitalizations and is more cost-effective than PCV10. These results should be considered when making decisions about the Peruvian National Inmunizations Schedule.

RECENT SCHOLAR PUBLICATIONS

Cost-effectiveness of ceftazidime/avibactam for infections due to carbapenem-resistant bacteria: analysis in Ecuadorian context
R Bolaos-Daz, C Moreno, G Salazar, C Fandio, LC Torres, ...
Journal of Pharmaceutical Health Services Research 15 (4), rmae024 2024

Patrones de costos de atencin a pacientes con enfermedades isqumicas del corazn en el Instituto Nacional Cardiovascular, 2019
C Sanabria-Montaez, J Cabrejos Polo, AR Olortegui Yzu, ...
Anales de la Facultad de Medicina 83 (2), 104-111 2022

Cost-effectiveness of ceftazidime/avibactam for infections due to carbapenem-resistant bacteria in Peru
R Bolaos-Daz, E Angles-Yanqui, G Prez-Lazo, C Sanabria-Montaez
Journal of Pharmaceutical Health Services Research 13 (1), 2-8 2022

Factores determinantes de la demanda y anlisis costo efectividad de los servicios preventivos de salud del cncer crvico uterino en el Per
CS Montaez
Universidad Nacional Mayor de San Marcos (UNMSM) 2022

Determinantes de la Demanda de Servicios de Prevencin Secundaria del cncer cervicouterino en Per
C Sanabria-Montaez
Revista Peruana de Investigacin en Salud 5 (4), 297-303 2021

Cost-effectiveness of interferon therapy for multiple sclerosis in Peru: impact of treatment adherence
R Bolaos-Daz, C Sanabria-Montaez, N Custodio-Capuay
Journal of Pharmaceutical Health Services Research 10 (1), 125-132 2019

Cost-effectiveness of Cetuximab as a treatment strategy for metastatic colon cancer in Peru: chemotherapy/Cetuximab versus chemotherapy alone
R Bolaos-Daz, C Sanabria-Montaez, C Farfn-Tello, ...
Journal of Pharmaceutical Health Services Research 9 (4), 319-326 2018

El proceso de reforma del sector salud en Per
PJ Mendoza-Arana, GRD Ro, C Gutirrez-Villafuerte, ...
Revista Panamericana de Salud Pblica 42, e74 2018

The process of health sector reform in PeruProcesso de reforma da sade no Peru
PJ Mendoza-Arana, GR Ro, C Gutierrez-Villafuerte, ...
Revista Panamericana de Salud Publica= Pan American Journal of Public Health 2018

The process of health sector reform in Peru
P Jesus Mendoza-Arana, G Rivera-Del Rio, C Gutierrez-Villafuerte, ...
REVISTA PANAMERICANA DE SALUD PUBLICA-PAN AMERICAN JOURNAL OF PUBLIC HEALTH 42 2018

Costo-efectividad de dos terapias antivirales para hepatitis B crnica en el Per: entecavir y tenofovir
R Bolaos-Daz, RA Tejada, C Sanabria, S Escobedo-Palza
Revista Peruana de Medicina Experimental y Salud Pblica 34, 377-385 2017

Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children
E Mezones-Holgun, R Bolaos-Daz, V Fiestas, C Sanabria, ...
The Journal of Infection in Developing Countries 8 (12), 1552-1562 2014

La demanda de televisin digital terrestre en el Per
CS Montaez
Pensamiento Crtico 12, 147-166 2014

Costo efectividad de Abatacept en comparacin con otras terapias biolgicas para el tratamiento de la artritis reumatoide moderada a severamente activa en pacientes que han
F Becerra Rojas, C Benites Chacaltana, E Aiello, C Zingoni, G Bergman, ...
Acta Mdica Peruana 28 (4), 200-210 2011

COST EFFECTIVENESS OF ABATACEPT IN COMPARISON WITH OTHER BIOLOGIC THERAPIES FOR THE TREATMENT OF MODERATE TO SEVERE ACTIVE RHEUMATOID ARTHRITIS PATIENTS WHO HAVE FAILED TO
F Becerra Rojas, C Benites Chacaltana, EC Aiello, C Zingoni, G Bergman, ...
VALUE IN HEALTH 14 (3), A129-A129 2011

PMS33 COST EFFECTIVENESS OF ABATACEPT IN COMPARISON WITH OTHER BIOLOGIC THERAPIES FOR THE TREATMENT OF MODERATE TO SEVERE ACTIVE RHEUMATOID ARTHRITIS PATIENTS WHO HAVE FAILED
FB Rojas, CB Chacaltana, EC Aiello, C Zingoni, G Bergman, P Drost, ...
Value in Health 14 (3), A129 2011

Cost-effectiveness of abatacept compared to other biological agents for the treatment of moderately to severely active rheumatoid arthritis in patients who failed with
F Becerra Rojas, C Benites Chacaltana, E Aiello, C Zingoni, G Bergman, ...
2011

Cost-effectiveness of hormone replacement therapy (HRT) Compared to isoflavones in post-menopausal osteoporosis.
R Bolaos Daz, C Sanabria Montaez, J Francia Romero, C Puente
2009

La demanda de televisin digital terrestre en el Per
C Sanabria Montaez
2009

Anlisis costo-efectividad de la terapia de reemplazo hormonal (TRH) frente a isoflavonas en osteoporosis posmenopusica
R Bolaos Daz, C Sanabria Montaez, J Francia Romero, ...
Acta Mdica Peruana 26 (1), 27-34 2009

MOST CITED SCHOLAR PUBLICATIONS

El proceso de reforma del sector salud en Per
PJ Mendoza-Arana, GRD Ro, C Gutirrez-Villafuerte, ...
Revista Panamericana de Salud Pblica 42, e74 2018
Citations: 37

La demanda por servicios de salud. Una aproximacin terica
C Montaez
Revista de la facultad deficiencias econmicas de la UNMSM, 151-70 2002
Citations: 23

El Rol del Estado y la salud en el Per
C Sanabria
Revista de la Facultad de Ciencias Econmicas 5 (15), 79-94 2000
Citations: 23

Anlisis de la Brecha entre Oferta y Demanda de Servicios de Salud para la Programacin de la Inversin Sectorial de Mediano Plazo
M Madueo, J Alarcn, C Sanabria
Lima: PHRplus Per 2003
Citations: 20

Estudio de oferta de los servicios de salud en el Per y el anlisis de brechas 2003-2020
M Madueo, C Sanabria
Informe tcnico N026s. Bethesda, MD: Proyecto Socios para la Reformaplus del 2003
Citations: 20

Financiamiento de Programas Sociales El Caso del Programa de Comedores Populares en el Per
CA Sanabria Montaez
2007
Citations: 16

Anlisis de la brecha entre oferta y demanda de servicios de salud para la programacin de la inversin sectorial de mediano plazo
M MADUEO DVILA, J ALARCN VILLAVERDE, ...
Phrplus–Per. Lima, 13-16 2003
Citations: 8

La evaluacin econmica en salud y la toma de decisiones en Iberoamrica
J Rovira, CSMCS MONTAEZ
Rev. Fac. Cien. Ecn. Univ. Nac. Mayor de San Marcos 10 (28), 27-46 2005
Citations: 4

Estimacin de Costos de los servicios de Salud de la Red Chilca-Mala
C Sanabria
Lima 2005
Citations: 3

Anlisis costo-efectividad de dos sistemas de comunicacin y reporte epidemiolgico en el Per
CASM CSAR, S MONTAEZ
TEMA CENTRAL 10 (25), 219-236 2005
Citations: 3

Determinantes de la Demanda de Servicios de Prevencin Secundaria del cncer cervicouterino en Per
C Sanabria-Montaez
Revista Peruana de Investigacin en Salud 5 (4), 297-303 2021
Citations: 2

Financiamiento de Programas Sociales
C Sanabria
El caso de Programas de Comedores Populares en el Per 2007
Citations: 2

CÉSAR SANABRIA

EDUCATION

RESEARCH INTERESTS

FUTURE PROJECTS

Determinantes socioeconómicos de la hipertensión en las mujeres del Perú

Scopus Publications

RECENT SCHOLAR PUBLICATIONS

MOST CITED SCHOLAR PUBLICATIONS