Cost-utility analysis of available inhaled corticosteroids in Colombia for the treatment of paediatric patients with persistent asthma

Análisis de costo-utilidad de los esteroides inhalados disponibles en Colombia para el manejo de pacientes pediátricos con asma persistente

Published 2009-09-01

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Vol. 21 No. 3 (2009)
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Cost-utility analysis of available inhaled corticosteroids in Colombia for the treatment of paediatric patients with persistent asthma.
rev. colomb. neumol. [Internet]. 2009 Sep. 1 [cited 2024 Nov. 21];21(3):111-35.
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Carlos E. Rodríguez Martínez
Neumólogo Pediatra. Universidad del Rosario. Bogotá, Colombia.
    Mónica P. Sossa Briceño
    Médico Internista epidemiólogo. Clínica Colsánitas. Bogotá, Colombia.
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      Carlos E. Rodríguez Martínez,

      Primer puesto Trabajo de Investigación Original XIII Congreso Colombiano de Neumología y IV Congreso de Cirugía de Tórax, Bogotá 8 a 11 de octubre de 2009

      Neumólogo Pediatra. Magíster en Epidemiología Clínica. Magíster en Economía de la Salud y del Medicamento (candidato). Clínica Infantil Colsubsidio. Universidad del Rosario. Universidad El Bosque. Bogotá, Colombia.

      Mónica P. Sossa Briceño,

      Médico Internista epidemiólogo. Magíster en Bioestadística. Clínica Colsánitas. Bogotá, Colombia.

      Introduction: Bronchial asthma causes a considerable economic burden for patients, health systems, and society in general, especially when adequate control of the disease is not achieved. The choice between different inhaled steroids, medicines regarded as the first choice controller therapy for the treatment of asthma, can have a high impact on the costs of the disease, so that the decision makers not only need to choose the steroids that have the greatest clinical effectiveness, but also need to consider their economic consequences.

      Objective: To estimate the incremental cost-utility ratio of 3 inhaled steroids used for the treatment of pediatric asthmatics patients compared with beclomethasone, which is the only inhaled steroid included in the Plan Obligatorio de Salud (Compulsory Health Insurance Plan) of Colombia.

      Desing: A decision-analysis and cost-utility Markov-type model.

      Methods: Effectiveness parameters were obtained from a systematic review of the literature. Cost data were obtained from the hospital charges and from drug acquisition costs of Empresas Promotoras de Salud (Medical Insurance Companies). The participants were a simulated cohort of patients under 18 years old with persistent asthma treated for 12 months, calculating the costs from a third-party payer perspective. The main outcome was the variable «quality-adjusted life-years» (QALY). To determine strength of results a sensitivity analysis was undertaken, with modified cost and effectiveness.

      Results: While the beclomethasone strategy is the least expensive (average cost per patient for 12 months: $314.036), the fluticasone strategy is the most effective (0,9325 quality adjusted life years on average per patient for 12 months). The ciclesonide and budesonide strategies are dominated by the fluticasone strategy, because they are more costly and less effective than the latter. When comparing the fluticasone strategy with beclomethasone, the mean incremental cost-utility ratio calculated was $58´672.561 per QALY.

      Conclusions: If decision-makers are willing to pay more than $62´500.000 annually per patient per additional QALY, fluticasone would be the most cost-effective strategy, otherwise beclomethasone would be the most cost-effective strategy.

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