Análisis de costo-utilidad de los esteroides inhalados disponibles en Colombia para el manejo de pacientes pediátricos con asma persistente
Cost-utility analysis of available inhaled corticosteroids in Colombia for the treatment of paediatric patients with persistent asthma
Número
Sección
Artículos de investigación
Cómo citar
Análisis de costo-utilidad de los esteroides inhalados disponibles en Colombia para el manejo de pacientes pediátricos con asma persistente.
rev. colomb. neumol. [Internet]. 2009 Sep. 1 [cited 2024 Nov. 25];21(3):111-35.
DOI
Licencia
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Ninguna publicación, nacional o extranjera, podrá reproducir ni traducir sus artículos ni sus resúmenes sin previa autorización escrita del editor; sin embargo los usuarios pueden descargar la información contenida en ella, pero deben darle atribución o reconocimiento de propiedad intelectual, deben usarlo tal como está, sin derivación alguna.
Mostrar biografía de los autores
Introducción: el asma tiene un considerable impacto económico en los pacientes, los sistemas de salud y la sociedad en general, en especial cuando no se logra controlar adecuadamente. La elección entre los distintos esteroides inhalados, medicamentos considerados como el tratamiento controlador de primera elección para el tratamiento del asma, puede tener un alto impacto en los costos derivados de la enfermedad, por lo que los tomadores de decisiones no sólo necesitan escoger el esteroide que tenga la mayor efectividad clínica, sino que también necesitan considerar sus consecuencias económicas.
Objetivo: estimar las razones incrementales de costo-utilidad (RICU) de tres esteroides inhalados utilizados para el tratamiento de pacientes pediátricos asmáticos, comparados con la beclometasona, que es el único esteroide inhalado incluido en el Plan Obligatorio de Salud de Colombia.
Diseño: modelo económico sanitario (MES) de costo-utilidad tipo modelo de Markov, estructurado sobre un análisis de decisiones (árbol de decisiones).
Materiales y métodos: los datos de efectividad se obtuvieron de una revisión sistemática de la literatura. Los datos de costos se obtuvieron de las tarifas de atención y de adquisición de medicamentos para Empresas Promotoras de Salud. Los participantes fueron una cohorte simulada de 1.000 pacientes menores de 18 años, con asma persistente, tratados durante 12 meses. La perspectiva utilizada fue la del asegurador. El desenlace principal fueron los años de vida ajustados por calidad (AVAC). Se verificó la robustez del modelo mediante análisis de sensibilidad determinísticos y probabilísticos.
Resultados: mientras que la estrategia beclometasona es la menos costosa (costo promedio por paciente durante los 12 meses: $314.036), la estrategia fluticasona es la más efectiva (0,9325 años de vida ajustados por calidad, en promedio por paciente, durante los 12 meses). Las estrategias ciclesonida y budesonida están dominadas por la estrategia fluticasona, pues son más costosas y menos efectivas que esta última. Al comparar la estrategia fluticasona con la beclometasona, se calculó una RICU promedio de $58´672.561 por AVAC adicional.
Conclusiones: si la máxima voluntad de pago de los tomadores de decisiones es mayor que $62´500.000 anuales por paciente por AVAC adicional, la fluticasona sería la estrategia terapéutica más costo-efectiva, o en caso contrario la beclometasona sería la estrategia más costo-efectiva
Visitas del artículo 491 | Visitas PDF 256
Descargas
Los datos de descarga todavía no están disponibles.
- Dennis R, Caraballo L, Garcia E, y cols. Asthma and other allergic conditions in Colombia: a study in 6 cities. Ann Allergy Asthma Immunol 2004; 93: 568-574
- Garcia E, Aristizabal G, Vasquez C, Rodriguez-Martinez CE, Sarmiento OL, Satizabal C. Prevalence and factors associated with current asthma symptoms in school children aged 6-7 and 13-14 years old in Bogota, Colombia. Pediatr Allergy Immunol 2008; 19: 307-314
- Global Initiative for Asthma (GINA), National Hearth Lung, Lung, and Blood Institute (NHLBI). Global strategy for asthma management and prevention. Bethesda, Maryland, USA: US Department of Health and Human Services, 2007.
- Neffen H, Fritscher C, Cuevas Schacht F, Levy G, Chiarella P, Soriano JB. Asthma control in Latin America: the Asthma Insights and Reality in Latin America (AIRLA) survey. Rev Panam Salud Publica 2005;17:191-197.
- Hoskins G, McCowan C, Neville RG, et al. Risk factors and cost associated with an asthma attack. Thorax 2000; 55: 19-24
- Castro M, Zimmermann NA, Crocker S, et al. Asthma intervention program prevents readmissions in high healthcare users. Am J Respir Crit Care Med 2003; 168: 1095-1099
- Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl Med 1992; 323: 862- 866.
- Weiss KB, Sullivan SD. The health economics of asthma and rhinitis: I. Assessing the economic impact. J Allergy Clin Immunol 2001; 107: 3-8
- Weiss KB, Sullivan SD. The economic costs of asthma: a review and conceptual model. Pharmacoeconomics 1993;4:14-30
- Tina Shih YC, Mauskopf J, Borker R. A cost-effectiveness analysis of first-line controller therapies for persistent asthma. Pharmacoeconomics 2007; 25: 577-590
- Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. New York: Oxford University Press,2006.
- Price MJ, Briggs AH. Development of an economic model to assess the cost effectiveness of asthma management strategies. Pharmaeconomics 2002; 20: 183-194
- O´Connor RD, Nelson H, Borker R, Emmett A, Jhingran P, Rickard K, et al. Cost effectiveness of fluticasone propionate plus salmeterol versus fluticasone propionate plus montelukast in the treatment of persistent asthma. Pharmacoeconomics 2004; 22: 815-825
- Johansson G, Andreasson EB, Larsson PE, Vogelmeier CF. Cost effectiveness of budesonide/formoterol for maintenance and reliever therapy versus salmeterol/fluticasone plus salbutamol in the treatment of asthma. Pharmaeconomics 2006; 24: 695-708
- Sheth K, Borker R, Emmett A, Rickard K, Dorinsky P. Cost-effectiveness comparison of salmeterol/fluticasone propionate versus montelukast in the treatment of adults with persistent asthma. Pharmaeconomics 2002; 20: 909-918.
- Johansson G, Price MJ, Sondhi S. Cost-effectiveness analysis of salmeterol/fluticasone propionate 50/100mg vs. fluticasone propionate 100mg in adults and adolescents with astma. III: Results. Pharmaeconomics 1999; 16 Suppl 2: 15-21
- Stempel DA, Stanford RH, Thwaites RMA, Price MJ. Cost-efficacy comparison of inhaled fluticasone propionate and budesonide in the treatment of asthma. Clin Ther 2000; 22: 1562-1574
- Rand CS, Wise RA. Measuring adherence to asthma medication regimens. Am J Respir Crit Care Med 1994; 149: S69-S76
- Rubio-Terrés C, Echevarría A. Modelos de Markov: Una herramienta útil para el análisis farmacoeconómico. Pharmacoeconomics - Spanish Reasearch Articles 2006; 3: 71-78
- Briggs A, Sculpher M. An introduction to Markov modeling for economic evaluation. Pharmacoeconomics 1998; 13: 397-409
- Phillips K, Oborne J, Lewis S, Harrison TW, Tattersfield AE. Time course of action of two inhaled corticosteroids, fluticasone propionate and budesonide. Thorax 2004; 59: 26-30
- Stempel DA, Mauskopf J, McLaughlin T, et al. Comparison of asthma costs in patients starting fluticasone propionate compared to patients starting montelukast. Respir Med 2001; 95: 227-234.
- Briggs A, Claxton K, Sculpher M. Decision modeling for health economic evaluation. New York: Oxford University Press, 2006
- Drummond M, McGuire A. Economic evaluation in health care. Merging theory with practice. New York: Oxford University Press, 2006
- Chiou CF, Weaver MR, Bell MA, Lee TA, Krieger JW. Development of the multi-atribute Pediatric Asthma Health Outcome Measure (PAHOM). Int J Qual Health Care 2005; 17: 23-30.
- O´Brien BJ, Drummond MF, Labelle RJ, Willan A. In search of power and significance: issues in the design and analysis of stochastic cost-effectiveness studies in health care. Med Care 1994;32: 150-163
- Briggs AH, Goeree R, Blackhouse G, O´Brien B. Probabilistic analysis of cost-effectiveness models: choosing between treatment strategies for gastroesophageal reflux disease. Med Decis Making 2002; 22: 290-308
- Luce BR, Tina Shih Y, Claxton C. Introduction: Bayesian approaches to technology assessment and decision making. Int J Technol Assess Health Care 2001; 17: 1-5
- Stinnett AA, Mullahy J. Net health benefits: a new framework for the analysis of uncertainty in cost-effectiveness analysis. Med Decis Making 1998; 18 Supl 2: 68-80
- Claxton K, Neumann PJ, Araki S, Weinstein MC. Bayesian value-of-information analysis: an application to a policy model of Alzheimer´s disease. Int J Technol Asses Health Care 2001; 17: 38-55
- Análisis coste-efectividad de tipo probabilístico del tratamiento de la apnea del sueño. Gac Sanit 2006; 20: 47-53
- Connett GJ, Warde C, Wooler E, Lenney W. Use of budesonide in severe asthmatics aged 1-3 years. Arch Dis Child 1993; 69: 351-355
- Nielsen KG, Bisgaard H. The effect of inhaled budesonide on symptoms, lung function, and cold air and methacholine responsiveness in 2 to 5 year-old asthmatic children. Am J Respir Crit Care Med 2000:162: 1500-1506
- Lonnkvist K, Hellman C, Lundhal J, Hallden G, Hedlin G. Eosinophil markers in blood, serum, and urine for monitoring the clinical course in childhood asthma: impact of budesonide treatment and withdrawal. J Allergy Clin Immunol 2001; 107: 812-817
- Gelfand EW, Georgitis JW, Noonan M, Ruff ME. Once-daily ciclesonide in children: efficacy and safety in asthma. J Pediatr 2006; 148: 377-381
- Katz Y, Lebas FX, Medley HK, Robson R. Fluticasone propionate 50mcg BID versus 100mcg BID in the treatment of children with persistent asthma. Clin Ther 1998; 20: 424-437
- Gleeson JGA, Price JF. Controlled trial of budesonide given by the Nebuhaler in preschool children with asthma. BMJ 1988; 297: 163-166
- Boner AL, Piacentini GL, Bonizzato C, Dattoli V, Sette L. Effect of inhaled beclomethasone dipropionate on bronchial hyperreactivity in asthmatic children during maximal allergen exposure. Pediatr Pulmonol 1991; 10: 2-5
- Benito-Fernández J, Onis-González E, Alvarez-Pitti J, Capapé-Zache S, Vásquez-Ronci MA, Mintegi-Raso S. Factors associated with short-term clinical outcomes after acute treatment of asthma in a Pediatric Emergency Department. Pediatr Pulmonol 2004; 38: 123-128
- Kattan M, Mitchell H, Eggleston P, Gergen P, Crain E, Redline S, y cols. Characteristics of inner-city children with asthma: The National Cooperative Inner-CityStudy. Pediatr Pulmonol 1997; 24: 253-262.
- Adams NP, Bestall JB, Malouf R, Lasserson TJ, Jones PW. Beclomethasone versus placebo for chronic asthma. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD002738. DOI: 10.1002/14651858. CD002738.pub2
- Adams N, Bestall J, Jones PW. Budesonide versus placebo for chronic asthma in children and adults. Cochrane Database of Systematic Reviews 1999, Issue 4. Art No.: CD003274. DOI: 10.1002/14651858.CD003274
- Adams NP, Bestall JC, Lasserson TJ, Jones PW. Cates CJ. Fluticasone versus placebo for chronic asthma in adults and children. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003135. DOI: 10.1002/ 14651858.CD003135.pub3.
- Manning P, Gibson PG, Lasserson TJ. Ciclesonide versus placebo for chronic asthma in adults and children. Cochrane Database of Systemic Reviews 2008, Issue 2. Art. No.: CD006217. DOI: 10.1002/14651858. CD006217.pub2
- Pedersen S, Garcia Garcia ML, Manjra Al, Theron I, Engelstatter R. A comparative study of inhaled ciclesonide 160mcg/day and fluticasone propionate 176 mcg/day in children with asthma. Pediatr Pulmonol 2006; 41: 954-961
- Gustafsson P, Tsanakas J, Gold M, Primhak R, Radford M, Gillies E. Comparison of the efficacy and safety of inhaled fluticasone propionate 200 mcg/day with inhaled beclomethasone dipropionate 400 mcg/day in mild and moderate asthma. Arch Dis Child 1993;69: 206-211.
- Pedersen S, Warner J, Wahn U, Staab D, Le Bourgeois M, Van Essen-Zandvliet EEM et al. Growth, systemic safety, and efficacy during 1 year of asthma treatment with different beclomethasone dipropionate formulations: an open-label, randomized comparison of extrafine and conventional aerosols in children. Pediatrics 2002; 109(6).
- Springer C, Avital A, Maayan CH, Rosler A, Godfrey S. Comparison of budesonide and beclomethasone dipropionate for treatment of asthma. Arch Dis Child 1987; 62: 815-819.
- Szefler SJ, Warner J, Staab D, Wahn U, Le Bourgeois M, Van Essen- Zandvliet EEM et al. Switching from conventional to extrafine aerosol beclomethasone dipropionate therapy in children: A 6-month, open-label randomized trial. J Allergy Clin Immunol 2002; 110: 45-50.
- Yiallourous PK, Milner AD, Conway E, Honour JH. Adrenal function and high dose inhaled corticosteroids for asthma. Arch Dis Child 1997; 76: 405- 410
- Francis RS. Long-term beclomethasone dipropionate aerosol therapy in juvenile asthma. Thorax 1976; 31: 309-314.
- Varsano I, Volovitz B, Malik H, Amir Y. Safety of 1 year of treatment with budesonide in young children with asthma. J Allergy Clin Immunol 1990; 85: 914-920.
- Vermeulen JH, Gyurkovits K, Rauer H, Engelstatter R. Randomized comparison and safety of ciclesonide and budesonide in adolescents with severe asthma. Respir Med 2007; 101: 2182-2191.
- Von Berg A, Engelstatter R, Minic P, Sreckovic M, Garcia MLG, Latos T, et al. Comparison of the efficacy and safety of ciclesonide 160mcg once daily vs. budesonide 400mcg once daily in children with asthma. Pediatric Allergy Immunol 2007;18:391-400.
- Garcia Garcia ML, Wahn U, Gilles L, Swern A, Tozzi CA, Polos P. Montelukast, compared with fluticasone, for control of asthma among 6 to 14-year-old patients with mild asthma: The MOSAIC study. Pediatrics 2005; 116:360-369.
- Johasson G, Carlsen KH, Mowinckel P. Asthma drug adherence in a long term clinical trial. Arch Dis Child 2000; 83: 330-333.
- Masoli M, Weatherall M, Holt S, Beasley R. Budesonide once versus twice- daily administration: meta-analysis. Respirology 2004; 9: 528-534.
- Ricciardolo FLM. The treatment of asthma in children: Inhaled corticosteroids. Pulm Pharmacol Therap 2007; 20: 473-482.
- Mallol J, Aguirre V. Once versus twice daily budesonide metered-dose inhaler in children with mild to moderate asthma: effect on symptoms and bronchial responsiveness. Allergol Immunopathol 2007;35: 25-31.
- Hoekx JCM, Hedlin G, Pedersen W, Sorva R, Hollingworth, Efthimiou J. Fluticasone propionate compared with budesonide: a double-blind trial in asthmatic children using powder devices at a dosage of 400 mg/day. Eur Respir J 1996; 9: 2263-2272.
- Verberne AAPH, Frost C, Roorda RJ, Laag HVD, Kerrebijn KF. One year treatment with salmeterol compared with beclomethasone in children with asthma. Am J Respir Crit Care Med 1997; 156: 688-695.
- Rodríguez Barrios JM. Papel de los modelos en las evaluaciones económicas en el campo sanitario. Farm Hosp (Madrid) 2004; 28: 231-242
- Evaluación económica en salud: tópicos teóricos y aplicaciones en Colombia. Observatorio de la Seguridad Social. Grupo de Economía de la Salud - GES. 2006 No. 14. ISSN 1657-5415.
- Que no nos falten los “remedios”. El Pulso. Periódico para el Sector Salud. http://www.periodicoelpulso.com.co/html/0902feb/editorial/editorial.htm (consulta: mayo 29 de 2009).
- Barnes NC, Thwaites RMA, Price MJ. The cost-effectiveness of inhaled fluticasone propionate and budesonide in the treatment of asthma in adults and children. Respir Med 1999; 93: 402-407.
- Rand CS, Wise RA. Measuring adherence to asthma medication regimens. Am J Respir Crit Care Med 1994; 149: S69-S76.
- Hand CH, Bradley C. Health beliefs of adults with asthma: Toward an understanding of the difference between symptomatic and preventive use of inhaler treatment. J Asthma 1996; 33: 331-338.
- Alvarez Sintes R, Alvarez Sintes R, Alvarez MR. Corticoides inhalados en el asma. Resumed 1999; 12: 212-222.
- Allen DB. Safety of inhaled corticosteroids in children. Pediatr Pulmonol 2002; 33: 208-220.
- The Childhood Asthma Management Program Research Group. Long-term effects of budesonide or nedocromil in children with asthma. N Engl J Med 2000; 343: 1054-1063.
- Boulet LP, Phillips R, O’Byme P, Becker A. Evaluation of asthma control by physicians and patients: comparison with current guidelines. Can Respir J 2002; 9: 417-42371.
- Brand PLP, Duiverman EJ, Waalkens HJ, van Essen-Zandvliet EEM, Kerrebjin KF. Peak flow variation in childhood asthma: correlation with symptoms, airways obstruction, and hyperresponsiveness during long term treatment with inhaled corticosteroids. Thorax 1999; 54: 103-107.
- National Institute for Clinical Excellence (NICE). Guide to the methods of technology appraisal. London: National Institute for Clinical Excellence; 2004.
- Commission on Macroeconomics and Health, World Health Organization (WHO). Macroeconomics and health: investing in health for economic development. Geneva: World Health Organization, 2001
Información
Historia de la revista
Palabras clave
Código QR
Directorios e indexadores
Perfil de Google Scholar
Más leídos en los últimos 30 días
