Like most of the world, low- and middle-income countries have faced a growing demand for new health technologies and higher budget constraints. It is necessary to have technical instruments to make decisions based on real-world evidence that allows maximization of the population’s health with a limited budget. We estimated the supply-based cost-effectiveness elasticity, which was then used to determine the cost-effectiveness threshold for the healthcare system of Colombia, a middle-income country where multiple insurers, paid under capitation rules, manage the compulsory contributions of the citizens and government subsidies. Using administrative data, we explored the variation of health expenditures and outcomes at the insurer, geographical region, diagnosis group, and year levels. To deal with endogeneity in a two-way fixed-effects model, we instrumented health expenditures using characteristics of the health system such as drug-price regulation. We estimated the threshold to be US$ 4487.5 per YLL avoided (14.7 million COP at 2019 prices) and US$ 5180.8 per QALY gained (17 million COP at 2019 prices), around one times the GDP per capita. To our knowledge, this is the first estimation of the cost-effectiveness threshold elasticity supply-based in a middle-income country with a managed care health system.

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METHODS:A retrospective analysis of the HealthCore Integrated Research Database (HIRD) was conducted to estimate the incidence, costs, and predictors of COPD exacerbations. The study population included CB patients aged Ն40 years with Ն2 years of continuous enrollment in the HIRD, Ն1 hospitalization/emergency department (ED) visit or Ն2 outpatient visits with CB diagnosis (ICD-9-CM 491.xx) from January 1, 2004 to May 31, 2011, and Ն2 pharmacy fills for COPD medications during the follow-up year (the first fill served as the index date). Patients with asthma, cystic fibrosis, respiratory tract cancer, and long-term oral corticosteroid use were excluded. COPD exacerbations were categorized as severe (hospitalization with COPD as primary diagnosis) or moderate (ED visit with a primary COPD diagnosis or an oral corticosteroid filled within 7 days of a COPD-related office visit). When multiple exacerbations occurred within a 14-day window, only one (the most severe, if applicable) was counted. Prevalence, costs, and predictors of exacerbations were measured. RESULTS: A total of 17,382 treated CB patients met inclusion/ exclusion criteria (50.6% female, mean age 66.7Ϯ11.4 years). During pre-index year, 25% had moderate or severe and 14.3% had severe exacerbations. During the postindex year, the mean COPD maintenance medication fills number was 7.6Ϯ6.3; 42.6% experienced moderate or severe and 24.7% experienced severe exacerbations. Mean exacerbation-related healthcare costs were $8,219Ϯ$22,644 per moderate or severe and $18,120Ϯ$31,592 per severe exacerbation. Incidence of baseline exacerbation was the best predictor of post-index incidence of exacerbation (␤ϭ0.2595, pϽ0.0001) and also predicted post-index exacerbation-related costs (␤ϭ0.0870, pϽ0.0002). CONCLUSIONS: CB individuals' exacerbation rates remain high despite treatment with COPD maintenance medications. New treatment strategies designed to reduce CB exacerbations and associated costs should focus on patients with high prior-year exacerbation rates.OBJECTIVES: Invasive aspergillosis (IA) is a major infectious complication in inmonusupressed patients. Its incidence ranges from 5 percent to more than 20 percent A55