Budget Impact Analysis of Surfactant Therapy for Bronchiolitis In Critically Ill Infants: The Colombian National Health System Perspective

Abstract

BACKGROUND: Exogen surfactant in mechanically ventilated infants decreased duration of stay in the intensive care unit and had favorable effects on oxygenation and carbon dioxide removal. This study aimed to evaluate the budget impact of surfactant therapy for bronchiolitis in critically ill infants in Colombia.METHODS: Budget impact analysis was performed to estimate the economic impact of surfactant therapy (ST) for the treatment of infants with a diagnosis of bronchiolitis, requiring mechanical ventilation. The analysis considered a 4-year time horizon and Colombian National Health System perspective. The model estimated drug costs associated with current scenario using humidified oxygen or adrenaline nebulization , and new scenario adding exogen surfactant. The size of the target population was calculated using epidemiological national data. Univariate one-way sensitivity analyses and scenario analyses were performed.RESULTS: In the base-case analysis the 4-year costs associated to ST and no-ST were estimated to be US$ 55.188.132 and US$ 55.972.082 respectively, indicating savings for Colombian National Health equal to US% 783.950 if ST is adopted for the routine management of patients with bronchiolitis requiring mechanical ventilation. Results were consistent at variation of most of the model’s parameters; only in case of increases of drug cost of surfactant and daily cost or length of stay in pediatric intensive unit , the savings are reducedCONCLUSION: ST was cost-saving in emergency settings for treating infants with severe bronchiolitis requiring mechanical ventilation. This shift in treatment approach proved to be economically favorable in the Colombian context.

Systematic review and cost‐utility of high flow nasal cannula versus continuous positive airway pressure in children with acute severe or moderate bronchiolitis in Colombia

“…Also, our results agree with previous economic evaluations of CPAP in preterm at ≥28 weeks of gestation with respiratory distress; in this study; CPAP saved approximately US$4800 compared with HFNC 23 . For individual and collective decision‐making, having information on the efficiency of technology is an input of equal relevance to information about the safety or effectiveness of this intervention 4,24–30 . The use of interventions that allow us to gain the greatest quantity and quality of life at the lowest possible cost constitutes a priority in scenarios with unlimited resources as occur in developing countries 31,32 …”

“…23 For individual and collective decision-making, having information on the efficiency of technology is an input of equal relevance to information about the safety or effectiveness of this intervention. 4,[24][25][26][27][28][29][30] The use of interventions that allow us to gain the greatest quantity and quality of life at the lowest possible cost constitutes a priority in scenarios with unlimited resources as occur in developing countries. 31,32 A critical aspect of our model is that it was robust to changing the Therefore, we are confident on the ability to draw conclusions to inform decisions based on our results.…”