Abstract: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 multipl… Show more
“…Given the short time horizon, no discount rates were applied to costs or QALYs. Cost-effectiveness was evaluated at a willingness-to-pay (WTP) value of US$5180 [ 6 ]. In Colombia there is no data on the frequency of recurrent pneumonia in the study population.…”
Introduction
Despite the growing evidence on efficacy, few economic evaluations have evaluated the cost-utility of Pidotimod (PDT) supplementation to decrease the probability of recurrent respiratory tract infections in children. This study aimed to determine the cost-utility of PDT to reduce the incidence rate of recurrent respiratory tract infections in children.
Methods
A decision tree model was used to estimate the cost and quality-adjusted life-years (QALYs) of PDT in a patient aged 1–6 with a history of recurrent respiratory tract infections. Multiple sensitivity analyses were conducted to evaluate the robustness of the model. Cost-effectiveness was evaluated at a willingness-to-pay (WTP) value of US$5180.
Results
The base-case analysis showed that compared with placebo, PDT was associated with lower costs and higher QALYs. The expected annual cost per patient with PDT was US$797 (CI 95% US$794- US$801) and with placebo was US$1175 (CI 95% US$1169- US$1181). The QALYs per person estimated with PDT was 0.95 (CI 95% 0.94–0.95) and with placebo was 0.94 (CI 95% 0.94–0.94). The NMB with PDT was US$ 4121 (CI 95% 4114–4127) and with placebo was US$ 3710 (CI 95% 3700–3720). This position of absolute dominance (PDT has lower costs and higher QALYs than placebo) of PDT it is unnecessary to estimate the incremental cost-effectiveness ratio.
Conclusion
In conclusion our study shows that PDT is a cost-effective strategy to reduce the incidence rate of recurrent respiratory tract infections in children. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines.
“…Given the short time horizon, no discount rates were applied to costs or QALYs. Cost-effectiveness was evaluated at a willingness-to-pay (WTP) value of US$5180 [ 6 ]. In Colombia there is no data on the frequency of recurrent pneumonia in the study population.…”
Introduction
Despite the growing evidence on efficacy, few economic evaluations have evaluated the cost-utility of Pidotimod (PDT) supplementation to decrease the probability of recurrent respiratory tract infections in children. This study aimed to determine the cost-utility of PDT to reduce the incidence rate of recurrent respiratory tract infections in children.
Methods
A decision tree model was used to estimate the cost and quality-adjusted life-years (QALYs) of PDT in a patient aged 1–6 with a history of recurrent respiratory tract infections. Multiple sensitivity analyses were conducted to evaluate the robustness of the model. Cost-effectiveness was evaluated at a willingness-to-pay (WTP) value of US$5180.
Results
The base-case analysis showed that compared with placebo, PDT was associated with lower costs and higher QALYs. The expected annual cost per patient with PDT was US$797 (CI 95% US$794- US$801) and with placebo was US$1175 (CI 95% US$1169- US$1181). The QALYs per person estimated with PDT was 0.95 (CI 95% 0.94–0.95) and with placebo was 0.94 (CI 95% 0.94–0.94). The NMB with PDT was US$ 4121 (CI 95% 4114–4127) and with placebo was US$ 3710 (CI 95% 3700–3720). This position of absolute dominance (PDT has lower costs and higher QALYs than placebo) of PDT it is unnecessary to estimate the incremental cost-effectiveness ratio.
Conclusion
In conclusion our study shows that PDT is a cost-effective strategy to reduce the incidence rate of recurrent respiratory tract infections in children. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines.
“…Given the shorter time, the horizon discount rate was not applied to cost and QALY. Cost-effectiveness was evaluated at a willingness-to-pay (WTP) value estimated in Colombia of US $5180 per QALY gained [ 14 ]. Fig.…”
Introduction
Previous evidence has shown that fractional exhaled nitric oxide (FeNO) and eosinophil count in induced sputum (EO) are cost-effective relative to standard of care in guiding the management of children with persistent asthma. There is some doubt as if there are differences between these two biomarkers in terms of costs and benefits. Clarifying this doubt would allow prioritization of the design of clinical practice guidelines. The study aimed to compare in terms of costs and benefits these biomarkers in patients with asthma between 4 and 18 years of age.
Methods
A Markov model was used to estimate the cost-utility of asthma management using FeNO and EO in patients between 4 and 18 years of age. Transition probabilities, cost and utilities were estimated from previously published local studies, while relative risks were obtained from the systematic review of published randomized clinical trials. The analysis was carried out from a societal perspective.
Results
The expected annual cost per patient with EO was US $1376 (CI 95% US $1376–US $1377) and for FeNO was US $1934 (CI 95% US $1333–US $1334), with a difference of US $42.3 between these strategies. The Quality-adjusted life years (QALYs) per person estimated with EO was 0.95 (CI 95% 0.951–0.952) and for FeNO was 0.94 (CI 95% 0.930–0.940), with a difference of 0.01 between these strategies. The NMB with EO was US $4902 (CI 95% 4900–4904) and for FeNO was US $4841 (CI 95% 4839–4843). The incremental cost-effectiveness ratio of EO was $3566 per QALY gained regarding FeNO.
Conclusion
Our study demonstrates that induced sputum-guided management is a strategy cost-effective over FeNO and standard asthma management in Colombia. This evidence should encourage the adoption of any of these techniques to objectively guide the management of children with asthma in routine clinical practice in low-resource settings.
“…Given the short time horizon, no type of discount to costs or results was applied. Treatment was considered cost-effective if the incremental cost-utility ratio was below $5180 per QALY gained using the willingness to pay (WTP) for QALY in Colombia (19).…”
Background: High-flow nasal cannula (HFNC) is an alternative for delivering respiratory support to adults with acute exacerbations of chronic obstructive pulmonary disease. Despite increased popularity for respiratory support, there is still uncertainty about if their l costs of justify the clinical benefits provided. This study aims to evaluate the cost-utility of HFNC in acute exacerbations of chronic obstructive pulmonary disease in Colombia
Methods: Using a decision tree model, we estimated the cost and quality-adjusted life-years (QALYs) associated with HFNC and conventional oxygen therapy (COT) in adults who presented to the emergency department with acute exacerbations of chronic obstructive pulmonary disease. All parameters for the model were derived from published research with local data. All analyses were done from a societal perspective.
Results: We estimate a gain of 0,49 and 0,48 QALYs per patient-year on HFNC and COT respectively, and a difference of US$314 in total discounted cost per person-year on HFNC respecting COT. Because HFNC was associated with lower costs compared to conventional therapy, the incremental cost effectiveness ratio was not calculated.
Conclusions: HFNC achieving better outcomes at a lower cost in patients with acute exacerbations of chronic obstructive pulmonary disease in Colombia. Evidence should continue to be generated with real-life effectiveness data and economic evaluations in other countries to confirm our findings
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