Introduction
Dupilumab is an effective and safe medicine for the management of severe asthma. Due to its high cost, concerns are generated regarding its cost‐effectiveness. This study aimed to ...estimate the cost‐utility of dupilumab plus standard of care (SoC) versus SoC alone in children between 6 and 11 years old with severe asthma and eosinophilic phenotype.
Methods
A Markov‐type model was developed to estimate costs and health outcomes of a simulated cohort of pediatric patients with persistent asthma treated over a 6‐year period. To determine the robustness of the model deterministic and probabilistic sensitivity analyses were conducted.
Results
The quality‐adjusted life‐years (QALYs) per patient estimated were 0.85 with dupilumab and 0.84 with SoC. The total mean of discounted costs per patient per cycle were US$ 379 for dupilumab and US$ 19 for SoC. The incremental cost‐effectiveness ratio estimated was $24 660 US$ per QALY
Conclusion
Dupilumab is not cost‐effective in Colombia in children between 6 and 11 years old with severe asthma and eosinophilic phenotype. Our evidence should motivate regulatory agencies to improve negotiations for new drugs with better information and evidence.
Introduction
Increasing evidence has demonstrated the effectiveness and safety of corticosteroids in community‐acquired pneumonia in children. More economic evaluations incorporating the new evidence ...and in the pediatric population are needed to know the efficiency of this treatment. This study aimed to evaluate the cost utility of the use of corticosteroids as adjuvant treatment for children with Mycoplasma pneumonia.
Methods
A decision tree model was used to estimate the cost and quality adjusted life years (QALY) associated with cost‐effectiveness as an adjunct treatment for children with Mycoplasma pneumonia with persistent signs after standard treatment with macrolide drugs for ≥1 week. Multiple sensitivity analyses were conducted.
Results
The QALYs per person estimated in the model for those treatments were 0.92 with corticosteroids plus antibiotics and 0.91 with antibiotics. The total costs per person were US$965 for corticosteroids plus antibiotics and US$1271 for antibiotics. This position of absolute dominance of corticosteroids plus antibiotics over antibiotics makes it unnecessary to estimate the incremental cost‐effectiveness ratio.
Conclusion
Corticosteroids are cost‐effective as an adjunct treatment for children with Mycoplasma pneumoniae pneumonia with persistent signs after standard treatment with macrolide drugs for ≥1 week. Our evidence should motivate the evaluation of this treatment in other countries.
Introduction
Despite the growing evidence of efficacy, little is known regarding the efficiency of ambrisentan to decrease cost and improve the functional classes of pediatric patients with pulmonary ...arterial hypertension. This study aims to determine the cost‐utility of ambrisentan regarding sildenafil to treat pediatric patients with pulmonary arterial hypertension in Colombia.
Methods
A decision tree model was used to estimate the cost and quality‐adjusted life‐years (QALYs) of ambrisentan, or sildenafil in pediatric patients with pulmonary arterial hypertension. 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 sildenafil, ambrisentan was associated with higher costs and higher QALYs. The expected annual cost per patient with ambrisentan was US$16,105 and with sildenafil was US$1431. The QALYs per person estimated with ambrisentan was 0.40 and for sildenafil was 0.39. The estimated improvement in quality of life and reduced costs results in an estimate of economic dominance for sildenafil over ambrisentan.
Conclusion
Our economic evaluation shows that ambrisentan is not cost‐effective regarding sildenafil to treat pediatric patients with pulmonary arterial hypertension in Colombia. Our study provides evidence that should be used by decision‐makers to improve clinical practice guidelines.
Introduction
Despite the growing evidence on efficacy, little is known regarding the efficiency of Vitamin A supplementation to decrease the probability of chronic lung disease (CLD) in preterm ...infants. This study aims to determine the cost‐utility of Vitamin A to prevent CLD in preterm infants in Colombia.
Methods
A decision tree model was used to estimate the cost and quality‐adjusted life‐years (QALYs) of Vitamin A supplementation in preterm infants. Multiple sensitivity analyses were conducted to evaluate the robustness of the model. Cost‐effectiveness was evaluated at a willingness‐to‐pay value of US$5180.
Results
Vitamin A was associated with lower costs and higher QALYs. The expected annual cost per patient with Vitamin A was US$1579 (95% CI US$1555–US$1585) and without Vitamin A was US$1913 (95% CI US$1891–US$1934). The QALYs per person estimated with Vitamin A was 0.66 (95% CI 0.66–0.67) and without Vitamin A was 0.61 (95% CI 0.60–0.61). This position of absolute dominance (Vitamin A has lower costs and higher QALYs than without Vitamin A) is unnecessary to estimate the incremental cost‐effectiveness ratio.
Conclusion
Our economic evaluation shows that Vitamin A is cost‐effective to reduce the incidence rate of CLD in premature infants in Colombia. Our study provides evidence that should be used by decision‐makers to improve clinical practice guidelines.
Background
Bronchopulmonary dysplasia (BPD) is the most common cause of chronic lung disease in children born prematurely. There is little information about the epidemiology and severity of BPD ...places with high altitude. This study aimed to evaluate the frequency of BPD severity levels and the associated risk factors with severity in a cohort of preterm newborns ≤36weeks of gestational age born in Rionegro, Colombia
Materials and Methods
We carried out a retrospective analytical cohort of preterm newborns without major malformations from Rionegro, Colombia between 2011 and 2018 admitted to neonatal intensive unit at high altitude (2200 m above sea level). The main outcomes were the incidence and severity of BPD.
Results
The BPD incidence was 23.5% 95% (confidence interval CI, 19.6–27.7). BPD was grade 1 in 69.9%, grade 2 in 15.5% and grade 3 in 14.5% of patients. After modeling regression analysis, the final variables associated with BPD severity levels were: sepsis (odds ratio OR, 4.15; 95% CI, 1.33–12.96) and pulmonary hypertension (OR: 3.86; 95% CI, 1.30‐11.4).
Conclusion
The incidence of BPD was higher and similar to cities with higher altitudes. In our population, the variables associated with BPD severity levels were: sepsis and pulmonary hypertension. It is necessary to increase the awareness of risk factors, the effect of clinical practices, and early recognition of BPD to reduce morbidity in patients with this pathology.
Background
Nasal Continuous Positive Airway Pressure (CPAP) and High‐Flow Nasal Cannula (HFNC) have emerged as alternatives to orotracheal intubation and conventional invasive ventilation in patients ...with moderate to severe bronchiolitis. This study aims to evaluate the evidence and the cost‐utility of HFNC compared to CPAP in infants with moderate‐severe bronchiolitis in Colombia.
Methods
The search includes electronic databases such as Pubmed, ScienceDirect, and Embase. Through inclusion and exclusion criteria, screen randomized controlled trials. A decision tree model was used to estimate the cost‐utility of CPAP compared with HFNC in infants with moderate‐severe bronchiolitis. Sensitivity analysis of transition probabilities, utilities, and cost was carried out.
Results
Incorporate five studies that meet the criteria. The risk of intubation rate in the patients with CPAP is lower than HFNC (relative risk 0.62; 95% confidence interval 0.46−0.84; I2 = 0%) The base‐case analysis showed that compared with HFNC, CPAP was associated with lower costs and higher quality‐adjusted life years (QALYs). The expected annual cost per patient with CPAP was US$17,574 and with HFNC was US$29,421. The QALYs per person estimated with CPAP were 0.92 and with HFNC was 0.91. This position of absolute dominance of CPAP (CPAP has lower costs and higher QALYs than HFNI) makes it unnecessary to estimate the incremental cost‐utility ratio.
Conclusions
CPAP is cost‐effective, over the HFNC, in infants with severe‐moderate bronchiolitis in Colombia. Our study provides evidence that should be used by decision‐makers to improve clinical practice guidelines and should be replicated to validate their results in other countries.
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