Costo utilidad de profilaxis con palivizumab versus no profilaxis en niños con riesgo de infección de virus sincitial respiratorio en Colombia

Objetivo: determinar la costo utilidad de la profilaxis del palivizumab en niños con factores de riesgo para infección por virus sincitial respiratorio. Materiales y métodos: fue realizado un árbol de decisión, desde la perspectiva del pagador, en niños pretérmino (menores de 35 semanas) o con enfermedad cardiaca congénita, usando datos de costos locales y datos de efectividad para el cálculo de años de vida ajustado a calidad (AVAC)  provenientes de estudios clínicos controlados con un horizonte temporal de toda la expectativa de vida. Los costos fueron reportados en pesos colombianos (ColP$) y se aplicó una tasa de descuento de 3,5$8 944 789 y en el grupo de no palivizumab $1 846 634. Los AVAC en estos grupos fueron de 72,28 y 72,17, respectivamente. La razón de costo utilidad incremental fue de$ 65 528 681/AVAC adicional. En el grupo de niños con enfermedad cardiaca congénita los costos de palivizumab fueron de $15 191 700 y de$4 657 187 en el grupo de no palivizumab. Los AVAC en estos grupos fueron de 72,16, respectivamente. La razón de costo utilidad incremental fue de $47 884 150/AVAC adicional. Existe una probabilidad mayor del 50$60 000 000. Conclusión: palivizumab es una alternativa costo útil en niños con riesgo de infección por virus sincitial respiratorio.Objective: To determine the incremental cost utility ratio (ICUR) of prophylaxis with palivizumab in children with risk factors for infection by respiratory syncytial virus (RSV). Material and methods: A decision tree using the perspective of the Colombian health sector was conducted in preterm infants (<35weeks) and children with congenital heart disease (CHD) using local data on costs and effectiveness data for the calculation of quality adjusted life years (QALYs) from randomized clinical trials with a time horizon of their life expectancy. Costs were reported in Colombian pesos ($ColP) and a discount rate of 3.5 evaluated using a Monte Carlo simulation. Results: The costs of palivizumab in the preterm group were$8’944.789 and the group of non palivizumab $1’846.634. The QALY in these groups were 72.28 and 72.17 respectively. The ICUR was$65’528.681/QALY additional. In the group of children with CHD the costs of palivizumab were $15’191.700 and$4’657.187 in no palivizumab group. The QALYs in these groups were 72.16 and 71.94, respectively. The ICUR was $47’884.150/QALY. There is a probability greater than 50 willingness to pay of$60’000.000. Conclusion: Palivizumab provides a costeffective alternative of prophylaxis against RSV infection

Budget impact analysis of the adoption of new hypertension guidelines in Colombia

Abstract Background Hypertension represents a high burden of disease in different healthcare systems. Recent guideline published in 2017 by the American Heart Association and the American College of Cardiology has generated a debate between clinicians and policymakers due to the lowering of diagnosis threshold and the subsequent increase of the prevalence and healthcare costs. No empirical research exists addressing the question about the pressure on healthcare costs generated by new standards. This study aims to quantify the impact on the hypertension diagnosis and treatment costs for healthcare system using the new hypertension guideline. Methods We conducted a budget impact analysis from a Colombian healthcare payer’s perspective with a 3-year time horizon (2018–2020), in which we estimated the difference in total medical care costs between previous hypertension cut-off points (140/90 mmHg) and new guideline cut-off points (130/80 mmHg). Results Our results show that the impact of the adoption of the new hypertension guideline would represent a decrease close to 22% in total annual high blood pressure costs in Colombia. This reduction is mainly driven by a lower number of cardiovascular complications. It is worth noting that these results should be taken with caution due to local available data. Conclusions A high-middle income country such as Colombia should carry out an exhaustive revision of the recommendations of the new hypertension guideline, due to its high probability of saving medical treatment costs for the healthcare system