RESUMO
INTRODUCTION: The choice among the different treatments available can have a great impact on the costs of asthma, OBJECTIVES: The objective of this study was to estimate the incremental cost-utility ratio of three inhaled corticosteroids (ICs): budesonide (BUD), fluticasone propionate (FP), and ciclesonide, compared to beclomethasone dipropionate (BDP) (the only IC included in the Compulsory Health Insurance Plan of Colombia), METHODS: A Markov-type model was developed to estimate costs and health outcomes of a simulated cohort of patients less than 18 years of age with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a systematic review of the literature. Cost data were obtained from a hospital´s bills and from the national manual of drug prices. The study assumed the perspective of the national healthcare in Colombia. The main outcome was the variable "quality-adjusted life years" (QALY), RESULTS: While treatment with BDP was associated with the lowest cost (£106.16 average cost per patient during 12 months), treatment with FP resulted in the greatest gain in QUALYs (0.9325 QALYs). FP was associated with a greater gain in QALYs compared to BUD and ciclesonide (0.9325 vs. 0.8999 and 0.9051 QALYs, respectively) at lower costs (£231.19 vs. £309.27 and £270.15, respectively), thus leading to dominance. The incremental cost-utility ratio of FP compared to BDP was £19,835.28 per QALY, CONCLUSIONS: BDP is the most cost-effective therapy for treating pediatric patients with persistent asthma when willingness to pay (WTP) is less than £21,129.22/QALY, otherwise, FP is the most cost-effective therapy.
Assuntos
Corticosteroides/uso terapêutico , Antiasmáticos/economia , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Asma/economia , Corticosteroides/economia , Androstadienos/economia , Androstadienos/uso terapêutico , Beclometasona/economia , Beclometasona/uso terapêutico , Budesonida/economia , Budesonida/uso terapêutico , Criança , Estudos de Coortes , Colômbia , Simulação por Computador , Análise Custo-Benefício , Custos de Medicamentos , Feminino , Fluticasona , Humanos , Masculino , Cadeias de Markov , Modelos Econômicos , Pregnenodionas/economia , Pregnenodionas/uso terapêutico , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: To assess the incremental cost-effectiveness of SFC compared with MON for the control of persistent asthma in children. METHODS: We conducted an economic evaluation on a 12-week prospective randomized open-label parallel-group comparison of SFC versus MON in children with symptomatic asthma receiving inhaled corticosteroids and short-acting ß2-agonists. Asthma-related medication, unscheduled physician contacts and hospitalizations were collected prospectively. The main effectiveness measure was percentage of asthma-controlled week with no short-acting ß2-agonist use during the study period. The analysis was conducted from the Mexican healthcare perspective using 2010 unit cost prices, and only direct costs were considered, all costs are reported in US dollar. . The model was made fully probabilistic to reflect the joint uncertainty in the model parameters. RESULTS: Over the whole treatment period, the median percentages of asthma-controlled weeks were 83.3% in the SFC group and 66.7% in the MON group (SFC-MON difference, 16.7%; 95% CI, 8.3-16.7; P < 0.001 in favor of SFC). The mean total cost of the SFC regimen was $ 2,323 compared with $ 3,230 for the MON regimen. The SFC was the dominant strategy (both more effective and less expensive) using the SFC was associated with an incremental cost per additional asthma-controlled of $ (5,467). Probabilistic sensitivity analysis tested numerous assumptions about the model cost and efficacy parameters and found that the results were robust to most changes. CONCLUSIONS: This analysis demonstrates that, compared with MON, SFC may be cost saving from the Mexican health care perspective for the treatment of pediatric patients with asthma. SFC provided a reduction in the number of severe exacerbations, frequent asthma symptoms and rescue medication use. Incremental cost-effectiveness analysis indicated the dominance of SFC because of both lower costs and greater efficacy.
Assuntos
Acetatos/economia , Corticosteroides/economia , Agonistas de Receptores Adrenérgicos beta 2/economia , Albuterol/análogos & derivados , Androstadienos/economia , Antiasmáticos/economia , Asma/economia , Custos de Medicamentos , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Quinolinas/economia , Acetatos/uso terapêutico , Adolescente , Corticosteroides/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Albuterol/economia , Albuterol/uso terapêutico , Androstadienos/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/diagnóstico , Asma/tratamento farmacológico , Criança , Redução de Custos , Análise Custo-Benefício , Ciclopropanos , Combinação de Medicamentos , Combinação Fluticasona-Salmeterol , Hospitalização/economia , Humanos , México , Modelos Econômicos , Programas Nacionais de Saúde/economia , Estudos Prospectivos , Quinolinas/uso terapêutico , Sulfetos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the comparative efficacy of fluticasone propionate (FP) and montelukast (MON), using administrative claims for pediatric asthma in a clinical setting. STUDY DESIGN: This retrospective observational study used the PharMetrics Integrated-Outcomes Database. Children age 4 to 17 years with an ICD-9-CM 493.xx for asthma, therapy with an inhaled corticosteroid in the 12 months before the index medications, and an index claim for FP or MON between January 2001 and December 2003 were studied. FP- and MON-treated children were propensity-matched based on health care utilization. Asthma-related parameters studied included treatment failure, hospitalizations, and total cost of care. RESULTS: The children treated with MON were more likely to experience treatment failure (odds ratio [OR] = 2.55; 95% confidence interval [CI] = 2.19 to 2.96) and to be admitted to the hospital for asthma-related care (OR = 1.99; 95% CI = 1.15 to 3.44) compared with those treated with FP. Furthermore, the children treated with MON incurred significantly higher asthma-related treatment costs compared with those treated with FP (parameter estimate = 0.418; P < .0001). CONCLUSIONS: In children with asthma, treatment with FP is associated with better outcomes and lower cost than treatment with MON.
Assuntos
Acetatos/uso terapêutico , Androstadienos/uso terapêutico , Asma/tratamento farmacológico , Quinolinas/uso terapêutico , Acetatos/economia , Administração por Inalação , Adolescente , Androstadienos/economia , Asma/diagnóstico , Broncodilatadores/uso terapêutico , Criança , Pré-Escolar , Estudos de Coortes , Intervalos de Confiança , Análise Custo-Benefício , Ciclopropanos , Feminino , Fluticasona , Seguimentos , Humanos , Masculino , Razão de Chances , Probabilidade , Quinolinas/economia , Testes de Função Respiratória , Estudos Retrospectivos , Índice de Gravidade de Doença , Sulfetos , Resultado do TratamentoRESUMO
OBJECTIVE: To compare the efficiency of adjuvant therapy with aromatase inhibitors or with tamoxifen in postmenopausal women with operable breast cancer and positive estrogen receptors. MATERIAL AND METHODS: A cost-utility analysis was performed based on a Markov model, from the Spanish National Health Care System perspective, comparing the treatment with exemestane (EXE: 25 mg/day) or tamoxifen (TAM: 20 mg/day) after 2-3 years of monotherapy with TAM; anastrozole (ANA, 1 mg/day) or TAM (20 mg/day) without previous TAM therapy; and letrozole (LET: 2.5 mg/day) or placebo after 5 years of monotherapy with TAM. The follow-up of a hypothetical cohort of women starting treatment at 63 years of age was simulated during 10 and 20 years. The probabilities of transition between health states and quality adjusted life years (QALYs) were obtained from the literature, and the unit costs (euro corresponding to 2004) from a Spanish database. RESULTS: After 10 and 20 years of follow-up, more QALYs per patient would be gained with the EXE scheme (0.230-0.286 and 0.566-0.708, respectively) than with ANA (0.114 and 0.285) and LET (0.176 and 0.474). The cost of gaining one QALY was lower with the EXE scheme (50,801-62,522 euro and 28,849- 35,371 euro, respectively) than with ANA (104,272 euro and 62,477 euro) and LET (91,210 euro and 49,460 euro). The result was stable for the cost per life-year gained (LYG) and in the sensitivity analysis. CONCLUSIONS: The EXE scheme after TAM is more cost-effective than the ANA and LET schemes.
Assuntos
Androstadienos/economia , Antineoplásicos Hormonais/economia , Neoplasias da Mama/economia , Quimioterapia Adjuvante/economia , Simulação por Computador , Antagonistas de Estrogênios/economia , Estrogênios , Modelos Teóricos , Neoplasias Hormônio-Dependentes/economia , Nitrilas/economia , Receptores de Estrogênio/análise , Tamoxifeno/economia , Triazóis/economia , Anastrozol , Androstadienos/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/economia , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/química , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Estudos de Coortes , Análise Custo-Benefício , Antagonistas de Estrogênios/uso terapêutico , Honorários Farmacêuticos , Feminino , Seguimentos , Humanos , Letrozol , Cadeias de Markov , Pessoa de Meia-Idade , Proteínas de Neoplasias/análise , Neoplasias Hormônio-Dependentes/química , Neoplasias Hormônio-Dependentes/tratamento farmacológico , Neoplasias Hormônio-Dependentes/cirurgia , Nitrilas/uso terapêutico , Pós-Menopausa , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Tamoxifeno/uso terapêutico , Triazóis/uso terapêuticoRESUMO
OBJECTIVE: To evaluate efficacy, safety, health outcomes, and cost-effectiveness of fluticasone propionate (FP) versus montelukast (MON) in 342 children (6 to 12 years of age) with persistent asthma. STUDY DESIGN: Randomized, double-blind, 12-week study of treatment with FP inhalation powder 50 mug twice daily or MON chewable 5 mg once daily for 12 weeks. RESULTS: Compared with MON, FP significantly increased mean percent change from baseline FEV1 (forced expiratory volume in 1 second) (P=.002), morning PEF (peak expiratory flow) (P=.004), evening PEF (P=.020), and percent rescue-free days (P=.002) at end point, and it significantly reduced nighttime symptom scores (P <.001) and mean total (P=.018), and nighttime (P <.001) albuterol use. Withdrawals from the study were more frequent with MON (21%) than with FP (13%). Adverse events (69% vs 71%) and mean end point to baseline 12-hour urinary cortisol excretion ratios were similar. Parents and physicians were more satisfied with FP treatment than with MON (P=.006 and P=.016, respectively, at Week 12). Mean total daily asthma-related cost per patient in the FP group was approximately one-third of that in the MON group ($1.25 vs $3.49). CONCLUSION: FP was significantly more effective than MON in improving pulmonary function, asthma symptoms, and rescue albuterol use. Both therapies had similar safety profiles. Parent- and physician-reported satisfaction ratings were higher with FP treatment, and asthma-related costs were lower.