Cost-utility analysis of the inhaled steroids available in a developing country for the management of pediatric patients with persistent asthma.
BACKGROUND
The choice among the different treatments available can have a great impact on the costs of asthma,


OBJECTIVE
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.
Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia. carerodriguezmar@unal.edu.co
Carlos E
CE
Rodríguez-Martínez
Mónica P
MP
Sossa-Briceño
Jose A
JA
Castro-Rodriguez
D000305:Adrenal Cortex Hormones / Q000191:economics / Q000627:therapeutic use*; D000730:Androstadienes / Q000191:economics / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000191:economics* / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000191:economics*; D001507:Beclomethasone / Q000191:economics / Q000627:therapeutic use; D019819:Budesonide / Q000191:economics / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D003105:Colombia; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D011282:Pregnenediones / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic
D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D011282:Pregnenediones; D019819:Budesonide; D000068298:Fluticasone; D001507:Beclomethasone; C120481:ciclesonide