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Ordóñez JE, Huertas VM. Cost-utility analysis of palivizumab for preventing respiratory syncytial virus in preterm neonates and infants in Colombia. BMC Infect Dis 2024; 24:418. [PMID: 38641577 PMCID: PMC11031882 DOI: 10.1186/s12879-024-09300-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 04/07/2024] [Indexed: 04/21/2024] Open
Abstract
AIM Palivizumab has proven effective in reducing hospitalizations, preventing severe illness, improving health outcomes, and reducing healthcare costs for infants at risk of respiratory syncytial virus (RSV) infection. We aim to assess the value of palivizumab in preventing RSV infection in high-risk infants in Colombia, where RSV poses a significant threat, causing severe respiratory illness and hospitalizations. METHODS We conducted a decision tree analysis to compare five doses of palivizumab with no palivizumab. The study considered three population groups: preterm neonates (≤ 35 weeks gestational age), infants with bronchopulmonary dysplasia (BPD), and infants with hemodynamically significant congenital heart disease (CHD). We obtained clinical efficacy data from IMpact-RSV and Cardiac Synagis trials, while we derived neonatal hospitalization risks from the SENTINEL-1 study. We based hospitalization and recurrent wheezing management costs on Colombian analyses and validated them by experts. We estimated incremental cost-effectiveness ratios and performed 1,000 Monte Carlo simulations for probabilistic sensitivity analyses. RESULTS Palivizumab is a dominant strategy for preventing RSV infection in preterm neonates and infants with BPD and CHD. Its high efficacy (78% in preventing RSV in preterm infants), the substantial risk of illness and hospitalization, and the high costs associated with hospitalization, particularly in neonatal intensive care settings, support this finding. The scatter plots and willingness-to-pay curves align with these results. CONCLUSION Palivizumab is a cost-saving strategy in Colombia, effectively preventing RSV infection in preterm neonates and infants with BPD and CHD by reducing hospitalizations and lowering healthcare costs.
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Rodriguez-Martinez CE, Sossa-Briceño MP, Soto-Martinez ME. The Use of Bacterial Lysate for the Prevention of Wheezing Episodes in Preschool Children: A Cost-Utility Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:220-227. [PMID: 36243402 DOI: 10.1016/j.jaip.2022.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although increasing recent evidence has shown the efficacy of bacterial lysate therapy for the prevention of wheezing episodes and asthma exacerbations in pediatric patients, evidence of its cost-effectiveness in preschool patients is scarce. OBJECTIVES To evaluate the cost-utility of bacterial lysate therapy as an add-on to standard care of preschool children with recurrent wheezing. METHODS To achieve the objectives of the study, we used a Markov simulation model with 3 mutually exclusive nonabsorbent states (regular Markov chain). Effectiveness parameters were obtained from a recent systematic review of the literature with meta-analyses (5 randomized controlled trials, 433 children). Cost data were obtained from hospital bills and from the national manual of drug prices in Colombia. The study was carried out from the perspective of the national health care system in Colombia. The main outcome of the model was quality-adjusted life-years. To assess the robustness of the model's results, we performed deterministic and probabilistic sensitivity analysis. RESULTS Compared with standard care, bacterial lysate add-on therapy to standard care was associated with lower overall treatment costs (US $694.03 vs $830.71 average cost per patient) and the greatest gain in QALYs (0.9211 vs 0.9154 QALYs on average per patient), thus showing dominance. CONCLUSIONS In Colombia, compared with standard care, bacterial lysate add-on therapy to standard care for treating preschool children with recurrent wheezing is a dominant strategy because it showed a greater gain in QALYs at lower total treatment costs.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia; Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia.
| | - Monica P Sossa-Briceño
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
| | - Manuel E Soto-Martinez
- Respiratory Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," Caja Costarricense Seguro Social, San José, Costa Rica; Section of Pediatrics, School of Medicine, Universidad de Costa Rica, San José, Costa Rica
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Buendía JA, Guerrero Patiño D, Giraldo Ramírez JE. Cost Utility of Intermittent Inhaled Corticosteroids in Preschoolers with Viral-Triggered Wheeze. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2022; 35:36-42. [PMID: 35320007 DOI: 10.1089/ped.2021.0143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: Evidence has demonstrated that adding intermittent inhaled corticosteroids (ICS) to treatment with short-acting b2-agonists (SABAs) in children 5 years of age and younger who experience intermittent viral-induced wheezing (VIW) reduces the risk of severe exacerbations. However, there is concern about whether the extra benefit offered by this drug outweighs the additional cost. This study aimed to evaluate the cost-effectiveness of intermittent ICS in children 5 years of age and younger who experience intermittent VIW. Methods: We constructed a probabilistic Markov model to estimate the cost and quality-adjusted life-years (QALYs) of intermittent ICS compared with SABA reliever therapy in preschoolers with viral-triggered wheezing in Colombia. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $5,180. Results: In an analysis of the Markov cohort model, we estimated a gain of 0.2 QALYs per patient per year on intermittent ICS compared with SABA and a reduction of cost per patient of USD $37 per year. This position of dominance negated the need to calculate an incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses, our base case results were robust to variations of all assumptions and parameters. Conclusion: Adding intermittent ICS to treatment with SABAs in children 5 years of age and younger who experience intermittent VIW was found to be cost effective. These results could improve the use of health care resources, especially in settings with limited economic resources.
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Affiliation(s)
- Jefferson Antonio Buendía
- Research Group in Pharmacology and Toxicology "INFARTO," Department of Pharmacology and Toxicology, University of Antioquia, Medellín, Colombia
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Sadatsafavi M, FitzGerald JM, O’Byrne PM, Soliman M, Sriskandarajah N, Vicente C, Golam SM. The cost-effectiveness of as-needed budesonide-formoterol versus low-dose inhaled corticosteroid maintenance therapy in patients with mild asthma in Canada. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2021; 17:108. [PMID: 34641954 PMCID: PMC8507225 DOI: 10.1186/s13223-021-00610-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Global Initiative for Asthma recommends the use of as-needed low-dose inhaled corticosteroid (ICS)-formoterol as a preferred controller therapy for patients with mild asthma. These recommendations were based, in part, on evidence from the SYGMA 1 and 2 studies of as-needed budesonide-formoterol. This analysis aimed to compare the cost-effectiveness of as-needed budesonide-formoterol to low-dose maintenance ICS plus as-needed short-acting β2-agonist (SABA) in patients with mild asthma. METHODS A Markov cohort model was designed that included three possible health states (non-exacerbation, severe exacerbation, and death) to compare as-needed budesonide-formoterol 200-6 μg to twice-daily budesonide 200 μg maintenance therapy (low-dose ICS) plus as-needed terbutaline 0.5 mg (SABA). The deterministic base-case analysis used severe exacerbation, adverse event (AE), and healthcare resource use data from SYGMA 2, and was conducted from a Canadian public payer perspective with a 50-year time horizon, and a discount rate of 1.5% per annum. Moderate exacerbation was modelled on data from SYGMA 1 in sensitivity analyses. Utility values were derived from SYGMA 2 quality of life data. All-cause- and asthma-related mortality rates and costs (reported in 2019 Canadian dollars) were based on published data, using Canada-specific values where available. One-way deterministic sensitivity, probabilistic sensitivity, and eight scenario analyses were conducted to examine the robustness of the results. RESULTS As-needed budesonide-formoterol was the dominant treatment option in the base-case analysis, providing incremental cost savings of $9882 per patient and quality-adjusted life year (QALY) gains of 0.002 versus low-dose maintenance ICS plus as-needed SABA over a 50-year time horizon. Using a willingness-to-pay threshold of $50,000/QALY ($100,000/QALY), as-needed budesonide-formoterol had a 94% (95%) probability of being cost-effective compared with maintenance ICS plus as-needed SABA. Cost-saving was mostly driven by lower overall medication and AE-related costs. As-needed budesonide-formoterol remained the dominant treatment in sensitivity and scenario analyses. CONCLUSIONS As-needed budesonide-formoterol is a cost-saving option for the treatment of mild asthma from the perspective of the Canadian public payer compared with low-dose maintenance ICS plus as-needed SABA.
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Affiliation(s)
- Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T1Z3 Canada
| | - J. Mark FitzGerald
- Centre for Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z1M9 Canada
| | - Paul M. O’Byrne
- Firestone Institute of Respiratory Health, St Joseph’s Healthcare and Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Health Science Center, 3W10, Hamilton, ON L8S 4K2 Canada
| | - Mena Soliman
- Medical Affairs, AstraZeneca, 1004 Middlegate Road, Mississauga, ON L4Y 1M4 Canada
| | | | - Colin Vicente
- PIVINA Consulting Inc., 2600 Skymark Avenue, Suite 11-202, Mississauga, ON L4W 5B2 Canada
| | - Sarowar Muhammad Golam
- Global Market Access and Pricing, BioPharmaceuticals R&D, AstraZeneca, Mölndal, 431 83 Gothenburg, Sweden
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Rodriguez-Martinez CE, Sossa-Briceño MP, Castro-Rodriguez JA. Cost-utility of omalizumab for the treatment of uncontrolled moderate-to-severe persistent pediatric allergic asthma in a middle-income country. Pediatr Pulmonol 2021; 56:2987-2996. [PMID: 34143576 DOI: 10.1002/ppul.25541] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/16/2021] [Accepted: 06/08/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Although several randomized clinical trials performed in children 6 years and older with Omalizumab as add-on therapy have reported improvements in diverse clinical outcomes, the evidence regarding its cost effectiveness is not sufficient, especially in less-affluent countries, where the clinical and economic burden of the disease is the greatest. The aim of the present study was to perform a cost-utility analysis of adding omalizumab to standard treatment for treating pediatric patients with uncontrolled severe allergic asthma in Colombia, a middle-income country (MIC). 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 5-year period. The effectiveness data and transition probabilities were obtained from various sources, including systematic reviews with meta-analysis. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The study was carried out from the perspective of the national healthcare system in Colombia. The main outcome was the variable ''quality-adjusted life-years'' (QALYs). RESULTS For the base-case analysis, the cost-utility analysis showed that compared with the standard treatment strategy, the omalizumab strategy involved higher costs (US$72,142.3 vs. $20,243.4 average cost per patient) and greater gain in QALYs (0.8718 vs. 0.8222 QALYs on average per patient). The incremental cost-utility ratio (ICUR) of omalizumab compared with standard treatment was US$82,748.1 per QALY CONCLUSIONS: This study shows that in Colombia, an MIC, compared with standard treatment, omalizumab is not a cost-effective strategy for treating pediatric patients with uncontrolled severe allergic asthma.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.,Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | | | - Jose A Castro-Rodriguez
- Division of Pediatrics, Department of Pediatric Pulmonology and Cardiology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Duenas-Meza E, Giraldo-Cadavid LF, Karpf E, Afanador F, Angarita OL, Barón O, Medina MS, Pachón A, Gonzalez A, Jurado J, Torres-Duque CA. Cost-utility analysis of an integrated care program for children with asthma in a medium-income country. Pediatr Pulmonol 2020; 55:3110-3118. [PMID: 33460317 DOI: 10.1002/ppul.24996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the cost-utility of an integrated care program (ASMAIRE Infantil Program [PAI]) for children with asthma compared with standard of care. METHODS A decision-analytic model was used to compare an integrated care program compared to the standard of care in children with asthma in Bogota, Colombia. Baseline characteristics of the patients were established according to the distribution of patients in the PAI database. Other inputs were obtained from published meta-analysis, local registries, medical bills, general mortality data, and expert opinion. Costs were presented in 2017 Colombian pesos. Outcomes included quality-adjusted life-years (QALYs). Costs and outcomes were discounted by 5% per year. Incremental cost-utility ratios were presented for PAI compared with standard of care. Univariate and multivariate probabilistic sensitivity analyses were conducted to assess model robustness to parameter uncertainty. RESULTS The model predicted that patients that are part of the PAI would accrue more QALYs than patients on standard of care. The incremental results suggest that the PAI is a cost-effective treatment (incremental cost-utility ratio of Colombian pesos $33 753 817/QALY) compared with standard of care. Sensitivity analyses suggest that results are most sensitive to cost of care (with and without PAI) and costs of severe exacerbation. However, the PAI is cost-effective irrespective of variation in any of the input parameters. CONCLUSION Our model predicted that an integrated intervention for the management of asthma in pediatric patients improves QALYs, reduces number of disease related exacerbations compared to standard therapy and is cost-effective for the long-term control of the disease in Colombia.
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Affiliation(s)
- Elida Duenas-Meza
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Pediatric Department, School of Medicine, University of La Sabana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Luis F Giraldo-Cadavid
- Department of Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Department of Epidemiology and Biostatistics, School of Medicine, University of La Sabana, Bogotá, Colombia
| | | | | | | | - Oscar Barón
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Maria S Medina
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Angelica Pachón
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia
| | - Angelica Gonzalez
- Department of Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia
| | - Jenny Jurado
- Section of Pediatric Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,Pediatric Department, School of Medicine, University of La Sabana, Bogotá, Colombia.,Department of Pediatric, Fundación Cardioinfantil-Instituto de Cardiologia, Bogotá, Colombia
| | - Carlos A Torres-Duque
- Department of Pulmonology, Fundacion Neumologica Colombiana, Bogotá, Colombia.,School of Medicine, University of La Sabana, Bogotá, Colombia
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FitzGerald JM, Arnetorp S, Smare C, Gibson D, Coulton K, Hounsell K, Golam S, Sadatsafavi M. The cost-effectiveness of as-needed budesonide/formoterol versus low-dose inhaled corticosteroid maintenance therapy in patients with mild asthma in the UK. Respir Med 2020; 171:106079. [PMID: 32917353 DOI: 10.1016/j.rmed.2020.106079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/30/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND As-needed budesonide/formoterol is effective in patients with mild asthma for whom low-dose inhaled corticosteroid (ICS) maintenance therapy is appropriate. We assessed the cost-effectiveness of this regimen versus maintenance low-dose ICS plus as-needed short-acting β2-agonist (SABA). METHODS A probabilistic Markov cohort model was developed that simulated time within/outside severe asthma exacerbations, conducted from a UK NHS perspective with a 70-year time horizon. Clinical efficacy inputs were derived from the SYGMA 2 trial. Patients with mild asthma eligible for low-dose maintenance ICS therapy received as-needed budesonide/formoterol 200/6 μg or twice-daily budesonide 200 μg maintenance therapy plus as-needed terbutaline 0.5 mg. A severe exacerbation was defined as worsening asthma requiring systemic corticosteroid use alone/in combination with an emergency department visit, or hospitalisation for acute asthma. Utility values were derived from SYGMA 2 EQ-5D-5L data, and all-cause- and asthma-related mortality, reduction in utility of an exacerbation, and costs were based on published data. The base-case analysis discount rate was 3.5%. Model robustness was evaluated with one-way sensitivity, probabilistic sensitivity, and two scenario analyses. RESULTS On average, as-needed budesonide/formoterol was associated with a £292.99 cost saving and quality-adjusted life year (QALY) gains of 0.001 versus ICS + SABA. At a willingness-to-pay of £20,000/QALY, as-needed budesonide/formoterol had >85% probability of being cost-effective versus ICS + SABA. Key drivers were budesonide/formoterol and budesonide maintenance annual exacerbation rates, mean daily budesonide/formoterol inhalations, and costs and outcomes discount rates. CONCLUSIONS From a UK healthcare payer perspective, as-needed budesonide/formoterol is a cost-effective option for the treatment of mild asthma versus regular ICS.
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Affiliation(s)
- J Mark FitzGerald
- Centre for Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, 2775, Laurel Street, Vancouver, BC, V5Z1M9, Canada
| | - Sofie Arnetorp
- AstraZeneca, Gothenburg, Pepparedsleden 1, 431 83, Mölndal, Sweden.
| | | | - Danny Gibson
- AstraZeneca, Horizon Place, 600 Capability Green, Luton, LU1 3LU, Bedfordshire, UK
| | - Karen Coulton
- AstraZeneca, 1 Francis Crick Avenue, Cambridge Biomedical Campus, Cambridge, CB2 0AA, UK
| | | | - Sarowar Golam
- AstraZeneca, Gothenburg, Pepparedsleden 1, 431 83, Mölndal, Sweden
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405, Wesbrook Mall, Vancouver, BC, V6T1Z3, Canada
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Phan HT, Vu GV, Vu GT, Ha GH, Pham HQ, Latkin CA, Tran BX, Ho CS, Ho RC. Global Mapping of Research Trends on Interventions to Improve Health-Related Quality of Life in Asthma Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103540. [PMID: 32438571 PMCID: PMC7277612 DOI: 10.3390/ijerph17103540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/14/2022]
Abstract
Globally, approximately 335 million people are being affected by asthma. Given that asthma is a chronic airway condition that cannot be cured, the disease negatively impacts physical health and results in losses of productivity of people experiencing asthma, leading to decrease in quality of life. This study aims at demonstrating the research trends worldwide and identifying the research gaps in interventions for improving quality of life of patients with asthma. Bibliometric approach and content analysis, which can objectively evaluate the productivity and research landscapes in this field, were utilized. In this study, we systematically quantified the development of research landscapes associated with interventions for improving quality of life of people experiencing asthma. Along with the gradual growth in the number of publications, these research topics have relatively expanded in recent years. While the understanding of the pathophysiology, diagnosis and treatment of asthma has been well-established, recent research has showed high interest in the control and management of asthma. Findings of this study suggest the need for more empirical studies in developing countries and further investigation into the effects of environment factors on asthma outcomes, as well as the economic burden of asthma.
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Affiliation(s)
- Hai Thanh Phan
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (H.T.P.); (B.X.T.)
| | - Giap Van Vu
- Department of Internal Medicine, Hanoi Medical University, Hanoi 100000, Vietnam;
- Respiratory Center, Bach Mai Hospital, Hanoi 100000, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam;
| | - Giang Hai Ha
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam;
- Faculty of Pharmacy, Duy Tan University, Da Nang 550000, Vietnam
- Correspondence: ; Tel.: +84-6954-8561
| | - Hai Quang Pham
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam;
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (H.T.P.); (B.X.T.)
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Cyrus S.H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Roger C.M. Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore;
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam
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Halmai LA, Neilson AR, Kilonzo M. Economic evaluation of interventions for the treatment of asthma in children: A systematic review. Pediatr Allergy Immunol 2020; 31:150-157. [PMID: 31571263 DOI: 10.1111/pai.13129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This systematic review aimed to identify and critique full economic evaluations (EEs) of childhood asthma treatments with the intention to guide researchers and commissioners of pediatric asthma services toward potentially cost-effective strategies. METHODS "MEDLINE," "Embase," "EconLit," "NHS EED," and "CEA" databases were searched to identify relevant EEs published between 2005 and May 2017. Quality of included studies was assessed with a published checklist. RESULTS Eighteen studies were identified and comprised one cost-benefit analysis, 11 cost-effectiveness analyses, one cost-minimization analysis, and six cost-utility analyses. Treatments included pharmaceutical (n = 11) and non-pharmaceutical (n = 7) interventions. Fourteen studies identified cost-effective strategies. The quality of the studies varied and there were uncertainties due to the methods and relevance of data used. CONCLUSION Good-quality economic evaluation studies of pediatric asthma treatments are lacking. EE of new technologies adapted to local settings is recommended and can result in cost savings.
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Affiliation(s)
- Luca Adél Halmai
- Health Economics Department, MediConcept Ltd., Budapest, Hungary
| | - Aileen Rae Neilson
- Usher Institute of Population Health Sciences and Informatics, School of Molecular Genetic and Population Health Sciences, Edinburgh University, Edinburgh, UK
| | - Mary Kilonzo
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Ehteshami-Afshar S, Zafari Z, Hamidi N, FitzGerald JM, Lynd L, Sadatsafavi M. A Systematic Review of Decision-Analytic Models for Evaluating Cost-Effectiveness of Asthma Interventions. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1070-1082. [PMID: 31511184 DOI: 10.1016/j.jval.2019.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/31/2019] [Accepted: 03/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To demonstrate the landscape of model-based economic studies in asthma and highlight where there is room for improvement in the design and reporting of studies. DESIGN A systematic review of the methodologies of model-based, cost-effectiveness analyses of asthma-related interventions was conducted. Models were evaluated for adherence to best-practice modeling and reporting guidelines and assumptions about the natural history of asthma. METHODS A systematic search of English articles was performed in MEDLINE, EMBASE, and citations within reviewed articles. Studies were summarized and evaluated based on their adherence to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). We also studied the underlying assumptions about disease progression, heterogeneity in disease course, comorbidity, and treatment effects. RESULTS Forty-five models of asthma were included (33 Markov models, 10 decision trees, 2 closed-form equations). Novel biological treatments were evaluated in 12 studies. Some of the CHEERS' reporting recommendations were not satisfied, especially for models published in clinical journals. This was particularly the case for the choice of the modeling framework and reporting on heterogeneity. Only 13 studies considered any subgroups, and 2 explicitly considered the impact of comorbidities. Adherence to CHEERS requirements and the quality of models generally improved over time. CONCLUSION It would be difficult to replicate the findings of contemporary model-based evaluations of asthma-related interventions given that only a minority of studies reported the essential parameters of their studies. Current asthma models generally lack consideration of disease heterogeneity and do not seem to be ready for evaluation of precision medicine technologies.
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Affiliation(s)
- Solmaz Ehteshami-Afshar
- Collaboration for Outcomes Research and Evaluation, The University of British Columbia, Vancouver, Canada; Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Zafar Zafari
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Nima Hamidi
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - J Mark FitzGerald
- Division of Respiratory Medicine and Institute for Heart and Lung Health, Vancouver General Hospital, The University of British Columbia, Vancouver, Canada
| | - Larry Lynd
- Collaboration for Outcomes Research and Evaluation, The University of British Columbia, Vancouver, Canada
| | - Mohsen Sadatsafavi
- Collaboration for Outcomes Research and Evaluation, The University of British Columbia, Vancouver, Canada; Division of Respiratory Medicine and Institute for Heart and Lung Health, Vancouver General Hospital, The University of British Columbia, Vancouver, Canada.
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Chongmelaxme B, Chaiyakunapruk N, Dilokthornsakul P. Incorporating adherence in cost-effectiveness analyses of asthma: a systematic review. J Med Econ 2019; 22:554-566. [PMID: 30663455 DOI: 10.1080/13696998.2019.1572014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aims: Non-adherence is associated with poor clinical outcomes among patients with asthma. While cost-effectiveness analysis (CEA) is increasingly used to inform value assessment of the interventions, most do not take into account adherence in the analyses. This study aims to: (1) Understand the extent of studies considering adherence as part of the economic analyses, and (2) summarize the methods of incorporating adherence in the economic models. Materials and methods: A literature search was performed from the inception to February 2018 using four databases: PubMed, EMBASE, NHS EED, and the Tufts CEA registry. Decision model-based CEA of asthma were identified. Outcomes of interest were the number of studies incorporating adherence in the economic models, and the incorporating methods. All data were extracted using a standardized data collection form. Results: From 1,587 articles, 23 studies were decision model-based CEA of asthma, of which four CEA (17.4%) incorporated adherence in the analyses. Only the method of incorporating adherence by adjusting treatment effectiveness according to adherence levels was demonstrated in this review. Two approaches were used to derive the associations between adherence and effectiveness. The first approach was to apply a mathematical formula, developed by an expert panel, and the second was to extrapolate the associations from previous published studies. The adherence-adjusted effectiveness was then incorporated in the economic models. Conclusions: A very low number of CEA of asthma incorporated adherence in the analyses. All the CEA adjusted treatment effectiveness according to adherence levels, applied to the economic models.
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Affiliation(s)
- Bunchai Chongmelaxme
- a Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand
| | - Nathorn Chaiyakunapruk
- a Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand
- b School of Pharmacy , Monash University Malaysia , Jalan Lagoon Selatan , Selangor Darul Ehsan , Malaysia
- c Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster , Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia , Jalan Lagoon Selatan , Selangor Darul Ehsan , Malaysia
- d School of Pharmacy , University of Wisconsin-Madison , Madison , WI , USA
| | - Piyameth Dilokthornsakul
- a Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences , Naresuan University , Phitsanulok , Thailand
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Kim CH, Dilokthornsakul P, Campbell JD, van Boven JFM. Asthma Cost-Effectiveness Analyses: Are We Using the Recommended Outcomes in Estimating Value? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:619-632. [PMID: 28967548 DOI: 10.1016/j.jaip.2017.07.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/15/2017] [Accepted: 07/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Asthma medication cost-effectiveness analyses (CEAs) lack the qualitative assessment regarding whether they capture the National Institutes for Health (NIH) 2012 recommended outcomes necessary to allow robust cross-study comparisons. OBJECTIVE We aimed to assess the current asthma outcomes used in CEAs and recommend a direction for improvement. METHODS We performed a systematic search using electronic databases including PubMed, EMBASE, Tufts CEA registry, Cochrane, and NHSEED from January 2010 through December 2015. Key words included (1) cost-effectiveness, cost-utility, economic evaluation, health economics, or cost-benefit AND (2) asthma. All CEA studies evaluating 1 or more asthma medication were included. Authors assessed each CEA study with respect to asthma-specific NIH outcome recommendations including core (hospitalizations, emergency department visits, outpatient visits, medication, interventions costs), supplemental (visit categories and work/school absence), and emerging (academic/job-related) asthma outcomes. Besides outcomes of each CEA, issues that could prevent robust cross-study comparison were identified and thematically summarized. RESULTS A total of 12 pre-NIH and 14 post-NIH recommendation CEAs were included. Eleven (91.7%) and 14 (100%) of the pre-/post-NIH studies included at least 1 core outcome, respectively. Of the 26 total studies, 7 (26.9%) included asthma-specific outpatient visit categories, 6 (23.1%) included asthma school or work absences, 5 (19.2%) included respiratory health care use, and none of the studies included emerging outcomes. Other issues that hamper cross-study comparison include lack of standardized cost data, time frames, quality-of-life measures, and incorporation of adherence. CONCLUSIONS Although the use of NIH-recommended asthma core outcomes has improved, there is still room for improvement in using supplemental and emerging outcomes. To allow robust cross-study comparisons, future work should focus on further standardizing of data sources and methods.
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Affiliation(s)
- Chong H Kim
- Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, Colo
| | - Piyameth Dilokthornsakul
- Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, Colo; Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Jonathan D Campbell
- Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, Colo
| | - Job F M van Boven
- Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, Colo; Department of General Practice, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Rodriguez-Martinez CE, Sossa-Briceño MP, Castro-Rodriguez JA. A cost-effectiveness threshold analysis of a multidisciplinary structured educational intervention in pediatric asthma. J Asthma 2017; 55:561-570. [PMID: 28759278 DOI: 10.1080/02770903.2017.1348512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Asthma educational interventions have been shown to improve several clinically and economically important outcomes. However, these interventions are costly in themselves and could lead to even higher disease costs. A cost-effectiveness threshold analysis would be helpful in determining the threshold value of the cost of educational interventions, leading to these interventions being cost-effective. The aim of the present study was to perform a cost-effectiveness threshold analysis to determine the level at which the cost of a pediatric asthma educational intervention would be cost-effective and cost-saving. METHODS A Markov-type model was developed in order to estimate costs and health outcomes of a simulated cohort of pediatric patients with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a single uncontrolled before-and-after study performed with Colombian asthmatic children. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable "quality-adjusted life-years" (QALYs). RESULTS A deterministic threshold sensitivity analysis showed that the asthma educational intervention will be cost-saving to the health system if its cost is under US$513.20. Additionally, the analysis showed that the cost of the intervention would have to be below US$967.40 in order to be cost-effective. CONCLUSIONS This study identified the level at which the cost of a pediatric asthma educational intervention will be cost-effective and cost-saving for the health system in Colombia. Our findings could be a useful aid for decision makers in efficiently allocating limited resources when planning asthma educational interventions for pediatric patients.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- a Department of Pediatrics, School of Medicine , Universidad Nacional de Colombia , Bogota , Colombia.,b Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine , Universidad El Bosque , Bogota , Colombia
| | - Monica P Sossa-Briceño
- c Department of Internal Medicine, School of Medicine , Universidad Nacional de Colombia , Bogota , Colombia
| | - Jose A Castro-Rodriguez
- d Division of Pediatrics, School of Medicine , Pontificia Universidad Catolica de Chile , Santiago , Chile
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Inhaled corticosteroids do not reduce initial high activity of matrix metalloproteinase (MMP)-9 in exhaled breath condensates of children with asthma exacerbation: a proof of concept study. Cent Eur J Immunol 2016; 41:221-7. [PMID: 27536209 PMCID: PMC4967657 DOI: 10.5114/ceji.2016.60998] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/07/2016] [Indexed: 12/13/2022] Open
Abstract
Inhaled corticosteroids (ICS) are the key component of asthma treatment. However, it is unclear whether they could control the activity and level of matrix metalloproteinase (MMP)-9, which is an important factor in asthma-associated inflammation and airway remodeling. Therefore, the aim of this proof of concept study was to analyze the influence of increased doses of ICS on MMP-9 in exhaled breath condensates (EBC) of patients with allergic asthma exacerbation. Apart from MMP-9, the assessment concerned selected inflammation markers – exhaled nitric oxide (eNO) and cytokines (IL-8 and TNF). The study involved a small group (n = 4) of individuals with asthma exacerbation. The intervention concerned increased doses of ICS with β-mimetics for 4 weeks. In addition to clinical evaluation, eNO measurements and EBC collections were done before and after 4 weeks of intense ICS treatment. The biochemical assessment of EBC concerned MMP-9, IL-8 and TNF. The data were compared to results of healthy controls (n = 6). The initial levels of eNO, MMP-9 and TNF in EBC were higher in the asthma group than in controls. In all subjects IL-8 levels were below the detection limit. After 4 weeks of ICS treatment in all patients we observed improvement of clinical and laboratory parameters. Interestingly, despite reduction of eNO and TNF, the activity of MMP-9/EBC remained on the initial level. Practical relevance of our results is limited by a small group. Nevertheless, our data suggest that ICS, although sufficient to control symptoms and inflammatory markers, may be ineffective to reduce MMP-9/EBC activity in asthma exacerbation and, possibly, airway remodeling.
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Birnkrant DJ, Yilmaz O, Nicolai T, Black JB, Mhanna MJ, Noah TL. Pediatric pulmonology year in review 2015: Part 3. Pediatr Pulmonol 2016; 51:747-53. [PMID: 27105321 DOI: 10.1002/ppul.23413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 03/03/2016] [Accepted: 03/12/2016] [Indexed: 12/21/2022]
Abstract
Our journal covers a broad range of research and scholarly topics related to children's respiratory disorders. For updated perspectives on the rapidly expanding knowledge in our field, we will summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages. The current review (Part 3) covers articles on asthma, diagnostic testing/endoscopy, respiratory complications of neuromuscular disorders, and rare lung diseases. Pediatr Pulmonol. 2016;51:747-753. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- David J Birnkrant
- MetroHealth Medical Center, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ozge Yilmaz
- Division of Pediatric Allergy and Pulmonology, Department of Pediatrics, Celal Bayar University, Manisa, Turkey
| | | | - Jane B Black
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Maroun J Mhanna
- MetroHealth Medical Center, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, 450 Macnider Building, Campus Box 7217, Chapel Hill, North Carolina, 27599-7217
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Dilokthornsakul P, Chaiyakunapruk N, Campbell JD. Does the use of efficacy or effectiveness evidence in cost-effectiveness analysis matter? J Asthma 2016; 54:17-23. [PMID: 27284904 DOI: 10.1080/02770903.2016.1193601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To test the association of clinical evidence type, efficacy-based or effectiveness-based ("E"), versus whether or not asthma interventions' cost-effectiveness findings are favorable. DATA SOURCES We conducted a systematic review of PubMed, EMBASE, Tufts CEA registry, Cochrane CENTRAL, and the UK National Health Services Economic Evaluation Database from 2009 to 2014. STUDY SELECTION All cost-effectiveness studies evaluating asthma medication(s) were included. Clinical evidence type, "E," was classified as efficacy-based if the evidence was from an explanatory randomized controlled trial(s) or meta-analysis, while evidence from pragmatic trial(s) or observational study(s) was classified as effectiveness-based. We defined three times the World Health Organization cost-effectiveness willingness-to-pay (WTP) threshold or less as a favorable cost-effectiveness finding. Logistic regression tested the likelihood of favorable versus unfavorable cost-effectiveness findings against the type of "E." RESULTS AND CONCLUSIONS 25 cost-effectiveness studies were included. Ten (40.0%) studies were effectiveness-based, yet 15 (60.0%) studies were efficacy-based. Of 17 studies using endpoints that could be compared to WTP threshold, 7 out of 8 (87.5%) effectiveness-based studies yielded favorable cost-effectiveness results, whereas 4 out of 9 (44.4%) efficacy-based studies yielded favorable cost-effectiveness results. The adjusted odds ratio was 15.12 (95% confidence interval; 0.59 to 388.75) for effectiveness-based versus efficacy-based achieving favorable cost-effectiveness findings. More asthma cost-effectiveness studies used efficacy-based evidence. Studies using effectiveness-based evidence trended toward being more likely to disseminate favorable cost-effective findings than those using efficacy. Health policy decision makers should pay attention to the type of clinical evidence used in cost-effectiveness studies for accurate interpretation and application.
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Affiliation(s)
- Piyameth Dilokthornsakul
- a Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice , Faculty of Pharmaceutical Sciences, Naresuan University , Phitsanulok , Thailand.,b Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus , Aurora , CO , USA
| | - Nathorn Chaiyakunapruk
- a Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice , Faculty of Pharmaceutical Sciences, Naresuan University , Phitsanulok , Thailand.,c School of Pharmacy, Monash University Malaysia , Selangor , Malaysia.,d School of Population Health, University of Queensland , Brisbane , Australia.,e School of Pharmacy, University of Wisconsin-Madison , Madison , WI , USA
| | - Jonathan D Campbell
- b Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus , Aurora , CO , USA
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Rodriguez-Martinez CE, Sossa-Briceño MP, Castro-Rodriguez JA. Cost-utility analysis of once-daily versus twice-daily inhaled corticosteroid dosing for maintenance treatment of asthma in pediatric patients. J Asthma 2016; 53:538-45. [PMID: 26786524 DOI: 10.3109/02770903.2015.1116087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Suboptimal adherence to inhaled corticosteroids (ICs) is an important cause of poor asthma control in pediatric patients. Among the factors that can be most easily changed for enhancing adherence to ICs is a reduction in the dosing frequency, from twice-daily dosing to once-daily dosing. However, no previous studies have reported an economic evaluation comparing once-daily versus twice-daily IC dosing for pediatric asthma. The aim of this study was to compare the cost-effectiveness of once-daily versus twice-daily IC dosing for maintenance treatment of asthma in pediatric patients. METHODS A Markov-type model was developed in order to estimate costs and health outcomes of a simulated cohort of pediatric patients 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 official databases provided by the Colombian Ministry of Health. The main outcome was the variable "quality-adjusted life-years" (QALYs). RESULTS For the base-case analysis, the model showed that compared with twice-daily dosing, once-daily dosing strategy involved lower costs (US$1529.3 versus $1709.1 average cost per patient over 12 months) and the greatest gain in QALYs (0.8284 versus 0.8084 QALYs on average per patient over 12 months), resulting in once-daily dosing strategy being considered dominant. CONCLUSIONS This study shows that compared with twice-daily dosing, once-daily IC dosing for treating pediatric patients with persistent asthma is the dominant strategy because it involves a greater gain in QALYs at lower total treatment cost.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- a Department of Pediatrics , School of Medicine, Universidad Nacional de Colombia , Bogota , Colombia .,b Department of Pediatric Pulmonology and Pediatric Critical Care Medicine , School of Medicine, Universidad El Bosque , Bogota , Colombia .,c Research Unit, Military Hospital of Colombia , Bogota , Colombia
| | - Monica P Sossa-Briceño
- d Department of Internal Medicine , School of Medicine, Universidad Nacional de Colombia , and
| | - Jose A Castro-Rodriguez
- e Departments of Pediatrics and Family Medicine , School of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile
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Domínguez-Ortega J, Phillips-Anglés E, Barranco P, Quirce S. Cost-effectiveness of asthma therapy: a comprehensive review. J Asthma 2015; 52:529-37. [PMID: 25539023 DOI: 10.3109/02770903.2014.999283] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Asthma has an important impact in terms of both direct and indirect costs. In Europe, the disease costs € 19 000 million a year. Moreover, the cost is greater among patients with severe uncontrolled asthma and is even higher when the work productivity is also taken into account. Improved control of the disease results in cost savings. In this context, cost-effectiveness and cost-utility studies offer important information for clinicians in deciding the best treatment options for asthmatic patients and contribute to ensure an efficient use of the available healthcare resources. METHODS An English and Spanish literature search using electronic search engines (PubMed and EMBASE) was conducted in peer-review journals, from 2009 to June 2014. In order to perform the search for the most suitable and representative articles, key words were selected ("asthma", "cost-effectiveness", "cost-utility", "QALY", "cost-benefit", "economic impact of asthma" "healthcare cost", "asthma treatment" and "work productivity with asthma"). RESULTS Two-hundred forty-three titles and abstracts were identified by the primary literature search. The full text of the potentially 76 eligible papers was reviewed, and 22 articles were qualified to be finally included. CONCLUSIONS This article provides a comprehensive review on the evidence of cost-effectiveness of asthma treatments derived from the published literature and offers an overall summary of the socioeconomic burden of asthma and its relationship with the degree of disease control. Management alternatives, such as the use of combination therapy with ICS/LABA or omalizumab, when administered according to their current therapeutic indications, have been shown to be cost-effective.
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Affiliation(s)
- Javier Domínguez-Ortega
- a Department of Allergy , Hospital La Paz Institute for Health Research (IdiPAZ) , Madrid , Spain
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