Sara Atehortúa

[Quality assessment of economic evaluations in health care in Colombia: a systematic review].

INTRODUCTION Economic evaluation is a tool that can provide useful information to decision-makers in health. The methodological quality of Colombian studies has not been assessed in a systematic way. OBJECTIVE To assess the methodological quality of economic evaluations in health care in Colombia. MATERIALS AND METHODS Systematic review of economic studies that assessed both costs and effectiveness of at least two technologies related to a decision problem in Colombia. Search was performed in international and Colombian databases and was completed with manual searches and contact with authors. Data was synthesized in tables that included relevant information about the studies. Methodological quality was evaluated using a predefined instrument. Searches were performed between January and February. RESULTS 48 studies were included in the review. Perspective of the study, incremental analyzes and description of alternatives were usually well specified. However, more than half of the articles did not state clearly the time horizon or discount rate and most studies did not address equity and implementation issues. Management of uncertainty was also problematic. CONCLUSIONS Economic evaluation in health care in Colombia has grown considerably in recent years. However, methods vary considerably between studies and therefore their usefulness for decisionmaking in health is limited. It is necessary to standardize methods in order to generate evidence of higher quality to support decisions within the Colombian health care system.

Análisis de costo efectividad de ondansetrón para el tratamiento del vómito en niños menores de cinco años con gastroenteritis en Colombia

INTRODUCTION Ondansetron reduces hospitalization rates for diarrhea and vomiting in children, but is not yet routinely used. OBJECTIVE To estimate from a social perspective the relative cost-effectiveness of ondansetron for the treatment of vomiting in children with gastroenteritis and at risk of dehydration in Colombia. METHODS Cost-effectiveness analysis from a social perspective, including direct medical costs and costs for caregivers. With a decision tree we compared costs and health outcomes of usual treatment without antiemetic to usual treatment plus ondansetron in children under 5 years with gastroenteritis and vomiting. Effectiveness of intervention was measured as reduction in hospitalization rates, and the time horizon of the model was the episode. Probabilities were obtained from clinical trials and systematic reviews, measurement of resources use was based on protocols and expert opinions, while unit costs were obtained from Colombian tariff manuals. We performed a survey to estimate indirect costs for caregivers (n=81) that included questions about wage loss, transportation, meals expenditures and other out-of-pocket payments. Deterministic and probabilistic sensitivity analyses were performed. RESULTS Usual treatment plus ondansetron is a dominant strategy compared to usual treatment without antiemetic yielding fewer hospitalizations and saving

Cost-effectiveness analysis of ticagrelor compared to clopidogrel for the treatment of patients with acute coronary syndrome in Colombia

44.562 Colombian pesos (23,98USD) per episode. Ondansetron was dominant in 98,91% of simulations of the probabilistic analysis. CONCLUSIONS Ondansetron is a dominant intervention that reduces hospitalization rates and costs for health system and caregivers. We recommend assessing the inclusion of this drug in the Colombian Health Benefit Plan for the treatment of gastroenteritis in children under 5 years.

Cost-Effectiveness Analysis of Diagnosis of Duchenne/Becker Muscular Dystrophy in Colombia

INTRODUCTION Acute coronary syndrome is one of the most frequent medical emergencies in developing countries. OBJECTIVE To determine, from the perspective of the Colombian health system, the cost-effectiveness of ticagrelor compared to clopidogrel for the treatment of patients with acute coronary syndrome. MATERIALS AND METHODS We conducted a cost-effectiveness analysis from the perspective of the Colombian health system comparing ticagrelor and clopidogrel for the treatment of patients with acute coronary syndrome. To estimate the expected costs and outcomes, a Markov model was constructed in which patients could remain stable without experiencing new cardiovascular events, suffer from a new event, or die. For the baseline case, a 10-year time horizon and a discount ratio of 3% for costs and benefits were adopted. The transition probabilities were extracted from the PLATO (Platelet Inhibition and Patient Outcomes) clinical trial. Vital statistics were drawn from the Departmento Administrativo Nacional de Estadística (DANE) and additional information from Colombian patients included in the Access registry. To identify and measure resource use, a standard case was built by consulting guidelines and protocols. Unit costs were obtained from Colombian rate lists. A probabilistic sensitivity analysis was conducted in which costs were represented by a triangular distribution, and the effectiveness through a beta distribution. RESULTS In the base case, the additional cost per quality-adjusted life-year gained with ticagrelor was COP

Costos de la rehidratación oral y nasogástrica comparadas con la rehidratación endovenosa en niños con diarrea en Colombia

28,411,503. The results were sensitive to changes in the time horizon and the unit cost of clopidogrel. For a willingness-to-pay equivalent to three times the Colombian per capita gross domestic product, the probability of ticagrelor being cost-effective was 75%. CONCLUSIONS Ticagrelor is a cost-effective strategy for the treatment of patients with acute coronary syndrome in Colombia.

Analisis De Costo Efectividad Del Diagnostico De La Distrofia Muscular De Duchenne O Becker En Colombia

OBJECTIVES To determine the cost-effectiveness ratio of different courses of action for the diagnosis of Duchenne or Becker muscular dystrophy in Colombia. METHODS The cost-effectiveness analysis was performed from the Colombian health system perspective. Decision trees were constructed, and different courses of action were compared considering the following tests: immunohistochemistry (IHC), Western blot (WB), multiplex polymerase chain reaction, multiplex ligation-dependent probe amplification (MLPA), and the complete sequencing of the dystrophin gene. The time horizon matched the duration of sample extraction and analysis. Transition probabilities were obtained from a systematic review. Costs were constructed with a type-case methodology using the consensus of experts and the valuation of resources from consulting laboratories and the 2001 Social Security Institute cost manual. Deterministic sensitivity and scenario analyses were performed with one or more unavailable alternatives. Costs were converted from Colombian pesos to US dollars using the 2014 exchange rate. RESULTS In the base case, WB was the dominant strategy, with a cost of US

Evaluación Económica Del Cardio-Desfibrilador Implantable Comparado Con La Terapia Farmacológica Optima Para El Tratamiento De Los Pacientes Con Falla Cardiaca En Colombia

419.07 and a sensitivity of 100%. This approach remains the dominant strategy down to a 98.2% sensitivity and while costs do not exceed US

Impacto del seguro subsidiado en el acceso y el uso de servicios de salud: el caso de Medellín, Colombia

837.38. If WB was not available, IHC had the best cost-effectiveness ratio, followed by MLPA and sequencing. CONCLUSIONS WB is a cost-effective alternative for the diagnosis of patients suspected of having Duchenne or Becker muscular dystrophy in the Colombian health system. The IHC test is rated as the second-best detection method. If these tests are not available, MLPA followed by sequencing would be the most cost-effective alternative.

Análisis de costo efectividad de prasugrel, comparado con clopidogrel, para pacientes con síndrome coronario agudo sometidos a intervención coronaria percutánea en Colombia

OBJECTIVE To evaluate the costs of oral rehydration therapy (ORT) and nasogastric rehydration therapy (NRT) compared with intravenous rehydration therapy (IRT) to treat dehydration in children under 5 years of age with diarrhea. METHODOLOGY Cost-minimization analysis from the perspective of the Colombian Health System, comparing ORT, (followed by NRT when ORT fails), with IRT. The time horizon was the duration of rehydration. The effectiveness measure was obtained from a systematic review of the literature. To determine costs, a typical case was created based on current guidelines and medical records; this case was validated by experts. Unit costs were obtained from Colombian databases and were provided in Colombian pesos (COP) and US dollars (USD) for 2010. One- and two-way sensitivity analyzes were performed. RESULTS ORT and ERT are similarly effective to prevent hospitalization and to achieve rehydration. In the base case, the expected cost of ORT was

Analysis of cost effectiveness of prasugrel compared with clopidogrel for patients with acute coronary syndrome undergoing percutaneous coronary intervention in Colombia

91,221 COP (40.5 USD) and for IRT was