El fortalecimiento técnico de la Superintendencia Nacional de Salud (SuperSalud), ente de inspección, vigilancia y control del Sistema General de Seguridad Social en Salud de Colombia, es necesario. Para tal fin, se propone el uso eficiente de los sistemas de información, que permita la toma de decisiones en política pública y que garantice el derecho fundamental de la salud.
INTRODUCTION: Dabigatran is a novel oral anticoagulant considered as an alternative to warfarin in patients with non-valvular Atrial Fibrillation (AF) to prevent Stroke. Hypothesis: dabigatran compared to warfarin for stroke prevention in AF is a good investment for the health care system in Colombia. Methods: We developed a Markov model to represent the health states of AF and its complications: 6 health states (disabling and non-disabling stroke, myocardial infarction, pulmonary embolism and death) and 2 transitional states (major and minor hemorrhage). Probabilities were derived from clinical trials; resource use was estimated from the guidelines of the Colombian Society of Cardiology and validated to adjust to usual practice. Direct medical costs were extracted from public and private insurers and hospitals, and indirect costs (e.g. wages lost, transportation costs, etc.) were obtained from the most recent National Health Survey. Utilities were obtained from a systematic literature review. Two separate analysis, payer and societal perspective, were performed in a 20-year horizon. Multivariate sensitivity analysis was also performed and results were discounted at 3% annually. Results: After 20 years of follow up, cumulative discounted direct medical costs per patient accounted for USD$70,500 for warfarin and $78,840 and $79,860 for 150mg and 110mg of dabigatran, respectively. When taking into account indirect costs, warfarin increased their costs by 13% while dabigatran costs were increased by 7%. Estimated life years (LY) for Dabigatran were higher (9.4 and 9.3 for 150mg and 110mg) as well as the QALYs (8.5, 8.4) than for warfarin 9.1 LY and 8.1 QALYs. The calculated ICER was $23,760 and $34,690 per additional QALY gained with dabigatran 150mg and 110 mg from the payer perspective and $19,380 and $28,730 from the societal perspective. The budget impact of including coverage for dabigatran would not surpass 3% of the current unit of payment per capita. CONCLUSIONS: In Colombia, coverage for dabigatran for the management of non-complicated AF could increase LY and QALYs at a modest financial impact.
OBJECTIVES:To analyze the cost-effectiveness of treating hypertensive patients with azilsartan medoxomil and chlorthalidone fixed dose combination (AZL-M/ CLD FDC) therapy compared with other angiotensin receptor blocker (ARB) and hydrochlorothiazide (HCT) combinations commonly available in the US market. METHODS: A Markov Cohort Simulation approach was utilized. Simulated patients start in a hypertensive state and are followed over multiple time periods as they transition between mutually exclusive health states. Cost per Quality Adjusted Life Year (Cost/QALY) and Incremental Cost-effectiveness Ratios (ICERs) are calculated over all possible dose combinations. Cardiovascular disease (CVD) risks were based on the Framingham risk equations. FDCs of HCT and eight ARBs commonly used in the US market (Atacand HCT, Avalide, Benicar HCT, Hyzaar, Diovan HCT, generic Losartan HCT, Micardis HCT and Teveten HCT) were included in the analyses. RESULTS: Results suggest that AZL-M/CLD FDC is less expensive and more effective in lowering BP versus all branded ARB/HCT FDC comparators. When considering average costs and the CVD risks based on the Framingham risk equations for all therapies over a five year time horizon, AZL-M/CLD FDC would remain the least expensive and most effective branded ARB/Diuretic FDC therapy up to a 23.5% unit cost increase with the average office SBP reduction of -22.3% and up to 18.1% unit cost increase with the 24-hour ambulatory BP reduction of -17.0%. CONCLUSIONS: AZL-M/CLD FDC is predicted to be less expensive and more effective in reducing blood pressure and cardiovascular risk when compared to all branded ARB/HCT FDC comparators during a five year time horizon.
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