Cost utility, budget impact, and scenario analysis of racecadotril in addition to oral rehydration for acute diarrhea in children in Malaysia

Abstract

ObjectiveTo perform cost utility (CU) and budget impact (BI) analyses augmented by scenario analyses of critical model structure components to evaluate racecadotril as adjuvant to oral rehydration solution (ORS) for children under 5 years with acute diarrhea in Malaysia.MethodsA CU model was adapted to evaluate racecadotril plus ORS vs ORS alone for acute diarrhea in children younger than 5 years from a Malaysian public payer’s perspective. A bespoke BI analysis was undertaken in addition to detailed scenario analyses with respect to critical model structure components.ResultsAccording to the CU model, the intervention is less costly and more effective than comparator for the base case with a dominant incremental cost-effectiveness ratio of −RM 1,272,833/quality-adjusted life year (USD −312,726/quality-adjusted life year) in favor of the intervention. According to the BI analysis (assuming an increase of 5% market share per year for racecadotril+ORS for 5 years), the total cumulative incremental percentage reduction in health care expenditure for diarrhea in children is 0.136578%, resulting in a total potential cumulative cost savings of −RM 73,193,603 (USD −17,983,595) over a 5-year period. Results hold true across a range of plausible scenarios focused on critical model components.ConclusionAdjuvant racecadotril vs ORS alone is potentially cost-effective from a Malaysian public payer perspective subject to the assumptions and limitations of the model. BI analysis shows that this translates into potential cost savings for the Malaysian public health care system. Results hold true at evidence-based base case values and over a range of alternate scenarios.

From Evidence to Policy: Economic Evaluations of Healthcare in Malaysia: A Systematic Review

“…Thirty studies (47%) were partial economic evaluations which included cost-consequence, cost-minimization, and budget impact analyses, while the full economic evaluations consisted of 17 CEAs 41-57 and 17 CUAs. [58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] The number of published economic evaluations in Malaysia has increased considerably in the past five years (Figure 2). In 2017, 15 economic evaluations from Malaysia were published total; as of April 2018, 8 studies have been published so far.…”

Randomized Clinical Trial Comparing The Effect Of Oral Rehydration Therapy With And Without Racecadotril In The Management Of Acute Diarrhea In Children

“…Notably, a study from Malaysia claimed that ORS combined with racecadotril was more effective and costeffective than ORS alone. 7 Similarly, Sreeni vas et al indicated a noticeable reduction in stool frequency at 48 hours and reduced time for recovery with racecadotril use. 9 However, it is worth noting that these studies were conducted in different populations, and regional variations in response to treatment may play a role.…”

“…While racecadotril has been employed in developed countries, its incorporation into guidelines for routine use in children with acute diarrhoea is yet to be definitively established. 8 According to a study conducted in Malaysia, the combination of ORS and racecadotril is reported to be more advantageous and cost-effective than using ORS alone 7 . Additionally, Sreeni vas et al observed a significant 34.1% reduction in stool frequency at 48 hours.…”

Drugs in Focus

“…As stated before, the mainstay treatment of AGE is ORS. Three cost-efficacy analyses performed on available data from UK, Thailand, and Malaysia showed that the addition of racecadotril to ORS is more cost-efficient than ORS treatment alone, leading to savings to the health care systems up to 900 Euros/patient (21)(22)(23).…”