Professional Documents
Culture Documents
DOI 10.1007/s12325-015-0192-6
ORIGINAL RESEARCH
ABSTRACT
observed
in
the
pediatric
population,
producing a significant morbidity, and an
nasal
spray
(BDNS)
C. E. Rodrguez-Martnez (&)
Department of Pediatrics, School of Medicine,
Universidad Nacional de Colombia, Carrera 45 No.
26-85, Bogota, Colombia
e-mail: carlos2671@gmail.com;
carerodriguezmar@unal.edu.co
C. E. Rodrguez-Martnez
Research Unit, Military Hospital of Colombia,
Transversal 3A No. 49-00, Bogota, Colombia
o
M. P. Sossa-Bricen
Department of Internal Medicine, School of
Medicine, Universidad Nacional de Colombia,
Carrera 45 No. 26-85, Bogota, Colombia
e-mail: mocasossa1@gmail.com
E. Vladimir Lemos
Outcomes Research Manager MSD Colombia, Calle
100 No. 7-33, piso 8, 802, Bogota, Colombia
255
have
shown
to
reduce
nasal
congestion,
of
the
INTRODUCTION
and
most
common
chronic
Furthermore,
in
pediatric
patients,
METHODS
many
therapeutic
estimate
the
cost-effectiveness
of
MFNS
256
incorporates
the
probability
that
this
improvement of symptoms has been due to
options
without
assumptions.
unrealistic
simplifying
ocular
improvement
of
nasal
symptoms,
257
Sources of Data
the
symptoms
and
global
assessment,
BDNS
MFNS
BANS
TNSS
TOSS
PGA
ES
Epistaxis
AES
TIX (ES/AES)
0.57
258
(Immunoglobulin
immunotherapy,
otolaryngologists,
number of medical
year
(pediatrician,
allergologist,
259
and
the
effect
of
alternative
model
Sensitivity Analyses
(TreeAgePro
2012,
TreeAge
Software,
260
RESULTS
Base-Case Analysis
Variable
and
endoscopic
was
associated
with
lower
costs
Improvement of
symptoms
Baseline
value
Low
value
High
value
44.0
40.0
48.0
Improvement of nasal
symptoms
50.0
45.0
50.0
Improvement of ocular
symptoms
25.0
23.0
28.0
Side effects
77.0
69.0
85.0
Epistaxis
28.0
25.0
31.0
77.0
69.0
85.0
Improvement of nasal
symptoms
43.0
39.0
47.0
Improvement of ocular
symptoms
28.0
25.0
31.0
Side effects
11.0
10.0
12.0
Epistaxis
100.0
0.0
0.0
88.0
79.2
96.8
Improvement of nasal
symptoms
25.0
23.0
28.0
Improvement of ocular
symptoms
37.0
33.0
41.0
Side effects
44.0
40.0
48.0
Epistaxis
44.0
40.0
48.0
(Table 5).
Sensitivity Analyses
One-way,
two-way,
and
multi-way
261
Table 3 Unit costs of resources for pediatric allergic rhinitis (US$, 2013)
Cost item
Baseline value
Low value
High value
17.81
13.36
22.26
28.56
21.42
35.70
Topical antibiotic
3.21
2.41
4.01
Analgesic
3.47
2.60
4.33
26.75
20.06
33.44
Immunoglobulin E
32.41
24.30
40.51
80.26
60.20
100.33
62.02
46.51
77.52
18.43
13.82
23.04
193.61
145.21
242.01
6.02
4.51
7.52
Endoscopic nasopharyngoscopy
474.73
356.05
593.41
200.12
150.09
250.15
Turbinoplasty
433.26
324.95
541.58
Adenoidectomy
333.47
250.10
416.84
Septoplasty
824.84
618.63
1,031.05
24.08
18.06
30.10
2.34
2.29
2.76
13.29
9.13
14.25
43.62
37.59
46.22
Seric cortisol
Diagnostic and/or therapeutic proceduresa
Immunotherapy
Medical consultationsc
Topical intranasal corticosteroids
Beclomethasone dipropionate nasal sprayd
e
CT computed tomography
Diagnostic and/or therapeutic procedures for patients whose symptoms did not improve
b
Complete monthly cost of immunotherapy
c
Unit cost of medical consultations (pediatrician, otolaryngologist, allergologist, endocrinologist, and ophthalmologist)
d
Unit cost of beclomethasone dipropionate nasal spray, 200 doses
e
Unit cost of mometasone furoate nasal spray, 140 doses
f
Unit cost of budesonide aqueous nasal spray, 120 doses
a
262
Table 4 Rates of resource utilization for patients with no improvement of allergic rhinitis symptoms and for patients with
treatment-related adverse events with topical INS
Resources
Range
3.7%
1.75.7%
46.7%
40.051.7%
50.0%
38.358.3%
34.4%
31.037.3%
41.7%
37.346.0%
Immunotherapy
Impedance audiometrya
3.3%
1.76.7%
50.0%
44.055.0%
0.7%
0.02.0%
25.0%
20.030.0%
7.7%
3.313.3%
2.3%
1.06.3%
4.3
4.05.0
4.3
4.05.0
3.0
2.04.0
4.7%
2.39.7%
0.7%
0.32.7%
3.7%
27.3%
Endoscopic nasopharyngoscopy
Turbinoplasty
Adenoidectomya
Septoplasty
Pediatric consultationb
Otolaryngologist consultation
Allergologist consultationb
Patients with treatment-related adverse events with INS
Epistaxis
Cauterizationa
Anterior nasal packinga
Topical antibiotic
Analgesica
Pediatric consultation
Otolaryngologist consultation
1.3%
0.33%
3.6
3.04.0
2.6
2.03.0
3.0
2.04.0
2.0
1.03.0
2.0
1.03.0
2.0
1.03.0
Ophthalmologist consultation
Seric cortisol measurement
263
Table 5 Base-case cost-effectiveness analysis of MFNS versus BDNS for pediatric allergic rhinitis treatment
Category
Absolutely
dominated
Strategy Cost
(US$)
Incremental
cost (US$)
Effectiveness
(TIX score)
Incremental
Cost/effectiveness
effectiveness (TIX score)
MFNS
229.78
0.9724
236.31
BDNS
289.74
59.96
0.8712
-0.1012
332.58
BDNS beclomethasone dipropionate nasal spray, MFNS mometasone furoate nasal spray, TIX therapeutic index
US$348.60, respectively. Likewise, these 95% UI
for
and
DISCUSSION
BDNS,
TIX
scores
therapy
were
with
0.94640.9897
MFNS
for
treating
the
variables
that
exhibited
pediatric
patients
with
AR
diagnosis
in
264
Distribution parameters
Distribution parameters
Beta distribution
Alpha
Beta
BDNS
270.600
344.400
MFNS
84.459
25.228
BANS
47.120
6.425
BDNS
199.500
199.500
MFNS
263.052
348.697
BANS
299.750
899.250
BDNS
299.750
899.250
MFNS
250.600
644.400
BANS
215.247
366.502
BDNS
84.459
25.228
MFNS
430.650
3484.350
BANS
270.600
344.400
BDNS
250.600
644.400
MFNS
BANS
270.600
344.400
Alpha
Lambda
Cost of cauterization
64.072
3.597
64.000
2.241
64.400
20.062
Cost of analgesic
64.370
18.550
63.952
2.390
Cost of immunoglobulin E
64.039
1.975
64.000
0.797
Cost of immunotherapy
64.000
1.031
63.930
3.468
64.006
0.330
Probability of epistaxis
Gamma distribution
265
Table 6 continued
Probability distribution
Distribution parameters
Distribution parameters
64.000
10.631
2583.447
5.441
64.000
0.319
Cost of turbinoplasty
64.000
0.147
Cost of adenoidectomy
63.996
0.191
Cost of septoplasty
64.000
0.077
Cost of BDNS
396.603
169.488
Cost of MFNS
107.802
8.111
Cost of BANS
408.761
9.370
BANS budesonide aqueous nasal spray, BDNS beclomethasone dipropionate nasal spray, CT computed tomography, MFNS
mometasone furoate nasal spray
266
267
CONCLUSIONS
there
has
not
been
direct
ocular
symptoms
and
global
ACKNOWLEDGMENTS
The study was partially funded by Merck Sharp
& Dohme (MSD) Colombia. The article
processing charges for this publication were
funded by MSD Colombia. However, the
authors had complete independence over the
conduct, integrity, and publication of the study.
The authors thank Mr. Charlie Barrett for his
editorial assistance. All named authors meet the
International Committee of Medical Journal
Editors (ICMJE) criteria for authorship for this
manuscript, take responsibility for the integrity
of the work as a whole, and have given final
approval for the version to be published. All
authors had full access to all of the data in this
study and take complete responsibility for the
integrity of the data and accuracy of the data
analysis.
Conflict of interest. Carlos E. Rodriguezo declare
Martinez and Monica P. Sossa-Bricen
that they have no conflict of interest. Elkin
Vladimir Lemos is an outcomes research
manager in MSD Colombia.
268
Compliance
REFERENCES
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2.
3.
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8.
9.
Sistema
de
Informacion
de
precios
de
medicamentosSISMED. Listado de precios
promedio y unidades en la cadena de
comercializacion de medicamentos. Ministerio de
la Proteccion Social. Republica de Colombia. http://
web.sispro.gov.co/WebPublico/SISMED/LibroVirtual/
index2.html. Accessed June 12, 2014.
269