OBJECTIVE To determine the most cost-effective drug in the treatment of bleeding esophageal varices within the formulary available in the Mexican Institute of Social Security. METHODS Economic evaluation that used costs and quality of life information from a multicentric clinical study in Mexican population and an expert panel. Efficacy data were obtained from a meta-analysis. The alternatives included were terlipressin and octreotide. The study perspective was institutional, 5 years time horizon, 3% real discount rate for both effectiveness and costs. Costs were estimated from financial information from IMSS, and are reported in US 2006 dollars. A decision tree with a Bayesian approach, as well as a Markov model with four health states describing the natural disease course and correction in the middle of the cycle, were used in the analysis. Mean cost-utility rates, net economic benefits and net health benefits were calculated. The sensitivity analysis included threshold, one-way, scenarios and probabilistic Monte Carlo simulation. RESULTS Terlipressin had the lowest cost per QALY, \$119,321 compared with octreotide, \$179,984. The number of QALYs was similar for both alternatives, with a lower cost per QALY for terlipressin; therefore, due its being the cheaper one, terlipressin was the dominant alternative. The expected mean cost per patient in five years of octreotide was \$83,650, and $66,385 for terlipressin. Acceptability curves showed that independently of WTP, terlipressin had a larger proportion of cost-utility cases in more than 70% and larger net economic and health benefits compared with octreotide. CONCLUSION Terlipressin was the option with the lower cost per QALY in the pharmacological treatment of bleeding esophageal varices. Sensitivity analysis showed that the conclusions of the base study were robust.
OBJECTIVE To evaluate the cost-effectiveness of IMSS formulary drugs for preventing uterine atony in patients with risk factors. METHODS A final report of a randomized pragmatic clinical trial at the Mexican Institute of Social Security (IMSS) is presented. Carbetocine and oxytocin are the only drugs within IMSS formulary for preventing uterine atony. Risk factor included fetal macrosomia, polyhydramnios, low insertion of the placenta, multiple gestation, prolonged labor, uterine myomas and chorioamnionitis. The effectiveness was defined as the reduction of the number of patients with uterine atony. The use of resources was obtained from the clinical trial and the costs were gotten from financial information from IMSS, and are expressed in US 2006 dollars. Squared ji and U de Mann Whitney test were used. Univariate and probabilistic sensitivity analyses, a Monte Carlo microsimulation with 10,000 iterations was performed using probability distribution data from the clinical trial. A 95% confidence interval of ICER was calculated by ellipse method. RESULTS Seventy-seven patients received carbetocine and 75 oxytocin. Both groups had similar obstetrics and sociodemographic characteristics. Uterine atony was reported in 19% in the oxytocin group compared to 8% in the carbetocine one (p
OBJECTIVE To assess the cost-effectiveness of add-on therapy drugs within the formulary of the Mexican Institute of Social Security for partial refractory epilepsy. METHODS Cost-effectiveness study that used costs information from a retrospective cohort of a multicentric study. Efficacy (50% seizure reduction) and adverse events of oxcarbazepine, topiramate, levetiracetam and lamotrigine were obtained from a meta-analysis. Experts suggested excluding vigabatrin from the analysis, and gabapentin was also eliminated because IMSS formulary recommends its use only for neuropathic pain. Study perspective was institutional with 1 year time horizon, and no discount rate was used. Costs were estimated from financial information from IMSS, and are reported in US 2006 dollars. A decision tree with a Bayesian approach included efficacy and adverse events. Mean cost-effectiveness and incremental ratios, net health benefits and net economic benefits were calculated. ICER confidence interval was estimated with ellipse method. Sensitivity analysis included threshold, scenarios, one-way and probabilistic Monte Carlo simulation. RESULTS Levetiracetam had the lowest mean cost-effectiveness ratio, \$6238. Incremental analysis showed that topiramate was dominated by levetiracetam, while the ICER for lamotrigine and oxcarbazepine was \$1938 and \$2156 compared with not providing add-on therapy. Acceptability curves showed that lamotrigine was the most cost-effective option with a WTP between \$955 and \$1476. Levetiracetam was the most cost-effective option when WTP was above $1476, and the components analysis confirmed this result. CONCLUSIONS Levetiracetam was the alternative with lowest cost per controlled patient and provided the largest health benefit compared with using standard therapy alone (not add-on). Topiramate was dominated by levetiracetam. Standard therapy was the cheapest alternative; however, due to its low effectiveness, it had more health care costs per controlled patient. Sensitivity analysis showed that the base study case was robust.
OBJECTIVE To estimate the cost-utility of levodopa-carbidopa and levodopa-carbidopa-entacapone in the treatment of Parkinson disease in the Mexican Institute of Social Security in Mexico. METHODS Cost-utility analysis. Use of resources information was obtained from a retrospective cohort and was validated by a Mexican expert panel. Costs were estimated from financial information from IMSS, and are reported in US 2006 dollars. The source of utility information, measured in QALYs, and transition probabilities was a meta-analysis and a Mexican expert panel. Study perspective used public health services provider (IMSS); five years time horizon, 3% real discount rate. A decision tree with a Bayesian approach and a Markov model were used. Mean cost-utility, incremental ratios and net health benefits were estimated. The sensitivity analysis included one-way, two-way, threshold and probabilistic with Monte Carlo simulation. RESULTS Cost per utility unit for levodopa-carbidopa was \$5623 and for levodopa-carbidopa-entacapone, \$5168. Incremental cost-utility ratio using levodopa-carbidopa as a comparator was \$1585. Independently of WTP, levodopa-carbidopa-entacapone had larger net health benefits than levodopa-carbidopa. In the five years analysis, levodopa-carbidopa-entacapone showed 12.8% more utility in relation-ship to levodopa-carbidopa, with 3.5% more costs. The cost per utility unit with levodopa-carbidopa-entacapone had an accumulated decrease of 18.4% during the period of time analyzed. The acceptability curves and the component analysis of the ellipse graph showed that with the actual cost that the IMSS is investing in the treatment of Parkinson disease, the cost-utility proportion of levodopa-carbidopa-entacapone would be 80%. CONCLUSIONS Levodopa-carbidopa-entacapone had the lowest cost per unit of success in the treatment of patients with Parkinson disease compared with levodopa-carbidopa. Cost per additional utility unit of levodopa-carbidopa-entacapone was$1585. At the end of the follow-up levodopa-carbidopa-entacapone reduced annual health care costs to a greater extent than levodopa-carbidopa and provided better quality of life per patient.