the risk of assuming foreign cost-effectiveness ratios the case of palivizumab in colombia and...
TRANSCRIPT
1/10
THE RISK OF ASSUMING FOREIGN COST-EFFECTIVENESS RATIOSTHE CASE OF PALIVIZUMAB IN COLOMBIA AND NORTHERN CANADA
Anna Banerji 1, Diego Rosselli 2, Juan David Rueda 2, 31 University of Toronto, 2 Pontificia Universidad Javeriana, 3 Cochrane Collaboration
Toronto - Bogota
2/10
Sincitial Respiratory Virus (SRV)
The problem
Important cause of respiratory disease in childrenLife threatening in pre-term babies
Predisposes to asthmaIncidence varies with seasons and genetic factors
From 2-4% in tropical countriesto 17-52% in the Arctic winter
3/10
Palivizumab (Synagis ®)
The intervention
Monoclonal antibody against fusion protein of RSV
Licensed in 1998
One clinical trial (IMpact Study, Pediatrics 1998)
55% reduction in hospitalization rates
Non-significant reduction in mortality
The context
Inuit territory
The context
6/10
InuitColombia
The context
Population 100,000 46 million
Newborns per year 2,000 900,000
Pre-term (<35 weeks) 180 80,000
Urban (cities > 100 k) 0% 75%
7/10
CanadaColombia
The costs
Palivizumab (per mg) € 11.48 € 10.97
per 50 mg vial € 574 € 549
per child € 2,755 € 2,635
RSV infection € 21,575 € 777
8/10
The analysis
9/10
The results
In Northern Canada Palivizumab is cost-saving.
Even in the best-case scenario, palivizumab in Colombia is
NOT cost-effective.
Cost per QALY almost 5 times per capita GDP
€ 275,000 per asthma case averted
€ 850,000 per death averted
10/10
Conclusions
Cost-effectiveness “does not travel”
Despite similar basic assumptions and similar price
Great variations due to local epidemiology of disease
and cost of complications
Budget impact would also support different decisions
11/10
Conclusions
¡Gracias!