the risk of assuming foreign cost-effectiveness ratios the case of palivizumab in colombia and...
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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
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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
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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
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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%
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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
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The analysis
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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
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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
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Conclusions
¡Gracias!
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