Challenges and opportunities in building a health economic framework for personalized medicine in oncology.

Personalized medicine has allowed for knowledge at an individual level for several diseases and this has led to improvements in prevention and treatment of various types of neoplasms. Despite the greater availability of tests, the costs of genomic testing and targeted therapies are still high for most patients, especially in low- and middle-income countries. Although value frameworks and health technology assessment are fundamental to allow decision-making by policymakers, there are several concerns in terms of personalized medicine pharmacoeconomics. A global effort may improve these tools in order to allow access to personalized medicine for an increasing number of patients with cancer.

Análisis de costos de la atención hospitalaria en un paciente con fibrilación auricular no valvular y accidente cerebrovascular a repetición / Cost analysis of in hospital attention in a non-valvular atrial fibrillation patient and recurrent stroke

RESUMEN INTRODUCCIÓN: Paciente de 71 años con diagnóstico de fibrilación auricular y ataques cerebrovasculares recurrentes, tratada con varios anticoagulantes. El costo del tratamiento del ictus en Colombia para el año 2008 fue de $450.000 millones de pesos colombianos. OBJETIVO: Estimar el costo hospitalario de la atención de un paciente con ictus a repetición secundario a fibrilación auricular. MÉTODOS: Estudio económico parcial de microcosteo de la atención intrahospitalaria para un caso de espectro severo recurrente, que no necesariamente refleja el caso promedio. El consumo de recursos se valoró mediante el uso de tarifas de referencia nacionales. Los resultados se presentan en precios actuales del 2019 (peso colombiano y dólar americano). RESULTADOS: Paciente con 3 eventos hospitalarios, que estuvo 31 días hospitalizada. Las hospitalizaciones tuvieron unos costos de: $53.883.490 (USD 16.141,1), $6.343.096 (USD 1.900,1) y $15.719.443 (USD 4.708,9) respectivamente, con un precio promedio por cada hospitalización de $25.315.343 (USD 7.583,4), costo total de $75.946.029 (USD 22.750,1) costo día de $2.449.872 (USD 729,5). El rubro que aumentó consistentemente los costos fueron los procedimientos (35,7 %). CONCLUSIONES: El ictus recurrente causado por fibrilación auricular no valvular se asocia con un incremento significativo de los costos directos, con un impacto de casi dos veces el PIB per cápita. Un diagnóstico oportuno y una selección adecuada pueden reducirlo.

ABSTRACT INTRODUCTION: A 71-year-old patient with a diagnosis of atrial fibrillation and recurrent strokes, treated with various anticoagulants, the stroke treatment in Colombia for 2008 was $ 450 billion Colombian pesos. OBJECTIVE: To estimate the hospital cost of caring for a patient with recurrent stroke secondary to atrial fibrillation. METHODS: Partial economic study of micro costing of in-hospital care for a case of recurrent severe spectrum stroke, which does not necessarily reflect the average case. Resource consumption was valued using national reference rates. The results are presented in current 2019 prices (Colombian pesos and US dollars). RESULTS: Patient with 3 hospital events, who was hospitalized for 31 days. Hospitalizations had costs of $ 53,883,490 (USD 16,141.1), $ 6,343,096 (USD 1,900.1) and $ 15,719,443 (USD 4,708.9) respectively, with an average price for each hospitalization of $ 25,315,343 (USD 7,583.4), total cost of $ 75,946,029 (USD 22,750.1) daily cost of $ 2,449,872 (USD 729.5). The item that consistently increased costs was procedures (35.7 %). CONCLUSIONS: Recurrent stroke caused by nonvalvular atrial fibrillation is associated with a significant increase in direct costs, with an impact of almost twice the GDP per capita. A timely diagnosis and proper selection can reduce it.

Impact of quadrivalent influenza vaccines in Brazil: a cost-effectiveness analysis using an influenza transmission model.

BACKGROUND: Influenza epidemics significantly weight on the Brazilian healthcare system and its society. Public health authorities have progressively expanded recommendations for vaccination against influenza, particularly to the pediatric population. However, the potential mismatch between the trivalent influenza vaccine (TIV) strains and those circulating during the season remains an issue. Quadrivalent vaccines improves vaccines effectiveness by preventing any potential mismatch on influenza B lineages. METHODS: We evaluate the public health and economic benefits of the switch from TIV to QIV for the pediatric influenza recommendation (6mo-5yo) by using a dynamic epidemiological model able to consider the indirect impact of vaccination. Results of the epidemiological model are then imputed in a health-economic model adapted to the Brazilian context. We perform deterministic and probabilistic sensitivity analysis to account for both epidemiological and economical sources of uncertainty. RESULTS: Our results show that switching from TIV to QIV in the Brazilian pediatric population would prevent 406,600 symptomatic cases, 11,300 hospitalizations and almost 400 deaths by influenza season. This strategy would save 3400 life-years yearly for an incremental direct cost of R$169 million per year, down to R$86 million from a societal perspective. Incremental cost-effectiveness ratios for the switch would be R$49,700 per life-year saved and R$26,800 per quality-adjusted life-year gained from a public payer perspective, and even more cost-effective from a societal perspective. Our results are qualitatively similar in our sensitivity analysis. CONCLUSIONS: Our analysis shows that switching from TIV to QIV to protect children aged 6mo to 5yo in the Brazilian influenza epidemiological context could have a strong public health impact and represent a cost-effective strategy from a public payer perspective, and a highly cost-effective one from a societal perspective.

Personas mayores en Chile: el nuevo desafío social, económico y sanitario del Siglo XXI / Older people in Chile: the new social, economic and health challenge for the 21st century

Ageing will be one of the most significant social transformations of the 21st century worldwide. In the last 40 years, Chile has tripled its older adult population. As a result, by 2050 the country will have the highest proportion of older adults in Latin America. This remarkable growth reinforces the need to identify their current situation and to revise what is the society doing to maintain older people as active members. In this context, this narrative revision aimed to describe the sociodemographic, epidemiologic and sociocultural profile of the older Chilean adults. Besides, programs and public policies focused on the improvement of their quality of life were identified.

Midori de Habich: the economist who ran Peru's health ministry.

Midori de Habich speaks to Gary Humphreys about Peru's journey towards universal health coverage and the advantages of being an economist in a world of doctors.

Costes informales: definición, obtención y análisis. La importancia de su incorporación en las evaluaciones económicas en salud / Informal costs: definition, obtaining and analysis. The importance of its incorporation in economic evaluations in health

Introducción: Los costes informales derivan de cuidados informales que es la atención prestada a un enfermo o discapacitado por parte de personas que no son profesionales socio sanitarios y que no reciben una remuneración económica. El objetivo del trabajo es explicar los costes informales en salud, su definición, su obtención, análisis y el im­ pacto en su incorporación en las evaluaciones económicas en salud. Materiales y métodos: Se realizó una búsqueda del tema sobre costes informales en la base de datos de Medline­Pubmed y en la búsqueda de la biblioteca de la Universidad Carlos III Madrid vía internet a través de varias bases de datos como EconLit y ABI/IN­ FORM collection. Resultados: Se define los cuidados informales, los métodos para su medición en tiempo, en preferencias reveladas, preferencias establecidos fijados, otros métodos, la importan­ cia de incorporar los costos informales en las evaluaciones económicas en salud. Conclusión: La evaluación económica a nivel de la perspectiva de la sociedad se debe incluir, pero muchas veces se realiza según el pagador por lo difícil que puede ser su medición.

Introduction: Informal costs derive from informal care, which is the care provided to a sick or disabled person by people who are not socio­health professionals and who do not receive financial compensation. The objective of the work is to explain the informal costs in health, its definition, its obtaining, analysis and the impact on its incorporation in the economic health evaluations. Material and methods: A search of the topic on informal costs was carried out in the Medli­ ne­Pubmed database and in the search of the Carlos III Madrid University library via the In­ ternet through several databases such as EconLit and ABI / INFORM collection. Results: Informal care is defined, the methods for its measurement in time, in revealed preferences, established preferences, other methods, the importance of incorporating informal costs in economic health evaluations. Conclusion: The economic evaluation at the level of the society perspective must be in­ cluded, but many times it is carried out according to the payer because of how difficult its measurement can be done

[Older people in Chile: the new social, economic and health challenge for the 21st century]. / Personas mayores en Chile: el nuevo desafío social, económico y sanitario del Siglo XXI.

Ageing will be one of the most significant social transformations of the 21st century worldwide. In the last 40 years, Chile has tripled its older adult population. As a result, by 2050 the country will have the highest proportion of older adults in Latin America. This remarkable growth reinforces the need to identify their current situation and to revise what is the society doing to maintain older people as active members. In this context, this narrative revision aimed to describe the sociodemographic, epidemiologic and sociocultural profile of the older Chilean adults. Besides, programs and public policies focused on the improvement of their quality of life were identified.

Auditoria em saúde e economia da saúde: análise de um estudo de caso / Audit in health and health economics: analysis of a case study

Objective: to analyze the results of the health audit in the area of orthoses, prostheses and special materials (OPM), multiple and sequential surgeries (CMS), performed by the State Health Department of Rio Grande do Sul, Brazil (SES/RS). Methodology: Descriptive quantitative study, based on secondary data from SES/RS, in the area of OPM and CMS, referring to the period of post-payment audit practice, from March 2013 to January 2017, using the case study approach. Results: 1,004 completed observations were analyzed for the period; the number of administrative processes requiring a return of financial resources did not have a tendency in the analyzed historical series, a result influenced by the presence of administrative processes that were not conclusive, especially from 2014, on the execution of the audit or even the judicialisation of the subject audited institutions. As for the financial value requested for the return of the analyzed processes, it was higher in 2014, decreasing in 2015 and decreasing considerably in the years 2016 and 2017. Considering the 30 health regions of the state of Rio Grande do Sul, Brasil, three hospitals were highlighted, the first with 43 administrative processes requesting the return of financial resources; the second with 30; and the third with 28. Conclusion: health actions in this area can be qualified through special attention to the regions of health and hospital institutions that repeat more and have large financial volume glossed. (AU).

Objetivo: analisar os resultados da auditoria em saúde na área de órteses, próteses e materiais especiais (OPM) e cirurgias múltiplas e sequenciais (CMS), realizada pela Secretaria Estadual de Saúde do Rio Grande do Sul (SES/RS). Metodologia: estudo quantitativo descritivo, baseado em dados secundários da SES/RS, na área de OPM e CMS, referente ao período da prática de auditoria de pós-pagamento, de março de 2013 a janeiro de 2017, utilizando a abordagem estudo de caso. Resultados: foram analisadas 1.004 observações concluídas para o período; o número de processos administrativos com solicitação de devolução de recursos financeiros não teve uma tendência na série histórica analisada, resultado influenciado pela presença de processos administrativos não conclusos, em especial a partir de 2014, relativos à execução da auditoria ou até mesmo a judicialização do assunto pelas instituições auditadas. Quanto ao valor financeiro solicitado para devolução dos processos analisados, foi maior em 2014, decrescendo em 2015 e diminuiu consideravelmente nos anos 2016 e 2017. Considerando as 30 regiões de saúde do estado do Rio Grande do Sul, três instituições hospitalares tiveram destaque, a primeira com 43 processos administrativos com solicitação de devolução de recursos financeiros; a segunda com 30; e a terceira com 28. Conclusão: as ações em saúde, nessa área, podem ser qualificadas por meio de atenção especial para as regiões de saúde e instituições hospitalares que mais reincidem e tem grandes volumes financeiros glosados. (AU).

Objetivo: analizar los resultados de la auditoría de salud en el área de ortesis, prótesis y materiales especiales (OPM), cirugías múltiples y secuenciales (CMS), realizadas por el Departamento de Salud del Estado de Rio Grande do Sul, Brasil (SES / RS). Metodología: estudio cuantitativo descriptivo, basado en datos secundarios de SES / RS, en el área de OPM y CMS, en referencia al período de la práctica de auditoría posterior al pago, desde marzo de 2013 hasta enero de 2017, utilizando el enfoque de estudio de caso. Resultados: se analizaron 1,004 observaciones completas para el período; el número de procesos administrativos que requirieron un retorno de los recursos financieros no tuvo una tendencia en las series históricas analizadas, un resultado influenciado por la presencia de procesos administrativos que no fueron concluyentes, especialmente a partir de 2014, en la ejecución de la auditoría o incluso la judicialización del sujeto Instituciones auditadas. En cuanto al valor financiero solicitado para el retorno de los procesos analizados, fue mayor en 2014, disminuyó en 2015 y disminuyó considerablemente en los años 2016 y 2017. Considerando las 30 regiones de salud del estado de Rio Grande do Sul, Brasil, se destacaron tres hospitales, el primero con 43 procesos administrativos solicitando la devolución de recursos financieros; el segundo con 30; y el tercero con 28. Conclusión: las acciones de salud en esta área se pueden calificar a través de una atención especial a las regiones de salud y las instituciones hospitalarias que repiten más y tienen grandes volúmenes financieros. (AU).

Impacto económico institucional del programa Receta Resurtible con pacientes diabéticos / Institutional economic impact of the Receta Resurtible (Resupply Prescription) program in diabetic patients

Objetivo: determinar el impacto económico institucional del programa Receta Resurtible con pacientes diabéticos. Material y métodos: estudio de costos antes y después del programa Receta Resurtible con pacientes diabéticos. El costo promedio incluyó perfil de uso y costo unitario. El perfil de uso se determinó para Consulta externa, Farmacia y medicamentos. En el análisis se plantearon escenarios y se adoptaron supuestos. Resultados: el promedio de consultas antes y después se ubica en 6.45 y 4.73, respectivamente. La dotación de medicamentos fue 55.8% y 99%. El impacto del programa para una unidad de medicina familiar con 6400 pacientes diabéticos, de los cuales 18% se encuentra en el programa Receta Resurtible, permite un ahorro de $ 490 366 en la consulta de Medicina familiar y atención en Farmacia, sin embargo existe un incremento de $112 100 por consumo de medicamentos, el ahorro total en este escenario es de $378 266. Conclusión: el impacto económico del programa Receta Resurtible es benéfico para la institución.

Objective: To determine the institutional economic impact of the Resupply Prescription program in diabetic patients. Material and methods: Study of costs before and after the Resupply Prescription program with diabetic patients. The average cost included usage profile and unit cost. The profile of use was determined for External consultation, Pharmacy and medication. In the analysis, scenarios were raised and assumptions were adopted. Results: The average of before and after consultations is located at 6.45 and 4.73, respectively. The medication provision was 55.8 and 99%. The impact of the program for a Family Medicine Unit with 6400 diabetic patients, of which 18% is in the Resupply Prescription program, allows a saving of $ 490 366 in the consultation of Family Medicine and Pharmacy, however there is a increase of $ 112 100 for drug consumption, the total saving in this scenario is $ 378 266. Conclusion: The economic impact of the Resupply Prescription program is beneficial for the institution.

Términos económicos más utilizados en la salud (II parte) / Most used economic terms in health (II part)

En este artículo se ofrece el resto de los términos económicos, organizados alfabéticamente de la letra E a la Z, con lo cual se completa el glosario iniciado en el número anterior de esta revista. Se espera que pueda ser útil a todos los estudiantes y profesionales de las ciencias médicas que lo necesiten como material de consulta, y para todos aquellos lectores que deseen incrementar su acervo cultural en la esfera económica(AU)

In this work the rest of the economic terms alphabetically organized are offered from E to Z letters, with which the glossary initiated in the previous number of the present journal is completed. It is expected that this glossary can be useful to all the students and professionals of the medical sciences that need it as consultation material, and for all those readers that want to increase their cultural heritage in the economic sphere(AU)

Términos económicos más utilizados en la salud (II parte) / Most used economic terms in health (II part)

En este artículo se ofrece el resto de los términos económicos, organizados alfabéticamente de la letra E a la Z, con lo cual se completa el glosario iniciado en el número anterior de esta revista. Se espera que pueda ser útil a todos los estudiantes y profesionales de las ciencias médicas que lo necesiten como material de consulta, y para todos aquellos lectores que deseen incrementar su acervo cultural en la esfera económica.

In this work the rest of the economic terms alphabetically organized are offered from E to Z letters, with which the glossary initiated in the previous number of the present journal is completed. It is expected that this glossary can be useful to all the students and professionals of the medical sciences that need it as consultation material, and for all those readers that want to increase their cultural heritage in the economic sphere.

Epidemiología social y economía política: la UCI como punto de encuentro / Social epidemiology and political economy: ICU as point of convergence / Epidemiologia social e economia política: a UTI como ponto de encontro

Las interrogantes acerca de epidemiología, economía y cuidado crítico suelen estar en la mente de casi cualquier profesional de la salud. Sin embargo, casi nunca se tiene presente que la epidemiología y la economía pueden converger -a pesar de ser campos de estudio aparentemente separados- y que lo pueden hacer para explicar la situación actual o las tendencias futuras de un servicio hospitalario o de salud pública. Este ensayo presenta brevemente el devenir de la epidemiología social y de la economía política y cómo ambas actividades académicas pueden encontrar intereses comunes a propósito de la Unidad de Cuidado Intensivo (UCI), en particular para generar interrogantes, posibles áreas de investigación y alternativas hacia el desarrollo de servicios de salud más eficientes, más efectivos y más humanos.

Questions around epidemiology, economics and critical care are often in the mind of almost any healthcare professional. However, it is seldom realized that epidemiology and economymay converge -in spite of being apparently separated fields of study- in order to explain the present situation or future trends of a hospital or public health service. This essay briefly depictshow social epidemiology and political economy have developed and how both academic activities may find a common ground about the Intensive Care Unit (ICU), particularly to pose questions, to create possible research lines and feasible alternatives towards more efficient, effective and humane health services.

As interrogantes sobre de epidemiologia, economia e cuidado crítico acostumam estar na mente de quase qualquer professional da saúde. Porém, quase nunca se tem presente que a epidemiologia e a economia podem convergir -apesar de ser campos de estudo aparentemente separados- e que o podem fazer para explicar a situação atual ou as tendências futuras de um serviço hospitalar ou de saúde pública. Este ensaio apresenta brevemente o devir da epidemiologia social e da economia política e como ambas atividades acadêmicas podem encontrar interesses comuns a propósito da Unidade de Tratamento Intensivo (UTI), em particular para gerar interrogantes, possíveis áreas de investigação e alternativas para o desenvolvimento de serviços de saúde mais eficientes, maisefetivos e mais humanos.

Situación financiera y propuesta de sostenibilidad régimen enfermedad – maternidad del Instituto Hondureño de Seguridad Social, periodo 2008 - 2022

El seguro social de Honduras tiene tres formas de organizar la provisión de serviciosde salud: i) a través de su red propia de hospitales y clínicas en las que se brindanatenciones de los tres niveles de atención; ii) por medio de proveedores privados -servicios sub rogados que ofrecen atenciones de primer y segundo nivel; y, iii) elservicio médico de empresas que otorga cuidados de primer nivel.El IHSS tiene las tasas de cotización más bajas de Centroamérica y un déficitfinanciero ya inoperable por lo bajo de dichas tasas; en cinco de los últimos ochoaños los flujos de recursos financieros para garantizar la entrega oportuna de lasprestaciones del REM, han venido presentando déficits en sus balances operativos,situación que podría agravarse en los próximos años, debido esencialmente (i) elestablecimiento de un techo máximo de cotización relativamente bajo, (ii) el cambioen la política cambiaria de estado, la que paso de un tipo de cambio fijo a uno dedeslizamiento reptante1, la que produce un encarecimiento relativo de los insumosimportados, sobre todo medicamentos y material de reposición periódica, (iii) la bajacobertura poblacional, y (iv) al potencial efecto de la desaceleración de la economía.En aras superar esta difícil situación financiera y operativa se propone diferentesmecanismos de solución potencial, para ello se simularon cuatro escenarios a fin deque las autoridades del IHSS tengan un abanico de opciones al respecto. En aras superar esta difícil situación financiera y operativa se propone diferentesmecanismos de solución potencial, para ello se simularon cuatro escenarios a fin deque las autoridades del IHSS tengan un abanico de opciones al respecto...

Perfil do cirurgião plástico no Estado de Goiás, Brasil / Profile of plastic surgeons in the state of Goias, Brazil

INTRODUÇÃO: A Cirurgia Plástica tem sido popularizada nos últimos anos, por meio do acesso aos procedimentos e exposição nos meios de comunicação. O contexto atual relata dificuldades no mercado de trabalho devido à competividade e diminuição de honorários. O objetivo deste estudo é relatar o perfil do cirurgião plástico que atua no Estado de Goiás. MÉTODOS: A pesquisa foi realizada com cirurgiões plásticos que atuam no estado de Goiás registrados na regional da Sociedade Brasileira de Cirurgia Plástica (SBCP) até janeiro de 2015. Os dados foram divididos em perfil socioeconômico e demográfico. Foram considerados como critérios de inclusão residência pelo Ministério da Educação ou pela SBCP e estar atuando em Cirurgia Plástica no estado de Goiás. Como critérios de exclusão ser médico residente em cirurgia plástica e não estar atuando na área de Cirurgia Plástica. RESULTADOS: Obteve-se o índice de resposta de 70%. A maioria tem menos de 40 anos, masculino, casado, com 1 a 2 filhos, atuando em Goiás, há menos de 10 anos, são especialistas, trabalhando de 40 a 60 horas semanais e atuam na área estética e reconstrutiva e a maioria não usa auxiliar em mais de 50% das cirurgias realizadas. CONCLUSÃO: O perfil do cirurgião plástico do estado de Goiás é o de um médico jovem, do sexo masculino, casado, com até 2 filhos, que atua principalmente na capital, sendo a maioria especialista, que trabalha de 40 a 60 horas semanais, e atuando na cirurgia estética e reconstrutiva.

INTRODUCTION: Plastic surgery has become popular in the recent years for the access to procedures and exposure in the media. The current scenario brings difficulties in the job market because of competitiveness and reduced fees. This study describes the profile of the plastic surgeons working in the state of Goias. METHODS: The survey was conducted with plastic surgeons who work in the state of Goias and are registered in local chapter of the Brazilian Society of Plastic Surgery in January 2015. Data were divided into socio-economic and demographic profile. Inclusion criteria were residence certified by the Brazilian Ministry of Education or by the Brazilian Society of Plastic Surgery,, practice of plastic surgery in the state of Goias. We excluded residents in plastic surgery, and those who not practice in plastic surgery area. RESULTS: Rate of response was 70%. Most participants were younger than 40 years old, men, married, with 1-2 children, work in Goias, had less than 10 years as a surgeion, had specialization in plastic surgery, work 40-60 hours weekly and main practice was in aesthetic and reconstructive area, the majority of them do not employ assistances in more than 50% of surgeries. CONCLUSION: The profile of plastic surgeon in state of Goias is composed by young physicians, men, married, with no more than 2 children, and whom practice mainly in the state capital, most of them are specialists, work 40-60 hours per week, and their main practice is with aesthetic and reconstructive surgery.

Análisis de costo efectividad de prasugrel, comparado con clopidogrel para pacientes con síndrome coronario agudo sometidos a intervención coronaria percutánea en Colombia / Analysis of cost effectiveness of prasugrel compared with clopidogrel for patients with acute coronary syndrome undergoing percutaneous coronary intervention in Colombia

Objetivo: determinar, desde la perspectiva del sistema de salud colombiano, la relación de costo-efectividad del prasugrel comparado con clopidogrel, para el tratamiento de pacientes adultos con síndrome coronario agudo. Material y métodos: se construyó un modelo de Markov con ciclos anuales en el cual los pacientes pueden permanecer sin experimentar nuevos eventos cardiovasculares, sufrir un nuevo evento o morir. En el caso base se adoptó un horizonte temporal de 10 años y una tasa de descuento de 3%. Las probabilidades de transición se extrajeron del ensayo clínico TRITON-TIMI 38, de las estadísticas vitales del Departamento Nacional de Estadística y de la información de los pacientes colombianos del registro ACCESS. Para identificar y medir el uso de recursos se diseñó un caso típico a partir de la revisión de guías y protocolos; para la valoración se emplearon manuales tarifarios colombianos. Se realizaron análisis de sensibilidad determinísticos y probabilísticos. Resultados: en el caso base, el costo por año de vida ajustado por calidad ganado con prasugrel es $79 987 695 pesos colombianos. Los resultados son sensibles a cambios en el horizonte temporal y al costo del clopidogrel. Bajo un umbral de disposición a pagar de tres veces el PIB per cápita colombiano, la probabilidad de que el prasugrel sea costo efectivo es 7%. Conclusiones: la decisión respecto a la inclusión del prasugrel en el tratamiento de pacientes con síndrome coronario agudo, sometidos a intervención coronaria percutánea depende fundamentalmente del costo del clopidogrel que el decisor considere relevante para realizar la comparación. (Acta Med Colomb 2015; 40: 310-317).

Objective: to determine the cost-effectiveness relation of prasugrel compared with clopidogrel for the treatment of adult patients with acute coronary syndrome from the perspective of Colombian health system. Material and methods: a Markov model with annual cycles in which patients can remain without experiencing new cardiovascular events, have a new event or die, was built. In the base case a time horizon of 10 years and a discount rate of 3% was adopted. Transition probabilities were taken from the clinical trial TRITON-TIMI 38, of vital statistics from the National Department of Statistics and from the information of Colombian patients in ACCESS registry. To identify and measure the use of resources, a typical case was designed from the review of guidelines and protocols; Colombian tariff manuals were used for assessment. Deterministic and probabilistic sensitivity analyzes were performed. Results: in the base case, the cost per year of quality-adjusted life gained with prasugrel is $ 79,987,695 Colombian pesos. The results are sensitive to changes in the timeframe and cost of clopidogrel. Under a threshold willingness to pay three times the per capita GDP of Colombia, the probability that prasugrel may be cost-effective, is 7%. Conclusions: the decision on the inclusion of prasugrel in the treatment of patients with acute coronary syndrome undergoing percutaneous coronary intervention depends mainly on the cost of clopidogrel that the decision maker considers relevant to perform the comparison. (Acta Med Colomb 2015; 40: 310-317).