RESUMEN
The high cost of drugs for hepatitis C limits access and adherence to treatment. In 2017, the Colombian health care system decided to design a strategy. It consisted of centralized purchasing, regulations, clinical practice guidelines, and direct observation of the treatment and follow-up of patients. The main objective of this study was to assess the centralized purchasing strategy in Colombia. The study design was a policy implementation assessment. We analyzed the change in prices, the clinical outcomes, and the opinions of stakeholders using data from the Ministry of Health. Additional information about effectiveness came from the Colombian Fund for High-Cost Diseases and semi-structured interviews of the stakeholders. The follow-up was from October, 2017 to October, 2018. The total number of patients reported in the cohort period was 1069. The number that finished 12 weeks of treatment, completed the follow-up for the case closure, and were considered cured through the end of October, 2018 was 563 (53%). The remainder, 506 patients (47%), are currently in treatment. A total of 543 of these treated patients (96%) were cured. After implementing this strategy, the drug prices decreased by more than 90% overall. Before implementation, the total direct cost was $100 102 171.75 dollars. Afterward, the cost was $8 378 747 dollars.
Asunto(s)
Antivirales/economía , Atención a la Salud/organización & administración , Costos de los Medicamentos/legislación & jurisprudencia , Implementación de Plan de Salud , Hepatitis C/tratamiento farmacológico , Antivirales/uso terapéutico , Colombia/epidemiología , Ahorro de Costo/economía , Ahorro de Costo/estadística & datos numéricos , Análisis Costo-Beneficio , Atención a la Salud/economía , Atención a la Salud/legislación & jurisprudencia , Atención a la Salud/normas , Costos de los Medicamentos/estadística & datos numéricos , Industria Farmacéutica/economía , Industria Farmacéutica/estadística & datos numéricos , Femenino , Adquisición en Grupo/economía , Adquisición en Grupo/legislación & jurisprudencia , Adquisición en Grupo/organización & administración , Adquisición en Grupo/normas , Hepacivirus/aislamiento & purificación , Hepatitis C/epidemiología , Hepatitis C/virología , Humanos , Masculino , Persona de Mediana Edad , Negociación , Políticas , Guías de Práctica Clínica como Asunto , Evaluación de Programas y Proyectos de Salud , Participación de los Interesados , Resultado del TratamientoRESUMEN
OBJECTIVES: This article presents a cost-utility analysis from the Colombian health system perspective comparing primary prophylaxis to on-demand treatment using exogenous clotting factor VIII (FVIII) for patients with severe hemophilia type A. METHODS: We developed a Markov model to estimate expected costs and outcomes (measured as quality-adjusted life-years, QALYs) for each strategy. Transition probabilities were estimated using published studies; utility weights were obtained from a sample of Colombian patients with hemophilia and costs were gathered using local data. Both deterministic and probabilistic sensitivity analysis were performed to assess the robustness of results. RESULTS: The additional cost per QALY gained of primary prophylaxis compared with on-demand treatment was 105,081,022 Colombian pesos (COP) (55,204 USD), and thus not considered cost-effective according to a threshold of up to three times the current Colombian gross domestic product (GDP) per-capita. When primary prophylaxis was provided throughout life using recombinant FVIII (rFVIII), which is much costlier than FVIII, the additional cost per QALY gained reached 174,159,553 COP (91,494 USD). CONCLUSIONS: using a decision rule of up to three times the Colombian GDP per capita, primary prophylaxis (with either FVIII or rFVIII) would not be considered as cost-effective in this country. However, a final decision on providing or preventing patients from primary prophylaxis as a gold standard of care for severe hemophilia type A should also consider broader criteria than the incremental cost-effectiveness ratio results itself. Only a price reduction of exogenous FVIII of 50 percent or more would make primary prophylaxis cost-effective in this context.
Asunto(s)
Factor VIII/economía , Hemofilia A/tratamiento farmacológico , Años de Vida Ajustados por Calidad de Vida , Colombia , Análisis Costo-Beneficio , Factor VIII/uso terapéutico , Humanos , Cadenas de Markov , Modelos Económicos , Índice de Severidad de la EnfermedadRESUMEN
La unidad de pago por capitación (UPC) es la prima del seguro en el Sistema de Seguridad Social en Salud de Colombia. El análisis de su comportamiento es de suma importancia por sus efectos sobre la capacidad del sistema de lograr sus objetivos en cuanto al estado de salud de la población, el acceso a los servicios y su sostenibilidad financiera. En el caso del régimen contributivo, la UPC ha estado asociada a la dinámica de la compensación entre las cotizaciones y los recursos necesarios para financiar la población a cargo de las EPS, con pocas consideraciones sobre el costo del Plan Obligatorio de Salud (POS). En el caso del régimen subsidiado, se evidencia una tendencia a la igualación de ingresos y gastos, aunque se reconocen presiones sobre la sostenibilidad, resultado de la disminución del ritmo de crecimiento de las fuentes de financiación y el incremento en la demanda por atenciones costosas