Demostrar en base a un modelo económico de oligopolio que los formularios provoca oligopolios e incentiva a mantener precios altos. Los formularios son una barrera a la entrada al mercado que desincentiva la competencia. Los medicamentos patentados no son sujetos a competencia directa por precio, por lo tanto son sujetos a competir conforme a un modelo de Cournot. Este modelo se basa en que los competidores pelean el mercado por cantidades. Los productos patentados no son sujetos a licitación si no a adjudicación directa. Se toma como supuesto que hay un "n" número de competidores en los formularios nacionales, siendo "N" el número total de competidores, cada una con un producto que vende a un precio "P". Los competidores toman decisiones al mismo tiempo. La demanda del mercado está dada por P (Q) = a - bQ, siendo "Q" la sumatoria de todas las producciones. Hay "X" número de competidores que están fuera del formulario nacional. El precio del productor dependerá, principalmente, de "Q" y de "N". Si incrementa "Q", y "N" constante, entonces se incrementan los precios. Si incrementa "N", y "Q" constante, bajan los precios. Si no existieran los formularios nacionales, no habría barreras a la entrada y la competencia incrementaría en "X" que provocaría un menor precio. Si "N" tiende al infinito, entonces el modelo tiende a la competencia perfecta. En un caso donde solo un producto ha logrado el acceso al formulario nacional formará monopolio. Las barreras a la entrada causada por formularios nacionales mantendrán precios altos hasta que un nuevo competidor sea incorporado al formulario. Entre mayor sea el número de oferentes se incrementará la competencia y menor será el precio. Se recomienda analizar los beneficios de los formularios nacionales y explorar otros métodos de reembolso como pagar por el desenlace en salud y no por el producto en sí.

To evaluate whether the use of bevacizumab in first line treatment for patients with advanced ovarian cancer represents a cost-effective strategy for health institutions in Mexico. Ovarian Cancer is the sixth most common cancer and second gynecologic malignancy worldwide, with approximately 190,000 new cases per year. Ovarian cancer is considered highly lethal for their growth characteristics, low symptoms and recurrence. A complete economic evaluation of cost-effectiveness was performed in women with ovarian cancer stage III and IV, classified as high risk, taking carboplatin + paclitaxel (CP) and bevacizumab+ carboplatin +paclitaxel (BCP) as comparators. The 1st cycle, carboplatin + paclitaxel are administered alone; from 2nd to 6th is added bevacizumab (7.5 mg/kg). From cycle 7, all patients with no evidence of disease progression received maintenance bevacizumab as monotherapy, giving a maximum of 18 cycles. The progression was emulated with a Markov model considering the stages of: progression free survival, progression and death in a 11.5 year time horizon. Costs are expressed in US dollars. BCP gained more months with progression free survival compared with CP (16.77 vs. 14.40). BCP obtained 40.89 months of overall survival versus 31.17 with CP, generating a 36% increase in overall life expectancy. The Incremental Cost Effectiveness Ratio (ICER) for BCP is $25,544 per year of additional life year gained with respect the use of CP. According to the International Monetary Fund, the Gross Domestic Product (GDP) for Mexico in 2011 was $9471. For a threshold of 3 times this value (3 GDP per capita: $28,413), the use of BCP in advanced ovarian cancer would be cost-effective. BCP is an alternative that substantially increases the patient overall survival expectancy. It also lies within the international cost-effectiveness threshold.

Assess whether the use of Erlotinib as 1st line treatment in metastatic or advanced Non Small Cell Lung Cancer (NSCLC) patients with Epidermal Growth Factor Receptor (EGFR) mutation positive, is a dominant alternative from the perspective of public health system in Mexico. It was developed a cost-utility analysis using a Markov model with monthly cycles stages: response to treatment, stable disease, disease progression and death in a time horizon of 5 years. The costing method is the direct medical costs and the main outcome measures were QALY's and total cost of treatment per patient. The drugs compared in the study were Erlotinib, Gefitinib and chemotherapy with Gemcitabine plus Carboplatin. Costs are expressed in US dollars. Erlotinib was the alternative that provided a greater number of QALY's (1.49) compared with Gefitinib (1.32) and chemotherapy with Carboplatin (1.07). Furthermore, treatment with Erlotinib was the least expensive with a cost per patient of $51,249 on a horizon of 5 years while the cost of Gefitinib was $ 53,817 per patient and the QT with Gemcitabine + Carboplatin $53,258 per patient. This implies that the dominant treatment for these patients (NSCLC and positive EGFR mutation) is Erlotinib with a cost-effectiveness average of $34,456. The dominance results of treatment with Erlotinib were consistent with sensitivity analysis, which provides robustness to the results. Considering the average annual costs, Erlotinib represents savings for the health sector from $402 (versus Gemcitabine + Carboplatin) to $514 (vs Gefitinib) for each patient according to its comparator in 1 year. Therefore, under the context of public health system in Mexico, treatment with Erlotinib was shown to be a cost-effective treatment and dominant over other treatment alternatives considered in this study for patients with NSCLC and EGFR mutation.

Juvenile Idiopathic Arthritis (JIA) is defined as arthritis (diagnosed by limitation in mobility, pain, pressure and local heat) in 1 or more joints for more than 6 weeks without an apparent etiology, prior to age 16 of age. In particular, the presentation systemic JIA (sJIA) is manifested clinically as chronic arthritis accompanied by intermittent fever, rash, anemia, hepatomegaly and/or splenomegaly and pericarditis and/or pleuritis, in both genders during all pediatric stages. To evaluate the cost-effectiveness of different biological therapies and identify which one is dominant for the treatment of sJIA in Mexico. It was done an evaluation of cost-effectiveness of using Tocilizumab, Etanercept, Adalimumab, Infliximab and placebo as a treatment for sJIA in a model of decision time horizon of 12 weeks. Costs are expressed in US dollars. Tocilizumab demonstrated superior effectiveness in patients achieving 71.6% ACR Pedi 70, with a cost per patient of $ 2,022, followed by Etanercept, Infliximab and Adalimumab with 24.8% at a cost of $ 1,260, $ 2,621 and $ 2,760 respectively in the base case. The expected cost to achieve one patient reaching an ACR Pedi 70 was significantly lower with tocilizumab than with the rest of the alternatives. The decision to use Tocilizumab for the treatment of sJIA would reduce the cost of getting a patient to achieve an ACR Pedi 70 in almost half the cost per response ratio calculated for Etanercept and reducing this value by about three-quarters compared with the estimated cost with Infliximab or Adalimumab. The results show that Tocilizumab is cost-effective ($ 1,886) and the dominant alternative compared to Etanercept ($ 2,702), Infliximab ($ 11,898) and Adalimumab ($ 12,835). The cost-effectiveness analysis showed that tocilizumab is cost-effective and is the dominant strategy over Infliximab, Adalimumab and Etanercept for the treatment of sJIA in Mexico.

To identify which is the chemotherapy scheme alternative that minimizes costs in the 1st line treatment of Metastatic Colorectal Cancer (mCRC) in Mexico. Cost minimization comparing different chemotherapy schemes for mCRC: XELOX (Capecitabine+Oxaliplatin), FOLFOX-4 (Oxaliplatin+Fluorouracil+folinic acid), FOLFOX-6 (Oxaliplatin+ Fluorouracil+ folinic acid) and FOLFIRI (Irinotecan+Fluorouracil+folinic acid). It was performed a Markov model with 3 stages: disease progression, disease free progression and death in a time horizon of 3 years. Costs were based on direct medical costs of the institution, drug administration costs and cost for the management of adverse events and they are expressed in US dollars. The average treatment cost for the alternatives were: $ 16,133.78 for XELOX, $ 25,690.58 for FOLFOX-4, $ 27,686.35 for FOLFOX-6 and $ 21,904.12 for FOLFIRI. XELOX is the least costly alternative. The difference in costs is mainly due to the difference in management costs and the presence of grade 3-4 adverse events, mainly neutropenia. Based on clinical trials, FOLFOX-6 presented neutropenia (47%), FOLFOX-4 (44%) and FOLFIRI (26%), while the most severe adverse event was diarrhea with XELOX (12%). In the disease management, FOLFOX-6, FOLOFX-4 and FOLFIRI require two hospitalizations per cycle for the application of the drug. Instead, XELOX requires only one chemotherapy session. Since Capecitabine is orally administered, not only minimizes the costs of administration, also has a better safety profile with less adverse events. The use of Capecitabine combined with Oxaliplatin scheme as first-line treatment of metastatic colorectal cancer, is the alternative that minimizes costs to the health institutions, as well as improve quality of life resulting from Capecitabine's oral administration.

To evaluate the costs associated with the treatment of Hepatitis C Virus (HCV) treated with Peg-interferon Alpha-2a versus Peg-Interferon Alpha 2b. For an initial distribution of patients it was used as an assumption that 60% of patients had chronic hepatitis and the other had compensated hepatitis. With this information was developed a Markov model with probabilities of disease evolution. The stages for this model from this were: liver cancer, ascites, refractory ascites, gastrointestinal bleeding, hepatic encephalopathy, liver transplantation and death. Costs are expressed in US dollars. The highest response rates were found with Peg-Interferon Alpha-2a for genotypes 1, 2 and 3 with a difference up to 15% compared to Peg-Interferon Alpha-2b. Due to a higher sustained virological response rate with Peg-Interferon Alpha-2a, the percentage of patients using this treatment had a lower probability of falling and developing chronic complications of the disease. Therefore, the cost of the disease treatment decreases. Also the cost of treatment with Peg-Interferon Alpha-2a is lower compared to Peg-Interferon Alpha 2b. For a 10-year projection which simulates through a Markov model that patients that did not respond to treatment evolved to chronicity of the disease costs per patient with Peg-interferon Alpha-2a was $ 25,913, while with Peg-Interferon Alpha-2b was $ 37,352, generating savings of $ 11,439 per patient who was treated with Peg-interferon Alpha-2a. The use of Peg-Interferon Alpha-2a was the dominant alternative because it was the most effective and least costly to treat HCV.

To identify which is the alternative that minimizes costs in the treatment of Rheumatoid Arthritis with biological therapy in Mexico. A cost minimization evaluation was done, comparing alternatives considered comparable in effectiveness in the management of RA in adult patients (Infliximab, Etanercept and Adalimumab, Rituximab, Tocilizumab) in a 9-year horizon. Since the frequency of retreatment with Rituximab hasn′t been standarized, the assumption of the retreatment scheme of every 9 months as the average of the standards was taken in account. Costs are expressed in US dollars. The total cost for 9 years with Rituximab was the lowest ($ 74,040), followed by Tocilizumab ($ 75,328), Etanercept ($ 76,034), Adalimumab ($ 89,490) and Infliximab ($ 91,543), generating savings with Rituximab of $ 1,288, $ 1,994, $ 15,450 and $ 17,503 respectively. Likewise, Rituximab was the alternative with the lowest number of applications (26), compared with Tocilizumab (117), Etanercept (468), infliximab (60) and Adalimumab (234). In the budget impact analysis, assuming that 100% of the patients are treated with Rituximab, the health facility could generate savings and therefore could gain access to biological therapy to more patients tan if they were treated under a scheme without Rituximab. The results of the sensitivity analysis, taking as a variable number of applications of Rituximab year showed, with an 85.44% of probability, that rituximab is shown to be the least costly alternative compared with Infliximab; 74.09% compared with Adalimumab; 53.17% compared with Etanercept, and with 51.38%, Rituximab is also less expensive compared to Tocilizumab. Rituximab proved to be an alternative that minimizes costs, generating savings and allowing greater access to therapy for patients with RA, offering benefits to health institutions, not only improving the quality of care with an innovative therapy, but also allowing significant cost savings.

To identify which of the different chemotherapy alternatives minimizes costs for the treatment of advanced and/or metastatic Gastric Cancer (GC) in Mexico. A cost minimization was performed considering the alternatives: EOX (epirubicin+oxaliplatin+capecitabine), EOF (epirubicin+oxaliplatin+fluorouracil), ECX (epirubicin+cisplatin+capecitabine) and ECF (epirubicin+cisplatin+fluorouracil) for the treatment of advanced and/or metastatic gastric cancer (advGA) using a Markov model with 3 stages: progression, disease free progression and death. For a time horizon of 3 years, it was taken into account direct medical costs for the disease management, drug and its application cost, and costs incurred in the management of the associated adverse events. Costs are expressed in USD dollars. ECX was the alternative with less costs ($6,293), followed by EOX ($7,692). The chemotherapy combinations based on capecitabine proved to be the least expensive. The alternative EOF had a cost of $10,904, while ECF was $9,873. The factor that increased costs of EOF and ECF was the drug administration costs, as they require to be administered as daily intravenous infusions in comparison of the oral administration of capecitabine. Therefore, the administration costs of ECX and EOX represent only 4.76% of the administration costs of ECF and EOF. The results of the univariate sensitivity analysis confirmed savings with capecitabine versus ECF from $5,721 to $6,209 and versus EOF from $5,691 to $6,178 in the total management costs. The probabilistic analysis results also confirmed that in the ECF scheme versus ECX, the combination with capecitabine is a cost-saving alternative. ECX and EOX are alternatives that minimize costs at 100% of cases compared to ECF and EOX respectively. The oral administration of capecitabine is the factor that minimizes the cost of the alternatives in the chemotherapy combination schemes, also, the safety profile of capecitabine helps incurring in less costs associated to the management of side adverse events.

To identify the drug that offers the best pharmacoeconomic result for the treatment of advanced or metastatic NSCLC previously treated with a chemotherapy regimen in public health institutions in Mexico. It was developed a cost-utility analysis using a Markov model with monthly cycles in a time horizon of 2 years. The main output indicators were: Years of Quality Adjusted Life (QALY's) and total treatment cost per patient. The alternatives in the study were: Erlotinib, Docetaxel and Pemetrexed. Costs are expressed in US dollars. The average cost per patient for Erlotinib was $9,862, and $21,583 to $24,049 for Docetaxel and Pemetrexed. Erlotinib provided 0.33 QALY's, while Docetaxel provided 0.30 and Docetaxel 0.31. Therefore, Erlotinib therapy is positioned as a dominant (more effective and less costly) compared to Docetaxel and Pemetrexed. These results were consistent in the sensitivity analysis, giving strength to them. Therefore, Erlotinib could represent annual savings of $5860 compared to Docetaxel and $7090 with Pemetrexed per patient. Additionally, Erlotinib contributes to costs reduction in patients with NSCLC, because it is a chemotherpay administered orally, instead os a intravenous infusion, and with a better safety profile with no hematologic toxicity in comparison with standard chemotherapy. The cost-utility analysis of the use of Erlotinib vs. Docetaxel or Pemetrexed in the treatment of previously treated metastatic or advanced NSCLC showed that Erlotinib is a cost-effective therapy because it consumes fewer resources to obtain clinical success. Under the perspective of the Mexican public health system Erlotinib is dominant alternative in second-line treatment for patients with advanced or metastatic NSCLC.

To analyze which alternative treatment for advanced gastric cancer with HER2 positive gives a better outcome in terms of life years gained (LY gained). An analysis of effectiveness using as outcome measure overall survival by a Markov model with 3 stages: progression-free, progression and death, as alternatives to taking trastuzumab plus chemotherapy (capecitabine/fluorouracil and cisplatin), epirubicin + cisplatin + fluorouracil (ECF), cisplatin + capecitabine + epirubicine (ECX), epirubicin + oxaliplatin + fluorouracil (EOF) and epirubicin + oxaliplatin + capecitabine (EOX). The outcome was LY gained. The effectiveness was obtained through survival curves of Kaplan-Meier overall survival for patients with advanced gastric cancer and overexpression of HER2 obtained from ToGA (Bang et al 2010). The time horizon considered in the model was 8 years (96 months). This time horizon was also in the TA 208 evaluation appraisal of trastuzumab as first-line treatment of the NICE. The treatment of trastuzumab + chemotherapy proved more effectiveness than all other treatment options. Trastuzumab generates 1.33 LY gained (life years) versus 1.04 of the chemotherapies with capecitabine (ECX and EOX) and 0.92 of the chemotherapies with fluorouracil (ECF and EOF) in HER2 positive patients. Trastuzumab treatment for HER2 positive advanced gastric cancer proved to be the alternative with more LY gained in comparison to all treatment options considered in this study.

To evaluate whether the use of bevacizumab + paclitaxel offers best cost-effective results regarding the use of paclitaxel for patients with metastatic breast cancer mBC The treatment was evaluated up to the progression of the disease, rescue management and palliative up to to death in a Markov model, operating 65 cycles of 28 days. An incremental cost effectiveness analysis and sensitivity analysis was performed considering as an outcome measure progression-free survival (PFS), on the cohort of 2000 patients with Her2 Ne mBC negative and a subanalysis of the populations of patients with triple negative of patients with Her2 Neu Negative, taking into account direct medical costs and social costs due to premature death, in a horizon of 5 years (discount rate 5%). The 40.35% of patients survived after 12 months using bevacizumab + paclitaxel, while only 35.20% did so with only administered paclitaxel. 59.6% of these patients were PFS with combination therapy, while 37.71% did with monotherapy. Combined therapy provides more effectiveness than monotherapy in terms of overall survival, progression-free survival (PFS) and therapeutic response The incremental cost of bevacizumab + paclitaxel is $7529 USD obeying the PFS difference in time between the two cohorts, and higher consumption on the combination versus monotherapy. For triple negative subpopulation, the ICER is $1793 USD while for the sub-population of HER 2 is $1448 USD. The ICER is compared against a threshold of 3 times GDP per capita in Mexico. The ICER is lower than the threshold, so it is cost-effective The combination of bevacizumab + paclitaxel, for all cases studied, represents a better alternative cost effective versus paclitaxel monotherapy.

Half of patients with systemic juvenile idiopathic arthritis (sJIA) will eventually fail to non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. Tocilizumab (TCZ) is indicated for patients with refractory sJIA. We aimed to determine the cost and the effectiveness of adding TCZ to conventional treatment for sJIA in Mexico. We designed two decision models to compare TCZ versus placebo. In each model, two time horizons were analyzed: 12 weeks and one year. Target population consists of patients (2-19 years) with active sJIA and inadequate response to NSAIDs and corticosteroids. The dosing scheme for TCZ was based on body weight: 8 mg/kg for patients ≥30 kg and 12 mg/kg for patients <30 kg. The analysis was performed under the perspective of the public health care system in Mexico. Tocilizumab acquisition cost, infusion fees and standard management of sJIA according to level of response were evaluated. Efficacy was defined in terms of the American College of Rheumatology Pediatric response criteria. Resource use and unit costs were gathered from local sources; efficacy was derived from two phase-3 clinical trials; increase in mortality and utility scores associated with level of response was based on literature. All costs are expressed in 2011 euros (€). A markedly higher proportion of patients achieved an ACRPedi70 response with TCZ in both children with the possibility of maintaining methotrexate (71% vs. 8%) and in those without that alternative (75% vs. 13%). The incremental cost per achieving an ACRPedi70 response was around 2400€ in both models. During base-case, the incremental cost per Quality-Adjusted Life Year (QALY) gained with TCZ ranged from 10,636€ to 10,681€. The gross domestic product per capita in Mexico during 2010 was estimated at 7048€. Results were robust to variation in all parameters. TCZ is a cost-effective option to treat sJIA in Mexico.

To evaluate whether the use of bevacizumab + paclitaxel offers best cost-effective results regarding the use of paclitaxel for patients with metastatic breast cancer mBC The treatment was evaluated up to the progression of the disease, rescue management and palliative up to to death in a Markov model, operating 65 cycles of 28 days. An incremental cost effectiveness analysis and sensitivity analysis was performed considering as an outcome measure progression-free survival (PFS), on the cohort of 2000 patients with Her2 Ne mBC negative and a subanalysis of the populations of patients with triple negative of patients with Her2 Neu Negative, taking into account direct medical costs and social costs due to premature death, in a horizon of 5 years (discount rate 5%). The 40.35% of patients survived after 12 months using bevacizumab + paclitaxel, while only 35.20% did so with only administered paclitaxel. 59.6% of these patients were PFS with combination therapy, while 37.71% did with monotherapy. Combined therapy provides more effectiveness than monotherapy in terms of overall survival, progression-free survival (PFS) and therapeutic response. The incremental cost of bevacizumab + paclitaxel is $9,639 USD obeying the PFS difference in time between the two cohorts, and higher consumption on the combination versus monotherapy. For triple negative subpopulation, the ICER is $2295 USD while for the sub-population of HER 2 is $1854 USD. The ICER is compared against a threshold of 3 times GDP per capita in Mexico. The ICER is lower than the threshold, so it is cost-effective The combination of bevacizumab + paclitaxel, for all cases studied, represents a better alternative cost effective versus paclitaxel monotherapy.

Evaluates if modifying the epidemiology of renal disease, more patients in predialysis and less in dialysis, improves the quality of life Chronic Kidney Disease (CKD) is a long-term condition described as the gradual loss of kidney function over time There are various stages of chronic renal failure prior to dialysis which are also considered as kidney failure. Those in stages III and IV present a significant percentage of complications from CKD which damage the renal function and accelerate the need of dialysis. Medical literature suggests early treatment of renal anemia, proteinuria and hypertension in patients who have not reached the renal replacement therapy Preventing complications, through adequate care of known progression factors (diabetes, hypertension, correction of anemia, and proteinuria), of CKD in predialysis stages reduces the progression of renal disease. Progression of renal damage can be slow down through early intervention preventive treatments such as control of glucose levels, anemia, hypertension and proteinuria in the early stages of the disease. We developed a simulation of 1000 patients from predialysis stage coming to dialysis in a period of 30 months. Without prevention treatment 57% of the patients will require dialysis, 1% will be transplanted and 9.1% will die, while with the prevention treatment only 25% will require dialysis, 0.5% will be transplanted and 4% will die during this period. The early treatment of patients provides better quality of life and significant savings compared with dialysis. Transplantation as a form of replacement therapy is the best choice for quality life and cost.

Realizar un análisis teórico de las preferencias del paciente derivado de la elección entre dos bienes: un medicamento biotecnológico de patente y un medicamento biosimilar. Suponemos que son bienes sustitutos perfectos, pues el paciente no puede consumir los dos bienes al mismo tiempo, debe elegir entre uno u otro. Definimos la función de utilidad del paciente como U(BT,BS)=aBT+bBS. Donde, BT es el Biotecnológico de patente, BS Biosimilar, a es la seguridad y eficacia del medicamento BT y b seguridad y eficacia del medicamento BS. Entre más seguro y eficaz sea el medicamento el paciente lo prefiere más. Entre mayor sea U su estado de salud es mejor. Suponemos que BT tiene estudios clínicos confiables que demuestran su seguridad y eficacia y que BS no presenta estudios clínicos y no se sabe su seguridad y eficacia real, por lo tanto BT es preferido, es decir a>b. El paciente posee una restricción presupuestal determinada por la ecuación y=PBTBT+PBSBS. Derivado de las inversiones en estudios clínicos suponemos que PBT>PBS. La tasa marginal de sustitución está determinada por la pendiente -a/b, es decir que el paciente sacrificará una unidad de BT por b/a unidades del bien BS. Dada la restricción presupuestal, la pendiente y tasa de sustitución objetivo es -PBT/PBS. De acuerdo a las preferencias del consumidor, su consumo óptimo se determinan de acuerdo a lo siguiente, si PBT/PBSa/b entonces el paciente solo consumirá BS, y si PBT/PBS=a/b el paciente está indiferente entre consumir BT o BS. Podemos concluir que las preferencias del paciente son sensibles al precio y a la seguridad y eficacia del medicamento. Entre más seguro y eficaz sea BT el paciente lo prefiere y estará dispuesto a pagar más.

Osteoporosis (OP) and fragility fractures (FF) significantly affect both mortality and health-related-quality-of-life, causing high costs. We aimed to determine the cost and the effectiveness of three different bisphosphonates (BP) in Mexico. A six health-state life-time Markov microsimulation model was adapted to compare intravenously (IV) ibandronate 3mg injection every 3 months (IBD), oral weekly (OW) alendronate 70mg (ALD) and OW risedronate 35mg (RSD), under the perspective of the public health care system in Mexico. Target population consists of postmenopausal (PW) women over 50 years with or without prior fracture. Only direct costs were accounted for and these included drug acquisition and acute medical attention of FF. All costs are expressed in 2009 United States dollars (USD). Unit cost and antifracture efficacy was derived from published literature. Outcomes measures were the type and frequency of FF avoided with each agent compared with no treatment and quality-adjusted life years (QALY). Cost and efficacy were calculated taking into account persistence and compliance data. The avoided fractures rate was higher with IV IBD (644 per 10,000 patients Vs. 205 and 203 with ALD and RSD, respectively). When compared with OW BP, IV IBD reduced the total FF frequency in about 10%. Hence, the use of IV IBD resulted in a gain of 37 QALY per every 1,000 patients. The incremental cost per QALY gained with IV IBD ranged from 9898 USD (vs. ALD) to 15,047 USD (vs. RSD). The gross domestic product per capita in Mexico during 2009 was estimated at 8337 USD. Results were robust to variation in all parameters. By reducing significantly the number of doses needed per year, IV IBD improves adherence and decrease the expected frequency of FF in comparison with OW BF. These results suggest that IV IBD is a cost-effective intervention for PM OP in Mexico.