To determine the cost effectiveness of colistimethate sodium for the treatment of infections caused by multidrug-resistant (MDR). We compare key outcomes related to survival, infection averted and costs for infections caused by MDR. A lifetime Markov model was used to estimate the expected outcomes and costs for patients treated with colistimethate sodium vs non- colistimethate sodium group. Colistimethate sodium at a dosage of 5mg/kg/day was given intravenously in two divided doses. Primary outcomes were the clinical response and 30-day mortality; secondary outcomes were microbiological response and adverse events. The cost-effective analysis was conducted from the Mexican Health care perspective. Costs were derived from the literature, future costs and effects were discounted at 5% per recommendations for analyses in Mexico. All costs are presented in 2013 US dollars. Multiple 1-way and Probabilistic sensitivity analyses were performed. In the colistimethate sodium group, 80.8% had a favorable clinical response, the overall mortality of the patients in the colistimethate sodium group was 46.2% and that in the non- colistimethate sodium group was 80%. Nephrotoxicity was found in 30.8% in the colistimethate sodium group. The model projects an accumulated discounted cost to the Mexican health care system per patient receiving the Colistimethate sodium regimen of $8,525 compared to $7,384 for non- colistimethate sodium regimen. The base-case analysis presented incremental cost-effectiveness ratios for colistimethate sodium vs non- colistimethate sodium grup of $ 2,213 per LYG. These values are in accordance with the recommendations of the Commission on Macroeconomics and Health, WHO, suggesting that health technologies with ICERs below the per capita GDP are considered very cost-effective. Results were robust to various assumptions tested in the sensitivity analysis. This study suggest that in the Mexican setting, use of non- colistimethate sodium for treatment of infections caused by MDR is likely to be cost effective.

Little information exists on the acute treatment provided for rhinosinusitis and its associated costs. This study assessed the cost-effectiveness of mometasone furoate versus amoxicillin for the treatment of rhinosinusitis in Mexico from a health care perspective. A decision tree model was constructed using decision analytical techniques. Data sources included published literature, clinical trials, official price/tariff lists, and Delphi panel data. The comparators were mometasone furoate 200µg twice daily and amoxicillin 500mg three times daily. This study further do not included MFNS 200µg once daily as a treatment arm because it was not found to be superior to amoxicillin. The time horizon was 2 weeks. The effectiveness outcomes of the study were modeled as changes in the Major Symptom Score (MSS). MSS consists of five questions concerning rhinorrhoea, post-nasal drip, nasal congestion, sinus headache, and facial pain. Costs were valued in US dollar, year 2012 values. One-way and probabilistic sensitivity analyses were conducted to evaluate uncertainty in the results. The projected costs were US$ 258 with Mometasone furoate and $US 272 with.The benefits were 0.52 with Mometasone furoate, 0.45 with Amoxicilin. Mometasone furoate was associated with a cost savings per patient of US$ 13.92 versus amoxicillin over a period of 2 weeks from a health care perspective. The incremental cost-effectiveness ratio for Mometasone furoate dominated Amoxicilin. Sensitivity analysis confirmed the overall cost savings and gains in effectiveness. Our analysis suggests Mometasone Furoate improves health outcomes in a cost-effective manner compared with Amoxicilin, and highlights the importance of using evidence-based effectiveness estimates in economic studies of rhinosinusitis therapies

Little information exists on the acute treatment provided for rhinosinusitis and its associated costs. We hypothesize that introducing the administration of mometasone furoate (MFNS) as a treatment for rhinosinusitis will have a substantial impact on medical resource costs, outcomes and possibly cost-effectiveness. The goal of this paper is to estimate the cost-effectiveness of treating patients with rhinosinusitis with MFNS versus amoxicillin. A decision-analytic model was developed to estimate lifetime costs and outcomes associated with MFNS 200µg twice daily and amoxicillin 500mg three times daily in treating rhinosinusitis from the Mexican health care perspective. This study further do not included MFNS 200µg once daily as a treatment arm because it was not found to be superior to amoxicillin. Data sources included published literature, clinical trials, official price/tariff lists, and Delphi panel data. The time horizon was 2 weeks. The effectiveness outcomes of the study were modeled as changes in the Major Symptom Score (MSS). MSS consists of five questions concerning rhinorrhoea, post-nasal drip, nasal congestion, sinus headache, and facial pain. Costs were valued in US dollar, year 2012 values. Multiple 1-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulation were performed to handle uncertainty. The projected costs were US$ 258 with MFNS and $US 272 with. The benefits (changes in the MSS) were 0.52 with MFNS 0.45 with Amoxicilin. MFNS was associated with a cost savings per patient of US$ 14 versus amoxicillin over a period of 2 weeks from a health care perspective. The incremental cost-effectiveness ratio for MFNS dominated Amoxicilin. Sensitivity analysis confirmed the overall cost savings and gains in effectiveness. Our analysis suggests MFNS improves health outcomes in a cost-effective manner compared with Amoxicilin. The economic value of Amoxicillin is influenced by difficulties involved in diagnosing the condition, effectiveness, resistance, patient compliance with treatment, and treatment failure associated with antibiotics.

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 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 evaluate the cost-effectiveness of fluticasone furoate vs. mometasone furoate in the treatment of ocular symptoms in allergic rhinitis patients in Mexico. A decision-analytic model was developed to estimate the cost-effectiveness of fluticasone furoate versus mometasone furoate. Patients initiated on treatment either completed initial therapy or switched to second line therapy due to non-response. Probability of a switch and resource use was based on expert panel and literature. Costs were based on local drug acquisition costs, local cost estimates for outpatient and hospitalization. Effectiveness was defined as the net improvement in Total Ocular Symptom Score (TOSS) at 12 weeks from Keith PK. 2009 study. The analysis was carried out from the perspective of the Mexican health care system and all costs are reported in 2010 US dollars. The corresponding health effects were 0.47 net improvement TOSS for fluticaone furoate and 0.31 for mometasone furoate regimen. The mean total cost of the fluticaone furoate regimen was $ 627 compared with $ 827 for the furoate mometasone regimen. Treatment with fluticasone furoate compared to treatment with mometasone furoate was less costly and resulted in a greater net improvement of TOSS. Probabilistic sensitivity analyses demonstrated that the cost savings observed were maintained over a wide range of alternative values for costs and resource utilization. Cost-effectiveness analysis indicated the dominance of fluticasone furoate over mometasone furoate because of both lower costs and greater efficacy. Cost savings with fluticasone furoate were attributable to lower drug acquisition costs. In addition, a net improvement in ocular symptoms may be expected in allergic rhinitis patients.

To estimate the 5-year projected impact on the annual pharmacy budget for allergic rhinitis (AR) patients in Mexico. Mexican prevalence and treatment data for AR patients were obtained from published and nonpublished sources. The model considered 2 scenarios—without (pre) and with (post) FFNS. Market share data for corticosteroid treatment options for AR pre-FFNS and in the first year post-FFNS were obtained from nonpublished, real-world drug utilization data collected by GSK. Market shares for the second until fifth years post- FFNS were forecasted by the study authors. Drug costs were based on the Mexican Social Security Institute (IMSS). Wholesale Acquisition Cost was accessed on March 2010. The results for each indication were analyzed individually and summed to reflect the total impact of FFNS. Results were also considered on a per member per month (PMPM) basis to examine the relative impact on the plan. Sensitivity analyses were performed by varying several model input parameters. The estimated prevalence of AR in 2010 was 10%. In the year after its introduction, 60% of the AR population filled a prescription for FFNS. The estimated total cost for AR treatment prior to introduction of FFNS was $ 552 million and (532 to $ 384 million post FFNS. The incremental decrease in pharmacy benefit cost was ($ 20 to $ 84 millions) in 2010 dollars. These reductions translated to a medical care cost saving of $ 266 millions over 5 years. Model results suggest that increasing the use of fluticasone furoate decreases total budget costs due to decreased acquisition drug costs.

The objective of this study was to determine whether initial maintenance therapy for the treatment of inflammation and bronchoconstriction associated with persistent asthma is more effective with a combination product (100 microg of fluticasone propionate and 50 microg of salmeterol [FSC]) administered twice daily through the Diskus device (GlaxoWellcome, Research Triangle Park, NC) or with montelukast at 10 mg once daily. A 12-wk, randomized, double-blind, double-dummy, multicenter study was conducted with 423 patients 15 yr of age and older with asthma and who were symptomatic while receiving short-acting beta(2)-agonists alone. At end point, FSC resulted in significantly greater increases in morning predose FEV(1) (0.54 +/- 0.03 vs. 0.27 +/- 0.03 L), morning peak expiratory flow (PEF) (89.9 +/- 6.7 vs. 34.2 +/- 4.7 L/min), evening PEF (69.9 +/- 5.8 vs. 31.1 +/- 4.5 L/min), the percentage of symptom-free days (48.9 +/- 2.9 vs. 21.7 +/- 2.5%), the percentage of rescue-free days (53.0 +/- 2.8 vs. 26.2 +/- 2.5%), and the percentage of nights with no awakenings (23.0 +/- 2.5 vs. 15.5+/-2.4%) compared with montelukast (p < or = 0.001, all comparisons). FSC significantly reduced asthma symptom scores (-1.0 +/- 0.1 vs. -0.6 +/- 0.1), rescue albuterol use (-3.3 +/- 0.2 vs. -1.9 +/- 0.2 puffs/d), and the number of exacerbations (0 vs. 11) compared with montelukast (p < 0.001). Both treatments were well tolerated. In summary, treatment of the two main components of asthma (inflammation and bronchoconstriction) with fluticasone propionate and salmeterol in a combination product was a more effective initial maintenance treatment strategy than treatment with montelukast, a single-mediator antagonist.