Costo efectividad y análisis de impacto presupuestario del óxido nítrico inhalatorio neonatal en un hospital, desde la perspectiva del sistema público de salud / Cost effectiveness and budget impact analysis of inhaled nitric oxide in a neonatal unit from the perspective of the public health system
Rev. chil. pediatr
; 87(6): 463-467, Dec. 2016. ilus, graf, tab
Article
in Spanish
| LILACS
| ID: biblio-844566
Responsible library:
BR1.1
RESUMEN
El óxido nítrico inhalatorio (ONi) es actualmente la terapia de primera línea en la insuficiencia respiratoria hipoxémica grave del recién nacido; la mayor parte de los centros neonatales de regiones en Chile no cuentan con esta alternativa terapéutica. Objetivo:
Determinar el costo-efectividad del ONi en el tratamiento de la insuficiencia respiratoria asociada a hipertensión pulmonar del recién nacido, comparado con el cuidado habitual y el traslado a un centro de mayor complejidad. Pacientes ymétodo:
Se modeló un árbol de decisiones clínicas desde la perspectiva del sistema de salud público chileno, se calcularon razones de costo-efectividad incremental (ICER), se realizó análisis de sensibilidad determinístico y probabilístico, se estimó el impacto presupuestario, software TreeAge Health Care Pro 2014.Resultados:
La alternativa ONi produce un aumento promedio en los costos de 11,7 millones de pesos por paciente tratado, con una razón de costo-efectividad incremental comparado con el cuidado habitual de 23 millones de pesos por muerte o caso de oxigenación extracorpórea evitada. Al sensibilizar los resultados por incidencia, encontramos que a partir de 7 casos tratados al año resulta menos costoso el óxido nítrico que el traslado a un centro de mayor complejidad.Conclusiones:
Desde la perspectiva de un hospital regional chileno incorporar ONi en el manejo de la insuficiencia respiratoria neonatal resulta la alternativa óptima en la mayoría de los escenarios posibles.ABSTRACT
Inhaled nitric oxide (iNO) is currently the first-line therapy in severe hypoxaemic respiratory failure of the newborn. Most of regional neonatal centres in Chile do not have this therapeutic alternative. Objective:
To determine the cost effectiveness of inhaled nitric oxide in the treatment of respiratory failure associated with pulmonary hypertension of the newborn compared to the usual care, including the transfer to a more complex unit. Patients andmethod:
A clinical decision tree was designed from the perspective of Chilean Public Health Service. Incremental cost effectiveness rates (ICER) were calculated, deterministic sensitivity analysis was performed, and probabilistic budget impact was estimated using TreeAge Pro Healthcare 2014 software.Results:
The iNO option leads to an increase in mean cost of $ 11.7 million Chilean pesos ( 15,000) per patient treated, with an ICER compared with the usual care of $ 23 million pesos ( 30,000) in case of death or ECMO avoided. By sensitising the results by incidence, it was found that from 7 cases and upwards treated annually, inhaled nitric oxide is less costly than the transfer to a more complex unit.Conclusions:
From the perspective of a Chilean regional hospital, incorporating inhaled nitric oxide into the management of neonatal respiratory failure is the optimal alternative in most scenarios.
Full text:
Available
Collection:
International databases
Health context:
SDG3 - Target 3.8 Achieve universal access to health
/
Sustainable Health Agenda for the Americas
/
SDG3 - Health and Well-Being
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SDG3 - Target 3.4 Reduce premature mortality due to noncommunicable diseases
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SDG3 - Target 3.2 Reduce avoidable death in newborns and children under 5
Health problem:
Delivery Arrangements
/
Financial Arrangements
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Goal 4: Health financing
/
Target 3.2: Reduce avoidable death in newborns and children under 5
/
Cardiovascular Disease
/
Other Respiratory Diseases
/
Environmental Health
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Noncommunicable Diseases
Database:
LILACS
Main subject:
Respiratory Insufficiency
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Bronchodilator Agents
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Hypertension, Pulmonary
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Nitric Oxide
Type of study:
Etiology study
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Health economic evaluation
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Prognostic study
Limits:
Humans
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Infant, Newborn
Country/Region as subject:
South America
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Chile
Language:
Spanish
Journal:
Rev. chil. pediatr
Journal subject:
Pediatrics
Year:
2016
Document type:
Article
Affiliation country:
Chile
Institution/Affiliation country:
Hospital Dr. Hernán Henríquez Aravena/CL