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Coste-beneficio del tratamiento farmacologico de la paralisis cerebral con espasticidad en Mexico [Cost-benefit of the pharmacologic treatment of cerebral palsy with spasticity in Mexico] |
Arroyave Loaiza G, Jarillo Soto E C, Garfias Garnica M G, Ribera Ibarra D B, Uribe Zamarripa J A |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of botulinum toxin A, a pharmacologic treatment for children suffering from cerebral palsy with spasticity. The drug dosage depended on the age and weight of the children.
Type of intervention Palliative care and rehabilitation.
Study population The study population comprised children suffering from cerebral palsy with spasticity who were aged between 6 and 12 years.
Setting The setting was a hospital. The economic study was conducted in Mexico.
Dates to which data relate The dates and the price year were not reported.
Source of effectiveness data The effectiveness data were derived from published studies and from official Mexican statistics.
Modelling A mathematical model was used to assess the costs and benefits of treatment in the five scenarios during 2000 to 2004.
Outcomes assessed in the review The outcomes estimated from published studies and national statistics were:
the number of children suffering from the disease in 1995;
the incidence of disease in the five scenarios during 2000 to 2004; and
the impact of disease on the quality of life, as estimated using an index of disease burden for children.
Study designs and other criteria for inclusion in the review Sources searched to identify primary studies Criteria used to ensure the validity of primary studies Methods used to judge relevance and validity, and for extracting data Number of primary studies included One published study and several sources of Mexican statistics were used in the analysis.
Methods of combining primary studies The primary study estimates were combined using narrative methods.
Investigation of differences between primary studies Results of the review The number of cases of disease in the population of children aged between 6 and 12 years was 11.55 in 1,000 people in 1995.
The number of children suffering from the disease during 2000 to 2004 ranged from 1,046,673 to 692,038 in the optimistic scenario, from 1,096,272 to 947,095 in the relatively optimistic scenario, from 1,145,871 to 1,208,686 in the probable scenario, from 1,150,831 to 1,234,845 in the relatively probably scenario, and from 1,154,799 to 1,255,773 in the pessimist scenario.
The index of disease burden was 0.92 in children with the disease and 0.40 in the children who were treated. Thus, therapy led to a gain of 0.52 in the quality of life for children affected by cerebral palsy with spasticity.
Measure of benefits used in the economic analysis The benefit measures used in the economic analysis were the quality-adjusted life-years (QALYs), the number of healthy life-years and the number of children receiving benefits from the intervention. The utility weights were derived from a published study.
Direct costs The analysis of the costs included the drug acquisition costs only. The cost/resource boundary adopted was not stated. The unit costs were not reported separately from the quantities of resources. No discounting was performed, although the time horizon of the study was 5 years. No price year was reported. The drug dosages were based on the manufacturers' recommendations. The source of the cost data was not reported.
Statistical analysis of costs No statistical analysis of the costs was conducted.
Indirect Costs The indirect costs were not included.
Currency Mexican pesos (pesos), converted to US dollars ($).
Sensitivity analysis No sensitivity analysis was carried out.
Estimated benefits used in the economic analysis At the individual level, the treatment led to 0.08 to 0.60 QALYs gained for each child.
The treatment of all children with cerebral palsy with spasticity led to a gain of 595,817 of healthy years, compared with no treatment.
The number of children receiving benefits from the intervention during 2000 to 2004 would range from 171,881 to 181,303 in the optimistic scenario, from 343,761 to 362,606 in the relatively optimistic scenario, from 515,642 to 543,909 in the probable scenario, from 687,523 to 725,212 in the relatively probably scenario, and from 859,403 to 906,515 in the pessimist scenario.
The number of healthy life-years saved with the treatment ranged from 7,150 to 7,542 in the optimistic scenario, from 14,300 to 15,084 in the relatively optimistic scenario, from 21,514 to 22,627 in the probable scenario, from 28,601 to 30,181 in the relatively probably scenario, and from 35,751 to 37,711 in the pessimist scenario.
Cost results The total costs (in Mexican pesos) required to treat all children with cerebral palsy with spasticity during 2000 to 2004 ranged from 468,472,590 to 494,153,580 in the optimistic scenario, from 936,945,180 to 988,307,160 in the relatively optimistic scenario, from 1,405,417,770 to 1,482,460,740 in the probable scenario, from 1,873,890,360 to 1,976,614,350 in the relatively probably scenario, and from 2,342,362,950 to 2,470,767,930 in the pessimist scenario.
The average yearly cost to treat a child was 2,725.00 Mexican pesos (US$283.00).
Synthesis of costs and benefits The costs and benefits were not combined.
Authors' conclusions The use of botulinum toxin A, a pharmacological treatment, for the palliative care of children with cerebral palsy with spasticity led to gains in healthy life-years and improvements in quality of life. The costs of the treatment appear to have been small in comparison with the benefits of the treatment.
CRD COMMENTARY - Selection of comparators No therapy was considered as the basic comparator, as the authors aimed to assess the active value of the treatment. You should decide whether it represents a valid comparator in your own setting.
Validity of estimate of measure of effectiveness The analysis of effectiveness used data derived from a published study and from some official statistics. These data were used in a mathematical model, which predicted the benefits of the intervention in different scenarios. The primary study estimates were combined using narrative methods.
Validity of estimate of measure of benefit QALYs were used as the benefit measure in the economic analysis, thus enabling the benefit of the study treatment to be easily compared with the benefits of other interventions. Other outcomes of the model were also reported.
Validity of estimate of costs The perspective adopted in the study was not reported and only the drug costs were included in the analysis. The unit costs were not reported separately. The authors did not state which source of cost data was used. No price year was reported. Statistical analyses on the costs were not conducted. Overall, there were few details of the cost analysis. Discounting was relevant, but was not applied.
Other issues The authors did not compare their findings with those from other studies. In addition, they did not address the issue of the generalisability of the study results to other settings. Thus, the external validity of the analysis was fairly low. The study referred to children with cerebral palsy with spasticity and this was reflected in the conclusions of the analysis.
Implications of the study The implication of the study is that, regardless of the disease incidence rates which could be observed in Mexico in the next years, the treatment with botulinum toxin A proved to be a cost-effective palliative intervention for children suffering from cerebral palsy with spasticity.
Bibliographic details Arroyave Loaiza G, Jarillo Soto E C, Garfias Garnica M G, Ribera Ibarra D B, Uribe Zamarripa J A. Coste-beneficio del tratamiento farmacologico de la paralisis cerebral con espasticidad en Mexico. [Cost-benefit of the pharmacologic treatment of cerebral palsy with spasticity in Mexico] Revista Espanola de Salud Publica 2000; 74(5-6): 549-559 Indexing Status Subject indexing assigned by NLM MeSH Cerebral Palsy /drug therapy /economics; Child; Cost-Benefit Analysis; Female; Humans; Male; Mexico; Muscle Spasticity /drug therapy AccessionNumber 22001006214 Date bibliographic record published 31/05/2003 Date abstract record published 31/05/2003 |
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