THE RISK OF ASSUMING FOREIGN COST-EFFECTIVENESS RATIOS THE CASE OF PALIVIZUMAB IN COLOMBIA AND NORTHERN CANADA

1. 1/10
THE RISK OF ASSUMING FOREIGN
COST-EFFECTIVENESS RATIOS
THE CASE OF PALIVIZUMAB IN COLOMBIA AND NORTHERN CANADA
Anna Banerji 1, Diego Rosselli 2, Juan David Rueda 2, 3
1 University of Toronto, 2 Pontificia Universidad Javeriana, 3 Cochrane Collaboration
Toronto - Bogota
diego.rosselli@gmail.com

2. The problem
2/10
Sincitial Respiratory Virus (SRV)
Important cause of respiratory disease in children
Life threatening in pre-term babies
Predisposes to asthma
Incidence varies with seasons and genetic factors
From 2-4% in tropical countries
to 17-52% in the Arctic winter
diego.rosselli@gmail.com

3. The intervention
3/10
Palivizumab (Synagis ®)
Monoclonal antibody against fusion protein of RSV
Licensed in 1998
One clinical trial (IMpact Study, Pediatrics 1998)
55% reduction in hospitalization rates
Non-significant reduction in mortality
diego.rosselli@gmail.com

4. The context
Inuit territory

5. The context

6. The context
6/10
Inuit Colombia
Population 100,000 46 million
Newborns per year 2,000 900,000
Pre-term (<35 weeks) 180 80,000
Urban (cities > 100 k) 0% 75%
diego.rosselli@gmail.com

7. The costs
7/10
Canada Colombia
Palivizumab (per mg) € 11.48 € 10.97
per 50 mg vial € 574 € 549
per child € 2,755 € 2,635
RSV infection € 21,575 € 777
diego.rosselli@gmail.com

8. The analysis
8/10
diego.rosselli@gmail.com

9. The results
9/10
In Northern Canada Palivizumab is cost-saving.
Even in the best-case scenario, palivizumab in Colombia is
NOT cost-effective.
Cost per QALY almost 5 times per capita GDP
€ 275,000 per asthma case averted
€ 850,000 per death averted
diego.rosselli@gmail.com

10. Conclusions
10/10
Cost-effectiveness “does not travel”
Despite similar basic assumptions and similar price
Great variations due to local epidemiology of disease
and cost of complications
Budget impact would also support different decisions
diego.rosselli@gmail.com

11. Conclusions
11/10
¡Gracias!
diego.rosselli@gmail.com