15 February 2020 by Mauricio Orozco-Levi

Medical cost of the drug treatment for pulmonary arterial hypertension in Colombia

INTRODUCTION: In Colombia, no record exists regarding the potential cost of treatment for patients with Pulmonary Arterial Hypertension (PAH) receiving single, dual or triple combination of specific drugs. It is necessary to evaluate these medical care costs due that new modules have appeared in the line of the recent Nice Guidelines for PAH.
AIM: To estimate the ceiling cost of medical treatment of patients with PAH in Colombia, according to the pharmacological possibilities existing in the country in line with the 2018-Nice Guidelines.

METHODS: The cost of the specific pharmacological treatment was estimated by modelling a tracer for adult patients (estimating 60 kg weight) submitted to drug therapy due to diagnosis of PAH (group 1 or 4). Ceiling estimations consider 100% of access, 100% adherence and 100% of tolerance to several pharmacological options available in Colombia in 2019. The information frequency of use and cost units of pharmacological treatment was obtained from a National Drug Price Information System (SISMED, official source of prices of medicines in Colombia) for IIIQ of 2018. Maximum, minimum and mean price ranges were defined in order to include market behavior. The cost was expressed in both $COP and $USD. The difference between maximum and minimum represented the range. Normalization of the cost as proportion of Current Minimum Legal Salary (CLMS) were also performed order to allow both future and international comparisons.

RESULTS: The current drug therapy of PAH in Colombia can include four pharmaceutical groups defined according to the action mechanisms: ERA (Bosentan, Ambrisentan, Macitentan), PDE5i (Sildenafil, Tadalafil) or GCs (Riociguat), and prostanoids (Iloprost, Treprostinil, Epoprostenol). The model was developed in line with both the recommendations of the international guidelines for the management of PAH and the common current clinical practice to estimate the cost of treatment using monotherapy, double combinations or triple combinations. Drug monotherapy discloses a mean annual cost of $66,800 USD (equivalent to 265 CLMS); a double combination $125,765 USD (501 SMLV); and a triple combination $200,130 USD (798 SMLV). The cost of medical treatment is inversely correlated with the percentage of adherence, tolerance and access to the medications, together with the actual percentage of patients under treatment.

CONCLUSIONS: The cost of PAH drug treatment in Colombia imposes an extremely high cost to the national health system. This impact will increase significantly due to the improvements in the detection, treatment, adherence and survival of patients with PAH, as it will increase the number of patients and the duration of these specific treatments. This prognosis makes the indication, prescription and administration of these medications a priority for improvement through integrated medical actions such as HAPred.com and the national Colombian health system responsibilities.

Supported in part by unrestricted BAYER grant, HAPred.co 2019.

Key Contributors

Mauricio Orozco-Levi, MD, MSc, PhD; Alejandro Londoño, MD; Rafael Conde, MD, Ludy Alexandra Parada, Ruben Marrugo Figueroa, Camilo Andres Leon. HAPRed.Co; Hospital Internacional de Colombia, Floridablanca, CO; CardioVID, Medellín, CO; Fundación Neumológica Colombiana, Bogotá, CO; BAYER.


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