Introduction. Respiratory syncytial virus infection is the leading cause of lower respiratory infection globally. Recently, nirsevimab has been approved to prevent RSV infection. This study explores the economically justifiable price of nirsevimab for preventing RSV infection in Colombia’s children under one year of age. Materials and methods. A static model was developed using the decision tree microsimulation to estimate the quality-adjusted costs and life years of two interventions: a single intramuscular dose of nirsevimab versus not applying nirsevimab. This analysis was made during a time horizon of 1 year and from a societal perspective. Results The annual savings in Colombia associated with this cost per dose ranged from U$ 2.5 to 4.1 million. Based on thresholds of U$4828, U$ 5128, and U$19 992 per QALY evaluated in this study, we established economically justifiable drug acquisition prices of U$ 21.88, U$ 25.04, and U$ 44.02 per dose of nirsevimab. Conclusion the economically justifiable cost for nirsevimab in Colombia is between U$21 to U$44 per dose, depending on the WTP used to decide its implementation. This result should encourage more studies in the region that optimize decision-making processes when incorporating this drug into the health plans of each country.

Introduction An important proportion of asthma patients remain uncontrolled despite using inhaled corticosteroids and long-acting beta-agonists. Some add-on therapies, such as tiotropium bromide have been recommended for this subgroup of patients. The purpose of this study was to assess the cost-effectiveness of tiotropium as add-on therapies to ICS + LABA for children and adolescents with uncontrolled allergic asthma. Methods A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with severe asthma in Colombia. Total costs and QALYS of two interventions including standard therapy (ICS + LABA), add-on therapy with tiotropium, were calculated over a time horizon from 6 to 18 years. Probability sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. Results The model suggests a potential gain of 0.51 QALYs per patient per year on tiotropium, with a difference of US$265 per patient year with respect to standard therapy. The incremental cost-effectiveness ratio estimated was U$ 1928 in the deterministic model and US$2,017 in the probabilistic model after Monte-Carlo simulation. Our base‐case results were robust to variations in all assumptions and parameters. Conclusion Add-on therapy with tiotropium was cost-effective when added to usual care in children and adolescents with severe asthma who remained uncontrolled despite treatment with medium or high-dose ICS/LABA. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

Introduction Previous evidence has shown that FeNO and EO are cost-effective relative to standard of care in guiding the management of children with persistent asthma. There is some doubt as if there are differences between these two biomarkers in terms of costs and benefits. Clarifying this doubt would allow to prioritize in the design of clinical practice guidelines. The study aimed to compare in terms of costs and benefits these biomarkers in patients with asthma between 4 and 18 years of age.3 Methods A Markov model was used to estimate the cost-utility of asthma management using FeNO and EO in patients between 4 and 18 years of age. Transition probabilities, cost and utilities were estimated from previously published local studies, while relative risks were obtained from the systematic review of published randomized clinical trials. The analysis was carried out from a societal perspective. Results FeNO was associated with lower cost (US$ 1333 CI 95% US$ 1331-1335 vs US$ 1452 CI 95% US$ 1449-1454) and highest QALY (0.93 CI 95% 0.93-0.94 vs 0.92 CI 95% 0.91-0.92) than EO. In the sensitivity analyses, our base‐case results were robust to variations of all assumptions and parameters. Conclusion Our study demonstrates that FeNO-guided treatment is better than EO because it offers a greater number of years of life with a lower cost per patient. This evidence should encourage the adoption of any of these techniques to objectively guide the management of children with asthma in routine clinical practice in low resource settings.

Background Impulse oscillometry is an alternative to measure lung function in preschoolers because is much simpler and can be performed in tidal breathing with minimal patient cooperation. The introduction of new health technologies such as impulse oscillometry raises concerns as if the extra benefit offered outweighs the additional cost compared to spirometry This study aimed to evaluate the cost-effectiveness of impulse oscillometry in preschoolers in Colombia. Methods We conducted a decision tree model to estimate the cost and proportion of correctly diagnosed cases of asthma of impulse oscillometry compared to spirometry in preschooler’s children between 3-6 years old . The analysis was carried out from a societal perspective. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. Results With impulse oscillometry, the proportion of correctly diagnosed cases was 42%, while with spirometry was 39%. The expected cost estimated by the model for a patient diagnosed with IOS was U$ 174 while with spirometry was U$ 99. The incremental cost-effectiveness ratio estimated in the probabilistic model was US$ 6881. The one-way and probabilistic sensitivity analyses, our base‐case results were robust to variations of all assumptions and parameters Conclusion Impulse oscillometry was found to be cost-effective for the diagnosis of asthma in preschoolers. Our results should stimulate further research to expand the use of this diagnostic test in developing countries.

Background: Bronchopulmonary dysplasia (BPD) is the most common cause of chronic lung disease in children born prematurely. There is little information about the epidemiology and severity of BPD places with high altitude. This study aimed to evaluate the frequency of BPD severity levels and the associated risk factors with severity in a cohort of preterm newborns ≤34 weeks of gestational age born in Rionegro, Colombia Materials and methods: We carried out a retrospective analytical cohort of preterm newborns without major malformations from Rionegro, Colombia between 2011-2018 admitted to neonatal intensive unit at high altitude (2200m above sea level). The main outcomes were the incidence and severity of bronchopulmonary dysplasia. Results: The bronchopulmonary dysplasia incidence was 25.7% (95% CI, 21.6-29.9). Bronchopulmonary dysplasia was moderate in 62.1% of patients and severe in 26.7%. After modeling regression analysis, the final variables associated with BPD severity levels were: sepsis (OR 2.37 CI 95% 1.04-5.40) and pulmonary hypertension (OR 3.79 CI95% 1.19-12). Conclusion: The incidence of BPD was higher and similar to cities with higher altitudes. In our population, the variables associated with BPD severity levels were: duration of oxygen therapy and pulmonary hypertension. It is necessary to increase the awareness of risk factors, the effect of clinical practices, and early recognition of bronchopulmonary dysplasia to reduce morbidity in patients with this pathology.

Background: Bronchopulmonary dysplasia (BPD) is the most common cause of chronic lung disease in children born prematurely. There is little information about the epidemiology and severity of BPD places with high altitude. This study aimed to evaluate the frequency of BPD severity levels and the associated risk factors with severity in a cohort of preterm newborns ≤34 weeks of gestational age born in Rionegro, Colombia Materials and methods: We carried out a retrospective analytical cohort of preterm newborns without major malformations from Rionegro, Colombia between 2011-2018 admitted to neonatal intensive unit at high altitude (2200m above sea level). The main outcomes were the incidence and severity of bronchopulmonary dysplasia. Results: The bronchopulmonary dysplasia incidence was 25.7% (95% CI, 21.6-29.9). Bronchopulmonary dysplasia was moderate in 62.1% of patients and severe in 26.7%. The most frequent complications were sepsis (62.1%), hyaline membrane disease (59.5%), and pneumonia (26.7%). After modeling regression analysis, and force in the model the variable gestational age at birth, the final variables associated with BPD severity levels were: duration of oxygen therapy and pulmonary hypertension. Conclusion: The incidence of BPD was higher and similar to cities with higher altitudes. In our population, the variables associated with BPD severity levels were: duration of oxygen therapy and pulmonary hypertension. It is necessary to increase the awareness of risk factors, the effect of clinical practices, and early recognition of bronchopulmonary dysplasia to reduce morbidity in patients with this pathology.

Introduction. Dietary habits in developing countries are characterized in the last decades by low intake of fruits, vegetables, and high consumption of sweetened drinks. Most of the evidence linking carbohydrate intake and asthma comes from children over 6 years of age. The aim of this study was to examine the association of macronutrient intake with the severity of wheezing exacerbation in children aged 2 to 6 years Methods. We performed a prospective cohort study that included all children aged 2 to 6 years hospitalized by a wheezing exacerbation in two tertiary centers in Rionegro, Colombia. Dietary data were collected using a food frequency questionnaire (FFQ) validated in the Colombian population. Gina classification of acute wheezing in children 5 years and younger was to define the severity of the wheezing Results During the study period, 228 cases of patients with wheezing exacerbation were included. Wheezing severity was dose-dependently associated with protein and carbohydrate-rich intake. The variables included in the multivariable analysis included reactive C protein, smoking at home, atopic dermatitis, protein, and carbohydrate-rich food intake Conclusion High carbohydrate-rich food intake was associated with severity of wheezing exacerbation adjusted by other known risk factors such as atopic, smoking, and reactive C protein. Also, we found a negative association of severity of wheezing exacerbation with high protein-rich food intake adjusted by the factors mentioned above. This evidence should motivate the development of public health policies to control the consumption of sugar-rich products in children under 6 years of age.

Intravenous Magnesium SulfateIV was cost-saving in emergency settings for treating children with asthma exacerbations. This shift in treatment approach proved to be economically favorable, reducing the cost of hospitalization and mechanical ventilation

Introduction The risk stratification of infants presenting to the emergency department with bronchiolitis who are at risk for receiving airway support during their hospital stay has been insufficiently studied. The aim of this study was to determine the clinical predictors of hospitalization with airway support (“escalated care”) among infants with recurrent wheezing evaluated in the emergency department Methods: We conducted a retrospective cohort study in infants with one or more wheezing episode, younger than two years of age in tertiary centers in Rionegro, Colombia. The primary outcome measure was escalated care defined as hospitalization plus any airway support. A multivariate logistic regression model was performed to estimate predictors of escalated care. To assess discrimination and calibration, area-under-the-curve (AUC) and calibration plots were calculated. Results A total of 665 cases were included and 85 infants received escalated care. The variables included risk score for escalated care within 5 days of admission to the emergency room including prematurity, poor feeding, nasal flaring and/or grunting, and previous wheezing episodes requiring hospitalization, The model has a high specificity (99.6%) with acceptable AUC of 0.70 (CI 95% 0.60- 0.74). Conclusion: A clinical risk score was created based on the odds ratio of each of the identified variables, which appears to be useful for estimating the absolute risk of escalated care within 5 days of admission to the ED. However, external validation is required before this clinical score is applied in general practice in any ED setting

Introduction Fractional exhaled nitric oxide (FeNO) is a simple, noninvasive measurement of airway inflammation with minimal discomfort to the patient and with results available with a few minutes. This study aimed to evaluate the cost-effectiveness of the Fractional exhaled nitric oxide in asthma. Methods A markov model was used to estimate the cost-utility of FeNO versus standard treatment (control group) an infant with mild to moderate allergic asthma. Cost data were obtained from a retrospective study on asthma from tertiary center, in Medellin, Colombia, while utilities were collected from the literature. The analysis was carried out from a societal perspective. Results The model showed that FeNO, was associated with lower total cost than SC (US $1333 vs US $1452 average cost per patient), and higher QALYs (0.93 vs. 0.92 average per patient); showing dominance. The probability that MS provides a more cost-effective use of resources compared with standard therapy exceeds 99% for all willingness to pay thresholds Conclusion FeNO was cost-effective for the hospital treatment of an infant with infant with mild to moderate allergic asthma. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

BACKGROUND: The burden of disease generated by acute bronchiolitis (AB) in infants is unknown in developing countries. Evidence on the disease burden is important for decision-making processes within the health sector. The objective of the present study is to determine the Disability-Adjusted Life Years in a middle-income country METHODS: DALYs were calculated, using the methodology of Global Burden of Disease Study, for the following health outcomes of AB: AB uncomplicated, AB with complications, AB with severe complications, with long term complications. To estimate the DALY of each outcome, we performed a systematic review of evidence and complemented with information from the national epidemiological surveillance system. Sensibility analysis was made using a bootstrapped method with 10000 iterations in package DALY calculator of R program. RESULTS: In 2019, we estimated that 482 993 years of life (IC 95% 366 565- 690 294) were lost due to AB in infants. The rate of DALYs estimated for AB with mild complications were 19 DALYs / 1000 person-year, 6 DALYs / 1000 person-year for AB with severe complications, 6 DALYs / 1000 person-year for AB uncomplicated CONCLUSION: The burden of AB is a serious problem in Colombia, with a considerable social impact in terms of disability and mortality. It is necessary novel pharmacological strategies to minimize the impact of this serious problem in Colombia.

Objectives. Although recent evidence suggests that management of viral bronchiolitis requires something other than guidelines-guided therapy, there is a lack of evidence supporting the economic benefits of phenotypic-guided bronchodilator therapy for treating this disease. The aim of the present study was to compare the cost-effectiveness of phenotypic-guided versus guidelines-guided bronchodilator therapy in infants with viral bronchiolitis. Methods: A decision‐analysis model was developed in order to compare the cost-effectiveness of phenotypic-guided versus guidelines-guided bronchodilator therapy in infants with viral bronchiolitis. The effectiveness parameters and costs of the model were obtained from electronic medical records. The main outcome was avoidance of hospital admission after initial care in the ED. Results: Compared to guidelines-guided strategy, treating patients with viral bronchiolitis with the phenotypic-guided bronchodilator therapy strategy was associated with lower total costs (US$250.99 vs US$263.46 average cost per patient) and a higher probability of avoidance of hospital admission (0.7902 vs 0.7638), thus leading to dominance. Results were robust to deterministic and probabilistic sensitivity analyses. Conclusions: Compared to guidelines-guided strategy, treating infants with viral bronchiolitis using the phenotypic-guided bronchodilator therapy strategy is a more cost-effective strategy, because it involves a lower probability of hospital admission at lower total treatment costs.