Montelukast + fluticasone propionate vs. fluticasone propionate in the treatment of cough variant asthma in children: Cost-utility analysis.

Introduction: The treatment of cough variant asthma is the same as for asthma in general. Recent evidence suggests montelukast (Mon) + fluticasone propionate (Flu) reduced cough recurrence regarding Flu in monotherapy. For health insurers whether this extra benefit offered by this combination of Flu is compensated by this additional cost compared to monotherapy with Flu. This study aims to evaluate the cost-utility of Montelukast (Mon) and Fluticasone Propionate (Flu) versus Flu monotherapy in children with Cough variant asthma in Colombia.

Materials and methods: We simulated a hypothetical cohort of 10,000 pediatric patients diagnosed with cough variant asthma, reflecting the typical clinical profile in Colombia .A probabilistic Markov model was created to estimate the cost and quality-adjusted life-years (QALYs) of patients with cough variant asthma. Cost-effectiveness was evaluated at a willingness-to-pay (WTP) value of US$5180. This analysis used quality-adjusted life years (QALYs) and costs from a third-payer perspective over a 5-year time horizon.

Results: The combination of Mon and Flu is not cost-effective since the incremental cost-utility ratio is greater than the willingness to pay per QALY in Colombia (USD 55,547 vs USD 5,180). The cost of Montelukast has the greatest influence on cost effectiveness, if the cost per dose of montelukast 5mg is less than US$0.034, the combination of Mon and Flu will be cost-effective at WTP of US$5180.

Conclusion: The combination of Montelukast and Fluticasone Propionate is not cost-effective for the management of cough variant asthma in children in Colombia, given the current WTP threshold. To enhance the cost-effectiveness of this combination therapy, efforts should focus on reducing the price of Montelukast and further optimizing its clinical use.