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\begin{document}

\title{Tiotropium for children and adolescents with severe asthma}



\author[1]{Jefferson Buendia}%
\author[1]{Diana Guerrer}%
\affil[1]{University of Antioquia}%


\vspace{-1em}



  
  \date{May 26, 2024}


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\begin{abstract}
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.%
\end{abstract}%



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