OBJECTIVES

: to establish the cost-effectiveness ratio of Mycophenolate Mofetil compared to Cyclophosphamide, for the management of diffuse interstitial pulmonary involvement in diffuse systemic sclerosis, with a health system perspective.

METHODS

: Systematic review of the literature and identification of clinical trials up to 2020. A decision tree model was constructed to determine the quality-adjusted life years of the two strategies. The time horizon encompasses the maximum drug induction period (12 months). The costs of treatment and management of adverse events were estimated using databases and official rates in Colombia. The results were tested using sensitivity analysis.

RESULTS : Mycophenolate compared to cyclophosphamide, is cost effective since they are improved in units of effectiveness and utility. $ 761,453 USD is invested for each unit of effectiveness measured by the% change in FVC, or $ 828,052 USD for each QALY. When the Monte Carlo simulation was carried out with 10,000 patients, observing in the cost-effectiveness plane, that 86% of the iterations fell in the lower right segment, which suggests that the mycophenolate mofetil alternative is dominant. When performing the sensitivity analysis, using the tornado chart, cyclophosphamide could only be dominant if its effectiveness is improved by 76% or completely dominated and if the price of cyclophosphamide is greater than 1,197.4 US. In general terms, a concordance between the deterministic and probabilistic models is presented, confirming the cost-effectiveness of mycophenolate mofetil.

CONCLUSIONS

: As a conclusion to the present study, it is highlighted that the use of mycophenolate mofetil for the induction of pulmonary fibrosis related to systemic sclerosis is cost effective compared to cyclophosphamide.