Costo efectividad del antibiótico oral vs. Local en mujeres no gestantes con flujo vaginal sugestivo de vaginosis bacteriana

Objective: To estimate the cost-effectiveness of local vs. oral antibiotic in non-pregnant women with vaginal discharge suggestive of bacterial vaginosis. Methods: We compared four combinations of antibiotics for the first option and for the treatment of clinical failure: vaginal clindamycin and tinidazol PO, single dose; vaginal clindamycin and secnidazol PO, single dose; tinidazol PO, single dose y vaginal clindamycin; secnidazol PO, single dose, and vaginal clindamycin. A Markov model was built in TreeAge® to represent the natural history of bacterial vaginosis. Treatment changes in the face of recurrence without adverse events where modeled separately as a decision tree. The perspective was that of the health system, including all direct costs. All monetary amounts were expressed in Colombian pesos of 2010. The outcome was clinical improvement. Effectiveness, security, persistence and recurrence data were extracted from the literature. The incremental cost-effectiveness ratio was calculated; univariate and probabilistic sensitivity analyses were performed. Results: Both for the general and the particular cases, treatment with vaginal clindamycin as the first choice and tinidazole PO, single dose, to treat recurrence and persistence with adverse events is a dominant strategy because it is less costly and more effective than the other treatment regimes evaluated. Per 1.000 patients, the cost of the dominant alternative is $ 16.795.411 COP with 985,6 clinical improvements in the general case and $ $ 23.979.230 COP with 903,4 clinical improvements in the particular case. Conclusion: Vaginal clindamycin as the first choice for treatment of bacterial vaginosis and tinidazole PO, single dose, to treat recurrence and persistence with adverse events of clindamycin is cost effective in Colombia. The results were robust to variations in the parameters of the model.