Evaluating the cost utility of racecadotril in addition to oral rehydration solution versus oral rehydration solution alone for children with acute watery diarrhea in four low middle-income countries: Egypt, Morocco, Philippines and Vietnam

Figures & data

Figure 1. Model schematic reproduced with permission from Dove Medical Press. Rautenberg et al. ⁴¹.

Table 1. Cost parameters for Egypt, Morocco, Philippines and Vietnam (local currency).

Country	Value	Description/notes	Reference
Egypt
Weight of an average child	8–10 kg*	Average weight of a child under five years	Electronic Medicines Compendium (EMC) [Internet].
Total daily cost of Racecadotril	6.25 EGP	Based on 3 administrations of 1.5 mg/kg per day average weight of per child (30 mg sachet)	Personal Communication Abbott Products Operations AG Egypt Affiliate
Total daily cost of ORS	4.13 EGP	Based on 250 ml per stool, frequency 3 times daily (conservative) and 1 sachet per stool
Vomiting	15.80 EGP	Motilium suspension oral, 1 mg/ml 100 ml bottle
One episode of fever	16.00 EGP	Brufen Syrup 100 mg/5 ml, 1, 150 ml 1
One episode of allergic reaction	20.00 EGP	Zyrtec solution oral, 1% 100 ml
Outpatient visit	10 EGP	Single visit to public outpatient clinic	Personal communication Professor Ehab Khairy Elkhashab, Professor of Pediatrics, Head of the Pediatric Clinical Nutrition Unit, Ain Shams University. Ahmed M Hamdy, Professor of Pediatrics. Ain Shams University, Head of Ain Shams Pediatric Gastroenterology & Endoscopy Unit
One bed day public hospital	350 EGP	Per bed day in public hospital
Morocco
Weight of an average child	8.00 kg	–	Electronic Medicines Compendium (EMC) [Internet].
Total daily cost of Racecadotril	28.00 DAM	Based on 3 administrations of 1.5 mg/kg per day average weight of per child	Personal Communication Abbott Products Operations AG Morocco Affiliate
Total daily cost of ORS	12.21 DAM		Personal Communication Abbott Products Operations AG Morocco Affiliate
Vomiting	21.90 DAM	Primperan syrup	Personal Communication Abbott Products Operations AG Morocco Affiliate
One episode of fever	18.80 DAM	Efferalgan peadiatric syrup	Personal Communication Abbott Products Operations AG Morocco Affiliate
One episode of allergic reaction	31.90 DAM	Zyrtec peadiatric syrup	Personal Communication Abbott Products Operations AG Morocco Affiliate
Outpatient visit	60.00 DAM	Cost per visit Public Hospital Outpatient Visit	Ministry of Health Morocco Le Ministère de la Santé [Internet].
One bed day public hospital	100.00 DAM	Cost per bed-day public hospital	Ministry of Health Morocco Le Ministère de la Santé [Internet].
Philippines
Weight of an average child	10.35 kg		National Nutrition Council Philippines [Internet].
Total daily cost of Racecadotril	236.25 PHP	Based on 3 administrations of 1.5 mg/kg per day/kg	Abbott Laboratories. Racecadotril Moving Annual Total Drug Cost, Fourth Quarter 2016. Data on File.
Total daily cost of ORS	20.55 PHP		Dept of Health Drug Price Reference Index
Vomiting	0.00 PHP	Single episode of vomiting, not treated	Data not available, conservative assumption
Fever	16.62 PHP	Single episode of fever (outpatient)	Market insights and KOL feedback
Allergic reaction	43.04 PHP	Single episode of allergic reaction (outpatient)
Outpatient visit	0 PHP	No cost	Free at point of service, market insights and KOL feedback
One bed day public hospital	1,500 PHP		Market insights and KOL feedback
Vietnam
Weight of an average child	10.00 kg*		Vietnam statistics
Total daily cost of Racecadotril	10,7080 VND	Based on 3 administrations of 1.5 mg/kg per day /kg	Personal Communication Abbott Products Operations AG Vietnam Affiliate
Total daily cost of ORS	67.50 VND	Cost of a pack of ORS (900 VND) divided by 40 sachets
Vomiting	18,713 VND	Single episode of vomiting (outpatient)
Fever	150,516 VND	Single episode of fever (outpatient)
Allergic reaction	316,897 VND	Single episode of allergic reaction (outpatient)
Outpatient visit	92,230 VND	Cost per visit Public Hospital Outpatient Visit	Fischer et al.^5.
One bed day public hospital	128,800 VND	Cost per bed-day public hospital	Fischer et al.^5.

*When changing the weight of the child from 8 to 10 kg there is no impact on the model results.

Table 2. Cost-effectiveness results in local country currency per country for Egypt, Morocco, Philippines and Vietnam.

Country regimen	Cost (local country currency)	Health Outcome (QALY gain)	Incremental Cost (local country currency)	Incremental outcome (QALY gain)	Incremental C/E ratio (ICER) (local country currency/QALY). Cost per QALY gain.
Egypt
ORS	310 EGP	0.0128
R + ORS	74 EGP	0.0136
			−236 EGP	0.0008	−304,152 EGP/QALY gain
Morocco
ORS	226 MAD	0.0128
R + ORS	221 MAD	0.0136
			−5.10 MAD	0.0008	−6,561 MAD/QALY gain
Philippines
ORS	1,266 PHP	0.0128
R + ORS	932 PHP	0.0136
			−334 PHP	0.0008	−428,612 PHP/QALY gain
Vietnam
ORS	265,062 VND	0.0128
R + ORS	176,467 VND	0.0136
			−88,595 VND	0.0008	−113,985,734 VND/QALY gain

Table 3. Univariate sensitivity analysis, parameters influencing the results by more than twenty percent.

Parameter	Egypt	Morocco	Philippines	Vietnam
Utility: child without diarrhoea	√	√	√	√
Utility: child with diarrhoea (inpatient)	√	√	√	√
Cost: inpatient setting (LOS 1 night)	√	√	√	√
Inpatient referral 48 hrs ORS	X	√	√	X
Diarrhoea resolves 48 hrs ORS	X	√	√	X
Cost: daily drug R + ORS	X	√	√	X
Cost: outpatient setting	X	√	√	X
Diarrhoea resolves 48 hrs R + ORS	√	X	√	X
Utility: child with diarrhoea (outpatient)	X	X	X	X
Inpatient referral 48 hrs R + ORS	X	X	X	X
Cost: daily drug ORS	X	X	X	X
Weighted Average Cost AE	X	X	X	X
Adverse events ORS	X	X	X	X
Adverse events R + ORS	X	X	X	X

Rautenberg TA, Zerwes U, Foerster D, et al. Evaluating the cost utility of racecadotril for the treatment of acute watery diarrhea in children: the RAWD model. Clinicoecon Outcomes Res. 2012;4:109–116.

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Fischer TK, Duc Anh D, Antil L, et al. Health care costs of diarrheal disease and estimates of the cost-effectiveness of rotavirus vaccination in vietnam. J Infect Dis. 2005;192(10):1720–1726.

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