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Objective: To compare the cost‐effectiveness of three different formulations indicated for moderate and severe acute pain, commercialized in Colombia [acetaminophen 500 mg + codeine 30 mg (AC), acetaminophen 500mg + hydrocodone 5 mg (AH) and acetaminophen 325 mg+ tramadol 37.5 mg (AT)]. Materials and methods: Cost‐effectiveness analysis using the NNT as the health outcome indicator. The costs were evaluated in two specific settings: Institutional Channel (IC), representing the cost for the Colombian Ministry of Health (SISMED 2011); Retail Channel (RC), representing consumer prices, obtained from the IMS annual average for 2011, plus an adjustment to include the average profit margin for pharmacies (10%). The incremental cost effectiveness ratios (ICER) were calculated for the three formulations and the two settings (IC and RC). The intervention values are expressed in Colombian pesos (COP). Results: The prices/NNT for each formulation were $1816 COP/2.2 for AC, $4772 COP/2.3 for AH and $5342/2.6 for AT. Using these data and taking AC as the comparator, the ICER for the other formulations shows the following results: in the RC, $5065 COP for AT and $19,600 COP for AH; in the IC setting, $8790 COP for AT and $29,460 COP for AH. The probabilistic sensitivity analysis demonstrated that the majority of simulation results fell between the 1st and 4th quadrants of the cost‐effectiveness matrix, using AC as a reference. Conclusion: The analysis, from the payer and patient perspectives, demonstrates that the AC formulation has a lower cost and is more effective in reducing pain within the first 4‐6 h after administration, compared with the AH and AT formulations in their specific indications. Objetivo: Comparar diferencias en costo‐efectividad de 3 formulaciones comercializadas en Colombia (acetaminofén 500 mg + codeína 30 mg [AC], acetaminofén 500 mg + hidrocodona5 mg [AH] y acetaminofén 325 mg + tramadol 37,5 mg [AT]) indicadas para el tratamiento del dolor agudo moderado‐severo. Materiales y métodos: Análisis de costo‐efectividad, usando el NNT como medida de desenlace. Los costos fueron evaluados en 2 canales específicos: canal institucional (CI), representado por los costos relacionados con el medicamento consignados en SISMED 2011,y canal al por menor (CM), que representa los precios al consumidor tomados de IMS promedio anual 2011 más margen de farmacia (10%). Se calcularon las razones de costo‐efectividad incremental (RCEI) para las 3 formulaciones en cada canal (CI y CM). Los valores de las intervenciones fueron expresados en pesos colombianos. Resultados: Los precios/NNT para cada formulación fueron $1.816 COP/2,2 para AC, $4.772COP/2,3 para AH y $5.342/2,6 para AT. Con base en estos datos y tomando AC como el comparador, las RCEI para las otras formulaciones fueron: en el CM, $5.065 COP para la formulación AT y $19.600 COP para la formulación AH; en el CI, $8.790 COP para la formulación AT y$29.460 COP para la formulación AH. El análisis de sensibilidad probabilístico evidencia que las observaciones simuladas se ubican entre el primer y el cuarto cuadrante del plano de costo‐efectividad, tomando como referente AC. Conclusión: El análisis, desde la perspectiva del tercer pagador y el paciente, permite concluir que la formulación AC tiene un menor costo y mayor efectividad para reducir el dolor en las primeras 4‐6 h, comparada con AH y AT es sus indicadores específicos.

Cost/effectiveness evaluation of three fixed combinations of acetaminophen and opioids in the management of acute pain in Colombia