Background: Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. This study assessed the cost-effectiveness of adjuvanted RSVPreF3 vaccination among adults aged ≥60 years. Methods: A static, multi-cohort Markov model with 1-month cycles and a 5-year horizon was developed in Microsoft Excel to simulate RSV-related outcomes from the societal perspective. The model incorporated seasonality, waning vaccine efficacy, and reinfection risk. Epidemiologic inputs were adapted from international data using Colombian adjustment factors. Vaccine efficacy over 30.6 months was modeled logarithmically from the AReSVi-006 trial and extrapolated to 5 years. Costs were derived from national cost-of-illness studies and expressed in 2025 USD, discounting costs and QALYs at 3%. Results: RSVPreF3 vaccination reduced RSV-related hospitalizations, deaths, and QALY losses. The base-case incremental cost-effectiveness ratio (ICER) was US $5,155 per QALY gained, marginally below Colombia’s willingness-to-pay threshold (US $5,180 per QALY). Subgroup analyses showed greater absolute health gains and lower ICERs in adults ≥65 years (US $2,990 per QALY). Probabilistic analysis confirmed cost-effectiveness in >95% of simulations; the vaccine remained cost-effective if priced ≤US $150 per dose. Conclusions: Adjuvanted RSVPreF3 vaccination is a cost-effective intervention for older adults in Colombia, offering substantial health and economic benefits under current national thresholds.

Background Bronchopulmonary dysplasia (BPD) is a heterogeneous syndrome encompassing multiple biological and structural phenotypes. This study aimed to identify latent phenotypic subgroups of preterm infants with BPD and characterize their clinical and perinatal profiles. Methods We conducted a retrospective cohort of preterm infants born at ≤32 weeks’ gestation and admitted to a tertiary neonatal unit in Medellín, Colombia (2021–2023). Infants with major malformations or genetic syndromes were excluded. Clinical and respiratory variables were analyzed using latent class analysis (LCA) to identify subgroups based on markers of prematurity, oxygen dependency, and respiratory support. Results Among 236 infants, a three-class model best described the data (AIC = 12,002; BIC = 12,440; entropy = 0.83). Class 1 (64%) comprised more mature infants with mild respiratory disease and 5% mortality. Class 2 (27%) showed prolonged oxygen therapy and intermediate outcomes. Class 3 (9%), composed mainly of extremely preterm infants, exhibited severe respiratory failure and 88% mortality. The classes reflected a progression from mild inflammatory to interstitial and vascular phenotypes. Conclusions LCA revealed three distinct BPD phenotypes with increasing respiratory severity and mortality, paralleling biological models of parenchymal, interstitial, and vascular injury. This approach supports data-driven phenotyping as a foundation for precision neonatal care.

Rationale, aims, and objectives Pharmacological treatment for bronchiolitis is primarily supportive because bronchodilators, steroids, and antibiotics, show little benefit. Clinical studies have suggested that nebulized 3% HS is useful for infants with bronchiolitis. The aim of this study was to evaluate the cost-effectiveness of the HS nebulized in infant bronchiolitis in a middle-income tropical country Methods A decision tree model was used to estimate the cost-effectiveness of the use of nebulized hypertonic saline (3-7%) compared with treatment without hypertonic saline nebulization (control) in bronchiolitis. Cost data were obtained from a retrospective study on bronchiolitis from tertiary centers in Rionegro, Colombia, while utilities were collected from the literature. The analysis was carried out from a societal perspective. Results The control strategy was dominated by HS nebulized group. The expected costs per patient were US$ 200 (CI 95% US$ 178- 222) in the HS nebulized group and US$ 240 (CI 95% US$ 213- 267) in controls. The expected utilities were 0.923 (CI 95% 0.922- 0.924) in the HS nebulized group and 0.91 (CI 95% 0.918- 0.920) in controls. Sensitivity analyses of parameters in the model showed that the cost-effectiveness of HS was only sensitive to the probability of hospitalization. Conclusion The strategy treatment without hypertonic saline nebulization was dominated by the strategy with HS nebulized in infants with bronchiolitis. 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 tropical countries.

Introduction. Respiratory syncytial virus infection is the leading cause of lower respiratory infection globally. Recently, nirsevimab has been approved to prevent RSV infection. This study explores the economically justifiable price of nirsevimab for preventing RSV infection in Colombia’s children under one year of age. Materials and methods. A static model was developed using the decision tree microsimulation to estimate the quality-adjusted costs and life years of two interventions: a single intramuscular dose of nirsevimab versus not applying nirsevimab. This analysis was made during a time horizon of 1 year and from a societal perspective. Results The annual savings in Colombia associated with this cost per dose ranged from U$ 2.5 to 4.1 million. Based on thresholds of U$4828, U$ 5128, and U$19 992 per QALY evaluated in this study, we established economically justifiable drug acquisition prices of U$ 21.88, U$ 25.04, and U$ 44.02 per dose of nirsevimab. Conclusion the economically justifiable cost for nirsevimab in Colombia is between U$21 to U$44 per dose, depending on the WTP used to decide its implementation. This result should encourage more studies in the region that optimize decision-making processes when incorporating this drug into the health plans of each country.

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.

Introduction Previous evidence has shown that FeNO and EO are cost-effective relative to standard of care in guiding the management of children with persistent asthma. There is some doubt as if there are differences between these two biomarkers in terms of costs and benefits. Clarifying this doubt would allow to prioritize in the design of clinical practice guidelines. The study aimed to compare in terms of costs and benefits these biomarkers in patients with asthma between 4 and 18 years of age.3 Methods A Markov model was used to estimate the cost-utility of asthma management using FeNO and EO in patients between 4 and 18 years of age. Transition probabilities, cost and utilities were estimated from previously published local studies, while relative risks were obtained from the systematic review of published randomized clinical trials. The analysis was carried out from a societal perspective. Results FeNO was associated with lower cost (US$ 1333 CI 95% US$ 1331-1335 vs US$ 1452 CI 95% US$ 1449-1454) and highest QALY (0.93 CI 95% 0.93-0.94 vs 0.92 CI 95% 0.91-0.92) than EO. In the sensitivity analyses, our base‐case results were robust to variations of all assumptions and parameters. Conclusion Our study demonstrates that FeNO-guided treatment is better than EO because it offers a greater number of years of life with a lower cost per patient. This evidence should encourage the adoption of any of these techniques to objectively guide the management of children with asthma in routine clinical practice in low resource settings.

Background Impulse oscillometry is an alternative to measure lung function in preschoolers because is much simpler and can be performed in tidal breathing with minimal patient cooperation. The introduction of new health technologies such as impulse oscillometry raises concerns as if the extra benefit offered outweighs the additional cost compared to spirometry This study aimed to evaluate the cost-effectiveness of impulse oscillometry in preschoolers in Colombia. Methods We conducted a decision tree model to estimate the cost and proportion of correctly diagnosed cases of asthma of impulse oscillometry compared to spirometry in preschooler’s children between 3-6 years old . The analysis was carried out from a societal perspective. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. Results With impulse oscillometry, the proportion of correctly diagnosed cases was 42%, while with spirometry was 39%. The expected cost estimated by the model for a patient diagnosed with IOS was U$ 174 while with spirometry was U$ 99. The incremental cost-effectiveness ratio estimated in the probabilistic model was US$ 6881. The one-way and probabilistic sensitivity analyses, our base‐case results were robust to variations of all assumptions and parameters Conclusion Impulse oscillometry was found to be cost-effective for the diagnosis of asthma in preschoolers. Our results should stimulate further research to expand the use of this diagnostic test in developing countries.

Background: Bronchopulmonary dysplasia (BPD) is the most common cause of chronic lung disease in children born prematurely. There is little information about the epidemiology and severity of BPD places with high altitude. This study aimed to evaluate the frequency of BPD severity levels and the associated risk factors with severity in a cohort of preterm newborns ≤34 weeks of gestational age born in Rionegro, Colombia Materials and methods: We carried out a retrospective analytical cohort of preterm newborns without major malformations from Rionegro, Colombia between 2011-2018 admitted to neonatal intensive unit at high altitude (2200m above sea level). The main outcomes were the incidence and severity of bronchopulmonary dysplasia. Results: The bronchopulmonary dysplasia incidence was 25.7% (95% CI, 21.6-29.9). Bronchopulmonary dysplasia was moderate in 62.1% of patients and severe in 26.7%. After modeling regression analysis, the final variables associated with BPD severity levels were: sepsis (OR 2.37 CI 95% 1.04-5.40) and pulmonary hypertension (OR 3.79 CI95% 1.19-12). Conclusion: The incidence of BPD was higher and similar to cities with higher altitudes. In our population, the variables associated with BPD severity levels were: duration of oxygen therapy and pulmonary hypertension. It is necessary to increase the awareness of risk factors, the effect of clinical practices, and early recognition of bronchopulmonary dysplasia to reduce morbidity in patients with this pathology.

Background: Bronchopulmonary dysplasia (BPD) is the most common cause of chronic lung disease in children born prematurely. There is little information about the epidemiology and severity of BPD places with high altitude. This study aimed to evaluate the frequency of BPD severity levels and the associated risk factors with severity in a cohort of preterm newborns ≤34 weeks of gestational age born in Rionegro, Colombia Materials and methods: We carried out a retrospective analytical cohort of preterm newborns without major malformations from Rionegro, Colombia between 2011-2018 admitted to neonatal intensive unit at high altitude (2200m above sea level). The main outcomes were the incidence and severity of bronchopulmonary dysplasia. Results: The bronchopulmonary dysplasia incidence was 25.7% (95% CI, 21.6-29.9). Bronchopulmonary dysplasia was moderate in 62.1% of patients and severe in 26.7%. The most frequent complications were sepsis (62.1%), hyaline membrane disease (59.5%), and pneumonia (26.7%). After modeling regression analysis, and force in the model the variable gestational age at birth, the final variables associated with BPD severity levels were: duration of oxygen therapy and pulmonary hypertension. Conclusion: The incidence of BPD was higher and similar to cities with higher altitudes. In our population, the variables associated with BPD severity levels were: duration of oxygen therapy and pulmonary hypertension. It is necessary to increase the awareness of risk factors, the effect of clinical practices, and early recognition of bronchopulmonary dysplasia to reduce morbidity in patients with this pathology.

Introduction. Dietary habits in developing countries are characterized in the last decades by low intake of fruits, vegetables, and high consumption of sweetened drinks. Most of the evidence linking carbohydrate intake and asthma comes from children over 6 years of age. The aim of this study was to examine the association of macronutrient intake with the severity of wheezing exacerbation in children aged 2 to 6 years Methods. We performed a prospective cohort study that included all children aged 2 to 6 years hospitalized by a wheezing exacerbation in two tertiary centers in Rionegro, Colombia. Dietary data were collected using a food frequency questionnaire (FFQ) validated in the Colombian population. Gina classification of acute wheezing in children 5 years and younger was to define the severity of the wheezing Results During the study period, 228 cases of patients with wheezing exacerbation were included. Wheezing severity was dose-dependently associated with protein and carbohydrate-rich intake. The variables included in the multivariable analysis included reactive C protein, smoking at home, atopic dermatitis, protein, and carbohydrate-rich food intake Conclusion High carbohydrate-rich food intake was associated with severity of wheezing exacerbation adjusted by other known risk factors such as atopic, smoking, and reactive C protein. Also, we found a negative association of severity of wheezing exacerbation with high protein-rich food intake adjusted by the factors mentioned above. This evidence should motivate the development of public health policies to control the consumption of sugar-rich products in children under 6 years of age.

Intravenous Magnesium SulfateIV was cost-saving in emergency settings for treating children with asthma exacerbations. This shift in treatment approach proved to be economically favorable, reducing the cost of hospitalization and mechanical ventilation

Introduction The risk stratification of infants presenting to the emergency department with bronchiolitis who are at risk for receiving airway support during their hospital stay has been insufficiently studied. The aim of this study was to determine the clinical predictors of hospitalization with airway support (“escalated care”) among infants with recurrent wheezing evaluated in the emergency department Methods: We conducted a retrospective cohort study in infants with one or more wheezing episode, younger than two years of age in tertiary centers in Rionegro, Colombia. The primary outcome measure was escalated care defined as hospitalization plus any airway support. A multivariate logistic regression model was performed to estimate predictors of escalated care. To assess discrimination and calibration, area-under-the-curve (AUC) and calibration plots were calculated. Results A total of 665 cases were included and 85 infants received escalated care. The variables included risk score for escalated care within 5 days of admission to the emergency room including prematurity, poor feeding, nasal flaring and/or grunting, and previous wheezing episodes requiring hospitalization, The model has a high specificity (99.6%) with acceptable AUC of 0.70 (CI 95% 0.60- 0.74). Conclusion: A clinical risk score was created based on the odds ratio of each of the identified variables, which appears to be useful for estimating the absolute risk of escalated care within 5 days of admission to the ED. However, external validation is required before this clinical score is applied in general practice in any ED setting