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A cost-utility and budget impact analysis of allogeneic hematopoietic stem cell transplantation for severe thalassemic patients in Thailand.

Leelahavarong P, Chaikledkaew U, Hongeng S, Kasemsup V, Lubell Y, Teerawattananon Y - BMC Health Serv Res (2010)

Bottom Line: A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes taking a societal perspective as recommended by Thailand's health technology assessment guidelines.All future costs and outcomes were discounted at a rate of 3% per annum.Primary outcomes of interest were lifetime costs, quality adjusted life years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in Thai baht (THB) per QALY gained.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand. pyuck@mahidol.ac.th

ABSTRACT

Background: Hematopoietic stem cell transplantation (HSCT) is the only curative treatment available to severe thalassemic patients. The treatment, however, is very costly, particularly in the context of low and middle income countries, and no studies have been carried out to explore its economic justifiability. This study aimed to estimate the cost-utility of HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT) for severe thalassemia in Thailand, and to investigate the affordability of HSCT using a budget impact analysis.

Methods: A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes taking a societal perspective as recommended by Thailand's health technology assessment guidelines. All future costs and outcomes were discounted at a rate of 3% per annum. Primary outcomes of interest were lifetime costs, quality adjusted life years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in Thai baht (THB) per QALY gained.

Results: Compared to BT-ICT, the incremental cost-effectiveness ratio increased with patient age from 80,700 to 183,000 THB per QALY gained for related HSCT and 209,000 to 953,000 THB per QALY gained for unrelated HSCT among patients aged 1 to 15 years (US$1= 34 THB). The governmental budget impact analysis showed that providing 200 related HSCT to patients aged 1 to 10 years, in accordance with the current infrastructure limitations, would initially require approximately 90 million additional THB per year.

Conclusions: At a societal willingness to pay of 100,000 THB per QALY gained, related HSCT was likely to be a cost-effective and affordable treatment for young children with severe thalassemia in Thailand.

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Related in: MedlinePlus

Schematic diagram of the Markov model. Each thalassemic patient has two treatment options (i.e. HSCT and BT-ICT). The Markov model consists of five health states and patients receiving HSCT can transition through each of these health states whereas BT-ICT patients can be in either alive BT-ICT state or death state. The cycle length is one year with a 99-year time horizon. HSCT: hematopoietic stem cell transplantation; BT-ICT: blood transfusion combined with subcutaneous iron chelating therapy.
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Figure 1: Schematic diagram of the Markov model. Each thalassemic patient has two treatment options (i.e. HSCT and BT-ICT). The Markov model consists of five health states and patients receiving HSCT can transition through each of these health states whereas BT-ICT patients can be in either alive BT-ICT state or death state. The cycle length is one year with a 99-year time horizon. HSCT: hematopoietic stem cell transplantation; BT-ICT: blood transfusion combined with subcutaneous iron chelating therapy.

Mentions: Figure 1 illustrates the structure of a Markov model used to estimate the relevant costs and health outcomes. The time horizon used is the patients' estimated lifetimes and the length of each cycle is one year. Two mutually exclusive treatment options, related and unrelated HSCT, were compared with BT-ICT (i.e. desferrioxamine--DFO), which is standard practice and currently covered under the UC scheme.


A cost-utility and budget impact analysis of allogeneic hematopoietic stem cell transplantation for severe thalassemic patients in Thailand.

Leelahavarong P, Chaikledkaew U, Hongeng S, Kasemsup V, Lubell Y, Teerawattananon Y - BMC Health Serv Res (2010)

Schematic diagram of the Markov model. Each thalassemic patient has two treatment options (i.e. HSCT and BT-ICT). The Markov model consists of five health states and patients receiving HSCT can transition through each of these health states whereas BT-ICT patients can be in either alive BT-ICT state or death state. The cycle length is one year with a 99-year time horizon. HSCT: hematopoietic stem cell transplantation; BT-ICT: blood transfusion combined with subcutaneous iron chelating therapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2914036&req=5

Figure 1: Schematic diagram of the Markov model. Each thalassemic patient has two treatment options (i.e. HSCT and BT-ICT). The Markov model consists of five health states and patients receiving HSCT can transition through each of these health states whereas BT-ICT patients can be in either alive BT-ICT state or death state. The cycle length is one year with a 99-year time horizon. HSCT: hematopoietic stem cell transplantation; BT-ICT: blood transfusion combined with subcutaneous iron chelating therapy.
Mentions: Figure 1 illustrates the structure of a Markov model used to estimate the relevant costs and health outcomes. The time horizon used is the patients' estimated lifetimes and the length of each cycle is one year. Two mutually exclusive treatment options, related and unrelated HSCT, were compared with BT-ICT (i.e. desferrioxamine--DFO), which is standard practice and currently covered under the UC scheme.

Bottom Line: A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes taking a societal perspective as recommended by Thailand's health technology assessment guidelines.All future costs and outcomes were discounted at a rate of 3% per annum.Primary outcomes of interest were lifetime costs, quality adjusted life years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in Thai baht (THB) per QALY gained.

View Article: PubMed Central - HTML - PubMed

Affiliation: Health Intervention and Technology Assessment Program (HITAP), Department of Health, Ministry of Public Health, Nonthaburi, Thailand. pyuck@mahidol.ac.th

ABSTRACT

Background: Hematopoietic stem cell transplantation (HSCT) is the only curative treatment available to severe thalassemic patients. The treatment, however, is very costly, particularly in the context of low and middle income countries, and no studies have been carried out to explore its economic justifiability. This study aimed to estimate the cost-utility of HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT) for severe thalassemia in Thailand, and to investigate the affordability of HSCT using a budget impact analysis.

Methods: A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes taking a societal perspective as recommended by Thailand's health technology assessment guidelines. All future costs and outcomes were discounted at a rate of 3% per annum. Primary outcomes of interest were lifetime costs, quality adjusted life years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in Thai baht (THB) per QALY gained.

Results: Compared to BT-ICT, the incremental cost-effectiveness ratio increased with patient age from 80,700 to 183,000 THB per QALY gained for related HSCT and 209,000 to 953,000 THB per QALY gained for unrelated HSCT among patients aged 1 to 15 years (US$1= 34 THB). The governmental budget impact analysis showed that providing 200 related HSCT to patients aged 1 to 10 years, in accordance with the current infrastructure limitations, would initially require approximately 90 million additional THB per year.

Conclusions: At a societal willingness to pay of 100,000 THB per QALY gained, related HSCT was likely to be a cost-effective and affordable treatment for young children with severe thalassemia in Thailand.

Show MeSH
Related in: MedlinePlus