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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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Tornado diagram. The diagram shows the percentage change in the ICER attributable to the change of each individual parameter. The numbers at each end of the bars indicate the most extreme values used in the sensitivity analysis. ICER: incremental cost-effectiveness ratio; THB: Thai baht (in 2008 value); QALY: quality adjusted life year; HSCT: hematopoietic stem cell transplantation; and BT-ICT: blood transfusion combined with subcutaneous iron chelating therapy.
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Figure 3: Tornado diagram. The diagram shows the percentage change in the ICER attributable to the change of each individual parameter. The numbers at each end of the bars indicate the most extreme values used in the sensitivity analysis. ICER: incremental cost-effectiveness ratio; THB: Thai baht (in 2008 value); QALY: quality adjusted life year; HSCT: hematopoietic stem cell transplantation; and BT-ICT: blood transfusion combined with subcutaneous iron chelating therapy.

Mentions: Figure 3 shows a tornado diagram presenting the results of one-way sensitivity analyses in the case of patients at 1 year of age receiving related HSCT. It was found that when altering the value of each parameter within plausible ranges, the ICER per QALY gained was most sensitive to changes in the utility of blood transfusion patients, followed by changes in the discount rate to 0% and 6% per annum, direct non-medical costs of related HSCT, utility of HSCT patients, and direct medical costs. It is noteworthy that the ICER was less sensitive to changes in the transition probabilities of both related HSCT and BT-ICT.


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)

Tornado diagram. The diagram shows the percentage change in the ICER attributable to the change of each individual parameter. The numbers at each end of the bars indicate the most extreme values used in the sensitivity analysis. ICER: incremental cost-effectiveness ratio; THB: Thai baht (in 2008 value); QALY: quality adjusted life year; HSCT: hematopoietic stem cell transplantation; and 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 3: Tornado diagram. The diagram shows the percentage change in the ICER attributable to the change of each individual parameter. The numbers at each end of the bars indicate the most extreme values used in the sensitivity analysis. ICER: incremental cost-effectiveness ratio; THB: Thai baht (in 2008 value); QALY: quality adjusted life year; HSCT: hematopoietic stem cell transplantation; and BT-ICT: blood transfusion combined with subcutaneous iron chelating therapy.
Mentions: Figure 3 shows a tornado diagram presenting the results of one-way sensitivity analyses in the case of patients at 1 year of age receiving related HSCT. It was found that when altering the value of each parameter within plausible ranges, the ICER per QALY gained was most sensitive to changes in the utility of blood transfusion patients, followed by changes in the discount rate to 0% and 6% per annum, direct non-medical costs of related HSCT, utility of HSCT patients, and direct medical costs. It is noteworthy that the ICER was less sensitive to changes in the transition probabilities of both related HSCT and BT-ICT.

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