A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension

被引:18
作者
Boon, Gudula J. A. M. [1 ]
van den Hout, Wilbert B. [2 ]
Barco, Stefano [3 ,4 ]
Bogaard, Harm Jan [5 ]
Delcroix, Marion [6 ]
Huisman, Menno, V [1 ]
Konstantinides, Stavros, V [3 ,7 ]
Meijboom, Lilian J. [8 ]
Nossent, Esther J. [5 ]
Symersky, Petr [9 ]
Noordegraaf, Anton Vonk [5 ]
Klok, Frederikus A. [1 ,3 ]
机构
[1] Leiden Univ, Med Ctr, Dept Med Thrombosis & Hemostasis, Leiden, Netherlands
[2] Leiden Univ, Med Ctr, Dept Biomed Data Sci Med Decis Making, Leiden, Netherlands
[3] Johannes Gutenberg Univ Mainz, Univ Med Ctr, Ctr Thrombosis & Hemostasis, Mainz, Germany
[4] Univ Hosp Zurich, Clin Angiol, Zurich, Switzerland
[5] Amsterdam Univ Med Ctr, Dept Pulm Med, Amsterdam, Netherlands
[6] Univ Hosp Leuven, Dept Pneumol, Leuven, Belgium
[7] Democritus Univ Thrace, Dept Cardiol, Xanthi, Greece
[8] Amsterdam Univ Med Ctr, Dept Radiol & Nucl Med, Amsterdam, Netherlands
[9] Amsterdam Univ Med Ctr, Dept Cardiac Surg, Amsterdam, Netherlands
关键词
QUALITY-OF-LIFE; ANGIOPLASTY;
D O I
10.1183/23120541.00719-2020
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background Diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) exceeds 1 year, contributing to higher mortality. Health economic consequences of late CTEPH diagnosis are unknown. We aimed to develop a model for quantifying the impact of diagnosing CTEPH earlier on survival, quality-adjusted life-years (QALYs) and healthcare costs. Material and methods A Markov model was developed to estimate lifelong outcomes, depending on the degree of delay. Data on survival and quality of life were obtained from published literature. Hospital costs were assessed from patient records (n=498) at the Amsterdam UMC - VUmc, which is a Dutch CTEPH referral center. Medication costs were based on a mix of standard medication regimens. Results For 63-year-old CTEPH patients with a 14-month diagnostic delay of CTEPH (median age and delay of patients in the European CTEPH Registry), lifelong healthcare costs were estimated at EUR 117100 for a mix of treatment options. In a hypothetical scenario of maximal reduction of current delay, improved survival was estimated at a gain of 3.01 life-years and 2.04 QALYs. The associated cost increase was EUR 44654, of which 87% was due to prolonged medication use. This accounts for an incremental cost-utility ratio of EUR 21900/QALY. Conclusion Our constructed model based on the Dutch healthcare setting demonstrates a substantial health gain when CTEPH is diagnosed earlier. According to Dutch health economic standards, additional costs remain below the deemed acceptable limit of EUR 50000/QALY for the particular disease burden. This model can be used for evaluating cost-effectiveness of diagnostic strategies aimed at reducing the diagnostic delay.
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收藏
页数:10
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