COST-UTILITY ANALYSIS OF PRIMARY PROPHYLAXIS, COMPARED WITH ON-DEMAND TREATMENT, FOR PATIENTS WITH SEVERE HEMOPHILIA TYPE A IN COLOMBIA

被引:13
作者
Castro Jaramillo, Hector Eduardo [1 ]
Moreno Viscaya, Mabel [1 ]
Mejia, Aurelio E. [1 ]
机构
[1] Inst Evaluac Tecnol Salud IETS, Bogota, Colombia
关键词
Hemophilia A; Cost-benefit analysis; Colombia; Healthcare rationing; FACTOR-VIII; INHIBITOR DEVELOPMENT; CLOTTING FACTOR; CURRENT OPTIONS; THERAPY; RECOMBINANT; MANAGEMENT; PRODUCTS; CHILDREN; PROGRESS;
D O I
10.1017/S0266462316000544
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objectives: This article presents a cost-utility analysis from the Colombian health system perspective comparing primary prophylaxis to on-demand treatment using exogenous clotting factor VIII (FVIII) for patients with severe hemophilia type A. Methods: We developed a Markov model to estimate expected costs and outcomes (measured as quality-adjusted life-years, QALYs) for each strategy. Transition probabilities were estimated using published studies; utility weights were obtained from a sample of Colombian patients with hemophilia and costs were gathered using local data. Both deterministic and probabilistic sensitivity analysis were performed to assess the robustness of results. Results: The additional cost per QALY gained of primary prophylaxis compared with on-demand treatment was 105,081,022 Colombian pesos (COP) (55,204 USD), and thus not considered cost-effective according to a threshold of up to three times the current Colombian gross domestic product (GDP) per-capita. When primary prophylaxis was provided throughout life using recombinant FVIII (rFVIII), which is much costlier than FVIII, the additional cost per QALY gained reached 174,159,553 COP (91,494 USD). Conclusions: using a decision rule of up to three times the Colombian GDP per capita, primary prophylaxis (with either FVIII or rFVIII) would not be considered as cost-effective in this country. However, a final decision on providing or preventing patients from primary prophylaxis as a gold standard of care for severe hemophilia type A should also consider broader criteria than the incremental cost-effectiveness ratio results itself. Only a price reduction of exogenous FVIII of 50 percent or more would make primary prophylaxis cost-effective in this context.
引用
收藏
页码:337 / 347
页数:11
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