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- Title
COST-UTILITY ANALYSIS OF PRIMARY PROPHYLAXIS, COMPARED WITH ON-DEMAND TREATMENT, FOR PATIENTS WITH SEVERE HEMOPHILIA TYPE A IN COLOMBIA.
- Authors
Castro Jaramillo, Héctor Eduardo; Moreno Viscaya, Mabel; Mejia, Aurelio E.; Castro Jaramillo, Héctor Eduardo
- Abstract
<bold>Objectives: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Subjects
COLOMBIA; PREVENTIVE medicine; HEMOPHILIA treatment; HEMOPHILIACS; MEDICAL care costs; PUBLIC health; BLOOD coagulation factors; COST effectiveness; HEMOPHILIA; PROBABILITY theory; QUALITY-adjusted life years; STATISTICAL models; THERAPEUTICS
- Publication
International Journal of Technology Assessment in Health Care, 2016, Vol 32, Issue 5, p337
- ISSN
0266-4623
- Publication type
journal article
- DOI
10.1017/S0266462316000544