Cost-Utility Analysis of Intravenous Immunoglobulin for the Treatment of Steroid-Refractory Dermatomyositis in Thailand

Bamrungsawad, Naruemon, Chaiyakunapruk, Nathorn, Upakdee, Nilawan, Pratoomsoot, Chayanin, Sruamsiri, Rosarin and Dilokthornsakul, Piyameth (2015) Cost-Utility Analysis of Intravenous Immunoglobulin for the Treatment of Steroid-Refractory Dermatomyositis in Thailand. PharmacoEconomics, 33 5: 521-531. doi:10.1007/s40273-015-0269-8


Author Bamrungsawad, Naruemon
Chaiyakunapruk, Nathorn
Upakdee, Nilawan
Pratoomsoot, Chayanin
Sruamsiri, Rosarin
Dilokthornsakul, Piyameth
Title Cost-Utility Analysis of Intravenous Immunoglobulin for the Treatment of Steroid-Refractory Dermatomyositis in Thailand
Journal name PharmacoEconomics   Check publisher's open access policy
ISSN 1179-2027
1170-7690
Publication date 2015-05
Year available 2015
Sub-type Article (original research)
DOI 10.1007/s40273-015-0269-8
Open Access Status
Volume 33
Issue 5
Start page 521
End page 531
Total pages 11
Place of publication Auckland, New Zealand
Publisher Springer International Publishing
Formatted abstract
Introduction

Intravenous immunoglobulin (IVIG) has been shown to be effective in treating steroid-refractory dermatomyositis (DM). There remains no evidence of its cost-effectiveness in Thailand.

Objective

Our objective was to estimate the cost utility of IVIG as a second-line therapy in steroid-refractory DM in Thailand.

Methods

A Markov model was developed to estimate the relevant costs and health benefits for IVIG plus corticosteroids in comparison with immunosuppressant plus corticosteroids in steroid-refractory DM from a societal perspective over a patient’s lifetime. The effectiveness and utility parameters were obtained from clinical literature, meta-analyses, medical record reviews, and patient interviews, whereas cost data were obtained from an electronic hospital database and patient interviews. Costs are presented in $US, year 2012 values. All future costs and outcomes were discounted at a rate of 3 % per annum. One-way and probabilistic sensitivity analyses were also performed.

Results

Over a lifetime horizon, the model estimated treatment under IVIG plus corticosteroids to be cost saving compared with immunosuppressant plus corticosteroids, where the saving of costs and incremental quality-adjusted life-years (QALYs) were $US4738.92 and 1.96 QALYs, respectively. Sensitivity analyses revealed that probability of response of immunosuppressant plus corticosteroids was the most influential parameter on incremental QALYs and costs. At a societal willingness-to-pay threshold in Thailand of $US5148 per QALY gained, the probability of IVIG being cost effective was 97.6 %.

Conclusions


The use of IVIG plus corticosteroids is cost saving compared with treatment with immunosuppressant plus corticosteroids in Thai patients with steroid-refractory DM. Policy makers should consider using our findings in their decision-making process for adding IVIG to corticosteroids as the second-line therapy for steroid-refractory DM patients.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Public Health Publications
 
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