Iron-chelating therapies in a transfusion-dependent thalassaemia population in Thailand: A cost-effectiveness study

Luangasanatip,Nantasit, Chaiyakunapruk, Nathorn, Upakdee, Nilawan and Wong, Peerapon (2011) Iron-chelating therapies in a transfusion-dependent thalassaemia population in Thailand: A cost-effectiveness study. Clinical Drug Investigation, 31 7: 493-505. doi:10.2165/11587120-000000000-00000

Author Luangasanatip,Nantasit
Chaiyakunapruk, Nathorn
Upakdee, Nilawan
Wong, Peerapon
Title Iron-chelating therapies in a transfusion-dependent thalassaemia population in Thailand: A cost-effectiveness study
Journal name Clinical Drug Investigation   Check publisher's open access policy
ISSN 1173-2563
Publication date 2011-07-01
Sub-type Article (original research)
DOI 10.2165/11587120-000000000-00000
Volume 31
Issue 7
Start page 493
End page 505
Total pages 13
Place of publication Auckland, New Zealand
Publisher Adis International
Language eng
Formatted abstract
Background and Objective: b-Thalassaemia is a major public health problem in Thailand. Use of appropriate iron-chelating agents could prevent thalassaemia-related complications, which are costly to the healthcare system. This study aimed to evaluate the cost effectiveness of deferoxamine (DFO), deferiprone (DFP) and deferasirox (DFX) in Thai transfusion-dependent b-thalassaemia patients from the societal perspective. Methods: A Markov model was used to project the life-time costs and outcomes represented as quality-adjusted life-years (QALYs). Data on the clinical efficacy and safety of all therapeutic options were obtained from systematic review and clinical trials. Transition probabilities were derived from published studies. Costs were obtained from the Thai Drug and Medical Supply Information Center, Thai national reimbursement rate information and other Thai literature sources. A discount rate of 3% was used. Incremental cost-effectiveness ratios (ICERs) were presented as year 2009 values. A base-case analysis was performed for thalassaemia patients requiring regular blood transfusion therapy, while a separate analysis was performed for patients requiring low (i.e. symptom-dependent, less frequent) blood transfusion therapy. A series of sensitivity analysis and cost-effectiveness acceptability curves were constructed. Results: Compared with DFO, using DFP was dominant with lifetime cost savings of $US91 117. Comparing DFX with DFO, the incremental cost was $US522 863 and incremental QALY was 5.77 with an ICER of $US90 648 per QALY. When compared with DFP, the ICER of DFX was $US106 445 per QALY. A cost-effectiveness analysis curve showed the probability of DFX being cost effective was 0% when compared with either DFO or DFP, based on the cost-effectiveness cut-off value of $US2902 per QALY.When compared with DFP, DFX was cost effective only if the DFX cost was as low as $US1.68 per 250mg tablet. The results of the analysis in patients requiring low blood transfusion therapy were not different from those of the base-case analysis. Conclusions: Our findings suggest that using DFP is cost saving when compared with conventional therapy, while using DFX is not cost effective compared with either DFO or DFP in Thai patients with transfusiondependent b-thalassaemia. Policy-makers and clinicians may consider using such information in their decision-making process in Thailand
Keyword Beta-thalassemia
Oral Deferiprone
Deferoxamine Dfo
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Public Health Publications
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Created: Tue, 20 Mar 2012, 02:03:17 EST by Geraldine Fitzgerald on behalf of School of Public Health