TY - JOUR
T1 - Extracorporeal Photopheresis for Second-Line Treatment of Chronic Graft-versus-Host Diseases
T2 - Results from a Health Technology Assessment in Italy
AU - De Waure, Chiara
AU - Capri, Stefano
AU - Veneziano, Maria Assunta
AU - Specchia, Maria Lucia
AU - Cadeddu, Chiara
AU - Di Nardo, Francesco
AU - Ferriero, Anna Maria
AU - Gennari, Francesca
AU - Hamilton, Colette
AU - Mancuso, Agostino
AU - Quaranta, Gianluigi
AU - Raponi, Matteo
AU - Valerio, Luca
AU - Gensini, Gianfranco
AU - Ricciardi, Walter
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Abstract Objectives To develop a comparative, cost-effectiveness, and budget impact analysis of Therakos online extracorporeal photopheresis (ECP) compared with the main alternatives used for the treatment of steroid-refractory/resistant chronic graft-versus-host disease (cGvHD) in Italy. Methods The current therapeutic pathway was identified by searching medical databases and from the results of a survey of practice in Italian clinical reference centers. A systematic review was performed to evaluate the efficacy and safety of second-line alternatives. Budget impact and cost-effectiveness analyses were performed from the Italian National Health Service perspective over a 7-year time horizon through the adaption of a Markov model. The following health states were considered: complete and partial response, stable disease, and progression. A discount rate of 3% was applied to costs and outcomes. Results The most common alternatives used in Italy for the management of steroid-refractory/resistant cGvHD were ECP, mycophenolate, pentostatin, and imatinib. The literature review highlighted that complete and partial responses are higher with ECP than with the alternatives while serious adverse events are less common. The economic analysis showed that Therakos online ECP represents the dominating alternative, in that it delivers greater benefit at a lower cost. In fact, according to the alternatives considered, cost saving ranged from €3237.09 to €19,903.51 per patient with 0.04 to 0.21 quality-adjusted life-year gained. Conclusions Therakos online ECP should be considered an effective, safe, and cost-effective alternative in steroid-refractory/resistant cGvHD. There is inequality in access, and a dedicated reimbursement tariff, however, should be introduced to overcome these barriers.
AB - Abstract Objectives To develop a comparative, cost-effectiveness, and budget impact analysis of Therakos online extracorporeal photopheresis (ECP) compared with the main alternatives used for the treatment of steroid-refractory/resistant chronic graft-versus-host disease (cGvHD) in Italy. Methods The current therapeutic pathway was identified by searching medical databases and from the results of a survey of practice in Italian clinical reference centers. A systematic review was performed to evaluate the efficacy and safety of second-line alternatives. Budget impact and cost-effectiveness analyses were performed from the Italian National Health Service perspective over a 7-year time horizon through the adaption of a Markov model. The following health states were considered: complete and partial response, stable disease, and progression. A discount rate of 3% was applied to costs and outcomes. Results The most common alternatives used in Italy for the management of steroid-refractory/resistant cGvHD were ECP, mycophenolate, pentostatin, and imatinib. The literature review highlighted that complete and partial responses are higher with ECP than with the alternatives while serious adverse events are less common. The economic analysis showed that Therakos online ECP represents the dominating alternative, in that it delivers greater benefit at a lower cost. In fact, according to the alternatives considered, cost saving ranged from €3237.09 to €19,903.51 per patient with 0.04 to 0.21 quality-adjusted life-year gained. Conclusions Therakos online ECP should be considered an effective, safe, and cost-effective alternative in steroid-refractory/resistant cGvHD. There is inequality in access, and a dedicated reimbursement tariff, however, should be introduced to overcome these barriers.
KW - cost-effectiveness analysis
KW - economic evaluation
KW - graft-versus-host disease
KW - Markov model
KW - photopheresis
KW - technology assessment
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U2 - 10.1016/j.jval.2015.01.009
DO - 10.1016/j.jval.2015.01.009
M3 - Article
C2 - 26091600
AN - SCOPUS:84931573850
VL - 18
SP - 457
EP - 466
JO - Value in Health
JF - Value in Health
SN - 1098-3015
IS - 4
M1 - 1100
ER -