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

Published online by Cambridge University Press:  06 December 2016

Héctor Eduardo Castro Jaramillo ,
Mabel Moreno Viscaya  and
Aurelio E. Mejia
Héctor Eduardo Castro Jaramillo
Affiliation:
Instituto de Evaluación Tecnológica en Salud – IETShcastro@hsph.harvard.edu; dochecj@hotmail.com
Mabel Moreno Viscaya
Affiliation:
Instituto de Evaluación Tecnológica en Salud – IETS
Aurelio E. Mejia
Affiliation:
Instituto de Evaluación Tecnológica en Salud – IETS
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Abstract

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.

Keywords

Hemophilia ACost-benefit analysisColombiaHealthcare rationing
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 32 , Issue 5 , 2016 , pp. 337 - 347
Copyright
Copyright © Cambridge University Press 2016 

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