Cost effectiveness of once-daily oral chelation therapy with deferasirox versus infusional deferoxamine in transfusion-dependent thalassaemia patients: US healthcare system perspective.
BACKGROUND
Deferasirox is a recently approved once-daily oral iron chelator that has been shown to reduce liver iron concentrations and serum ferritin levels to a similar extent as infusional deferoxamine.


OBJECTIVE
To determine the cost effectiveness of deferasirox versus deferoxamine in patients with beta-thalassaemia major from a US healthcare system perspective.


METHODS
A Markov model was used to estimate the total additional lifetime costs and QALYs gained with deferasirox versus deferoxamine in patients with beta-thalassaemia major and chronic iron overload from blood transfusions. Patients were assumed to be 3 years of age at initiation of chelation therapy and to receive prescribed dosages of deferasirox and deferoxamine that have been shown to be similarly effective in such patients. Compliance with chelation therapy and probabilities of iron overload-related cardiac disease and death by degree of compliance were estimated using data from published studies. Costs ($US, year 2006 values) of deferoxamine administration and iron overload-related cardiac disease were based on analyses of health insurance claims of transfusion-dependent thalassaemia patients. Utilities were based on a study of patient preferences for oral versus infusional chelation therapy, as well as published literature. Probabilistic and deterministic sensitivity analyses were employed to examine the robustness of the results to key assumptions.


RESULTS
Deferasirox resulted in a gain of 4.5 QALYs per patient at an additional expected lifetime cost of $US126,018 per patient; the cost per QALY gained was $US28,255. The cost effectiveness of deferasirox versus deferoxamine was sensitive to the estimated costs of deferoxamine administration and the quality-of-life benefit associated with oral versus infusional therapy. Cost effectiveness was also relatively sensitive to the equivalent daily dose of deferasirox, and the unit costs of deferasirox and deferoxamine, and was more favourable in younger patients.


CONCLUSIONS
Results of this analysis of the cost effectiveness of oral deferasirox versus infusional deferoxamine suggest that deferasirox is a cost effective iron chelator from a US healthcare perspective.
Delea
Thomas E
TE
Policy Analysis Inc. (PAI), Brookline, Massachusetts 02445, USA. tdelea@pai2.com
Sofrygin
Oleg
O
Thomas
Simu K
SK
Baladi
Jean-Francois
JF
Phatak
Pradyumna D
PD
Coates
Thomas D
TD
D000284:Administration, Oral; D001565:Benzoates / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D000077588:Deferasirox; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods; D004334:Drug Administration Schedule; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D017850:Economics, Pharmaceutical / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007262:Infusions, Intravenous; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D007502:Iron Chelating Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D019190:Iron Overload / Q000188:drug therapy; D008390:Markov Chains; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D014481:United States; D017086:beta-Thalassemia / Q000188:drug therapy
D001565:Benzoates; D007502:Iron Chelating Agents; D014230:Triazoles; D000077588:Deferasirox