title: Development of a population-based cost-effectiveness model of chronic graft-versus-host disease in Spain.
abstract: BACKGROUND
  Chronic graft-versus-host disease (cGvHD) is the leading cause of late nonrelapse mortality (transplant-related mortality) after hematopoietic stem cell transplant. Given that there are a wide range of treatment options for cGvHD, assessment of the associated costs and efficacy can help clinicians and health care providers allocate health care resources more efficiently.
  
  
  OBJECTIVE
  The purpose of this study was to assess the cost-effectiveness of extracorporeal photopheresis (ECP) compared with rituximab (Rmb) and with imatinib (Imt) in patients with cGvHD at 5 years from the perspective of the Spanish National Health System.
  
  
  METHODS
  The model assessed the incremental cost-effectiveness/utility ratio of ECP versus Rmb or Imt for 1000 hypothetical patients by using microsimulation cost-effectiveness techniques. Model probabilities were obtained from the literature. Treatment pathways and adverse events were evaluated taking clinical opinion and published reports into consideration. Local data on costs (2010 Euros) and health care resources utilization were validated by the clinical authors. Probabilistic sensitivity analyses were used to assess the robustness of the model.
  
  
  RESULTS
  The greater efficacy of ECP resulted in a gain of 0.011 to 0.024 quality-adjusted life-year in the first year and 0.062 to 0.094 at year 5 compared with Rmb or Imt. The results showed that the higher acquisition cost of ECP versus Imt was compensated for at 9 months by greater efficacy; this higher cost was partially compensated for (€517) by year 5 versus Rmb. After 9 months, ECP was dominant (cheaper and more effective) compared with Imt. The incremental cost-effectiveness ratio of ECP versus Rmb was €29,646 per life-year gained and €24,442 per quality-adjusted life-year gained at year 2.5. Probabilistic sensitivity analysis confirmed the results. The main study limitation was that to assess relative treatment effects, only small studies were available for indirect comparison.
  
  
  CONCLUSIONS
  ECP as a third-line therapy for cGvHD is a more cost-effective strategy than Rmb or Imt.
authors: Statistics Department, University of Barcelona, Barcelona, Spain. carlos.crespo@oblikue.com
authors: Carlos
authors: C
authors: Crespo
authors: José Anton
authors: JA
authors: Pérez-Simón
authors: José Manuel
authors: JM
authors: Rodríguez
authors: Jordi
authors: J
authors: Sierra
authors: Max
authors: M
authors: Brosa
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001549:Benzamides; D002908:Chronic Disease; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D017048:Health Care Costs; D015276:Health Care Rationing / Q000191:economics; D006301:Health Services Needs and Demand / Q000191:economics; D006801:Humans; D000068877:Imatinib Mesylate; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics; D020380:Needs Assessment / Q000191:economics; D017893:Photopheresis / Q000009:adverse effects / Q000191:economics*; D010879:Piperazines / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D011743:Pyrimidines / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D000069283:Rituximab; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D001549:Benzamides; D007166:Immunosuppressive Agents; D010879:Piperazines; D011743:Pyrimidines; D000069283:Rituximab; D000068877:Imatinib Mesylate