A cost-effectiveness study of intravenous immunoglobulin in childhood idiopathic thrombocytopenia purpura patients with life-threatening bleeding.
BACKGROUND
Although the international guideline recommends intravenous immunoglobulin (IVIG) as the first-line treatment for childhood idiopathic thrombocytopenia purpura (ITP) with life-threatening bleeding, ITP patients may not be able to access IVIG because of the limitation in health benefit packages especially in developing countries. There remains an important policy question as to whether IVIG used as a first-line treatment is worth the money spent. Thus, the objective of this study was to perform a cost-effectiveness analysis of adding IVIG to the standard treatment of platelet transfusion and corticosteroids, for the treatment of childhood ITP with life-threatening bleeding in the context of Thailand.


METHODS
A cost-effectiveness analysis using a hybrid model consisting of a decision tree and Markov models was conducted with a societal perspective. The effectiveness and utility parameters were determined by systematic reviews, while costs and mortality parameters were determined using a retrospective electronic hospital database analysis. All costs were presented in 2012 US$. The discount rate of 3 % was applied for both costs and outcomes. One-way and probabilistic sensitivity analyses were also performed.


RESULTS
The incremental cost-effectiveness ratio (ICER) was $3,172 per quality-adjusted life-year gained ($/QALY) for the addition of IVIG versus standard treatment alone. The probability of response to corticosteroids was the most influential parameter on ICER. According to the willingness-to-pay of Thailand, of approximately $3,861/QALY, the probability of IVIG being cost effective was 33 %.


CONCLUSIONS
The addition of IVIG to standard treatment in the treatment of childhood ITP with life-threatening bleeding is possibly a cost-effective intervention in Thailand. However, our findings were highly sensitive. Policy makers may consider our findings as part of the information for their decision making.
Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand.
Rosarin
R
Sruamsiri
Piyameth
P
Dilokthornsakul
Chayanin
C
Pratoomsoot
Nathorn
N
Chaiyakunapruk
D002648:Child; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D016527:Drug Costs; D017048:Health Care Costs; D006470:Hemorrhage / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics / Q000627:therapeutic use*; D008390:Markov Chains; D018803:Models, Economic; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D013785:Thailand
D016756:Immunoglobulins, Intravenous