title: Cost-utility analysis of intravenous immunoglobulin for the treatment of steroid-refractory dermatomyositis in Thailand.
abstract: BACKGROUND
  Intravenous immunoglobulin (IVIG) has been shown to be effective in treating steroid-refractory dermatomyositis (DM). There remains no evidence of its cost-effectiveness in Thailand.
  
  
  OBJECTIVE
  Our objective was to estimate the cost utility of IVIG as a second-line therapy in steroid-refractory DM in Thailand.
  
  
  METHODS
  A Markov model was developed to estimate the relevant costs and health benefits for IVIG plus corticosteroids in comparison with immunosuppressant plus corticosteroids in steroid-refractory DM from a societal perspective over a patient's lifetime. The effectiveness and utility parameters were obtained from clinical literature, meta-analyses, medical record reviews, and patient interviews, whereas cost data were obtained from an electronic hospital database and patient interviews. Costs are presented in $US, year 2012 values. All future costs and outcomes were discounted at a rate of 3% per annum. One-way and probabilistic sensitivity analyses were also performed.
  
  
  RESULTS
  Over a lifetime horizon, the model estimated treatment under IVIG plus corticosteroids to be cost saving compared with immunosuppressant plus corticosteroids, where the saving of costs and incremental quality-adjusted life-years (QALYs) were $US4738.92 and 1.96 QALYs, respectively. Sensitivity analyses revealed that probability of response of immunosuppressant plus corticosteroids was the most influential parameter on incremental QALYs and costs. At a societal willingness-to-pay threshold in Thailand of $US5148 per QALY gained, the probability of IVIG being cost effective was 97.6%.
  
  
  CONCLUSIONS
  The use of IVIG plus corticosteroids is cost saving compared with treatment with immunosuppressant plus corticosteroids in Thai patients with steroid-refractory DM. Policy makers should consider using our findings in their decision-making process for adding IVIG to corticosteroids as the second-line therapy for steroid-refractory DM patients.
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
authors.forename: Naruemon
authors.initials: N
authors.lastname: Bamrungsawad
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
authors.forename: Nilawan
authors.initials: N
authors.lastname: Upakdee
authors.forename: Chayanin
authors.initials: C
authors.lastname: Pratoomsoot
authors.forename: Rosarin
authors.initials: R
authors.lastname: Sruamsiri
authors.forename: Piyameth
authors.initials: P
authors.lastname: Dilokthornsakul
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003882:Dermatomyositis / Q000188:drug therapy* / Q000191:economics; D004359:Drug Therapy, Combination / Q000191:economics; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D007155:Immunologic Factors / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors