Cost-Effectiveness of Extracorporeal Photopheresis in Patients With Chronic Graft-vs-Host Disease
**Background:** The mainstay first-line therapy for chronic graft-vs-host disease (cGVHD) is corticosteroids; however, for steroid-refractory patients, there is a distinct lack of cost-effective or efficacious treatment. The aim of this study was to assess the cost-effectiveness of extracorporeal ph...
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| Format: | Article |
| Language: | English |
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Columbia Data Analytics, LLC
2024-02-01
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| Series: | Journal of Health Economics and Outcomes Research |
| Online Access: | https://doi.org/10.36469/001c.92028 |
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| author | Adrian Peacock Frances C. Dehle Oscar A. Mesa Zapata Francesca Gennari Maro R.I. Williams Nada Hamad Stephen Larsen Simon J. Harrison Colman Taylor |
| author_facet | Adrian Peacock Frances C. Dehle Oscar A. Mesa Zapata Francesca Gennari Maro R.I. Williams Nada Hamad Stephen Larsen Simon J. Harrison Colman Taylor |
| author_sort | Adrian Peacock |
| collection | DOAJ |
| description | **Background:** The mainstay first-line therapy for chronic graft-vs-host disease (cGVHD) is corticosteroids; however, for steroid-refractory patients, there is a distinct lack of cost-effective or efficacious treatment. The aim of this study was to assess the cost-effectiveness of extracorporeal photopheresis (ECP) compared with standard-of-care therapies for the treatment of cGVHD in Australia. The study formed part of an application to the Australian Government to reimburse ECP for these patients.
**Methods:** A cost-utility analysis was conducted comparing ECP to standard of care, which modeled the response to treatment and disease progression of cGVHD patients in Australia. Mycophenolate, tacrolimus, and cyclosporin comprised second-line standard of care based on a survey of Australian clinicians. Health states in the model included treatment response, disease progression, and death. Transition probabilities were obtained from Australian-specific registry data and randomized controlled evidence. Quality-of-life values were applied based on treatment response. The analysis considered costs of second-line treatment and disease management including immunosuppressants, hospitalizations and subsequent therapy. Disease-specific mortality was calculated for treatment response and progression.
**Results:** Over a 10-year time horizon, ECP resulted in an average cost reduction of $23 999 and an incremental improvement of 1.10 quality-adjusted life-years per patient compared with standard of care. The sensitivity analysis demonstrated robustness over a range of plausible scenarios.
**Conclusion:** This analysis demonstrates that ECP improves quality of life, minimizes the harms associated with immunosuppressant therapy, and is a highly cost-effective option for steroid-refractory cGVHD patients in Australia. Based in part on this analysis, ECP was listed on the Medicare Benefits Schedule for public reimbursement. |
| format | Article |
| id | doaj-art-a880cab482ce48a299dffcef8d778670 |
| institution | Kabale University |
| issn | 2327-2236 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | Columbia Data Analytics, LLC |
| record_format | Article |
| series | Journal of Health Economics and Outcomes Research |
| spelling | doaj-art-a880cab482ce48a299dffcef8d7786702025-02-10T16:12:49ZengColumbia Data Analytics, LLCJournal of Health Economics and Outcomes Research2327-22362024-02-01111Cost-Effectiveness of Extracorporeal Photopheresis in Patients With Chronic Graft-vs-Host DiseaseAdrian PeacockFrances C. DehleOscar A. Mesa ZapataFrancesca GennariMaro R.I. WilliamsNada HamadStephen LarsenSimon J. HarrisonColman Taylor**Background:** The mainstay first-line therapy for chronic graft-vs-host disease (cGVHD) is corticosteroids; however, for steroid-refractory patients, there is a distinct lack of cost-effective or efficacious treatment. The aim of this study was to assess the cost-effectiveness of extracorporeal photopheresis (ECP) compared with standard-of-care therapies for the treatment of cGVHD in Australia. The study formed part of an application to the Australian Government to reimburse ECP for these patients. **Methods:** A cost-utility analysis was conducted comparing ECP to standard of care, which modeled the response to treatment and disease progression of cGVHD patients in Australia. Mycophenolate, tacrolimus, and cyclosporin comprised second-line standard of care based on a survey of Australian clinicians. Health states in the model included treatment response, disease progression, and death. Transition probabilities were obtained from Australian-specific registry data and randomized controlled evidence. Quality-of-life values were applied based on treatment response. The analysis considered costs of second-line treatment and disease management including immunosuppressants, hospitalizations and subsequent therapy. Disease-specific mortality was calculated for treatment response and progression. **Results:** Over a 10-year time horizon, ECP resulted in an average cost reduction of $23 999 and an incremental improvement of 1.10 quality-adjusted life-years per patient compared with standard of care. The sensitivity analysis demonstrated robustness over a range of plausible scenarios. **Conclusion:** This analysis demonstrates that ECP improves quality of life, minimizes the harms associated with immunosuppressant therapy, and is a highly cost-effective option for steroid-refractory cGVHD patients in Australia. Based in part on this analysis, ECP was listed on the Medicare Benefits Schedule for public reimbursement.https://doi.org/10.36469/001c.92028 |
| spellingShingle | Adrian Peacock Frances C. Dehle Oscar A. Mesa Zapata Francesca Gennari Maro R.I. Williams Nada Hamad Stephen Larsen Simon J. Harrison Colman Taylor Cost-Effectiveness of Extracorporeal Photopheresis in Patients With Chronic Graft-vs-Host Disease Journal of Health Economics and Outcomes Research |
| title | Cost-Effectiveness of Extracorporeal Photopheresis in Patients With Chronic Graft-vs-Host Disease |
| title_full | Cost-Effectiveness of Extracorporeal Photopheresis in Patients With Chronic Graft-vs-Host Disease |
| title_fullStr | Cost-Effectiveness of Extracorporeal Photopheresis in Patients With Chronic Graft-vs-Host Disease |
| title_full_unstemmed | Cost-Effectiveness of Extracorporeal Photopheresis in Patients With Chronic Graft-vs-Host Disease |
| title_short | Cost-Effectiveness of Extracorporeal Photopheresis in Patients With Chronic Graft-vs-Host Disease |
| title_sort | cost effectiveness of extracorporeal photopheresis in patients with chronic graft vs host disease |
| url | https://doi.org/10.36469/001c.92028 |
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