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Cost-utility of new film-coated tablet formulation of deferasirox vs deferoxamine among major beta-thalassemia patients in Iran.

伊朗重型 β 地中海贫血患者中地拉罗司与去铁胺新型薄膜包衣片剂的成本效用。

  • 影响因子:1.95
  • DOI:10.1097/MD.0000000000020949
  • 作者列表:"Saiyarsarai P","Khorasani E","Photogeraphy H","Ghaffari Darab M","Seyedifar M
  • 发表时间:2020-07-10
Abstract

OBJECTIVES:Thalassemia is a hereditary disease, which caused economic burden in developing countries. This study evaluated the cost utility of new formulation of deferasirox (Jadenu) vs deferoxamine (Desferal) among B-Thalassemia-major patients from payer perspective in Iran. METHODS:An economic-evaluation through Markov model was performed. A systematic review was conducted in order to evaluate the clinical effectiveness of comparators. Because of chelating therapy is weight-dependent, patients were assumed to be 2 years-old at initiation in first and 18 years-old in second scenario, and model was estimated lifetime costs and utilities. Costs were calculated to the Iran healthcare system through payer perspective and measured effectiveness using quality-adjusted life years (QALYs). One-way sensitivity analysis and budget impact analysis was also employed. RESULTS:The 381 studies were retrieved from systematic searching through databases. After eliminating duplicate and irrelevant studies, 2 studies selected for evaluating the effectiveness. Jadenu was associated with an incremental cost-effectiveness ratio (ICER) of 1470.6 and 2544.7 US$ vs Desferal in first and second scenario respectively. The estimated ICER for Jadenu compared to generic deferoxamine was 2837.0 and 6924.1 US$ for first and second scenario respectively. For all scenarios Jadenu is presumed as cost-effective option based on calculated ICER which was lower than 1 gross domestic product per capita in Iran. Sensitivity analysis showed that different parameters except discount rate and indirect cost did not have impact on results. Based on budget impact analysis the estimated cost for patients using Desferal (based on the market share of brand) was 44,021,478 US$ in 3 years vs 42,452,606 US$ in replacing 33% of brand market share with Jadenu. This replacement corresponded to the cost saving of almost 1,568,872 US$ for the payers in 3 years. The calculated cost of using generic deferoxamine in all patients was 68,948,392 US$. The increase in the cost of using Jadenu for 10% of all patients in this scenario would be 934,427 US$ (1.36%) US$ at the first year. CONCLUSIONS:Based on this analysis, film-coated deferasirox appeared to be cost-effective treatment in comparison with Desferal for managing child and adult chronic iron overload in B-thalassemia major patients of Iran.

摘要

目的: 地中海贫血是一种遗传性疾病,在发展中国家造成经济负担。本研究从付款人的角度评估了在伊朗B-地中海贫血-主要患者中,地拉罗司 (Jadenu) 新制剂与去铁胺 (deferal) 的成本效用。 方法: 采用Markov模型进行经济评价。进行了系统评价以评价比较者的临床有效性。由于螯合治疗是体重依赖性的,患者在第一种情况下开始时被假定为2岁,在第二种情况下被假定为18岁,模型是估计的终身成本和效用。通过付款人视角向伊朗医疗保健系统计算成本,并使用质量调整生命年 (QALYs) 测量有效性。还采用了单向敏感性分析和预算影响分析。 结果: 从系统检索数据库中检索到381项研究。在排除重复和不相关的研究后,选择2项研究进行有效性评估。在第一种和第二种情况下,Jadenu的增量成本效益比 (ICER) 分别为1470.6和2544.7美元。与仿制药去铁胺相比,Jadenu的估计ICER在第一和第二种情况下分别为2837.0和6924.1美元。在所有情况下,根据计算的ICER,Jadenu被认为是成本效益高的选择,其低于伊朗人均国内生产总值1。敏感性分析表明,除折现率和间接成本外,不同参数对结果没有影响。根据预算影响分析,使用Desferal (基于品牌市场份额) 的患者3年的估计费用为44,021,478美元,相比之下,使用Jadenu替代42,452,606的品牌市场份额为33% 美元。这一替换相当于在3年内为付款人节省了近1,568,872美元的成本。在所有患者中使用仿制药去铁胺的计算成本为68,948,392美元。在这种情况下,10% 的所有患者使用Jadenu的成本增加将在第一年为934,427美元 (1.36%) 美元。 结论: 基于这一分析,与Desferal相比,薄膜涂层地拉罗司似乎是治疗伊朗重型B地中海贫血患者的儿童和成人慢性铁过载的成本有效治疗方法。

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影响因子:1.74
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DOI:10.1177/1049909119868657
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