TY - JOUR
T1 - Extracorporeal Photopheresis for Second-Line Treatment of Chronic Graft-versus-Host Diseases: Results from a Health Technology Assessment in Italy
AU - De Waure, Chiara
AU - Capri, S
AU - Veneziano, Maria Assunta
AU - Specchia, Maria Lucia
AU - Cadeddu, Chiara
AU - Di Nardo, Francesco
AU - Ferriero, Anna Maria
AU - Gennari, F
AU - Hamilton, C
AU - Mancuso, Agostino
AU - Quaranta, Gianluigi
AU - Raponi, Matteo
AU - Valerio, L
AU - Gensini, G
AU - Ricciardi, Walter
PY - 2015
Y1 - 2015
N2 - OBJECTIVES:\r\nTo develop a comparative, cost-effectiveness, and budget impact analysis of Therakos online extracorporeal photopheresis (ECP) compared with the main alternatives used for the treatment of steroid-refractory/resistant chronic graft-versus-host disease (cGvHD) in Italy.\r\nMETHODS:\r\nThe current therapeutic pathway was identified by searching medical databases and from the results of a survey of practice in Italian clinical reference centers. A systematic review was performed to evaluate the efficacy and safety of second-line alternatives. Budget impact and cost-effectiveness analyses were performed from the Italian National Health Service perspective over a 7-year time horizon through the adaption of a Markov model. The following health states were considered: complete and partial response, stable disease, and progression. A discount rate of 3% was applied to costs and outcomes.\r\nRESULTS:\r\nThe most common alternatives used in Italy for the management of steroid-refractory/resistant cGvHD were ECP, mycophenolate, pentostatin, and imatinib. The literature review highlighted that complete and partial responses are higher with ECP than with the alternatives while serious adverse events are less common. The economic analysis showed that Therakos online ECP represents the dominating alternative, in that it delivers greater benefit at a lower cost. In fact, according to the alternatives considered, cost saving ranged from €3237.09 to €19,903.51 per patient with 0.04 to 0.21 quality-adjusted life-year gained.\r\nCONCLUSIONS:\r\nTherakos online ECP should be considered an effective, safe, and cost-effective alternative in steroid-refractory/resistant cGvHD. There is inequality in access, and a dedicated reimbursement tariff, however, should be introduced to overcome these barriers.
AB - OBJECTIVES:\r\nTo develop a comparative, cost-effectiveness, and budget impact analysis of Therakos online extracorporeal photopheresis (ECP) compared with the main alternatives used for the treatment of steroid-refractory/resistant chronic graft-versus-host disease (cGvHD) in Italy.\r\nMETHODS:\r\nThe current therapeutic pathway was identified by searching medical databases and from the results of a survey of practice in Italian clinical reference centers. A systematic review was performed to evaluate the efficacy and safety of second-line alternatives. Budget impact and cost-effectiveness analyses were performed from the Italian National Health Service perspective over a 7-year time horizon through the adaption of a Markov model. The following health states were considered: complete and partial response, stable disease, and progression. A discount rate of 3% was applied to costs and outcomes.\r\nRESULTS:\r\nThe most common alternatives used in Italy for the management of steroid-refractory/resistant cGvHD were ECP, mycophenolate, pentostatin, and imatinib. The literature review highlighted that complete and partial responses are higher with ECP than with the alternatives while serious adverse events are less common. The economic analysis showed that Therakos online ECP represents the dominating alternative, in that it delivers greater benefit at a lower cost. In fact, according to the alternatives considered, cost saving ranged from €3237.09 to €19,903.51 per patient with 0.04 to 0.21 quality-adjusted life-year gained.\r\nCONCLUSIONS:\r\nTherakos online ECP should be considered an effective, safe, and cost-effective alternative in steroid-refractory/resistant cGvHD. There is inequality in access, and a dedicated reimbursement tariff, however, should be introduced to overcome these barriers.
KW - Chronic Graft-versus-Host Diseases
KW - Extracorporeal Photopheresis
KW - Health Technology Assessment
KW - Chronic Graft-versus-Host Diseases
KW - Extracorporeal Photopheresis
KW - Health Technology Assessment
UR - https://publicatt.unicatt.it/handle/10807/70931
UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=84931573850&origin=inward
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84931573850&origin=inward
U2 - 10.1016/j.jval.2015.01.009
DO - 10.1016/j.jval.2015.01.009
M3 - Article
SN - 1098-3015
SP - 457
EP - 466
JO - Value in Health
JF - Value in Health
IS - 18(4)
ER -