Abstract
Background
Chronic graft-versus-host disease (cGvHD) is the leading cause of late nonrelapse
mortality (transplant-related mortality) after hematopoietic stem cell transplant.
Given that there are a wide range of treatment options for cGvHD, assessment of the
associated costs and efficacy can help clinicians and health care providers allocate
health care resources more efficiently.
Objective
The purpose of this study was to assess the cost-effectiveness of extracorporeal photopheresis
(ECP) compared with rituximab (Rmb) and with imatinib (Imt) in patients with cGvHD
at 5 years from the perspective of the Spanish National Health System.
Methods
The model assessed the incremental cost-effectiveness/utility ratio of ECP versus
Rmb or Imt for 1000 hypothetical patients by using microsimulation cost-effectiveness
techniques. Model probabilities were obtained from the literature. Treatment pathways
and adverse events were evaluated taking clinical opinion and published reports into
consideration. Local data on costs (2010 Euros) and health care resources utilization
were validated by the clinical authors. Probabilistic sensitivity analyses were used
to assess the robustness of the model.
Results
The greater efficacy of ECP resulted in a gain of 0.011 to 0.024 quality-adjusted
life-year in the first year and 0.062 to 0.094 at year 5 compared with Rmb or Imt.
The results showed that the higher acquisition cost of ECP versus Imt was compensated
for at 9 months by greater efficacy; this higher cost was partially compensated for
(€517) by year 5 versus Rmb. After 9 months, ECP was dominant (cheaper and more effective)
compared with Imt. The incremental cost-effectiveness ratio of ECP versus Rmb was
€29,646 per life-year gained and €24,442 per quality-adjusted life-year gained at
year 2.5. Probabilistic sensitivity analysis confirmed the results. The main study
limitation was that to assess relative treatment effects, only small studies were
available for indirect comparison.
Conclusion
ECP as a third-line therapy for cGvHD is a more cost-effective strategy than Rmb or
Imt.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical TherapeuticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- ONT. 2010; (Accessed June 14, 2011)
- National Institutes of Health consensus development project on criteria for clinical trials in chronic graft versus host disease: I.Biol Blood Marrow Transplant. 2005; 11: 945-956
- Quality of life after allogeneic hematopoietic cell transplantation.Blood. 2009; 114: 7-19
- Impact of graft-versus-host disease on survival.Best Pract Res Clin Haematol. 2008; 21: 193-204
- Graft-versus-host disease: a complex long-term side effect of hematopoietic stem cell transplant.Oncology (Williston Park). 2008; 22: 31-45
- Prognostic factors of chronic graft-versus-host disease following allogeneic peripheral blood stem cell transplantation: the National Institutes of Health scale plus the type of onset can predict survival rates and the duration of immunosuppressive therapy.Biol Blood Marrow Transplant. 2008; 14: 1163-1171
- Diagnosis and manifestations of chronic graft-versus-host disease.Best Pract Res Clin Haematol. 2008; 21: 251-257
- Consensus conference on clinical practice in chronic GVHD: second-line treatment of chronic graft-versus-host disease.Biol Blood Marrow Transplant. 2011; 17: 1-17
- Novel strategies for steroid-refractory acute graft-versus-host disease.Curr Opin Hematol. 2005; 12: 40-44
- Chronic graft-versus-host disease: pathogenesis and clinical management.Drugs. 2006; 66: 1041-1057
- Parenteral administration of 8-methoxypsoralen in photopheresis.J Am Acad Dermatol. 1993; 28: 580-584
- Treatment of cutaneous T-cell lymphoma by extracorporeal photochemotherapy.N Engl J Med. 1987; 316: 297-303
- Extracorporeal photo-apheresis for the treatment of steroid-resistant graft versus host disease.Transfus Apher Sci. 2009; 41: 209-216
- Developing NICE clinical guidelines: The guidelines manual 2009.(Accessed September 20, 2010)
- Spanish recommendations on economic evaluation of health technologies.Eur J Health Econ. 2010; 11: 513-520
- Consumer Price Index.http://www.ine.es(Accessed April 15, 2012)Date: 2010
- Recent developments in decision-analytic modelling for economic evaluation.Pharmacoeconomics. 2006; 24: 1043-1053
- Modelling in the economic evaluation of healthcare: selecting the appropriate approach.J Health Serv Res Policy. 2004; 9: 110-118
- Cost-effectiveness of olanzapine long-acting injection in the treatment of patients with schizophrenia in the United States: a micro-simulation economic decision model.Curr Med Res Opin. 2011; 27: 713-730
- Recognizing and managing chronic graft-versus-host disease.Hematology Am Soc Hematol Educ Program. 2008; : 134-141
- U.K. consensus statement on the use of extracorporeal photopheresis for treatment of cutaneous T-cell lymphoma and chronic graft-versus-host disease.Br J Dermatol. 2008; 158: 659-678
- Photopheresis in the treatment of chronic graft versus-host disease (cGvHD).Blood. 1990; 76: 529a
- Extracorporeal photochemotherapy in the treatment of chronic graft-versus-host disease after allogenic bone marrow transplantation.American Society of Clinical Oncology Annual Meeting. 1991; : 19-21
- Successful treatment of chronic graft-versus-host disease with extracorporeal photopheresis.Bone Marrow Transplant. 1994; 14: 845-848
- Extracorporeal photochemotherapy for treatment of drug resistant chronic graft-versus-host disease.J Clin Aphresis. 1995; 10 (Abstract): 51
- Extracorporeal photochemotherapy as an effective treatment modality in chronic graft-versus-host disease.J Eur Acad Dermatol Venereol. 1996; 7: 155-162
- Case report: chronic graft versus-host disease (cGvHD) treated with extracorporeal photochemotherapy (ECP).Florence, Italy: Sixth World Apheresis Association Meeting. 1996; 137a
- Extracorporeal photopheresis (ECP) with UVADEX for the treatment of chronic graft-versus-host disease (cGvHD).J Exp Hematol. 1998; 26: 8
- Extracorporeal photochemotherapy in the treatment of graft-versus-host disease.Abstract Book IBMTR/ABMTR Meeting Keystone Resort Colorado. 1998; 7a
- Extracorporeal photopheresis (EP) is effective treatment for chronic refractory graft versus host disease.J Am Soc Hematol. 1998; 92: 454
- The North American experience with photopheresis.Ther Apher. 1999; 3: 50-62
- Effectiveness of extracorporeal photochemotherapy in treating refractory chronic graft-versus-host disease.Haematologica. 2000; 85: 329-330
- Immunomodulatory effects of extracorporeal photochemotherapy in patients with extensive chronic graft-versus-host disease.Blood. 2001; 98: 1622-1625
- Immunologic mechanisms of extracorporeal photochemotherapy in chronic graft-versus-host disease.Blood. 2002; 100: 941-947
- Mononuclear cell collection in patients undergoing extra-corporeal photo-chemotherapy for acute and chronic graft-vs.-host-disease (GvHD): comparison between COBE Spectra version 4.7 and 6.0 (AutoPBSC).J Clin Apher. 2002; 17: 65-71
- Extracorporeal photochemotherapy is accompanied by increasing levels of circulating CD4+CD25+GITR+Foxp3+CD62L+ functional regulatory T-cells in patients with graft-versus-host disease.Transplantation. 2007; 84: 31-39
- A multicenter prospective phase 2 randomized study of extracorporeal photopheresis for treatment of chronic graft-versus-host disease.Blood. 2008; 112: 2667-2674
- Classic and overlap chronic graft-versus-host disease (cGvHD) is associated with superior outcome after extracorporeal photopheresis (ECP).Biol Blood Marrow Transplant. 2009; 15: 1288-1295
- Extracorporeal photopheresis in dermatology [article in Spanish].Actas Dermosifiliogr. 2009; 100: 459-471
- Treatment of chronic graft versus host disease with anti-CD20 chimeric monoclonal antibody.Biol Blood Marrow Transplant. 2003; 9: 505-511
- Anti-CD20 monoclonal antibody-treatment in 6 patients with therapy-refractory chronic graft versus host disease.Blood. 2004; 104: 2603-2606
- Rituximab is effective for steroid-refractory sclerodermatous chronic graft versus host disease.Leukemia. 2006; 20: 172-173
- Rituximab for steroid-refractory chronic graft-versus-host disease.Blood. 2006; 108: 756-762
- Treatment of refractory chronic GVHD with rituximab: a GITMO study.Bone Marrow Transplant. 2007; 40: 273-277
- Treatment of chronic steroid-refractory graft-versus-host disease with low-dose rituximab.Transplantation. 2008; 86: 875-879
- Rituximab as salvage therapy for refractory chronic GVHD.Bone Marrow Transplant. 2008; 41: 909-911
- Rituximab for the treatment of corticosteroid-refractory chronic graft-versus-host disease.Int J Hematol. 2009; 90: 253-260
- Effectiveness and side effects of anti-CD20 therapy for autoantibody-mediated blistering skin diseases: a comprehensive survey of 71 consecutive patients from the Initial use to 2007.Ther Clin Risk Manag. 2009; 5: 1-7
- Efficacy of imatinib mesylate in the treatment of refractory sclerodermatous chronic GVHD.Bone Marrow Transplant. 2008; 42: 757-760
- Limited efficacy of imatinib in severe pulmonary chronic graft-versus-host disease.Blood. 2009; 114: 3718-3719
- Imatinib mesylate as salvage therapy for refractory sclerotic chronic graft-versus-host disease.Blood. 2009; 114: 719-722
- Imatinib for refractory chronic graft-versus-host disease with fibrotic features.Blood. 2009; 114: 709-718
- G-CSF for imatinib-induced neutropenia.Leukemia. 2003; 17: 805-807
- Neutropenia associated with rituximab therapy.Curr Opin Hematol. 2010; 18: 49-54
- Spanish cost database.Oblikue Consulting. 2010; (Accessed September 20, 2010.)
- Health state utilities for non small cell lung cancer.Health Qual Life Outcomes. 2008; 6: 84Health Qual Life Outcomes. 2008; 6: 84
- (Accessed September 20, 2010.)
- Extracorporeal photochemotherapy for the treatment of steroid-resistant chronic GVHD.Blood. 2006; 107: 3074-3080
- Probabilistic sensitivity analysis for NICE technology assessment: not an optional extra.Health Econ. 2005; 14: 339-347
- Handling uncertainty in cost-effectiveness models.Pharmacoeconomics. 2000; 17: 479-500
- Using and interpreting cost-effectiveness acceptability curves: an example using data from a trial of management strategies for atrial fibrillation.BMC Health Serv Res. 2006; 6: 52
- The use of cost per life year gained as a measurement of cost-effectiveness in Spain: a systematic review of recent publications.Eur J Health Econ. 2011 Jun 10; ([Epub ahead of print])
- Economic evaluation of posaconazole vs fluconazole in the prevention of invasive fungal infections in patients with GVHD following haematopoietic SCT.Bone Marrow Transplant. 2010; 45: 925-932
- Extracorporeal photochemotherapy as adjuvant treatment of heart transplant recipients with recurrent rejection.Transplantation. 1995; 60: 45-49
- Extracorporeal photochemotherapy for the treatment of graft-versus-host disease.Ther Apher. 2002; 6: 296-304
Article info
Publication history
Published online: July 27, 2012
Accepted:
June 29,
2012
Identification
Copyright
© 2012 Elsevier HS Journals, Inc. Published by Elsevier Inc. All rights reserved.
