Cost-Effectiveness of Related Hematopoietic Stem Cell Transplantation Versus Chemotherapy for Consolidation Treatment to Acute Myeloid Leukemia in Pediatric Patients

Abstract

Methods: A decision tree model was built with life years gained as outcome, from the perspective of the health system, and including all direct costs. Pharmaceutical prices were obtained from the System of Information of Medicaments SISMED (2008), and the value of procedures was calculated from the 2001 ISS tariff manual adding 30%. All monetary amounts were expressed in Colombian pesos of 2010. No discount was applied as costs are incurred in during the first year. The cost-effectiveness threshold used was three times the 2010 per capita GDP per life year gained. Univariate and probabilistic sensitivity analysis were performed over the variables having the higher effect on the incremental cost-effectiveness ratio (ICER). Results: The ICER of transplantation was $6.646.980 in high risk and $6.246.762 in intermediate risk patients. The ICERs are lower than the per capita GDP of 2010, $12.047.418. Results are robust to changes in the values of the parameters. Probabilistic sensitivity analysis with ten thousand simulations showed that unrelated transplant has a 78% probability of being cost effective. Conclusions: In the Colombian health system, related stem cell transplantation is a cost-effective strategy for the treatment of AML in high or intermediate risk pediatric patients.