儿童急性髓系白血病治疗中风险分层试验与不进行风险分层试验的成本效益

M. García Molina, Liliana Chicaíza, Adriana Linares Ballesteros, Óscar Ramírez Wurttemberger
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引用次数: 0

摘要

目的:评估在急性髓性白血病(AML)儿童人群中进行风险分层试验与不进行风险分层试验的成本-效果。方法:从卫生系统的角度,以获得的生命年数为结果,包括所有直接成本,建立决策树模型。在移植组中,我们包括了所有患者的风险分层测试的费用,(即使是那些考虑到测试结果而不考虑移植的患者)。药品价格来源于药品信息系统(2008),程序价值来源于2001年ISS关税手册加30%计算。所有货币金额均以2010年哥伦比亚比索表示。由于费用是在第一年发生的,所以没有贴现。每个生命年获得的成本效益阈值是2010年人均GDP的三倍。进行单因素和概率敏感性分析。结果:当增加所有患者的风险分层试验成本时,移植的增量成本-效果比(ICER)为8.559.944美元,低于2010年人均GDP的12.047.418美元。因此,风险分层测试具有成本效益。结果对模型参数值的变化具有鲁棒性。1万个模拟的概率敏感性分析表明,非亲属移植具有成本效益的概率为74%。结论:在哥伦比亚的卫生系统中,对急性髓性白血病儿童患者进行风险分层试验是一种具有成本效益的替代方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cost Effectiveness of Risk Stratification Tests vs. Not Doing Them in the Treatment of Acute Myeloid Leukemia in Pediatric Population
Objective: To assess the cost-effectiveness of risk stratification tests vs. not doing them in pediatric population with acute myeloid leukemia (AML).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. In the transplant arm we included the costs of risk-stratification tests for all the patients, (even those who are not consolidated with transplant, given the test results). 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 per life year gained was three times the 2010 per capita GDP. Univariate and probabilistic sensitivity analysis were performed.Results: When adding the cost of risk-stratification tests for all patients the incremental cost-effectiveness ratio (ICER) of transplantation was $$8.559.944, which is lower than the per capita GDP of 2010, $12.047.418. Hence, risk-stratification tests are cost effective. Results are robust to changes in the values of the model’s parameters. Probabilistic sensitivity analysis with ten thousand simulations showed that unrelated transplant has a 74% probability of being cost effective. Conclusions: In the Colombian health system, performing risk-stratification tests in AML pediatric patients is a cost-effective alternative.
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