Cost-Utility Analysis of Intravenous Immunoglobulin for the Treatment of Steroid-Refractory Dermatomyositis in Thailand

• Published in: PharmacoEconomics 2015-05, Vol.33 (5), p.521-531
• Main Authors: Bamrungsawad, Naruemon, Chaiyakunapruk, Nathorn, Upakdee, Nilawan, Pratoomsoot, Chayanin, Sruamsiri, Rosarin, Dilokthornsakul, Piyameth
• Format: Article
• Language: English
• Subjects: Activities of daily living; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - economics; Adrenal Cortex Hormones - therapeutic use; Care and treatment; Corticoids; Cost analysis; Cost benefit analysis; Costs; Dermatomyositis; Dermatomyositis - drug therapy; Dermatomyositis - economics; Disability; Drug dosages; Drug Therapy, Combination - economics; Economic models; Evaluation; Health Administration; Health aspects; Health Economics; Health technology assessment; Humans; Immunoglobulins; Immunoglobulins, Intravenous - administration & dosage; Immunoglobulins, Intravenous - economics; Immunoglobulins, Intravenous - therapeutic use; Immunologic Factors - administration & dosage; Immunologic Factors - economics; Immunologic Factors - therapeutic use; Intravenous therapy; Lifetime; Markov analysis; Markov chains; Medicine; Medicine & Public Health; Models, Economic; Muscle strength; Original Research Article; Patient outcomes; Patients; Pharmacoeconomics and Health Outcomes; Public Health; Quality of life; Quality of Life Research; Quality-Adjusted Life Years; Recurrence; Remission (Medicine); Sensitivity analysis; Skin diseases; Steroids; Studies; Treatment Outcome
• ISSN: 1170-7690; 1179-2027
• DOI: 10.1007/s40273-015-0269-8

Introduction Intravenous immunoglobulin (IVIG) has been shown to be effective in treating steroid-refractory dermatomyositis (DM). There remains no evidence of its cost-effectiveness in Thailand. Objective Our objective was to estimate the cost utility of IVIG as a second-line therapy in steroid-refractory DM in Thailand. Methods A Markov model was developed to estimate the relevant costs and health benefits for IVIG plus corticosteroids in comparison with immunosuppressant plus corticosteroids in steroid-refractory DM from a societal perspective over a patient’s lifetime. The effectiveness and utility parameters were obtained from clinical literature, meta-analyses, medical record reviews, and patient interviews, whereas cost data were obtained from an electronic hospital database and patient interviews. Costs are presented in $US, year 2012 values. All future costs and outcomes were discounted at a rate of 3 % per annum. One-way and probabilistic sensitivity analyses were also performed. Results Over a lifetime horizon, the model estimated treatment under IVIG plus corticosteroids to be cost saving compared with immunosuppressant plus corticosteroids, where the saving of costs and incremental quality-adjusted life-years (QALYs) were $US4738.92 and 1.96 QALYs, respectively. Sensitivity analyses revealed that probability of response of immunosuppressant plus corticosteroids was the most influential parameter on incremental QALYs and costs. At a societal willingness-to-pay threshold in Thailand of $US5148 per QALY gained, the probability of IVIG being cost effective was 97.6 %. Conclusions The use of IVIG plus corticosteroids is cost saving compared with treatment with immunosuppressant plus corticosteroids in Thai patients with steroid-refractory DM. Policy makers should consider using our findings in their decision-making process for adding IVIG to corticosteroids as the second-line therapy for steroid-refractory DM patients.