Abstract 16276: Cost-Effectiveness Analysis of Dexrazoxane in Preventing Long-Term Cardiac Dysfunction in Paediatric Patients With Haematological Malignancies
Introduction: Dexrazoxane (DRZ) prevents cardiac dysfunction after chemotherapy for hematological malignancies (HM) in the pediatric population. However, the cost-effectiveness of this approach is unknown.
Hypothesis: DRZ use produces additional Quality-Adjusted-Life-years (QALYS) at a cost that is below the current US willingness-to-pay threshold
Methods: A Markov model was assembled using four states; well, asymptomatic cardiotoxicity (CTX), heart failure (HF) and death. The base case scenario was a 15-year with acute lymphocytic leukemia treated with 360 mg/m2 cumulative anthracycline dose, followed over a 25-year time-horizon. Costs, utilities and transition probabilities were derived from published scientific literature. Costs are in 2016 US$ and calculated from a societal perspective. Costs and utilities were discounted at 3%/annum. Treatment costs included wholesale acquisition cost for DRZ. Sensitivity analyses were performed on key inputs including; transition probabilities of CTX and HF, costs of CTX and HF, efficacy and cost of DRZ. Willingness-to-pay (WTP) threshold of US$53,000 was selected
Results: Treatment with DRZ extensively dominated standard therapy, providing cost savings of $2369 and QALY savings of 0.28 QALYs per-patient. Major determinants were probabilities of cardiotoxicity, heart failure and death, and costs of cardiotoxicity and therapy. Extended dominance by DRZ persisted throughout published 95%CI of efficacy, with loss of dominance if RR was ≥0.66. Incremental Cost-Effectiveness (ICE) Ratio only exceeded the WTP threshold if RR was ≥0.92. ICE scatterplot of 1000 bootstrap samples (Figure) showed 65.1% of DRZ samples were superior or produced additional QALYs at cost <WTP. There was no change in life expectancy.
Conclusions: DRZ provided a modest increase in long-term QALYs and reduction in healthcare costs in the pediatric HM population. These results were robust across plausible ranges of DRZ efficacy.
Author Disclosures: M.T. Nolan: None. Y. Wang: None. F. Pathan: None. T.H. Marwick: None.
- © 2016 by American Heart Association, Inc.