A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension.

BACKGROUND

Diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) exceeds 1 year, contributing to higher mortality. Health economic consequences of late CTEPH diagnosis are unknown. We aimed to develop a model for quantifying the impact of diagnosing CTEPH earlier on survival, quality-adjusted life-years (QALYs) and healthcare costs.

MATERIAL AND METHODS

A Markov model was developed to estimate lifelong outcomes, depending on the degree of delay. Data on survival and quality of life were obtained from published literature. Hospital costs were assessed from patient records (n=498) at the Amsterdam UMC - VUmc, which is a Dutch CTEPH referral center. Medication costs were based on a mix of standard medication regimens.

RESULTS

For 63-year-old CTEPH patients with a 14-month diagnostic delay of CTEPH (median age and delay of patients in the European CTEPH Registry), lifelong healthcare costs were estimated at EUR 117 100 for a mix of treatment options. In a hypothetical scenario of maximal reduction of current delay, improved survival was estimated at a gain of 3.01 life-years and 2.04 QALYs. The associated cost increase was EUR 44 654, of which 87% was due to prolonged medication use. This accounts for an incremental cost-utility ratio of EUR 21 900/QALY.

CONCLUSION

Our constructed model based on the Dutch healthcare setting demonstrates a substantial health gain when CTEPH is diagnosed earlier. According to Dutch health economic standards, additional costs remain below the deemed acceptable limit of EUR 50 000/QALY for the particular disease burden. This model can be used for evaluating cost-effectiveness of diagnostic strategies aimed at reducing the diagnostic delay.

Informations de copyright

Copyright ©The authors 2021.

Déclaration de conflit d'intérêts

Conflict of interest: G.J.A.M. Boon reports grants from the Dutch Heart Foundation and Actelion Pharmaceuticals Ltd outside the submitted work. Conflict of interest: W.B. van den Hout reports grants from the Netherlands Organisation for Health Research and Development (ZonMw) and National Health Care Institute (Zorginstituut Nederland) outside the submitted work. Conflict of interest: S. Barco has nothing to disclose. Conflict of interest: H.J. Bogaard has nothing to disclose. Conflict of interest: M. Delcroix has nothing to disclose. Conflict of interest: M.V. Huisman reports grants from the ZonMW Dutch Healthcare Fund, grants and personal fees from Pfizer–BMS, Bayer Health Care and Daiichi-Sankyo, and grants from Leo Pharma, outside the submitted work. Conflict of interest: S.V. Konstantinides has nothing to disclose. Conflict of interest: L.J. Meijboom has nothing to disclose. Conflict of interest: E.J. Nossent has nothing to disclose. Conflict of interest: P. Symersky has nothing to disclose. Conflict of interest: A. Vonk Noordegraaf reports grants from the Netherlands CardioVascular Research Initiative and Netherlands Organization for Scientific Research, other support from Johnson & Johnson and Ferrer in the past 3 years, and nonfinancial support as a member of a scientific advisory board of Morphogen-XI, outside the submitted work. Conflict of interest: F.A. Klok reports grants from Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, MSD, Actelion, the Netherlands Thrombosis Foundation and the Dutch Heart Foundation outside the submitted work.