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

Abstract

Objetive: To assess the cost effectiveness of unrelated stem cell transplantation versus consolidation chemotherapy in pediatric population with high-risk acute myeloid leukemia (AML).

Methods: A decision tree model was built with life years gained as outcome, from the perspective of the health system, including all direct costs. Pharmaceutical prices were obtained from the official 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 are expressed in Colombian pesos of 2010. No discount rate was applied as costs are incurred during the first year. The cost-effectiveness threshold used was three times the 2010 per capita GDP per life year gained. Deterministic and probabilistic sensitivity analyses were performed over the variables with the higher effect on the incremental cost-effectiveness ratio (ICER).

Results: The ICER of transplantation was $9.226.421, which is lower than the per capita GDP of 2010, $12.047.418. Results are robust to changes in the model data. Probabilistic sensitivity analysis with ten thousand simulations showed that unrelated transplant has a 70% probability of being cost effective.

Conclusions: In the Colombian health system, unrelated stem cell transplantation is a cost-effective strategy for the treatment of high risk AML in pediatric patients.

Note: Downloadable document is in Spanish.

Keywords: Cost-benefit analysis, Cost effectiveness, Health economics, Acute myeloid leukemia, unrelated hematopoietic stem cell transplantation, chemotherapy

JEL Classification: D61, I10, I12, I19