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

Gudula J.A.M. Boon, Wilbert B. van den Hout, Stefano Barco, Harm Jan Bogaard, Marion Delcroix, Menno V. Huisman, Stavros V. Konstantinides, Lilian J. Meijboom, Esther J. Nossent, Petr Symersky, Anton Vonk Noordegraaf, Frederikus A. Klok
ERJ Open Research 2021 7: 00719-2020; DOI: 10.1183/23120541.00719-2020
Gudula J.A.M. Boon
1Dept of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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  • ORCID record for Gudula J.A.M. Boon
  • For correspondence: g.j.a.m.boon@lumc.nl
Wilbert B. van den Hout
2Dept of Biomedical Data Science – Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
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Stefano Barco
3Center for Thrombosis and Hemostasis, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
4Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
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Harm Jan Bogaard
5Dept of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Marion Delcroix
6Dept of Pneumology, University Hospitals Leuven, Leuven, Belgium
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  • ORCID record for Marion Delcroix
Menno V. Huisman
1Dept of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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Stavros V. Konstantinides
3Center for Thrombosis and Hemostasis, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
7Dept of Cardiology, Democritus University of Thrace, Xanthi, Greece
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  • ORCID record for Stavros V. Konstantinides
Lilian J. Meijboom
8Dept of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Esther J. Nossent
5Dept of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Petr Symersky
9Dept of Cardiac Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Anton Vonk Noordegraaf
5Dept of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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Frederikus A. Klok
1Dept of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
3Center for Thrombosis and Hemostasis, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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  • FIGURE 1
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    FIGURE 1

    States and transitions in the Markov model. The state “After diagnosis” is also split up by type of treatment (pulmonary endarterectomy, balloon pulmonary angioplasty, pulmonary arterial hypertension-targeted and no treatment). Utilities and costs are modelled depending on health state, treatment and time since diagnosis. CTEPH: chronic thromboembolic pulmonary hypertension.

  • FIGURE 2
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    FIGURE 2

    Average healthcare expenses per treatment group in years before and after chronic thromboembolic pulmonary hypertension (CTEPH) diagnosis for the base case analysis, distinguishing hospital and medication costs. PEA: pulmonary endarterectemy; BPA: balloon pulmonary angioplasty; PAH: pulmonary arterial hypertension.

  • FIGURE 3
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    FIGURE 3

    Estimated life expectancy, quality-adjusted life-years (QALYs) and lifelong healthcare costs plotted against diagnostic delay of chronic thromboembolic pulmonary hypertension. LE: life expectancy.

  • FIGURE 4
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    FIGURE 4

    Tornado diagram showing the impact of maximal reduction of delay on a) costs, b) quality-adjusted life-years (QALYs) and c) costs-per-QALY, depending on model assumptions (compared to current delay). CTEPH: chronic thromboembolic pulmonary hypertension; PEA: pulmonary endarterectomy; BPA: balloon pulmonary angioplasty.

Tables

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  • TABLE 1

    EuroQol five dimensions questionnaire (EQ-5D) utility values for each health state in the Markov model

    UtilitiesPEA groupBPA groupPAH-targeted therapy groupNo-treatment group
    Pre-treatment0.504 [23]#0.504 [23]#0.504 [23]#0.504 [23]#
    Post-treatment0.743 [23, 25]#0.705 [25]#0.73 [5]0.504¶

    PES: pulmonary endarterectemy; PAH: pulmonary arterial hypertension. #: after transforming the known utility values derived from the SF-36 questionnaire to estimated EuroQol five dimensions (EQ-5D) values following the method reported by Rowen et al. [25]. ¶: identical to pre-treatment utility in PEA group.

    • TABLE 2

      Estimated average lifelong healthcare costs (euros) and effectiveness

      Base case (i.e. current care)No delayDifference
      Screening programme costs-4125-
      Hospital costs21 49327 4725979
      Medication costs (weighted per treatment group)
       PEA (60%)40 29755 09414 797
       BPA (15%)27 63637 6199983
       PAH-targeted therapy (15%)27 67937 4499770
       No treatment (5%)---
      Total lifelong costs117 105161 75944 654
      Life expectancy years14.3 17.33.01
      QALYs years8.42 10.452.04
      Incremental cost-effectiveness ratio14 853 per life-year gained
      Incremental cost–utility ratio21 910 per QALY gained

      PEA: pulmonary endarterectomy; BPA: balloon pulmonary angioplasty; PH: pulmonary hypertension; QALY: quality-adjusted life-year.

      Supplementary Materials

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      • Supplementary Material

        Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

        Supplementary material 00719-2020.SUPPLEMENT

        Model 00719-2020.model

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      A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension
      Gudula J.A.M. Boon, Wilbert B. van den Hout, Stefano Barco, Harm Jan Bogaard, Marion Delcroix, Menno V. Huisman, Stavros V. Konstantinides, Lilian J. Meijboom, Esther J. Nossent, Petr Symersky, Anton Vonk Noordegraaf, Frederikus A. Klok
      ERJ Open Research Jul 2021, 7 (3) 00719-2020; DOI: 10.1183/23120541.00719-2020

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      A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension
      Gudula J.A.M. Boon, Wilbert B. van den Hout, Stefano Barco, Harm Jan Bogaard, Marion Delcroix, Menno V. Huisman, Stavros V. Konstantinides, Lilian J. Meijboom, Esther J. Nossent, Petr Symersky, Anton Vonk Noordegraaf, Frederikus A. Klok
      ERJ Open Research Jul 2021, 7 (3) 00719-2020; DOI: 10.1183/23120541.00719-2020
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