A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension
- Gudula J.A.M. Boon1⇑,
- Wilbert B. van den Hout2,
- Stefano Barco3,4,
- Harm Jan Bogaard5,
- Marion Delcroix6,
- Menno V. Huisman1,
- Stavros V. Konstantinides3,7,
- Lilian J. Meijboom8,
- Esther J. Nossent5,
- Petr Symersky9,
- Anton Vonk Noordegraaf5 and
- Frederikus A. Klok1
- 1Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
- 2Department of Biomedical Data Science - Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
- 3Center for Thrombosis and Hemostasis (CTH), University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
- 4Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
- 5Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- 6Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
- 7Department of Cardiology, Democritus University of Thrace, Xanthi, Greece
- 8Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- 9Department of Cardiac Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Gudula J.A.M. Boon (g.j.a.m.boon{at}lumc.nl)
Abstract
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 months diagnostic delay of CTEPH (median age and delay of patients in the European CTEPH Registry), lifelong healthcare costs were estimated at €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 €44 654, of which 87% was due to prolonged medication use. This accounts for an incremental cost-utility ratio of €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 €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.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Boon reports grants from Dutch Heart Foundation, grants from Actelion Pharmaceuticals Ltd., outside the submitted work.
Conflict of interest: Dr. van den Hout reports grants from Netherlands Organisation for Health Research and Development (ZonMw), grants from National Health Care Institute (Zorginstituut Nederland), outside the submitted work.
Conflict of interest: Dr. Barco has nothing to disclose.
Conflict of interest: Dr. Bogaard has nothing to disclose.
Conflict of interest: Dr. Delcroix has nothing to disclose.
Conflict of interest: Dr. Huisman reports grants from ZonMW Dutch Healthcare Fund, grants and personal fees from Pfizer-BMS, grants and personal fees from Bayer Health Care, grants and personal fees from Daiichi-Sankyo, grants from Leo Pharma, outside the submitted work.
Conflict of interest: Dr. Konstantinides has nothing to disclose.
Conflict of interest: Dr. Meijboom has nothing to disclose.
Conflict of interest: Dr. Nossent has nothing to disclose.
Conflict of interest: Dr. Symersky has nothing to disclose.
Conflict of interest: Conflict of interest: Dr. Vonk Noordegraaf reports grants from Netherlands CardioVascular Research Initiative , grants from Netherlands Organization for Scientific Research , other from Johnson & Johnson and Ferrer in the past 3 years, non-financial support from member of scientific advisory board of Morphogen-XI, outside the submitted work.
Conflict of interest: Dr. Klok reports grants from Bayer, grants from Bristol-Myers Squibb, grants from Boehringer-Ingelheim, grants from Daiichi Sankyo, grants from MSD, grants from Actelion, grants from Netherlands Thrombosis Foundation, grants from Dutch Heart Foundation, outside the submitted work.
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- Received October 2, 2020.
- Accepted June 14, 2021.
- Copyright ©The authors 2021
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