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Modelling cost effectiveness of horse antithymocyte globulin for treating severe aplastic anaemia in Germany

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Abstract

Acquired severe aplastic anaemia (AA) is a serious condition caused by immune-triggered bone marrow failure. For patients not eligible for bone marrow transplantation, treatment of choice is immunosuppression by a combined treatment with antithymocyte globulin (ATG) and cyclosporine. The debate on treatment optimization in AA is focused on conflicting data regarding ATG preparations from horse (h-ATG) versus rabbit (r-ATG), recently favouring h-ATG. H-ATG has been withdrawn from the European market in 2007. Reimbursement for imported preparations from outside Europe is frequently denied in negotiations with statutory health insurance companies. This raises the question of whether h-ATG is cost effective and a sensible investment with regard to healthcare budgets as well as patient health. We modelled the cost effectiveness of r-ATG versus h-ATG based on a recent randomized trial and cost data provided by the hospital pharmacy of Jena University Hospital. We calculated the amount of life years gained and the average incremental costs per life year gained when comparing h-ATG and r-ATG. Our calculations revealed average incremental costs per life year gained of €11,033.80 for the examined patient population treated with h-ATG when compared to r-ATG. Assuming a cost effectiveness threshold of €25,000–35,000 per life year gained, our calculations demonstrate cost effectiveness of h-ATG as compared to r-ATG.

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References

  1. Marsh JC, Ball SE, Cavenagh J et al (2009) Guidelines for the diagnosis and management of aplastic anaemia. Br J Haematol 147(1):43–70. doi:10.1111/j.1365-2141.2009.07842.x

    Article  PubMed  CAS  Google Scholar 

  2. Thomas ED, Storb R, Fefer A et al (1972) Aplastic anaemia treated by marrow transplantation. Lancet 1(7745):284–289

    Article  PubMed  CAS  Google Scholar 

  3. Speck B, Gluckman E, Haak HL et al (1977) Treatment of aplastic anaemia by antilymphocyte globulin with and without allogeneic bone-marrow infusions. Lancet 2(8049):1145–11484

    Article  PubMed  CAS  Google Scholar 

  4. Schrezenmeier H, Brümmendorf T, Linkesch W et al. (2012) Aplastische Anämie–Diagnostik und Therapie der erworbenen Aplastischen Anämie. Leitlinie. http://www.dgho-onkopedia.de/de/onkopedia/leitlinien/aplastische-anaemie-diagnostik-und-therapie-der/aplastische-ana-mie-diagnostik-und-therapie-der.pdf. Accessed 29 Nov 2012

  5. Aljurf M, Al-Zahrani H, Van Lint MT et al (2012) Standard treatment of acquired SAA in adult patients 18–40 years old with an HLA-identical sibling donor. Bone Marrow Transplant advance online publication. doi:10.1038/bmt.2012.223

  6. Dufour C, Svahn J, Bacigalupo (2012) Front-line immunosuppressive treatment of acquired aplastic anemia. Bone Marrow Transplant advance online publication. doi:10.1038/bmt.2012.222

  7. Passweg JR, Marsh JC (2010) Aplastic anemia: first-line treatment by immunosuppression and sibling marrow transplantation. Hematology Am Soc Hematol Educ Program 2010:36–426

    Article  PubMed  Google Scholar 

  8. Passweg JR, Socié G, Hinterberger W et al (1997) Bone marrow transplantation for severe aplastic anemia: has outcome improved. Blood 90(2):858–864

    PubMed  CAS  Google Scholar 

  9. Frickhofen N, Heimpel H, Kaltwasser JP et al (2003) Antithymocyte globulin with or without cyclosporin A: 11-year follow-up of a randomized trial comparing treatments of aplastic anemia. Blood 101(4):1236–1242

    Article  PubMed  CAS  Google Scholar 

  10. Atta EH, Dias DSP, Marra VLN et al (2010) Comparison between horse and rabbit antithymocyte globulin as first-line treatment for patients with severe aplastic anemia: a single-center retrospective study. Ann Hematol 89(9):851–859. doi:10.1007/s00277-010-0944-y

    Article  PubMed  CAS  Google Scholar 

  11. Halkes CJ, Brand A, von dem Borne PA et al (2011) Increasing the dose of rabbit-ATG does not lead to a higher response rate in the first-line treatment of severe aplastic anaemia. Bone Marrow Transplant 46(suppl):373

    Google Scholar 

  12. Marsh JC, Socié G, Tichelli A et al (2011) Prospective phase 2 pilot study of rabbit antithymocyte globulin with ciclosporin for patients with acquired aplastic anaemia and matched pair analysis with patients treated with horse ATG and ciclosporin. Bone Marrow Transplant 46(suppl):S30

    Google Scholar 

  13. Afable MG, Shaik M, Sugimoto Y et al (2011) Efficacy of rabbit anti-thymocyte globulin in severe aplastic anemia. Haematologica 96(9):1269–1275. doi:10.3324/haematol.2011.042622

    Article  PubMed  CAS  Google Scholar 

  14. Vallejo C, Colado E, Montesinos P et al (2009) Comparison between lymphoglobuline- and thymoglobuline-based immunosuppressive therapy as first-line treatment for patients with aplastic anemia. Blood 114(suppl):3194

    Google Scholar 

  15. Atta EH, de Sousa AM, Schirmer MR et al (2012) Different outcomes between cyclophosphamide plus horse or rabbit antithymocyte globulin for HLA-identical sibling bone marrow transplant in severe aplastic anemia. Biol Blood Marrow Transplant 2012. doi:10.1016/j.bbmt.2012.07.004

  16. Scheinberg P, Nunez O, Weinstein B et al (2011) Horse versus rabbit antithymocyte globulin in acquired aplastic anemia. N Engl J Med 365(5):430–438. doi:10.1056/NEJMoa1103975

    Article  PubMed  CAS  Google Scholar 

  17. Novitzky N, Mobara G, Jacobs P (1992) Antilymphocyte globulin and high-dose methylprednisolone improve survival in patients with aplastic anaemia without additional financial costs. S Afr Med J 81(5):257–257

    Google Scholar 

  18. Schommer JC, Pathak DS, Grauer DW (1996) Economic evaluation of immunosuppressive drugs: an empirical example using a secondary database of hospital charges. Transplant Proc 28(2):906

    PubMed  CAS  Google Scholar 

  19. Shereck EB, Deyell RJ, Kurre P (2011) Costs and consequences of immunosuppressive therapy in children with aplastic anemia. Haematologica 96(6):793–795

    Article  PubMed  Google Scholar 

  20. Ubel PA, Hirth RA, Chernew ME et al (2003) What is the price of life and why doesn’t it increase at the rate of inflation? Arch Intern Med 163(14):1637–1641. doi:10.1001/archinte.163.14.1637

    Article  PubMed  Google Scholar 

  21. National Institute for Health and Clinical Excellence (2008) Guide to the methods of technology appraisal http://www.nice.org.uk/media/B52/A7/TAMethodsGuideUpdatedJune2008.pdf Accessed 30 Aug 2012

  22. Tichelli A, Schrezenmeier H, Socié G et al (2011) A randomized controlled study in patients with newly diagnosed severe aplastic anemia receiving antithymocyte globulin (ATG), cyclosporine, with or without G-CSF: a study of the SAA Working Party of the European Group for Blood and Marrow Transplantation. Blood 117(17):4434–4441. doi:10.1182/blood-2010-08-304071

    Article  PubMed  CAS  Google Scholar 

  23. Tengs TO (2004) Cost-effectiveness versus cost-utility analysis of interventions for cancer: does adjusting for health-related quality of life really matter? Value Health 7(1):70–78. doi:10.1111/j.1524-4733.2004.71246.x

    Article  PubMed  Google Scholar 

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Acknowledgments

SH is supported by the Center for Sepsis Control & Care (CSCC) funded by the German Ministry of Education and Research (BMBF), grant no 01 E0 1002.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Center for Sepsis Control and Care, Universitätsklinikum Jena, Jena, Germany

    Steffen Heublein

  2. Apotheke des Universitätsklinikums Jena, Jena, Germany

    Steffen Heublein & Michael Hartmann

  3. Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany

    Franziska Wehner, Andreas Hochhaus & Paul La Rosée

  4. DRK-Blutspendedienst Baden-Württemberg–Hessen, Institut für Klinische Transfusionsmedizin und Immungenetik, Universität Ulm, Ulm, Germany

    Britta Höchsmann

  5. Integriertes Forschungs- und Behandlungszentrum, Sepsis und Sepsisfolgen/Center for Sepsis Control and Care, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Germany

    Steffen Heublein

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  1. Steffen Heublein
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  2. Franziska Wehner
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  3. Britta Höchsmann
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  4. Andreas Hochhaus
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  6. Paul La Rosée
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Correspondence to Steffen Heublein.

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Heublein, S., Wehner, F., Höchsmann, B. et al. Modelling cost effectiveness of horse antithymocyte globulin for treating severe aplastic anaemia in Germany. Ann Hematol 92, 825–830 (2013). https://doi.org/10.1007/s00277-013-1688-2

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  • DOI: https://doi.org/10.1007/s00277-013-1688-2

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