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Abstract
Background:
Patients with transfusional iron overload have relied on treatment with deferoxamine, a standard chelating agent. Deferoxamine is administered by intravenous or subcutaneous infusion over an 8∼12 hour period 5∼7 times per week; however, administration of deferoxamine may lead to poor compliance and reduced quality of life in patients. The use of deferasirox, a once daily oral chelation agent, was recently approved. We conducted an economic evaluation of these two iron-chelating medications in transfusion-dependent patients.
Methods:
The efficacy of oral deferasirox and infusion deferoxamine was assumed equal based on clinical trials of non-inferiority with the administration of 20mg/kg/day deferasirox versus 40mg/kg/day deferoxamine. Depending on the methods utilized for measuring administration time, travel time and convenience between the use of infusion and oral therapy, either cost analysis or cost-utility analysis was undertaken, respectively. Cost analysis included determination of direct medical costs (drug costs and administration costs), non-medical costs (travel costs), and indirect costs (productivity loss associated medical utilization). For cost utility analysis, the cost per QALYs (quality-adjusted life years) was calculated based on costs subtracting indirect costs (productivity loss) and gains of QALYs between the two agents.
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Table 1.
Comparison of available iron chelators
| Parameter | DFO | DSX |
|---|---|---|
| Dosages (based on 50kg) | 2,000mg | 1,000mg |
| Utility value QALYs | 0.61 28.85 | 0.85 40.21 |
| Costs | 10,959 Won/500mg | 27,462 Won/500mg |
Table 2.
Costs of DFO and DSX (Unit: Won)
Table 3.
Results of cost analysis and cost-utility analysis
Table 4.
LYG according to the compliance with DFO and DSX
Table 5.
Sensitivity analysis for compliance with DFO and DSX: ICER (Unit: Won/LYG)
| Compliance with DSX | ||
|---|---|---|
| 74% (271 days) (LYG: 47.3) | 84% (308 days) (LYG: 57) | |
| Compliance with DFO 64% (166 infusions) (LYG: 28.4) | −683,917 | −378,676 |
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