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Cost-Effectiveness Analysis of an Adherence-Promotion Intervention for Children With Leukemia: A Markov Model-Based
Meghan E McGrady1,2, Mark H Eckman3, Maureen M O'Brien4
1Division of Behavioral Medicine and Clinical Psychology, Patient and Family Wellness Center | Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center.
Insights
Adherence-promotion interventions (APIs) for children with B-cell acute lymphoblastic leukemia (B-ALL) show potential for improved health outcomes and cost savings. These interventions may reduce relapse rates and are predicted to be more effective and less costly than standard care.
Area of Science:
- Pediatric Oncology
- Health Economics
- Pharmacoeconomics
Background:
- Medication adherence is crucial for improving outcomes in pediatric B-cell acute lymphoblastic leukemia (B-ALL), potentially reducing relapse rates.
- Implementing adherence-promotion interventions (APIs) requires resource investment, necessitating an economic evaluation to justify their integration into standard care.
Purpose of the Study:
- To evaluate the cost-effectiveness of adherence-promotion interventions (APIs) compared to treatment as usual (TAU) for children with B-ALL in first continuous remission.
- To determine the potential impact of APIs on quality-adjusted life years (QALYs) and healthcare costs.
Main Methods:
- A Markov decision analytic model was employed to simulate the incremental cost-effectiveness per QALY gained.
- Model parameters were derived from existing published studies.
- The primary outcome measured was the incremental cost per QALY for API versus TAU.
Main Results:
- The model predicts APIs to yield superior health outcomes (4.87 vs. 4.86 QALYs) and significant cost savings ($43,540.73 vs. $46,675.71) compared to TAU.
- Simulations indicate a 95% probability that APIs are more effective and less costly than TAU across various parameter estimates.
- APIs were found to be more effective and less costly when nonadherence exceeds 32% or when API improves adherence by at least 3%.
Conclusions:
- Adherence-promotion interventions (APIs) for children with B-ALL demonstrate potential for improved health outcomes and cost savings over a 6-year period.
- Integrating APIs into standard clinical care may be a cost-effective strategy for managing B-ALL in pediatric patients.
Objective:
Improving medication adherence among children with B-cell precursor acute lymphoblastic leukemia (B-ALL) has the potential to reduce relapse rates but requires an investment in resources. An economic evaluation is needed to understand the potential costs and benefits of delivering adherence-promotion interventions (APIs) as part of standard clinical care.
Methods:
A Markov decision analytic model was used to simulate the potential incremental cost-effectiveness per quality-adjusted life year (QALY) to be gained from an API for children with B-ALL in first continuous remission compared with treatment as usual (TAU, no intervention). Model parameter estimates were informed by previously published studies. The primary outcome was incremental cost (2015 US$) per QALY gained for API compared with TAU.
Results:
The model predicts the API to result in superior health outcomes (4.87 vs. 4.86 QALYs) and cost savings ($43,540.73 vs. $46,675.71) as compared with TAU, and simulations indicate that, across a range of plausible parameter estimates, there is a 95% chance that the API is more effective and less costly than TAU. The API was estimated to remain more effective and less costly than TAU in situations where the prevalence of nonadherence exceeds 32% and when API improves baseline adherence in at least 3% of patients.
Conclusions:
Providing APIs to children with B-ALL may improve health outcomes and save costs over a 6-year period.
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