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Cost-Effectiveness Analysis of Crizanlizumab in Sickle Cell Disease in Iran
Marzieh Nosrati1,2, Shadi Izadidehkordi2,3, Shekoufeh Nikfar1,2
1Personalized Medicine Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Crizanlizumab is not cost-effective for sickle cell disease (SCD) in Iran. Even with a 20% price reduction, its high cost exceeds the acceptable threshold for both monotherapy and combination treatment with hydroxyurea.
Area of Science:
- Pharmacoeconomics
- Health Economics
- Hematology
Background:
- Sickle cell disease (SCD) prevalence is increasing globally.
- New FDA-approved medications for SCD are often inaccessible in low- and middle-income countries (LMICs) due to high costs.
- Crizanlizumab presents potential clinical and economic benefits, but its cost-effectiveness in Iran remains unstudied.
Purpose of the Study:
- To evaluate the cost-effectiveness of crizanlizumab for sickle cell disease (SCD) in Iran.
- To compare crizanlizumab monotherapy versus placebo.
- To compare crizanlizumab in combination with hydroxyurea versus hydroxyurea alone.
Main Methods:
- A decision-tree model and cost-utility analysis were employed.
- The study perspective was Iran's healthcare system.
- Data from the SUSTAIN trial informed effectiveness, with sensitivity analysis performed on medication costs.
Main Results:
- The incremental cost-effectiveness ratio (ICER) for crizanlizumab with hydroxyurea was $398,881 USD, surpassing Iran's cost-effectiveness threshold.
- Crizanlizumab monotherapy also exceeded the threshold.
- Sensitivity analysis indicated that a 20% price reduction did not render crizanlizumab cost-effective.
Conclusions:
- Crizanlizumab is not a cost-effective treatment for sickle cell disease (SCD) in Iran.
- Neither monotherapy nor combination therapy with hydroxyurea meets the cost-effectiveness criteria.
- High drug pricing remains a significant barrier to access in LMICs.
Background:
Sickle cell disease (SCD) prevalence is predicted to rise dramatically in the upcoming years. Although several medications have received Food and Drug Administration (FDA) approval in recent years, low- and middle-income countries (LMICs) still struggle to access these medications due to their remarkably high prices. Crizanlizumab, owing to its clinical and economic privileges, appears to be the most suitable option for addition to pharmacotherapy guidelines. However, no study has yet investigated its cost-effectiveness in Iran's healthcare system.
Methods:
This cost-effectiveness evaluation was conducted in 2022 at the Pharmacoeconomic and Pharmaceutical Administration Department of the Faculty of Pharmacy at Tehran University of Medical Sciences, Tehran, Iran. A decision-tree model was designed, followed by a cost-utility analysis for crizanlizumab in two separate scenarios, targeting not only monotherapy with crizanlizumab in SCD compared with placebo, but also crizanlizumab's concomitant use with hydroxyurea compared with hydroxyurea. The study reports the outcomes from Iran's healthcare system perspective. Direct medical costs, quality-adjusted life years related to vaso-occlusive crisis, hospitalizations, and adverse effects were calculated. Incremental cost-effectiveness ratios were compared. SUSTAIN trial was the main clinical source for modeling crizanlizumab's effectiveness in SCD. A sensitivity analysis was performed to measure the sensitivity of outcomes to changes in medication costs. Microsoft Excel 2020 was utilized for calculations and modeling.
Results:
Concomitant therapy with low-dose crizanlizumab added to hydroxyurea led to the lowest Incremental Cost Effectiveness Ratio (ICER) of 398,881 United States dollars (USD), exceeding Iran's accepted cost-effectiveness threshold. Sensitivity analysis results demonstrate that even a 20% reduction in the price of crizanlizumab does not lead to its cost-effectiveness in Iran.
Conclusion:
Crizanlizumab administration in sickle cell disease is not found cost-effective in Iran, neither as a monotherapy nor added to hydroxyurea.
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