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Cost-Utility Analysis of Intravenous Immunoglobulin for the Treatment of Steroid-Refractory Dermatomyositis in Thailand

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Abstract

Introduction

Intravenous immunoglobulin (IVIG) has been shown to be effective in treating steroid-refractory dermatomyositis (DM). There remains no evidence of its cost-effectiveness in Thailand.

Objective

Our objective was to estimate the cost utility of IVIG as a second-line therapy in steroid-refractory DM in Thailand.

Methods

A Markov model was developed to estimate the relevant costs and health benefits for IVIG plus corticosteroids in comparison with immunosuppressant plus corticosteroids in steroid-refractory DM from a societal perspective over a patient’s lifetime. The effectiveness and utility parameters were obtained from clinical literature, meta-analyses, medical record reviews, and patient interviews, whereas cost data were obtained from an electronic hospital database and patient interviews. Costs are presented in $US, year 2012 values. All future costs and outcomes were discounted at a rate of 3 % per annum. One-way and probabilistic sensitivity analyses were also performed.

Results

Over a lifetime horizon, the model estimated treatment under IVIG plus corticosteroids to be cost saving compared with immunosuppressant plus corticosteroids, where the saving of costs and incremental quality-adjusted life-years (QALYs) were $US4738.92 and 1.96 QALYs, respectively. Sensitivity analyses revealed that probability of response of immunosuppressant plus corticosteroids was the most influential parameter on incremental QALYs and costs. At a societal willingness-to-pay threshold in Thailand of $US5148 per QALY gained, the probability of IVIG being cost effective was 97.6 %.

Conclusions

The use of IVIG plus corticosteroids is cost saving compared with treatment with immunosuppressant plus corticosteroids in Thai patients with steroid-refractory DM. Policy makers should consider using our findings in their decision-making process for adding IVIG to corticosteroids as the second-line therapy for steroid-refractory DM patients.

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Acknowledgments

This work was funded by the Subcommittee for Development of the NLEM, Thailand. The authors thank the experts and stakeholders for their helpful comments and suggestions. Finally, we wish to thank the patients for their participation, and Ramathibodi Hospital, Bangkok, Thailand and the National Health Security Office (NHSO) for database management.

Conflict of interest

The authors declare that they have no conflicts of interest.

Author contributions

NB participated in the design of the study, developed the cost-effectiveness model, conducted stakeholder meetings, searched input parameters, and conducted the cost-effectiveness analyses. NC participated in the design of the study, developed the cost-effectiveness models, identified data sources, conducted stakeholder meetings, and conducted the cost-effectiveness analyses. NU and CP participated in the design of the study and identified data sources. RS and PD participated in the design of the study, searched input parameters, and conducted the cost-effectiveness analyses. Each author also contributed to interpreting data and results, drafting the manuscript, critically reviewing the manuscript for important intellectual content, and has read and approved the final version.

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Authors and Affiliations

  1. Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand

    Naruemon Bamrungsawad, Nathorn Chaiyakunapruk, Nilawan Upakdee & Piyameth Dilokthornsakul

  2. Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand

    Nathorn Chaiyakunapruk, Rosarin Sruamsiri & Piyameth Dilokthornsakul

  3. School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 46150, Bandar Sunway, Selangor, Malaysia

    Nathorn Chaiyakunapruk

  4. School of Population Health, University of Queensland, Brisbane, Australia

    Nathorn Chaiyakunapruk

  5. School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA

    Nathorn Chaiyakunapruk

  6. Faculty of Public Health, Naresuan University, Phitsanulok, Thailand

    Chayanin Pratoomsoot

Authors
  1. Naruemon Bamrungsawad
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  2. Nathorn Chaiyakunapruk
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  6. Piyameth Dilokthornsakul
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Corresponding author

Correspondence to Nathorn Chaiyakunapruk.

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Bamrungsawad, N., Chaiyakunapruk, N., Upakdee, N. et al. Cost-Utility Analysis of Intravenous Immunoglobulin for the Treatment of Steroid-Refractory Dermatomyositis in Thailand. PharmacoEconomics 33, 521–531 (2015). https://doi.org/10.1007/s40273-015-0269-8

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  • DOI: https://doi.org/10.1007/s40273-015-0269-8

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