PMID- 25774016
OWN - NLM
STAT- MEDLINE
DCOM- 20160219
LR  - 20181113
IS  - 1179-2027 (Electronic)
IS  - 1170-7690 (Linking)
VI  - 33
IP  - 5
DP  - 2015 May
TI  - Cost-utility analysis of intravenous immunoglobulin for the treatment of 
      steroid-refractory dermatomyositis in Thailand.
PG  - 521-31
LID - 10.1007/s40273-015-0269-8 [doi]
AB  - 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.
FAU - Bamrungsawad, Naruemon
AU  - Bamrungsawad N
AD  - Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan 
      University, Phitsanulok, Thailand.
FAU - Chaiyakunapruk, Nathorn
AU  - Chaiyakunapruk N
FAU - Upakdee, Nilawan
AU  - Upakdee N
FAU - Pratoomsoot, Chayanin
AU  - Pratoomsoot C
FAU - Sruamsiri, Rosarin
AU  - Sruamsiri R
FAU - Dilokthornsakul, Piyameth
AU  - Dilokthornsakul P
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - New Zealand
TA  - Pharmacoeconomics
JT  - PharmacoEconomics
JID - 9212404
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Immunoglobulins, Intravenous)
RN  - 0 (Immunologic Factors)
MH  - Adrenal Cortex Hormones/administration & dosage/*economics/therapeutic use
MH  - *Cost-Benefit Analysis
MH  - Dermatomyositis/*drug therapy/economics
MH  - Drug Therapy, Combination/economics
MH  - Humans
MH  - Immunoglobulins, Intravenous/administration & dosage/*economics/therapeutic use
MH  - Immunologic Factors/administration & dosage/*economics/therapeutic use
MH  - Models, Economic
MH  - Quality-Adjusted Life Years
MH  - Recurrence
MH  - Treatment Outcome
EDAT- 2015/03/17 06:00
MHDA- 2016/02/20 06:00
CRDT- 2015/03/17 06:00
PHST- 2015/03/17 06:00 [entrez]
PHST- 2015/03/17 06:00 [pubmed]
PHST- 2016/02/20 06:00 [medline]
AID - 10.1007/s40273-015-0269-8 [doi]
PST - ppublish
SO  - Pharmacoeconomics. 2015 May;33(5):521-31. doi: 10.1007/s40273-015-0269-8.