Sanofi, France, Chilly-Mazarin, Paris, France.
Avalere Health, Washington, DC, USA.
J Med Econ. 2021 Jan-Dec;24(1):1178-1184. doi: 10.1080/13696998.2021.1992413.
This study aimed to model the financial impact of caplacizumab with therapeutic plasma exchange (TPE) + immunosuppression for patients experiencing an acute acquired thrombotic thrombocytopenic purpura (aTTP) episode versus TPE + immunosuppression, from a US hospital's perspective.
We developed an economic model to estimate the impact of caplacizumab on a US hospital's budget. Cost offsets from caplacizumab utilization targeted inpatient general ward days, intensive care unit (ICU) days, and TPE utilization. Costs and event probabilities were estimated from primary data analyses of the phase 3 HERCULES trial and peer-reviewed literature or other public sources. Plan reimbursement was obtained from 2019 Medicare Fee Schedules and adjusted to represent reimbursement from different US payers. Cost of ICU and general ward utilization were estimated from Medicare Provider Analysis and Review data analyses capturing hospital discharges.
The model results indicate that caplacizumab leads to hospitalization cost savings of over $8,000 ($23,148 versus $14,904) along with TPE cost savings of over $14,000 ($37,150 versus $23,033) per patient. When the cost of caplacizumab and plan reimbursement are incorporated into the results, the per-patient cost of TPE + immunosuppression is $23,120 versus $70,068 for caplacizumab with TPE + immunosuppression, an incremental cost of $46,948. The model was robust to several scenario analyses; however, when limited to Medicare fee-for-service (FFS), the incremental cost of caplacizumab per patient was reduced to $4,852 due to add-on payments.
Caplacizumab with TPE + immunosuppression is associated with an increase in costs; however, the increase is nominal among payers who provide an add-on payment consistent with that of Medicare FFS.
本研究旨在从美国医院的角度，构建模型评估急性获得性血栓性血小板减少性紫癜（aTTP）患者接受卡普芦单抗联合治疗性血浆置换（TPE）+免疫抑制疗法与 TPE+免疫抑制疗法的财务影响。
我们开发了一种经济模型，以估算卡普芦单抗对美国医院预算的影响。卡普芦单抗的使用成本节约主要针对住院普通病房日、重症监护病房（ICU）日和 TPE 利用。成本和事件概率是根据 3 期 HERCULES 试验的主要数据分析以及同行评议文献或其他公开资料估算的。计划报销是从 2019 年医疗保险费用表中获得的，并进行了调整以代表不同美国支付者的报销。从捕获医院出院的医疗保险提供者分析和审查数据分析中估算 ICU 和普通病房的使用成本。
模型结果表明，卡普芦单抗可使每位患者的住院费用节省超过 8000 美元（23148 美元比 14904 美元），同时还可使 TPE 费用节省超过 14000 美元（37150 美元比 23033 美元）。当将卡普芦单抗的成本和计划报销纳入结果时，TPE+免疫抑制联合卡普芦单抗的每位患者 TPE+免疫抑制费用为 23120 美元，而 TPE+免疫抑制联合卡普芦单抗的每位患者 TPE+免疫抑制费用为 70068 美元，增量成本为 46948 美元。该模型对几种方案分析具有稳健性；然而，当仅限于医疗保险按服务收费（FFS）时，由于附加付款，每位患者卡普芦单抗的增量成本降低至 4852 美元。
TPE+免疫抑制联合卡普芦单抗会增加成本；然而，对于提供与医疗保险 FFS 一致的附加付款的支付者而言，这种增加是微不足道的。
