Boon Gudula J A M, van den Hout Wilbert B, Barco Stefano, Bogaard Harm Jan, Delcroix Marion, Huisman Menno V, Konstantinides Stavros V, Meijboom Lilian J, Nossent Esther J, Symersky Petr, Vonk Noordegraaf Anton, Klok Frederikus A
Dept of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Dept of Biomedical Data Science - Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands.
ERJ Open Res. 2021 Sep 6;7(3). doi: 10.1183/23120541.00719-2020. eCollection 2021 Jul.
Diagnostic delay of chronic thromboembolic pulmonary hypertension (CTEPH) exceeds 1 year, contributing to higher mortality. Health economic consequences of late CTEPH diagnosis are unknown. We aimed to develop a model for quantifying the impact of diagnosing CTEPH earlier on survival, quality-adjusted life-years (QALYs) and healthcare costs.
A Markov model was developed to estimate lifelong outcomes, depending on the degree of delay. Data on survival and quality of life were obtained from published literature. Hospital costs were assessed from patient records (n=498) at the Amsterdam UMC - VUmc, which is a Dutch CTEPH referral center. Medication costs were based on a mix of standard medication regimens.
For 63-year-old CTEPH patients with a 14-month diagnostic delay of CTEPH (median age and delay of patients in the European CTEPH Registry), lifelong healthcare costs were estimated at EUR 117 100 for a mix of treatment options. In a hypothetical scenario of maximal reduction of current delay, improved survival was estimated at a gain of 3.01 life-years and 2.04 QALYs. The associated cost increase was EUR 44 654, of which 87% was due to prolonged medication use. This accounts for an incremental cost-utility ratio of EUR 21 900/QALY.
Our constructed model based on the Dutch healthcare setting demonstrates a substantial health gain when CTEPH is diagnosed earlier. According to Dutch health economic standards, additional costs remain below the deemed acceptable limit of EUR 50 000/QALY for the particular disease burden. This model can be used for evaluating cost-effectiveness of diagnostic strategies aimed at reducing the diagnostic delay.
慢性血栓栓塞性肺动脉高压（CTEPH）的诊断延迟超过1年，这导致了更高的死亡率。CTEPH晚期诊断对健康经济的影响尚不清楚。我们旨在开发一种模型，用于量化早期诊断CTEPH对生存率、质量调整生命年（QALY）和医疗成本的影响。
开发了一个马尔可夫模型，以根据延迟程度估计终身结果。生存和生活质量数据来自已发表的文献。医院成本是根据荷兰CTEPH转诊中心阿姆斯特丹大学医学中心 - 自由大学医学中心的患者记录（n = 498）评估的。药物成本基于标准药物治疗方案的组合。
对于CTEPH诊断延迟14个月的63岁CTEPH患者（欧洲CTEPH登记处患者的中位年龄和延迟时间），综合治疗方案的终身医疗成本估计为117,100欧元。在当前延迟最大程度降低的假设情景下，估计生存率提高，增加3.01个生命年和2.04个QALY。相关成本增加为44,654欧元，其中87% 是由于药物使用时间延长。这相当于每QALY的增量成本效益比为21,900欧元。
我们基于荷兰医疗环境构建的模型表明，早期诊断CTEPH可带来显著的健康收益。根据荷兰的健康经济标准，对于特定的疾病负担，额外成本仍低于认为可接受的每QALY 50,000欧元的限制。该模型可用于评估旨在减少诊断延迟的诊断策略的成本效益。
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