Chui BK et al. – Although the cost per QALY gained with epoetin alfa use may fall into an acceptable range, there is significant uncertainty about its true cost–effectiveness. If data regarding long–term efficacy and safety are confirmed in future trials, epoetin alfa could potentially be cost–effective in this population.Methods
- The authors constructed a decision analytic model to compare adjunctive use of epoetin alfa with standard care in trauma patients from the perspective of a Canadian payer.
- Baseline risks of events, relative efficacy, and resource use were obtained from RCTs and observational studies.
- One–way and probabilistic sensitivity analyses were conducted and longer time horizons explored through Markov models.
- Epoetin alfa was associated with a cost per quality–adjusted life year (QALY) gained of $89,958 compared with standard care at 1year.
- One–way sensitivity analyses indicated that results were sensitive to plausible ranges of mortality risk, risk of thrombosis, relative risk of mortality, relative risk of thrombosis, and quality of life estimates.
- Cost–effectiveness acceptability curves generated from probabilistic sensitivity analysis indicated that the probability that epoetin alfa would be considered attractive ranged from 0% to 85% over a willingness–to–pay range of $25,000 to $120,000/QALY.
- Consideration of lifetime time horizons reduced the cost per QALY gained to $7,203, but results were sensitive to the effect of epoetin alfa on mortality.