@article{e4e6f58e1dd748438f3912400f86bc55,
title = "A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension",
abstract = "Background 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. Material and methods 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. Results 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 117100 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. Conclusion 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.",
author = "Boon, {Gudula J.A.M.} and {van den Hout}, {Wilbert B.} and Stefano Barco and Bogaard, {Harm Jan} and Marion Delcroix and Huisman, {Menno V.} and Konstantinides, {Stavros V.} and Meijboom, {Lilian J.} and Nossent, {Esther J.} and Petr Symersky and {Vonk Noordegraaf}, Anton and Klok, {Frederikus A.}",
note = "Funding Information: Conflict of interest: G.J.A.M. Boon reports grants from the Dutch Heart Foundation and Actelion Pharmaceuticals Ltd outside the submitted work. W.B. van den Hout reports grants from the Netherlands Organisation for Health Research and Development (ZonMw) and National Health Care Institute (Zorginstituut Nederland) outside the submitted work. S. Barco has nothing to disclose. H.J. Bogaard has nothing to disclose. M. Delcroix has nothing to disclose. M.V. Huisman reports grants from the ZonMW Dutch Healthcare Fund, grants and personal fees from Pfizer–BMS, Bayer Health Care and Daiichi-Sankyo, and grants from Leo Pharma, outside the submitted work. S.V. Konstantinides has nothing to disclose. L.J. Meijboom has nothing to disclose. E.J. Nossent has nothing to disclose. P. Symersky has nothing to disclose. A. Vonk Noordegraaf reports grants from the Netherlands CardioVascular Research Initiative and Netherlands Organization for Scientific Research, other support from Johnson & Johnson and Ferrer in the past 3 years, and nonfinancial support as a member of a scientific advisory board of Morphogen-XI, outside the submitted work. F.A. Klok reports grants from Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, MSD, Actelion, the Netherlands Thrombosis Foundation and the Dutch Heart Foundation outside the submitted work. Funding Information: Support statement: This work was supported by unrestricted grants from Actelion Pharmaceuticals Ltd. F.A. Klok and G.J.A.M. Boon were supported by the Dutch Heart Foundation (2017T064). Funding information for this article has been deposited with the Crossref Funder Registry. Publisher Copyright: {\textcopyright}The authors 2021.",
year = "2021",
doi = "https://doi.org/10.1183/23120541.00719-2020",
language = "English",
volume = "7",
journal = "ERJ open research",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "3",
}