易解鐵(Exjade®) 治療海洋性貧血病人鐵質沉積之藥物經濟評估

Objective: To propose a study, which employs the pharmaco-economic approach to prove that Exjade is not only effective medication in patients suffering from iron overload, but is also cost-effective if administered in Taiwan. Design: By using the Markov model provided by Norvatis, the lifetime occurrence of complications/death as well as costs will be simulated for patients treated with either Exjade or deferoxamine. Parameters: Drug costs: provided by Norvatis. Treatment costs for complications are from Bureau of the National Health Insurance (BNHI). Results: Results of base case analysis show that, if treated with deferasirox, patients were expected to have fewer incidences of complications and obtain two more life years or three more quality-adjusted life-years (QALYs) than those who treated with deferoxamine. However, the total medical cost during the lifetime under the circumstances of using deferasirox would be 36,291 USD more per patient than that of using deferoxamine. After combining cost and outcomes indicators to become an incremental cost-utility ratio, it is estimated that 15,596USD is needed for obtaining an additional QALY for each patient treated with deferasirox. Sensitivity analyses show that unit cost of deferasirox has the greatest impacts on the incremental cost-utility ratio. In addition, the incremental cost-utility ratio would increase if delaying the starting age of chelation therapy. Conclusions: Comparing to the injection type of deferoxamine, deferasirox could improve clinical outcomes as well as quality-of-life at a reasonable cost.