Cost-Effectiveness of Peripheral Neuropathy Screening in Malaysian Adults With Thalassemia: An Integrated Modeling Approach
Author(s)
Ai Ch'i Liew, MSc1, Asrul Akmal Shafie, PhD2, Irene Looi, MRCP (UK)3.
1PhD candidate, UNIVERSITI SAINS MALAYSIA, Penang, Malaysia, 2Universiti Sains Malaysia, Minden, Penang, Malaysia, 3Hospital Seberang Jaya, Seberang Jaya, Malaysia.
1PhD candidate, UNIVERSITI SAINS MALAYSIA, Penang, Malaysia, 2Universiti Sains Malaysia, Minden, Penang, Malaysia, 3Hospital Seberang Jaya, Seberang Jaya, Malaysia.
OBJECTIVES: To evaluate the cost-effectiveness of peripheral neuropathy (PN) screening versus no screening among adult thalassemia patients in Malaysia from the healthcare payer perspective.
METHODS: A dual-model approach combined cohort-based decision trees to estimate detection rates with a lifetime Markov model simulating PN progression in annual cycles. Model structure and assumptions were validated by expert opinion. Key parameters—including detection rates, transition probabilities, health utilities, and costs—were obtained from published literature, local data, and expert input. Outcomes were reported as incremental cost-effectiveness ratios (ICERs) in Malaysia Ringgit (MYR) per quality-adjusted life year (QALY) gained, using a 3% annual discount rate. Uncertainty was assessed via one-way and probabilistic sensitivity analyses (PSA) with 1,000 Monte Carlo simulations. A willingness-to-pay (WTP) threshold of MYR 50,000 per QALY was applied.
RESULTS: PN screening increased QALYs at higher costs, with an overall ICER of MYR 11,658 per QALY gained. Screening was most cost-effective in the 18-29 age group (ICER: MYR 11,315/QALY), followed by the ≥40 age group (MYR 11,868/QALY) and the 30-39 age group (MYR 12,320/QALY). One-way sensitivity analysis identified age-specific drivers of cost-effectiveness. PSA indicated a 90% probability of cost-effectiveness at the WTP threshold. Initiating screening at younger ages consistently yielded greater health benefits per unit cost.
CONCLUSIONS: This is the first economic evaluation supporting PN screening in adult thalassemia care. Despite assumptions due to limited PN data, findings suggest that earlier screening is a cost-effective strategy in Malaysia.
METHODS: A dual-model approach combined cohort-based decision trees to estimate detection rates with a lifetime Markov model simulating PN progression in annual cycles. Model structure and assumptions were validated by expert opinion. Key parameters—including detection rates, transition probabilities, health utilities, and costs—were obtained from published literature, local data, and expert input. Outcomes were reported as incremental cost-effectiveness ratios (ICERs) in Malaysia Ringgit (MYR) per quality-adjusted life year (QALY) gained, using a 3% annual discount rate. Uncertainty was assessed via one-way and probabilistic sensitivity analyses (PSA) with 1,000 Monte Carlo simulations. A willingness-to-pay (WTP) threshold of MYR 50,000 per QALY was applied.
RESULTS: PN screening increased QALYs at higher costs, with an overall ICER of MYR 11,658 per QALY gained. Screening was most cost-effective in the 18-29 age group (ICER: MYR 11,315/QALY), followed by the ≥40 age group (MYR 11,868/QALY) and the 30-39 age group (MYR 12,320/QALY). One-way sensitivity analysis identified age-specific drivers of cost-effectiveness. PSA indicated a 90% probability of cost-effectiveness at the WTP threshold. Initiating screening at younger ages consistently yielded greater health benefits per unit cost.
CONCLUSIONS: This is the first economic evaluation supporting PN screening in adult thalassemia care. Despite assumptions due to limited PN data, findings suggest that earlier screening is a cost-effective strategy in Malaysia.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE267
Topic
Clinical Outcomes, Economic Evaluation, Methodological & Statistical Research
Topic Subcategory
Thresholds & Opportunity Cost
Disease
Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)