Cost-Utility Analysis of the AlloMap® Test for the Monitoring of Patients After Heart Transplantation: Economic Evaluation Alongside the CUPIDON Trial
Author(s)
Hassan Serrier, PhD1, Laure Huot, PharmD, PhD1, Magali Hanser, MSc2, Bernard Lelong, MD3, Eric Epailly, MD4, Aude Boignard, MD5, Richard Dorent, MD6, Pascal Battistella, MD7, Guillaume Coutance, MD6, Joelle Guitard, MD8, Sabine Pattier, MD9, Catherine Nafeh-Bizet, MD10, Karine Nubret, MD11, Guillaume Baudry, MD2, Mirjana Radosavljevic, MD12, Laurent Sebbag13.
1Hôpitaux de Lyon, Lyon, France, 2Hospices Civils de Lyon, Lyon, France, 3Rennes university Hospital, Rennes, France, 4Strasbourg University Hospitals, Strasbourg, France, 5Grenoble University Hospital, Grenoble, France, 6Assistance Publique Hopitaux de Paris URCEco, Paris, France, 7Réunion University Hospital, Saint Denis, France, 8Toulouse University Hospital, Toulouse, France, 9Nantes University Hospital, Nantes, France, 10Rouen university Hospital, Rouen, France, 11Hopitaux Universitaires de Bordeaux, Bordeaux, France, 12New Civil Hospital, Strasbourg, France, 13Hôpitaux de Lyon, France.
1Hôpitaux de Lyon, Lyon, France, 2Hospices Civils de Lyon, Lyon, France, 3Rennes university Hospital, Rennes, France, 4Strasbourg University Hospitals, Strasbourg, France, 5Grenoble University Hospital, Grenoble, France, 6Assistance Publique Hopitaux de Paris URCEco, Paris, France, 7Réunion University Hospital, Saint Denis, France, 8Toulouse University Hospital, Toulouse, France, 9Nantes University Hospital, Nantes, France, 10Rouen university Hospital, Rouen, France, 11Hopitaux Universitaires de Bordeaux, Bordeaux, France, 12New Civil Hospital, Strasbourg, France, 13Hôpitaux de Lyon, France.
OBJECTIVES: AlloMap® is a non-invasive blood test that can identify patients with low probability of moderate to severe acute cellular transplant rejection. The International Society of Heart and Lung Transplantation recommends its use for the monitoring of patients between 6 months and 5 years after heart transplantation. This test could be an alternative to systematic biopsies but is expensive and not covered by French health insurance. Our objective was to perform an economic evaluation of the AlloMap® test for the monitoring of patients after heart transplantation.
METHODS: Economic evaluation was conducted alongside the CUPIDON multicenter randomized controlled trial which enrolled patients between 2016 and 2020 in either the “AlloMap” or “Biopsies” strategy. The evaluation was conducted from a healthcare system perspective over a 30-month period. Costs were estimated using actual hospital stay data and QALYs were estimated using the EQ5D-5L questionnaire and preference scores validated in the French population. Uncertainty was handled using the nonparametric bootstrap and univariate analysis.
RESULTS: 190 patients were randomized and included in the cost-utility analysis. Initial characteristics of the populations were comparable. In the main analysis, the “AlloMap” strategy represented an additional cost of around €15,380 compared with the “Biopsies” strategy. The average cost per patient was estimated at €39,069 for the “AlloMap” strategy and €23,689 for the “Biopsies” strategy. The average QALY per patient was estimated at 1.87 for the “AlloMap” strategy and 1.92 for the “Biopsies” strategy but the difference was not significant. Further analysis showed that the “Biopsies” strategy became more costly than the “AlloMap” strategy when the price of the test fell below €799.
CONCLUSIONS: The AlloMap® test is expected to be cost effective for a price below €799 in a French setting. According to these results, there is a need to reflect on the optimal follow-up for heart transplantation patients.
METHODS: Economic evaluation was conducted alongside the CUPIDON multicenter randomized controlled trial which enrolled patients between 2016 and 2020 in either the “AlloMap” or “Biopsies” strategy. The evaluation was conducted from a healthcare system perspective over a 30-month period. Costs were estimated using actual hospital stay data and QALYs were estimated using the EQ5D-5L questionnaire and preference scores validated in the French population. Uncertainty was handled using the nonparametric bootstrap and univariate analysis.
RESULTS: 190 patients were randomized and included in the cost-utility analysis. Initial characteristics of the populations were comparable. In the main analysis, the “AlloMap” strategy represented an additional cost of around €15,380 compared with the “Biopsies” strategy. The average cost per patient was estimated at €39,069 for the “AlloMap” strategy and €23,689 for the “Biopsies” strategy. The average QALY per patient was estimated at 1.87 for the “AlloMap” strategy and 1.92 for the “Biopsies” strategy but the difference was not significant. Further analysis showed that the “Biopsies” strategy became more costly than the “AlloMap” strategy when the price of the test fell below €799.
CONCLUSIONS: The AlloMap® test is expected to be cost effective for a price below €799 in a French setting. According to these results, there is a need to reflect on the optimal follow-up for heart transplantation patients.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE309
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas