Abstract

Objective

This study aimed to evaluate the cost-utility of the home-based care policy versus the no home-based care policy of factor VIII and factor IX concentrate in Thai patients with hemophilia A and B who had no inhibitor or less than 5 Bethesda units.

Methods

A Markov model was used to evaluate the cost utility of the two policies. The first policy was “no home-based care” in which patients were treated with blood components only when admitted at the hospital but without home treatment. The second policy was “home-based care” in which factors were prescribed and infused for treatment of early bleeding episodes at home. Input parameters related to clinical and cost were obtained from primary data collection at the National Health Security Office, while patients’ quality of life was surveyed from mailed questionnaires. Both costs and health outcomes were discounted at 3%. One-way analysis and probabilistic sensitivity analysis were performed to assess uncertainty surrounding model parameters.

Results

Based on governmental perspective, the “home-based care” policy had cost saving in patients with moderate and severe hemophilia when compared with the “no home-based care” policy; in patients with mild hemophilia, the incremental cost-effectiveness ratio was 80,542 Thailand baht (THB) or US $2,684.73 (US $1 = 30 THB).

Conclusions

At the ceiling threshold of one time of gross domestic product per capita (120,000 THB per quality-adjusted life-year gained), the “home-based care” policy was cost-effective when compared with the “no home-based care” policy.