Direct and Indirect Cost of Beta Thalassemia Major: Resuts from the ITHACA Study.

Abstract

Background: Patients with beta Thalassemia Major (TM) require life-long blood transfusions and, to avoid iron overload, Iron Chelation Treatment (ICT), based on 8–12 hour infusions of Deferoxamine (DFO) for 5–7 days/week, and/or Deferiprone (L1) orally administered. ICT regimen often causes low satisfaction and low compliance, with potentially negative consequences on patients’ health, wellbeing and costs. Aims: to investigate direct and indirect costs for TM patients on ICT. Methods: The Italian-THAlassemia-Cost-&-Outcomes-Assessment (ITHACA) was a naturalistic multicentre study conducted to evaluate costs, quality of life, compliance and treatment satisfaction in TM patients undergoing ICT. Patients of any age, on ICT for at least 3 years, were sequentially enrolled at 8 Italian Thalassemia Care Centers. Direct and indirect costs were estimated from retrospective data: those on direct costs were drawn from medical records, referred to a median of 11.6 months before enrolment. As regards as indirect costs, patients completed modified versions of the Health and Labour Questionnaire (HLQ). Questions on indirect costs were referred to a 2 weeks (adults) or a 12 weeks (children) time horizon. Costs were estimated from a societal perspective, using tariffs, prices, average net earning applied in 2006, as appropriate. Results: 137 patients were enrolled and aged a median of 28.3 years (2.7–48.5), 49.6% were male. Overall, mean direct cost was 1,245.33euro/patient/month, with ICT representing 55.4% of costs, followed by transfusions (33.1%), hospitalizations and surgery (3.3%), laboratory and instrumental tests and medical visits (3.1%), concomitant medications (1.6%), non-medical costs (transportation, 3.4%). Patients treated with DFO were 51.5%, 31.6% were treated with L1, 16.9% with DFO+L1. Treatment in patients taking DFO cost on average 552.88euro/patient/month plus 211.20 euro for pump and consumables; patients taking L1 cost 383.25 euro/patient/month, patients taking DFO+L1 cost 918.41 euro. Concerning indirect costs, 116 adults (> 16 years old) completed the HLQ. Sixty-one patients (52.7%) were in paid employment. Twenty-one patients (34.4%) had experienced absenteeism from work in the previous 2 weeks due to ill health. The average absenteeism among patients in paid employment was 0.7 days/week. Indirect costs related to absenteeism were 27.6 euro/patient/week. Fifteen patients (26.6% of patients in paid employment) were hindered by health problems at work. Indirect costs per patient based on hours needed to catch up on tasks neglected due to health problems were 9.4 euro/week. Patients received 1.24 hours of household help/week. Twenty-one children (<15 years old) or their caregivers completed the HLQ children-part. Eighteen children (85.7%) missed schooldays in previous twelve weeks (mean=0.66 days/week) and 6 missed regular activities. Discussion: Transfusions and ICT account for 90% of total costs in TM patients, corresponding to approximately 1,000 euro/patient/month. The disease and the current treatment adopted have a high socio-economic impact on both TM patients and the healthcare system.

Productivity Loss and Associated Costs Among Patients with Transfusion-Dependent Thalassemia in Dubai, United Arab Emirates

“…This finding is inconsistent with other studies. [7][8][9] Estimated indirect costs in Italy were EUR 37 per patient per week (EUR 1924 per year). 7 In Thailand, the average annual productivity loss costs were USD 229.6.…”

“…Hence, comparisons could not be accurate due to different tools used in estimation or via the lack of relevant literature. 7 , 9 Second, there is no consensus on how to differentiate the severity of thalassemia; thus, different criteria to evaluate thalassemia’s severity in different studies were found, 24 , 25 which could, in turn, affect the quality of comparison between studies. Third, concerning estimating productivity loss, this study did not assess the productivity loss incurred by parents or caregivers, as most patients came to the thalassemia center with their parents or caregivers.…”

“…The annual cost of unpaid productivity loss=patient ¼ the cost of unpaid productivity loss= patient � 13 (7) As such, the total cost of productivity lost due to the disease per patient was calculated by adding the annual cost of productivity lost due to absenteeism per patient, the annual cost of productivity lost due to presenteeism/ patient, and the annual cost of unpaid productivity loss per patient. The total annual cost of productivity lost/patient = (Eq.2) + (Eq.…”

“…In Italy, a 2006 study estimated that the indirect cost caused by TDT was €37/patient/week (USD 47/patient/week). 7 In Thailand, the average annual indirect cost was estimated as USD 229.60, representing nearly 24.2% of the total cost associated with thalassemia major in Thai children in 2005. 8 In Iran, a 2015 study found that the average annual indirect cost amounted to USD 573.5.…”

Economic methods of medical technology assessment in hematology

“…Выбранная перспектива влияет как на затраты, так и на то, какие результаты следует учитывать при анализе. Например, если рассматривать экономическую оценку ТГСК с учетом перспективы учреждения здравоохранения, то в расчетах следует учитывать только расходы учреждения, такие как оплата труда персонала (медицинского и немедицинского), закупка расходных материалов (медикаменты, медицинские и немедицинские изделия), расходы на основное оборудование и коммунальные расходы [36]. Однако, если проводить оценку с точки зрения общества, то необходимо включать в расчеты все затраты (и выгоды) вне зависимости от того, кто их несет (или получает выгоду) [36], то есть должны быть учтены затраты, понесенные пациентами и их родственниками (транспортные расходы до места лечения, потери в заработной плате), а также издержки, понесенные работодателем пациента в связи с его отсутствием на работе, и потери в валовом внутреннем продукте (ВВП) [3,12,36].…”