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Du H, Wang J, Livingston J, Alrajhi Z, Kirby-Allen M, Chan B, Hancock-Howard R, Coyte PC. A cost-utility analysis of thrombopoietin receptor agonists for treating pediatric immune thrombocytopenia purpura after failure of first-line therapies. Pediatr Blood Cancer 2023:e30523. [PMID: 37391862 DOI: 10.1002/pbc.30523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/01/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Thrombopoietin receptor agonists (TPO-RAs) have emerged as a recommended treatment for children with persistent and/or chronic immune thrombocytopenic purpura (ITP). The purpose of this study was to evaluate the cost-effectiveness of TPO-RAs relative to treatment without TPO-RAs (non-TPO-RAs/usual care) for ITP in children who do not respond to first-line therapy and in whom splenectomy is not recommended in Ontario, Canada, from a hospital payer perspective. PROCEDURE A 2-year Markov model with an embedded decision tree was used. Data on medications used, dose, response rate, bleeding, and emergency treatment events were collected from the Hospital for Sick Children in Toronto. The health outcomes were described in quality-adjusted life-years (QALYs). Health-state utilities were derived from the peer-reviewed literature. Scenario analyses, deterministic, and probabilistic sensitivity analyses were conducted. Economic costs were measured in 2021 Canadian dollars ($1.00 = US$0.80) RESULTS: TPO-RAs are estimated to result in an increased cost of $27,118 and a QALY gain of 0.21 compared to non-TPO-RAs over a 2-year horizon, resulting in an incremental cost-effectiveness ratio (ICER) of $129,133. In a 5-year scenario analysis, the ICER fell to $76,403. In the probabilistic sensitivity analysis, TPO-RAs exhibit a 40.0% probability of being cost-effective at a conventional ($100,000) willingness-to-pay threshold per QALY gained. CONCLUSIONS Further assessment of the long-term efficacy of TPO-RAs is warranted to obtain more precise long-term estimates. As the costs of TPO-RAs decline with the introduction of generic formulations, TPO-RAs may be increasingly cost-effective.
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Affiliation(s)
- Huimin Du
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
| | - Jiamin Wang
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
| | - Joel Livingston
- Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Ziyad Alrajhi
- Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Melanie Kirby-Allen
- Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian Chan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - Rebecca Hancock-Howard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Livingston J, Alrajhi Z, Jackson M, McGuire C, Newhook D, Klaassen RJ, Kirby-Allen M. Evaluating the impact of thrombopoietin receptor agonist medications on patient outcomes and quality of life in paediatric immune thrombocytopenia through semi-structured interviews. Br J Haematol 2023; 200:506-516. [PMID: 36345812 DOI: 10.1111/bjh.18545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022]
Abstract
Over the last decade, treatment of immune thrombocytopenia (ITP) in children has advanced to include thrombopoietin receptor agonist (TPO-RA) medications. Concurrently, there has been an increased emphasis on patient-reported outcomes-especially quality of life-to guide treatment. Assessing the impact of TPO-RAs on quality of life in paediatric ITP is therefore a priority. In this single-centre integrative mixed-methods study, a cohort of children with ITP prescribed a TPO-RA was identified. These children and/or their caregivers were invited to participate in semi-structured interviews focussed on quality-of-life measures. Independently, a retrospective chart review collected ITP-related data (platelet count, bleeding events) and TPO-RA data (dosing, side effects). Among the 23 eligible patients, 20 were represented in interviews. On chart review, 11/20 patients responded to TPO-RA by meeting platelet count criteria of ≥50 × 109 /L for six or more weeks in the absence of rescue therapy. In interviews with these children and/or their parents, 19/20 expressed the TPO-RA had 'worked', with 11/20 reporting benefit to mood and 11/20 reporting increased participation in activities/sports. Concerns were raised in interviews about TPO-RA medication cost (17/20), medication administration (10/20) and potential side effects (10/20). In conclusion, this study suggests that TPO-RA use in children with ITP improves quality of life.
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Affiliation(s)
- Joel Livingston
- The Hospital for Sick Children (SickKids), The University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, The University of Alberta, Alberta, Edmonton, Canada
| | - Ziyad Alrajhi
- The Hospital for Sick Children (SickKids), The University of Toronto, Toronto, Ontario, Canada.,King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Melanie Jackson
- The Hospital for Sick Children (SickKids), The University of Toronto, Toronto, Ontario, Canada
| | - Catherine McGuire
- The Children's Hospital of Eastern Ontario (CHEO), The University of Ottawa, Ottawa, Ontario, Canada
| | - Dennis Newhook
- The Children's Hospital of Eastern Ontario (CHEO), The University of Ottawa, Ottawa, Ontario, Canada
| | - Robert J Klaassen
- The Children's Hospital of Eastern Ontario (CHEO), The University of Ottawa, Ottawa, Ontario, Canada
| | - Melanie Kirby-Allen
- The Hospital for Sick Children (SickKids), The University of Toronto, Toronto, Ontario, Canada
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Alrajhi Z, Alhamdan A, Alshareef M, Almubaireek O, Mahmoud M, Omair A, Masuadi E, Hamad B. Perspectives of medical students and teaching faculty on teaching medicine in their native language. East Mediterr Health J 2019; 25:562-566. [PMID: 31612970 DOI: 10.26719/emhj.18.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/30/2018] [Indexed: 11/09/2022]
Abstract
Background One of the basic policy questions to be decided at the inception of medical education institutes is the language of instruction. Aims This study explored the perspectives of medical faculty and students at a college in Saudi Arabia on the language of instruction in medical education. Methods A cross-sectional survey of undergraduate medical students and full-time faculty members at a medical college in Riyadh, Saudi Arabia, was conducted in 2016. Each participant completed a self-administered, validated 28-item questionnaire. Results The total number of students and faculty who responded were 468 (76%) and 37 (93%) respectively. Most students and faculty members agreed that studying in English enables a better access to medical information (n=457, 91%) and more job opportunities (n=419, 83%). Less than 15% of the students preferred to be taught in Arabic in most of the curriculum aspects except for communication skills (n=131, 28%) and the Objective Structured Clinical Examination (OSCE) (n=119, 26%). Conclusions Most medical students and faculty members preferred English as the language of instruction for medical education and did not believe that teaching medicine in Arabic should be sought as a future goal.
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Affiliation(s)
- Ziyad Alrajhi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ali Alhamdan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Musab Alshareef
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Osama Almubaireek
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mahmoud Mahmoud
- Department of Medical Education, College of Medicine, King Saudi bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Aamir Omair
- Department of Medical Education, College of Medicine, King Saudi bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Emad Masuadi
- Department of Medical Education, College of Medicine, King Saudi bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Bashir Hamad
- Sudan Medical Specialization Board, Sudan Khartoum. International University of Africa, Khartoum, Sudan
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