Cost-effectiveness of follow-up algorithms for chronic thromboembolic pulmonary hypertension in pulmonary embolism survivors

Abstract

IntroductionAchieving an early diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in pulmonary embolism (PE) survivors results in better quality of life and survival. Importantly, dedicated follow-up strategies to achieve an earlier CTEPH diagnosis involve costs that were not explicitly incorporated in the models assessing their cost-effectiveness. We performed an economic evaluation of 11 distinct PE follow-up algorithms to determine which should be preferred.Materials and methods11 different PE follow-up algorithms and 1 hypothetical scenario without a dedicated CTEPH follow-up algorithm were included in a Markov model. Diagnostic accuracy of consecutive tests was estimated from patient-level data of the InShape II study (n=424). The life-long costs per CTEPH patient were compared and related to Quality-Adjusted Life-Years (QALYs) for each scenario.ResultsCompared to not performing dedicated follow-up, the integrated follow-up algorithms are associated with an estimated increase of 0.89–1.2 QALY against an incremental cost-effectiveness ratio (ICER) of 25 700–46 300 € per QALY per CTEPH patient. When comparing different algorithms with each other, the maximum differences were 0.27 QALY and €27 600. The most cost-effective algorithm was the InShape IV algorithm, with an ICER of €26 700 per QALY compared to the next best algorithm.ConclusionSubjecting all PE survivors to any of the currently established dedicated follow-up algorithm to detect CTEPH is cost-effective and preferred above not performing a dedicated follow-up, evaluated against the Dutch acceptability threshold of €50 000 per QALY. The model can be used to identify the locally preferred algorithm from an economical point-of-view within local logistical possibilities.