Cost Effectiveness of Risk Stratification Tests vs. Not Doing Them in the Treatment of Acute Myeloid Leukemia in Pediatric Population

Abstract

Objective: To assess the cost-effectiveness of risk stratification tests vs. not doing them in pediatric population with acute myeloid leukemia (AML).Methods: A decision tree model was built with life years gained as outcome, from the perspective of the health system, and including all direct costs. In the transplant arm we included the costs of risk-stratification tests for all the patients, (even those who are not consolidated with transplant, given the test results). Pharmaceutical prices were obtained from the System of Information of Medicaments SISMED (2008), and the value of procedures was calculated from the 2001 ISS tariff manual adding 30%. All monetary amounts were expressed in Colombian pesos of 2010. No discount was applied as costs are incurred in during the first year. The cost-effectiveness threshold per life year gained was three times the 2010 per capita GDP. Univariate and probabilistic sensitivity analysis were performed.Results: When adding the cost of risk-stratification tests for all patients the incremental cost-effectiveness ratio (ICER) of transplantation was $$8.559.944, which is lower than the per capita GDP of 2010, $12.047.418. Hence, risk-stratification tests are cost effective. Results are robust to changes in the values of the model’s parameters. Probabilistic sensitivity analysis with ten thousand simulations showed that unrelated transplant has a 74% probability of being cost effective. Conclusions: In the Colombian health system, performing risk-stratification tests in AML pediatric patients is a cost-effective alternative.