PMD68 - Cost-Effectiveness Analysis of Serum Free Light Chain Assay (FREELITE®) for The Diagnosis of Monoclonal Gammopathy in The Brazilian Public and Private Healthcare Systems

Abstract

To assess the efficiency of SFLC for the diagnosis of MG in the Brazilian Public Healthcare System (SUS) and Brazilian Private Healthcare System (BPHS) perspectives From a study already published in literature, data of 652 patients under suspect of MG were used to populate the decision tree model. This model is capable to distinguish which diagnosis protocol provides the highest value to each monetary unit invested. Three strategies were tested: standard protocol (SP) that considers serum electrophoresis (SPEP) as screening test, and two comparators, SP plus SFLC (PP1) and SP plus SFLC and Serum Immunofixation Electrophoresis (SIFE) (PP2). Probabilistic sensitivity analysis was carried out to assess model’s parametric uncertainty. Results are interpreted as the amount of currency (BRL) spent for each incremental correct diagnosis of MG (benefit). Probabilistic simulation pointed an average ICER of BRL 1,192 and BRL 1,470 for PP1 and PP2, respectively in SUS. For BPHS, ICERs were BRL 3,620 and 4,193, respectively. Considering a willingness-to-pay over BRL 1,500 (SUS) and BRL 4,000 (BPHS), PP1 is the strategy more likely to be the cost-effective. PP2 is costlier and promotes more sensitivity compared to SP, resulting in similar efficiency with a trend favouring PP1, though. In SUS and BPHS perspective, adding SFLC in the initial diagnostic work up of MG improves efficiency of financial resources allocated to MG diagnosis regardless its concomitancy to SIFE. The strategy considering SFLC+SPEP for screening purposes adds more value for money compared to SFLC+SPEP+SIFE.