Cardiotoxicity of cancer therapy: a cost-benefit analysis of a cardioncology assessment in Portugal

• Autor(a) principal: Fontes, Joana Baltazar
• Data de Publicação: 2019
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10071/19515
• topic: Health economics; Cost-benefit analysis; Cardiotoxicity; Cancer therapy; Economia da saúde; Análise de custo-benefício; Cardiotoxicidade; Terapêutica do cancro

Cardiotoxicity caused by cancer therapy can be monitored using LVEF assessment. This dissertation aims to develop a cost-benefit model to analyze a LVEF assessment using a healthcare payer perspective and five, ten and thirty years time horizon. A Markov model, informed by the retrospective clinical course of 109 patients followed by Hospital de Santa Maria, Portugal on transitional probabilities, was built to assess the cost-benefit of LVEF assessment. Costs and utilities were assessed over a 5, 10 and 30-year range, with sensitivity analyses for significant variables. In the reference cases of a 50 years old and 60 years old patients treated in LVEF assessment, the 5-year time horizon (4.23 QALYS and €5,824 cost over 5 years) and (3.79 QALYs and €13,657 cost over 5 years), respectively dominated the 10 and 30-year time horizon. Under a time horizon of 5 years at a Willingness to Pay threshold of €375.000, over 53,6% and 50,3% of simulation adds QALYs above average for patients starting treatment with 50 and 60 years old, respectively. Monte Carlo simulation of the Markov model had no effect on model conclusions. From a Portuguese health payer perspective, the analysis of cost-benefit in cardiotoxicity suggest that the costs per QALY increase substantially with the time horizon and with the starting age. Also, the probability of additional QALY relatively to the average QALY of the hypothetical cohort of 1000 patients at Willingness to pay decreases with the increase of the time horizon and with the starting age.