help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Published ahead of print on February 5, 2003, doi:10.1164/rccm.200209-1035OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 10, May 2003, 1387-1392

A more recent version of this article appeared on May 15, 2003
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
200209-1035OCv1
167/10/1387    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gildea, T. R
Right arrow Articles by Stoller, J. K
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gildea, T. R
Right arrow Articles by Stoller, J. K

Submitted on September 13, 2002
Accepted on February 3, 2003

Cost-Effectiveness Analysis of Augmentation Therapy for Severe Alpha 1-Antitrypsin Deficiency

Thomas R Gildea1*, Kenneth M Shermock2, Mendel E Singer3, and James K Stoller1

1 Pulmonary and Critical Care Medicine and Pharmacy, The Cleveland Clinic Foundation, Cleveland, OH, USA, 2 Center for Pharmaceutical Outcomes and Policy, The Johns Hopkins Hospital, Baltimore, MD, USA, 3 Center for Quality Improvement Research, Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA; Institute for Public Health Sciences, MetroHealth Medical Center, Cleveland, OH, USA

* To whom correspondence should be addressed. E-mail: gildeat{at}ccf.org.

A Markov-based decision model was created to assess the cost-effectiveness of augmentation therapy (Aug) for severe alpha 1-antitrypsin (AAT) deficiency, comparing strategies of: 1. No Aug, 2. Aug for life, and 3. Aug until FEV1 < 35% predicted. A hypothetical cohort of 46 year old patients with FEV1 49% predicted was followed over time using Monte Carlo simulation across 5 possible health states: 1. FEV1 50-79% predicted, 2. FEV1 35-49% predicted, 3. FEV1 < 35% predicted, 4. Status-post lung transplantation, and 5. Dead. Treatment for life yielded 7.19 quality-adjusted life-years (QALYs) and cost $895,243. Treating until FEV1 < 35% predicted cost $511,930 and produced 6.64 QALYs. "No Aug" cost $92,091 with 4.62 QALYs. The incremental cost-effectiveness ratio (ICER) was $207,841/QALY for Aug until FEV1 < 35% predicted and $312,511/QALY for the "Aug for life" strategy. In all sensitivity analyses, the ICER for "Aug for life" exceeded $100,000. The cost of Aug needed to be reduced from $54,765 to $4,900 for the "Aug for life" strategy to become cost-effective. We conclude that, compared with other conventionally used health interventions, Aug is less cost-effective. These results should encourage the development of more clinically and cost-effective therapies for AAT deficiency.
Key words: cost-effectivness, alpha 1-antitrypsin defiency, decision analysis




This article has been cited by other articles:


Home page
 Arch Intern MedHome page
J. K. Stoller and L. S. Aboussouan
Myths and Misconceptions About {alpha}1-Antitrypsin Deficiency
Arch Intern Med, March 23, 2009; 169(6): 546 - 550.
[Full Text] [PDF]

Home page
 ChestHome page
R. A. Sandhaus, G. Turino, J. Stocks, C. Strange, B. C. Trapnell, E. K. Silverman, S. E. Everett, J. K. Stoller, and for the Medical and Scientific Advisory Committee
{alpha}1-Antitrypsin Augmentation Therapy for PI*MZ Heterozygotes: A Cautionary Note
Chest, October 1, 2008; 134(4): 831 - 834.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
J K Stoller and L S Aboussouan
{alpha}1-Antitrypsin deficiency {middle dot} 5: Intravenous augmentation therapy: current understanding
Thorax, August 1, 2004; 59(8): 708 - 712.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
M. D. Wewers
{alpha}1-Antitrypsin Deficiency: More Than a Protease Imbalance?
Chest, May 1, 2004; 125(5): 1607 - 1609.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
M. J. Tobin
Chronic Obstructive Pulmonary Disease, Pollution, Pulmonary Vascular Disease, Transplantation, Pleural Disease, and Lung Cancer in AJRCCM 2003
Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 301 - 313.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
American Thoracic Society/European Respiratory Society Statement: Standards for the Diagnosis and Management of Individuals with Alpha-1 Antitrypsin Deficiency
Am. J. Respir. Crit. Care Med., October 1, 2003; 168(7): 818 - 900.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2003 American Thoracic Society 		  CCM abstracts