Population screening for hereditary haemochromatosis in Australia

construction and validation of a state-transition cost-effectiveness model

Barbara de Graaff, Lei Si, Amanda L. Neil, Kwang Chien Yee, Kristy Sanderson, Lyle C. Gurrin, Andrew J. Palmer

Research output: Contribution to journalArticle

3 Citations (Scopus)
11 Downloads (Pure)

Abstract

Introduction: HFE-associated haemochromatosis, the most common monogenic disorder amongst populations of northern European ancestry, is characterised by iron overload. Excess iron is stored in parenchymal tissues, leading to morbidity and mortality. Population screening programmes are likely to improve early diagnosis, thereby decreasing associated disease. Our aim was to develop and validate a health economics model of screening using utilities and costs from a haemochromatosis cohort. Methods: A state-transition model was developed with Markov states based on disease severity. Australian males (aged 30 years) and females (aged 45 years) of northern European ancestry were the target populations. The screening strategy was the status quo approach in Australia; the model was run over a lifetime horizon. Costs were estimated from the government perspective and reported in 2015 Australian dollars ($A); costs and qualityadjusted life-years (QALYs) were discounted at 5% annually. Model validity was assessed using goodness-of- fit analyses. Second-order Monte-Carlo simulation was used to account for uncertainty in multiple parameters. Results: For validity, the model reproduced mortality, life expectancy (LE) and prevalence rates in line with published data. LE for C₂8₂Y homozygote males and females were 49.9 and 40.2 years, respectively, slightly lower than population rates. Mean (95% confidence interval) QALYS were 15.7 (7.7-23.7) for males and 14.4 (6.7-22.1) for females. Mean discounted lifetime costs for C282Y homozygotes were $A22,737 (3670-85,793) for males and $A13,840 (1335-67,377) for females. Sensitivity analyses revealed discount rates and prevalence had the greatest impacts on outcomes. Conclusion: We have developed a transparent, validated health economics model of C₂8₂Y homozygote haemochromatosis. The model will be useful to decision makers to identify cost-effective screening strategies.
Original languageEnglish
Pages (from-to)37-51
Number of pages15
JournalPharmacoEconomics - Open
Volume1
Issue number1
DOIs
Publication statusPublished - Mar 2017
Externally publishedYes

Bibliographical note

Copyright The Author(s) 2016. This article is published with open access at Springerlink.com. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • Iron Overload
  • C₂8₂Y Homozygote
  • Northern European Ancestry
  • Irreversible Organ Damage
  • C₂8₂Y Homozygosity

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