Cost-effectiveness Analysis of Deferiprone and Deferasirox on Thalassemia Major Patients in Tangerang District Hospital, Indonesia

Background: Blood transfusion are needed in improving the quality of life of thalassemia major patients. However since it can lead to excess iron, the iron chelation therapy is needed. Deferiprone and deferasirox are the most often used therapy in Indonesia. Objective: The aim of this study was to compare the cost-effectiveness of deferasirox with deferiprone with cost-effectiveness analysis (CEA). Methods: Data were taken retrospectively and sampling was done using total sampling based on medical records and hospital information system. Serum ferritin levels of patients consuming deferasirox (n=27) and deferiprone (n=33) were measured to observe the mean changes of serum ferritin levels as effectiveness' parameter.The cost was median of the total direct medical cost, summed from the cost of drugs, medical devices, hospitalization, administration, physician, laboratories and blood bags. Results: Based on the results of this study, the effectiveness of deferasirox (1164 ng/mL) was greater than deferiprone (692 ng/mL). Median total cost of deferasirox was more expensive (Rp 76,610,618.69) than deferiprone (Rp 51,869,965.64). Cost-effectiveness ratio of deferasirox (CER: Rp 65,816.68/effectiveness) was lower than deferiprone (CER: Rp 74,956.60/ effectiveness). None of both medications was dominant and therefore we could not determine which medication was the most cost-effective therapy. Changing of medication from deferiprone to deferasirox requires an extra cost of Rp 52,416.64 per one incremental unit of effectivity. Conclusion: The policy maker in healthcare facility need to consider the budget and whether the incremental cost of deferasirox is proportional to its increased effectiveness.