수혈의존성 헤모시데린침착증 치료제의 투여경로 변화에 따른 경제성 평가: 주사제와 경구제의 비교
Economic Evaluation of Iron Chelation Agents: Oral Deferasirox versus Infusional Deferoxamine

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김진현; 김윤희
Issue Date
대한혈액학회 = The Korean Society of Hematology
Korean J Hematol 2008;43:89-97
DeferasiroxDeferoxamineIron chelating agentsCost analysisCost utility analysis
배경: Deferoxamine은 철 킬레이트 요법의 표준치료로 사용되어 왔으나 1주일에 5∼7일 하루에 8∼12시간 주사에 의해 투입해야 하기 때문에 순응도가 낮았다. 최근 1일 1회 경구투여할 수 있는 deferasirox가 철 킬레이트 요법으로 개발되었는바 기존 주사요법에 비해 경제적인 방법인지를 평가하였다.

방법: Deferasirox 20mg (/kg/일)이 deferoxamine 40 mg (/kg/일)에 비해 비열등하다는 임상문헌 결과에 따라 두 약물 간 효과가 동일하다고 전제하고, 주사제와 경구투여제의 차이에서 비롯되는 편의성과 약물투여시간 및 의료기관방문시간에 중점을 두고 비용최소화분석과 비용-효용분석을 실시하였다. 비용최소화분석에서는 두 약물의 약제비용 및 수반되는 직접의료비용뿐 아니라 교통비를 비의료비 항목으로 설정하였고 간접비용으로 의료비용으로 인한 작업손실비용을 고려하였다. 비용-효용 분석에서는 작업손실비용을 제외하고 두 약물의 효용가중치(utility weight)를 반영한 QALY를 계산하여 비용-효용비를 산출하였다.

결과: 비용최소화분석에서 deferasirox가 deferoxamine에 비해 23,471,777원의 비용이 절감되는 것으로 나타났으며, 비용-효용분석에서는 deferasirox가 4,527,819원의 비용이 절감되면서 11.35QALYs의 개선을 가져와 우월전략(ICER=?355,648원)으로 나타났다.

결론: 경구제인 deferasirox와 주사제인 deferoxamine을 사회적 관점에서 경제성 평가를 한 결과 비용최소화분석과 비용-효용분석에서 철 킬레이트 요법으로서 deferasirox가 deferoxamine보다 경제적인 약제로 평가되었다.

Background: Patients with transfusional iron overload have relied on treatment with deferoxamine, a standard chelating agent. Deferoxamine is administered by intravenous or subcutaneous infusion over an 8∼12 hour period 5∼7 times per week; however, administration of deferoxamine may lead to poor compliance and reduced quality of life in patients. The use of deferasirox, a once daily oral chelation agent, was recently approved. We conducted an economic evaluation of these two iron-chelating medications in transfusion-dependent patients.

Methods: The efficacy of oral deferasirox and infusion deferoxamine was assumed equal based on clinical trials of non-inferiority with the administration of 20mg/kg/day deferasirox versus 40mg/kg/day deferoxamine. Depending on the methods utilized for measuring administration time, travel time and convenience between the use of infusion and oral therapy, either cost analysis or cost-utility analysis was undertaken, respectively. Cost analysis included determination of direct medical costs (drug costs and administration costs), non-medical costs (travel costs), and indirect costs(productivity loss associated medical utilization). For cost utility analysis, the cost per QALYs (quality-adjusted life years) was calculated based on costs subtracting indirect costs (productivity loss) and gains of QALYs between the two agents.
Results: Deferasirox therapy resulted in a cost savings per patient of 23,471,777 Korean won based on cost analysis. Based on cost utility analysis, the cost per QALYs gained was ?398,576 Korean won (4,527,819 Korean won savings with a gain of 11.5 QALYs per patient).

Conclusion: The results of cost analysis and cost utility analysis of the use of oral deferasirox versus infusion deferoxamine showed that deferasirox is a more economical and potentially socially beneficial iron-chelating agent in Korea.
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