Medical cost analysis reveals systemic health inequities faced by people with sickle cell disease


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A new dissemination cost-effectiveness analysis of gene therapy and standard-of-care for sickle cell disease (SCD) suggests that although gene therapy is cost-effective by conventional measures, it may be an equitable treatment strategy for people living with SCD. United States Medical Equity, Cost, and Value Taken Together.

These findings highlight the systemic health inequities that people face Sickle cell disease (SCD) According to the authors, this is the first quantitative assessment of health equity for patients with SCD regarding the decision between them. Gene therapy and routine care and the first study of its kind in any A rare disease. The analysis was published in Annals of internal medicine.

People with SCD experience significant mortality and reduced quality of life during the year they live with the disease. SCD occurs most often in people whose ancestors are from sub-Saharan Africa and other parts of the world who have or are familiar with malaria. In the United States, this means that patients are mostly from socially disadvantaged ethnic minorities. Gene therapy can eliminate lifelong disease without the risks associated with allo-transplantation, but it is very expensive.

Yale University School of Medicine researchers analyzed claims data and other published sources to compare gene therapy and standard care in patients with SDD using conventional cost-effectiveness and cost-effectiveness measures.

Although conventional cost-effectiveness analysis does not capture the effects of treatment differences, distributional cost-effectiveness uses equity weights to account for these issues. The authors found that total quality-adjusted life years, or QALYs, were for people receiving Gene therapy It costs $2.8 million versus $1.2 million for people receiving standard care for SCD.

According to the authors, the inequality aversion parameter should be 0.90 for gene therapy for the entire SCD population to be selected by distributional cost-effectiveness criteria. This is consistent with previously reported benchmark values ​​for inequality in the United States (0.5-3.0), with higher values ​​indicating greater focus on reducing specific health disparities.

Accompanying editor from York University Center for Health Economics; York, United Kingdom The results of this analysis highlight that US health care payers do not provide a simple answer to how much they should be willing to pay to increase health equity, but provide quantitative data to help make clear and consistent decisions.

The author argues that to help reduce health disparities, health care payers should invest more in equity-enhancing technologies for conditions that disproportionately affect disadvantaged populations and often go undiagnosed and poorly managed in such populations.


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