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Value of mesenchymal stem cell therapy for patients with septic shock: an early health economic evaluation

Published online by Cambridge University Press:  16 October 2020

Kednapa Thavorn Open the ORCID record for Kednapa Thavorn [Opens in a new window] ,
Sasha van Katwyk ,
Murray Krahn ,
Shirley H.J. Mei ,
Duncan J. Stewart ,
Dean Fergusson ,
Doug Coyle  and
Lauralyn McIntyre
Kednapa Thavorn*
Affiliation:
Ottawa Hospital Research Institute, Ontario, Canada School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
Sasha van Katwyk
Affiliation:
Ottawa Hospital Research Institute, Ontario, Canada School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
Murray Krahn
Affiliation:
Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Ontario, Canada
Shirley H.J. Mei
Affiliation:
Ottawa Hospital Research Institute, Ontario, Canada
Duncan J. Stewart
Affiliation:
Regenerative Medicine Program, Ottawa Hospital Research Institute, Ontario, Canada Department of Cell and Molecular Medicine, University of Ottawa, Ontario, Canada
Dean Fergusson
Affiliation:
Ottawa Hospital Research Institute, Ontario, Canada
Doug Coyle
Affiliation:
School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
Lauralyn McIntyre
Affiliation:
Ottawa Hospital Research Institute, Ontario, Canada Department of Medicine (Division of Critical Care), University of Ottawa, Ottawa, Canada
*
Author for correspondence: Kednapa Thavorn, E-mail: kthavorn@ohri.ca
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Abstract

Background.

This study estimates the maximum price at which mesenchymal stem cell (MSC) therapy is deemed cost-effective for septic shock patients and identifies parameters that are most important in making treatment decisions.

Methods

We developed a probabilistic Markov model according to the sepsis care trajectory to simulate costs and quality-adjusted life years (QALYs) of septic shock patients receiving either MSC therapy or usual care over their lifetime. We calculated the therapeutic headroom by multiplying the gains attributable to MSCs with willingness-to-pay (WTP) threshold and derived the maximum reimbursable price (MRP) from the expected net monetary benefit and savings attributable to MSCs. We performed scenario analyses to assess the impact of changes to assumptions on the study findings. A value of information analysis is performed to identify parameters with greatest impact on the uncertainty around the cost-effectiveness of MSC therapy.

Results

At a WTP threshold of $50,000 per QALY, the therapeutic headroom and MRP of MSC therapy were $20,941 and $16,748, respectively; these estimates increased with the larger WTP values and the greater impact of MSCs on in-hospital mortality and hospital discharge rates. The parameters with greatest information value were MSC's impact on in-hospital mortality and the baseline septic shock in-hospital mortality.

Conclusion

At a common WTP of $50,000/QALY, MSC therapy is deemed to be economically attractive if its unit cost does not exceed $16,748. This ceiling price can be increased to $101,450 if the therapy significantly reduces both in-hospital mortality and increases hospital discharge rates.

Keywords

Early economic evaluationeconomic analysismaximum reimbursable pricemesenchymal stem cellseptic shock
Type
Assessment
Information
International Journal of Technology Assessment in Health Care , Volume 36 , Issue 5 , October 2020 , pp. 525 - 532
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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