Hematopoietic Stem Cell Transplantation versus Immunosuppressive Therapy in Patients with Acquired Severe Aplastic Anemia: A Cost-Effectiveness Analysis

BackgroundControversy remains regarding which therapy to initially select for severe aplastic anemia (SAA) patients aged 35-50-years-old. This analysis of cost-effectiveness using a Markov model compared immunosuppressive therapy (IST) with hematopoietic stem cell transplantation (HSCT) in age-stratified patients with SAA.MethodsIn younger patients (aged 18-35-years-old), HSCT yielded 22.67 quality-adjusted life years (QALYs), compared with 12.21 QALYs for IST therapy, offering an expected benefit with HSCT of 10.46 QALY.ResultsThe HSCT strategy dominated in younger patients, though it was $146,970 more expensive than IST and the ICER of HSCT to IST was $14,054.19/QALY, which was less than the willingness to pay (WTP) value of $25,397.57/QALY. The IST strategy dominated in older patients because it was $72,009 less expensive than HSCT and yielded 3.24 QALYs more than HSCT. The model was vigorous in the sensitivity analyses of the key variables tested through the plausible ranges that were acquired from costing sources and previously-published literature.ConclusionsThe preferred induction strategy for younger patients with SAA appears to be HSCT and the preferred strategy for older patients is IST, which minimizes cost while maximizing QALYs.