Cost-Effectiveness of Peripheral Neuropathy Screening in Patients With Thalassemia: A Hybrid Decision-Markov Model

OBJECTIVES: To evaluate the cost-effectiveness of a systematic screening program for thalassemia-related peripheral neuropathy (ThalPN) compared with standard care in Malaysia. METHODS: A hybrid decision-Markov model was developed to simulate the lifetime health outcomes and costs for a hypothetical cohort of adult thalassemia patients (both transfusion-dependent and non-transfusion-dependent). The analysis was conducted from a healthcare provider perspective, utilizing the neuropathy symptomatic score and neuropathy disability score as screening tools. The model was populated with data from the Malaysian Thalassemia Registry, a clinical cohort study for prevalence and utility values, and published literature. Costs and health outcomes were discounted at 3% annually. RESULTS: The screening strategy for ThalPN was found to be highly cost-effective across all age cohorts compared with standard care. The incremental cost-effectiveness ratio was most favorable in the ≥40 age group at USD 2027 per quality-adjusted life-year gained. The incremental cost-effectiveness ratios for the 18 to 29 and 30 to 39 age groups were USD 2951 and USD 3209 per quality-adjusted life-year gained, respectively. CONCLUSIONS: Incorporating a ThalPN screening program into standard care is a cost-effective strategy. By facilitating early intervention, screening can prevent or slow irreversible disease progression, thereby improving health-related quality of life and potentially reducing long-term costs for this patient population.