Modelling the resource implications of managing adults with Fabry disease in Norway favours home infusion.

Authors: JF Guest, T Jenssen , G Houge, W Aaseboe, C Tøndel & E Svarstad.
Source: European Journal Of Clinical Investigation 2010; Epub November 2010.

ABSTRACT

Background: To estimate the resource implications and budget impact of managing adults with Fabry disease in Norway, from the perspective of the publicly funded healthcare system.

Methods: A decision model was constructed using published clinical outcomes and clinician-derived resource utilisation estimates. The model was used to estimate the annual healthcare cost of managing a cohort of 64 adult Fabry patients in an average year.

Results: The expected annual cost of managing 60 existing Fabry disease patients and 4 new patients in Norway each year was estimated to be NOK 55.8 million (€6.7 million). In an average year, patients receiving enzyme replacement therapy (ERT) with agalsidase alfa (Replagal®) at 0.2mg/kg or agalsidase beta (Fabrazyme®) at 1.0mg/kg are collectively expected to make 586 attendances to their family practitioner’s office for their infusions, which equates to 128 eight-hour days associated with ERT. Encouraging more patients to undergo home-based infusions has enormous potential to free-up community-based resources. In comparison, the community-related benefit that can be obtained by switching from agalsidase beta (1.0mg/kg) to agalsidase alpha (0.2mg/kg) is marginal, and dependent on the two doses being clinically equivalent.

Conclusions: Maximising the proportion of adults with Fabry disease undergoing home-based infusions has the potential to release community-based resources for alternative use by non-Fabry patients, thereby improving the efficiency of the publicly funded healthcare system in Norway.