Cost-Effectiveness Analysis of Crizanlizumab in Sickle Cell Disease in Iran
Background: Sickle cell disease (SCD) prevalence is predicted to rise dramatically in the upcoming years. Although several medications have received Food and Drug Administration (FDA) approval in recent years, low- and middle-income countries (LMICs) still struggle to access these medications due to...
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Shiraz University of Medical Sciences
2025-08-01
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| Series: | Iranian Journal of Medical Sciences |
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| Online Access: | https://ijms.sums.ac.ir/article_51078_3ed130f6ad6d84cd2a423316653e315f.pdf |
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| author | Marzieh Nosrati Shadi Izadidehkordi Shekoufeh Nikfar Fatemeh Sadat Heydari |
| author_facet | Marzieh Nosrati Shadi Izadidehkordi Shekoufeh Nikfar Fatemeh Sadat Heydari |
| author_sort | Marzieh Nosrati |
| collection | DOAJ |
| description | Background: Sickle cell disease (SCD) prevalence is predicted to rise dramatically in the upcoming years. Although several medications have received Food and Drug Administration (FDA) approval in recent years, low- and middle-income countries (LMICs) still struggle to access these medications due to their remarkably high prices. Crizanlizumab, owing to its clinical and economic privileges, appears to be the most suitable option for addition to pharmacotherapy guidelines. However, no study has yet investigated its cost-effectiveness in Iran’s healthcare system. Methods: This cost-effectiveness evaluation was conducted in 2022 at the Pharmacoeconomic and Pharmaceutical Administration Department of the Faculty of Pharmacy at Tehran University of Medical Sciences, Tehran, Iran. A decision-tree model was designed, followed by a cost-utility analysis for crizanlizumab in two separate scenarios, targeting not only monotherapy with crizanlizumab in SCD compared with placebo, but also crizanlizumab’s concomitant use with hydroxyurea compared with hydroxyurea. The study reports the outcomes from Iran’s healthcare system perspective. Direct medical costs, quality-adjusted life years related to vaso-occlusive crisis, hospitalizations, and adverse effects were calculated. Incremental cost-effectiveness ratios were compared. SUSTAIN trial was the main clinical source for modeling crizanlizumab’s effectiveness in SCD. A sensitivity analysis was performed to measure the sensitivity of outcomes to changes in medication costs. Microsoft Excel 2020 was utilized for calculations and modeling. Results: Concomitant therapy with low-dose crizanlizumab added to hydroxyurea led to the lowest Incremental Cost Effectiveness Ratio (ICER) of 398,881 United States dollars (USD), exceeding Iran’s accepted cost-effectiveness threshold. Sensitivity analysis results demonstrate that even a 20% reduction in the price of crizanlizumab does not lead to its cost-effectiveness in Iran.Conclusion: Crizanlizumab administration in sickle cell disease is not found cost-effective in Iran, neither as a monotherapy nor added to hydroxyurea. |
| format | Article |
| id | doaj-art-58695fb75238417ca33468e2b0e13ed3 |
| institution | Kabale University |
| issn | 0253-0716 1735-3688 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Shiraz University of Medical Sciences |
| record_format | Article |
| series | Iranian Journal of Medical Sciences |
| spelling | doaj-art-58695fb75238417ca33468e2b0e13ed32025-08-25T03:45:16ZengShiraz University of Medical SciencesIranian Journal of Medical Sciences0253-07161735-36882025-08-0150854855510.30476/ijms.2025.102567.357351078Cost-Effectiveness Analysis of Crizanlizumab in Sickle Cell Disease in IranMarzieh Nosrati0Shadi Izadidehkordi1Shekoufeh Nikfar2Fatemeh Sadat Heydari3Personalized Medicine Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, IranDepartment of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, IranPersonalized Medicine Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, IranDepartment of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, IranBackground: Sickle cell disease (SCD) prevalence is predicted to rise dramatically in the upcoming years. Although several medications have received Food and Drug Administration (FDA) approval in recent years, low- and middle-income countries (LMICs) still struggle to access these medications due to their remarkably high prices. Crizanlizumab, owing to its clinical and economic privileges, appears to be the most suitable option for addition to pharmacotherapy guidelines. However, no study has yet investigated its cost-effectiveness in Iran’s healthcare system. Methods: This cost-effectiveness evaluation was conducted in 2022 at the Pharmacoeconomic and Pharmaceutical Administration Department of the Faculty of Pharmacy at Tehran University of Medical Sciences, Tehran, Iran. A decision-tree model was designed, followed by a cost-utility analysis for crizanlizumab in two separate scenarios, targeting not only monotherapy with crizanlizumab in SCD compared with placebo, but also crizanlizumab’s concomitant use with hydroxyurea compared with hydroxyurea. The study reports the outcomes from Iran’s healthcare system perspective. Direct medical costs, quality-adjusted life years related to vaso-occlusive crisis, hospitalizations, and adverse effects were calculated. Incremental cost-effectiveness ratios were compared. SUSTAIN trial was the main clinical source for modeling crizanlizumab’s effectiveness in SCD. A sensitivity analysis was performed to measure the sensitivity of outcomes to changes in medication costs. Microsoft Excel 2020 was utilized for calculations and modeling. Results: Concomitant therapy with low-dose crizanlizumab added to hydroxyurea led to the lowest Incremental Cost Effectiveness Ratio (ICER) of 398,881 United States dollars (USD), exceeding Iran’s accepted cost-effectiveness threshold. Sensitivity analysis results demonstrate that even a 20% reduction in the price of crizanlizumab does not lead to its cost-effectiveness in Iran.Conclusion: Crizanlizumab administration in sickle cell disease is not found cost-effective in Iran, neither as a monotherapy nor added to hydroxyurea.https://ijms.sums.ac.ir/article_51078_3ed130f6ad6d84cd2a423316653e315f.pdfcost-effectiveness analysiscrizanlizumabsickle cell diseasesickle cell anemiaadakveo |
| spellingShingle | Marzieh Nosrati Shadi Izadidehkordi Shekoufeh Nikfar Fatemeh Sadat Heydari Cost-Effectiveness Analysis of Crizanlizumab in Sickle Cell Disease in Iran Iranian Journal of Medical Sciences cost-effectiveness analysis crizanlizumab sickle cell disease sickle cell anemia adakveo |
| title | Cost-Effectiveness Analysis of Crizanlizumab in Sickle Cell Disease in Iran |
| title_full | Cost-Effectiveness Analysis of Crizanlizumab in Sickle Cell Disease in Iran |
| title_fullStr | Cost-Effectiveness Analysis of Crizanlizumab in Sickle Cell Disease in Iran |
| title_full_unstemmed | Cost-Effectiveness Analysis of Crizanlizumab in Sickle Cell Disease in Iran |
| title_short | Cost-Effectiveness Analysis of Crizanlizumab in Sickle Cell Disease in Iran |
| title_sort | cost effectiveness analysis of crizanlizumab in sickle cell disease in iran |
| topic | cost-effectiveness analysis crizanlizumab sickle cell disease sickle cell anemia adakveo |
| url | https://ijms.sums.ac.ir/article_51078_3ed130f6ad6d84cd2a423316653e315f.pdf |
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