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132:poster Cost-effectiveness of using hydroxyurea to treat sickle cell anemiain uganda: a model-based comparison of two dosing regimens
  1. David Teigen1,
  2. Robert O Opoka2,
  3. Philip Kasirye2,3,
  4. Catherine Nabaggala2,
  5. Heather A Hume4,
  6. Bjørn Blomberg5,6,
  7. Chandy C John7,
  8. Russell E Ware8,
  9. Bjarne Robberstad1
  1. 1Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
  2. 2Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
  3. 3Directorate of Paediatrics and Child Health, Mulago National Referral Hospital, Kampala, Uganda
  4. 4Centre hospitalier universitaire Ste-Justine, Université de Montréal, Montréal QC, Canada
  5. 5Department of Clinical Science, University of Bergen, Bergen, Norway
  6. 6National Advisory Unit for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
  7. 7Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, IN, USA
  8. 8Division of Hematology, Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH, USA


Background Recognition of the burden of sickle cell anaemia (SCA) in sub-Saharan African (SSA) countries is increasing, with few therapies available for clinical management. Hydroxyurea is the only disease-modifying therapy that has proven feasible and clinically efficacious in low-income countries in SSA; however, the health economic implications of its use in this region have not been quantified. Thus, we examined the incremental cost-effectiveness of hydroxyurea given as a fixed-dose regimen or at the maximum tolerated dose (MTD).

Methods We estimated the cost of outpatient treatment at a specialized sickle cell clinic in Kampala, Uganda, from a provider’s perspective. These estimates were used in a discrete-event simulation model to project mean costs (US$), disability-adjusted life years (DALYs), and consumption of blood products per patient (450 ml units). We calculated cost-effectiveness as the ratio of incremental costs over incremental DALYs averted, discounted at 3% annually.

Findings For Ugandan patients under the age of 18, we predicted that hydroxyurea at the MTD would avert an expected 1.38 DALYs and save US$ 111 per patient compared to standard care, while hydroxyurea at a fixed dose would avert 0.81 DALYs per patient at an incremental cost of US$ 21. Additionally, we predicted that the fixed-dose alternative would save 9.2 (95% CI 9.0–9.3) units of whole-blood equivalents per patient, while the MTD strategy saved 11.3 (95% CI 11.1–11.4) units of blood per patient.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: .

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