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Cherry MG, Greenhalgh J, Osipenko L, et al. The Clinical Effectiveness and Cost-Effectiveness of Primary Stroke Prevention in Children with Sickle Cell Disease: A Systematic Review and Economic Evaluation. Southampton (UK): NIHR Journals Library; 2012 Nov. (Health Technology Assessment, No. 16.43.)

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The Clinical Effectiveness and Cost-Effectiveness of Primary Stroke Prevention in Children with Sickle Cell Disease: A Systematic Review and Economic Evaluation.

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Appendix 3Assumptions used in the cost-effectiveness analysis

TABLE 39Assumptions used in the economic model

AssumptionReason
TCD scans start at the age of 2 years and are repeated once a year for those with blood velocity of < 200 cm/second until the age of 18 yearsDefined by the briefing document
TCD scans start at the age of 2 years and are repeated every year for those with blood velocity of > 200 cm/second until the age of 18 yearsClinical practice
Population enters the model stroke free (no previous strokes have been experienced by a patient)Defined by the briefing document
Once blood transfusions are initiated, they continue until adulthoodSimplification based on clinician's opinion
Adherence to chelation is assumed to be 100%Simplification
Only three strokes are modelled owing to an assumption that no-one survives a fourth strokeClinical opinion
The population can move to ‘transfusion > 200 cm/second’ only by first going through ‘no transfusion > 200 cm/second’, i.e. the population cannot directly move from ‘no transfusion < 200 cm/second’ to ‘transfusion > 200 cm/second’ or vice versaModel structure enforced assumption. Patients are kept in ‘no transfusion’ state for one cycle only
Post 18 years of age, the model is simplified to no longer account for annual TCD scan resultsThe briefing document states age 16 years, but experts are recommended to use 18 years
Post-stroke patients remain in the same state until they have a subsequent strokeClinical opinion and simplification
At the age of 18 years, patients remain in either ‘transfusion’ or ‘no transfusion’ until they die, unless patients have a stroke and are moved into a post-stroke health stateClinical opinion and simplification
QoL of those with SCD on blood transfusion is similar to that for patients with thalassaemia who are on blood transfusion. Data from the Osborne et al.82 time trade-off study using utility values from the general public have been applied to the modelled population including children between the ages of 2 and 18 yearsAssumption
Effect data from Adams et al.31 trial for 1 year is the same for ages 2–18 yearsAssumption
© 2012, Crown Copyright.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK115678

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