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This analysis evaluated cost-effectiveness of adding ropeginterferon alfa-2b (ropegIFN\u03b1) to phlebotomy in patients with low-risk PV (those younger than 60 years without prior thrombosis), compared to phlebotomy alone. We combined a 12-month decision tree with a semi-Markov cohort model comparing ropegIFN\u03b1 to the standard treatment from the Austrian healthcare system perspective over 30 years. Outcomes were quality adjusted life years (QALYs), costs, and incremental cost-utility ratio (ICUR). Model inputs were obtained from the phase 2 Low-PV study, additional published literature and from Austrian-specific cost databases. One-way and probabilistic sensitivity analyses (SA) assessed the robustness of findings. RopegIFN\u03b1 led to 1,43 higher QALYs and 50.960 EUR overall higher costs compared to phlebotomy alone, with an ICUR of 35.525 EUR\/QALY. Thrombosis, MF, and AML costs decreased for the ropegIFN\u03b1 group by 12%, 30% and 16% respectively, due to the delayed complications onset and disease progression. In the one-way SA, ropegIFN\u03b1 costs and discount rates had the greatest impact on results. The probabilistic SA showed a 100% probability of cost-effectiveness at willingness-to-pay threshold aligned to the Austrian GDP per capita. RopegIFN\u03b1 is a cost-effective treatment option for patients with low-risk PV. These findings suggest that early treatment with ropegIFN\u03b1 could ensure optimal resource allocation by preventing costly thrombotic events and progression to MF whilst increasing patient quality of life.<\/jats:p>","DOI":"10.1007\/s00277-025-06229-w","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T09:55:42Z","timestamp":1738317342000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-utility analysis of ropeginterferon alfa-2b to manage low-risk patients with polycythemia vera as compared to phlebotomy only in the Austrian healthcare system"],"prefix":"10.1007","author":[{"given":"Evelyn","family":"Walter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2177-8186","authenticated-orcid":false,"given":"Francesca","family":"Torelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziano","family":"Barbui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"issue":"1","key":"6229_CR1","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1002\/ajh.26751","volume":"98","author":"J Thiele","year":"2023","unstructured":"Thiele J, Kvasnicka HM, Orazi A, Gianelli U, Gangat N, Vannucchi AM et al (2023) The international consensus classification of myeloid neoplasms and acute Leukemias: myeloproliferative neoplasms. 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