Title | Cost-effectiveness of Tyrosine Kinase Inhibitor Treatment Strategies for Chronic Myeloid Leukemia in Chronic Phase After Generic Entry of Imatinib in the United States. |
Publication Type | Journal Article |
Year of Publication | 2016 |
Authors | Padula WV, Larson RA, Dusetzina SB, Apperley JF, Hehlmann R, Baccarani M, Eigendorff E, Guilhot J, Guilhot F, Hehlmann R, Mahon F-X, Martinelli G, Mayer J, Müller MC, Niederwieser D, Saussele S, Schiffer CA, Silver RT, Simonsson B, Conti RM |
Journal | J Natl Cancer Inst |
Volume | 108 |
Issue | 7 |
Date Published | 2016 Jul |
ISSN | 1460-2105 |
Keywords | Adult, Aged, Antineoplastic Agents, Cost-Benefit Analysis, Drugs, Generic, Female, Humans, Imatinib Mesylate, Leukemia, Myelogenous, Chronic, BCR-ABL Positive, Male, Markov Chains, Middle Aged, Models, Econometric, Practice Patterns, Physicians', Protein Kinase Inhibitors, Protein-Tyrosine Kinases, Quality-Adjusted Life Years, Survival Analysis, Treatment Outcome, United States |
Abstract | BACKGROUND: We analyzed the cost-effectiveness of treating incident chronic myeloid leukemia in chronic phase (CML-CP) with generic imatinib when it becomes available in United States in 2016. In the year following generic entry, imatinib's price is expected to drop 70% to 90%. We hypothesized that initiating treatment with generic imatinib in these patients and then switching to the other tyrosine-kinase inhibitors (TKIs), dasatinib or nilotinib, because of intolerance or lack of effectiveness ("imatinib-first") would be cost-effective compared with the current standard of care: "physicians' choice" of initiating treatment with any one of the three TKIs. METHODS: We constructed Markov models to compare the five-year cost-effectiveness of imatinib-first vs physician's choice from a US commercial payer perspective, assuming 3% annual discounting ($US 2013). The models' clinical endpoint was five-year overall survival taken from a systematic review of clinical trial results. Per-person spending on incident CML-CP treatment overall care components was estimated using Truven's MarketScan claims data. The main outcome of the models was cost per quality-adjusted life-year (QALY). We interpreted outcomes based on a willingness-to-pay threshold of $100 000/QALY. A panel of European LeukemiaNet experts oversaw the study's conduct. RESULTS: Both strategies met the threshold. Imatinib-first ($277 401, 3.87 QALYs) offered patients a 0.10 decrement in QALYs at a savings of $88 343 over five years to payers compared with physician's choice ($365 744, 3.97 QALYs). The imatinib-first incremental cost-effectiveness ratio was approximately $883 730/QALY. The results were robust to multiple sensitivity analyses. CONCLUSION: When imatinib loses patent protection and its price declines, its use will be the cost-effective initial treatment strategy for CML-CP. |
DOI | 10.1093/jnci/djw003 |
Alternate Journal | J. Natl. Cancer Inst. |
PubMed ID | 26944912 |
PubMed Central ID | PMC4948567 |
Grant List | K12 HD001441 / HD / NICHD NIH HHS / United States UL1 TR001111 / TR / NCATS NIH HHS / United States K07-CA138906 / CA / NCI NIH HHS / United States UL1TR001111 / TR / NCATS NIH HHS / United States |
Submitted by jaj2026 on October 27, 2017 - 3:12pm