Cost Effectiveness of Asciminib for the Post 2 Tyrosine Kinase Inhibitor Treatment of Chronic Phase Chronic Myeloid Leukaemia in Türkiye

OBJECTIVES: Chronic Myeloid Leukemia (CML) is a rare cancer with three phases: chronic (CP), accelerated and blast crisis. The current standard of care for patients with CP-CML is tyrosine kinase inhibitors (TKIs). The objective of this study is to estimate the cost-effectiveness of asciminib for post 2 TKI treatment of CP-CML compared to bosutinib in Türkiye.

METHODS: A Markov model was developed to cover adult patients with CP-CML who have received two prior lines of treatment. Effectiveness data was obtained from the ASCEMBL trial with a minimum follow-up of 96 weeks. The analysis was conducted from the Turkish payer perspective (The Social Security Institution-SSI) with a life-time horizon. The SSI price for asciminib was determined according to local pricing and reimbursement regulations (based on the lowest reference country price and a 41% mandatory institutional discount). The study included costs for drug acquisition, administration, monitoring, disease management, subsequent treatment and adverse event treatment. Costs were calculated using SSI reimbursement prices. All costs and outcomes were discounted by 3%.

RESULTS: The cost-effectiveness analysis estimated an incremental cost of 2,459,086 TRY per patient over a 40-year time horizon for asciminib vs bosutinib. The treatment cost per patient was 3,793,842TRY for asciminib and 1,334,756 TRY for bosutinib. Asciminib generated 8.26 QALYs and 10.07 life year (LY) gains while bosutinib generated 3.85 QALYs and 5.16 LYs. The incremental QALY and LY gains were 4.41 and 4.92 respectively. The incremental cost effectiveness ratio (ICER) was 557,615 TRY for QALY and 499,814 TRY for LY. Sensitivity analysis results indicated the robustness of the findings.

CONCLUSIONS: Türkiye does not have a threshold value for decision-making. The GNP per capita was estimated as 307.952TRY in 2023. Based on this, it can be concluded that asciminib is a cost-effective option compared to bosutinib in Türkiye for third line treatment of CP-CML.