A MARKOV COHORT MODEL EVALUATING THE COST-EFFECTIVENESS OF ASCIMINIB VERSUS STANDARD TYROSINE KINASE INHIBITORS IN THIRD-LINE CHRONIC-PHASE CHRONIC MYELOID LEUKEMIA: A FIVE-YEAR ANALYSIS FROM THE PAYER PERSPECTIVE
Author(s)
Omar Maoujoud, PhD, MD1, sanaa haouraji, Msc2;
1Research team of Pharmacoeconomics & Pharmacoepidemiology, Moroccan Society of health economics (SMEPS), Faculty of Medicine, Mohamed V university, Rabat, Morocco, 2EOS Executive Lab, Casablanca, Morocco
1Research team of Pharmacoeconomics & Pharmacoepidemiology, Moroccan Society of health economics (SMEPS), Faculty of Medicine, Mohamed V university, Rabat, Morocco, 2EOS Executive Lab, Casablanca, Morocco
OBJECTIVES: Patients with Philadelphia-positive chronic-phase chronic myeloid leukemia (CP-CML) failing two or more tyrosine kinase inhibitors (TKIs) face limited therapeutic options with poor outcomes. Asciminib, a first-in-class STAMP inhibitor targeting the BCR-ABL1 myristoyl pocket, demonstrated superior efficacy in the ASCEMBL trial. This analysis evaluated the cost-effectiveness of asciminib versus standard TKIs from the Moroccan payer perspective
METHODS: A three-state Markov cohort model (major molecular response [MMR+], non-MMR, death) was developed following ISPOR modeling guidelines and CHEERS 2022 reporting standards. Cycle length was one year; time horizon five years (2026-2030); discount rate 3.5% for costs and outcomes. Transition probabilities were derived from ASCEMBL (NCT03106779): MMR achievement 25.5% (year 1) and 37.6% (years 2-5) for asciminib versus 11.5% and 14.0% for comparators; MMR loss 3.0% versus 8.0%; mortality 1.5% (MMR+) and 5.0% (non-MMR). Hematopoietic stem cell transplantation (HSCT) probability for non-MMR patients (2.0%/year) was sourced from the Swedish CML Registry. Annual costs (2024 USD): asciminib $53,251; weighted comparator (dasatinib/imatinib 50:50) $10,800; HSCT $75,000. Target population: 279 patients annually. Outcomes included MMR+ rates, life-years (LYs), quality-adjusted life-years (QALYs; utilities from Szabo 2010), HSCT avoided, and net budget impact
RESULTS: At five years, MMR+ rates were 64.9% (asciminib) versus 43.0% (comparators), yielding +21.9 percentage points difference. Per-patient incremental outcomes: +0.26 LYs, +0.20 QALYs. The Markov trace demonstrated 84.5% survival (asciminib) versus 87.3% (comparators) at horizon end. Across the cohort (408 patient-years on asciminib), 5.8 HSCT procedures were avoided, generating $1.02 million in savings. Total five-year budget impact: $16.3 million gross, reduced to $15.3 million net (-6.2%) after integrating HSCT offsets. Scenario analyses varying HSCT probability (1-5%/year) showed savings ranging $0.22-1.09 million
CONCLUSIONS: Asciminib provides clinically meaningful improvements in molecular response and survival outcomes for third-line CP-CML patients in Morocco. Downstream cost offsets from avoided transplantations partially mitigate the incremental drug cost, supporting value-based pricing negotiations
METHODS: A three-state Markov cohort model (major molecular response [MMR+], non-MMR, death) was developed following ISPOR modeling guidelines and CHEERS 2022 reporting standards. Cycle length was one year; time horizon five years (2026-2030); discount rate 3.5% for costs and outcomes. Transition probabilities were derived from ASCEMBL (NCT03106779): MMR achievement 25.5% (year 1) and 37.6% (years 2-5) for asciminib versus 11.5% and 14.0% for comparators; MMR loss 3.0% versus 8.0%; mortality 1.5% (MMR+) and 5.0% (non-MMR). Hematopoietic stem cell transplantation (HSCT) probability for non-MMR patients (2.0%/year) was sourced from the Swedish CML Registry. Annual costs (2024 USD): asciminib $53,251; weighted comparator (dasatinib/imatinib 50:50) $10,800; HSCT $75,000. Target population: 279 patients annually. Outcomes included MMR+ rates, life-years (LYs), quality-adjusted life-years (QALYs; utilities from Szabo 2010), HSCT avoided, and net budget impact
RESULTS: At five years, MMR+ rates were 64.9% (asciminib) versus 43.0% (comparators), yielding +21.9 percentage points difference. Per-patient incremental outcomes: +0.26 LYs, +0.20 QALYs. The Markov trace demonstrated 84.5% survival (asciminib) versus 87.3% (comparators) at horizon end. Across the cohort (408 patient-years on asciminib), 5.8 HSCT procedures were avoided, generating $1.02 million in savings. Total five-year budget impact: $16.3 million gross, reduced to $15.3 million net (-6.2%) after integrating HSCT offsets. Scenario analyses varying HSCT probability (1-5%/year) showed savings ranging $0.22-1.09 million
CONCLUSIONS: Asciminib provides clinically meaningful improvements in molecular response and survival outcomes for third-line CP-CML patients in Morocco. Downstream cost offsets from avoided transplantations partially mitigate the incremental drug cost, supporting value-based pricing negotiations
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE266
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Oncology, SDC: Rare & Orphan Diseases