Presentation (CTI)

OBJECTIVES: This study aimed to assess the cost-effectiveness of blinatumomab plus chemotherapy as first-line versus as second-line therapy for standard-risk pediatric B-cell ALL with average risk of relapse from the perspective of the Hong Kong public healthcare provider.
METHODS: A Markov model was designed to simulate clinical and economic outcomes over a 10-year horizon in a hypothetical cohort of pediatric patients newly diagnosed with B-cell ALL at average risk of relapse. Two strategies were evaluated: Blinatumomab plus chemotherapy as first-line and as second-line therapy. Model inputs were based on published literature and public data. The outcomes included direct medical costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICER). Sensitivity analyses were conducted to evaluate the robustness of base-case results.
RESULTS: In base-case analysis, the first-line blinatumomab plus chemotherapy treatment gained an incremental 0.24 QALYs with additional cost of HKD104,252 (USD 1=HKD 7.78) when compared to the second-line blinatumomab plus chemotherapy. The ICER of first-line blinatumomab plus chemotherapy versus second-line blinatumomab plus chemotherapy was 426,336 HKD/QALY (<willingness-to-pay (WTP) threshold 1,265,970 HKD/QALY(3× gross domestic product per capita of Hong Kong)). In the one-way sensitivity analysis, first-line blinatumomab plus chemotherapy remained cost-effective when exponential rate of disease-free survival first-line blinatumomab was lower than 0.001380, or cost of blinatumomab per cycle was lower than HKD 200,965. The first-line blinatumomab was cost-effective in 90.3% of simulations in probabilistic sensitivity analysis.
CONCLUSIONS: First-line blinatumomab plus chemotherapy appears to be cost-effective for newly diagnosed standard-risk B-cell ALL pediatric patients with average risk of relapse, from the perspective of public healthcare providers in Hong Kong.