A Cost-Effectiveness Evaluation of Blinatumomab Use in the Measurable Residual Disease-Negative Remission State to Treat Adults With Philadelphia-Chromosome–Negative B-cell Acute Lymphoblastic Leukemia in France
Author(s)
Jérémy CARETTE, PharmD1, Guillaume Laubel, PharmD1, Benjamin Mazaleyrat, PharmD2.
1Public Health Expertise, Paris, France, 2AMGEN France, Courbevoie, France.
1Public Health Expertise, Paris, France, 2AMGEN France, Courbevoie, France.
OBJECTIVES: The ECOG-ACRIN E1910 trial assessed the efficacy and safety of the addition of 4 cycles of blinatumomab to consolidation chemotherapy (‘blinatumomab + chemotherapy’) in adult patients in measurable residual disease-negative (MRD-) remission from Philadelphia-chromosome-negative (Ph-) B-cell acute lymphoblastic leukemia (B-ALL). Our aim was to assess the cost-effectiveness of blinatumomab + chemotherapy versus standard consolidation chemotherapy (‘standard chemotherapy’) in France.
METHODS: A three state (relapse-free, post-relapse and death) partitioned survival model was developed to extrapolate clinical outcomes, quality of life, and treatment-related costs (drug acquisition, administration, maintenance, medical follow-up, relapse, adverse event, subsequent treatments) for patients with Ph- B-ALL who received consolidation with blinatumomab + chemotherapy versus standard chemotherapy over a 50-year lifetime horizon. Survival outcomes were extrapolated using mixture cure models. Quality of life (EQ-5D-3L with French tariffs) were sourced from a published real-world study that collected quality of life in 219 French ALL patients between 30 March 2018 and 18 January 2019. Costs were estimated from a collective perspective using national French medico-administrative databases. Uncertainty was assessed through deterministic, probabilistic and scenario sensitivity analyses.
RESULTS: Blinatumomab + chemotherapy was associated with 4.3 additional quality adjusted life years (QALYs) compared to standard chemotherapy alone (4.1 versus 0.2), and an incremental cost of 168,754 € (327,581 € versus 158,827 €) over a lifetime horizon. The incremental cost-utility ratio (ICUR) was 39,273 €/QALY gained. Incremental QALYs were 4,1 and 0,15 respectively in the relapse-free and the relapse states. Incremental costs were 209,839 € in the relapse-free state and partially offset by a saving of 44,242 € in the relapse state, due to blinatumomab avoidance relapse and costly subsequent treatments.
CONCLUSIONS: Blinatumomab added to consolidation chemotherapy in the treatment of Ph- MRD- B-ALL is a cost-effective option compared to standard chemotherapy with the recently published ICUR in France (147 093€/QALY to 201 398€/QALY).
METHODS: A three state (relapse-free, post-relapse and death) partitioned survival model was developed to extrapolate clinical outcomes, quality of life, and treatment-related costs (drug acquisition, administration, maintenance, medical follow-up, relapse, adverse event, subsequent treatments) for patients with Ph- B-ALL who received consolidation with blinatumomab + chemotherapy versus standard chemotherapy over a 50-year lifetime horizon. Survival outcomes were extrapolated using mixture cure models. Quality of life (EQ-5D-3L with French tariffs) were sourced from a published real-world study that collected quality of life in 219 French ALL patients between 30 March 2018 and 18 January 2019. Costs were estimated from a collective perspective using national French medico-administrative databases. Uncertainty was assessed through deterministic, probabilistic and scenario sensitivity analyses.
RESULTS: Blinatumomab + chemotherapy was associated with 4.3 additional quality adjusted life years (QALYs) compared to standard chemotherapy alone (4.1 versus 0.2), and an incremental cost of 168,754 € (327,581 € versus 158,827 €) over a lifetime horizon. The incremental cost-utility ratio (ICUR) was 39,273 €/QALY gained. Incremental QALYs were 4,1 and 0,15 respectively in the relapse-free and the relapse states. Incremental costs were 209,839 € in the relapse-free state and partially offset by a saving of 44,242 € in the relapse state, due to blinatumomab avoidance relapse and costly subsequent treatments.
CONCLUSIONS: Blinatumomab added to consolidation chemotherapy in the treatment of Ph- MRD- B-ALL is a cost-effective option compared to standard chemotherapy with the recently published ICUR in France (147 093€/QALY to 201 398€/QALY).
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE12
Topic
Economic Evaluation, Health Technology Assessment
Disease
Oncology