Impact of Indirect Treatment Comparison (ITC) Methodology on Cost-Effectiveness of Quizartinib in Acute Myeloid Leukemia (AML) in Canada and the United Kingdom (UK)
Author(s)
Yulia Privolnev, MSc1, Sudhir Unni, MBA, PhD2, Efthalia Nikoglou, MBA, MSc, Other3, Farhan Mughal, MSc4, Chuyi Zhang, MSc5, Anna Maria Vanessa Gittfried, MSc6, Sergey Muratov, PhD7, Tara Bourgoin, Other8, Scott Shi, PharmD, MBA7, Arushi Sharma, BA8.
1Daiichi Sankyo, Toronto, ON, Canada, 2Daiichi Sankyo, Basking Ridge, NJ, USA, 3Daiichi Sankyo, Munich, Germany, 4Daiichi Sankyo, Croydon, United Kingdom, 5IQVIA, London, United Kingdom, 6OPEN Health, Rotterdam, Netherlands, 7IQVIA, Toronto, ON, Canada, 8IQVIA, Ottawa, ON, Canada.
1Daiichi Sankyo, Toronto, ON, Canada, 2Daiichi Sankyo, Basking Ridge, NJ, USA, 3Daiichi Sankyo, Munich, Germany, 4Daiichi Sankyo, Croydon, United Kingdom, 5IQVIA, London, United Kingdom, 6OPEN Health, Rotterdam, Netherlands, 7IQVIA, Toronto, ON, Canada, 8IQVIA, Ottawa, ON, Canada.
OBJECTIVES: Reimbursement decisions worldwide require estimates of comparative effectiveness of all relevant treatments. When direct evidence from head-to-head studies are not available, indirect treatment comparisons (ITC) are often used to generate evidence. ITC methodology is evolving, with multilevel network meta-regression (ML-NMR) representing a recent addition to the cohort of population-adjusted ITCs. This study compared the impact of using two ITC approaches to generate comparative evidence on results of a cost-effectiveness (CE) analysis conducted in Canadian and UK settings for quizartinib in acute myeloid leukemia (AML).
METHODS: A cost-utility model was developed to compare the CE of quizartinib versus midostaurin in newly diagnosed FLT3-ITD-mutated AML patients. The model used a semi-Markov structure with eleven distinct health states and death. Relative efficacy for key clinical parameters such as relapse-free survival and overall survival were informed by two approaches: an anchored matching-adjusted indirect comparison (MAIC) and an ML-NMR using data from QuANTUM-First (quizartinib) and RATIFY (midostaurin) trials. Key outcomes included total costs, total quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). The base case (deterministic) was from the Canadian and UK public payer perspective.
RESULTS: For both jurisdictions, the incremental QALYs for quizartinib were considerably higher than for midostaurin and were clinically meaningful regardless of approach, although the ML-NMR generated smaller incremental QALYs (2.20) compared to the MAIC (3.87). The incremental total costs were also lower using the ML-NMR approach (CAD127,715) compared to the MAIC (CAD138,234), leading to incremental ICERs of CAD58,179 (ML-NMR) vs. CAD35,729 (MAIC) in Canada. In the UK, the incremental ICERs of £4,220 (ML-NMR) vs. £3,459 (MAIC) were directionally similar to results observed in Canada. Despite some limitations, the ML-NMR approach was preferred by HTA agencies in both countries.
CONCLUSIONS: Quizartinib represents a cost-effective treatment for patients with FLT3-ITD+ AML. This conclusion did not change when different ITC methods were used.
METHODS: A cost-utility model was developed to compare the CE of quizartinib versus midostaurin in newly diagnosed FLT3-ITD-mutated AML patients. The model used a semi-Markov structure with eleven distinct health states and death. Relative efficacy for key clinical parameters such as relapse-free survival and overall survival were informed by two approaches: an anchored matching-adjusted indirect comparison (MAIC) and an ML-NMR using data from QuANTUM-First (quizartinib) and RATIFY (midostaurin) trials. Key outcomes included total costs, total quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). The base case (deterministic) was from the Canadian and UK public payer perspective.
RESULTS: For both jurisdictions, the incremental QALYs for quizartinib were considerably higher than for midostaurin and were clinically meaningful regardless of approach, although the ML-NMR generated smaller incremental QALYs (2.20) compared to the MAIC (3.87). The incremental total costs were also lower using the ML-NMR approach (CAD127,715) compared to the MAIC (CAD138,234), leading to incremental ICERs of CAD58,179 (ML-NMR) vs. CAD35,729 (MAIC) in Canada. In the UK, the incremental ICERs of £4,220 (ML-NMR) vs. £3,459 (MAIC) were directionally similar to results observed in Canada. Despite some limitations, the ML-NMR approach was preferred by HTA agencies in both countries.
CONCLUSIONS: Quizartinib represents a cost-effective treatment for patients with FLT3-ITD+ AML. This conclusion did not change when different ITC methods were used.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE535
Topic
Economic Evaluation, Health Technology Assessment, Study Approaches
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology