OBJECTIVES: Tyrosine kinase inhibitors (TKIs) transformed Chronic Myeloid Leukemia (CML) from a life-threatening blood cancer to a treatable disease. However, TKI therapy in ≥3^rd line treatment, following prior resistance and/or intolerance, is associated with increasing failure rates, progression risk and substantial economic burden. The aim of the study is to map the treatment patterns of chronic phase CML (CML-CP) in patients who have received >2 TKIs to investigate the disease related resource use and to estimate the economic impact in Greece from the perspective of the national payer (EOPYY).

METHODS: A cost-of-illness (COI) analysis was conducted to capture the annual economic burden of CML-CP in patients who have received >2 TKIs in Greece, employing a prevalence-based and a bottom-up approach to identify and measure the costs. Three hematologists were interviewed with a semi-structured questionnaire and provided their opinion on real-world data, treatment patterns and resource use for CML management to populate the economic model. Only direct medical costs, reimbursed by EOPYY, were included; categorized into drug acquisition costs (disease-specific treatment costs) follow-up costs and hospitalization costs (due to management of adverse events). Costs were calculated in Euros with a reference year of 2022.

RESULTS: In total, 132 CML-CP prevalent cases in ≥3^rd treatment line were estimated, receiving one of the available TKIs in Greece, including bosutinib, dasatinib, nilotinib and ponatinib. The annual cost was estimated at €5,324,800, with drug acquisition costs being the main cost driver (96.1%) and follow-up and hospitalization costs following (3.8% and 0.1%, respectively). The total annual cost per patient was calculated at €40,236.

CONCLUSIONS: Third or further treatment line in CML-CP can be expensive and still leads to complications, highlighting the need for an effective, tolerable, and cost-effective therapy for patients with resistance and/or intolerance to previous therapies.