OBJECTIVES

: All-trans retinoic acid (ATRA) - Arsenic trioxide (ATO) combination is the first-line treatment recommended by experts’ groups for promyelocytic acute leukemia (PAL), with demonstrated reduction of relapse risk and significantly toxicity decrease. Since 2016, European Medicines Agency approved this treatment for low to intermediate risk APL patients. However, this combination is not reimbursed by FrenchNational Health Insurance, whereas the good tolerance of ATO should avoid some cost caused by chemotherapy adverse effects. The aim of this work was to compare the direct medical cost of ATO strategy to reference chemotherapy strategy.

METHODS

: A cost-utility and cost-effectivenessanalysis between the two strategies was conduct with the French National Health Insurance perspective andthe life patients as time horizon. Costs and effectivenesswere modelized for the two different strategies with a tree decision model. This modeling was made from observational data from hematology department between 2011 to 2018and data from the literature. A decision tree was built to compare the ATO arm (ATO and ATRA) and the CT arm (chemotherapy (CT) + ATRA).

RESULTS

: We obtained a gain of 0,30 QALY with the arsenic arm and an ICER of 91857 € / QALY. The cost-effectiveness analysis found a gain of 0,297 LY for the ATO arm compared to the CT arm for a cost of 27 041€. The ICER was 90 905€/ LY.

CONCLUSIONS

: ATRA-ATO combination seems cost -effective for the treatment of PAL patients with an high willingness to pay. This study underlines the need to assess the quality of life of patients treated for PAL in real life and to obtain multicentric data to increase the number of patients.