OBJECTIVES : Azacitidine is a hypomethylating agent that has been adopted for the treatment of acute myeloid leukemia in patients who are not eligible for curative-intent chemotherapy because of their age or comorbidities. Patients with low bone marrow blast counts (<30%) seem to derive the greatest benefit from azacitidine compared to the patients with blasts > 30%. We present here a cost-effective analysis of azacitidine in patients with AML with > 30% blasts.

METHODS : A markow model with a 22 months time horizon divided in 35 days cycles was developed. Cost-utility of azacitidine was compared to that of conventional care regiment (CCR: which includes best supportive care, low-dose AraC and induction chemotherapy). A Canadian public health care system as a third party public payer perspective was selected. Overall survival and utilities values were derived from the AZA-AML- 001.

RESULTS : In the case base, azacitidine has an incremental cost-effectiveness ratio of $142,932 per quality adjusted life year compared to CCR. The results were most sensitive to cost of azacitidine and then to survival with both azacitidine and CCR.

CONCLUSIONS : The value of azacitidine for the treatment of azacitidine exceeds the commonly used willingness to pay in the Canadian health care system.