COST-EFFECTIVENESS OF NILOTINIB VERSUS DASATINIB FOR THE SECOND-LINE TREATMENT OF PATIENTS WITH PHILADELPHIA CHROMOSOME-POSITIVE CHRONIC MYELOID LEUKEMIA IN CHRONIC PHASE (CML-CP), RESISTANT OR INTOLERANT TO IMATINIB, IN FRAME OF RUSSIAN HE ...
Author(s)
Goyert N1, Tran D1, Efremova E2, Apostopoulos C3, Grima D1
1Cornerstone Research Group, Burlington, ON, Canada, 2Novartis Pharma LLC, Moscow, Russian Federation, 3Novartis Pharma AG Switzerland, Basel, Basel-City, Switzerland
OBJECTIVES: The 2013 European LeukemiaNet (ELN) guidelines recommend switching to 2nd-line tyrosine kinase inhibitor (TKI) therapy as early as 6 months for patients who fail to achieve adequate molecular response (MR) (BCR-ABL1 ≤10%). They also recognize the possibility of treatment-free remission (TFR) for patients with deep MR. These emerging shifts in practice will dramatically change CML treatment patterns. This study examined the impact of these guidelines on the cost-effectiveness of nilotinib compared with dasatinib in the 2nd-line setting in Russia. METHODS: A partitioned survival model was developed based on a published chart review. Model states included 2nd-line TKI treatment, 2nd-line TFR, post–nd-line TKI treatment, and accelerated phase (AP) and blast crisis (BC). Molecular responses (BCR-ABL1 ≤10% and ≤0.01%) over time were not reported and were estimated based on published clinical trials. Patients sustaining BCR-ABL1 ≤0.01% became eligible for TFR, with approximately 50% of patients maintaining TFR beyond 12 months. All resource use estimates and costs were specific to Russia. Discounting at 5% of costs and effects was used. RESULTS: Greater MR, progression-free survival (PFS), and overall survival (OS) for nilotinib translated into more total life years (1.64 more), greater year spent in 2nd-line TKI treatment (0.63) and TFR (0.31), and fewer years in AP/BC (-0.16). Total costs were greater in the nilotinib-treated group (2,046,144 RUB), despite a lower acquisition cost, due to more years of treatment. The incremental cost per QALY was 1,598,727 RUB. The model was most sensitive to assumptions regarding OS and PFS. Removing the option to enter TFR had minimal impact (1,686,256 RUB per QALY). CONCLUSIONS: Nilotinib is cost-effective compared with dasatinib for the 2nd-line treatment of CML-CP patients in a Russian public health care setting. Inclusion of TFR, which is currently recommended only within clinical studies, provides the opportunity for additional cost savings.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PCN164
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology, Systemic Disorders/Conditions