OBJECTIVES: Chronic myeloid leukaemia (CML) is associated with reduced survival and quality of life; however, BCR-ABL tyrosine kinase inhibitors (TKIs) have dramatically improved outcomes in patients. Although generic imatinib is provided in the UK, outcomes are superior for second-generation TKIs (dasatinib and nilotinib) and their availability enables clinicians to optimise treatment in clinical practice. The objective of this study was to determine the cost-effectiveness of dasatinib versus nilotinib for the treatment of CML in the UK.

METHODS: A lifetime Markov disease progression and cost-effectiveness model was developed. Complete and partial cytogenetic response rates were derived from systematic literature review and network meta-analysis of studies in treatment-naïve (first-line) patients, and naïve comparison between non-comparative studies in treatment-experienced (second-line) patients. Response-specific survival was derived from patient-level data of dasatinib studies and applied to both treatment arms. Remaining model inputs were derived from previously published literature and UK health technology assessments. A UK payer perspective was adopted; costs and benefits were discounted at 3.5% annually.

RESULTS: Dasatinib and nilotinib response rates were comparable in the first-line and second-line settings; minor differences resulted in marginally improved mean survival (an additional 0.186 and 0.187 years, respectively) and longer time in the pre-progression state for the dasatinib arm. Due to improved mean survival outcomes and lower acquisition costs (dasatinib: £30,498/annum; nilotinib: £31,736/annum), dasatinib was associated with lifetime cost-savings, and therefore dominance, compared to nilotinib in the first-line and second-line settings (savings of £29,308 and £28,706, respectively). Results were relatively insensitive to alternative assumptions and inputs.

CONCLUSIONS: Dasatinib and nilotinib provide comparable clinical benefits; however, it was estimated that dasatinib would result in a reduction in total lifetime costs. Availability of both therapies enables clinicians to tailor the CML therapy to an individual patient, potentially improving outcomes in clinical practice, with no additional cost to the NHS.