OBJECTIVES

: Imatinib is the first line treatment for chronic myeloid leukemia (CML) in Ethiopian hospitals. An alternative option is nilotinib, which is more expensive but improves disease progression and survival outcomes. We assessed the cost-effectiveness of imatinib versus nilotinib from a healthcare payer perspective in the Ethiopian setting.

METHODS

: We developed a Markov model to simulate CML over a lifetime time horizon. Individuals start in the ‘chronic’ health state. CML may progress over time with individuals transitioning to the ‘progressed’ health state, which is associated with higher costs and lower survival outcomes. Primary outcomes are life years, healthcare cost (in 2018 US dollars) and the incremental cost-effectiveness ratio (ICER). Cost and health outcomes were discounted at 3% as per WHO guidelines. We conducted deterministic sensitivity analyses to assess parameter uncertainty.

RESULTS

: First line treatment with imatinib was associated with an expected 11.12 life years at a total lifetime cost of $404,651. First line treatment with nilotinib was associated with an expected 12.99 life years, an incremental gain of 1.87 life years; but had a higher lifetime cost of $483,171, an incremental cost of $78,520. The resulting ICER was $42,094 per life year gained. There are no conventional cost-effectiveness threshold (CET) estimates documented in Ethiopia. The commonly used CET of three times the GDP per capita is $1,879 per QALY gained. Given that QALYs gained will be lower than life years gained, $42,094 per life year gained is not considered to be cost-effective. Deterministic sensitivity analyses showed that varying the survival efficacy of nilotinib had no large impact on the ICER as the high cost of the drug was incurred in any additional years of life.

CONCLUSIONS

: Replacing imatinib with nilotinib as first line treatment for hospitalized patients with CML is not a cost-effective use of healthcare resources in Ethiopia.