OBJECTIVES

: Acute lymphoblastic leukemia (ALL) in adults is an acute and frequently fatal rare disease associated with high rates of relapse and substantial humanistic and economic burden. The primary objective of this study was to evaluate the incremental cost-effectiveness of inotuzumab ozogamicin compared with an alternative drug (blinatumomab) in the treatment of adult patients with relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL).

METHODS

: A Markov state transition model with five possible health states was developed to simulate the costs and effectiveness of treatment in patients with ALL. The model was developed and populated with epidemiologic local data, included all possible health states reflecting the disease process and all the probabilities for transition from one health state to another were foreseen. For the Bulgarian base case, the key comparator was blinatumomab. Costs were calculated according to the positive drug list (PDL) as of March 2018. Both costs and health outcomes were estimated for a lifetime horizon and discounted at an annual rate of 5% using TreeAge Pro Software.

RESULTS

: Total cost per patient over the time horizon for treating ALL with alternatives was: inotuzumab - 221 107,15 BGN (Bulgarian Lev) and blinatumomab- 223 565,55 BGN. The cost- effectiveness analysis demonstrated that inotuzumab dominated blinatumomab with higher QALY (+0.82) and lower cost per treated patient (-2458,40 BGN).

CONCLUSIONS

: From the Bulgarian NHIF perspective, inotuzumab is a cost-effective option in the treatment of ALL as it dominates blinatumomab. The inclusion of inotuzumab in the PDL will enable specialists in Bulgaria to further individualize the treatment of ALL and provide patients with access to the latest trends in the treatment of their disease.