THE ECONOMIC EVALUATION OF IMATINIB COMBINED WITH CHEMOTHERAPY FOR PEDIATRIC PHILADELPHIA CHROMOSOME-POSITIVE ACUTE LYMPHOBLASTIC LEUKEMIA IN CHINA
Author(s)
Wang VW1, Li Z2
1Key Lab of HTA, Fudan University, Shanghai, 31, China, 2School of Public Health, Fudan University, Shanghai, China
OBJECTIVES: Pediatric Philadelphia chromosome-positive Acute Lymphoblastic Leukemia (Ph+ ALL) is a very rare disease with poor prognosis. imatinib combined with chemotherapy is currently the first-line treatment. However, Ph+ ALL has long been unlisted as the relevant indication for imatinib in the national healthcare reimbursement system in China. To inform the relevant decision makers, we aimed to evaluate the cost-effectiveness of imatinib combined with conventional chemotherapy (imatinib+CC) as compared to conventional chemotherapy alone (CC) for this neglected and vulnerable population. METHODS: We first conducted a systematic review to summarize literature evidence on clinical effectiveness and cost-effectiveness of imatinib+CC, and then developed a Markov model based on the best available published data and local expert opinions. From the perspective of the Chinese healthcare system, the model simulated the following health states over a life-time horizon for a hypothetical cohort of newly diagnosed 8-year old Ph+ ALL children: event-free survival, relapsed/resistant disease, cure, and death. A few of tunnel states were also built to reflect the treatment pathway according to the clinical guideline CCLG-ALL 2008 (HR protocol). In the absence of published cost data for Ph+ ALL patients, we sought expert opinions from an ongoing Chinese Childhood Cancer Group ALL-2015 trial consisting of 20 centers nationwide. RESULTS: The base case analysis showed quality-adjusted life-years (QALYs) increased by 1.25 QALYs with imatinib in addition to CC. The resulting mean Incremental Cost-Effectiveness Ratio (ICER) was CNY 32,725/QALY. At a willingness-to-pay threshold of CNY 53,935/QALY according to China’s GDP per capita in 2016, imatinib+CC was considered highly cost-effective. The decision outcomes were robust to the probabilistic and deterministic sensitivity analyses. CONCLUSIONS: For children with Ph+ ALL, imatinib+CC was found to be a cost-effective intervention, compared to CC alone. The addition of imatinib is associated with increased life years and increased QALYs at a reasonable incremental cost.
Conference/Value in Health Info
2018-11, ISPOR Europe 2018, Barcelona, Spain
Value in Health, Vol. 21, S3 (October 2018)
Code
PCN137
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology, Pediatrics