Cost-Effectiveness of First-Line Tyrosine Kinase Inhibitor Therapy Initiation Strategies for Chronic Myeloid Leukemia

Oct 1, 2020, 00:00
10.1016/j.jval.2020.05.019
https://www.valueinhealthjournal.com/article/S1098-3015(20)32173-2/fulltext
Title : Cost-Effectiveness of First-Line Tyrosine Kinase Inhibitor Therapy Initiation Strategies for Chronic Myeloid Leukemia
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(20)32173-2&doi=10.1016/j.jval.2020.05.019
First page : 1292
Section Title : COMPARATIVE-EFFECTIVENESS RESEARCH/HTA
Open access? : No
Section Order : 1292

Objectives

Overall survival in chronic myeloid leukemia (CML) in chronic phase is not significantly different by treatment with first-line tyrosine kinase inhibitors (TKIs), but emerging evidence reveals differences in costs and safety profiles. We evaluated the 1-year cost-effectiveness of TKI initiation with imatinib, dasatinib, or nilotinib among a hypothetical cohort of incident patients with CML from a US payer's perspective.

Methods

We constructed a decision analytic model to assess quality-adjusted life years (QALYs), healthcare costs, net monetary benefit, and incremental cost-effectiveness of treatment strategies. We used published studies and data from the IBM Watson Health MarketScan database for model parameters. To calculate TKI costs, we used the 2018 Federal Supply Schedule estimates for generic imatinib and branded second-generation TKIs. We evaluated cost-effectiveness under various willingness-to-pay thresholds. We accounted for uncertainty with deterministic and probabilistic sensitivity analyses.

Results

In the base-case analysis, imatinib was favored over dasatinib and nilotinib at a lower cost per QALY gained. Imatinib remained the favored strategy after 1-way variations in TKI costs, TKI switching, QALYs, adverse event risk, and CML progression. When we assessed model uncertainty with prespecified parameter distributions, imatinib was cost-saving compared with dasatinib in 40% of 100 0000 simulations and was favored over all simulations compared with nilotinib. First-line treatment with second-generation TKIs was cost-effective in 50% of simulations at a $200 000/QALY willingness-to-pay threshold.

Conclusions

Generic availability of imatinib provides a more cost-effective treatment approach in the first year compared with other available TKIs for newly diagnosed patients with CML.

Categories :
  • Artificial Intelligence, Machine Learning, Predictive Analytics
  • Clinical Outcomes
  • Comparative Effectiveness or Efficacy
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Decision Modeling & Simulation
  • Economic Evaluation
  • Hospital and Clinical Practices
  • Oncology
  • Specific Diseases & Conditions
  • Study Approaches
Tags :
  • chronic myeloid leukemia, economic evaluation, tyrosine kinase inhibitor
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