COST-EFFECTIVENESS OF THE SEQUENTIAL APPLICATION OF TYROSINE KINASE INHIBITORS FOR THE TREATMENT OF CHRONIC MYELOID LEUKEMIA PATIENTS IN THE UNITED STATES

Purpose:

  The aim of this project was to adapt and update an existing Austrian decision-analytic model for chronic myeloid leukemia (CML) treatment to the US-American health care context. The model assesses different sequential treatment strategies with tyrosine kinase inhibitors (TKIs) for chronic phase CML while considering quality of life and restricted health care resources. Model results are compared and differences between health care contexts are discussed.

Method:

  We evaluated 18 different treatment strategies within the US-American setting. For model parameters, literature data, data from a conducted US-American expert survey, Diagnosis Related Groups (DRG) data from a US-American database, and data from the Utah Cancer Registry were used. The model was analyzed as a cohort simulation over a lifelong time horizon, a third-party payer perspective was adopted and a discount rate of 3% was used. We conducted several deterministic and probabilistic sensitivity analyses for the US-American model.

Result:

   Imatinib without a second-line TKI resulted in an incremental cost-utility ratio (ICUR) of $148,700/QALY gained and an incremental cost-effectiveness ratio (ICER) of $128,800/LYs gained compared to the baseline strategy of ‘chemotherapy’. Imatinib with second-line nilotinib yielded an ICUR of $217,100/QALY gained and an ICER of $242,200/LY gained compared to imatinib without second-line TKI. Imatinib followed by second-line bosutinib had an ICUR of $331,300/QALY gained and an ICER of $265,100/LY gained compared to imatinib followed by second-line nilotinib. Imatinib with second-line dasatinib produced an ICUR of $343,200/QALY gained and an ICER of $279,600/LY gained compared to imatinib with second-line bosutinib. All remaining strategies were excluded due to dominance. ICURs and ICERs obtained from the probabilistic sensitivity analysis deviated from -1.7% to +6.5% and -1.9% to +2.5% compared to ICURs and ICERs obtained from base-case analysis. When considering guideline recommendations, imatinib followed by second-line nilotinib is the most cost-effective treatment strategy for chronic phase CML in the Austrian and US-American health care contexts.

Conclusion:

  The model results suggest, imatinib followed by second-line nilotinib is the most cost-effective treatment strategy for chronic phase CML. These results may be used to support CML treatment decision-making by clinicians and patients.

This work was supported by the COMET Center ONCOTYROL, which is funded by the Austrian Federal Ministries BMVIT/BMWFJ (via FFG) and the Tiroler Zukunftsstiftung/Standortagentur Tirol (SAT).