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Cost-effectiveness of Tyrosine Kinase Inhibitor Treatment Strategies for Chronic Myeloid Leukemia in Chronic Phase After Generic Entry of Imatinib in the United States.
- Source :
- PharmacoEconomics & Outcomes News; 3/26/2016, Vol. 749 Issue 1, p17-17, 1p
- Publication Year :
- 2016
-
Abstract
- <bold>Background: </bold>We analyzed the cost-effectiveness of treating incident chronic myeloid leukemia in chronic phase (CML-CP) with generic imatinib when it becomes available in United States in 2016. In the year following generic entry, imatinib's price is expected to drop 70% to 90%. We hypothesized that initiating treatment with generic imatinib in these patients and then switching to the other tyrosine-kinase inhibitors (TKIs), dasatinib or nilotinib, because of intolerance or lack of effectiveness ("imatinib-first") would be cost-effective compared with the current standard of care: "physicians' choice" of initiating treatment with any one of the three TKIs.<bold>Methods: </bold>We constructed Markov models to compare the five-year cost-effectiveness of imatinib-first vs physician's choice from a US commercial payer perspective, assuming 3% annual discounting ($US 2013). The models' clinical endpoint was five-year overall survival taken from a systematic review of clinical trial results. Per-person spending on incident CML-CP treatment overall care components was estimated using Truven's MarketScan claims data. The main outcome of the models was cost per quality-adjusted life-year (QALY). We interpreted outcomes based on a willingness-to-pay threshold of $100 000/QALY. A panel of European LeukemiaNet experts oversaw the study's conduct.<bold>Results: </bold>Both strategies met the threshold. Imatinib-first ($277 401, 3.87 QALYs) offered patients a 0.10 decrement in QALYs at a savings of $88 343 over five years to payers compared with physician's choice ($365 744, 3.97 QALYs). The imatinib-first incremental cost-effectiveness ratio was approximately $883 730/QALY. The results were robust to multiple sensitivity analyses.<bold>Conclusion: </bold>When imatinib loses patent protection and its price declines, its use will be the cost-effective initial treatment strategy for CML-CP. [ABSTRACT FROM AUTHOR]
- Subjects :
- COST effectiveness
IMATINIB
LEUKEMIA treatment
GENERIC drugs
ANTINEOPLASTIC agents
COMPARATIVE studies
RESEARCH methodology
MEDICAL cooperation
PROBABILITY theory
PROTEIN-tyrosine kinases
RESEARCH
SURVIVAL analysis (Biometry)
EVALUATION research
CHRONIC myeloid leukemia
TREATMENT effectiveness
QUALITY-adjusted life years
STATISTICAL models
CHEMICAL inhibitors
PROTEIN kinase inhibitors
ECONOMICS
THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 11735503
- Volume :
- 749
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- PharmacoEconomics & Outcomes News
- Publication Type :
- Periodical
- Accession number :
- 114011289
- Full Text :
- https://doi.org/10.1093/jnci/djw003