Cost-effectiveness of dasatinib versus high-dose imatinib in patients with Chronic Myeloid Leukemia (CML), resistant to standard dose imatinib--a Swedish model application

Chronic myeloid leukemia (CML) is a progressive disease, consisting of three phases, chronic, accelerated and blast phase. Treatment with imatinib has demonstrated high response rates and improved prognosis for patients with CML. The emergence of imatinib resistance is a major concern. Dasatinib is an oral kinase inhibitor of BCR-ABL that has been developed for treating CML patients across all phases of disease who are resistant or intolerant to imatinib.The objective of this study was to assess the cost-effectiveness of dasatinib versus high-dose imatinib treatment in chronic phase CML patients, resistant to lower doses of imatinib (or =600 mg) in Sweden.A Markov simulation model was adapted to Swedish treatment practice. The model was populated with efficacy data from clinical trials, resource utilisation by expert opinion, published quality of life data and unit prices from official price lists. A life-long, societal perspective was used and sensitivity analyses were performed to test the robustness of the results.The results showed that chronic phase CML patients resistant to standard dose imatinib gain on average 0.67 life-years, or 0.62 quality adjusted life-years, when treated with dasatinib 140 mg/day compared with high-dose imatinib 800 mg/day. The incremental societal cost amounts to EUR 4 250 during the lifetime period, or EUR6880 per QALY gained.The results indicate that dasatinib is a cost-effective treatment among imatinib-resistant CML patients in Sweden in comparison to imatinib 800 mg/daily.