To evaluate the economic outcome of conventional and targeted therapies of patients with chronic myelogenous leukemia (CML).
Two Markov simulation models were designed to measure the cost and quality-adjusted life years (QALYs) for newly diagnosed CML patients whether to be administered conventional therapy or six tyrosine kinase inhibitors (TKIs) based strategies. Clinical and utility data were taken mostly from the literature by a MEDLINE search. Costs were based on local charges. The primary output was reported in terms of incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to examine the robustness of the model output. The impact of patient assistance program (PAP) was assessed.
The imatinib plus peginterferon-Á switch 2nd TKIs strategy yielded the most health benefits for newly diagnosed CML patients when compared with the conventional, imatinib switch 2nd TKIs, imatinib switch conventional, imatinib plus IFN-Á switch conventional, nilotinib switch conventional and dasatinib switch conventional strategies (figure 1). Marginal cost-effectiveness was $79,134 or $17,600 per QALY gained relative to conventional strategy without or with PAP (figure 2). Both the nilotinib and dasatinib based strategies were more expensive yet less effective than the alternative strategies and were therefore dominated. Model outputs were sensitive to the cost of TKIs.
Imatinib and imatinib plus peginterferon-Á based strategies are potentially more cost-effective and 2nd-generation TKIs may be preferred in the setting of imatinib failure. Patient assistant program in health resource limited setting might notably improve the economic outcome of TKIs based therapies.
No relevant conflicts of interest to declare.
Asterisk with author names denotes non-ASH members.