Cost-effectiveness of Tyrosine Kinase Inhibitor Treatment Strategies for Chronic Myeloid Leukemia in Chronic Phase After Generic Entry of Imatinib in the United States

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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

Padula, William V. (författare): Johns Hopkins Univ, Dept Hlth Policy & Management, Baltimore, MD 21218 USA.

Larson, Richard A. (författare): Univ Chicago, Dept Med, 5841 S Maryland Ave, Chicago, IL 60637 USA.

Dusetzina, Stacie B. (författare): Univ N Carolina, Eshelman Sch Pharm, Chapel Hill, NC 27599 USA.;Univ N Carolina, Gillings Sch Global Publ Hlth, Lineberger Comprehens Canc Ctr, Chapel Hill, NC 27599 USA.;Univ N Carolina, Cecil G Sheps Ctr Hlth Serv Res, Chapel Hill, NC 27599 USA.

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Apperley, Jane F. (författare): Imperial Coll, Hammersmith Hosp, Dept Haematol, London, England.

Hehlmann, Rudiger (författare): Heidelberg Univ, Dept Med, Mannheim, Germany.

Baccarani, Michele (författare): S Orsola Malpighi Univ Hosp, Dept Haematol & Oncol, Bologna, Italy.

Eigendorff, Ekkehard (författare): Univ Hosp, Dept Haematol & Oncol, Jena, Germany.

Guilhot, Joelle (författare): CHU Poitiers, INSERM, CIC 1402, Poitiers, France.

Guilhot, Francois (författare): CHU Poitiers, INSERM, CIC 1402, Poitiers, France.

Mahon, Francois-Xavier (författare): Univ Victor Segalen, Lab Hematol, Pessac, France.

Martinelli, Giovanni (författare): Univ Bologna, Dept Hematol, L & A Seragnoli, Bologna, Italy.

Mayer, Jiri (författare): Univ Hosp Brno, Dept Internal Med Hematol & Oncol, Brno, Czech Republic.

Müller, Martin C. (författare): Heidelberg Univ, Dept Hematol & Oncol, Mannheim, Germany.

Niederwieser, Dietger (författare): Univ Hosp Leipzig, Dept Hematol & Oncol, Leipzig, Germany.

Saussele, Susanne (författare): Heidelberg Univ, Dept Med, Mannheim, Germany.

Schiffer, Charles A. (författare): Wayne State Univ, Barbara Ann Karmanos Canc Inst, Detroit, MI 48201 USA.

Silver, Richard T. (författare): Weill Cornell Med Ctr, Dept Med, New York, NY 10065 USA.

Simonsson, Bengt (författare): Uppsala universitet,Hematologi

Conti, Rena M. (författare): Univ Chicago, Dept Pediat, Chicago, IL 60637 USA.;Univ Chicago, Dept Publ Hlth Sci, Chicago, IL 60637 USA.

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Johns Hopkins Univ, Dept Hlth Policy & Management, Baltimore, MD 21218 USA Univ Chicago, Dept Med, 5841 S Maryland Ave, Chicago, IL 60637 USA. (creator_code:org_t)

2016-03-04
2016
Engelska.
Ingår i: Journal of the National Cancer Institute. - : Oxford University Press (OUP). - 0027-8874 .- 1460-2105. ; 108:7

Relaterad länk:: https://doi.org/10.1...; visa fler...; https://uu.diva-port... (primary) (Raw object); https://academic.oup...; https://urn.kb.se/re...; https://doi.org/10.1...; visa färre...

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Background: 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. Methods: 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. Results: 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 imatinibfirst incremental cost-effectiveness ratio was approximately $883 730/QALY. The results were robust to multiple sensitivity analyses. Conclusion: When imatinib loses patent protection and its price declines, its use will be the cost-effective initial treatment strategy for CML-CP.

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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

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