Impact of Genetic Mutations and Health Plan Access to Therapies on Treatment Response and Drug Costs Related to Tyrosine Kinase Inhibitor Treatment Among Patients With Chronic Myelogenous Leukemia.

Abstract

OBJECTIVES:

This study assessed treatment responses and economic consequences of limiting access to the second-generation BCR-ABL1 tyrosine kinase inhibitors (2G-TKI), dasatinib and nilotinib, for treatment of chronic myelogenous leukemia, while taking into account frequencies of genetic mutations that exhibit different sensitivities to the 2G-TKIs.

METHODS:

Frequencies of BCR-ABL1 mutations and the impact of mutations on responses to 2G-TKIs were obtained from published literature and used as inputs in a decision analytics model. Complete hematologic response (CHR) and major cytogenetic response (MCyR) were estimated after 12 months of 2G-TKI treatment. Total annual 2G-TKI drug costs per CHR and MCyR were estimated and compared among 3 2G-TKI access scenarios: (1) open access to both 2G-TKIs; (2) access restricted to dasatinib (DASA-only); and (3) access restricted to nilotinib (NILO-only).

RESULTS:

Among a hypothetical cohort of 1000 2G-TKI-treated chronic myelogenous leukemia patients, the percentage of patients with CHR and MCyR were greatest for the open access plan (CHR: 93%, MCyR: 56%), followed by DASA-only (88%, 53%) and NILO-only (67%, 47%). Compared with the 2G-TKI costs per CHR in open access ($120,706/CHR), the costs were 5% higher ($126,753/CHR) in DASA-only and 41% higher ($169,990/CHR) in NILO-only. Likewise, compared with the 2G-TKI costs per MCyR in open access ($198,284/MCyR), the costs were 6% higher ($209,259/MCyR) in DASA-only and 22% higher ($241,515/MCyR) in NILO-only.

CONCLUSION:

Open access to both 2G-TKIs is associated with improved clinical and economic outcomes: greater treatment response rates (CHR and MCyR) and lower drug costs compared with restricted access to 2G-TKIs.

• Authors: Elias Jabbour, Dinara Makenbaeva, Melissa Lingohr-Smith, Jay Lin
• Journal: American journal of clinical oncology (Am J Clin Oncol) Vol. 41 Issue 3 Pg. 213-217 (03 2018) ISSN: 1537-453X [Electronic] United States
• PMID: 26580245 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents
• BCR-ABL1 fusion protein, human
• Protein Kinase Inhibitors
• Pyrimidines
• Fusion Proteins, bcr-abl
• nilotinib
• Dasatinib

Topics

• Antineoplastic Agents (economics, therapeutic use)
• Dasatinib (economics, therapeutic use)
• Decision Support Techniques
• Drug Costs
• Fusion Proteins, bcr-abl (genetics)
• Health Services Accessibility
• Humans
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (drug therapy, economics, genetics)
• Mutation
• Protein Kinase Inhibitors (economics, therapeutic use)
• Pyrimidines (economics, therapeutic use)
• Treatment Outcome