Cost-effectiveness of the sequential application of tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia.

Abstract

Several tyrosine kinase inhibitors (TKIs) are approved for chronic myeloid leukemia (CML) therapy. We evaluated the long-term cost-effectiveness of seven sequential therapy regimens for CML in Austria. A cost-effectiveness analysis was performed using a state-transition Markov model. As model parameters, we used published trial data, clinical, epidemiological and economic data from the Austrian CML registry and national databases. We performed a cohort simulation over a life-long time-horizon from a societal perspective. Nilotinib without second-line TKI yielded an incremental cost-utility ratio of 121,400 €/quality-adjusted life year (QALY) compared to imatinib without second-line TKI after imatinib failure. Imatinib followed by nilotinib after failure resulted in 131,100 €/QALY compared to nilotinib without second-line TKI. Nilotinib followed by dasatinib yielded 152,400 €/QALY compared to imatinib followed by nilotinib after failure. Remaining strategies were dominated. The sequential application of TKIs is standard-of-care, and thus, our analysis points toward imatinib followed by nilotinib as the most cost-effective strategy.

• Authors: Ursula Rochau, Gaby Sroczynski, Dominik Wolf, Stefan Schmidt, Beate Jahn, Martina Kluibenschaedl, Annette Conrads-Frank, David Stenehjem, Diana Brixner, Jerald Radich, Günther Gastl, Uwe Siebert
• Journal: Leukemia & lymphoma (Leuk Lymphoma) Vol. 56 Issue 8 Pg. 2315-25 ( 2015) ISSN: 1029-2403 [Electronic] United States
• PMID: 25393806 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents
• Protein Kinase Inhibitors

Topics

• Antineoplastic Agents (adverse effects, economics, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, economics, therapeutic use)
• Austria (epidemiology)
• Cost-Benefit Analysis
• Decision Support Techniques
• Female
• Health Care Costs
• Hematopoietic Stem Cell Transplantation (economics)
• Humans
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (diagnosis, drug therapy, epidemiology, therapy)
• Male
• Markov Chains
• Outcome Assessment, Health Care
• Protein Kinase Inhibitors (adverse effects, economics, therapeutic use)
• Quality-Adjusted Life Years
• Registries