scholarly journals Decision Analysis on the Cost-Effectiveness of Sequential Treatment Strategies for Patients with Chronic Myeloid Leukemia in the United States

2014 ◽  
Vol 17 (7) ◽  
pp. A639
Author(s):  
U. Rochau ◽  
M. Kluibenschaedl ◽  
D. Stenehjem ◽  
K.L. Kuo ◽  
G. Oderda ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Chronic Myeloid Leukemia ◽  
Decision Analysis ◽  
Myeloid Leukemia ◽  
Treatment Strategies ◽  
The United States ◽  
Sequential Treatment ◽  
The Cost

scholarly journals Effectiveness and Cost-Effectiveness of Sequential Treatment of Patients with Chronic Myeloid Leukemia in the United States: A Decision Analysis

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Ursula Rochau ◽  
Martina Kluibenschaedl ◽  
David Stenehjem ◽  
Kuo Kuan-Ling ◽  
Jerald Radich ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Treatment Guidelines ◽  
The United States ◽  
Cost Utility ◽  
Sequential Treatment ◽  
Third Party ◽  
Model Parameters ◽  
Life Years

Currently several tyrosine kinase inhibitors (TKIs) are approved for treatment of chronic myeloid leukemia (CML). Our goal was to identify the optimal sequential treatment strategy in terms of effectiveness and cost-effectiveness for CML patients within the US health care context. We evaluated 18 treatment strategies regarding survival, quality-adjusted survival, and costs. For model parameters, the literature data, expert surveys, registry data, and economic databases were used. Evaluated strategies included imatinib, dasatinib, nilotinib, bosutinib, ponatinib, stem-cell transplantation (SCT), and chemotherapy. We developed a Markov state-transition model, which was analyzed as a cohort simulation over a lifelong time horizon with a third-party payer perspective and discount rate of 3%. Remaining life expectancies ranged from 5.4 years (3.9 quality-adjusted life years (QALYs)) for chemotherapy treatment without TKI to 14.4 years (11.1 QALYs) for nilotinib→dasatinib→chemotherapy/SCT. In the economic evaluation, imatinib→chemotherapy/SCT resulted in an incremental cost-utility ratio (ICUR) of $171,700/QALY compared to chemotherapy without TKI. Imatinib→nilotinib→chemotherapy/SCT yielded an ICUR of $253,500/QALY compared to imatinib→chemotherapy/SCT. Nilotinib→dasatinib→chemotherapy/SCT yielded an ICUR of $445,100/QALY compared to imatinib→nilotinib→chemotherapy/SCT. All remaining strategies were excluded due to dominance of the clinically superior strategies. Based on our analysis and current treatment guidelines, imatinib→nilotinib→chemotherapy/SCT and nilotinib→dasatinib→chemotherapy/SCT can be considered cost-effective for patients with CML, depending on willingness-to-pay.

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