Abstract
BACKGROUNDChronic Lymphocytic leukemia is the most common leukemia in the western world. In the last decade, treatment options expanded with an expressive rise in treatment costs. In Brazil the overall cancer treatment costs are rising mainly due to the judicialization law suits. The efficacy and safety of associating rituximab to fludarabine and cyclophosphamide (R-FC) for the treatment of chronic lymphocytic leukemia has been demonstrated by the CLL8 trial, which was conducted in previously untreated patients positioning the immunochemotherapy regimen as the standard choice for physically fit patients. Considering this scenario, the current study has as objective to evaluate the cost-effectiveness of the addition of rituximab to the FC protocol considering the Brazilian public health system perspective. METHODSWe developed a Markov model with three health states to extrapolate the CLL8 trial results. The transition probabilities and adverse events incidence were obtained from the trial published data. The costs were assessed from Brazil’s ministry of health pricing database (public available). A simplified treatment algorithm was developed according to the current available treatment options in the Brazilian public health system and assuming the availability of rituximab. RESULTSThe addition of rituximab to the FC regimen results in an incremental cost-effectiveness ratio (ICER) of 8389 USD (45003,86 BRL) per year life free of progression. The sensititvity analysis conducted shows a From the Brazilian public health system perspective, the combination of rituximab with the FC chemotherapy represents a cost-effective strategic approach for first-line treatment of patients with CLL.CONCLUSIONSconsidering the data described in this study, we cqn conclude that the addition of rituximab to the first-line treatment of CLL is cost-effective strategy for the Brazil public health system. With the advent of new drugs and new treatment regimens that presents positive clinical outcomes in patients refratary to the R-FC regimen (del17p, p53 mutations), new studies must be conducted to evaluate their cost-effectiveness considering this population of patients.
Cost-effectiveness of insulin analogs from the perspective of the Brazilian public health system
