Artikel
Cost-Effectiveness of Personalized Treatment Switching Depending on Achievement of Early Molecular Response in Patients with Chronic Myeloid Leukemia
Suche in Medline nach
Autoren
-
Ursula Rochau
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Area 4 Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria, Hall in Tirol, Österreich
-
Durda Vukicevic
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria, Hall in Tirol, Österreich
-
Stefan Schmidt
- Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Austria, Innsbruck, Österreich
-
David Stenehjem
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA; Huntsman Cancer Institute, University of Utah Hospitals & Clinics, Salt Lake City, UT; USA, Salt Lake City, Vereinigte Staaten
-
Diana Brixner
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Dept. of Public Health, Health Services Research and HTA, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria; Area 4 HTA and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria; Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA; Program in Personalized Health University of Utah,SLC, UT, USA, Salt Lake City, Vereinigte Staaten
-
Jerry Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, Seattle, Vereinigte Staaten
-
Günther Gastl
- Internal Medicine V, Hematology and Oncology, Medical University Innsbruck, Austria, Innsbruck, Österreich
-
Uwe Siebert
- Institute of Public Health, MDM and HTA, Dept. of Public Health, Health Services Research and HTA, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Area 4 HTA and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria; Center for Health Decision Science, Dept. of Health Policy and Management, Harvard Chan School of Public Health;Institute for Technology Assessment & Dept. of Radiology, MGH, Harvard Medical School,Boston,MA,USA, Hall in Tirol, Österreich
| Veröffentlicht: | 23. Februar 2016 |
|---|
Gliederung
Text
Background: Sequential application of tyrosine kinase inhibitors (TKIs) is standard-of-care for patients with chronic myeloid leukemia (CML).
Objectives: To evaluate the cost-effectiveness of several sequential treatment strategies for CML dependent on early molecular response (EMR) in the Austrian healthcare context.
Methods: We adapted a previously developed Markov state-transition model to incorporate eight different sequential treatment strategies dependent on the achievement of EMR after 3 months and performed a cohort simulation over a lifelong time horizon. Model parameters were extracted from published literature, epidemiological and economic databases. A 3% discount for health outcomes and costs was applied. We analyzed 3 different base-case scenarios assuming different effectiveness for second-generation TKIs when applied after failure of 3-month imatinib treatment. Comprehensive sensitivity analyses were conducted.
Results: When we assumed a high effectiveness of second-generation TKIs after imatinib failure, strategies starting with imatinib, followed by nilotinib in case of non-achieved EMR, are the preferred options. If we assume lower effectiveness of second-generation TKIs, our analysis results in two non-dominated strategies: (1) imatinib, followed by nilotinib in case of non-achieved EMR at 3 months and dasatinib after treatment failure or imatinib continuation in case of achieved 3-month EMR and nilotinib after treatment failure (2) nilotinib followed by its continuation in case of non-achieved EMR at 3 months or switch to imatinib in case of achieved 3 month EMR and dasatinib after treatment failure. Depending on the scenario, strategy 2 resulted in an incremental cost-effectiveness ratio of 196,200 €/QALY, 157,400 €/QALY or 87,700 €/QALY compared to the baseline strategy. Remaining strategies were excluded due to dominance. Sensitivity analyses on generic pricing of imatinib showed that starting with a more potent second-generation TKI and switching to imatinib after an achieved EMR are the preferred strategies.
Conclusions: Based on our analyses, according to the most realistic scenario assuming a medium effectiveness of second-generation TKIs after imatinib failure, we suggest nilotinib and its continuation for non-achieved EMR at 3 months or switch to imatinib after achieving 3-month EMR and dasatinib after treatment failure as a cost-effective strategy for Austria if the willingness-to pay threshold is at least around 157,000 €/QALY.
