Cost–effectiveness of treatments for high-risk myelodysplastic syndromes after failure of first-line hypomethylating agent therapy. (3rd March 2016)

• Record Type: Journal Article
• Authors: Cogle, Christopher R; Ortendahl, Jesse D; Bentley, Tanya GK; Anene, Ayanna M; Megaffin, Scott; McKearn, Thomas J; Petrone, Michael E; Mukherjee, Sudipto
• Is Part Of: Expert review of pharmacoeconomics & outcomes research. Volume 16:Number 2(2016)
• Page Start: 275
• Page End: 284
• Publication Date: 2016-03-03
• Subjects: cost–effectiveness analysis -- economic modeling -- health care resource utilization -- hypomethylating agents -- myelodysplastic syndromes; Pharmacology -- Economic aspects -- Periodicals; 338.47615105
• DOI: 10.1586/14737167.2016.1096200
• Languages: English
• ISSNs: 1473-7167

Abstract

Abstract : Purpose: To evaluate optimal salvage therapy in high-risk myelodysplastic syndromes patients who have failed a first-line hypomethylating agent (HMA) therapy, given that treatment choice is challenging. Methods: Using published literature and expert opinion, we developed a Markov model to evaluate the cost–effectiveness of current treatments for patients who failed first-line HMA therapy. The model predicted costs, life years, quality-adjusted life years and incremental cost-effectiveness ratios. Sensitivity analyses were conducted to assess the impact of uncertainty in model inputs. Results: Supportive care was the least expensive option ($65, 704/patient) with the shortest survival (0.48 years). Low- and high-intensity chemotherapies and hematopoietic cell transplantation increased survival and costs with incremental cost-effectiveness ratios of $108, 808, 306, 103 and 318, 163/life year, respectively. Switching HMA was more costly and less efficacious than another treatment option, namely low-intensity chemotherapy. Conclusions: Subsequent treatments in myelodysplastic syndrome patients who failed first-line HMA significantly increase costs, while only providing marginal clinical benefit and substantially increasing treatment-related morbidities. Additional treatment options would benefit resource allocation, clinical decision-making and patient outcomes.