An exploratory cost-effectiveness analysis of systemic treatments for cutaneous T-cell lymphoma. (4th July 2018)

• Record Type: Journal Article
• Authors: Geskin, Larisa; Malone, Daniel C.
• Is Part Of: Journal of dermatological treatment. Volume 29:Number 5(2018)
• Page Start: 522
• Page End: 530
• Publication Date: 2018-07-04
• Subjects: Cost-effectiveness -- cutaneous T-cell lymphoma -- extracorporeal photopheresis; Skin -- Diseases -- Treatment -- Periodicals; Skin Diseases -- drug therapy -- Periodicals; Skin Diseases -- therapy -- Periodicals; 616.5
• DOI: 10.1080/09546634.2017.1412064
• Languages: English
• ISSNs: 0954-6634

Abstract

Abstract: Purpose: To conduct an exploratory cost-effectiveness analysis of systemic treatment options for more advanced cutaneous T-cell lymphoma (CTCL). Methods: A cost-effectiveness model compared systemic bexarotene, denileukin diftitox, interferon-α, methotrexate, pralatrexate, romidepsin, vorinostat, and extracorporeal photopheresis (ECP) treatment of CTCL. Treatment effectiveness data were extracted from published studies and/or US product labeling. Overall response, the primary effectiveness measure, was defined as the proportion of patients achieving complete or partial response. Costs were based on wholesale acquisition cost (medications) and Medicare reimbursement rates (ECP, medication administration, adverse drug effect treatment). The perspective of the study was from that of a payer. Results: Methotrexate was the lowest cost option [mean $436; standard deviation (SD) $284], followed by interferon-α (mean $32, 174; SD $27, 582), denileukin difitox (mean $40, 107; SD $18, 598), and ECP (mean $40, 985; SD $45, 633). Other treatments had costs greater than $50, 000, ranging from vorinostat ($65, 958; SD $40, 637) to bexarotene ($239, 424; SD $178, 881). The incremental cost-effectiveness ratio per successfully treated patient was $396, 725 (interferon) and $213, 416 (ECP). Denileukin diftitox, romidepsin, and vorinostat were less effective and cost more than methotrexate. Conclusion: Methotrexate is the most cost-effective option for CTCL; however, its low cost is offset by its limited effectiveness in advanced stages of CTCL. ECP and interferon appear the next most cost-effective therapies.