Cost-effectiveness of the sequential application of tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia. Issue 8 (3rd August 2015)

• Record Type: Journal Article
• Authors: Rochau, Ursula; Sroczynski, Gaby; Wolf, Dominik; Schmidt, Stefan; Jahn, Beate; Kluibenschaedl, Martina; Conrads-Frank, Annette; Stenehjem, David; Brixner, Diana; Radich, Jerald; Gastl, Günther; Siebert, Uwe
• Is Part Of: Leukemia & lymphoma. Volume 56:Issue 8(2015:Aug.)
• Page Start: 2315
• Page End: 2325
• Publication Date: 2015-08-03
• Subjects: Chronic myeloid leukemia -- decision-analytic model -- tyrosine kinase inhibitors -- decision analysis -- cost-effectiveness analysis -- health economic modeling; Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.3109/10428194.2014.982635
• Languages: English
• ISSNs: 1042-8194

Abstract

Abstract : Several tyrosine kinase inhibitors (TKIs) are approved for chronic myeloid leukemia (CML) therapy. We evaluated the long-term cost-effectiveness of seven sequential therapy regimens for CML in Austria. A cost-effectiveness analysis was performed using a state-transition Markov model. As model parameters, we used published trial data, clinical, epidemiological and economic data from the Austrian CML registry and national databases. We performed a cohort simulation over a life-long time-horizon from a societal perspective. Nilotinib without second-line TKI yielded an incremental cost-utility ratio of 121 400 €/quality-adjusted life year (QALY) compared to imatinib without second-line TKI after imatinib failure. Imatinib followed by nilotinib after failure resulted in 131 100 €/QALY compared to nilotinib without second-line TKI. Nilotinib followed by dasatinib yielded 152 400 €/QALY compared to imatinib followed by nilotinib after failure. Remaining strategies were dominated. The sequential application of TKIs is standard-of-care, and thus, our analysis points toward imatinib followed by nilotinib as the most cost-effective strategy.