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J Natl Cancer Inst. 2016 Mar 4;108(7). pii: djw003. doi: 10.1093/jnci/djw003. Print 2016 Jul.

Cost-effectiveness of Tyrosine Kinase Inhibitor Treatment Strategies for Chronic Myeloid Leukemia in Chronic Phase After Generic Entry of Imatinib in the United States.

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  • 1Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD (WVP); Department of Medicine (RAL) and Departments of Pediatrics and of Public Health Sciences (RMC), University of Chicago, Chicago, IL; Eshelman School of Pharmacy and Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, and Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (SBD); Department of Haematology, Hammersmith Hospital, Imperial College, London, UK (JFA); Department of Medicine (RH, SS) and Department of Hematology and Oncology (MCM), University of Heidelberg, Mannheim, Germany; Department of Haematology and Oncology, S. Orsola-Malpighi University Hospital (MB), and Department of Hematology, "L. e A. Seragnoli" (GM), University of Bologna, Bologna, Italy; Department of Haematology and Oncology, University Hospital, Jena, Germany (EE); INSERM Centre d'Investigation Clinique (CIC) 1402, CHU de Poitiers, Poitiers, France (JG, FG); Laboratoire d'Hematologie, Universite Victor Segalen, Bordeaux, Pessac, France (FXM); Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (JM); Department of Hematology and Oncology, University Hospital Leipzig, Leipzig, Germany (DN); Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI (CAS); Department of Medicine, Weill Cornell Medical Center, New York, NY (RTS); Uppsala University, Uppsala, Sweden (BS).
  • 2Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD (WVP); Department of Medicine (RAL) and Departments of Pediatrics and of Public Health Sciences (RMC), University of Chicago, Chicago, IL; Eshelman School of Pharmacy and Gillings School of Global Public Health, Lineberger Comprehensive Cancer Center, and Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (SBD); Department of Haematology, Hammersmith Hospital, Imperial College, London, UK (JFA); Department of Medicine (RH, SS) and Department of Hematology and Oncology (MCM), University of Heidelberg, Mannheim, Germany; Department of Haematology and Oncology, S. Orsola-Malpighi University Hospital (MB), and Department of Hematology, "L. e A. Seragnoli" (GM), University of Bologna, Bologna, Italy; Department of Haematology and Oncology, University Hospital, Jena, Germany (EE); INSERM Centre d'Investigation Clinique (CIC) 1402, CHU de Poitiers, Poitiers, France (JG, FG); Laboratoire d'Hematologie, Universite Victor Segalen, Bordeaux, Pessac, France (FXM); Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic (JM); Department of Hematology and Oncology, University Hospital Leipzig, Leipzig, Germany (DN); Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI (CAS); Department of Medicine, Weill Cornell Medical Center, New York, NY (RTS); Uppsala University, Uppsala, Sweden (BS). rconti@peds.bsd.uchicago.edu.

Abstract

BACKGROUND:

We analyzed the cost-effectiveness of treating incident chronic myeloid leukemia in chronic phase (CML-CP) with generic imatinib when it becomes available in United States in 2016. In the year following generic entry, imatinib's price is expected to drop 70% to 90%. We hypothesized that initiating treatment with generic imatinib in these patients and then switching to the other tyrosine-kinase inhibitors (TKIs), dasatinib or nilotinib, because of intolerance or lack of effectiveness ("imatinib-first") would be cost-effective compared with the current standard of care: "physicians' choice" of initiating treatment with any one of the three TKIs.

METHODS:

We constructed Markov models to compare the five-year cost-effectiveness of imatinib-first vs physician's choice from a US commercial payer perspective, assuming 3% annual discounting ($US 2013). The models' clinical endpoint was five-year overall survival taken from a systematic review of clinical trial results. Per-person spending on incident CML-CP treatment overall care components was estimated using Truven's MarketScan claims data. The main outcome of the models was cost per quality-adjusted life-year (QALY). We interpreted outcomes based on a willingness-to-pay threshold of $100 000/QALY. A panel of European LeukemiaNet experts oversaw the study's conduct.

RESULTS:

Both strategies met the threshold. Imatinib-first ($277 401, 3.87 QALYs) offered patients a 0.10 decrement in QALYs at a savings of $88 343 over five years to payers compared with physician's choice ($365 744, 3.97 QALYs). The imatinib-first incremental cost-effectiveness ratio was approximately $883 730/QALY. The results were robust to multiple sensitivity analyses.

CONCLUSION:

When imatinib loses patent protection and its price declines, its use will be the cost-effective initial treatment strategy for CML-CP.

© The Author 2016. Published by Oxford University Press.

PMID:
26944912
[PubMed - in process]
PMCID:
PMC4864987
Free PMC Article
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