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

2016/03/04 by William V. Padula, Richard A. Larson, Stacie B. Dusetzina +22 · 26 citations
Medicine · Social Sciences · Economics, Econometrics and Finance · #Chronic Myeloid Leukemia Treatments #Health, Education, and Cultural Studies #Economic and Financial Impacts of Cancer

paper · pdf · doi:10.1093/jnci/djw003

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.

Cited by

• European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia
• Targeted therapy: Generic imatinib - impact on frontline and salvage therapy for CML. [europepmc]
• Radotinib and its clinical potential in chronic-phase chronic myeloid leukemia patients: an update. [europepmc]
• Balancing patient value and payer cost in hematologic malignancies: can it be done? [europepmc]
• Tyrosine Kinase Inhibitors in the Treatment of Chronic-Phase CML: Strategies for Frontline Decision-making. [europepmc]
• Imatinib is still recommended for frontline therapy for CML. [europepmc]
• Response to Therapy, Treatment Intolerance and Tyrosine Kinase Inhibitor Cessation Eligibility in a Real-World Cohort of Chronic Myeloid Leukaemia Patients. [europepmc]
• Treatment value of second-generation BCR-ABL1 tyrosine kinase inhibitors compared with imatinib to achieve treatment-free remission in patients with chronic myeloid leukaemia: a modelling study. [europepmc]
• Efficacy and safety of generic imatinib after switching from original imatinib in patients treated for chronic myeloid leukemia in the United States. [europepmc]
• Analysis of the cost-effectiveness of treatment strategies for CML with incorporation of treatment discontinuation. [europepmc]
• Cost effectiveness of therapeutic drug monitoring for imatinib administration in chronic myeloid leukemia. [europepmc]
• Managing chronic myeloid leukemia for treatment-free remission: a proposal from the GIMEMA CML WP. [europepmc]
• Expenditures for First- and Second-Generation Tyrosine Kinase Inhibitors Before and After Transition of Imatinib to Generic Status. [europepmc]
• Investigating the role of the innate immune response in relapse or blast crisis in chronic myeloid leukemia. [europepmc]
• Silent NK/T cell reactions to dasatinib during sustained deep molecular response before cessation are associated with longer treatment-free remission. [europepmc]
• Use of generic imatinib as first-line treatment in patients with chronic myeloid leukemia (CML): the GIMS (Glivec to Imatinib Switch) study. [europepmc]
• Chronic Myeloid Leukemia in 2020. [europepmc]
• Assessment of Outcomes After Stopping Tyrosine Kinase Inhibitors Among Patients With Chronic Myeloid Leukemia: A Nonrandomized Clinical Trial. [europepmc]
• Public research funding and pharmaceutical prices: do Americans pay twice for drugs? [europepmc]
• The New ELN Recommendations for Treating CML. [europepmc]
• Economics influences therapy decisions in chronic myeloid leukaemia: should it? [europepmc]
• Current evidence on the efficacy and safety of generic imatinib in CML and the impact of generics on health care costs. [europepmc]
• Which Tyrosine Kinase Inhibitors Should Be Selected as the First-Line Treatment for Chronic Myelogenous Leukemia in Chronic Phase? [europepmc]
• Hybrids of Imatinib with Quinoline: Synthesis, Antimyeloproliferative Activity Evaluation, and Molecular Docking. [europepmc]
• Imatinib Optimized Therapy Improves Major Molecular Response Rates in Patients with Chronic Myeloid Leukemia. [europepmc]
• Case report: Pleural effusion during tyrosine-kinase inhibitor treatment in chronic myeloid leukemia: Not only a dasatinib-related adverse event. [europepmc]

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