Cost-effectiveness of the sequential application of tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia

Ursula Rochau, Gaby Sroczynski, Dominik Wolf, Stefan Schmidt, Beate Jahn, Martina Kluibenschaedl, Annette Conrads-Frank, David Stenehjem, Diana Brixner, Jerald Radich, Günther Gastl, Uwe Siebert

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2315-2325
Number of pages11
JournalLeukemia and Lymphoma
Volume56
Issue number8
DOIs
StatePublished - Aug 3 2015

Keywords

  • Chronic myeloid leukemia
  • cost-eff ectiveness analysis
  • decision analysis
  • decision-analytic model
  • health economic modeling
  • tyrosine kinase inhibitors

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