Cost-effectiveness of tyrosine kinase inhibitor treatment strategies for chronic myeloid leukemia in chronic phase after generic entry of imatinib in the United States

William Padula, Richard A. Larson, Stacie B. Dusetzina, Jane F. Apperley, Rudiger Hehlmann, Michele Baccarani, Ekkehard Eigendorff, Joelle Guilhot, Francois Guilhot, Francois Xavier Mahon, Giovanni Martinelli, Jiri Mayer, Martin C. Müller, Dietger Niederwieser, Susanne Saussele, Charles A. Schiffer, Richard T. Silver, Bengt Simonsson, Rena M. Conti

Research output: Contribution to journalArticle

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 (×quot;imatinib-first×quot;) would be cost-effective compared with the current standard of care: ×quot;physicians' choice×quot; 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 (×dollar;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 ×dollar;100 000/QALY. A panel of European LeukemiaNet experts oversaw the study's conduct. Results: Both strategies met the threshold. Imatinib-first (×dollar;277 401, 3.87 QALYs) offered patients a 0.10 decrement in QALYs at a savings of ×dollar;88 343 over five years to payers compared with physician's choice (×dollar;365 744, 3.97 QALYs). The imatinibfirst incremental cost-effectiveness ratio was approximately ×dollar;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.

Original languageEnglish (US)
Article numberdjw003
JournalJournal of the National Cancer Institute
Volume108
Issue number7
DOIs
StatePublished - 2016

Fingerprint

Leukemia, Myeloid, Chronic Phase
Quality-Adjusted Life Years
Protein-Tyrosine Kinases
Cost-Benefit Analysis
Physicians
Costs and Cost Analysis
Therapeutics
Standard of Care
Imatinib Mesylate
Clinical Trials
Survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Cost-effectiveness of tyrosine kinase inhibitor treatment strategies for chronic myeloid leukemia in chronic phase after generic entry of imatinib in the United States. / Padula, William; Larson, Richard A.; Dusetzina, Stacie B.; Apperley, Jane F.; Hehlmann, Rudiger; Baccarani, Michele; Eigendorff, Ekkehard; Guilhot, Joelle; Guilhot, Francois; Mahon, Francois Xavier; Martinelli, Giovanni; Mayer, Jiri; Müller, Martin C.; Niederwieser, Dietger; Saussele, Susanne; Schiffer, Charles A.; Silver, Richard T.; Simonsson, Bengt; Conti, Rena M.

In: Journal of the National Cancer Institute, Vol. 108, No. 7, djw003, 2016.

Research output: Contribution to journalArticle

Padula, W, Larson, RA, Dusetzina, SB, Apperley, JF, Hehlmann, R, Baccarani, M, Eigendorff, E, Guilhot, J, Guilhot, F, Mahon, FX, Martinelli, G, Mayer, J, Müller, MC, Niederwieser, D, Saussele, S, Schiffer, CA, Silver, RT, Simonsson, B & Conti, RM 2016, 'Cost-effectiveness of tyrosine kinase inhibitor treatment strategies for chronic myeloid leukemia in chronic phase after generic entry of imatinib in the United States', Journal of the National Cancer Institute, vol. 108, no. 7, djw003. https://doi.org/10.1093/jnci/djw003
Padula, William ; Larson, Richard A. ; Dusetzina, Stacie B. ; Apperley, Jane F. ; Hehlmann, Rudiger ; Baccarani, Michele ; Eigendorff, Ekkehard ; Guilhot, Joelle ; Guilhot, Francois ; Mahon, Francois Xavier ; Martinelli, Giovanni ; Mayer, Jiri ; Müller, Martin C. ; Niederwieser, Dietger ; Saussele, Susanne ; Schiffer, Charles A. ; Silver, Richard T. ; Simonsson, Bengt ; Conti, Rena M. / Cost-effectiveness of tyrosine kinase inhibitor treatment strategies for chronic myeloid leukemia in chronic phase after generic entry of imatinib in the United States. In: Journal of the National Cancer Institute. 2016 ; Vol. 108, No. 7.
@article{0c92746801e44fd08bd851f06443fc4c,
title = "Cost-effectiveness of tyrosine kinase inhibitor treatment strategies for chronic myeloid leukemia in chronic phase after generic entry of imatinib in the United States",
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 (×quot;imatinib-first×quot;) would be cost-effective compared with the current standard of care: ×quot;physicians' choice×quot; 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 (×dollar;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 ×dollar;100 000/QALY. A panel of European LeukemiaNet experts oversaw the study's conduct. Results: Both strategies met the threshold. Imatinib-first (×dollar;277 401, 3.87 QALYs) offered patients a 0.10 decrement in QALYs at a savings of ×dollar;88 343 over five years to payers compared with physician's choice (×dollar;365 744, 3.97 QALYs). The imatinibfirst incremental cost-effectiveness ratio was approximately ×dollar;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.",
author = "William Padula and Larson, {Richard A.} and Dusetzina, {Stacie B.} and Apperley, {Jane F.} and Rudiger Hehlmann and Michele Baccarani and Ekkehard Eigendorff and Joelle Guilhot and Francois Guilhot and Mahon, {Francois Xavier} and Giovanni Martinelli and Jiri Mayer and M{\"u}ller, {Martin C.} and Dietger Niederwieser and Susanne Saussele and Schiffer, {Charles A.} and Silver, {Richard T.} and Bengt Simonsson and Conti, {Rena M.}",
year = "2016",
doi = "10.1093/jnci/djw003",
language = "English (US)",
volume = "108",
journal = "Journal of the National Cancer Institute",
issn = "0027-8874",
publisher = "Oxford University Press",
number = "7",

}

TY - JOUR

T1 - Cost-effectiveness of tyrosine kinase inhibitor treatment strategies for chronic myeloid leukemia in chronic phase after generic entry of imatinib in the United States

AU - Padula, William

AU - Larson, Richard A.

AU - Dusetzina, Stacie B.

AU - Apperley, Jane F.

AU - Hehlmann, Rudiger

AU - Baccarani, Michele

AU - Eigendorff, Ekkehard

AU - Guilhot, Joelle

AU - Guilhot, Francois

AU - Mahon, Francois Xavier

AU - Martinelli, Giovanni

AU - Mayer, Jiri

AU - Müller, Martin C.

AU - Niederwieser, Dietger

AU - Saussele, Susanne

AU - Schiffer, Charles A.

AU - Silver, Richard T.

AU - Simonsson, Bengt

AU - Conti, Rena M.

PY - 2016

Y1 - 2016

N2 - 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 (×quot;imatinib-first×quot;) would be cost-effective compared with the current standard of care: ×quot;physicians' choice×quot; 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 (×dollar;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 ×dollar;100 000/QALY. A panel of European LeukemiaNet experts oversaw the study's conduct. Results: Both strategies met the threshold. Imatinib-first (×dollar;277 401, 3.87 QALYs) offered patients a 0.10 decrement in QALYs at a savings of ×dollar;88 343 over five years to payers compared with physician's choice (×dollar;365 744, 3.97 QALYs). The imatinibfirst incremental cost-effectiveness ratio was approximately ×dollar;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.

AB - 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 (×quot;imatinib-first×quot;) would be cost-effective compared with the current standard of care: ×quot;physicians' choice×quot; 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 (×dollar;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 ×dollar;100 000/QALY. A panel of European LeukemiaNet experts oversaw the study's conduct. Results: Both strategies met the threshold. Imatinib-first (×dollar;277 401, 3.87 QALYs) offered patients a 0.10 decrement in QALYs at a savings of ×dollar;88 343 over five years to payers compared with physician's choice (×dollar;365 744, 3.97 QALYs). The imatinibfirst incremental cost-effectiveness ratio was approximately ×dollar;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.

UR - http://www.scopus.com/inward/record.url?scp=84979255197&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84979255197&partnerID=8YFLogxK

U2 - 10.1093/jnci/djw003

DO - 10.1093/jnci/djw003

M3 - Article

VL - 108

JO - Journal of the National Cancer Institute

JF - Journal of the National Cancer Institute

SN - 0027-8874

IS - 7

M1 - djw003

ER -