Cost-Effectiveness of Bosutinib for the Treatment of Adult Patients with Chronic Phase Chronic Myeloid Leukemia in the Second-Line Setting

Abstract

Background A recently conducted matching-adjusted indirect comparison demonstrated that bosutinib improved progressionfree survival, and delayed progression to advanced disease compared with dasatinib and nilotinib in patients with second line (2L) chronic-phase chronic myeloid leukemia (CP-CML). However, the long-term clinical and economic impact of using bosutinib versus dasatinib and nilotinib has not been evaluated. The objective was to determine the cost-effectiveness of bosutinib compared with dasatinib and bosutinib compared with nilotinib from a US payer perspective. Methods A cost-effectiveness model was developed using partition survival methods and three health states: progressionfree, progression, and death. Trial data (individual patient-level and aggregate-level data) informed the progression-free and overall survival estimates. Costs included drugs and medical resource use. Utility values were obtained from literature. Sensitivity analyses (SAs) included one-way and probabilistic sensitivity analyses (PSAs). Results Comparing bosutinib versus dasatinib resulted in a gain of 0.4 discounted life years, 1.5 quality-adjusted life years (QALYs), and incremental costs of $28,459 (values in 2020 US dollars), for an incremental cost-effectiveness ratio (ICER) of $19,811/QALY gained. Comparing bosutinib versus nilotinib resulted in a gain of 0.8 discounted life-years, 1.8 QALYs, and incremental costs of $76,563, for an ICER of $41,932/QALY gained. Drug costs and extrapolation distribution type were the main drivers of the model in the one-way SAs. In the PSAs, bosutinib had >90% and >80% probabilities of being cost-effective at a willingness-to-pay threshold of $100,000/QALY versus dasatinib and nilotinib, respectively. Conclusions Our results suggest that compared with dasatinib and nilotinib, bosutinib may represent good value for money for treating 2L CP-CML patients.

Cost‐effectiveness analysis of dinutuximab β for the treatment of high‐risk neuroblastoma in China

“…The model involved three mutually exclusive health states based on one international, open‐label, phase 3, randomized, controlled trial (NCT01704716): EFS, post‐progression survival (PPS), and death 7 . The proportion of EFS patients, PPS patients, and deaths was estimated by plotting EFS and OS curves 11,12 …”

“…7 The proportion of EFS patients, PPS patients, and deaths was estimated by plotting EFS and OS curves. 11,12 The population in this study was assumed to be patients with high-risk NB who achieved at least partial remission after induction chemotherapy, surgical resection, autologous hematopoietic stem cell transplantation, and radiotherapy. Furthermore, NB onset mainly occurs at 3 years of age, and thus the initial age was set at 3 years.…”