Economic Analysis of Alemtuzumab (MabCampath®) in Fludarabinerefractory Chronic Lymphocytic Leukemia

Abstract

Abstract:Objective: The objective of this economic analysis is to determine the cost-effectiveness of alemtuzumab in the treatment of B cell chronic lymphocytic leukemia (B-CLL) patients who have progressed despite fludarabine therapy. Method:This model was developed according to the Canadian public payer health system considering only direct medical costs. Effectiveness information was obtained from the published literature. Resource utilization was based on guidelines, literature and expert opinion. Cost information was obtained from provincial costing sources and presented in 2008 Canadian dollars. The primary comparators for this analysis were alemtuzumab, Various Treatments (VT) (combination of agents), fludarabine+cyclophosphamide (FC), fludarabine+cyclophosphamide+rituximab (FCR) and best supportive care (BSC).Results: Estimated mean survival for alemtuzumab was 22.68 months (1.89 years). Mean survival for VT was estimated from the literature at 16.32 months (1.36 years). The mean survival for FC was 17.44 months (1.45 years) and FCR 20.06 months (1.67 years). The incremental cost-effectiveness ratio (ICER) for alemtuzumab vs VT was $43,615/life year gained (LYG); $52,536/LYG for the alemtuzumab vs FC; $21,818/LYG vs FCR; and less costly and more effective vs BSC. ICERs were sensitive to three variables: treatment duration of alemtuzumab; treatment duration of FCR; and additional survival due to rituximab for FCR patients compared to FC. Conclusion:The results showed that the ICERs for alemtuzumab in B-CLL patients who have failed fludarabine ranged from $21,818/LYG to $52,536/LYG compared to active treatment, and was less costly and more efficacious compared to BSC.

Frontline rituximab monotherapy induction versus a watch and wait approach for asymptomatic advanced‐stage follicular lymphoma: A cost‐effectiveness analysis

“…Costs were derived from a public health payer's perspective. The drug acquisition costs of rituximab and bendamustine were derived from Canadian cost analyses . Supportive drug costs were derived from hospital pharmacies.…”

“…Pharmacy and nursing costs were obtained from hospital human resources departments. Resource utilization and overhead costs were based on published guidelines and statistics . The costs of adverse events were derived from the literature.…”

Economic evaluation of obinutuzumab in combination with chlorambucil in first-line treatment of patients with chronic lymphocytic leukemia in Spain

“…This was considered to be the most appropriate structure, which has been frequently used in the evaluation of cancer treatments, according to a systematic review of the medical and economic literature. 11 – 14 Each health state was assigned a specific cost and utility value (patient-perceived quality of life).…”

Cost Effectiveness of Monoclonal Antibody Therapy for Rare Diseases: A Systematic Review

“…Therefore, our review included 16 articles that evaluated nine mAb drugs for ten different orphan indications. Because several studies included more than one comparator or perspective in their economic evaluations, 24 economic evaluations were abstracted from 16 articles [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Table 2 presents an overview of the characteristics of the included economic studies.…”

“…Mittmann et al [17] conducted an economic analysis of alemtuzumab for patients with fludarabine-refractory chronic lymphocytic leukemia in Canada. Analyses of alemtuzumab with three different comparators showed its ICERs ranged from $Can21,818/life-year gained (LYG) to $Can52,536/LYG.…”