Cost-effectiveness of dasatinib and nilotinib for imatinib-resistant or –intolerant chronic phase chronic myeloid leukaemia

Martin Hoyle, Gabriel Rogers, Tiffany Moxham, Zulian Liu, Ken Stein

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objectives
To estimate the cost-effectiveness of dasatinib and nilotinib compared with high-dose imatinib for people with chronic phase chronic myeloid leukemia, which are resistant to normal-dose imatinib and compared with interferon-α for people intolerant to imatinib, from the perspective of the UK National Health Service.

Methods
An an area under the curve partitioned survival model was developed to estimate the cost-effectiveness of dasatinib and nilotinib. Clinical effectiveness evidence was taken mostly from single-arm trials.

Results
Both progression-free survival and overall survival are highly uncertain. In the base case, patients take nilotinib for much less time than dasatinib. Nilotinib is expected to dominate high-dose imatinib, yielding slightly more (0.32) quality-adjusted life years (QALYs) at slightly less cost (£11,100 [pound sterling]) per person. Dasatinib is predicted to provide slightly more (0.53) QALYs at substantially greater cost (£48,900), yielding a very high incremental cost-effectiveness ratio of £91,500 QALY against high-dose imatinib. Cost-effectiveness, however, changes radically under the plausible assumption that the drugs are taken for the same time. For people intolerant to imatinib, nilotinib is expected to yield an incremental cost-effectiveness ratio of £104,700/QALY, and dasatinib £82,600/QALY compared with interferon-α. Further, both drugs represent poor value for money for a range of plausible structural assumptions.

Conclusions
The model should be viewed as an exploratory analysis of the cost-effectiveness of dasatinib and nilotinib because it relies on many assumptions. Whilst clinical data remains immature, the cost-effectiveness of dasatinib and nilotinib for imatinib-resistant people is highly uncertain. Both nilotinib and dasatinib are highly unlikely to be cost-effective versus interferon-α for people intolerant to imatinib.
Original languageEnglish
Pages (from-to)1057–1067
Number of pages11
JournalValue in Health
Volume14
Issue number8
DOIs
Publication statusPublished - 2011
Externally publishedYes

Keywords

  • chronic myeloid leukemia
  • cost-effectiveness
  • cost-utility
  • dasatinib
  • decision analytic modeling
  • Glivec
  • imatinib
  • nilotinib
  • Sprycel
  • Tasigna

Fingerprint Dive into the research topics of 'Cost-effectiveness of dasatinib and nilotinib for imatinib-resistant or –intolerant chronic phase chronic myeloid leukaemia'. Together they form a unique fingerprint.

Cite this