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Economic evaluation of arsenic trioxide compared to all‐trans retinoic acid + conventional chemotherapy for treatment of relapsed acute promyelocytic leukemia in Canada
Author(s) -
Lachaine Jean,
Mathurin Karine,
Barakat Stéphane,
Couban Stephen
Publication year - 2015
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12475
Subject(s) - acute promyelocytic leukemia , arsenic trioxide , medicine , refractory (planetary science) , cost effectiveness , oncology , retinoic acid , arsenic , biochemistry , chemistry , materials science , physics , risk analysis (engineering) , astrobiology , metallurgy , gene
Objectives Acute promyelocytic leukemia (APL) is an uncommon type of acute leukemia characterized by high early mortality. Current first‐line treatments include all‐trans retinoic acid (ATRA), anthracyclines, and other conventional chemotherapies (CTs). Although APL is generally associated with a good prognosis, about 20% of patients who achieve remission subsequently relapse and are resistant to the previously administrated treatment. The objective of this study was to assess, from a Canadian perspective, the economic impact of arsenic trioxide (ATO) compared to ATRA+CT for treatment of patients with relapsed/refractory APL. Methods The cost‐effectiveness of ATO compared to ATRA+CT for treating patients with relapsed/refractory APL was assessed over a lifetime horizon using a Markov model. The model considers five health states: induction, second remission, treatment failure or relapse, postfailure, and death. Markov cycle length was 1 month for the first 24 months and 1 yr thereafter. The model also takes into account the incidence of grade 3–4 adverse events reported in clinical trials. Analyses were conducted from a Canadian Ministry of Health (MoH) and a societal perspective. Results Compared to ATRA+CT, ATO was associated with incremental cost‐effectiveness ratios of $20 551/quality‐adjusted life year (QALY) from a MoH perspective and $22 219/QALY from a societal perspective. Results of the probabilistic sensitivity analysis indicated that ATO is a cost‐effective strategy in 99.27% and 98.98% of the simulations from a MoH and a societal perspective, respectively. Conclusions This economic evaluation demonstrates that ATO is a cost‐effective strategy compared to ATRA+CT for treatment of patients with relapsed/refractory APL in Canada.