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Cost‐Efficacy of Imatinib versus Allogeneic Bone Marrow Transplantation with a Matched Unrelated Donor in the Treatment of Chronic Myelogenous Leukemia: A Decision‐Analytic Approach
Author(s) -
Skrepnek Grant H.,
Ballard Erin E.
Publication year - 2005
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.25.3.325.61593
Subject(s) - medicine , imatinib , chronic myelogenous leukemia , oncology , context (archaeology) , cost effectiveness , transplantation , leukemia , surgery , myeloid leukemia , paleontology , risk analysis (engineering) , biology
Study Objective . To develop and populate a decision‐analytic model for comparing the 2‐year cost and efficacy of imatinib versus allogeneic bone marrow transplantation (BMT) with a matched unrelated donor in the treatment of a 35‐year‐old man with newly diagnosed, Philadelphia chromosome—positive (Ph[+]) chronic myelogenous leukemia (CML) in the chronic phase. Design . Markov cohort analysis and first‐order Monte Carlo microsimulation. Measurements and Main Results . Direct medical costs were measured from the perspective of a third‐party payer. Efficacy data and probabilities were obtained from survivability findings, most of which were derived from randomized controlled trials. We employed a 2‐year time horizon with 3‐month treatment cycles. The comparator was BMT with a matched unrelated donor, and the base case was defined as a 35‐year‐old, Ph(+) man with newly diagnosed CML. The Monte Carlo microsimulation indicated that the incremental cost:efficacy ratio was −$5000 for imatinib (95% confidence interval −$70,000–84,000). Analysis of the cost‐efficacy plane revealed that imatinib was dominant over BMT in 84.69% of cases, whereas BMT dominated imatinib in 0.76% of cases. Trade‐offs were warranted in the remaining cases. Sensitivity analyses of costs and discount rates found these results to be generally robust. Conclusion . In most cases, imatinib was both less costly and more efficacious than BMT in the 2‐year treatment of CML. Results of this investigation should be viewed in the context of emerging long‐term clinical data. These data are necessary to assess cost‐efficacy beyond the short‐term time horizon of this study.