title: Cost-utility analysis of imatinib mesilate for the treatment of advanced stage chronic myeloid leukaemia.
abstract: Imatinib mesilate (Glivec), Novartis Pharmaceuticals) is a novel therapy for the treatment of chronic myeloid leukaemia (CML). We evaluated the cost-effectiveness of imatinib (600 mg daily) when used for the treatment of patients in advanced stages of CML (accelerated phase and blast crisis) against conventional therapies of combination chemotherapy (DAT) and palliative care in hospital or at home. A Markov model simulated the transitions of hypothetical patient cohorts and outcomes were modelled for 5 years from the start of treatment. Costs were estimated from the perspective of the UK National Health Service. Over 5 years, a patient in accelerated phase will, on average, accrue an additional 2.09 QALYs with imatinib compared to conventional therapies, while patients in blast crisis will accrue an additional 0.58 quality-adjusted life-years (QALYs) with imatinib compared to conventional therapies. The costs per additional QALY gained from treatment with imatinib compared with conventional therapies were pound 29344 (accelerated phase) and pound 42239 (blast crisis). The results were particularly sensitive to the price of imatinib, improvements in quality of life, and the duration of haematological responses. We conclude that treatment of CML with imatinib confers considerably greater survival and quality of life than conventional treatments but at a cost.
authors.affiliation: York Health Economics Consortium Ltd, University of York, Market Square (level 2), York YO10 5NH, UK.
authors.forename: A
authors.initials: A
authors.lastname: Gordois
authors.forename: P
authors.initials: P
authors.lastname: Scuffham
authors.forename: E
authors.initials: E
authors.lastname: Warren
authors.forename: S
authors.initials: S
authors.lastname: Ward
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D001549:Benzamides; D001752:Blast Crisis / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006801:Humans; D000068877:Imatinib Mesylate; D015466:Leukemia, Myeloid, Chronic-Phase / Q000188:drug therapy / Q000191:economics*; D008390:Markov Chains; D010879:Piperazines / Q000191:economics* / Q000627:therapeutic use; D011743:Pyrimidines / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate