Cost-utility analysis of imatinib mesylate for the treatment of chronic myelogenous leukemia in the chronic phase.
BACKGROUND
Imatinib mesylate is a targeted therapy for the treatment of chronic myeloid leukemia (CML).


OBJECTIVE
The aim of this study was to estimate the incremental cost-utility of imatinib mesylate compared with hydroxyurea in patients with chronic-phase CML for whom first-line treatment with interferon-alpha failed to produce a response.


METHODS
A Markov model was developed to simulate disease progression for hypothetical patients receiving imatinib mesylate or hydroxyurea, who had not previously responded to interferon-a therapy, to determine outcomes in terms of quality-adjusted life-years (QALYs). Costs were estimated from the perspective of the United Kingdom National Health Service. Patient data were derived from previously published trials.


RESULTS
The Markov model simulated the transitions of a hypothetical sample of 1000 chronic-phase CML patients using 1 monthly cycle over the lifetime of the patient sample. Median survival rates were estimated to be 77 months for imatinib mesylate-treated patients and 56 months for hydroxyurea-treated patients. Patients receiving imatinib mesylate accrued 5.95 QALYs, whereas hydroxyurea-treated patients accrued 3.49 QALYs. The estimated per-patient lifetime costs were 110,103 pound sterlings for patients in the imatinib mesylate group and 15,566 pound sterlings for patients in the hydroxyurea group (year-2001 values). The estimated year-2001 incremental cost per QALY gained from using imatinib mesylate compared with hydroxyurea in chronic phase CML was 38,468 pound sterlings.


CONCLUSIONS
In the present model analysis, imatinib mesylate as a second-line treatment for patients with chronic phase CML was found to offer considerable health benefits to patients, but at a cost to the payer. The incremental cost-effectiveness ratio was 38,468 pound sterlings (year-2001 values).
Warren
Emma
E
School of Health and Related Research, University of Sheffield, Sheffield, UK S1 4DA.
Ward
Sue
S
Gordois
Adam
A
Scuffham
Paul
P
D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use*; D001549:Benzamides; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D016527:Drug Costs; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000191:economics; D008390:Markov Chains; D018803:Models, Economic; D010879:Piperazines / Q000191:economics* / Q000627:therapeutic use*; D011743:Pyrimidines / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate