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.
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.


METHODS
Markov cohort analysis and first-order Monte Carlo microsimulation.


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.


CONCLUSIONS
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.
Skrepnek
Grant H
GH
Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, and the Center for Health Outcomes and PharmacoEconomic Research, Tucson, Arizona 85721, USA. skrepnek@pharmacy.arizona.edu
Ballard
Erin E
EE
D000328:Adult; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D001549:Benzamides; D016026:Bone Marrow Transplantation / Q000191:economics*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017048:Health Care Costs; D006801:Humans; D000068877:Imatinib Mesylate; D007349:Insurance, Health, Reimbursement / Q000191:economics; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000191:economics* / Q000628:therapy; D008297:Male; D008390:Markov Chains; D009010:Monte Carlo Method; D010879:Piperazines / Q000191:economics* / Q000627:therapeutic use; D011743:Pyrimidines / Q000191:economics* / Q000627:therapeutic use
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate