title: A cost-effectiveness analysis of using azacitidine vs. decitabine in treating patients with myelodysplastic syndromes.
abstract: OBJECTIVE
  Azacitidine and decitabine are used to treat patients with myelodysplastic syndromes (MDS) in the United States (US). This study sought to assess their relative cost-effectiveness.
  
  
  METHODS
  The authors developed a cost-effectiveness Markov model (1-month cycles) tracking hypothetical cohorts of MDS patients treated with azacitidine or decitabine over 2 years. The model used a US payer perspective and 2009 costs. Health states modeled included MDS with Transfusion Dependence, MDS with Transfusion Independence, Progression to Acute Myelogenous Leukemia (AML), and Death. Incremental cost-effectiveness outcomes included cost per quality-adjusted life year (QALY), cost per life year (LY), cost per patient-month of transfusion independence, and cost per case of AML progression avoided. One-way sensitivity analyses were performed on key model parameters.
  
  
  RESULTS
  Compared to decitabine, azacitidine was associated with better survival (1.512 LYs vs 1.292), more QALYs gained (1.041 vs 0.870), more patient-months with transfusion independence (8.328 vs 6.224), and a greater proportion of patients avoiding progression to AML (50.9% vs 28.5%). Total per-patient costs over 2 years for azacitidine were lower than for decitabine ($150,322 vs $166, 212).
  
  
  CONCLUSIONS
  To inform and update the model over time, it will be important that randomized or observational clinical studies be conducted to directly compare azacitidine and decitabine, provide new information on how these medicines are used, and on their relative clinical effectiveness.
  
  
  CONCLUSIONS
  Results demonstrate that azacitidine provides greater clinical benefit and costs less than decitabine across all key outcomes. These results accentuate the positive role of azacitidine in providing cost-effective care for MDS.
authors: United BioSource Corporation, Lexington, MA 02420, USA.
authors: Risha
authors: R
authors: Gidwani
authors: Zeba M
authors: ZM
authors: Khan
authors: Pierre
authors: P
authors: Fenaux
authors: C L
authors: CL
authors: Beach
authors: Chris L
authors: CL
authors: Pashos
mesh_terms: D000368:Aged; D001374:Azacitidine / Q000031:analogs & derivatives* / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D000077209:Decitabine; D004791:Enzyme Inhibitors / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D009190:Myelodysplastic Syndromes / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care / Q000191:economics*; D014481:United States
chemical_list: D004791:Enzyme Inhibitors; D000077209:Decitabine; D001374:Azacitidine