title: Cost-effectiveness of dasatinib and nilotinib for imatinib-resistant or -intolerant chronic phase chronic myeloid leukemia.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of dasatinib and nilotinib compared with high-dose imatinib for people with chronic phase chronic myeloid leukemia, which are resistant to normal-dose imatinib and compared with interferon-α for people intolerant to imatinib, from the perspective of the UK National Health Service.
  
  
  METHODS
  An an area under the curve partitioned survival model was developed to estimate the cost-effectiveness of dasatinib and nilotinib. Clinical effectiveness evidence was taken mostly from single-arm trials.
  
  
  RESULTS
  Both progression-free survival and overall survival are highly uncertain. In the base case, patients take nilotinib for much less time than dasatinib. Nilotinib is expected to dominate high-dose imatinib, yielding slightly more (0.32) quality-adjusted life years (QALYs) at slightly less cost (£11,100 [pound sterling]) per person. Dasatinib is predicted to provide slightly more (0.53) QALYs at substantially greater cost (£48,900), yielding a very high incremental cost-effectiveness ratio of £91,500 QALY against high-dose imatinib. Cost-effectiveness, however, changes radically under the plausible assumption that the drugs are taken for the same time. For people intolerant to imatinib, nilotinib is expected to yield an incremental cost-effectiveness ratio of £104,700/QALY, and dasatinib £82,600/QALY compared with interferon-α. Further, both drugs represent poor value for money for a range of plausible structural assumptions.
  
  
  CONCLUSIONS
  The model should be viewed as an exploratory analysis of the cost-effectiveness of dasatinib and nilotinib because it relies on many assumptions. Whilst clinical data remains immature, the cost-effectiveness of dasatinib and nilotinib for imatinib-resistant people is highly uncertain. Both nilotinib and dasatinib are highly unlikely to be cost-effective versus interferon-α for people intolerant to imatinib.
authors.affiliation: Peninsular College of Medicine and Dentistry, University of Exeter, Exeter, United Kingdom. martin.hoyle@pms.ac.uk
authors.forename: Martin
authors.initials: M
authors.lastname: Hoyle
authors.forename: Gabriel
authors.initials: G
authors.lastname: Rogers
authors.forename: Tiffany
authors.initials: T
authors.lastname: Moxham
authors.forename: Zulian
authors.initials: Z
authors.lastname: Liu
authors.forename: Ken
authors.initials: K
authors.lastname: Stein
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D019540:Area Under Curve; D001549:Benzamides; D003362:Cost-Benefit Analysis; D000069439:Dasatinib; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D019008:Drug Resistance, Neoplasm; D006801:Humans; D000068877:Imatinib Mesylate; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use; D015466:Leukemia, Myeloid, Chronic-Phase / Q000188:drug therapy* / Q000191:economics; D008962:Models, Theoretical; D010879:Piperazines / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D011743:Pyrimidines / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D016019:Survival Analysis; D015996:Survival Rate; D013844:Thiazoles / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D013997:Time Factors; D006113:United Kingdom
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D016898:Interferon-alpha; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D013844:Thiazoles; D000068877:Imatinib Mesylate; C498826:nilotinib; D000069439:Dasatinib