title: Medical decision analysis for first-line therapy of chronic myeloid leukemia.
abstract: Several tyrosine kinase inhibitors (TKIs) are approved for the treatment of chronic myeloid leukemia (CML). Our goal was to develop a clinical decision-analytic model for evaluation of the long-term effectiveness of different therapy regimens. We developed a Markov cohort model with a lifelong time horizon for first-line treatment with imatinib, dasatinib or nilotinib. Seven strategies including combinations of TKIs, chemotherapy and stem cell transplant were evaluated. The model was parameterized using published trial data, the Austrian CML registry and practice patterns estimated by experts. Health outcomes evaluated were life-years (LYs) and quality-adjusted LYs (QALYs). Based on our decision analysis, dasatinib following nilotinib failure was the most effective treatment in terms of LYs (19.8 LYs) and QALYs (16.1 QALYs). Sensitivity analyses showed that the ranking of strategies was mostly influenced by the duration of first- and second-line therapies. Our results may support decision-making regarding the sequential application of TKIs.
authors.affiliation: Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology , Hall i.T. , Austria.
authors.forename: Ursula
authors.initials: U
authors.lastname: Rochau
authors.forename: Gaby
authors.initials: G
authors.lastname: Sroczynski
authors.forename: Dominik
authors.initials: D
authors.lastname: Wolf
authors.forename: Stefan
authors.initials: S
authors.lastname: Schmidt
authors.forename: Annette
authors.initials: A
authors.lastname: Conrads-Frank
authors.forename: Beate
authors.initials: B
authors.lastname: Jahn
authors.forename: Kim
authors.initials: K
authors.lastname: Saverno
authors.forename: Diana
authors.initials: D
authors.lastname: Brixner
authors.forename: Jerald
authors.initials: J
authors.lastname: Radich
authors.forename: Guenther
authors.initials: G
authors.lastname: Gastl
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003198:Computer Simulation; D003661:Decision Support Techniques; D019468:Disease Management; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000175:diagnosis* / Q000628:therapy*; D015233:Models, Statistical; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors
keywords: Chronic myeloid leukemia; decision analysis; decision-analytic model; quality-adjusted life years; tyrosine kinase inhibitors