title: Cost-utility analysis of dasatinib and nilotinib in patients with chronic myeloid leukemia refractory to first-line treatment with imatinib in Thailand.
abstract: BACKGROUND
  Recently, the second-generation tyrosine kinase inhibitors dasatinib and nilotinib have emerged as alternative treatments in patients with chronic myeloid leukemia (CML) who are resistant to or intolerant of imatinib.
  
  
  OBJECTIVE
  This article aimed to assess the cost utility and budget impact of using dasatinib or nilotinib, rather than high-dose (800-mg/d) imatinib, in patients with chronic phase (CP) CML who are resistant to standard-dose (400-mg/d) imatinib in Thailand.
  
  
  METHODS
  A Markov simulation model was developed and used to estimate the lifetime costs and outcomes of treating patients aged ≥38 years with CP-CML. The efficacy parameters were synthesized from a systematic review. Utilities using the European Quality of Life-5 Dimensions tool and costs were obtained from the Thai CML population. Costs and outcomes were compared and presented as the incremental cost-effectiveness ratio in 2011 Thai baht (THB) per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses were performed to estimate parameter uncertainty.
  
  
  RESULTS
  From a societal perspective, treatment with dasatinib was found to yield more QALYs (2.13) at a lower cost (THB 1,631,331) per person than high-dose imatinib. Nilotinib treatment was also found to be more cost-effective than high-dose imatinib, producing an incremental cost-effectiveness ratio of THB 83,328 per QALY gained. This treatment option also resulted in the highest number of QALYs gained of all of the treatment options. The costs of providing dasatinib, nilotinib, and high-dose imatinib were estimated at THB 5 billion, THB 6 billion, and THB 7 billion, respectively.
  
  
  CONCLUSIONS
  Treatment with dasatinib or nilotinib is likely to be more cost-effective than treatment with high-dose imatinib in CP-CML patients who do not respond positively to standard-dose imatinib in the Thai context. Dasatinib was found to be more cost-effective than nilotinib.
authors.affiliation: Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand. Electronic address: wantanee.k@hitap.net.
authors.forename: Wantanee
authors.initials: W
authors.lastname: Kulpeng
authors.affiliation: Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Sumalai
authors.initials: S
authors.lastname: Sompitak
authors.affiliation: Bone Marrow Transplantation Program, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Saengsuree
authors.initials: S
authors.lastname: Jootar
authors.affiliation: Division of Hematology, Department of Medicine, Faculty of Medicine, Khonkaen University, Khonkaen, Thailand.
authors.forename: Kanchana
authors.initials: K
authors.lastname: Chansung
authors.affiliation: Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Yot
authors.initials: Y
authors.lastname: Teerawattananon
mesh_terms: D002017:Budgets; D003362:Cost-Benefit Analysis; D000069439:Dasatinib / Q000191:economics* / Q000627:therapeutic use; D016527:Drug Costs; D006801:Humans; D000068877:Imatinib Mesylate / Q000191:economics* / Q000627:therapeutic use; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy; D015466:Leukemia, Myeloid, Chronic-Phase / Q000188:drug therapy*; D008390:Markov Chains; D047428:Protein Kinase Inhibitors / Q000191:economics / Q000627:therapeutic use; D011743:Pyrimidines / Q000191:economics* / Q000627:therapeutic use; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013785:Thailand
chemical_list: D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D000068877:Imatinib Mesylate; C498826:nilotinib; D000069439:Dasatinib
keywords: Thailand; chronic myeloid leukemia; cost-utility analysis; dasatinib; imatinib; leukemia; nilotinib