title: Economic implications of using bendamustine, alemtuzumab, or chlorambucil as a first-line therapy for chronic lymphocytic leukemia in the US: a cost-effectiveness analysis.
abstract: BACKGROUND
  The objective of this analysis was to evaluate the cost-effectiveness of using bendamustine versus alemtuzumab or bendamustine versus chlorambucil as a first-line therapy in patients with Binet stage B or C chronic lymphocytic leukemia (CLL) in the US.
  
  
  METHODS
  A discrete event simulation of the disease course of CLL was developed to evaluate the economic implications of single-agent treatment with bendamustine, alemtuzumab, or chlorambucil, which are indicated for a treatment-naïve patient population with Binet stage B or C CLL. Data from clinical trials were used to create a simulated patient population, risk equations for progression-free survival and survival post disease progression, response rates, and rates of adverse events. Costs from a US health care payer perspective in 2012 US dollars, survival (life years), and quality-adjusted life years (QALYs) were estimated over a patient's lifetime; all were discounted at 3% per year.
  
  
  RESULTS
  Compared with alemtuzumab, bendamustine was considered to be a dominant treatment providing greater benefit (6.10 versus 5.37 life years and 4.02 versus 3.45 QALYs) at lower cost ($78,776 versus $121,441). Compared with chlorambucil, bendamustine was associated with higher costs ($78,776 versus $42,337) but with improved health outcomes (6.10 versus 5.21 life years and 4.02 versus 3.30 QALYs), resulting in incremental cost-effectiveness ratios of $40,971 per life year gained and $50,619 per QALY gained.
  
  
  CONCLUSIONS
  Bendamustine is expected to provide cost savings and greater health benefit than alemtuzumab in treatment-naïve patients with CLL. Furthermore, it can be considered as a cost-effective treatment providing health benefits at an acceptable cost versus chlorambucil in the US.
authors.affiliation: Evidera, Bangkok, Thailand.
authors.forename: Thitima
authors.initials: T
authors.lastname: Kongnakorn
authors.affiliation: formerly of Teva Branded Pharmaceutical Products R&D, Inc, Frazer, PA.
authors.forename: James A
authors.initials: JA
authors.lastname: Sterchele
authors.affiliation: Oncology Market Research, Teva Branded Pharmaceutical Products R&D, Inc, Frazer, PA.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Salvador
authors.affiliation: Evidera, Lexington, MA.
authors.forename: Denis
authors.initials: D
authors.lastname: Getsios
authors.affiliation: Tufts University School of Medicine, Public Health and Community Medicine, Boston, MA, USA.
authors.forename: Mkaya
authors.initials: M
authors.lastname: Mwamburi
keywords: alemtuzumab; bendamustine; chlorambucil; chronic lymphocytic leukemia; cost-effectiveness; discrete event simulation model
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