title: Economic evaluation of arsenic trioxide compared to all-trans retinoic acid + conventional chemotherapy for treatment of relapsed acute promyelocytic leukemia in Canada.
abstract: OBJECTIVE
  Acute promyelocytic leukemia (APL) is an uncommon type of acute leukemia characterized by high early mortality. Current first-line treatments include all-trans retinoic acid (ATRA), anthracyclines, and other conventional chemotherapies (CTs). Although APL is generally associated with a good prognosis, about 20% of patients who achieve remission subsequently relapse and are resistant to the previously administrated treatment. The objective of this study was to assess, from a Canadian perspective, the economic impact of arsenic trioxide (ATO) compared to ATRA+CT for treatment of patients with relapsed/refractory APL.
  
  
  METHODS
  The cost-effectiveness of ATO compared to ATRA+CT for treating patients with relapsed/refractory APL was assessed over a lifetime horizon using a Markov model. The model considers five health states: induction, second remission, treatment failure or relapse, postfailure, and death. Markov cycle length was 1 month for the first 24 months and 1 yr thereafter. The model also takes into account the incidence of grade 3-4 adverse events reported in clinical trials. Analyses were conducted from a Canadian Ministry of Health (MoH) and a societal perspective.
  
  
  RESULTS
  Compared to ATRA+CT, ATO was associated with incremental cost-effectiveness ratios of $ 20,551/quality-adjusted life year (QALY) from a MoH perspective and $ 22,219/QALY from a societal perspective. Results of the probabilistic sensitivity analysis indicated that ATO is a cost-effective strategy in 99.27% and 98.98% of the simulations from a MoH and a societal perspective, respectively.
  
  
  CONCLUSIONS
  This economic evaluation demonstrates that ATO is a cost-effective strategy compared to ATRA+CT for treatment of patients with relapsed/refractory APL in Canada.
authors.affiliation: Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Lachaine
authors.affiliation: Faculty of Pharmacy, University of Montreal, Montreal, QC, Canada.
authors.forename: Karine
authors.initials: K
authors.lastname: Mathurin
authors.affiliation: Market Access and Health Outcomes, Lundbeck Canada Inc., Montreal, QC, Canada.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Barakat
authors.affiliation: Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.|Department of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Couban
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000008:administration & dosage / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D010087:Oxides / Q000008:administration & dosage / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D017211:Treatment Failure; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage
chemical_list: D001152:Arsenicals; D010087:Oxides; D014212:Tretinoin; D000077237:Arsenic Trioxide
keywords: Canada; acute promyelocytic leukemia; all-trans retinoic acid; arsenic trioxide; cost-effectiveness; cost-utility