title: Cost-Effectiveness Analysis of Treating Acute Promyelocytic Leukemia Patients With Arsenic Trioxide and Retinoic Acid in the United States.
abstract: BACKGROUND
  This study estimated the cost-effectiveness of arsenic trioxide (ATO) added to all-trans retinoic acid (ATRA) when used in first-line acute promyelocytic leukemia (APL) treatment.
  
  
  METHODS
  A Markov cohort model was developed with 3 states: stable disease (during first- or second-line treatment), disease event, and death. Newly diagnosed patients with low- to intermediate-risk APL were included and each month could remain in their current health state or move to another. Treatment consisted of ATO + ATRA, ATRA + idarubicin (IDA), or ATRA + cytarabine (AraC) + additional chemotherapy. After an initial disease event, patients discontinued first-line therapy and switched to a second-line ATO regimen. Efficacy and safety data were obtained from published trials; quality of life/utility estimates were obtained from the literature; costs were obtained from US data sources. Costs and outcomes over time were used to calculate incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were conducted.
  
  
  RESULTS
  Compared to ATRA + AraC + additional chemotherapy, ATRA + IDA treatment had ICERs of $2933 per life-year (LY) saved and $3122 per quality-adjusted life-year (QALY) gained. Compared to the ATRA + IDA regimen, first-line ATO + ATRA treatment had ICERs of $4512 per LY saved and $5614 per QALY gained. Results were sensitive to changes in pharmacy costs of the ATO + ATRA regimen during consolidation.
  
  
  CONCLUSIONS
  The ATO + ATRA regimen is highly cost-effective compared to ATRA + AraC + additional chemotherapy or ATRA + IDA in the treatment of newly diagnosed low- to intermediate-risk APL patients.
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Martin
authors.initials: M
authors.lastname: Tallman
authors.affiliation: University Tor Vergata, Rome, Italy. Electronic address: Francesco.lo.coco@uniroma2.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Lo-Coco
authors.affiliation: Teva Pharmaceuticals, Frazer, PA.
authors.forename: Gisoo
authors.initials: G
authors.lastname: Barnes
authors.affiliation: Optum, Waltham, MA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Kruse
authors.affiliation: MAPI, Uxbridge, United Kingdom.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wildner
authors.affiliation: MAPI, Uxbridge, United Kingdom.
authors.forename: Monique
authors.initials: M
authors.lastname: Martin
authors.affiliation: Teva Pharmaceuticals, Ulm, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Mueller
authors.affiliation: Teva Pharmaceuticals, Frazer, PA.
authors.forename: Boxiong
authors.initials: B
authors.lastname: Tang
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics / Q000627:therapeutic use*; D000077237:Arsenic Trioxide; D001152:Arsenicals / Q000191:economics / Q000627:therapeutic use*; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D006801:Humans; D053208:Kaplan-Meier Estimate; D015473:Leukemia, Promyelocytic, Acute / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D008390:Markov Chains; D018803:Models, Economic; D010087:Oxides / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome; D014212:Tretinoin / Q000191:economics / Q000627:therapeutic use*; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D001152:Arsenicals; D010087:Oxides; D014212:Tretinoin; D000077237:Arsenic Trioxide
keywords: Acute promyelocytic leukemia; All-trans retinoic acid; Arsenic trioxide; Cost-effectiveness; Markov model