title: Societal implications of medical insurance coverage for imatinib as first-line treatment of chronic myeloid leukemia in China: a cost-effectiveness analysis.
abstract: OBJECTIVE
  Imatinib (Glivec) and nilotinib (Tasigna) have been covered by critical disease insurance in Jiangsu province of China since 2013, which changed local treatment patterns and outcomes of patients with chronic myeloid leukemia (CML). This study evaluated the long-term cost-effectiveness of insurance coverage with imatinib as the first-line treatment for patients with CML in China from a societal perspective.
  
  
  METHODS
  A decision-analytic model based on previously published and real-world evidence was applied to simulate and evaluate the lifetime clinical and economic outcomes associated with CML treatments before and after imatinib was covered by medical insurance. Incremental cost-effectiveness ratio (ICER) was calculated with both costs and quality-adjusted life years (QALYs) discounted at 3% annually. Different assumptions of treatment benefits and costs were taken to address uncertainties and were tested with sensitivity analyses.
  
  
  RESULTS
  In base case analysis, both cost and effectiveness of CML treatments increased after imatinib was covered by the medical insurance; on average, the incremental QALY and cost were 5.5 and ¥277,030 per patient in lifetime, respectively. The ICER of insurance coverage with imatinib was ¥50,641, which is less than the GDP per capita of China. Monte Carlo simulation resulted in the estimate of 100% probability that the insurance coverage of imatinib is cost-effective. Total cost was substantially saved at 5 years after patients initiated imatinib treatment with insurance coverage compared to no insurance coverage, the saved cost at 5 years was ¥99,565, which included the cost savings from both direct (e.g. cost of bone marrow or stem cell transplant) and indirect costs (e.g. productivity loss of patients and care-givers).
  
  
  CONCLUSIONS
  The insurance coverage of imatinib is very cost-effective in China, according to the local cost and clinical data in Jiangsu province. More importantly, the insurance coverage of imatinib and nilotinib have changed the treatment patterns of CML patients, thus dramatically increasing life expectancy and quality-of-life (QoL) saving on productivity losses for both CML patients and their caregivers.
authors.affiliation: a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China.
authors.forename: Guangying
authors.initials: G
authors.lastname: Sheng
authors.affiliation: a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China.
authors.forename: Suning
authors.initials: S
authors.lastname: Chen
authors.affiliation: b Institute for Social Security Research, Ministry of Human Resources and Social Security of P.R.C , Beijing , PR China.
authors.forename: Chaohui
authors.initials: C
authors.lastname: Dong
authors.affiliation: a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China.
authors.forename: Ri
authors.initials: R
authors.lastname: Zhang
authors.affiliation: a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China.
authors.forename: Miao
authors.initials: M
authors.lastname: Miao
authors.affiliation: a Department of Hematology , Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, the First Affiliated Hospital of Soochow University , Suzhou , PR China.
authors.forename: Depei
authors.initials: D
authors.lastname: Wu
authors.affiliation: c Health Economics & Outcomes Research, IMS Health Asia Pacific , Singapore.
authors.forename: Seng Chuen
authors.initials: SC
authors.lastname: Tan
authors.affiliation: d Novartis Oncology (China) , Beijing , PR China.
authors.forename: Chao
authors.initials: C
authors.lastname: Liu
authors.affiliation: e Health Economics & Outcomes Research, IMS Health China , Shanghai , PR China.
authors.forename: Tengbin
authors.initials: T
authors.lastname: Xiong
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D002681:China; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D000068877:Imatinib Mesylate / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy*; D008390:Markov Chains; D011743:Pyrimidines / Q000008:administration & dosage / Q000191:economics; D019057:Quality-Adjusted Life Years
chemical_list: D000970:Antineoplastic Agents; D011743:Pyrimidines; D000068877:Imatinib Mesylate; C498826:nilotinib
keywords: CML; China; Cost effectiveness; Imatinib; Insurance coverage