Once Patent Protection Is Lost, Imatinib as Initial Treatment for CP-CML Will Be Most Cost-effective Strategy

Imatinib, which will have a generic version available this year in the United States, will become the cost-effective initial treatment strategy administered to patients with chronic phase chronic myeloid leukemia (CML-CP), investigators predicted.¹

The price is expected to drop anywhere from 70% to 90%. Investigators researched whether initiating treatment with generic imatinib , then switching to other tyrosine kinase inhibitors dasatinib or nilotinib, due to lack of tolerance or response, would be cost-effective compared with the current standard of care, which is physician’s choice of initial tyrosine kinase inhibitor therapy.

Investigators constructed Markov models to compare the 5-year cost-effectiveness of imatinib vs physician’s choice from a consumer standpoint, assuming 3% annual discounting ($2013). The model’s endpoint was 5-year overall survival taken from a systematic review of clinical trial results.

Truven’s MarketScan claims data were used to estimate per-person cost on incident CML-CP treatment overall care components. Main outcome of the models was cost per quality-adjusted life-year (QALY). Outcomes were interpreted based on a willingness-to-pay threshold of $100 000/QALY.

Results showed that both strategies met the threshold. Imatinib-first gave patients a 0.10 decrement in QALYs at a savings of $88 343 over 5 years compared with physicians choice ($365 744, 3.97 QALYs). Imatinib-first incremental cost-effectiveness ratio was about $883 730/QALY.

Reference

1. Padula WV, Larson RA, Dusetzina SB, et al. Cost-effectiveness of tyrosine kinase inhibitor treatment strategies for chronic myeloid leukemia in chronic phase after generic entry of imatinib in the United States. J Natl Cancer Inst. 2016;108(7): doi: 10.1093/jnci/djw003.