Cost-effectiveness in Canada of azacitidine for the treatment of higher-risk myelodysplastic syndromes

Levy, Adrian R.; Zou, Dongling; Risebrough, Nancy; Buckstein, Rena; Kim, T.; Brereton, N.J.

doi:10.3747/co.21.1311

Cited by 15 publications

(14 citation statements)

References 13 publications

(14 reference statements)

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“… Utility was assigned from evidence available for initial treatment of myelodysplastic syndrome‐progressed acute myloid leukaemia (Levy et al , ) and physician surveys for remission and relapse utility (Kurosawa et al , ). …”

Section: Resultsmentioning

confidence: 99%

Economic impact of genomic diagnostics for intermediate‐risk acute myeloid leukaemia

Cressman¹,

Karsan

Hogge

et al. 2016

Br J Haematol

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SummaryAcute Myeloid Leukaemia (AML) is a rare but serious group of diseases that require critical decision‐making for curative treatment. Over the past decade, scientific discovery has revealed dozens of prognostic gene mutations for AML while sequencing costs have plummeted. In this study, we compared the cost‐effectiveness of multigene integrative analysis (genomic analysis) with the standard molecular testing currently used for diagnosis of intermediate‐risk AML. We used a decision analytic model with data for costs and outcomes from British Columbia, Canada, to assess the long‐term (10‐year) economic impacts. Our results suggest that genomic analysis would result in a 26% increase in the use of first‐remission allogeneic stem cell transplantation. The resulting treatment decisions and downstream effects would come at an additional cost of $12 556 [2013 Canadian dollars (CAD)] per person and the incremental cost‐effectiveness ratio would be $49 493 per quality‐adjusted life‐year gained. Cost‐effectiveness was dependent on quality of life during the long‐term (5–10) years of survival, relapse rates following first‐remission chemotherapy and the upfront cost of transplantation. Non‐relapse mortality rates, short‐term quality of life and the cost of genomic sequencing had only minor impacts. Further research on post‐remission outcomes can lead to improvements in the cost‐effectiveness of curative treatments for AML.

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Section: Resultsmentioning

confidence: 99%

Economic impact of genomic diagnostics for intermediate‐risk acute myeloid leukaemia

Cressman¹,

Karsan

Hogge

et al. 2016

Br J Haematol

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“…Levy et al [6] performed an economic analysis of azacitidine in the treatment of both myelodysplasia and AML and found that azacitidine for patients with AML was within the willingness-to-pay threshold for third-party public payers for patients with AML in Canada, with an incremental cost-effectiveness ratio (ICER) of $Can86.182 per qualityadjusted life-year (QALY) [6]. However, the Levy et al [6] study results were only valid for patients with < 30% blasts in the bone marrow, since patients with > 30% blast counts in the blood marrow were excluded from this study. Since these patients do not derive the same clinical benefit as patients with lesser blast counts [5], it is important for third-party payers to determine whether these patients derive the best value for money.…”

Section: Economic Analysis Of Azacitidine For the Treatment Of Myelodmentioning

confidence: 99%

“…Direct medical costs were adjusted to year 2018 values using the Bank of Canada inflation calculator [17]. Healthcare costs were derived from the Levy et al [6] study, in which the health costs were derived from a Canadian panel of four clinical experts who estimated the costs associated with health resource utilization borne to the Ministry of Health and Long-Term Care in Ontario, Canada. These costs included medication, human health resource, routine physician follow-up, hospitalization and laboratory investigations.…”

Section: Costsmentioning

confidence: 99%

“…The cost of 1 cycle of azacitidine in year 2018 values was estimated at $Can8701.25, with a unit price of azacitidine of $Can662 (average dose of 1.34 vials; Celgene Ltd). For the CCR comparators, the following assumptions were made: BSC is exclusively received as an outpatient, LDAC is administered 50% of the time by an outpatient clinic nurse and induction chemotherapy is received exclusively as an inpatient [6].…”

Section: Costsmentioning

confidence: 99%

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Economic Evaluation of Azacitidine in Elderly Patients with Acute Myeloid Leukemia with High Blast Counts

Coyle

Villeneuve

2019

PharmacoEconomics Open

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Background Azacitidine is an hypomethylating agent widely adopted for the treatment of acute myeloid leukaemia (AML) in patients who are ineligible for curative-intent chemotherapy. Patients with low bone marrow blast counts (< 30%) experience improved survival with azacitidine, but the benefits are significantly lower in patients with > 30% blasts in the bone marrow. As such, there is uncertainty around the economic benefit of azacitidine in patients with higher blast counts. Objective We present a cost-utility analysis of azacitidine in patients with AML with > 30% blasts to determine the economic value of azacitidine in this patient population from the perspective of a third-party payer. Methods A Markov model was developed with a time horizon of 25 months divided into 22 cycles of 35 days each. The cost utility of azacitidine was compared with that of conventional care regimens (which include best supportive care, low-dose cytarabine and induction chemotherapy). A Canadian public healthcare system perspective was selected. Results In the base case, the incremental cost per quality-adjusted life-year gained (incremental cost-effectiveness ratio [ICER]) for azacitidine compared with conventional care regimens was $Can160,438, year 2018 values. The estimated ICER was insensitive to a longer time horizon but sensitive to the cost of azacitidine and to assumptions relating to survival in both treatment regimens, although the ICER always remained greater than Can$80,000 in all scenarios. Conclusion Azacitidine is unlikely to be cost effective given that the estimated ICER exceeds the willingness to pay commonly used in the Canadian healthcare system.

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“…The units of transfusions and growth factors required differed based on MDS. The requirements were estimated based on the published literature, claims analysis and expert opinion [33,34]. Red blood cell and platelet requirements range from 1.3 units per event for patients on BSC to 9.0 units for patients receiving HCT.…”

Section: Adverse Event Inputsmentioning

confidence: 99%

Cost–effectiveness of treatments for high-risk myelodysplastic syndromes after failure of first-line hypomethylating agent therapy

Cogle

Ortendahl

Bentley

et al. 2015

Expert Review of Pharmacoeconomics & Outcomes Research

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Cost-effectiveness in Canada of azacitidine for the treatment of higher-risk myelodysplastic syndromes

Cited by 15 publications

References 13 publications

Economic impact of genomic diagnostics for intermediate‐risk acute myeloid leukaemia

Economic impact of genomic diagnostics for intermediate‐risk acute myeloid leukaemia

Economic Evaluation of Azacitidine in Elderly Patients with Acute Myeloid Leukemia with High Blast Counts

Cost–effectiveness of treatments for high-risk myelodysplastic syndromes after failure of first-line hypomethylating agent therapy

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