Cost-Effectiveness of Alemtuzumab for T-Cell Prolymphocytic Leukemia

Lu, Lanting; Peters, Jaime; Roome, Chris; Stein, Ken

doi:10.1017/s0266462312000244

Cited by 7 publications

(5 citation statements)

References 5 publications

(24 reference statements)

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“…Utility values can range from 1.00 (perfect health) to 0.00 (death) in the model. Published disease-specific utilities for patients with APL were not availabletherefore it was assumed that chronic lymphocytic leukemia (CLL) utility estimates from Woods 28 and Ferguson 29 were applicable to patients with APL, an approach that has been used in previous leukemia research 30 . To address a limitation of using CLL utilities (i.e., that CLL patients are typically older and have worse outcomes than APL patients), age-adjusted utilities were calculated for the model.…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness Analysis of Treating Acute Promyelocytic Leukemia Patients With Arsenic Trioxide and Retinoic Acid in the United States

Tallman

Lo‐Coco

Barnes

et al. 2015

Clinical Lymphoma Myeloma and Leukemia

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Introduction 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 three states: stable disease (during first- or second-line treatment), disease event, and death. Newly diagnosed patients with low/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 and switched to a second-line ATO regimen. Efficacy/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 $2,933 per life year (LY) saved and $3,122 per quality-adjusted life year (QALY) gained. Compared to the ATRA + IDA regimen, first-line ATO + ATRA treatment had ICERs of $4,512 per LY saved and $5,614 per QALY gained. Results were sensitive to changes in pharmacy costs of the ATO + ATRA regimen during consolidation. Conclusion 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.

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Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness Analysis of Treating Acute Promyelocytic Leukemia Patients With Arsenic Trioxide and Retinoic Acid in the United States

Tallman

Lo‐Coco

Barnes

et al. 2015

Clinical Lymphoma Myeloma and Leukemia

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“…Lu et al compared alemtuzumab with conventional chemotherapy in people with T-cell prolymphocytic leukemia and reported depending on different assumptions incremental QALYs ranging between 0.16 and 0.24 [60].…”

Section: J U S T a C C E P T E Dmentioning

confidence: 99%

Cost-effectiveness of the sequential application of tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia

Rochau¹,

Sroczynski²,

Wolf

et al. 2015

Leukemia & Lymphoma

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Several tyrosine kinase inhibitors (TKIs) are approved for chronic myeloid leukemia (CML) therapy. We evaluated the long-term cost-effectiveness of seven sequential therapy regimens for CML in Austria. A cost-effectiveness analysis was performed using a state-transition Markov model. As model parameters, we used published trial data, clinical, epidemiological and economic data from the Austrian CML registry and national databases. We performed a cohort simulation over a life-long time-horizon from a societal perspective. Nilotinib without second-line TKI yielded an incremental cost-utility ratio of 121,400 €/quality-adjusted life year (QALY) compared to imatinib without second-line TKI after imatinib failure. Imatinib followed by nilotinib after failure resulted in 131,100 €/QALY compared to nilotinib without second-line TKI. Nilotinib followed by dasatinib yielded 152,400 €/QALY compared to imatinib followed by nilotinib after failure. Remaining strategies were dominated. The sequential application of TKIs is standard-of-care, and thus, our analysis points toward imatinib followed by nilotinib as the most cost-effective strategy.

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“…Eight studies examining the costs or cost-effectiveness of alemtuzumab, ipilimumab, sipuleucel-T, or ofatumumab, were included in the final analyses. [25][26][27][28][29][30][31][32] Table 2 summarizes findings of review articles identified from the phase I search regarding the cost-effectiveness of therapeutic cancer vaccines and immunotherapy in the current literature. As shown, rituximab combined with chemotherapy was considered to be costeffective for non-Hodgkin's lymphoma (NHL) when compared to chemotherapy alone.…”

Section: Resultsmentioning

confidence: 99%

“…25,26 Four cost-effectiveness studies were identified from the Phase II search, covering alemtuzumab (for T-cell prolymphocytic leukemia, T-PLL), ipilimumab (for previously treated advanced melanoma), sipuleucel-T (CRPC), and ofatumumab (for CLL) (table 4). [29][30][31][32] Lu et al reported that while alemtuzumab (vs. chemotherapy) was likely to be cost-effective for T-PLL, especially if used earlier in the course of treatment, the cost-effectiveness of alemtuzumab is highly uncertain (ICER $42,710 » $119,701/ QALY among four scenarios). 29 Barzey et al reported that the probability that ipilimumab was cost-effective relative to BSC at willingness-to-pay (WTP) of $146,000 USD/QALY was 95% for patients with previously treated advanced melanoma.…”

Section: Resultsmentioning

confidence: 99%

“…[29][30][31][32] Lu et al reported that while alemtuzumab (vs. chemotherapy) was likely to be cost-effective for T-PLL, especially if used earlier in the course of treatment, the cost-effectiveness of alemtuzumab is highly uncertain (ICER $42,710 » $119,701/ QALY among four scenarios). 29 Barzey et al reported that the probability that ipilimumab was cost-effective relative to BSC at willingness-to-pay (WTP) of $146,000 USD/QALY was 95% for patients with previously treated advanced melanoma. It should be noted that while the authors concluded that ipilimumab was cost-effective, the ICER estimated from their study was $140,811/QALY, which was higher than commonly accepted cost-effectiveness thresholds (i.e., $50,000 » $100,000/QALY).…”

Section: Resultsmentioning

confidence: 99%

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Economic evaluation of therapeutic cancer vaccines and immunotherapy: A systematic review

Geynisman

Chien

Smieliauskas³

et al. 2014

Human Vaccines & Immunotherapeutics

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Cancer immunotherapy is a rapidly growing field in oncology. One attractive feature of cancer immunotherapy is the purported combination of minimal toxicity and durable responses. However such treatments are often very expensive. Given the wide-spread concern over rising health care costs, it is important for all stakeholders to be wellinformed on the cost and cost-effectiveness of cancer immunotherapies. We performed a comprehensive literature review of cost and cost-effectiveness research on therapeutic cancer vaccines and monoclonal antibodies, to better understand the economic impacts of these treatments. We summarized our literature searches into three tables by types of papers: systematic review of economic studies of a specific agent, cost and cost-effectiveness analysis. Our review showed that out of the sixteen immunotherapy agents approved, nine had relevant published economic studies. Five out of the nine studied immunotherapy agents had been covered in systematic reviews. Among those, only one (rituximab for non-Hodgkin lymphoma) was found to be costeffective. Of the four immunotherapy drugs not covered in systematic reviews (alemtuzumab, ipilimumab, sipuleucel-T, ofatumumab), high incremental cost-effectiveness ratio (ICER) was reported for each. Many immunotherapies have not had economic evaluations, and those that have been studied show high ICERs or frank lack of cost-effectiveness. One major hurdle in improving the cost-effectiveness of cancer immunotherapies is to identify predictive biomarkers for selecting appropriate patients as recipients of these expensive therapies. We discuss the implications surrounding the economic factors involved in cancer immunotherapies and suggest that further research on cost and costeffectiveness of newer cancer vaccines and immunotherapies are warranted as this is a rapidly growing field with many new drugs on the horizon.

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Cost-Effectiveness of Alemtuzumab for T-Cell Prolymphocytic Leukemia

Cited by 7 publications

References 5 publications

Cost-Effectiveness Analysis of Treating Acute Promyelocytic Leukemia Patients With Arsenic Trioxide and Retinoic Acid in the United States

Cost-Effectiveness Analysis of Treating Acute Promyelocytic Leukemia Patients With Arsenic Trioxide and Retinoic Acid in the United States

Cost-effectiveness of the sequential application of tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia

Economic evaluation of therapeutic cancer vaccines and immunotherapy: A systematic review

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