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

Rochau, Ursula; Sroczynski, Gaby; Wolf, Dominik; Schmidt, Stefan; Jahn, Beate; Kluibenschaedl, M.; Conrads-Frank, Annette; Stenehjem, David D.; Brixner, Diana I.; Radich, Jerald P.; Gastl, Günther; Siebert, Uwe

doi:10.3109/10428194.2014.982635

Cited by 21 publications

(22 citation statements)

References 52 publications

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“…Using first-line nilotinib resulted in an incremental cost:utility ratio of V121 400/QALY. 24 If generic imatinib is considered instead of the brand name version, and considering a price for the generic version that is 52% that of the brand name version, the difference is V402 500/QALY relative to the next effective strategy not using imatinib as first-line therapy (nilotinib followed by dasatinib followed by SCT), and V656 400 if the price of generic imatinib is 10% of the current price for the brand name version. In a similar analysis from the United Kingdom, imatinib followed by nilotinib was found to be the most cost-effective strategy with an incremental cost:utility ratio of £192 000/QALY.…”

Section: Cost-effectivenessmentioning

confidence: 99%

Chronic myeloid leukemia: sequencing of TKI therapies

Cortes

Kantarjian

2016

Hematology

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Multiple tyrosine kinase inhibitors (TKIs) are available for managing patients with chronic myeloid leukemia. Although most patients have a favorable outcome with their initial therapy, whether imatinib or a second-generation TKI was used, some will require subsequent use of one or more different TKIs. Such sequencing might be indicated in a reactive way (ie, for patients who have experienced resistance or intolerance to their initial therapy) or in a proactive way (ie, for patients with a somewhat favorable outcome who have not reached an "optimal" outcome). Sequencing of TKIs has become standard practice, and the proper use of sequenced TKIs is likely to optimize outcomes and resource utilization. Learning Objectives• Assess the different scenarios in which TKI sequencing can be used in patients with chronic myeloid leukemia • Critically review the outcomes associated with sequencing of TKI in patients with chronic myeloid leukemia Tyrosine kinase inhibitors (TKIs) became standard therapy for patients with chronic myeloid leukemia (CML) not long after the first patient received STI571 (later known as imatinib mesylate) on a phase I clinical trial. 1 The initial approved indication was for patients with resistance to or intolerance of interferon alpha-based therapy, the standard at the time. By 2003, imatinib was approved as frontline therapy for CML, 2 and since then, nearly all patients with access to TKIs have received them as initial therapy. Shortly thereafter, secondgeneration agents, including dasatinib, nilotinib, and bosutinib, with increased potency, different structures that allowed them to overcome most mutations leading to resistance to TKIs, and different toxicity profiles, were introduced and eventually received regulatory approval. Later, ponatinib, a drug with activity against T315I and all mutations tested, proved effective in overcoming resistance in most patients, even those who had received 3 or more prior TKIs. All TKIs were eventually compared with imatinib in the first-line setting, and they generally demonstrated higher response rates, with deeper and faster responses which, in the case of dasatinib and nilotinib, were sufficient to lead to their approval as initial therapy for patients with chronic phase CML (CML-CP). This rapid development has resulted in the availability of multiple TKIs, and along with this, the sequential use of various TKIs in patients with CML-CP (Figure 1).The use of sequential TKI therapy, regardless of the choice of initial therapy, is perhaps more common than is usually appreciated. Despite the professed efficacy of initial therapy with TKIs, at least onethird of all patients initially treated in clinical trials with any TKI for newly diagnosed CML, whether imatinib or a second-generation TKI, have received at least one additional TKI. After 5 years of follow-up in the DASISION trial (in the final report), 39% of patients initially treated with dasatinib and 37% of those treated with imatinib are no longer receiving their initial therapy.3 Similarly, the 5-ye...

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Section: Cost-effectivenessmentioning

confidence: 99%

Chronic myeloid leukemia: sequencing of TKI therapies

Cortes

Kantarjian

2016

Hematology

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“…EUthyroid has developed a decision-analytic model [15] to evaluate the long-term effectiveness and cost effectiveness of IDD prevention programmes. All relevant health conditions and events potentially caused by iodine deficiency or affected by related prevention programmes are included.…”

Section: Discussionmentioning

confidence: 99%

How Do We Improve the Impact of Iodine Deficiency Disorders Prevention in Europe and Beyond?

et al. 2018

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Background: Iodine deficiency disorders (IDD) represent a global health threat to individuals and societies. IDD prevention programmes have been introduced in many parts of the world. However, challenges remain, particularly in Europe due to fragmentation and diversity of approaches that are not harmonized. Objectives: This review is dedicated to the public-health impact of IDD prevention programmes. It sums up experiences collected by the EUthyroid consortium so far and provides information on stakeholders that should be involved in actions directed to improve the impact of IDD prevention. Methods: A joint European database for combining registry-based outcome and monitoring data as well as tools for harmonizing study methods were established. Methods for analyzing thyroglobulin from a dried blood spot are available for assessing the iodine status in the general population and at-risk groups. Mother-child cohorts are used for in-depth analysis of the potential impact of mild-to-moderate iodine deficiency on the neurocognitive development of the offspring. A decision-analytic model has been developed to evaluate the long-term effectiveness and cost effectiveness of IDD prevention programmes. Results: EUthyroid has produced tools and infrastructure to improve the quality of IDD monitoring and follows a dissemination strategy targeting policymakers and the general public. There are tight connections to major stakeholders in the field of IDD monitoring and prevention. Conclusions: EUthyroid has taken steps towards achieving a euthyroid Europe. Our challenge is to inspire a greater sense of urgency in both policymakers and the wider public to address this remediable deficit caused by IDD.

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“…More than 10 national and international scientific, and 30 national and international company partners are joined in 20 Oncotyrol -Center for Personalized Cancer Medicine 5 …”

Section: Partners Of the Consortiummentioning

confidence: 99%

“…Additionally, economic parameters and resource use data for the Austrian health care setting were collected and entered into the model to conduct a cost-effectiveness analysis. [20] In the absence of an Austrian willingness-to pay threshold, two strategies were considered potentially cost-effective among those including a second-line tyrosine kinase inhibitor: imatinib followed by second-line nilotinib (131,100 D /QALY) and nilotinib followed by second-line dasatinib following nilotinib failure (152,400 D /QALY). [20] Additionally, the model was applied to the U.S. health care context.…”

Section: Effectiveness and Cost Effectiveness Of Sequential Treatmentmentioning

confidence: 99%

Oncotyrol – Center for Personalized Cancer Medicine: Methods and Applications of Health Technology Assessment and Outcomes Research

Siebert

Jahn

Rochau

et al. 2015

Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheit

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

Cited by 21 publications

References 52 publications

Chronic myeloid leukemia: sequencing of TKI therapies

Chronic myeloid leukemia: sequencing of TKI therapies

How Do We Improve the Impact of Iodine Deficiency Disorders Prevention in Europe and Beyond?

Oncotyrol – Center for Personalized Cancer Medicine: Methods and Applications of Health Technology Assessment and Outcomes Research

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