Decitabine Is More Cost Effective Than Standard Conventional Induction Therapy In Elderly Acute Myeloid Leukemia Patients

Abstract

Introduction Decitabine (Dec) is not approved in the United States (US) for acute myeloid leukemia (AML) because it did not improve overall survival compared with standard conventional induction treatment. We asked what would be the cost effectiveness of Dec versus conventional induction therapy in AML patients (pts) older than 60 years of age. Methods The standard conventional induction including cytarabine, and daunorubicin, (AD) (N Engl J Med. 2009 361:1235-48) was compared with Dec (Haematologica. 2012 97:393-401) using a semi-Markov model compiling survival and cost data. Survival probabilities were retrieved from the literature. Data accounted for re-induction therapy with IDA-FLAG (idarubicin, fludarabine, cytarabine and granulocyte colony-stimulating factor) and consolidation therapy with high-dose cytarabine (HiDAC) but not for stem cell transplantation. The assumption-based model considered a maximum of 4 cycles of HiDAC and continuing Dec until loss of benefit. Drug costs were derived from the 2012 US market. Hospital costs accrued were evaluated in a diagnosis-related group (DRG) system. Drug dosage was estimated based on a body surface area of 1.85 m2. The quality of life (QoL) was assumed as 1 for healthy individuals; 0 for death; 0.524 for active disease; 0.91 for AML in remission on AD; 0.71 and 0.524 for AML being actively treated with Dec or AD, and 0.81 for AML in remission treated with Dec or HIDAC. QoL data were based on the literature except for pts on consolidation therapy. The latter was the mean of QoL of AML in remission and AML actively being treated. Results Assuming 1,000 pts for each treatment arm in a semi-Markov model over 1 year time horizon, the quality-adjusted life year (QALY) for AD vs. Dec was 0.1754 and 0.5982. The percentage survival for AD and Dec was 45.2% and 50.5%. Their costs were $127,867 and $55,777. The incremental cost-effectiveness ratio (ICER) was -$72,090/0.4228 = -$170,506/year. By sensitivity analysis, Dec was superior to AD to all parameters (Table 1). Conclusion Dec is a more cost-effective therapy for pts older than 60 years of age than conventional induction therapy. Given the economic pressures in the US Health System, one should consider approving Dec for newly diagnosed AML pts older than 60 years of age. Disclosures: No relevant conflicts of interest to declare.

American Society of Hematology 2020 guidelines for treating newly diagnosed acute myeloid leukemia in older adults

“…116,119,120 These showed that patients placed a high value on achieving CR (health state median, 0.70, on a scale from 0 to 1, where 0 is dead and 1 is totally healthy) 115 and consider relapse an outcome with a negative value (health state and utility ranged from 0.10 to 0.50 across studies). 116,119,120 There were 3 studies providing evidence regarding costs 54,135,136 and 1 providing evidence relevant to equity. 137 Because these 2 factors did not have an important bearing on the recommendation, their results are presented only in the EtD.…”

How to Calculate Better Our Financial Risk in Oncology?

“…Therefore, clinicians ought to be prepared to apprehend and pan this type of clinical trials that are more and more used by diverse sponsors in everyday search for getting the maximum clinical benefit at an affordable price. Therefore, it is imperative to review what criteria have been utilized to determine the validity of a cost-effectiveness study, for example the Drummond criteria as well as considering of the health care system of a particular country [1,2]. A flagrant example on how such criteria may affect the outcome with respect to adopting a therapy or not is the approval of abiraterone in prostate cancer by the US FDA versus the reluctance by the National Institute for Health and Care Excellence (NICE) in the United Kingdom.…”