Economic Evaluation of Third-Line Treatment with Alemtuzumab for Chronic Lymphocytic Leukaemia

Scott, W G; Scott, Helen

doi:10.2165/00044011-200727110-00002

Cited by 13 publications

(9 citation statements)

References 3 publications

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“…QALYs are particularly useful for conditions for which treatment is not curative but palliative, such as cancer. For example, the incremental cost per QALY gained was a key endpoint in recent cost-effectiveness evaluations in CLL and chronic myeloid leukaemia (CML) [6-8]. …”

Section: Introductionmentioning

confidence: 99%

Population preference values for treatment outcomes in chronic lymphocytic leukaemia: a cross-sectional utility study

Beusterien

Davies

Leach

et al. 2010

Health Qual Life Outcomes

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BackgroundGiven that treatments for chronic lymphocytic leukaemia (CLL) are palliative rather than curative, evaluating the patient-perceived impacts of therapy is critical. To date, no utility (preference) studies from the general public or patient perspective have been conducted in CLL. The objective of this study was to measure preferences for health states associated with CLL treatment.MethodsThis was a cross-sectional study of 89 members of the general population in the UK (England and Scotland). Using standard gamble, each participant valued four health states describing response status, six describing treatment-related toxicities based on Common Toxicity Criteria, and two describing line of treatment. The health states incorporated standardized descriptions of treatment response (symptoms have "improved," "stabilized," or "gotten worse"), swollen glands, impact on daily activities, fatigue, appetite, and night sweats. Utility estimates ranged from 0.0, reflecting dead, to 1.0, reflecting full health.ResultsComplete response (CR) was the most preferred health state (mean utility, 0.91), followed by partial response (PR), 0.84; no change (NC), 0.78; and progressive disease (PD), 0.68. Among the toxicity states, grade I/II nausea and nausea/vomiting had the smallest utility decrements (both were -0.05), and grade III/IV pneumonia had the greatest decrement (-0.20). The utility decrements obtained for toxicity states can be subtracted from utilities for CR, PR, NC, and PD, as appropriate. The utilities for second- and third-line treatments, which are attempted when symptoms worsen, were 0.71 and 0.65, respectively. No significant differences in utilities were observed by age, sex, or knowledge/experience with leukaemia.ConclusionsThis study reports UK population utilities for a universal set of CLL health states that incorporate intended treatment response and unintended toxicities. These utilities can be applied in future cost-effectiveness analyses of CLL treatment.

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Section: Introductionmentioning

confidence: 99%

Population preference values for treatment outcomes in chronic lymphocytic leukaemia: a cross-sectional utility study

Beusterien

Davies

Leach

et al. 2010

Health Qual Life Outcomes

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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%

“…24 There were four cost papers identified from the phase II search, covering alemtuzumab (for chronic lymphocytic leukaemia, CLL), ipilimumab (for metastatic melanoma) and sipuleucel-T (for castration-resistant prostate cancer, CRPC) (table 3). [25][26][27][28] Scott et al reported that alemtuzumab was cost saving ($11,181/patient) in New Zealand when compared to chemotherapy. 27 Jarkowski et al reported that ipilimumab with dose rounding was cost saving ($7,503/patient) in the United States when compared to ipilimumab without dose rounding.…”

Section: Resultsmentioning

confidence: 99%

“…[25][26][27][28] Scott et al reported that alemtuzumab was cost saving ($11,181/patient) in New Zealand when compared to chemotherapy. 27 Jarkowski et al reported that ipilimumab with dose rounding was cost saving ($7,503/patient) in the United States when compared to ipilimumab without dose rounding. 28 Two commentary-type papers calculated the incremental drug cost ($98,780 for a full course) of sipuleucel-T and commented on the high cost of this immunotherapy agent.…”

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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“…Consequently, determination of the cost-effectiveness of alemtuzumab was warranted. One published economic evaluation of alemtuzumab in CLL was found [23]. In that study, intravenous alemtuzumab was compared to FCR in refractory CLL.…”

Section: Introductionmentioning

confidence: 99%

Economic Analysis of Alemtuzumab (MabCampath®) in Fludarabinerefractory Chronic Lymphocytic Leukemia

Mittmann¹

2012

TOPHARMEJ

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Abstract:Objective: The objective of this economic analysis is to determine the cost-effectiveness of alemtuzumab in the treatment of B cell chronic lymphocytic leukemia (B-CLL) patients who have progressed despite fludarabine therapy. Method:This model was developed according to the Canadian public payer health system considering only direct medical costs. Effectiveness information was obtained from the published literature. Resource utilization was based on guidelines, literature and expert opinion. Cost information was obtained from provincial costing sources and presented in 2008 Canadian dollars. The primary comparators for this analysis were alemtuzumab, Various Treatments (VT) (combination of agents), fludarabine+cyclophosphamide (FC), fludarabine+cyclophosphamide+rituximab (FCR) and best supportive care (BSC).Results: Estimated mean survival for alemtuzumab was 22.68 months (1.89 years). Mean survival for VT was estimated from the literature at 16.32 months (1.36 years). The mean survival for FC was 17.44 months (1.45 years) and FCR 20.06 months (1.67 years). The incremental cost-effectiveness ratio (ICER) for alemtuzumab vs VT was $43,615/life year gained (LYG); $52,536/LYG for the alemtuzumab vs FC; $21,818/LYG vs FCR; and less costly and more effective vs BSC. ICERs were sensitive to three variables: treatment duration of alemtuzumab; treatment duration of FCR; and additional survival due to rituximab for FCR patients compared to FC. Conclusion:The results showed that the ICERs for alemtuzumab in B-CLL patients who have failed fludarabine ranged from $21,818/LYG to $52,536/LYG compared to active treatment, and was less costly and more efficacious compared to BSC.

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Economic Evaluation of Third-Line Treatment with Alemtuzumab for Chronic Lymphocytic Leukaemia

Abstract: Third-line treatment of eligible patients with alemtuzumab was found to be $NZ15,303 less costly than FCR per patient.

Cited by 13 publications

References 3 publications

Population preference values for treatment outcomes in chronic lymphocytic leukaemia: a cross-sectional utility study

Population preference values for treatment outcomes in chronic lymphocytic leukaemia: a cross-sectional utility study

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

Economic Analysis of Alemtuzumab (MabCampath®) in Fludarabinerefractory Chronic Lymphocytic Leukemia

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