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- Title
Cost-Effectiveness Analysis of Treating Acute Promyelocytic Leukemia Patients With Arsenic Trioxide and Retinoic Acid in the United States.
- Authors
Tallman, Martin; Lo-Coco, Francesco; Barnes, Gisoo; Kruse, Morgan; Wildner, Rebecca; Martin, Monique; Mueller, Udo; Tang, Boxiong
- Abstract
<bold>Introduction: </bold>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. <bold>Materials and Methods: </bold>A Markov cohort model was developed with 3 states: stable disease (during first- or second-line treatment), disease event, and death. Newly diagnosed patients with low- to 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 therapy and switched to a second-line ATO regimen. Efficacy and 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. <bold>Results: </bold>Compared to ATRA + AraC + additional chemotherapy, ATRA + IDA treatment had ICERs of $2933 per life-year (LY) saved and $3122 per quality-adjusted life-year (QALY) gained. Compared to the ATRA + IDA regimen, first-line ATO + ATRA treatment had ICERs of $4512 per LY saved and $5614 per QALY gained. Results were sensitive to changes in pharmacy costs of the ATO + ATRA regimen during consolidation. <bold>Conclusion: </bold>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.
- Subjects
UNITED States; ANTINEOPLASTIC agents; ARSENIC compounds; COST effectiveness; PROBABILITY theory; OXIDES; RESEARCH funding; TRETINOIN; TREATMENT effectiveness; CASE-control method; ACUTE promyelocytic leukemia; STATISTICAL models; KAPLAN-Meier estimator; THERAPEUTICS; ECONOMICS
- Publication
Clinical Lymphoma, Myeloma & Leukemia, 2015, Vol 15, Issue 12, p771
- ISSN
2152-2650
- Publication type
journal article
- DOI
10.1016/j.clml.2015.07.634