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Cost-Effectiveness Analysis of Tyrosine Kinase Inhibitors for Patients with Advanced Gastrointestinal Stromal Tumors

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Abstract

Introduction

The management of advanced gastrointestinal stromal tumors (GISTs) has been modified considerably by the availability of costly tyrosine kinase inhibitors (TKIs); however, the best therapeutic sequence in terms of cost and effectiveness remains unknown.

Objective

The aim of this study was to compare four potential strategies (reflecting the potential daily practice), each including imatinib 400 mg/day, as first-line treatment: S1 (imatinib400/best supportive care [BSC]); S2 (imatinib400/imatinib800/BSC); S3 (imatinib400/sunitinib/BSC); and S4 (imatinib400/imatinib800/sunitinib/BSC).

Methods

A Markov model was developed with a hypothetical cohort of patients and a lifetime horizon. Transition probabilities were estimated from the results of clinical trials. The analysis was performed from the French payer perspective, and only direct medical costs were included. Clinical and economic parameters were discounted, and the robustness of results was assessed.

Results

The least costly and effective strategy was S1, at a cost of €65,744 for 32.9 life months (reference). S3 was the most cost-effective strategy, with an incremental cost-effectiveness ratio (ICER) of €48,277/life-year saved (LYS). S2 was dominated, and S4 yielded an ICER of €363,320/LYS compared with S3. Sensitivity analyses confirmed the robustness of these results; however, when taking into account a price reduction of 80 % for imatinib, S2 and S4 become the most cost-effective strategies.

Conclusion

Our approach is innovative to the extent that our analysis takes into account the sequential application of TKIs. The results suggest that the S1 strategy is the best cost-effective strategy, but a price reduction of imatinib impacts on the results. This approach must continue, including new drugs and their impact on the quality of life of patients with advanced GISTs.

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Acknowledgments

The authors would like to thank Ms. Pamela Albert for her assistance in correcting the English language of this manuscript.

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Authors and Affiliations

  1. Department of Pharmacy, University Hospital, Boulevard Fleming, 25030, Besançon Cedex, France

    Virginie Nerich, Camille Fleck & Samuel Limat

  2. University Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions hôte-greffon-tumeur – Ingénierie Cellulaire et Génique, Besançon, France

    Virginie Nerich, Christophe Borg, Xavier Pivot & Samuel Limat

  3. Department of Medical Oncology, University Hospital, Besançon, France

    Loïc Chaigneau, Christophe Borg, Elsa Kalbacher, Marine Jary & Xavier Pivot

  4. Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France

    Nicolas Isambert

  5. Department of Pediatry, University Hospital, Besançon, France

    Pauline Simon

  6. Department of Medicine, Centre Léon Bérard, Lyon, France

    Jean-Yves Blay

  7. University Claude Bernard, Lyon, France

    Jean-Yves Blay

  8. French Sarcoma Group (GSF-GETO), Paris, France

    Jean-Yves Blay

  9. European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium

    Jean-Yves Blay

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  1. Virginie Nerich
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Correspondence to Virginie Nerich.

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No sources of funding were used in this study.

Conflict of interest

Virginie Nerich, Camille Fleck, Loïc Chaigneau, Nicolas Isambert, Christophe Borg, Elsa Kalbacher, Marine Jary, Pauline Simon, Xavier Pivot, Jean-Yves Blay, and Samuel Limat declare that they have no conflicts of interest and financial disclosures that are directly relevant to the content of this study.

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Nerich, V., Fleck, C., Chaigneau, L. et al. Cost-Effectiveness Analysis of Tyrosine Kinase Inhibitors for Patients with Advanced Gastrointestinal Stromal Tumors. Clin Drug Investig 37, 85–94 (2017). https://doi.org/10.1007/s40261-016-0463-2

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