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Economic Evaluations of Tyrosine Kinase Inhibitors for Patients with Chronic Myeloid Leukemia in Middle- and High-Income Countries: A Systematic Review

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Abstract

Objectives

The objective of this systematic review was to conduct a comprehensive assessment of economic evaluations of tyrosine kinase inhibitors (TKIs) in patients with chronic myeloid leukemia (CML) in middle- and high-income countries.

Methods

A literature search was conducted in Embase, MEDLINE (via PubMed) and the Cochrane library on March 3, 2018 to identify economic evaluations of chronic myeloid leukemia that met the inclusion criteria. Data on such parameters as patient characteristics, cost components, and main outcomes were extracted from eligible studies.

Results

The literature review retrieved 798 studies, 17 of which fulfilled the eligibility criteria. Eight studies included an economic analysis on newly diagnosed patients with CML. Seven studies investigated people with CML who were resistant or intolerant to standard-dose imatinib. One article focused on chronic phase (CP)-CML patients who experienced failure with first-line treatment for interferon-α. The last study investigated advanced stages of CML patients. Most studies (n = 70.6%) were conducted in high-income countries. Only five studies (n = 29.4%) were performed in middle-income countries. Most studies used a Markov model. The time horizon varied from six months to life-time.

Conclusions

Despite high costs, the included studies indicate that imatinib regimens are cost effective in newly diagnosed patients with CP-CML. For people with CML who are resistant or intolerant to standard-dose imatinib, dasatinib is likely to be a more cost-effective strategy in middle-income countries. More studies are necessary to assess the long-term efficacy and cost effectiveness of novel treatment options.

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References

  1. An X, et al. BCR-ABL tyrosine kinase inhibitors in the treatment of Philadelphia chromosome positive chronic myeloid leukemia: a review. Leuk Res. 2010;34(10):1255–68.

    Article  CAS  Google Scholar 

  2. Goldman J. ABC of clinical haematology. Chronic myeloid leukaemia. BMJ. 1997;314(7081):657–60.

    Article  CAS  Google Scholar 

  3. Hoglund M, Sandin F, Simonsson B. Epidemiology of chronic myeloid leukaemia: an update. Ann Hematol. 2015;94(Suppl 2):S241–7.

    Article  Google Scholar 

  4. Granatowicz A, et al. An overview and update of chronic myeloid leukemia for primary care physicians. Korean J Fam Med. 2015;36(5):197–202.

    Article  Google Scholar 

  5. Pallera A, et al. NCCN guidelines insights: chronic myeloid leukemia, version 1.2017. J Natl Compr Cancer Netw. 2016;14(12):1505–12.

    Article  CAS  Google Scholar 

  6. Jabbour E, Kantarjian H. Chronic myeloid leukemia: 2016 update on diagnosis, therapy, and monitoring. Am J Hematol. 2016;91(2):252–65.

    Article  CAS  Google Scholar 

  7. Pinilla-Ibarz J, et al. Long-term BCR-ABL1 tyrosine kinase inhibitor therapy in chronic myeloid leukemia. Anticancer Res. 2015;35(12):6355–64.

    CAS  PubMed  Google Scholar 

  8. Gambacorti-Passerini C, Piazza R. Imatinib—a new tyrosine kinase inhibitor for first-line treatment of chronic myeloid leukemia in 2015. JAMA Oncol. 2015;1(2):143–4.

    Article  Google Scholar 

  9. Apperley JF. Chronic myeloid leukaemia. Lancet. 2015;385(9976):1447–59.

    Article  Google Scholar 

  10. Dalziel K, et al. Cost effectiveness of imatinib compared with interferon-alpha or hydroxycarbamide for first-line treatment of chronic myeloid leukaemia. Pharmacoeconomics. 2005;23(5):515–26.

    Article  CAS  Google Scholar 

  11. Reed SD, et al. Cost-effectiveness of imatinib versus interferon-alpha plus low-dose cytarabine for patients with newly diagnosed chronic-phase chronic myeloid leukemia. Cancer. 2004;101(11):2574–83.

    Article  Google Scholar 

  12. Kattan MW, et al. Cost-effectiveness of interferon-alpha and conventional chemotherapy in chronic myelogenous leukemia. Ann Intern Med. 1996;125(7):541–8.

    Article  CAS  Google Scholar 

  13. Stovold E, et al. Study flow diagrams in Cochrane systematic review updates: an adapted PRISMA flow diagram. Syst Rev. 2014;3:54.

    Article  Google Scholar 

  14. van Mastrigt GA, et al. How to prepare a systematic review of economic evaluations for informing evidence-based healthcare decisions: a five-step approach (part 1/3). Expert Rev Pharmacoecon Outcomes Res. 2016;16(6):689–704.

    Article  Google Scholar 

  15. Husereau D, et al. Consolidated health economic evaluation reporting standards (CHEERS) statement. Int J Technol Assess Health Care. 2013;29(2):117–22.

    Article  Google Scholar 

  16. Fangzhou B, et al. Economic evaluation of liver cancer screening in China: a systematic review. Chin J Evid Based Med. 2018;18(05):442–9.

    Google Scholar 

  17. Li N, et al. Cost effectiveness of imatinib, dasatinib, and nilotinib as first-line treatment for chronic-phase chronic myeloid leukemia in China. Clin Drug Investig. 2018;38(1):79–86.

    Article  CAS  Google Scholar 

  18. Li N, et al. Nilotinib versus dasatinib as second-line therapy in patients with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase who are resistant or intolerant to imatinib: a cost-effectiveness analysis based on real-world data. J Med Econ. 2017;20(4):328–36.

    Article  Google Scholar 

  19. Wu B, Liu M, Li T, Lin H, Zhong H. An economic analysis of high-dose imatinib, dasatinib, and nilotinib for imatinib-resistant chronic phase chronic myeloid leukemia in China: a CHEERS-compliant article. Medicine (Baltimore). 2017;96(29):e7445.

    Article  CAS  Google Scholar 

  20. Padula WV, et al. Cost-effectiveness of tyrosine kinase inhibitor treatment strategies for chronic myeloid leukemia in chronic phase after generic entry of imatinib in the United States. J Natl Cancer Inst. 2016;108(7):djw003.

    Article  Google Scholar 

  21. Whalen J, et al. Cost-effectiveness analysis of second-line tyrosine kinase inhibitor treatment for chronic myelogenous leukemia. J Med Econ. 2016;19(5):445–61.

    Article  Google Scholar 

  22. Rochau U, et al. Effectiveness and cost-effectiveness of sequential treatment of patients with chronic myeloid leukemia in the United States: a decision analysis. Leuk Res Treat. 2015;2015:982395. https://doi.org/10.1155/2015/982395.

    Article  CAS  Google Scholar 

  23. Kulpeng W, et al. Cost-utility analysis of dasatinib and nilotinib in patients with chronic myeloid leukemia refractory to first-line treatment with imatinib in Thailand. Clin Ther. 2014;36(4):534–43.

    Article  Google Scholar 

  24. Rochau U, et al. Cost-effectiveness of the sequential application of tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia. Leuk Lymphoma. 2014;56(8):2315–25.

    Article  Google Scholar 

  25. Romero M, et al. Cost-effectiveness of nilotinib, dasatinib and imatinib as first-line treatment for chronic myeloid leukemia in Colombia, 2012. Biomedica. 2014;34(1):48–59.

    Article  Google Scholar 

  26. Hoyle M, et al. Cost-effectiveness of dasatinib and nilotinib for imatinib-resistant or -intolerant chronic phase chronic myeloid leukemia. Value Health. 2011;14(8):1057–67.

    Article  Google Scholar 

  27. Wu EQ, et al. Retrospective real-world comparison of medical visits, costs, and adherence between nilotinib and dasatinib in chronic myeloid leukemia. Curr Med Res Opin. 2010;26(12):2861–9.

    Article  Google Scholar 

  28. Ghatnekar O, Hjalte F, Taylor M. Cost-effectiveness of dasatinib versus high-dose imatinib in patients with chronic myeloid leukemia (CML), resistant to standard dose imatinib—a Swedish model application. Acta Oncol. 2010;49(6):851–8.

    Article  CAS  Google Scholar 

  29. Chen Z, et al. Cost-effectiveness study comparing imatinib with interferon-alpha for patients with newly diagnosed chronic-phase (CP) chronic myeloid leukemia (CML) from the Chinese public health-care system perspective (CPHSP). Value Health. 2009;12(Suppl 3):S85–8.

    Article  Google Scholar 

  30. Reed SD, et al. Updated estimates of survival and cost effectiveness for imatinib versus interferon-alpha plus low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukaemia. Pharmacoeconomics. 2008;26(5):435–46.

    Article  CAS  Google Scholar 

  31. Warren E, et al. Cost-utility analysis of imatinib mesylate for the treatment of chronic myelogenous leukemia in the chronic phase. Clin Ther. 2004;26(11):1924–33.

    Article  Google Scholar 

  32. Gordois A, et al. Cost-utility analysis of imatinib mesilate for the treatment of advanced stage chronic myeloid leukaemia. Br J Cancer. 2003;89(4):634–40.

    Article  CAS  Google Scholar 

  33. Guoen L, Shanlian H, Jiuhong W. China guidelines for pharmacoeconomic evaluations (version 2011). China J Pharm Econ. 2011;03:6–9.

    Google Scholar 

  34. Sanders GD, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. JAMA. 2016;316(10):1093–103.

    Article  Google Scholar 

  35. Loveman E, et al. Dasatinib, high-dose imatinib and nilotinib for the treatment of imatinib-resistant chronic myeloid leukaemia: a systematic review and economic evaluation. Health Technol Assess. 2012;16(23):1–137.

    Article  Google Scholar 

  36. Husereau D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)–explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health. 2013;16(2):231–50.

    Article  Google Scholar 

  37. Baio G, Dawid AP. Probabilistic sensitivity analysis in health economics. Stat Methods Med Res. 2015;24(6):615–34.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Medical Decision and Economic Group, Department of Pharmacy, Shanghai Jiao Tong University School of Medicine, Affiliated Renji Hospital, South Campus, Shanghai, China

    Jie Fu, Houwen Lin & Bin Wu

  2. College of Life Science and Biological Pharmacy, Shenyang Pharmaceutical University, Shenyang, China

    Jie Fu & Yuchen Liu

Authors
  1. Jie Fu
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  2. Yuchen Liu
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  3. Houwen Lin
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  4. Bin Wu
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Contributions

All authors contributed to the study concept and design. JF and YCL evaluated the included literature and conducted quality assessment of the articles. JF and BW wrote the first draft. All authors have explained the data and commented on the first draft.

Corresponding author

Correspondence to Bin Wu.

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Funding

This study was supported by the Fourth Round of the Three-year Action Plan on Public Health Discipline and Talent Program (Evidence-based Public Health and Health Economics, No. 15GWZK0901) from the Shanghai Health and Family Planning Commission.

Conflict of interest

The authors declare that they have no conflicts of interest to disclose regarding this study. We confirm that we have read the journal’s position on issues covered by ethical publications and confirm that this report meets these guidelines. All the authors were substantially involved in the study and/or preparation of the manuscript.

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Fu, J., Liu, Y., Lin, H. et al. Economic Evaluations of Tyrosine Kinase Inhibitors for Patients with Chronic Myeloid Leukemia in Middle- and High-Income Countries: A Systematic Review. Clin Drug Investig 38, 1167–1178 (2018). https://doi.org/10.1007/s40261-018-0706-5

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  • DOI: https://doi.org/10.1007/s40261-018-0706-5

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