Cost-Effectiveness Analysis of Treating Acute Promyelocytic Leukemia Patients with Arsenic Trioxide and Retinoic Acid in the United States

Martin Tallman, Francesco Lo-Coco*, Gisoo Barnes, Morgan Kruse, Rebecca Wildner, Monique Martin, Udo Mueller, Boxiong Tang

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Introduction 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. Materials and Methods 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. Results 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. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)771-777
Number of pages7
JournalClinical Lymphoma, Myeloma and Leukemia
Volume15
Issue number12
DOIs
StatePublished - Dec 1 2015

Funding

Sponsorship for this study and article processing charges were funded by Teva Pharmaceuticals, Frazer, PA. All named authors meet the ICMJE criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. The authors thank Dr Milton Weinstein and Dr Ashutosh Pathak for their contributions. Editorial assistance was provided by Jason Allaire, PhD, Generativity Solutions Group, Cary, NC. Support for this assistance was funded by Teva Pharmaceuticals. Sponsorship for this study and article processing charges were funded by Teva Pharmaceuticals, Frazer, PA. All named authors meet the ICMJE criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. The authors thank Dr Milton Weinstein and Dr Ashutosh Pathak for their contributions. Editorial assistance was provided by Jason Allaire, PhD, Generativity Solutions Group, Cary, NC. Support for this assistance was funded by Teva Pharmaceuticals.

Keywords

  • Acute promyelocytic leukemia
  • All-trans retinoic acid
  • Arsenic trioxide
  • Cost-effectiveness
  • Markov model

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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