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Cost effectiveness of imatinib compared with interferon-α or hydroxycarbamide for first-line treatment of chronic myeloid leukaemia

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Abstract

Objective: To evaluate the cost utility of imatinib compared with interferon (IFN)-α or hydroxycarbamide (hydroxyurea) for first-line treatment of chronic myeloid leukaemia.

Design and Setting: A cost-utility (Markov) model within the setting of the UK NHS and viewed from a health system perspective was adopted. Transition probabilities and relative risks were estimated from published literature. Costs of drug treatment, outpatient care, bone marrow biopsies, radiography, blood transfusions and inpatient care were obtained from the British National Formulary and local hospital databases. Costs (£, year 2001–03 values) were discounted at 6%. Quality-of-life (QOL) data were obtained from the published literature and discounted at 1.5%. The main outcome measure was cost per QALY gained. Extensive one-way sensitivity analyses were performed along with probabilistic (stochastic) analysis.

Results: The incremental cost-effectiveness ratio (ICER) of imatinib, compared with IFNα, was £26 180 per QALY gained (one-way sensitivity analyses ranged from £19 449 to £51 870) and compared with hydroxycarbamide was £86 934 per QALY (one-way sensitivity analyses ranged from £69 701 to £147 095) [£1 = $US1.691 = €1.535 as at 31 December 2002].

Based on the probabilistic sensitivity analysis, 50% of the ICERs for imatinib, compared with IFNα, fell below a threshold of approximately £31 000 per QALY gained. Fifty percent of ICERs for imatinib, compared with hydroxycarbamide, fell below approximately £95 000 per QALY gained.

Conclusions: This model suggests, given its underlying data and assumptions, that imatinib may be moderately cost effective when compared with IFNα but considerably less cost effective when compared with hydroxycarbamide. There are, however, many uncertainties due to the lack of long-term data.

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Acknowledgements

Kim Dalziel contributed to the design of the study, obtained parameter estimates, implemented the cost-effectiveness model and drafted the report.

Ken Stein and Ali Round contributed to the design of the study, reviewed the cost-effectiveness model and drafted the report.

Ruth Garside contributed to the design of the study, obtained parameter estimates and drafted the report.

Source of funding: UK NHS Research and Development (R&D) Health Technology Assessment Programme (Grant number 01/34/01). The authors declare that they have no conflicts of interest.

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  1. Peninsula Technology Assessment Group, Peninsula Medical School, Exeter, England

    Kim Dalziel, Ali Round, Ruth Garside &  Ken Stein

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  1. Kim Dalziel
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Correspondence to Ken Stein.

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Dalziel, K., Round, A., Garside, R. et al. Cost effectiveness of imatinib compared with interferon-α or hydroxycarbamide for first-line treatment of chronic myeloid leukaemia. Pharmacoeconomics 23, 515–526 (2005). https://doi.org/10.2165/00019053-200523050-00010

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