Cost-effectiveness of dasatinib versus nilotinib for the secondline treatment of patients with chronic myeloid leukemia (CML) under the Brazilian Private Healthcare System

Abstract

INTRODUCTION: CML is noted for an excessive proliferation of myeloid lineage, followed by aggressive loss of cellular differentiation. This disease is associated with significant health and economic burden, which is driven greatly by the costs associated with drug treatments. Treatment with imatinib is the current standard of care, however some patients become resistant or intolerant to imatinib. Dasatinib and nilotinib have proven efficacy in this population, and are incorporated into the clinical practice as second-line treatment. OBJECTIVE: Evaluate the cost-effectiveness of dasatinib as second line treatment for patients with CML intolerant or resistant to imatinib on supplementary health system (SSS). METHOD: A Markov model was developed to simulate the treatment of the evaluated clinical condition. In the model patients can remain stable in the chronic phase, progress to the accelerated and blast phases, die or have adverse events related to treatment. The costs of medications and side events were obtained from CMED (PF 0%) and CBHPM 2010 updated to 2013 costs. The outcome of the analysis was QALYs. RESULTS: The results were divided into two scenarios. The base scenario considered a lifetime horizon and the alternative scenario considered four years. Both scenarios presented a gain of effectiveness and relevant resource savings when compared to nilotinib, representing cost-saving scenarios. Furthermore, treatment with dasatinib in chronic phase, in which patients remain for a longer period, revealed the lowest monthly cost compared to nilotinib, R$ 7,928.10 for dasatinib (100 mg) and R$ 9,980.40 for nilotinib. CONCLUSION: The results demonstrate an advantage in terms of cost-effectiveness of dasatinib compared to nilotinib in the base and alternative scenarios. The budget impact analysis suggests that dasatinib can bring significant economy of resources.