Blinatumomab in high-risk first relapse pediatric patients with acute lymphoblastic leukemia: a cost-effectiveness analysis

Abstract

Objective: To estimate the cost-effectiveness of blinatumomab as the new standard treatment of consolidation in high-risk first relapse pediatric patients with B-cell acute lymphoblastic leukemia (B-ALL). Methods: A partitioned survival model with a lifetime horizon and a 4-week cycle was developed from the Brazilian public healthcare payer’s perspective (SUS). Event-free survival and overall survival were extrapolated based on data from the 20120215 clinical trial using parametric functions. A 5% discount rate was used, and the impact of variations in model parameters and assumptions were explored in scenario analyses. Results: The discounted base case lifetime cost was R$ 351,615 for blinatumomab vs. R$ 97,770 for standard chemotherapy control group (HC3), with 9.96 QALYs gained with blinatumomab vs. 6.74 QALYs gained with HC3. The incremental cost-effectiveness ratio (ICER) was R$ 78,873/QALY. Considering an undiscounted scenario, the ICER was R$ 33,731/QALY gained. The other scenarios with the greatest impact on ICER were the exclusion of blinatumomab wastage (i.e., considering the use of leftover medication from one vial for a new infusion: R$ 35,751) and the change in infusion time (48h or 96h bag instead of 24h bag, R$ 35,515). The probability of cost-effectiveness with blinatumomab was 65,7% for a R$ 95,501 threshold in the probabilistic sensitivity analysis. Conclusions: Blinatumomab is cost-effective for high-risk first relapse pediatric patients with Ph- B-ALL from a public healthcare payer’s perspective.