Decitabine is more cost effective than cytarabine and daunorubicin in elderly acute myeloid leukemia patients

N. Batty, Yong Yin, M. Wetzler
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引用次数: 12

Abstract

Introduction: Decitabine is not approved in the United States (US) for acute myeloid leukemia (AML) because it did not improve overall survival compared with standard conventional induction treatment with cytarabine and daunorubicin (AD). We asked what would be the cost effectiveness of decitabine versus AD in AML patients older than 60 years of age. Methods: A semi-Markov model compiling survival and cost data was used based on survival probabilities from the literature. Data accounted for re-induction therapy with idarubicin, fludarabine, cytarabine and granulocyte colonystimulating factor and consolidation therapy with high-dose cytarabine (HiDAC) but not for stem cell transplantation. The assumption-based model considered a maximum of four cycles of HiDAC and continuing decitabine until loss of benefit. Results: Assuming 1,000 patients for each treatment arm in a semi-Markov model over one year time horizon, the qualityadjusted life year (QALY) for AD vs. decitabine were 0.47 and 0.61. The percentage survival for AD and decitabine were 45.2% and 50.5%. Their costs were $168,863 and $108,084. The incremental cost-effectiveness ratio was -$60,779/0.14 =-$433,756 per QALY. By sensitivity analysis, decitabine was superior to AD in all parameters. Conclusion: Decitabine is a more cost-effective therapy for patients older than 60 years of age than AD. While cost effectiveness is certainly important, decitabine may be arguably considered for elderly newly diagnosed AML patients given the economic pressures in the US health system; however, this is not a criterion for drug approval.
在老年急性髓系白血病患者中,地西他滨比阿糖胞苷和柔红霉素更具成本效益
在美国,地西他滨尚未被批准用于治疗急性髓性白血病(AML),因为与阿糖胞苷和柔红霉素(AD)的标准常规诱导治疗相比,地西他滨并没有提高总生存率。我们询问地西他滨与AD在60岁以上AML患者中的成本效益。方法:基于文献中的生存概率,采用综合生存和成本数据的半马尔可夫模型。数据包括伊达柔比星、氟达拉滨、阿糖胞苷和粒细胞集落刺激因子的再诱导治疗和高剂量阿糖胞苷(HiDAC)的巩固治疗,但不包括干细胞移植。基于假设的模型考虑了最多四个周期的HiDAC和持续地西他滨,直到失去效益。结果:假设在半马尔可夫模型中每个治疗组有1000名患者,在一年的时间范围内,AD与地西他滨的质量调整生命年(QALY)分别为0.47和0.61。AD和地西他滨的生存率分别为45.2%和50.5%。他们的成本分别为168,863美元和108,084美元。增量成本效益比为- 60 779美元/0.14 =- 433 756美元。通过敏感性分析,地西他滨的各项指标均优于AD。结论:对于60岁以上的老年患者,地西他滨是一种比AD更具成本效益的治疗方法。虽然成本效益当然很重要,但考虑到美国卫生系统的经济压力,地西他滨可能会被考虑用于新诊断的老年AML患者;然而,这并不是药物批准的标准。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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