Cost-effectiveness model for chemoimmunotherapy options in patients with previously untreated chronic lymphocytic leukemia unsuitable for full-dose fludarabine-based therapy

Becker, U., Briggs, A. H. , Moreno, S. G., Ray, J. A., Ngo, P. and Samanta, K. (2016) Cost-effectiveness model for chemoimmunotherapy options in patients with previously untreated chronic lymphocytic leukemia unsuitable for full-dose fludarabine-based therapy. Value in Health, 19(4), pp. 374-382. (doi:10.1016/j.jval.2015.12.018) (PMID:27325329)

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Abstract

Objectives To evaluate the cost-effectiveness of treatment with anti-CD20 monoclonal antibody obinutuzumab plus chlorambucil (GClb) in untreated patients with chronic lymphocytic leukemia unsuitable for full-dose fludarabine-based therapy. Methods A Markov model was used to assess the cost-effectiveness of GClb versus other chemoimmunotherapy options. The model comprised three mutually exclusive health states: "progression-free survival (with/without therapy)", "progression (refractory/relapsed lines)", and "death". Each state was assigned a health utility value representing patients’ quality of life and a specific cost value. Comparisons between GClb and rituximab plus chlorambucil or only chlorambucil were performed using patient-level clinical trial data; other comparisons were performed via a network meta-analysis using information gathered in a systematic literature review. To support the model, a utility elicitation study was conducted from the perspective of the UK National Health Service. Results There was good agreement between the model-predicted progression-free and overall survival and that from the CLL11 trial. On incorporating data from the indirect treatment comparisons, it was found that GClb was cost-effective with a range of incremental cost-effectiveness ratios below a threshold of £30,000 per quality-adjusted life-year gained, and remained so during deterministic and probabilistic sensitivity analyses under various scenarios. Conclusions GClb was estimated to increase both quality-adjusted life expectancy and treatment costs compared with several commonly used therapies, with incremental cost-effectiveness ratios below commonly referenced UK thresholds. This article offers a real example of how to combine direct and indirect evidence in a cost-effectiveness analysis of oncology drugs.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Briggs, Professor Andrew
Authors: Becker, U., Briggs, A. H., Moreno, S. G., Ray, J. A., Ngo, P., and Samanta, K.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
Journal Name:Value in Health
Publisher:Blackwell
ISSN:1098-3015
ISSN (Online):1524-4733
Published Online:04 March 2016

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