Is interferon-α worthwhile in chronic myeloid leukaemia?

INTERNATIONAL RESEARCH & OPINION Is interferon-a. worthwhile in chronic myeloid leukaemia? Interferon-a is an effective but costly option for the treatment of patients with chronic myeloid leukaemia, indicate the results of an Italian cost-effectiveness :In:llv,,i,,. .. - .I Using a Markov decision-analytical model, the researchers estimated lifetime costs and outcomes for a cohort of patients (aged 45-50 years) with early chronic myeloid leukaemia who received either hydroxycarbamide 1.5 glday or interferon-a 5MU/m 2 /day. Two time periods were modelled: the first 8 months of treatment (induction phase) and average duration of life-expectancy (long-term treatment phase). Two interferon-a treatment strategies were modelled: patients who responded to induction therapy continued interferon-a until the secondary chronic phase or blastic phase (strategy A); or patients continued therapy for 18 months after induction before switching to conventional chemotherapy if they were not in cytogenetic remission. Patients who did not respond to hydroxycarbamide received busulfan. The analysis, which was conducted from the perspective of Italian society, used outcomes data from published trials of interferon-a. Health state and treatment utilities were based on the expert judgement of 10 physicians. Incremental costIQALY 'moderately attractive' Compared with conventional chemotherapy, interferon-a increased quality-adjusted life-expectancy by 15.5 and 12.5 months per patient in strategies A and B, respectively. The incrementa! per patient cost of interferon-a over conventional chemotherapy was SUS 115 600 for strategy A and SUS66 100 for strategy B. Therefore, the incremental cost utility for interferon-a, compared with conventional chemotherapy, was $US89 500 and $US63 500 per quality- adjusted life-year (QALY) gained for strategies A and B, respectively. Outcomes were sensitive to variations in the acquisition cost of interferon-a. Strategy A became cost effective « $US50 OOOIQALY gained) if the acquisition cost was reduced to 55% of baseline, whereas strategy B became cost effective if the acquisition cost was reduced to 87% of baseline. The researchers suggest that interferon-a should be targeted to patients who will achieve cytogenetic conversion, or be given at lower dosages after the effectiveness of such dosages have been proven. Liberato NL, Quaglini S, Barosi G. Cost-effectiveness of interferon alfa in chronic myelogenous leukemia Journal of Clinical Oncology 15: 2673-2682, Jul 1997 llIlIlWl'" Jl 1173·550319710122·000111$01.00°Adlslnlernationa' Limited 1997. All rights reserved PharmacoEconomics & Outcomes News 26 Ju11997 No. 122

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Transcript of Is interferon-α worthwhile in chronic myeloid leukaemia?

Page 1: Is interferon-α worthwhile in chronic myeloid leukaemia?

INTERNATIONAL RESEARCH & OPINION

Is interferon-a. worthwhilein chronic myeloid leukaemia?

Interferon-a is an effective but costly option for thetreatment of patients with chronic myeloid leukaemia,indicate the results of an Italian cost-effectiveness:In:llv,,i,, ... - .I

Using a Markov decision-analytical model, theresearchers estimated lifetime costs and outcomes fora cohort of patients (aged 45-50 years) with earlychronic myeloid leukaemia who received eitherhydroxycarbamide 1.5 glday or interferon-a5MU/m2/day. Two time periods were modelled: thefirst 8 months of treatment (induction phase) andaverage duration of life-expectancy (long-termtreatment phase).

Two interferon-a treatment strategies were modelled:patients who responded to induction therapy continuedinterferon-a until the secondary chronic phase or blasticphase (strategy A); or patients continued therapy for18 months after induction before switching to conventional chemotherapy if they were not in cytogeneticremission. Patients who did not respond tohydroxycarbamide received busulfan.

The analysis, which was conducted from theperspective of Italian society, used outcomes datafrom published trials of interferon-a. Health state andtreatment utilities were based on the expert judgementof 10 physicians.

Incremental costIQALY 'moderately attractive'Compared with conventional chemotherapy,

interferon-a increased quality-adjusted life-expectancyby 15.5 and 12.5 months per patient in strategies Aand B, respectively. The incrementa! per patient costof interferon-a over conventional chemotherapy wasSUS 115 600 for strategy A and SUS66 100 forstrategy B. Therefore, the incremental cost utility forinterferon-a, compared with conventional chemotherapy, was $US89 500 and $US63 500 per qualityadjusted life-year (QALY) gained for strategies A andB, respectively.

Outcomes were sensitive to variations in the acquisition cost of interferon-a. Strategy A became costeffective « $US50 OOOIQALY gained) if the acquisitioncost was reduced to 55% of baseline, whereas strategy Bbecame cost effective if the acquisition cost wasreduced to 87% of baseline.

The researchers suggest that interferon-a should betargeted to patients who will achieve cytogeneticconversion, or be given at lower dosages after theeffectiveness of such dosages have been proven.

Liberato NL, Quaglini S, Barosi G. Cost-effectiveness of interferon alfa inchronic myelogenous leukemia Journal ofClinical Oncology 15: 2673-2682,

Jul 1997 llIlIlWl'"