Budget impact analysis of treatment‐free remission in nilotinib‐treated Japanese chronic myeloid leukemia patients
Open Access
- 23 April 2020
- journal article
- research article
- Published by Wiley in Cancer Science
- Vol. 111 (7), 2526-2535
- https://doi.org/10.1111/cas.14430
Abstract
Treatment‐free remission (TFR), wherein patients discontinue pharmacotherapy and remain in molecular remission, is an emerging treatment goal for patients with chronic myeloid leukemia (CML). Attainment of TFR requires an increased frequency of molecular monitoring, to ensure that patients maintain a deep molecular response. The objective of this analysis was to assess the economic impact of stopping nilotinib among Japanese TFR‐eligible patients. A Markov model evaluated the economic impact of TFR among the study population, TFR‐eligible CML patients diagnosed since 2012. The model compared patients who discontinued tyrosine kinase inhibitor (TKI) treatment (i.e., attempted TFR) with patients that continued TKI treatment. A three‐year time horizon was modelled from a Japanese public payer perspective. Costs associated with drug treatment, hospital/physician visits, and molecular monitoring were considered. TFR‐eligible patients were calculated from Japanese CML incidence rates and efficacy was derived from nilotinib trials. Japanese co‐payment maximums were utilized to assess the patient perspective. An estimated 761 and 140 patients were eligible for first‐ and second‐line nilotinib, respectively, in 2019. Assuming that 100% of eligible patients complied, TFR was associated with cost savings of ¥7,625,174,640 ($66,567,775 USD) over three years. In scenarios with reduced willingness to attempt TFR, cost savings persisted. Achievement of TFR was estimated to markedly reduce out‐of‐pocket expenses for CML patients, regardless of the timing of relapse. Stopping nilotinib for TFR‐eligible patients in Japan may result in significant cost savings to both payers and patients. Monitoring costs contributed little to overall annual costs and decreased over time.Keywords
This publication has 42 references indexed in Scilit:
- Differences in incidence and trends of haematological malignancies in Japan and the United StatesBritish Journal of Haematology, 2013
- European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013Blood, 2013
- Nilotinib versus imatinib for the treatment of patients with newly diagnosed chronic phase, Philadelphia chromosome-positive, chronic myeloid leukaemia: 24-month minimum follow-up of the phase 3 randomised ENESTnd trialThe Lancet Oncology, 2011
- First-line treatment for chronic myeloid leukemia: dasatinib, nilotinib, or imatinibJournal of Hematology & Oncology, 2010
- Nilotinib versus Imatinib for Newly Diagnosed Chronic Myeloid LeukemiaNew England Journal of Medicine, 2010
- Healthcare resource utilization and costs associated with non-adherence to imatinib treatment in chronic myeloid leukemia patientsCurrent Medical Research and Opinion, 2009
- Treatment Interruptions and Non-Adherence with Imatinib and Associated Healthcare CostsPharmacoEconomics, 2007
- Evolving concepts in the management of chronic myeloid leukemia: recommendations from an expert panel on behalf of the European LeukemiaNetBlood, 2006
- BCR – ABL activates pathways mediating cytokine independence and protection against apoptosis in murine hematopoietic cells in a dose-dependent mannerOncogene, 1998
- Bcr/Abl expression stimulates integrin function in hematopoietic cell lines.JCI Insight, 1996