Research Article

Effectiveness and Cost-Effectiveness of Sequential Treatment of Patients with Chronic Myeloid Leukemia in the United States: A Decision Analysis

Table 2

Data for natural history, effectiveness, adverse events, and costs.

Input parameterValueSource (references)

Treatment effectiveness
Probability of staying on 1st-line chemotherapy Weibull, shape: 1.17, scale: 53.15[14, 15]
Probability of staying on 1st-line bosutinibWeibull, shape: 0.92, scale: 54.79 [13, 1618]
Probability of staying on 1st-line dasatinibWeibull, shape: 0.92, scale: 102.4 [1921]
Probability of staying on 1st-line imatinibWeibull, shape: 0.92, scale: 79.65[13, 1624]
Probability of staying on 1st-line nilotinibWeibull, shape: 0.92, scale: 106[2224]
Probability of staying on 2nd-line bosutinibExponential, 0.97[25, 26]
Probability of staying on 2nd-line dasatinibExponential, 0.98[2729]
Probability of staying on 2nd-line nilotinibExponential, 0.97[3033]
Probability of staying on 2nd-line ponatinibExponential, 0.97[3437]
Probability of staying in CP on chemotherapy after TKI failureExponential, 0.01[38]
Probability of staying in AP on chemotherapy Exponential, 0.11[39]
Probability of dying from CML in BP on chemotherapy Exponential, 0.09[38]
Utilities
Chronic phase0.92 × (age-dependent utility general population)[4042]
Accelerated phase0.79 × (age-dependent utility general population)[41, 42]
Blast phase0.57 × (age-dependent utility general population)[41, 42]
After SCT without GvHD0.98 × (age-dependent utility general population)[42, 43]
After SCT with GvHD0.9 × (age-dependent utility general population)[42, 43]
Drug cost
Imatinib 1st line 400 mg qd$10,057.04 per month[44]
Dasatinib 1st line 100 mg qd$11,021.20 per month[44]
Nilotinib 1st line 300 mg bid$10,436.08 per month[44]
Bosutinib 1st line 500 mg qd$11,277.36 per month[44]
Dasatinib 2nd line 100 mg qd$11,021.20 per month[44]
Nilotinib 2nd line 400 mg bid$10,436.00 per month[44]
Bosutinib 2nd line 500 mg qd$11,277.36 per month[44]
Ponatinib 2nd line 45 mg qd$12,611.04 per month[44]
Hydroxyurea 2000 mg qd$655.24 per month[44]
Tacrolimus 2 mg/day$313.20 per month[44]
Mycophenolate 2000 mg/day$1,887.35 per month[44]
Therapy cost
Outpatient in CP$162.52 per month[40, 45]
Inpatient in CP$323.09 per month[40, 45]
Outpatient in AP$261.98 per month[40, 45]
Inpatient in AP$2,173.10 per month[40, 45]
Outpatient in BP$261.98 per month[40, 45]
Inpatient in BP$1,890.59 per month[40, 45]
Stem-cell transplantation and its complication
Acute GvHD $66,821.50[46]
Chronic GvHD $10,082.11[46]
Follow-up care within the first year after SCT $556.15 per month[40, 45], clinical expert opinion
Follow-up care beyond the first year after SCT$485.61 per month[40, 45], clinical expert opinion
Transplant from live related donor (occurs just once)$90,234.54[47]
Transplant from live unrelated donor (occurs just once)$131,976.34[47]
Adverse events
Abdominal pain$5,176.34 per inpatient stay[47]
Anemia$4,919.15 per inpatient stay[47]
Diarrhea$5,389.65 per inpatient stay[47]
Hypertension$6,845.76 per inpatient stay[47]
Leukocytopenia$6,424.44 per inpatient stay[47]
Neutropenia$8,400.54 per inpatient stay[47]
Pancreatitis$7,656.35 per inpatient stay[47]
Rash$3,915.32 per inpatient stay[47]
Thrombocytopenia$5,846.95 per inpatient stay[47]

AP: accelerated phase; bid: twice a day; BP: blast phase; CML: chronic myeloid leukemia; CP: chronic phase; GvHD: graft-versus-host disease; qd: every day; SCT: stem cell transplantation.