Cost‐Effectiveness Analysis of Obinutuzumab for Previously Untreated Chronic Lymphocytic Leukaemia in Portuguese Patients who are Unsuitable for Full-Dose Fludarabine-Based Therapy

Autor: Ursula Becker, Carlos Gouveia Pinto, Luís Silva Miguel, A.T. Paquete, Catarina Pereira
Rok vydání: 2017
Předmět:
Oncology
Economics and Econometrics
medicine.medical_specialty
Cost-Benefit Analysis
Antineoplastic Agents
Antibodies
Monoclonal
Humanized
Drug Costs
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Pharmacotherapy
Obinutuzumab
hemic and lymphatic diseases
Internal medicine
medicine
Humans
030212 general & internal medicine
Antineoplastic Agents
Alkylating
health care economics and organizations
Chlorambucil
business.industry
Health Policy
Health Care Costs
General Medicine
Cost-effectiveness analysis
medicine.disease
Leukemia
Lymphocytic
Chronic
B-Cell
Markov Chains
Quality-adjusted life year
Fludarabine
Surgery
Leukemia
chemistry
030220 oncology & carcinogenesis
Drug Therapy
Combination
Rituximab
Quality-Adjusted Life Years
business
Vidarabine
medicine.drug
Zdroj: Applied Health Economics and Health Policy. 15:501-512
ISSN: 1179-1896
1175-5652
DOI: 10.1007/s40258-017-0321-2
Popis: Chronic lymphocytic leukaemia (CLL) mostly affects patients with comorbidities and limited therapeutic options. Obinutuzumab in combination with chlorambucil (GClb) is a new therapeutic option for previously untreated CLL patients who are unsuitable for full-dose fludarabine-based therapy. This combination delays disease progression but incurs additional costs; thus, an assessment of its value for money is relevant. To estimate the incremental cost-utility ratio of GClb in comparison with (i) rituximab in combination with chlorambucil (RClb), and (ii) chlorambucil alone (Clb) from the perspective of the Portuguese National Health Service (NHS). A Markov model was used to predict disease progression. Pre‐progression clinical data were based on the latest CLL11 trial data, and post‐progression clinical data were obtained from CLL5 trial data. Utility values are from Kosmas et al. (Leuk Lymphoma 56:1320–1326, 14). Only direct medical costs were included. The resource consumption was estimated by a panel of Portuguese experts, and the unit costs were obtained from official sources. A discount rate of 5% was applied to costs and consequences. GClb and RClb were associated with an increase of 1.06 and 0.39 quality-adjusted life-years (QALY) at an additional cost of €21,720 and €9836 when compared to Clb, respectively. The cost-utility ratio of GClb versus Clb was €20,397/QALY, while RClb was extendedly dominated. The use of GClb for previously untreated CLL patients who are unsuitable for full-dose fludarabine-based therapy incurs an incremental cost per QALY that is generally accepted in Portugal. Therefore, although there is some uncertainty, obinutuzumab is probably a cost-effective therapy in the Portuguese setting.
Databáze: OpenAIRE
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