Christopher R Cogle1, Jesse D Ortendahl2, Tanya Gk Bentley2, Ayanna M Anene2, Scott Megaffin3,4, Thomas J McKearn3, Michael E Petrone3, Sudipto Mukherjee5. 1. a Division of Hematology and Oncology, Department of Medicine, College of Medicine , University of Florida , Gainesville , FL , USA. 2. b Partnership for Health Analytic Research, LLC , Beverly Drive , Beverly Hills , CA 90212 , USA. 3. c Onconova Therapeutics, Inc , Newtown , PA , USA. 4. d Churchill Pharmaceuticals, LLC , King of Prussia , PA , USA. 5. e Department of Hematology and Medical Oncology , Cleveland Clinic Taussig Cancer Institute , Cleveland , OH , USA.
Abstract
PURPOSE: To evaluate optimal salvage therapy in high-risk myelodysplastic syndromes patients who have failed a first-line hypomethylating agent (HMA) therapy, given that treatment choice is challenging. METHODS: Using published literature and expert opinion, we developed a Markov model to evaluate the cost-effectiveness of current treatments for patients who failed first-line HMA therapy. The model predicted costs, life years, quality-adjusted life years and incremental cost-effectiveness ratios. Sensitivity analyses were conducted to assess the impact of uncertainty in model inputs. RESULTS: Supportive care was the least expensive option ($65,704/patient) with the shortest survival (0.48 years). Low- and high-intensity chemotherapies and hematopoietic cell transplantation increased survival and costs with incremental cost-effectiveness ratios of $108,808, 306,103 and 318,163/life year, respectively. Switching HMA was more costly and less efficacious than another treatment option, namely low-intensity chemotherapy. CONCLUSIONS: Subsequent treatments in myelodysplastic syndrome patients who failed first-line HMA significantly increase costs, while only providing marginal clinical benefit and substantially increasing treatment-related morbidities. Additional treatment options would benefit resource allocation, clinical decision-making and patient outcomes.
PURPOSE: To evaluate optimal salvage therapy in high-risk myelodysplastic syndromespatients who have failed a first-line hypomethylating agent (HMA) therapy, given that treatment choice is challenging. METHODS: Using published literature and expert opinion, we developed a Markov model to evaluate the cost-effectiveness of current treatments for patients who failed first-line HMA therapy. The model predicted costs, life years, quality-adjusted life years and incremental cost-effectiveness ratios. Sensitivity analyses were conducted to assess the impact of uncertainty in model inputs. RESULTS: Supportive care was the least expensive option ($65,704/patient) with the shortest survival (0.48 years). Low- and high-intensity chemotherapies and hematopoietic cell transplantation increased survival and costs with incremental cost-effectiveness ratios of $108,808, 306,103 and 318,163/life year, respectively. Switching HMA was more costly and less efficacious than another treatment option, namely low-intensity chemotherapy. CONCLUSIONS: Subsequent treatments in myelodysplastic syndromepatients who failed first-line HMA significantly increase costs, while only providing marginal clinical benefit and substantially increasing treatment-related morbidities. Additional treatment options would benefit resource allocation, clinical decision-making and patient outcomes.
Entities:
Keywords:
cost–effectiveness analysis; economic modeling; health care resource utilization; hypomethylating agents; myelodysplastic syndromes
Authors: Christopher R Cogle; Sandra E Kurtin; Tanya G K Bentley; Michael S Broder; Eunice Chang; Scott Megaffin; Steven Fruchtman; Michael E Petrone; Sudipto Mukherjee Journal: Oncologist Date: 2017-03-10
Authors: Leylah M Drusbosky; Neeraj Kumar Singh; Kimberly E Hawkins; Cesia Salan; Madeleine Turcotte; Elizabeth A Wise; Amy Meacham; Vindhya Vijay; Glenda G Anderson; Charlie C Kim; Saumya Radhakrishnan; Yashaswini Ullal; Anay Talawdekar; Huzaifa Sikora; Prashant Nair; Arati Khanna-Gupta; Taher Abbasi; Shireen Vali; Subharup Guha; Nosha Farhadfar; Hemant S Murthy; Biljana N Horn; Helen L Leather; Paul Castillo; Caitlin Tucker; Christina Cline; Leslie Pettiford; Jatinder K Lamba; Jan S Moreb; Randy A Brown; Maxim Norkin; John W Hiemenz; Jack W Hsu; William B Slayton; John R Wingard; Christopher R Cogle Journal: Blood Adv Date: 2019-06-25