Venetoclax in Combination with Azacitidine for the Treatment of Newly Diagnosed Acute Myeloid Leukemia: A Canadian Cost–Utility Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Model Structure
2.2. Efficacy and Safety Data
2.3. Utilities
2.4. Cost Data
2.5. Incremental Cost–Utility Analysis
2.6. Sensitivity Analyses
3. Results
3.1. Base-Case Analysis
3.2. Sensitivity Analysis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Parameters | Model/Estimate | Reference |
---|---|---|
Extrapolation Models | VIALE-A trial [26] | |
OS—Ven+Aza | Log-normal | |
OS—Aza | Exponential | |
EFS—Ven+Aza | Gompertz | |
EFS—Aza | Exponential | |
Utility inputs | VIALE-A trial, VIALE-C trial, Xie (2016) [27,32,33] | |
EFS with CR/CRi | 0.815 | |
EFS without CR/CRi | 0.804 | |
PD/RL | 0.733 | |
Disutility Associated with AEs | Wehler (2018) [34] | |
Hematological disorder | −0.090 | |
Atrial fibrillation | −0.121 | |
Dyspnea | −0.219 | |
Fatigue | −0.073 | |
Hemorrhage | −0.131 | |
Hypertension | −0.020 | |
Hypokalemia/Hypophosphataemia | −0.121 | |
Renal insufficiency | −0.218 | |
Sepsis/UTI/Pneumonia | −0.218 | |
Subsequent HSCT | ||
Rate—Ven+Aza | 0.70% | Guadagnolo (2006) [35] |
Rate—Aza | 0.69% | |
Disutility (Ven+Aza and Aza) | −0.0021 | |
Duration of disutility (cycles) | 13 | Assumption |
Parameters | Cost/Estimate | Reference |
---|---|---|
Drug and Administration Costs | Drug cost: VIALE-A trial [26], IQVIA [39]; Administration costs: Government of Canada [40], Schedule of Benefits [41], CCO Regimens [42], Job Bank Canada [43], Pettigrew (2015) [44] | |
Ven+Aza | ||
First cycle | $10,526 | |
Subsequent cycles | $10,736 | |
Aza | $6355 | |
Subsequent Treatment Cost by First-Line Treatment | IQVIA [39], Dosing for Aza: VIALE-A [26], Dosing for cytarabine: VIALE-C [33], Dosing for hydroxycarbamide: CCO, HYDR regimen [45], Stahl (2018) [46] | |
Ven+Aza | $384.30 | |
Aza | $811.90 | |
Subsequent HSCT | OCC [47] Interprovincial Billing Rates for Designated High Cost Transplants, 2020 [48] | |
Stem cell harvesting cost | $2475 | |
Cost associated with allogeneic SCT procedure | $183,244 | |
Medical Costs by Health State | ||
EFS with CR/Cri | CIHI, Code 624 (adults) [49], CIHI 2016 [50], Lagerquist (2017) [51], OCC [47] | |
First Cycle | $7940 | |
Subsequent cycles | $668.76 | |
EFS without CR/Cri | ||
First Cycle | $8497 | |
Subsequent cycles | $1434 | |
PD/RL | $2654 | |
Adverse Events by Treatment | ||
Ven+Aza | $5699 | VIALE-A trial [26], OCC 2017/2018 [47], OCC [47] |
Aza | $3743 | |
Follow-Up Costs by Health State | $668.76 | Canadian KOL input, Schedule of Benefits for Laboratory Services [52], Canadian Cancer Society [53] |
Costs of Terminal Care | $86,582 | de Oliveira (2016) [54] |
Costs of Productivity Loss | ||
Average monthly wage | $4700 | Statistics Canada. Table: 14-10-0320-02 [55] |
Employment rate (%) | ||
15–24 years old | 49.2 | Statistics Canada. Table: 14-10-0287-02 [56] |
25–55 years old | 79.7 | |
55 years and older | 33.7 |
Aza | Ven+Aza | |
---|---|---|
Total QALYs | 0.87 | 2.53 |
Incremental QALYs | 1.65 | |
Total costs, MoH perspective | $82,333 | $204,305 |
Incremental total costs, MoH perspective | $121,973 | |
Total costs, Societal perspective | $77,955 | $177,510 |
Incremental total costs, Societal perspective | $99,554 | |
Incremental costs/QALY, MoH perspective | $73,841/QALY | |
Incremental costs/QALY, Societal perspective | $60,269/QALY |
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Guinan, K.; Mathurin, K.; Au, Y.; Schuh, A.C.; Bui, C.N.; Chai, X.; Lachaine, J. Venetoclax in Combination with Azacitidine for the Treatment of Newly Diagnosed Acute Myeloid Leukemia: A Canadian Cost–Utility Analysis. Curr. Oncol. 2022, 29, 7524-7536. https://doi.org/10.3390/curroncol29100592
Guinan K, Mathurin K, Au Y, Schuh AC, Bui CN, Chai X, Lachaine J. Venetoclax in Combination with Azacitidine for the Treatment of Newly Diagnosed Acute Myeloid Leukemia: A Canadian Cost–Utility Analysis. Current Oncology. 2022; 29(10):7524-7536. https://doi.org/10.3390/curroncol29100592
Chicago/Turabian StyleGuinan, Kimberly, Karine Mathurin, Yunghan Au, Andre C. Schuh, Cat N. Bui, Xinglei Chai, and Jean Lachaine. 2022. "Venetoclax in Combination with Azacitidine for the Treatment of Newly Diagnosed Acute Myeloid Leukemia: A Canadian Cost–Utility Analysis" Current Oncology 29, no. 10: 7524-7536. https://doi.org/10.3390/curroncol29100592
APA StyleGuinan, K., Mathurin, K., Au, Y., Schuh, A. C., Bui, C. N., Chai, X., & Lachaine, J. (2022). Venetoclax in Combination with Azacitidine for the Treatment of Newly Diagnosed Acute Myeloid Leukemia: A Canadian Cost–Utility Analysis. Current Oncology, 29(10), 7524-7536. https://doi.org/10.3390/curroncol29100592