Peninsular College of Medicine and Dentistry, University of Exeter, Exeter, United Kingdom.
Value Health. 2011 Dec;14(8):1057-67. doi: 10.1016/j.jval.2011.07.006. Epub 2011 Oct 12.
To estimate the cost-effectiveness of dasatinib and nilotinib compared with high-dose imatinib for people with chronic phase chronic myeloid leukemia, which are resistant to normal-dose imatinib and compared with interferon-α for people intolerant to imatinib, from the perspective of the UK National Health Service.
An an area under the curve partitioned survival model was developed to estimate the cost-effectiveness of dasatinib and nilotinib. Clinical effectiveness evidence was taken mostly from single-arm trials.
Both progression-free survival and overall survival are highly uncertain. In the base case, patients take nilotinib for much less time than dasatinib. Nilotinib is expected to dominate high-dose imatinib, yielding slightly more (0.32) quality-adjusted life years (QALYs) at slightly less cost (£11,100 [pound sterling]) per person. Dasatinib is predicted to provide slightly more (0.53) QALYs at substantially greater cost (£48,900), yielding a very high incremental cost-effectiveness ratio of £91,500 QALY against high-dose imatinib. Cost-effectiveness, however, changes radically under the plausible assumption that the drugs are taken for the same time. For people intolerant to imatinib, nilotinib is expected to yield an incremental cost-effectiveness ratio of £104,700/QALY, and dasatinib £82,600/QALY compared with interferon-α. Further, both drugs represent poor value for money for a range of plausible structural assumptions.
The model should be viewed as an exploratory analysis of the cost-effectiveness of dasatinib and nilotinib because it relies on many assumptions. Whilst clinical data remains immature, the cost-effectiveness of dasatinib and nilotinib for imatinib-resistant people is highly uncertain. Both nilotinib and dasatinib are highly unlikely to be cost-effective versus interferon-α for people intolerant to imatinib.
从英国国家医疗服务体系的角度出发，评估达沙替尼和尼洛替尼相较于高剂量伊马替尼（用于治疗对标准剂量伊马替尼耐药的慢性期慢性髓性白血病患者）和干扰素-α（用于治疗不耐受伊马替尼的患者）的成本效益。
通过建立分区生存曲线下面积模型来评估达沙替尼和尼洛替尼的成本效益。临床疗效证据主要来自单臂试验。
无进展生存期和总生存期的不确定性都很高。在基础情况下，患者使用尼洛替尼的时间明显短于达沙替尼。尼洛替尼预计将优于高剂量伊马替尼，为每人带来略多（0.32）的质量调整生命年（QALY），且成本略低（11100 英镑）。达沙替尼预计将提供略多（0.53）的 QALY，但成本要高得多（48900 英镑），增量成本效益比高达 91500 英镑/QALY，相较于高剂量伊马替尼非常高。然而，在药物使用时间相同的合理假设下，成本效益会发生巨大变化。对于不耐受伊马替尼的患者，尼洛替尼预计将比干扰素-α产生增量成本效益比为 104700 英镑/QALY，达沙替尼为 82600 英镑/QALY。此外，在一系列合理的结构假设下，这两种药物的性价比都很差。
由于该模型依赖于许多假设，因此应将其视为对达沙替尼和尼洛替尼成本效益的探索性分析。虽然临床数据仍不成熟，但对于对伊马替尼耐药的患者，达沙替尼和尼洛替尼的成本效益仍高度不确定。对于不耐受伊马替尼的患者，尼洛替尼和达沙替尼均不太可能比干扰素-α更具成本效益。
