Imataki Osamu, Ishida Tomoya, Kida Jun-Ichiro, Uemura Makiko, Fujita Haruyuki, Kadowaki Norimitsu
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan.
J Clin Med Res. 2022 Oct;14(10):432-435. doi: 10.14740/jocmr4799. Epub 2022 Oct 28.
Tyrosine kinase inhibitors (TKIs) and FMS-like tyrosine kinase 3 (FLT3) inhibitors are promising agents for Ph-positive acute leukemia (Ph AL) and FLT3 mutated acute myeloid leukemia (FLT3-AML), respectively.
We examined the cost-effectiveness ratio (CER) of dasatinib and ponatinib for Ph AL and the cost-effectiveness of gilteritinib and quizartinib for FLT3-AML in elderly patients. Molecular therapy can fit the elderly population better than chemotherapy (CT).
The daily drug cost of dasatinib, ponatinib, gilteritinib, and quizartinib was $240, $170, $524, and $479 in terms of treatment maintenance dose, respectively. Treatment of Ph AL with stem cell transplantation (SCT), CT, dasatinib, and ponatinib yielded CERs of $322,375, $34,928, $61,104, and $46,234, respectively. The CERs for FLT3-AML treated with SCT, CT, gilteritinib, and quizartinib were $355,270, $42,717, $94,987, and $90,080, respectively. Treatment of elderly patients with TKIs and FLT3 inhibitors remained expensive and inferior to conventional CT.
Although TKIs and FLT3 inhibitors have an inferior CER than does conventional CT, their promising survival benefit with better QOL can offer a profound advantage. TKI or FLT3 inhibitor monotherapy is recommended as an alternative treatment option for unfit (vulnerable) elderly patients with Ph AL or FLT3-AML.
酪氨酸激酶抑制剂（TKIs）和FMS样酪氨酸激酶3（FLT3）抑制剂分别是治疗Ph阳性急性白血病（Ph AL）和FLT3突变急性髓系白血病（FLT3-AML）的有前景的药物。
我们研究了达沙替尼和波纳替尼治疗Ph AL的成本效益比（CER）以及吉列替尼和奎扎替尼治疗老年FLT3-AML患者的成本效益。分子疗法比化疗（CT）更适合老年人群。
就治疗维持剂量而言，达沙替尼、波纳替尼、吉列替尼和奎扎替尼的每日药物成本分别为240美元、170美元、524美元和479美元。采用干细胞移植（SCT）、CT、达沙替尼和波纳替尼治疗Ph AL的CER分别为322,375美元、34,928美元、61,104美元和46,234美元。采用SCT、CT、吉列替尼和奎扎替尼治疗FLT3-AML的CER分别为355,270美元、42,717美元、94,987美元和90,080美元。用TKIs和FLT3抑制剂治疗老年患者仍然昂贵，且不如传统CT。
尽管TKIs和FLT3抑制剂的CER低于传统CT，但其有前景的生存获益和更好的生活质量可提供显著优势。对于不适合（脆弱的）老年Ph AL或FLT3-AML患者，建议将TKI或FLT3抑制剂单药治疗作为替代治疗选择。
