Cost Effectiveness of Molecular Diagnostic Testing Algorithms for the Treatment Selection of Frontline Ibrutinib for Patients with Chronic Lymphocytic Leukemia in Australia

Vu, M; Degeling, K; Thompson, ER; Blombery, P; Westerman, D; IJzerman, MJ

Author(s): Vu, M; Degeling, K; Thompson, ER; Blombery, P; Westerman, D; IJzerman, MJ;
Details: Publication Year 2024-01,Volume 22,Issue #1,Page 107-122
Journal Title: Applied Health Economics and Health Policy
Publication Type: Research article
Abstract: BACKGROUND: Clinical indications for ibrutinib reimbursement in Australia should consider the inclusion of patients with chronic lymphocytic leukemia (CLL) harboring prognostically unfavorable TP53/IGHV genomic aberrations. This study assessed the cost effectiveness of five first-line treatment strategies in CLL for young (aged ≤ 65 years), fit patients without significant comorbidities: (1) no testing (fludarabine, cyclophosphamide and rituximab [FCR] for all), (2) test for del(17p) only, (3) test for TP53 gene mutation status, (4) test for TP53 and IGHV gene mutation status and (5) no testing (ibrutinib for all). METHOD: A decision analytic model (decision tree and partitioned survival model) was developed from the Australian healthcare system perspective with a lifetime horizon. Comparative treatment effects were estimated from indirect treatment comparisons and survival analysis using several studies. Costs, utility and adverse events were derived from public literature sources. Deterministic and probabilistic sensitivity analyses explored the impact of modeling uncertainties on outcomes. RESULTS: Strategy 1 was associated with 5.69 quality-adjusted life-years (QALYs) and cost 458,836 Australian dollars (AUD). All other strategies had greater effectiveness but were more expensive than Strategy 1. At the willingness-to-pay (WTP) threshold of 100,000 AUD per QALY gained, Strategy 1 was most cost effective with an estimated probability of 68.8%. Strategy 4 was cost effective between thresholds 155,000-432,300 AUD per QALY gained, and Strategy 5 >432,300 AUD per QALY gained. CONCLUSION: Population targeting using mutation testing for TP53 and IGHV when performed with del(17p) testing specifically in the context of frontline ibrutinib choice does not make a cost-ineffective treatment into a cost-effective treatment.
Publisher: Springer Nature
Keywords: Humans; *Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy/genetics; Cost-Effectiveness Analysis; Cost-Benefit Analysis; Australia; Algorithms; Quality-Adjusted Life Years
Department(s): Pathology; Clinical Haematology
Publisher's Version: https://doi.org/10.1007/s40258-023-00826-4
Open Access at Publisher's Site: https://doi.org/10.1007/s40258-023-00826-4
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-02-22 12:18:52

Last Modified: 2024-02-22 12:19:18