Cost Effectiveness of Ofatumumab Plus Chlorambucil in First-Line Chronic Lymphocytic Leukaemia in Canada

Objective Our objective was to estimate the cost effectiveness of ofatumumab plus chlorambucil (OChl) versus chlorambucil in patients with chronic lymphocytic leukaemia for whom fludarabine-based therapies are considered inappropriate from the perspective of the publicly funded healthcare system in...

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Bibliographic Details
Published in:PharmacoEconomics Vol. 34; no. 1; pp. 77 - 90
Main Authors: Herring, William, Pearson, Isobel, Purser, Molly, Nakhaipour, Hamid Reza, Haiderali, Amin, Wolowacz, Sorrel, Jayasundara, Kavisha
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 01.01.2016
Springer
Springer Nature B.V
Subjects:
Antibodies, Monoclonal - adverse effects
Antibodies, Monoclonal - economics
Antibodies, Monoclonal - therapeutic use
Canada
Chlorambucil
Chlorambucil - adverse effects
Chlorambucil - economics
Chlorambucil - therapeutic use
Chronic lymphocytic leukemia
Clinical practice guidelines
Cost analysis
Cost-Benefit Analysis
Costs
Drug therapy
Drug therapy, Combination
Drug Therapy, Combination - adverse effects
Drug Therapy, Combination - economics
Economic aspects
Health Administration
Health care expenditures
Health Economics
Humans
Leukemia
Leukemia, Lymphocytic, Chronic, B-Cell - drug therapy
Leukemia, Lymphocytic, Chronic, B-Cell - economics
Markov analysis
Markov chains
Medicine
Medicine & Public Health
Models, Economic
Ofatumumab
Original Research Article
Patients
Pharmaceuticals
Pharmacoeconomics and Health Outcomes
Public Health
Quality of Life Research
Quality-Adjusted Life Years
Sensitivity analysis
Studies
Survival analysis
Testing
Canada
Chlorambucil
Chronic Lymphocytic Leukaemia
Overall Response Rate
Progressive Multifocal Leukoencephalopathy
Overall Survival
ISSN:1170-7690, 1179-2027, 1179-2027
Online Access:Get full text
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Summary:Objective Our objective was to estimate the cost effectiveness of ofatumumab plus chlorambucil (OChl) versus chlorambucil in patients with chronic lymphocytic leukaemia for whom fludarabine-based therapies are considered inappropriate from the perspective of the publicly funded healthcare system in Canada. Methods A semi-Markov model (3-month cycle length) used survival curves to govern progression-free survival (PFS) and overall survival (OS). Efficacy and safety data and health-state utility values were estimated from the COMPLEMENT-1 trial. Post-progression treatment patterns were based on clinical guidelines, Canadian treatment practices and published literature. Total and incremental expected lifetime costs (in Canadian dollars [$Can], year 2013 values), life-years and quality-adjusted life-years (QALYs) were computed. Uncertainty was assessed via deterministic and probabilistic sensitivity analyses. Results The discounted lifetime health and economic outcomes estimated by the model showed that, compared with chlorambucil, first-line treatment with OChl led to an increase in QALYs (0.41) and total costs ($Can27,866) and to an incremental cost-effectiveness ratio (ICER) of $Can68,647 per QALY gained. In deterministic sensitivity analyses, the ICER was most sensitive to the modelling time horizon and to the extrapolation of OS treatment effects beyond the trial duration. In probabilistic sensitivity analysis, the probability of cost effectiveness at a willingness-to-pay threshold of $Can100,000 per QALY gained was 59 %. Conclusions Base-case results indicated that improved overall response and PFS for OChl compared with chlorambucil translated to improved quality-adjusted life expectancy. Sensitivity analysis suggested that OChl is likely to be cost effective subject to uncertainty associated with the presence of any long-term OS benefit and the model time horizon.
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ISSN:1170-7690
1179-2027
1179-2027
DOI:10.1007/s40273-015-0332-5