Safety and cost-effectiveness of ponatinib versus other tyrosine kinase inhibitors as second-line therapy in patients with chronic myeloid leukemia in the United States

Abstract

To evaluate the cost-effectiveness of ponatinib compared with second-line TKIs in the treatment of adult patients with CML who failed, or were intolerant to, first-line TKIs. A Markov state transition model was conducted. Model transition, adverse-effect probabilities, utility data and medical costs were obtained from clinical trials and literature. Measurements included medications, follow-ups, adverse events, allogeneic stem cell transplantation and quality-adjusted life years (QALYs). Univariable and Bayesian multivariable probabilistic sensitivity analyses were conducted using Monte Carlo simulations. Dasatinib resulted in an ICER of $79,086/QALY compared to nilotinib. Ponatinib yielded an ICER of $176,278/QALY and $141,563/QALY compared to dasatinib and nilotinib, respectively. Dasatinib was the optimal treatment at a $100,000/QALY threshold. The probability (36%–40%) for ponatinib or dasatinib optimal treatment was associated with thresholds of $160,000–$180,000/QALY. Dasatinib and ponatinib can be considered cost-effective options and provide clinical benefits compared to other second-line TKIs for CML in the US.

Keywords:

• Treatment outcome
• stem cell transplant
• dasatinib
• nilotinib
• bosutinib

Disclosure statement

The author(s) declare(s) that there is no conflict of interest concerning this research. Dr. Guo has received research grant or unrestricted grant funding from the following: The Ohio Department of Jobs and Family Services (Medicaid Agency), Ortho-McNeil Janssen Scientific Affairs LLC, Eli-Lilly Company, Novartis Company, and Roche-Genentech Company. The opinions and conclusions expressed in this manuscript are solely those of the authors.

Part of this information was presented as a Spotlight Poster at the 35th International Conference on Pharmacoepidemiology and Therapeutic Risk Management (ICPE 2019) on 24–28 August 2019 at the Pennsylvania Convention Center, Philadelphia, Pennsylvania.