Cost-effectiveness of azacitidine and ivosidenib in newly diagnosed older, intensive chemotherapy-ineligible patients with IDH1-mutant acute myeloid leukemia

Abstract

Ivosidenib + azacitidine (IVO/AZA) is approved in the United States for newly diagnosed, older or intensive chemotherapy-ineligible patients with IDH1-mutated acute myeloid leukemia. We created a partitioned survival analysis model to evaluate the health economic implications of this approval. Model outputs were used to calculate the incremental cost-effectiveness ratio (ICER) of IVO/AZA versus AZA. One-way and probabilistic sensitivity analyses were conducted. In the base case scenario, IVO/AZA and AZA resulted in life-time costs of $403,062 and $161,887, respectively. With an incremental gain of 0.95 QALYs, the ICER of IVO/AZA was $252,782/QALY. In sensitivity analyses, only a reduction in the price of IVO by 59.3% lowered the ICER to below $150,000/QALY and 99.95% of model calculations yielded ICERs of >$150,000/QALY. In a model in which all patients received IVO monotherapy after progression on AZA monotherapy, the ICER was $155,453/QALY and various model inputs that would make IVO/AZA cost-effective were identified.

Keywords:

• Acute myeloid leukemia
• AML
• azacitidine
• ivosidenib
• cost-effectiveness

Disclosure statement

NAP received consulting fees from Pfizer, Agios Pharmaceuticals, Blueprint Medicines, Incyte, Novartis, Celgene/Bristol-Myers Squibb, CTI BioPharma, PharmaEssentia, Constellation Pharmaceuticals, and AbbVie; other financial support for serving on an Independent Data Review Committee for Cogent Biosciences. R.M.S. has served as a member of an advisory board for Bristol Myers Squibb and Gilead Sciences, Inc. M.S. has consulted for Curis Oncology, Boston Consulting and is member of the advisory board for Novartis and Kymera. E.M.S. received research funding from Bayer; was a consultant for Amgen, AbbVie, Seattle Genetics, and Biotheryx; served as a consultant and received research funding from Syndax; was a member of the Board of Directors or advisory committee for PTC Therapeutics and Syros; served as a consultant and was member of the Board of Directors or advisory committee for Astellas Pharmaceutical, Agios Pharmaceuticals, and Genentech; served as a consultant, received research funding, and was a member of the Board of Directors or advisory committee for Daiichi-Sankyo, Celgene Pharmaceuticals, and Novartis; and is a current equity holder in privately held Auron Therapeutics. S.F.H. has been a consultant for Celgene, Bayer, Genentech, Pharmacyclics, AbbVie and received research funding from DTRM Biopharm, Celgene, and TG Therapeutics. A.M.Z. received research funding (institutional) from Celgene/BMS, Abbvie, Astex, Pfizer, Medimmune/AstraZeneca, Boehringer-Ingelheim, Trovagene/Cardiff oncology, Incyte, Takeda, Novartis, Aprea, and ADC Therapeutics. AMZ participated in advisory boards, and/or had a consultancy with and received honoraria from AbbVie, Otsuka, Pfizer, Celgene/BMS, Jazz, Incyte, Agios, Boehringer-Ingelheim, Novartis, Acceleron, Astellas, Daiichi Sankyo, Cardinal Health, Taiho, Seattle Genetics, BeyondSpring, Cardiff Oncology, Takeda, Ionis, Amgen, Janssen, Epizyme, Syndax, Gilead, Kura, Chiesi, ALX Oncology, BioCryst, and Tyme. AMZ served on clinical trial committees for Novartis, Abbvie, Geron and Celgene/BMS. AMZ received travel support for meetings from Pfizer, Novartis, and Cardiff Oncology. None of these relationships were related to the development of this work. Other authors have nothing to disclose.

Disclaimer

Part of this work has been accepted as an oral presentation (Abstract #130) at the 64th American Society of Hematology annual meeting 2022.

Additional information

Funding

The Frederick A. DeLuca Foundation supported this work. K.K.P. is funded by the American Society of Hematology Physician-Scientist Career Development Award. G.G. is funded by the Yale Forget Scholarship. A.M.Z. is a Leukemia and Lymphoma Society Scholar in Clinical Research and was also supported by a National Cancer Institute (NCI) Cancer Clinical Investigator Team Leadership Award. Research reported in this publication was in part supported by the NCI, National Institutes of Health [under awards P30 CA016359 and P30 CA008748]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.