Cost-effectiveness of adding quizartinib to induction chemotherapy for patients with FLT3-mutant acute myeloid leukemia

Abstract

The FLT3 inhibitor quizartinib has been shown to improve overall survival when added to intensive induction chemotherapy (“7 + 3”) in patients 18-75 years old with newly diagnosed AML harboring a FLT3-ITD mutation. However, the health economic implications of this approval are unknown. We evaluated the cost-effectiveness of quizartinib using a partitioned survival analysis model. One-way and probabilistic sensitivity analyses were conducted. In the base case scenario, the addition of quizartinib to 7 + 3 resulted in incremental costs of $289,932 compared with 7 + 3 alone. With an incremental gain of 0.84 quality-adjusted life years (QALYs) with quizartinib + 7 + 3 induction vs. 7 + 3 alone, the incremental cost-effectiveness ratio for the addition of quizartinib to standard 7 + 3 was $344,039/QALY. Only an 87% reduction in the average wholesale price of quizartinib or omitting quizartinib continuation therapy after completion of consolidation therapy and allogeneic hematopoietic cell transplant would make quizartinib a cost-effective option.

Keywords:

• acute myeloid leukemia
• AML
• FLT3 inhibitor
• quizartinib
• cost-effectiveness

Disclosure statement

NAP received consulting fees from Pfizer, Agios Pharmaceuticals, Blueprint Medicines, Incyte, Novartis, Celgene/Bristol-Myers Squibb, CTI BioPharma/Sobi, PharmaEssentia, Constellation Pharmaceuticals/MorphoSys, Aptose Biosciences 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. served on the advisory board for Novartis, Kymera, Sierra Oncology, GSK, Rigel, BMS, Sobi; consulted for Boston Consulting and Dedham group and ­participated in GME activity for Novartis, Curis Oncology, Haymarket Media and Clinical care options. 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.

Authorship contribution

J.P.B., K.K.P., and G.G. performed statistical analysis. K.K.P., S.F.H., and A.M.Z. obtained funding; and A.M.Z. and G.G. supervised the study. J.P.B. wrote the first draft of the manuscript. All authors reviewed and edited subsequent drafts of the manuscript.

Data sharing statement

Original data can be requested from the corresponding author ([email protected])

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 Bunker Endowment and the Frederick A. DeLuca Foundation. 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.