cost-effectiveness

Pharmacoeconomic Analysis of the Use of Thrombopoietin Receptors Agonists in Idiopathic Thrombocytopenic Purpura Therapy

PHARMACOECONOMICS ,

VA Shuvaev1, SV Voloshin1, AK Hadzhidis2, AV Chechetkin1

1Russian Research Institute of Hematology and Transfusiology, 16 2-ya Sovetskaya str., Saint Petersburg, Russian Federation, 191024

2Saint Petersburg State Pediatric Medical University, 2 Litovskaya str., Saint Petersburg, Russian Federation, 194100

For correspondence: Vasilii Anatol’evich Shuvaev, PhD, 16 2-ya Sovetskaya str., Saint Petersburg, Russian Federation, 191024; e-mail: shuvaev77@mail.ru

For citation: Shuvaev VA, Voloshin SV, Khadzhidis AK, Chechetkin AV. Pharmacoeconomic Analysis of the Use of Thrombopoietin Receptors Agonists in Idiopathic Thrombocytopenic Purpura Therapy. Clinical oncohematology. 2017;10(4):435–42 (In Russ).

DOI: 10.21320/2500-2139-2017-10-4-435-442

ABSTRACT

Background. New medications, thrombopoietin mimetics which were recently introduced into clinical practice allowed to achieve clinical response in patients with chronic glucocorticoid-resistant idiopathic thrombocytopenic purpura (ITP). However, the high cost and the need for long-term administration necessitate a pharmacoeconomic analysis of the use of thrombopoietin receptors agonists in the treatment of ITP.

Aim. To assess the cost-effectiveness of the use of thrombopoietin mimetics (romiplostim and eltrombopag) and immunosuppressive therapy in the treatment of chronic glucocorticoid-resistant ITP.

Materials & Methods. The Markov modelling of diagnosis and treatment of ITP was conducted in accordance with the National guidelines for diagnosis and treatment of primary ITP. The cost-benefit analysis of the use of thrombopoietin receptors agonists (romiplostim and eltrombopag) and immunosuppressive therapy was performed. The time period (horizon) of the study was 5 years.

Results. The therapy with thrombopoietin mimetics had higher costs but was shown to be more effective compared to immunosuppressive therapy. The cost-effectiveness for achieving 1 QALY in the treatment was 1.33 million rubles with eltrombopag, 4.2 million rubles with romiplostim, and 0.17 million rubles with immunosuppressive therapy. The lowest additional costs compared to immunosuppressive therapy had eltrombopag treatment, whereas romiplostim treatment doubled the additional costs. The threshold values of the ratio of thrombopoietin receptors agonists costs were determined for the cost-benefit analysis. The use of romiplostim is cost-effective at a price for 1 vial of 15–18 % less than for 1 package of eltrombopag. The total cumulative burden of treatment of chronic ITP for 5 years may be 7.18 billion rubles with the use of eltrombopag, 23.23 billion rubles with romiplostim, and 0.91 billion rubles with immunosuppressive therapy only. The results confirm the need for budgeting the diagnosis and treatment of ITP not as a part of general approach, but to consider ITP as an orphan disease.

Conclusion. The developed pharmacoeconomic model can be used as an assessment tool of the costs of new diagnostic approaches and treatment strategies and optimizing budget expenditures.

Keywords: idiopathic thrombocytopenic purpura, romiplostim, eltrombopag, cost-effectiveness.

Received: May 15, 2017

Accepted: August 7, 2017

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First Line Treatment Choice for Chronic Myelogenous Leukemia: Modeling of Clinical and Economic Factors

MYELOID TUMORS , , , ,

VA Shuvaev, KM Abdulkadyrov, IS Martynkevich, MS Fominykh

Russian Scientific Research Institute of Hematology and Transfusiology, 16 2-ya Sovetskaya str., Saint Petersburg, Russian Federation, 191024

For correspondence: Vasilii Anatol’evich Shuvaev, PhD, 16 2-ya Sovetskaya str., Saint Petersburg, Russian Federation, 191024; Tel.: +7(921)636-54-72; e-mail: shuvaev77@mail.ru

For citation: Shuvaev VA, Abdulkadyrov KM, Martynkevich IS, Fominykh MS. First Line Treatment Choice for Chronic Myelogenous Leukemia: Modeling of Clinical and Economic Factors.. Clinical oncohematology. 2015;8(1):78–83 (In Russ).

ABSTRACT

Background. Second generation tyrosine kinase inhibitors (nilotinib and dasatinib) have advantages over imatinib in frequency and rate of cytogenetic and molecular responses obtaining in chronic myelogenous leukemia (CML) treatment. At the same time, they produced more severe adverse effects and are more expensive than imatinib. At present, CML patients with stable deep molecular response are considered as candidates for enrollment into clinical trials studying the management of treatment-free remission. Constant growth of expenses for CML diagnosing and treatment require a pharmacoeconomic analysis in order to optimize expenses and provide cost-effectiveness data for introduction of novel highly effective drugs.

Objective. Pharmacoeconomic modeling of the choice of CML treatment using first and second generation tyrosine kinase inhibitors in first-line therapy with an analysis of sensitivity of clinico-economic factors.

Methods. Pharmacoeconomic modeling of CML diagnosing and treatment. Cost-utility analysis of first and second generation tyrosine kinase inhibitors in first-line treatment. Sensitivity analysis with identification of most important clinical and economic factors affecting treatment results. Simulation for feasibility analysis of the nationwide use of first and second generation tyrosine kinase inhibitors in first-line therapy.

Results. Sensitivity analyses of pharmacoeconomic models showed its robustness. The threshold limits for drug costs and frequency of achievement of a complete molecular response affecting economic feasibility of the choice of first and second generation tyrosine kinase inhibitors were determined.

Conclusions. These pharmacoeconomic models may be applied for improvement of diagnostic and therapeutic standards.

Keywords: chronic myeloleukemia, tyrosine kinase inhibitors, imatinib, nilotinib, dasatinib, pharmacoeconomics, cost-effectiveness.

Received: September 11, 2014

Accepted: November 7, 2014

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