BUDGET IMPACT ANALYSIS OF MIDOSTAURIN IN PATIENTS WITH NEWLY DIAGNOSED FLT3 MUTATION-POSITIVE ACUTE MYELOID LEUKEMIA

NATALIA ESPÍNOLA; ALFREDO PALACIOS; SAENZ, VICTORIA; RIVAS, MM; ARIEL BARDACH; GARCIA MARTI S; ANDRÉS PICHON-RIVIERE; AUGUSTOVSKI F

Congreso; ISPOR 2019 COLOMBIA; 2019

OBJECTIVES: To assess the cost-effectiveness of incorporating midostaurin to induction and consolidation therapies in combination with chemotherapy drugs and as monotherapy in the maintenance phase of FLT3 mutation-positive acute myeloid leukemia (AML), compared with chemotherapy without midostaurin, from the social security perspective in ArgentinaMETHODS: A partitioned survival model provided by Novartis Laboratories and developed by Purple Squirrel Economics was adapted. It included five comprehensive and mutually exclusive partitions: 1) FLT3+ AML and induction therapy initiation; 2) Complete remission; 3) Relapse; 4) Hematopoietic stem cell transplantation and 5) Death. The clinical and epidemiological parameters were obtained through comprehensive bibliographic searches and the consensus of a group of expert hematologists using the modified Delphi technique. The costs were expressed in United States dollars (USD), 2018.RESULTS: Incorporating midostaurin as add-on to standard treatment for FLT3+ AML accounted for an average increase of 1.164 quality-adjusted life-year (QALY) and an average incremental cost of USD 64,859, versus the standard treatment. The Incremental cost-effectiveness ratio (ICER) of midostaurin was USD 55,707 by QALY. The results of the probabilistic sensitivity analysis showed that midostaurin therapy has a 6.10% probability of being cost-effective with a threshold of 1 per capita GDP of 2018 per QALY gained, whereas if a less restrictive threshold is considered, e.g. 5 per capita GDP, the probability of midostaurin being cost effective would rise to 77.60%. The treatment efficacy and the distribution function used to extrapolate survival were parameters to which the results were more sensitive.CONCLUSIONS: The relevant clinical benefit of midostaurin for the treatment of FLT3+ AML when compared to the standard of care, although more expensive, is in line with other economic evaluations in the international literature. In the base case, midostaurin ICER was between 3 per capita GDP and 5 per capita GDP per QALY gained in Argentina.