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Bankar A, Korula A, Kulkarni UP, Devasia AJ, Na F, Lionel S, Abraham A, Balasubramanian P, Janet NB, Nair SC, S S, Jeyaseelan V, N J, Prasad J, George B, Mathews V. Resource utilization and cost effectiveness of treating acute promyelocytic leukaemia using generic arsenic trioxide. Br J Haematol 2019; 189:269-278. [PMID: 31863602 DOI: 10.1111/bjh.16343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 09/17/2019] [Indexed: 11/28/2022]
Abstract
Arsenic trioxide (ATO)-based regimens are the standard of care for treating acute promyelocytic leukaemia (APL) and have replaced chemotherapy-based approaches. However, the cost of "patented" ATO is prohibitive because of patent rights. "Generic" ATO has been used in a few countries, but its implications for health resource utilization (HRU) and cost of treatment are unknown. We hypothesized that treating APL patients using generic ATO (APL-ATO) will be cost effective compared to the chemotherapy-based regimen (APL-CT). In a single-centre retrospective study, we used a bottom-up costing method to compare the direct medical cost of treatment and HRU between APL-ATO and APL-CT. These costs and the survival and relapse probabilities were imputed in a three-state Markov decision model to estimate the cost effectiveness of APL-ATO compared to APL-CT. The mean cost of treatment for APL-ATO (n = 30, $8500 ± 2078) was significantly less than for APL-CT (n = 30, $22 600 ± 5528) (P < 0·001). APL-ATO reduced hospitalization, antibiotic and antifungal usage (P < 0·001). In the Markov model, five-year treatment costs were significantly lower for APL-ATO ($11 131) than for APL-CT ($17 926) (P < 0·001). Treatment cost and health resource utilization were significantly lower for generic ATO-treated APL patients compared to the chemotherapy-based regimen.
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Affiliation(s)
- Aniket Bankar
- Department of Hematology, Christian Medical College, Vellore, India
| | - Anu Korula
- Department of Hematology, Christian Medical College, Vellore, India
| | - Uday P Kulkarni
- Department of Hematology, Christian Medical College, Vellore, India
| | - Anup J Devasia
- Department of Hematology, Christian Medical College, Vellore, India
| | - Fouzia Na
- Department of Hematology, Christian Medical College, Vellore, India
| | - Sharon Lionel
- Department of Hematology, Christian Medical College, Vellore, India
| | - Aby Abraham
- Department of Hematology, Christian Medical College, Vellore, India
| | | | | | - Sukesh C Nair
- Department of Immunohematology and Transfusion Medicine, Christian Medical College, Vellore, India
| | - Sezlian S
- Accounts Department, Christian Medical College, Vellore, India
| | - Visali Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Jeyaseelan N
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Jasmine Prasad
- Department of Community Medicine, Christian Medical College, Vellore, India
| | - Biju George
- Department of Hematology, Christian Medical College, Vellore, India
| | - Vikram Mathews
- Department of Hematology, Christian Medical College, Vellore, India
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Affiliation(s)
| | - Matti Aapro
- Multidisciplinary Oncology Institute, Clinique de Genolier, Genolier, Switzerland
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Daroudi R, Mirzania M, Nikravanfard N, Sadighi S, Sedighi Z, Zendehdel K. Estimation of the prevalence and direct medical costs of chronic myeloid leukemia in the I.R. of Iran in the era of tyrosine kinase inhibitors. Asia Pac J Clin Oncol 2016; 13:e416-e422. [PMID: 26990676 DOI: 10.1111/ajco.12470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 11/01/2015] [Accepted: 01/13/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND After the introduction of tyrosine kinase inhibitors for chronic myeloid leukemia (CML), the survival of these patients has increased significantly. However, these new drugs are expensive and impose considerable expense to patients and governments. Epidemiologic and economic evaluation studies provide good information for resource allocation and decision making. We estimated the incidence, prevalence and direct medical cost of CML in Iran. METHODS We used the National Cancer Registry (NCR) data from 2006 to 2009 to estimate the incidence rate of CML (ICD-10 code C92.1). After adjustment for the underestimation of incidence rates, we used survival rates of CML and estimated the 5-year prevalence for these patients. In addition, we used clinical practice guideline, expert opinions and medical tariffs to estimate the direct medical costs through the prevalence approach. RESULTS After an adjustment for the underestimation, the incidence rate of CML was 0.5 per 100 000 in the I.R. of Iran. The 5-year prevalence was about 2263 cases (2.98 per 100 000). The total direct medical cost of CML was $23 089 323 and the majority of the cost (97%) was related to drug costs. The total cost will increase considerably to $40 728 869 if all patients use the new drug nilotinib (800 mg/day) as a second-line treatment. CONCLUSIONS The increased survival of CML patients and a possible increase in incidence of CML in Iran will most likely lead to a considerable rise in its prevalence and economic burden.
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Affiliation(s)
- Rajabali Daroudi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences (TUMS), Tehran, I.R of Iran.,Department of Health Economics and Management, School of Public Health, TUMS, Tehran, I.R of Iran
| | - Mehrzad Mirzania
- Hematology and Medical Oncology Group, Cancer Research Center, Cancer Institute, Imam Khomeini Hospital Complex, TUMS, Tehran, I.R of Iran
| | - Nazila Nikravanfard
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences (TUMS), Tehran, I.R of Iran.,National Research Ethics Committee, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, I.R of Iran
| | - Sanambar Sadighi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences (TUMS), Tehran, I.R of Iran
| | - Zahra Sedighi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences (TUMS), Tehran, I.R of Iran
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences (TUMS), Tehran, I.R of Iran.,Cancer Models Research Center, Cancer Institute of Iran, TUMS, Tehran, I.R of Iran
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Soysal T, Eskazan AE, Ar MC. Generics in chronic myeloid leukemia: current arguments for and against and the established evidence. Expert Rev Hematol 2014; 7:697-9. [DOI: 10.1586/17474086.2014.966679] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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