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Health Technology Assessment of Novel Immunotherapy for the Treatment of Acute Myeloid Leukemia
Negin Razavilar1, Klemens Wallner1, Silvy Lachance2, Jean-Sebastien Delisle2, Christopher McCabe1
Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
Faculty of Medicine, University of Montreal, Montreal, QC, Canada
Introduction
Results and Discussion
As cancer therapies and in particular, immunotherapies become more accessible, the costs of care are rising significantly, and often perceived out of proportion to the improvements in effectiveness when compared to current standard therapies. Health care payers are increasingly using cost-effectiveness analysis (CEA) to compare the additional costs and benefits of new technologies to inform decisions on whether to cover these new technologies and if so, how much to pay for them.
In this study we explore the cost-effectiveness of T-cell immunotherapy compared to chemotherapy in the treatment of Acute Myeloid Leukemia (AML) in relapse following hematopoietic cell transplantation.
NBInc = (λ × ∆Emean - ∆Cmean) (3)
Where NBInc is the incremental net monetary benefit and λ (lambda) is the willingness-to-pay (CAD$/QALY); $50K per QALY in Canada and $100K per QALY in United States.
Methodology
Model: Stochastic Decision Analytic Markov State Transition Model
Treatments compared: chemotherapy (Azacitidine) with immunotherapy
Transition Probabilities:
HR_PD= P SD_PD Imm P SD_PD Chemo,lit (1)
HR_success = P SD_CR Imm P SD_CR Chemo,lit (2)
P SD_PD Imm is the transition probability from SD to PD in our immunotherapy model. P SD_PD Chemo,lit is the transition probability from SD to PD in our chemotherapy model.
Stable Disease (SD)
Death (D)
Complete Response (CR)
Figure 2 plots of net monetary benefit for immunotherapy vs. hazard ratio of progressive disease (HR_PD), hazard ratio of success (HR_success) and cost of immunotherapy at lambda = $50K and $100K per QALY.
Progressive Disease (PD)
Chemotherapy (HR_PD = 0.33, HR_success~7, cost of immunotherapy= $90K, lambda=$50K per QALY):
8.8% of patients achieved complete response in first treatment cycle
1-year survival rate and complete response rate was 19% and 7%
Immunotherapy (HR_PD = 0.33, HR_success~7, cost of immunotherapy=
$90K):
79.2% of patients achieved complete response in first treatment cycle
1-year survival rate and complete response rate was 41% and 24.4%
The base cost-effectiveness analysis (CEA) scenario shows that immunotherapy is more effective but more costly compared to chemotherapy
Figure 1 model structure for immunotherapy and chemotherapy arms
Table 1 Cost and Utility parameters for Cellular Immunotherapy and chemotherapy. All transition probabilities to different health states for cellular immunotherapy were calculated based on the following parameters and hazard ratio, Eqn (1,2)
Parameter
Distribution
Mean
Standard Deviation
Source
Complete remission (CR) in stable disease (SD)
Beta
0.1260
0.031
2, expert opinion
Progression from SD to PD
0.2960
0.074
Dying from SD
0.0100
0.002
Progression from CR to PD
0.1050
0.0537
2, adjusted to meet a response duration of average 9 months
Dying from CR
0.0060
0.0015
Dying from PD
0.2440
0.061
Cost Parameters, immunotherapy1 chemotherapy2
Mean, $
Complete Response (CR)
Gamma /
14.601/30.002 23
Progressive Disease (PD) Immunotherapy ,2
83.631,2
Stable Disease (SD) Immunotherapy /
/50.002
Utility Parameters, immunotherapy1 chemotherapy2
0.81,2
0.0011/0.004
23,24
Progressive Disease (PD)
0.71/0.692
0.0351/0.0342
Stable Disease (SD)
0.781/0.72
0.0391/0.0352
Immunotherapy becomes the cost-effective option compared to chemotherapy at HR_PD of and a lambda value of $100K per QALY based on the calculated ICER value of $99, per QALY.
Conclusions
The base cost-effectiveness analysis scenario has shown that immunotherapy is more effective but more costly compared to chemotherapy. We found the hazard ratios and thresholds which resulted in immunotherapy being the cost-effective option. Our study provides a structured evaluation of the new technologies at early stages of commercialization.
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