Cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC) in myelodysplastic syndrome (MDS)
ABSTRACTIntroductionMyelodysplastic syndrome (MDS) comprises a group of clonal hematological disorders, characterized by ineffective hematopoiesis and progressive bone marrow failure. It increases the risk of transformation to acute myeloid leukemia (AML). Therapeutic benefit should include overall...
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2017-06-01
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doaj-3372cca050ea4231b62fda9942030f8a2020-11-25T01:06:44ZengAboutScience SrlGlobal & Regional Health Technology Assessment2284-24032283-57332017-06-0141e114e12110.5301/grhta.5000261Cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC) in myelodysplastic syndrome (MDS)Myrna Candelaria-HernándezXavier López KarpovitchFrancisco Javier MijangosEfreen MontañoArely Lemus CarmonaSilvia Guzmán VázquezHerman Soto MolinaABSTRACTIntroductionMyelodysplastic syndrome (MDS) comprises a group of clonal hematological disorders, characterized by ineffective hematopoiesis and progressive bone marrow failure. It increases the risk of transformation to acute myeloid leukemia (AML). Therapeutic benefit should include overall survival increase (OS), hematological improvement, transfusion dependence and time to progression to AML decrease.ObjectiveAssess, from a Mexican health-care perspective, the cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC) plus best supportive care (BSC) for the treatment of adult patients with intermediate-2 and high-risk MDS, who are not eligible for hematopoietic stem-cell transplantation. We developed a cost-effectiveness survival analysis model of three stages: MDS, AML, and death. OS and costs are extrapolated beyond three-year time horizon. Discount rate of 5% was applied. To estimate the model cycle probability transition to mortality state, survival curves were constructed for each treatment arm using individual patient-level data from Study AZA-001. Unitary costs are from public price list, and profiles for the management of MDS and AML were collected separately using a structured questionnaire. Probabilistic sensitivity analyses (PSA) were conducted by simultaneously sampling from estimated probability distributions of model parameters.ResultsOverall survival was projected to increase by 72.26 weeks with azacitidine. Incremental expected total costs for azacitidine compared to LDC was MXN$68,045. However, the cost of the drug therapy was lower with azacitidine. The incremental cost-effectiveness ratio (ICER) for azacitidine compared to LDC was MXN$48,932 per life-year gained (LYG). PSA showed that azacitidine was a highly cost-effective option in 96.49% of the simulated cases in MXN$180,000/LYG willingness-to-pay.ConclusionsCompared with LDC, azacitidine represents a cost-effective treatment alternative in patients with MDS from a Mexican perspective.http://www.grhta.com/Attach/E91F9375-A784-4DBF-B83B-CCF9F8DA53F1/B75EDBAF-943E-4326-876A-50E445D43272 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Myrna Candelaria-Hernández Xavier López Karpovitch Francisco Javier Mijangos Efreen Montaño Arely Lemus Carmona Silvia Guzmán Vázquez Herman Soto Molina |
spellingShingle |
Myrna Candelaria-Hernández Xavier López Karpovitch Francisco Javier Mijangos Efreen Montaño Arely Lemus Carmona Silvia Guzmán Vázquez Herman Soto Molina Cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC) in myelodysplastic syndrome (MDS) Global & Regional Health Technology Assessment |
author_facet |
Myrna Candelaria-Hernández Xavier López Karpovitch Francisco Javier Mijangos Efreen Montaño Arely Lemus Carmona Silvia Guzmán Vázquez Herman Soto Molina |
author_sort |
Myrna Candelaria-Hernández |
title |
Cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC) in myelodysplastic syndrome (MDS) |
title_short |
Cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC) in myelodysplastic syndrome (MDS) |
title_full |
Cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC) in myelodysplastic syndrome (MDS) |
title_fullStr |
Cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC) in myelodysplastic syndrome (MDS) |
title_full_unstemmed |
Cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC) in myelodysplastic syndrome (MDS) |
title_sort |
cost-effectiveness of azacitidine compared with low-doses of chemotherapy (ldc) in myelodysplastic syndrome (mds) |
publisher |
AboutScience Srl |
series |
Global & Regional Health Technology Assessment |
issn |
2284-2403 2283-5733 |
publishDate |
2017-06-01 |
description |
ABSTRACTIntroductionMyelodysplastic syndrome (MDS) comprises a group of clonal hematological disorders, characterized by ineffective hematopoiesis and progressive bone marrow failure. It increases the risk of transformation to acute myeloid leukemia (AML). Therapeutic benefit should include overall survival increase (OS), hematological improvement, transfusion dependence and time to progression to AML decrease.ObjectiveAssess, from a Mexican health-care perspective, the cost-effectiveness of azacitidine compared with low-doses of chemotherapy (LDC) plus best supportive care (BSC) for the treatment of adult patients with intermediate-2 and high-risk MDS, who are not eligible for hematopoietic stem-cell transplantation. We developed a cost-effectiveness survival analysis model of three stages: MDS, AML, and death. OS and costs are extrapolated beyond three-year time horizon. Discount rate of 5% was applied. To estimate the model cycle probability transition to mortality state, survival curves were constructed for each treatment arm using individual patient-level data from Study AZA-001. Unitary costs are from public price list, and profiles for the management of MDS and AML were collected separately using a structured questionnaire. Probabilistic sensitivity analyses (PSA) were conducted by simultaneously sampling from estimated probability distributions of model parameters.ResultsOverall survival was projected to increase by 72.26 weeks with azacitidine. Incremental expected total costs for azacitidine compared to LDC was MXN$68,045. However, the cost of the drug therapy was lower with azacitidine. The incremental cost-effectiveness ratio (ICER) for azacitidine compared to LDC was MXN$48,932 per life-year gained (LYG). PSA showed that azacitidine was a highly cost-effective option in 96.49% of the simulated cases in MXN$180,000/LYG willingness-to-pay.ConclusionsCompared with LDC, azacitidine represents a cost-effective treatment alternative in patients with MDS from a Mexican perspective. |
url |
http://www.grhta.com/Attach/E91F9375-A784-4DBF-B83B-CCF9F8DA53F1/B75EDBAF-943E-4326-876A-50E445D43272 |
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