Project example 6: Chronic Myelogenous Leukemia

Project type	Cost-utility analysis
Indication	Chronic Myelogenous Leukemia (CML)
Intervention	Oral medication
Methods	Markov modeling
Countries	The Netherlands Portugal Austria Belgium
Deliverables	Reimbursement dossiers
Presentations	International Society for Pharmacoeconomics and Outcomes Research (ISPOR). European conference Dublin, 2007. Poster

The aim of this project was to evaluate the incremental cost-utility (in four European countries) of dasatinib compared to imatinib in chronic-phase CML after failure of first-line imatinib. An existing economic Markov model was adapted to the local clinical setting of the four countries (i.e. the Netherlands, Portugal, Austria and Belgium). Long-term cost-effectiveness was calculated with a Markov model. Disease progression in the model depended on initial best response and current health-state, and was simulated with montly transition-probabilities based on literature data. The distribution of patients in terms of initial best response was derived from a randomized clinical trial in chronic-phase CML patients resistant to imatinib. The occurrence of serious adverse events was drawn from trial observations. Utilities were derived from a CML utility study using EQ-5D. Life expectancies were derived from national statistics. Resource use and cost-prices were derived from various sources specific for each European country. The methods and results of the analyses have been reported in pharmacoeconomic dossiers for reimbursement applications in the four European countries.