Cost-effectiveness of azacitidine and venetoclax in unfit patients with previously untreated acute myeloid leukemia
Cost-effectiveness of azacitidine and venetoclax in unfit patients with previously untreated acute myeloid leukemia
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DOI：
10.1182/bloodadvances.2020003902
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发表时间：
2021-02-16
期刊：
影响因子：
7.5
通讯作者：
Huntington, Scott F.
中科院分区：
文献类型：
--
作者：
Patel, Kishan K.;Zeidan, Amer M.;Huntington, Scott F.
3期VIALE-A试验报告，与阿扎胞苷单药治疗相比，维奈托克联合阿扎胞苷显著改善了老年、不适合既往未经治疗的急性髓性白血病（AML）患者的缓解率和总生存率。然而，阿扎胞苷-维奈托克在这种临床环境中的成本效益尚不清楚。在这项研究中，我们构建了一个分区生存模型，以比较阿扎胞苷-维奈托克与阿扎胞苷单独治疗既往未经治疗的AML的成本和有效性。每种治疗策略的无事件生存期和总生存期曲线来自VIALE-A试验，使用参数生存期建模。我们从美国付款人的角度计算了阿扎胞苷-维奈托达的增量成本-效果比（ICER）。与阿扎胞苷单药相比，阿扎胞苷-维奈托克与0.61质量调整生命年（QDs）的改善相关。然而，这一组合导致了更高的终身医疗保健成本（增量成本，159 595美元），导致ICER为260 343美元/QALY。维奈托克的价格需要降低60%，阿扎胞苷-维奈托克才能在每个QALY 150000美元的支付意愿阈值下具有成本效益。这些数据表明，在目前的价格下，阿扎胞苷-维奈托克用于不适合强化化疗的既往未经治疗的AML患者不太可能具有成本效益。需要大幅降低维奈托克的价格，以将ICER降低到更广泛接受的值。
The phase 3 VIALE-A trial reported that venetoclax in combination with azacitidine significantly improved response rates and overall survival compared with azacitidine alone in older, unfit patients with previously untreated acute myeloid leukemia (AML). However, the cost-effectiveness of azacitidine-venetoclax in this clinical setting is unknown. In this study, we constructed a partitioned survival model to compare the cost and effectiveness of azacitidine-venetoclax with azacitidine alone in previously untreated AML. Event-free and overall survival curves for each treatment strategy were derived from the VIALE-A trial using parametric survival modeling. We calculated the incremental cost-effectiveness ratio (ICER) of azacitidine-venetodax from a US-payer perspective. Azacitidine-venetoclax was associated with an improvement of 0.61 quality-adjusted life-years (QALYs) compared with azacitidine alone. However, the combination led to significantly higher lifetime health care costs (incremental cost, $159 595), resulting in an ICER of $260 343 per QALY gained. The price of venetoclax would need to decrease by 60% for azacitidine-venetoclax to be cost-effective at a willingness-to-pay threshold of $150000 per QALY. These data suggest that use of azacitidine-venetoclax for previously untreated AML patients who are ineligible for intensive chemotherapy is unlikely to be cost-effective under current pricing. Significant price reduction of venetoclax would be required to reduce the ICER to a more widely acceptable value.