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COST-EFFECTIVENESS OF ALEMTUZUMAB FOR T-CELL PROLYMPHOCYTIC LEUKEMIA

Published online by Cambridge University Press:  14 September 2012

Lanting Lu ,
Jaime Peters ,
Chris Roome  and
Ken Stein
Lanting Lu
Affiliation:
Unviersity of Exeter email: [email protected]
Jaime Peters
Affiliation:
University of Exeter
Chris Roome
Affiliation:
NHS Devon
Ken Stein
Affiliation:
University of Exeter
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Abstract

Objectives: The aim of this study was to evaluate the cost-effectiveness of alemtuzumab (CAMPATH-1H) compared with conventional chemotherapy in people with T-cell prolymphocytic leukemia (T-PLL).

Methods: We developed a decision-analytic model to assess the costs and benefits of alemtuzumab or conventional therapy based on their effects on quality of life of patients. The main outcome was the incremental cost-effectiveness ratio incorporating costs per additional quality-adjusted life-year (QALY) gained over lifetime. Due to the limited data available, a large number of assumptions had to be made to construct the cost-utility model. One-way, multi-way, and probabilistic sensitivity analyses (PSA) were conducted to explore the impact of these uncertainties. Expected values of perfect information were also calculated for four specific scenarios.

Results: Depending on different key assumptions made, the PSA suggested distinct conclusions using a willingness-to-pay threshold of 30,000 GBP per QALY gained. Using this threshold, the probability that alemtuzumab would be cost-effective varies from 0 percent to 53 percent for the four modeled scenarios. Population expected value of perfect information analysis suggests that resolving the parameter uncertainty in the analysis for people with T-PLL in the United Kingdom would have considerable value—up to 5.3 million euro.

Conclusions: Alemtuzumab appears more likely to be cost-effective if used earlier in the course of T-PLL and where it replaces the use of multiple alternative therapies. However, cost-effectiveness is highly uncertain and future research is clearly justified. Nevertheless, our analysis demonstrates the feasibility of considering the cost-effectiveness of an agent despite the presence of significant uncertainty to provide appropriate assessment information to policy makers.

Keywords

Cost-utility analysisAlemtuzumabT-cell prolymphocytic leukemiaValue of information analysisProbabilistic sensitivity analysis
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 3 , July 2012 , pp. 241 - 248
Copyright
Copyright © Cambridge University Press 2012

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References

REFERENCES

1.Dearden, C.Clinical case review: Successful treatment of T-cell prolymphocytic leukemia with full-intensity conditioning followed by matched Unrelated Donor Allogeneic Stem Cell Transplantation. Clin Adv Haematol Oncol. 2007;5:882–884.Google Scholar
2.Dearden, CE, Matutes, E, Cazin, B, et al.High remission rate in T-cell prolymphocytic leukaemia with CAMPATH-1H. Blood. 2001;98:1721–1726.CrossRefGoogle ScholarPubMed
3.Department of Health (UK). NHS reference costs. London: Department of Health; 2009.Google Scholar
4.General Medical Council. GMC guidance: Good practice in prescribing medicines. London: General Medical Council; 2008.Google Scholar
5.Genzyme Therapeutics. Summary of product characteristics - MabCampath 30mg/ml concentrate for solution for infusion. Cambridge, MA: Electronic Medicines Compendium; 2010.Google Scholar
6.Joint Formulary Committee. British National Formulary No. 58. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2009.Google Scholar
7.Keating, MJ, Cazin, B, Coutré, S, et al.Campath-1H treatment of T-cell prolymphocytic leukaemia in patients for whom at least one prior chemotherapy regimen has failed. J Clin Oncol. 2002;20:205–213.CrossRefGoogle ScholarPubMed
8.Kruspe, RC, Ashraf, KK, Foran, JM, Salzman, DE, Reddy, VV, Vaughan, WP. Successful treatment of T-cell prolymphocytic leukaemia with full-intensity conditioning followed by matched unrelated donor allogenic stem cell transplantation. Clin Adv Haematol Oncol. 2007;5:882–884.Google Scholar
9.Main, C, Pitt, M, Moxham, T, Stein, K, Peninsula Technology Assessment Group (PenTAG). The clinical and cost-effectiveness of Rituximab for the 1st line treatment of Chronic Lymphocytic Leukaemia: An evidence review of the submission from Roche: NICE; 2009.Google Scholar
10.Matutes, E, Brito-Babapulle, V, Swansbury, J, et al.Clinical and Laboratory features of 78 cases of T-prolymphocytic leukaemia. Blood. 1991;78:3269–3274.CrossRefGoogle Scholar
11.National Institute for Clinical Excellence. Guide to the methods of technology appraisal. London: NICE; 2008.Google Scholar
12.National Institute for Health and Clinical Excellence. Technology appraisal guidance: Rituximab for the first-line treatment of chronic lymphocytic leukemia. London: NICE; 2009.Google Scholar
13.Peninsula Health Technology Commissioning Group. Alemtuzumab in chronic lymphocytic leukaemia. Appendix 9. 2009. London: Peninsula Health Technology Commissioning Group.Google Scholar
14.Schnitzler, M, Hasskarl, J, Egger, M, Bertz, H, Finke, J. Successful treatment of severe acute intestinal graft-versus-host resistant to systemic and topical steroids with alemtuzumab. Biol Blood Marrow Transplant. 2009;15:910–918.CrossRefGoogle ScholarPubMed
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