Padula, William V.Larson, Richard A.Dusetzina, Stacie B.Apperley, Jane F.Hehlmann, RudigerBaccarani, MicheleEigendorff, EkkehardGuilhot, JoelleGuilhot, FrancoisHehlmann, RudigerMahon, Francois-XavierMartinelli, GiovanniMayer, JiriMüller, Martin C.Niederwieser, DietgerSaussele, SusanneSchiffer, Charles A.Silver, Richard T.Simonsson, BengtConti, Rena M.2021-08-182021-08-182016-07William V Padula, Richard A Larson, Stacie B Dusetzina, Jane F Apperley, Rudiger Hehlmann, Michele Baccarani, Ekkehard Eigendorff, Joelle Guilhot, Francois Guilhot, Rudiger Hehlmann, Francois-Xavier Mahon, Giovanni Martinelli, Jiri Mayer, Martin C Müller, Dietger Niederwieser, Susanne Saussele, Charles A Schiffer, Richard T Silver, Bengt Simonsson, Rena M Conti. 2016. "Cost-effectiveness of Tyrosine Kinase Inhibitor Treatment Strategies for Chronic Myeloid Leukemia in Chronic Phase After Generic Entry of Imatinib in the United States.." J Natl Cancer Inst, Volume 108, Issue 7, https://doi.org/10.1093/jnci/djw0031460-2105https://hdl.handle.net/2144/42908BACKGROUND: We analyzed the cost-effectiveness of treating incident chronic myeloid leukemia in chronic phase (CML-CP) with generic imatinib when it becomes available in United States in 2016. In the year following generic entry, imatinib's price is expected to drop 70% to 90%. We hypothesized that initiating treatment with generic imatinib in these patients and then switching to the other tyrosine-kinase inhibitors (TKIs), dasatinib or nilotinib, because of intolerance or lack of effectiveness ("imatinib-first") would be cost-effective compared with the current standard of care: "physicians' choice" of initiating treatment with any one of the three TKIs. METHODS: We constructed Markov models to compare the five-year cost-effectiveness of imatinib-first vs physician's choice from a US commercial payer perspective, assuming 3% annual discounting ($US 2013). The models' clinical endpoint was five-year overall survival taken from a systematic review of clinical trial results. Per-person spending on incident CML-CP treatment overall care components was estimated using Truven's MarketScan claims data. The main outcome of the models was cost per quality-adjusted life-year (QALY). We interpreted outcomes based on a willingness-to-pay threshold of $100 000/QALY. A panel of European LeukemiaNet experts oversaw the study's conduct. RESULTS: Both strategies met the threshold. Imatinib-first ($277 401, 3.87 QALYs) offered patients a 0.10 decrement in QALYs at a savings of $88 343 over five years to payers compared with physician's choice ($365 744, 3.97 QALYs). The imatinib-first incremental cost-effectiveness ratio was approximately $883 730/QALY. The results were robust to multiple sensitivity analyses. CONCLUSION: When imatinib loses patent protection and its price declines, its use will be the cost-effective initial treatment strategy for CML-CP.en-US© The Author 2016. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com.http://creativecommons.org/licenses/by/4.0/AdultAgedAntineoplastic agentsCost-benefit analysisDrugs, genericFemaleHumansImatinib mesylateLeukemia, myelogenous, chronic, BCR-ABL positiveMaleMarkov chainsMiddle agedModels, econometricPractice patterns, physicians'Protein kinase inhibitorsProtein-tyrosine kinasesQuality-adjusted life yearsSurvival analysisTreatment outcomeUnited StatesOncology and carcinogenesisOncology & carcinogenesisArticle10.1093/jnci/djw0030000-0002-4190-1839 (Conti, Rena M)490491