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. 2022 Oct;14(10):432-435.
doi: 10.14740/jocmr4799. Epub 2022 Oct 28.

Cost-Effectiveness Analysis of Transplantation-Ineligible Elderly Patients With Acute Leukemia Harboring a Molecular Target: Ph-Positive Acute Leukemia and FLT3-Mutated Acute Myeloid Leukemia

Osamu Imataki  1 , Tomoya Ishida  1 , Jun-Ichiro Kida  1 , Makiko Uemura  1 , Haruyuki Fujita  1 , Norimitsu Kadowaki  1
Affiliations

Cost-Effectiveness Analysis of Transplantation-Ineligible Elderly Patients With Acute Leukemia Harboring a Molecular Target: Ph-Positive Acute Leukemia and FLT3-Mutated Acute Myeloid Leukemia

Osamu Imataki et al. J Clin Med Res. 2022 Oct.

Abstract

Background: Tyrosine kinase inhibitors (TKIs) and FMS-like tyrosine kinase 3 (FLT3) inhibitors are promising agents for Ph-positive acute leukemia (Ph+ AL) and FLT3 mutated acute myeloid leukemia (FLT3-AML), respectively.

Methods: We examined the cost-effectiveness ratio (CER) of dasatinib and ponatinib for Ph+ AL and the cost-effectiveness of gilteritinib and quizartinib for FLT3-AML in elderly patients. Molecular therapy can fit the elderly population better than chemotherapy (CT).

Results: The daily drug cost of dasatinib, ponatinib, gilteritinib, and quizartinib was $240, $170, $524, and $479 in terms of treatment maintenance dose, respectively. Treatment of Ph+ AL with stem cell transplantation (SCT), CT, dasatinib, and ponatinib yielded CERs of $322,375, $34,928, $61,104, and $46,234, respectively. The CERs for FLT3-AML treated with SCT, CT, gilteritinib, and quizartinib were $355,270, $42,717, $94,987, and $90,080, respectively. Treatment of elderly patients with TKIs and FLT3 inhibitors remained expensive and inferior to conventional CT.

Conclusion: Although TKIs and FLT3 inhibitors have an inferior CER than does conventional CT, their promising survival benefit with better QOL can offer a profound advantage. TKI or FLT3 inhibitor monotherapy is recommended as an alternative treatment option for unfit (vulnerable) elderly patients with Ph+ AL or FLT3-AML.

Keywords: Cost-effectiveness analysis; FLT3-mutated acute myeloid leukemia; Health economic evaluation; Ph-positive acute leukemia; Transplantation-ineligible elderly.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Cost-effectiveness ratio for patients with Philadelphia chromosome-positive acute leukemia and FLT3-mutated AML treated with stem cell transplantation, chemotherapy, and molecular targeting agents. (a) The CERs for Ph+ AL treated with SCT, CT, dasatinib (D), and ponatinib (P) were $322,375, $34,928, $61,104, and $46,234, respectively. (b) The CERs for FLT3-AML treated with SCT, CT, gilteritinib (G), and quizartinib (Q) were $355,270, $42,717, $94,987, and $90,080, respectively. CER: cost-effectiveness ratio; CR: cytotoxic chemotherapy; FLT3: FMS-like tyrosine kinase 3; FLT3-AML: FLT3-mutated acute myeloid leukemia; Ph+ AL: Philadelphia chromosome-positive acute leukemia; SCT: stem cell transplantation
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