Cost-effectiveness of alemtuzumab for T-cell prolymphocytic leukemia.

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.

• Authors: Lanting Lu, Jaime Peters, Chris Roome, Ken Stein
• Journal: International journal of technology assessment in health care (Int J Technol Assess Health Care) Vol. 28 Issue 3 Pg. 241-8 (Jul 2012) ISSN: 1471-6348 [Electronic] England
• PMID: 22980700 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal, Humanized
• Antineoplastic Agents
• Alemtuzumab

Topics

• Alemtuzumab
• Antibodies, Monoclonal, Humanized (economics, therapeutic use)
• Antineoplastic Agents (economics, therapeutic use)
• Cost-Benefit Analysis
• England
• Humans
• Leukemia, Prolymphocytic, T-Cell (drug therapy)
• Models, Theoretical
• Quality-Adjusted Life Years