Economic evaluation of dasatinib in the treatment of chronic myeloid leukemia in patients resistant to imatinib in Chile

Objective. Within the framework of Chronic Myelogenous Leukaemia ( CML) treatment in Chile, and based on a previously performed economic evaluation, we compared the costs and cost- effectiveness ratio of using 100 mg/ day and 140 mg/ day doses of dasatinib with the use of 800 mg/ day doses of nilotinib or an increased dose of imatinib ( 800mg/ day), for each phase of the disease, in patients who developed resistance or intolerance to habitual doses of imatinib. Methods. A Markov model was used for this economic evaluation, which considered a cohort of 10.000 CML patients in its three phases ( chronic, accelerated or blast phase), a lifetime horizon and a 3.5 % discount rate for costs and benefits. Model results included the costs of each treatment alternative with dasatinib, nilotinib or imatinib, and Quality Adjusted Life Years ( QALYs) gained. Costs were measured in Chilean Pesos of year 2010. Results. In the chronic phase of the disease, dasatinib 100 mg/ day yielded the higher amount of QALYs with 6,65 and the lower cost- effectiveness ratio. In the accelerated phase, dasatinib 140 mg/ day also showed the lowest cost- effectiveness compared to nilotinib and imatinib. In the blast phase, dasatinib showed lower cost- effectiveness ratio than imatinib. Conclusions. Dasatinib 100 mg/ day showed lowest cost- effectiveness ratios than doses of 800 mg/ day of nilotinib and doses of 800 mg/ day of imatinib for the treatment of patients with CML resistant or intolerant to the usual imatinib doses of 400 mg/ day in the chronic phase. Dasatinib 140 mg/ day showed lowest costeffectiveness ratios than doses of 800 mg/ day of nilotinib and 800 mg/ day of imatinib for the treatment of patients with CML in the accelerated phase, and than doses of 800 mg/ day of imatinib in blast phase. Although there was an overall cost increase, especially due to the cost of dasatinib in 140 mg/ day doses, this fact was explained by the increase in life years gained and, consequently, the use of medical resources and drugs.