Cost-utility analysis of imatinib mesylate for the treatment of chronic myelogenous leukemia in the chronic phase.

Imatinib mesylate is a targeted therapy for the treatment of chronic myeloid leukemia (CML). The aim of this study was to estimate the incremental cost-utility of imatinib mesylate compared with hydroxyurea in patients with chronic-phase CML for whom first-line treatment with interferon-alpha failed to produce a response. A Markov model was developed to simulate disease progression for hypothetical patients receiving imatinib mesylate or hydroxyurea, who had not previously responded to interferon-a therapy, to determine outcomes in terms of quality-adjusted life-years (QALYs). Costs were estimated from the perspective of the United Kingdom National Health Service. Patient data were derived from previously published trials. The Markov model simulated the transitions of a hypothetical sample of 1000 chronic-phase CML patients using 1 monthly cycle over the lifetime of the patient sample. Median survival rates were estimated to be 77 months for imatinib mesylate-treated patients and 56 months for hydroxyurea-treated patients. Patients receiving imatinib mesylate accrued 5.95 QALYs, whereas hydroxyurea-treated patients accrued 3.49 QALYs. The estimated per-patient lifetime costs were 110,103 pound sterlings for patients in the imatinib mesylate group and 15,566 pound sterlings for patients in the hydroxyurea group (year-2001 values). The estimated year-2001 incremental cost per QALY gained from using imatinib mesylate compared with hydroxyurea in chronic phase CML was 38,468 pound sterlings. In the present model analysis, imatinib mesylate as a second-line treatment for patients with chronic phase CML was found to offer considerable health benefits to patients, but at a cost to the payer. The incremental cost-effectiveness ratio was 38,468 pound sterlings (year-2001 values).