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Cost-utility analysis of inotuzumab ozogamicin for relapsed or refractory B cell acute lymphoblastic leukemia from the perspective of Taiwan’s health care system

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Abstract

Objectives

We conduct a cost-utility analysis of inotuzumab ozogamicin (INO) versus chemotherapy as the standard of care (SOC) for adults with relapsed or refractory B cell acute lymphoblastic leukemia.

Methods

A Markov model incorporating transition probabilities between health states was applied to simulate disease progression. The model inputs, including overall survival, progression-free survival, and utility parameters, were obtained from the INO-VATE ALL trial and literatures. The Taiwan Cancer Registry Database and the Health and Welfare Database were utilized to identify the patient cohort and medical costs from the perspective of National Health Insurance Administration. The lifetime medical costs (in 2017 US dollars), quality-adjusted life years (QALYs) gained, and associated incremental cost-effectiveness ratio (ICER) were the main study outcomes.

Results

The lifetime medical costs for INO and SOC were $176,795 and $69,496, and the QALYs gained were 2.25 and 0.84, respectively. The ICER for INO versus SOC was $76,044 per QALY gained, which is slightly more than three times Taiwan’s gross domestic product per capita (i.e., $73,224). Favorable economic results for INO versus SOC were found with an increased time horizon for model simulation, less discounting for the future benefit, and higher stem cell transplantation (SCT) rate after INO treatment; and among patients aged less than 55 years, with no SCT history, or in the first salvage treatment.

Conclusions

INO versus SOC has higher costs but is more effective. The use of INO is favorable for patients in the early treatment course and when more future benefit associated with INO is considered.

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Acknowledgements

We gratefully thank National Cheng Kung University and its affiliated hospital for all support. The Excel model was originally developed by Ingress Health.

Funding

This project was supported by grants from the Ministry of Science and Technology in Taiwan (Grant MOST 107-2320-B-006-034) and Pfizer, Inc. (recipient: Huang-Tz Ou). The publication of study results was not contingent on the sponsors’ approval or censorship of the manuscript.

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Authors and Affiliations

  1. Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 70101, Taiwan

    Tsung-Ying Lee, Hsuan-Ying Chen & Huang-Tz Ou

  2. Division of Hematology/Oncology, Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan

    Tsai-Yun Chen & Sin-Syue Li

  3. Pfizer Ltd, Taipei, Taiwan

    Wei-Tse Fang, Yao-Chun Wen & Yu-Wen Lo

  4. Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Huang-Tz Ou

  5. Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan

    Huang-Tz Ou

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  1. Tsung-Ying Lee
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Contributions

TYL study design, data collection, model operation, result interpretation, writing and revision of draft and final manuscript. HYC data collection, statistical analysis. TYC, SSL study design, clinical consultation, result interpretation, revision of the manuscript. WTF, YWL clinical consultation, revision of the manuscript. YCW study design, result interpretation, revision of the manuscript. HTO study design, result interpretation, writing and revision of draft and final manuscript. TYL and HTO are the guarantors of this work and had full access to all the data in the study.

Corresponding author

Correspondence to Huang-Tz Ou.

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Conflict of interest

TYL, HYC, TYC, SSL and HTO have no conflicts of interest. YCW, WTF and YWL are employees of Pfizer.

Ethical approval

This study was approved by the Institutional Review Board of National Cheng Kung University Hospital (A-EX-106-029).

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Lee, TY., Chen, HY., Chen, TY. et al. Cost-utility analysis of inotuzumab ozogamicin for relapsed or refractory B cell acute lymphoblastic leukemia from the perspective of Taiwan’s health care system. Eur J Health Econ 21, 1105–1116 (2020). https://doi.org/10.1007/s10198-020-01207-7

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  • DOI: https://doi.org/10.1007/s10198-020-01207-7

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