Document Detail


Bendamustine versus chlorambucil for the first-line treatment of chronic lymphocytic leukemia in England and wales: a cost-utility analysis.
MedLine Citation:
PMID:  22867787     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVES: To evaluate the cost-effectiveness of bendamustine compared with chlorambucil as first-line treatment for patients with chronic lymphocytic leukemia who would be considered unsuitable for treatment with fludarabine combination chemotherapy regimens.
METHODS: A semi-Markov approach was used to estimate time in each health state. The model was parameterized primarily by using data from a phase III randomized, open-label trial comparing bendamustine with chlorambucil. It captured the increased progression-free survival and improved response rates with bendamustine, and the cost and quality of life impacts of postprogression treatments. The analysis was conducted from the perspective of the National Health Service in England and Wales. A lifetime (35-year) time horizon was used. Deterministic sensitivity analyses, probabilistic sensitivity analyses, and subgroup analyses in older patients and patients with poor performance status were carried out.
RESULTS: The estimated incremental cost-effectiveness ratio was £11,960 per quality-adjusted life-year. None of the deterministic sensitivity analyses increased the incremental cost-effectiveness ratio by more than £2000. Subgroup analyses showed that bendamustine remained cost-effective across different patient groups. Probabilistic sensitivity analysis showed that at the £20,000 threshold, bendamustine has a 90% probability of being cost-effective.
CONCLUSIONS: Bendamustine represents good value for first-line treatment of patients with chronic lymphocytic leukemia who are unsuitable for treatment with fludarabine combination chemotherapy. The incremental cost-effectiveness ratio is below the thresholds commonly applied in England and Wales (£20,000-£30,000 per quality-adjusted life-year).
Authors:
Beth Woods; Neil Hawkins; William Dunlop; Alison O'Toole; Steve Bramham-Jones
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Publication Detail:
Type:  Journal Article     Date:  2012-06-12
Journal Detail:
Title:  Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research     Volume:  15     ISSN:  1524-4733     ISO Abbreviation:  Value Health     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-08-07     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883818     Medline TA:  Value Health     Country:  United States    
Other Details:
Languages:  eng     Pagination:  759-70     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Affiliation:
Oxford Outcomes, Oxford, UK.
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