Journal of Clinical Oncology, Vol 15, 2673-2682, Copyright © 1997 by American Society of Clinical Oncology
Cost-effectiveness of interferon alfa in chronic myelogenous leukemia
NL Liberato, S Quaglini and G Barosi
Laboratory of Medical Informatics, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Pavia, Italy. barosi@mbox.medit.it
PURPOSE: To evaluate the cost-effectiveness of interferon alfa (IFN alpha)
treatment of patients with chronic myelogenous leukemia relative to
conventional chemotherapy. MATERIALS AND METHODS: A decision- analysis
model that involved a multistate Markov process was designed to estimate
the expected cost and quality-adjusted life expectancies for two cohorts of
patients to be administered conventional chemotherapy or IFN alpha. Two IFN
alpha strategies were modeled: prolonged treatment for patients who
achieved a hematologic response (scenario A) or only for patients who
achieved a cytogenetic remission in a 2-year period (scenario B). Data on
response and transition probabilities between health states were obtained
from the literature by a MEDLINE search and pooled with a meta-analytic
method. Costs were based on local charges. Expected survival was adjusted
for quality of life on the basis of an expert panel judgment. RESULTS:
Baseline analysis showed IFN alpha treatment to increase the
quality-adjusted life expectancy by 15.5 and 12.5 months relative to
conventional chemotherapy, in scenarios A and B, respectively. Marginal
cost- effectiveness was $89,500 and $63,500 per quality-adjusted life-year
(QALY) gained. Sensitivity analysis confirmed IFN alpha as the most
effective approach. Cost-effectiveness results were sensitive to the cost
of IFN alpha therapy and to the assumptions about the rate of cytogenetic
remission. Reducing the drug dose, as suggested by a recent report, would
decrease the marginal cost-effectiveness to less than $20,000. CONCLUSION:
IFN alpha is substantially superior to conventional chemotherapy in terms
of quality-adjusted survival, but, at the current doses, marginal
cost-effectiveness ranges from $50,000 to $100,000 per QALY gained under
most of our assumptions.
