A Cost-effectiveness Analysis Of Dasatinib For The Treatment Of Imatinib Mesylate Resistant Chronic Myelogenous Leukaemia

ObjectiveTo study the status of hospital drug treatment in patient with CML and their disease economic burden and then to do a cost-effectiveness analysis about two kinds of targeted drug treatment of the patients with Imatinib mesylate resistant chronic myelogenous leukaemia. To provide a scientific reference for making a implementation plan about medical insurance of high price and favourable effect drugs for policy makers of department of health in the end. Methods1. Data mining for the retrospective medical record and medical insurance information:Analyzing the diagnosis and treatment of 129 patients with CML and the composition of medical expenses and reimbursement ratio of 640 patients with CML that participated in medical insurance between 2006 and 2012.2. Documentary research method:Studying on the related literature about application of Markov model in pharmacoeconomics evaluation research and CML pathogenesis, diagnosis, treatment, prognosis and adverse drug reactions at home and abroad for building model and determining the model parameters.3. Delphi method: For achieving the frequency of a variety of adverse reaction severity levels and treatment costs when the Imatinib-resistant CML patients are taking Dasatinib or high dose Imatinib through two rounds of expert consultation in order to determining treatment cost parameters of adverse reactions of the two kinds of targeted drugs.4. Math modelling method: Building the time-dependent markov model and then calculating cost-effectiveness of two targeted regimen in the treatment of imatinib-resistant CML in short time and long time with the cohort simulation,sensitivity analysis and Monte Carlo simulation technology.Results1. In the 342 hospital medical records of 129 patients,there were 221 records showed that CML patients had used chemotherapy drugs at the time of hospitalization. There were 35 patients had used targeted drugs at the time of hospitalization. Among them, the drug intolerance or resistance happened to 19 patients for taking Imatinib;there were 2 patients had taken doubled dose of Imatinib in the treatment for Imatinib-resistant at the time of hospitalization;The 10 patients in the treatment of Imatinib showed that they had increased 50% dose of Imatinib for Imatinib-resistant at the time of hospitalization.After 2007,the number of patients in treatment of Imatinib and the number of usage of Imatinib at the time of hospitalization increased gradually.2. The average medical expense of CML patients in outpatient were 56.93 yuan, the proportion of drug cost was 77.8%, the proportion of patients’ consumption was 99.69%; the medical cost of CML hospitalized patients was 10273.07 yuan per capita, the proportion of drug cost was 57.8%, the proportion of patients’ consumption was 30.82%. In outpatient service specific project, The average medical expense of the CML patients of urban workers and urban residents were17663 yuan and 11929 yuan respectively and their proportion of drugs were over 99%, the proportion of patients’ consumption were 17.41% and 40.95% respectively.3. The evaluation results for imatinib resistant patients with CML either in the treatment of Dasatinib or high dose of Imatinib in short time:The cost-effectiveness ratio of imatinib resistant patients with chronic phase CML in the treatment of Dasatinib(C/E were 36307.83 yuan per QALM) was lower than the cost-effectiveness ratio in the treatment of high dose of Imatinib(C/E were 53097.78 yuan per QALM); The cost-effectiveness ratio of imatinib resistant patients with accelerated phase CML in the treatment of Dasatinib(C/E were 64461.86 yuan per QALM) was lower than the cost-effectiveness ratio in the treatment of high dose of Imatinib(C/E were 82664.00 yuan per QALM); The cost-effectiveness ratio of imatinib resistant patients with blast phase CML in the treatment of Dasatinib(C/E were 89362.82 yuan per QALM) was lower than the cost-effectiveness ratio in the treatment of high dose of Imatinib(C/E were 125757.90 yuan per QALM). The results of sensitivity analysis showed that the analysis results of chronic phase CML was stable but the analysis results of accelerated phase CML and blast phase CML were not stable and it needed a further resarch.4. The evaluation results for imatinib resistant patients with CML either in the treatment of Dasatinib or high dose of Imatinib in long time: The cost-effectiveness ratio of imatinib resistant patients with chronic phase CML in the treatment of Dasatinib was always lower than the cost-effectiveness ratio in the treatment of high dose of Imatinib no matter how to change the discount rate and the length of medication use. Such as when the discounted rate was 3% and the length of medication use was 30 years, The cost-effectiveness ratio of imatinib resistant patients with chronic phase CML in the treatment of Dasatinib(C/E were 38881.74 yuan per QALM) was lower than the cost-effectiveness ratio in the treatment of high dose of Imatinib(C/E were 53844.15 yuan per QALM), The results of sensitivity analysis showed that the results were stable.Conclusion1.More of CML patients were treated by support therapy or chemotherapy in level of first-class hospitals in Guangzhou at present,but more and more CML patients began to be treated by Imatinib. The phenomenons of stoping taking Imatinib for the reason of economics, Imatinib-resistance or patients could not tolerate Imatinib existed when the patients with CML were treated by Imatinib. At present, the number of CML patients treated by the second generation of targeted drugs such as Dasatinib was less,but this medicine were being used for clinical purposes in hospital.2.The disease economic burden of patients with CML was still heavier in Guangzhou area at present, the proportion of patients’ consumption was higher and the proportion of drug expenses in medical expenditure of patients with CML was the largest. Increasing the intensity compensation for medicine fee,especially the target medicine fee is the key to reducing the disease burden of CML patients.3.Taking Dasatinib instead of high dose of Imatinib immediately will get the advantage of cost-effectiveness when the Imatinib-resistant happened to the chronic phase CML patients with the treatment of Imatinib. Medical insurance department should analyze health insurance policy for the Imatinib-resistant CML patients. Medical insurance department should make the compensation measures of the using of the second generation targeted medicine such as Dasatinib reasonably for the interests of Imatinib-resistant CML patients.