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Using Genomic Information to Guide Ibrutinib Treatment Decisions in Chronic Lymphocytic Leukaemia: A Cost-Effectiveness Analysis

Author

Listed:
  • James Buchanan

    (Nuffield Department of Population Health, University of Oxford)

  • Sarah Wordsworth

    (Nuffield Department of Population Health, University of Oxford)

  • Ruth Clifford

    (Oxford University Hospitals Trust
    Churchill Hospital)

  • Pauline Robbe

    (Oxford University Hospitals Trust)

  • Jenny C. Taylor

    (National Institute for Health Research Oxford Biomedical Research Centre
    University of Oxford)

  • Anna Schuh

    (Oxford University Hospitals Trust
    Churchill Hospital
    National Institute for Health Research Oxford Biomedical Research Centre
    University of Oxford)

  • Samantha J. L. Knight

    (National Institute for Health Research Oxford Biomedical Research Centre
    University of Oxford)

Abstract

Background Genomic tests may improve the stratification of patients to receive new therapies in several disease areas. However, the use of expensive targeted therapies can impact on the cost effectiveness of these tests. This study presents an economic evaluation of genomic testing in chronic lymphocytic leukaemia in the context of the UK National Health Service. Methods Cost-effectiveness and cost-utility analyses (using life-years and quality-adjusted life-years) were undertaken from a National Health Service and societal perspective. Five strategies were evaluated across several age groups using Markov modelling: three strategies that reflected varying current genetic testing practice and two configurations of genomic testing (including ibrutinib treatment). Results Genomic testing strategies yielded the most life-years/quality-adjusted life-years per patient, but were not cost effective compared with a threshold of £30,000 per life-year/quality-adjusted life-year gained. Cost-effectiveness acceptability curves indicated that there was some uncertainty surrounding this result. A genomic testing strategy becomes the most cost-effective option if a higher end-of-life cost-effectiveness threshold of £50,000 is applied, if a societal costing perspective is considered in 25-year-old patients or if the cost of ibrutinib treatment falls. Conclusion Stratifying patients with chronic lymphocytic leukaemia to targeted treatment using genomic testing improves health outcomes, but will likely only represent a cost-effective use of limited National Health Service resources if a higher cost-effectiveness threshold or societal costing perspective is applied, or if the price of ibrutinib treatment is reduced. This result may be broadly indicative of the likely cost effectiveness of other genomic tests that inform the stratification of patients to high cost-targeted therapies.

Suggested Citation

  • James Buchanan & Sarah Wordsworth & Ruth Clifford & Pauline Robbe & Jenny C. Taylor & Anna Schuh & Samantha J. L. Knight, 2017. "Using Genomic Information to Guide Ibrutinib Treatment Decisions in Chronic Lymphocytic Leukaemia: A Cost-Effectiveness Analysis," PharmacoEconomics, Springer, vol. 35(8), pages 845-858, August.
    • Handle: RePEc:spr:pharme:v:35:y:2017:i:8:d:10.1007_s40273-017-0519-z
    DOI: 10.1007/s40273-017-0519-z
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    References listed on IDEAS

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    1. Simon Frey & Carl R. Blankart & Tom Stargardt, 2016. "Economic Burden and Quality-of-Life Effects of Chronic Lymphocytic Leukemia: A Systematic Review of the Literature," PharmacoEconomics, Springer, vol. 34(5), pages 479-498, May.
    2. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement," PharmacoEconomics, Springer, vol. 31(5), pages 361-367, May.
    3. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
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    1. Miriam Kasztura & Aude Richard & Nefti-Eboni Bempong & Dejan Loncar & Antoine Flahault, 2019. "Cost-effectiveness of precision medicine: a scoping review," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(9), pages 1261-1271, December.

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