Enabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in China.

<h4>Objective</h4>To determine the cost effectiveness of molecular monitoring in patients with chronic myeloid leukemia in the chronic phase (CML-CP) compared to no molecular monitoring from a Chinese payer perspective.<h4>Methods</h4>Analyses were conducted using a semi-Mark...

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Autores principales:	Vikalp Kumar Maheshwari, Cassandra Slader, Nidhi Dani, Christina Gkitzia, Quan Yuan, Tengbin Xiong, Yu Liu, Ricardo Viana
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/243bb6dcaa224dd58fedb368336d4650
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spelling	oai:doaj.org-article:243bb6dcaa224dd58fedb368336d46502021-12-02T20:13:31ZEnabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in China.1932-620310.1371/journal.pone.0259076https://doaj.org/article/243bb6dcaa224dd58fedb368336d46502021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0259076https://doaj.org/toc/1932-6203<h4>Objective</h4>To determine the cost effectiveness of molecular monitoring in patients with chronic myeloid leukemia in the chronic phase (CML-CP) compared to no molecular monitoring from a Chinese payer perspective.<h4>Methods</h4>Analyses were conducted using a semi-Markov model with a 50-year time horizon. Population data from multicenter registry-based studies of Chinese patients with CML-CP informed the model. Transition probabilities were based on time-to-event data from the literature. Utility values were obtained from published studies and were assumed to be the same for patients with and without molecular monitoring. Costs were based on values commonly used in the Chinese healthcare system, including drug acquisition, drug administration, follow-up, treatment for disease progression, molecular monitoring, and terminal care costs, and were in the local currency (2020 Chinese Yuan RMB [¥]). Outcomes were total life-years (LYs) and quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratio.<h4>Results</h4>Molecular monitoring was dominant to no molecular monitoring, with increased LYs (1.52) and QALYs (1.90) and costs savings (¥93,840) over a lifetime compared to no monitoring in discounted analyses. The opportunity of patients that receive molecular monitoring to discontinue treatment during treatment-free remission, an opportunity not afforded to those without molecular monitoring, was the principle driver of this result. Results were similar across multiple clinical scenarios. Particularly, molecular monitoring remained dominant even if the proportion of patients achieving deep molecular response (DMR) was reduced by 10%-30%, or the proportion of patients maintaining DMR for 1 year was reduced by 10%-30% or increased by 10%. Cost savings in these scenarios ranged from ¥62,230 to ¥103,964.<h4>Conclusions</h4>Overall, this analysis demonstrates that adherence to guideline recommendations of regular molecular monitoring of patients with CML-CP treated with TKIs provides significant clinical benefit that leads to substantial cost savings compared to no molecular monitoring from the perspective of a Chinese payer. In a time where healthcare systems have limited resources to allocate to optimal patient care, investment in molecular monitoring is an ideal choice for improving patient benefits at a reduced cost.Vikalp Kumar MaheshwariCassandra SladerNidhi DaniChristina GkitziaQuan YuanTengbin XiongYu LiuRicardo VianaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10, p e0259076 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Vikalp Kumar Maheshwari Cassandra Slader Nidhi Dani Christina Gkitzia Quan Yuan Tengbin Xiong Yu Liu Ricardo Viana Enabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in China.
description	<h4>Objective</h4>To determine the cost effectiveness of molecular monitoring in patients with chronic myeloid leukemia in the chronic phase (CML-CP) compared to no molecular monitoring from a Chinese payer perspective.<h4>Methods</h4>Analyses were conducted using a semi-Markov model with a 50-year time horizon. Population data from multicenter registry-based studies of Chinese patients with CML-CP informed the model. Transition probabilities were based on time-to-event data from the literature. Utility values were obtained from published studies and were assumed to be the same for patients with and without molecular monitoring. Costs were based on values commonly used in the Chinese healthcare system, including drug acquisition, drug administration, follow-up, treatment for disease progression, molecular monitoring, and terminal care costs, and were in the local currency (2020 Chinese Yuan RMB [¥]). Outcomes were total life-years (LYs) and quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratio.<h4>Results</h4>Molecular monitoring was dominant to no molecular monitoring, with increased LYs (1.52) and QALYs (1.90) and costs savings (¥93,840) over a lifetime compared to no monitoring in discounted analyses. The opportunity of patients that receive molecular monitoring to discontinue treatment during treatment-free remission, an opportunity not afforded to those without molecular monitoring, was the principle driver of this result. Results were similar across multiple clinical scenarios. Particularly, molecular monitoring remained dominant even if the proportion of patients achieving deep molecular response (DMR) was reduced by 10%-30%, or the proportion of patients maintaining DMR for 1 year was reduced by 10%-30% or increased by 10%. Cost savings in these scenarios ranged from ¥62,230 to ¥103,964.<h4>Conclusions</h4>Overall, this analysis demonstrates that adherence to guideline recommendations of regular molecular monitoring of patients with CML-CP treated with TKIs provides significant clinical benefit that leads to substantial cost savings compared to no molecular monitoring from the perspective of a Chinese payer. In a time where healthcare systems have limited resources to allocate to optimal patient care, investment in molecular monitoring is an ideal choice for improving patient benefits at a reduced cost.
format	article
author	Vikalp Kumar Maheshwari Cassandra Slader Nidhi Dani Christina Gkitzia Quan Yuan Tengbin Xiong Yu Liu Ricardo Viana
author_facet	Vikalp Kumar Maheshwari Cassandra Slader Nidhi Dani Christina Gkitzia Quan Yuan Tengbin Xiong Yu Liu Ricardo Viana
author_sort	Vikalp Kumar Maheshwari
title	Enabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in China.
title_short	Enabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in China.
title_full	Enabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in China.
title_fullStr	Enabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in China.
title_full_unstemmed	Enabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in China.
title_sort	enabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in china.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/243bb6dcaa224dd58fedb368336d4650
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Enabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in China.

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