Comparison of 12-Month Treatment Costs for Patients with Advanced Phase Chronic Myeloid Leukemia (CML) in China: Imatinib (IM) vs. Chemotherapy (Chemo) Plus Interferon-(IFN) in Accelerated Phase (AP) CML and IM vs. Chemo in Blast Crisis (BC) CML.
Authors: Chen Zi , Wang Chun , Feng Weiwei 
Published: October 2019

Abstract
Background: IM, an oral molecular targeted therapy, has demonstrated impressive efficacy in treating advanced CML. In China, IM has been approved to treat all phases of CML. However, it was not considered for reimbursement at national level. Chemos such as Homoharringtonine combined with cytarabine (HA) or Theprucine in combination with cytarabine (TA) have been used and reimbursed to treat advanced CML patients. The objective of this study was to conduct a total cost of treatment analysis comparing IM with chemo (HA or TA) in combination with IFN in AP and IM vs. chemo in BC CML in China.
Methods: Total cost of treatment contained drug cost, office visits, lab tests, hospitalizations, and cost of managing adverse events (AEs) and supportive care. The cost of managing AEs included the use of G-CSF, anti-infective medications, and blood transfusions. Treatment protocols for AP and BC CML from tier 3 hospitals in China were used to estimate the costs associated with treatment. Drug prices were based on the listed retail price in China. Dosages for IM and IFN were based on the approved product labels in China.
Results: AP patients received on average 3 courses of chemo in the hospital during a year and were treated with interferon-while off the chemo. BC patients received one course chemo every two months. As shown in the table, the 12-month cost of treatment for an AP patient treated with IM was RMB119,850 vs. RMB153,900 with chemo plus IFN. The corresponding numbers for a BC patient were RMB133,450 with IM vs. RMB18,5400 with chemo. Hospitalizations and costs of managing adverse events and supportive care were the key drivers of the savings for IM. The health care costs savings related to taking IM outweigh the drug cost difference between IM and chemo plus IFN in AP or IM and chemo in BC.
Conclusion: AP CML patients treated with IM incurred over RMB30,000 less health care costs in 1-year than those treated with chemo plus IFN. The savings were even more in BC: the 1-year cost of treatment with IM was over RMB50,000 lower than that with chemo. The cost of chemo used in this analysis was based on the 1st line chemo used in China. If patients failed the 1st line chemo, more expensive 2nd line chemos were usually used. Therefore, the total cost of treatment with chemo in advanced CML could be even more if 2nd line chemos were considered in this analysis. Providing advanced CML patients access to IM will not only improve clinical outcomes but also reduce the overall economic burden to the Chinese health care system.
Total 12-month Cost of Treatment for Advanced Phase CML Patients (unit: RMB) AP BC Imatinib Chemo+IFN Imatinib Chemo *Other = Chemo + IFN in AP; Other = Chemo in BC Drug cost 114,750 75,000 114,750 42,000 Office visits 600 8,100 600 9,000 Lab tests 600 3,600 600 included in above office visits Hospitalizations 1,400 18,000 6,000 36,000 Cost of managing AEs and supportive care 2,500 49,200 11,500 98,400 Total cost of treatment 119,850 153,900 133,450 185,400 Difference in total cost of treatment (Imatinib - Other*) − 34,050 − 51,950