Incremental Cost-Effectiveness of Unrelated Donor Transplantation for CML Compared With Interferon-
| Scenario . | ΔC (1996$) . | ΔE (QALY) . | Incremental C/E3-150 . |
|---|---|---|---|
| Baseline assumptions3-151 | 271,800 | 5.25 | 51,800 |
| Costs | |||
| No costs for CML | 333,600 | 5.25 | 63,500 |
| 80% treated for blast crisis | 257,000 | 5.25 | 48,900 |
| BMT costs $100,000 | 177,100 | 5.25 | 33,700 |
| BMT costs $300,000 | 377,000 | 5.25 | 71,800 |
| Continue follow-up at $6,900/6 mo | 287,500 | 5.25 | 54,800 |
| Effectiveness | |||
| Age = 25 yr | 291,500 | 6.75 | 43,200 |
| Age = 45 yr | 227,900 | 1.80 | 126,800 |
| Survival of FHCRC/BWH complete cohort, N = 157 | 263,400 | 4.55 | 57,900 |
| Survival of FHCRC/BWH best risk cohort, N = 453-152 | 335,400 | 7.95 | 42,200 |
| Utility without cGVHD = 0.9, utility with cGVHD = 0.7 | 271,800 | 3.76 | 72,300 |
| Utility of IFN = 0.9 | 271,800 | 5.49 | 49,500 |
| Costs and effectiveness | |||
| Discount rate 0%/yr | 338,200 | 10.38 | 32,600 |
| Discount rate 5%/yr | 249,200 | 3.52 | 70,900 |
| Discount rate 7%/yr | 235,000 | 2.43 | 96,800 |
| Scenario . | ΔC (1996$) . | ΔE (QALY) . | Incremental C/E3-150 . |
|---|---|---|---|
| Baseline assumptions3-151 | 271,800 | 5.25 | 51,800 |
| Costs | |||
| No costs for CML | 333,600 | 5.25 | 63,500 |
| 80% treated for blast crisis | 257,000 | 5.25 | 48,900 |
| BMT costs $100,000 | 177,100 | 5.25 | 33,700 |
| BMT costs $300,000 | 377,000 | 5.25 | 71,800 |
| Continue follow-up at $6,900/6 mo | 287,500 | 5.25 | 54,800 |
| Effectiveness | |||
| Age = 25 yr | 291,500 | 6.75 | 43,200 |
| Age = 45 yr | 227,900 | 1.80 | 126,800 |
| Survival of FHCRC/BWH complete cohort, N = 157 | 263,400 | 4.55 | 57,900 |
| Survival of FHCRC/BWH best risk cohort, N = 453-152 | 335,400 | 7.95 | 42,200 |
| Utility without cGVHD = 0.9, utility with cGVHD = 0.7 | 271,800 | 3.76 | 72,300 |
| Utility of IFN = 0.9 | 271,800 | 5.49 | 49,500 |
| Costs and effectiveness | |||
| Discount rate 0%/yr | 338,200 | 10.38 | 32,600 |
| Discount rate 5%/yr | 249,200 | 3.52 | 70,900 |
| Discount rate 7%/yr | 235,000 | 2.43 | 96,800 |
ΔC, difference in total lifetime discounted costs between transplant and nontransplant therapy; ΔE, difference in effectiveness between transplant and nontransplant therapy; incremental C/E, incremental cost-effectiveness ratio of transplant and nontransplant therapy, in dollars per quality-adjusted life year; utilities, quality of life adjustments; discount rate, annual adjustment applied to both costs and benefits.
Abbreviations: CML, chronic myelogenous leukemia; BMT, bone marrow transplant; FHCRC, Fred Hutchinson Cancer Research Center; BWH, Brigham and Women’s Hospital; cGVHD, chronic graft-versus-host disease; IFN, α-interferon.
$/QALY.
35-year-old patient transplanted within 1 year of diagnosis for CML in chronic phase versus α-interferon therapy.
Age ≤50 years old, matched donor, transplanted within 1 year of diagnosis.