LETTER
Cost-Effectiveness of Interferon-
as Maintenance Therapy in Chronic Myelogenous Leukemia
Andrea Messori;
Paola Becagli; and
Sabrina Trippoli
15 April 1997 | Volume 126 Issue 8 | Page 664
TO THE EDITOR:
In their study on the cost-effectiveness of interferon-
in chronic myelogenous leukemia [1], Kattan and colleagues describe a baseline analysis in which the monthly cost of interferon- is $1500 per patient and a sensitivity test wherein this cost is reduced to $1000.
Interferon- costs approximately $10 per million U, with small international variations [2, 3]. In evaluating this drug in chronic myelogenous leukemia, both the German and the Italian trials ([2, 3] in Kattan and colleagues' article) used a target dose of 62 million U per week (corresponding to 270 million U per month). This yields a cost of $2700 per patient per month.
Kattan and coworkers did not consider a sensitivity test in which the cost of interferon- is increased to this value of about $3000. On the basis of the data in their Figure 4, a simple linear extrapolation indicates that at these increased costs, the marginal cost-effectiveness worsens to about $80 000 per quality-adjusted life-year (QALY) gained. Because current benchmarks in cost–utility analysis [4] suggest that the cutoff between favorable and unfavorable ratios is approximately $50 000 per QALY, Kattan and colleagues' baseline scenario gives a "favorable" cost–utility ratio ($34 000 per QALY), but our alternate scenario yields an "unfavorable" result ($80 000 per QALY). These data confirm that the statistical variance of the authors' results is high.
Although the "true" interferon- dosage was 16% higher than the target dose in the Italian trial and 42% higher in the German trial (because of dosage individualization and noncompliance), other sources of cost [3] not considered by Kattan and colleagues (for example, physician's time for adjustment of medication and periodical laboratory examinations such as testing of liver function and assay of anti-interferon antibodies) can contribute to an increase in the cost of interferon- treatment. Thus, a cost of $3000 per patient per month is as realistic as Kattan and colleagues' figure of $1500.
|
Author and Article Information
|
|---|
Azienda Ospedaliera Careggi, Florence, Italy
1. Kattan MW, Inoue Y, Giles FJ, Talpaz M, Ozer H, Guilhot F, et al. Cost-effectiveness of interferon- and conventional chemotherapy in chronic myelogenous leukemia. Ann Intern Med. 1996; 125:541-8.
2. Schofield JR, Robinson WA, Murphy JR, Rovira DK. Low doses of interferon- are as effective as higher doses in inducing remissions and prolonging survival in chronic myeloid leukemia. Ann Intern Med. 1994; 121:736-44.
3. Messori A, Becagli P, Trippoli S, Tendi E. A retrospective cost-effectiveness analysis of interferon as adjuvant therapy in high-risk resected cutaneous melanoma. Eur J Cancer. [In press].
4. Mark DB, Hlatky MA, Califf RM, et al. Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction. N Engl J Med. 1995; 332:1418-24.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
Author & Article Info
References
Article
