A new study suggests that, if US patients with chronic myeloid leukemia (CML) discontinue tyrosine kinase inhibitor (TKI) treatment when eligible, more than $54 billion could be saved over the next 30 years.
These findings were published in JAMA Network Open.
For this study, researchers developed a microsimulation model that accounted for current and estimated new cases of CML in the United States.
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The researchers created the current (prevalent) cohort based on the population of patients with CML in 2018 using estimates from the SEER*Explorer website.
The team created the cohort of estimated new cases (incident cohort) by taking the current US population and adding new CML diagnoses each year based on past incidence rates.
To be eligible for TKI discontinuation, patients were required to have taken TKIs for at least 3 years and achieve a deep molecular response (MR4) for at least 2 years.
The researchers estimated that, in the prevalent cohort, the proportion of patients in MR4 would be 30% of those taking a first-generation TKI and 50% of those taking a second-generation TKI.
For the incident cohort, the researchers estimated the time to reach MR4 within 5 years of diagnosis based on results from past trials. The researchers assumed that patients who were not eligible for TKI discontinuation within 5 years would not become eligible.
The researchers also took into account that, after TKI discontinuation, patients are tested for disease recurrence every month for the first 6 months, bimonthly for the next 18 months, and every 3 months thereafter.
The estimated cost of a first-generation TKI was $1375, the estimated cost of a second-generation TKI was $12,530, and the estimated cost of a PCR test was $144.
Based on these estimates, the researchers found that the cumulative savings for attempting to discontinue a TKI was more than $15 billion over 10 years.
By 30 years, the estimated savings exceeded $54 billion. When the researchers conducted sensitivity analyses assuming CML patients had a mortality rate double the national average, the savings was $43 billion.
“Given the potential savings and improvements in health from attempting to stop use of TKIs as suggested by this decision analytical modeling study, future research should focus on the most effective treatment approaches that allow patients to discontinue TKI therapy,” the researchers concluded.
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Winn AN, Atallah E, Cortes J, et al. Estimated savings after stopping tyrosine kinase inhibitor treatment among patients with chronic myeloid leukemia. JAMA Netw Open. Published online December 18, 2023. doi:10.1001/jamanetworkopen.2023.47950
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