The study by Woudberg and Sinanovic evaluates the cost-effectiveness of different tyrosine kinase inhibitor (TKI) treatment strategies for chronic myeloid leukemia (CML) in South Africa. It examines cost-effective treatment options using a Markov model to compare the effectiveness and costs of imatinib, nilotinib, and dasatinib as first-line treatments over a 20-year period. The results indicate that imatinib is the most cost-effective option, offering lower costs and acceptable quality-adjusted life years (QALYs) compared to nilotinib and dasatinib, which exceed the willingness-to-pay threshold.

Key Insights

Imatinib emerges as the dominant strategy due to its lower costs and generic availability, making it a more cost-effective CML treatment than nilotinib and dasatinib.
Nilotinib and dasatinib incur higher expenses and incremental cost-effectiveness ratios (ICERs) that surpass the willingness-to-pay threshold. This renders them less cost-effective as first-line treatments. The probabilistic sensitivity analysis confirms the robustness of the results, showing that imatinib remains the most cost-effective strategy across various scenarios. The high costs associated with nilotinib and dasatinib place significant pressure on the limited resources of the South African healthcare system. This situation highlights the need for price negotiations or alternative funding mechanisms to enhance access to these treatments.

Background Context

The introduction of TKIs has transformed CML from a fatal disease to a manageable condition with significantly improved life expectancy. However, the cost-effectiveness of these treatments varies by country due to differing healthcare systems and economic conditions. In South Africa, CML patients are diagnosed at a younger age compared to global averages. The healthcare system faces challenges such as treatment interruptions, limited adherence, and long travel distances to healthcare facilities, all of which adversely affect treatment outcomes. The World Health Organization (WHO) recommends using one to three times the GDP per capita as a willingness-to-pay threshold for cost-effectiveness evaluations. In this study, they defined the threshold as three times South Africa’s GDP per capita.

Implications

The study emphasises the necessity of conducting country-specific economic evaluations to inform healthcare policy and resource allocation. Imatinib’s cost-effectiveness emphasises the importance of generic or affordable versions of TKIs in managing CML in resource-limited settings.

The findings highlight the need to address systemic challenges such as poor adherence, treatment interruptions, and limited access to second-line treatments and stem cell transplantation. These factors are crucial for optimising CML treatment outcomes in South Africa. Policymakers must carefully consider the financial implications of incorporating second-generation TKIs into routine care. To improve access to these treatments, they should explore strategies such as price negotiations or alternative funding mechanisms. This approach ensures that South Africa allocate resources efficiently to maximise health benefits.