COST-EFFECTIVENESS ANALYSIS OF A DIRECTLY SELECTED CMV-SPECIFIC T CELL THERAPY FOR MANAGEMENT OF CMV DISEASE IN PATIENTS POST ALLOGENEIC STEM CELL TRANSPLANTATION: A UK ANALYSIS
(Abstract release date: 05/19/16)
EHA Library. Müller H. 06/09/16; 132986; E1437
Dr. Holger Müller
Contributions
Contributions
Abstract
Abstract: E1437
Type: Eposter Presentation
Background
Hematopoietic stem cell transplantation (HSCT) is a curative treatment option for a variety of malignant and non-malignant hematological diseases. However, cytomegalovirus (CMV) infection, an acknowledged complication after HSCT, is associated with significant morbidity, decreased patient survival, and considerable cost to health-care systems. Two randomized clinical studies, CMV~ACE/ASPECT and CMV~IMPACT (NCT01220895 and NCT01077908), assessed the efficacy and safety of a CMV-specific T cell therapy for prevention or treatment of CMV reactivation post allogeneic HSCT.
Aims
We assessed the cost-effectiveness of a CMV-specific T cell therapy for the management of CMV disease in patients after allogeneic HSCT in the UK.
Methods
A Markov model, reflecting current clinical guidelines, was developed to estimate cost-effectiveness of a CMV-specific T cell therapy for the management of CMV infections and CMV disease in patients after allogeneic HSCT in the UK from the perspective of the NHS in 2015. Here we report the results of this economic analysis in the CMV disease setting. Data sources, in the model, included the two randomized clinical trials for the CMV-specific T cell therapy, published literature, national costs, tariff lists, and a Delphi panel of 7 English hematologists. The model simulated clinical and economic outcomes associated with the a CMV-specific T cell therapy and standard treatment. The main comparators in the analysis depended on the positioning of the CMV-specific T cell therapy and were foscarnet in 2-line and cidofovir in 3-line. Clinical probabilities included response probabilities, mortality and recurrence. Inpatient costs included daily hospital stay, laboratory analyses, microbiological culture, specialists’ visits, therapy acquisition and administration costs. Utilities were included for the Quality Adjusted Life Years (QALY).
Results
The use of the CMV-specific T cell therapy as 2-line CMV disease treatment increases costs from £27,882 to £30,656, which results in additional costs of £2,774, but leads to a gain in QALYs of 0.215 from 3.179 to 3.394. Consequently, the incremental cost-effectiveness ratio (ICER) is £12,902/QALY. The probabilistic sensitivity analysis (PSA) shows a probability of 79% that the ICER remains below £30,000/QALY. The use of the CMV-specific T cell therapy as 3-line CMV treatment increases total costs from £27,882 to £28,648 leading to additional costs of £766, but to a gain in QALYs of 0.031 from 3.179 to 3.210. Consequently, the resulting ICER is £24,710/QALY. The PSA shows the probability is 53% that the ICER remains below £30,000/QALY. The impact of risk adjustment for the clinical benefits of the CMV-specific T cell therapy versus standard therapy on the ICER was explored. The health economic outcomes were sensitive to a risk adjustment for mortality, but not for response and recurrence in the 2-line setting. In the 3-line setting, the ICER was sensitive to risk adjustment for mortality and response, but not to recurrence. The analyses also show that the health economic outcomes were quite robust for both 2-line and 3-line positioning of the CMV-specific T cell therapy for other variables. The favourable cost-effectiveness of the CMV-specific T cell therapy results mainly from the prevention of treatment failure and as a consequence the avoidance of mortality and the cost of salvage therapy.
Conclusion
CMV-specific T cell therapy is a cost-effective treatment for patients with CMV disease after allogeneic HSCT in 2-line and 3-line therapeutic treatment in the UK setting.
Session topic: E-poster
Keyword(s): Allogeneic hematopoietic stem cell transplant, Cellular therapy, CMV infection, Cost effectiveness
Type: Eposter Presentation
Background
Hematopoietic stem cell transplantation (HSCT) is a curative treatment option for a variety of malignant and non-malignant hematological diseases. However, cytomegalovirus (CMV) infection, an acknowledged complication after HSCT, is associated with significant morbidity, decreased patient survival, and considerable cost to health-care systems. Two randomized clinical studies, CMV~ACE/ASPECT and CMV~IMPACT (NCT01220895 and NCT01077908), assessed the efficacy and safety of a CMV-specific T cell therapy for prevention or treatment of CMV reactivation post allogeneic HSCT.
Aims
We assessed the cost-effectiveness of a CMV-specific T cell therapy for the management of CMV disease in patients after allogeneic HSCT in the UK.
Methods
A Markov model, reflecting current clinical guidelines, was developed to estimate cost-effectiveness of a CMV-specific T cell therapy for the management of CMV infections and CMV disease in patients after allogeneic HSCT in the UK from the perspective of the NHS in 2015. Here we report the results of this economic analysis in the CMV disease setting. Data sources, in the model, included the two randomized clinical trials for the CMV-specific T cell therapy, published literature, national costs, tariff lists, and a Delphi panel of 7 English hematologists. The model simulated clinical and economic outcomes associated with the a CMV-specific T cell therapy and standard treatment. The main comparators in the analysis depended on the positioning of the CMV-specific T cell therapy and were foscarnet in 2-line and cidofovir in 3-line. Clinical probabilities included response probabilities, mortality and recurrence. Inpatient costs included daily hospital stay, laboratory analyses, microbiological culture, specialists’ visits, therapy acquisition and administration costs. Utilities were included for the Quality Adjusted Life Years (QALY).
Results
The use of the CMV-specific T cell therapy as 2-line CMV disease treatment increases costs from £27,882 to £30,656, which results in additional costs of £2,774, but leads to a gain in QALYs of 0.215 from 3.179 to 3.394. Consequently, the incremental cost-effectiveness ratio (ICER) is £12,902/QALY. The probabilistic sensitivity analysis (PSA) shows a probability of 79% that the ICER remains below £30,000/QALY. The use of the CMV-specific T cell therapy as 3-line CMV treatment increases total costs from £27,882 to £28,648 leading to additional costs of £766, but to a gain in QALYs of 0.031 from 3.179 to 3.210. Consequently, the resulting ICER is £24,710/QALY. The PSA shows the probability is 53% that the ICER remains below £30,000/QALY. The impact of risk adjustment for the clinical benefits of the CMV-specific T cell therapy versus standard therapy on the ICER was explored. The health economic outcomes were sensitive to a risk adjustment for mortality, but not for response and recurrence in the 2-line setting. In the 3-line setting, the ICER was sensitive to risk adjustment for mortality and response, but not to recurrence. The analyses also show that the health economic outcomes were quite robust for both 2-line and 3-line positioning of the CMV-specific T cell therapy for other variables. The favourable cost-effectiveness of the CMV-specific T cell therapy results mainly from the prevention of treatment failure and as a consequence the avoidance of mortality and the cost of salvage therapy.
Conclusion
CMV-specific T cell therapy is a cost-effective treatment for patients with CMV disease after allogeneic HSCT in 2-line and 3-line therapeutic treatment in the UK setting.
Session topic: E-poster
Keyword(s): Allogeneic hematopoietic stem cell transplant, Cellular therapy, CMV infection, Cost effectiveness
Abstract: E1437
Type: Eposter Presentation
Background
Hematopoietic stem cell transplantation (HSCT) is a curative treatment option for a variety of malignant and non-malignant hematological diseases. However, cytomegalovirus (CMV) infection, an acknowledged complication after HSCT, is associated with significant morbidity, decreased patient survival, and considerable cost to health-care systems. Two randomized clinical studies, CMV~ACE/ASPECT and CMV~IMPACT (NCT01220895 and NCT01077908), assessed the efficacy and safety of a CMV-specific T cell therapy for prevention or treatment of CMV reactivation post allogeneic HSCT.
Aims
We assessed the cost-effectiveness of a CMV-specific T cell therapy for the management of CMV disease in patients after allogeneic HSCT in the UK.
Methods
A Markov model, reflecting current clinical guidelines, was developed to estimate cost-effectiveness of a CMV-specific T cell therapy for the management of CMV infections and CMV disease in patients after allogeneic HSCT in the UK from the perspective of the NHS in 2015. Here we report the results of this economic analysis in the CMV disease setting. Data sources, in the model, included the two randomized clinical trials for the CMV-specific T cell therapy, published literature, national costs, tariff lists, and a Delphi panel of 7 English hematologists. The model simulated clinical and economic outcomes associated with the a CMV-specific T cell therapy and standard treatment. The main comparators in the analysis depended on the positioning of the CMV-specific T cell therapy and were foscarnet in 2-line and cidofovir in 3-line. Clinical probabilities included response probabilities, mortality and recurrence. Inpatient costs included daily hospital stay, laboratory analyses, microbiological culture, specialists’ visits, therapy acquisition and administration costs. Utilities were included for the Quality Adjusted Life Years (QALY).
Results
The use of the CMV-specific T cell therapy as 2-line CMV disease treatment increases costs from £27,882 to £30,656, which results in additional costs of £2,774, but leads to a gain in QALYs of 0.215 from 3.179 to 3.394. Consequently, the incremental cost-effectiveness ratio (ICER) is £12,902/QALY. The probabilistic sensitivity analysis (PSA) shows a probability of 79% that the ICER remains below £30,000/QALY. The use of the CMV-specific T cell therapy as 3-line CMV treatment increases total costs from £27,882 to £28,648 leading to additional costs of £766, but to a gain in QALYs of 0.031 from 3.179 to 3.210. Consequently, the resulting ICER is £24,710/QALY. The PSA shows the probability is 53% that the ICER remains below £30,000/QALY. The impact of risk adjustment for the clinical benefits of the CMV-specific T cell therapy versus standard therapy on the ICER was explored. The health economic outcomes were sensitive to a risk adjustment for mortality, but not for response and recurrence in the 2-line setting. In the 3-line setting, the ICER was sensitive to risk adjustment for mortality and response, but not to recurrence. The analyses also show that the health economic outcomes were quite robust for both 2-line and 3-line positioning of the CMV-specific T cell therapy for other variables. The favourable cost-effectiveness of the CMV-specific T cell therapy results mainly from the prevention of treatment failure and as a consequence the avoidance of mortality and the cost of salvage therapy.
Conclusion
CMV-specific T cell therapy is a cost-effective treatment for patients with CMV disease after allogeneic HSCT in 2-line and 3-line therapeutic treatment in the UK setting.
Session topic: E-poster
Keyword(s): Allogeneic hematopoietic stem cell transplant, Cellular therapy, CMV infection, Cost effectiveness
Type: Eposter Presentation
Background
Hematopoietic stem cell transplantation (HSCT) is a curative treatment option for a variety of malignant and non-malignant hematological diseases. However, cytomegalovirus (CMV) infection, an acknowledged complication after HSCT, is associated with significant morbidity, decreased patient survival, and considerable cost to health-care systems. Two randomized clinical studies, CMV~ACE/ASPECT and CMV~IMPACT (NCT01220895 and NCT01077908), assessed the efficacy and safety of a CMV-specific T cell therapy for prevention or treatment of CMV reactivation post allogeneic HSCT.
Aims
We assessed the cost-effectiveness of a CMV-specific T cell therapy for the management of CMV disease in patients after allogeneic HSCT in the UK.
Methods
A Markov model, reflecting current clinical guidelines, was developed to estimate cost-effectiveness of a CMV-specific T cell therapy for the management of CMV infections and CMV disease in patients after allogeneic HSCT in the UK from the perspective of the NHS in 2015. Here we report the results of this economic analysis in the CMV disease setting. Data sources, in the model, included the two randomized clinical trials for the CMV-specific T cell therapy, published literature, national costs, tariff lists, and a Delphi panel of 7 English hematologists. The model simulated clinical and economic outcomes associated with the a CMV-specific T cell therapy and standard treatment. The main comparators in the analysis depended on the positioning of the CMV-specific T cell therapy and were foscarnet in 2-line and cidofovir in 3-line. Clinical probabilities included response probabilities, mortality and recurrence. Inpatient costs included daily hospital stay, laboratory analyses, microbiological culture, specialists’ visits, therapy acquisition and administration costs. Utilities were included for the Quality Adjusted Life Years (QALY).
Results
The use of the CMV-specific T cell therapy as 2-line CMV disease treatment increases costs from £27,882 to £30,656, which results in additional costs of £2,774, but leads to a gain in QALYs of 0.215 from 3.179 to 3.394. Consequently, the incremental cost-effectiveness ratio (ICER) is £12,902/QALY. The probabilistic sensitivity analysis (PSA) shows a probability of 79% that the ICER remains below £30,000/QALY. The use of the CMV-specific T cell therapy as 3-line CMV treatment increases total costs from £27,882 to £28,648 leading to additional costs of £766, but to a gain in QALYs of 0.031 from 3.179 to 3.210. Consequently, the resulting ICER is £24,710/QALY. The PSA shows the probability is 53% that the ICER remains below £30,000/QALY. The impact of risk adjustment for the clinical benefits of the CMV-specific T cell therapy versus standard therapy on the ICER was explored. The health economic outcomes were sensitive to a risk adjustment for mortality, but not for response and recurrence in the 2-line setting. In the 3-line setting, the ICER was sensitive to risk adjustment for mortality and response, but not to recurrence. The analyses also show that the health economic outcomes were quite robust for both 2-line and 3-line positioning of the CMV-specific T cell therapy for other variables. The favourable cost-effectiveness of the CMV-specific T cell therapy results mainly from the prevention of treatment failure and as a consequence the avoidance of mortality and the cost of salvage therapy.
Conclusion
CMV-specific T cell therapy is a cost-effective treatment for patients with CMV disease after allogeneic HSCT in 2-line and 3-line therapeutic treatment in the UK setting.
Session topic: E-poster
Keyword(s): Allogeneic hematopoietic stem cell transplant, Cellular therapy, CMV infection, Cost effectiveness
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