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      Análisis de minimización de costes de la leucemia linfocítica crónica en España en la era de las terapias orales dirigidas Translated title: Cost-minimisation analysis of chronic lymphocytic leukemia in Spain in the era of oral targeted therapies

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          Abstract

          Resumen Objetivo: La leucemia linfocítica crónica supone una carga económica considerable para el Sistema Nacional de Salud español. Este estudio estimó los costes directos de las terapias orales dirigidas para leucemia linfocítica crónica desde 2011 a 2025, inclusive, en un escenario con terapias orales de duración fija y en un escenario sin ellas. Método: Se representó el curso clínico de pacientes adultos con leucemia linfocítica crónica mediante un modelo de Markov con cuatro estados de salud: vigilancia activa, tratamiento de primera línea, recaída y muerte. Patrón de tratamiento definido por tipo de paciente: estado o situación de la enfermedad, edad, presencia o no de deleción en el brazo corto del cromosoma 17, estado mutacional de la cadena pesada de inmunoglobulinas y año de tratamiento. Algoritmo de tratamiento simulado desde 2011 a 2025, incluyendo terapias financiadas por el Sistema Nacional de Salud español y su uso en práctica clínica habitual, validado por expertos de referencia. Se asumió una opción de tratamiento por tipo de paciente y periodo de tiempo (la más ampliamente utilizada en cada momento). Se incluyeron costes directos: farmacológicos, administración, pruebas realizadas, visitas rutinarias, hospitalizaciones y acontecimientos adversos. Resultados: Se estimó una prevalencia media anual de leucemia linfocítica crónica desde 2011 a 2025 de 16.436 pacientes en el escenario sin terapias orales de duración fija y 16.413 en el escenario con terapias orales de duración fija. Los costes totales desde 2011 a 2025 en el escenario sin terapias orales de duración fija ascendieron a 4.676,7 millones de € y a 4.111,8 millones de € en el escenario con terapias orales de duración fija. Así, la introducción de las terapias orales de duración fija supondría un ahorro de 564,9 millones de € (12,1% del total del coste de atención de los pacientes con leucemia linfocítica crónica durante el periodo evaluado). El coste total por paciente en este periodo de tiempo pasaba de 266.019 € en el escenario sin terapias orales de duración fija a 236.852 € en el escenario con terapias orales de duración fija, suponiendo un ahorro de 29.167 € por paciente. Conclusiones: Este estudio estima que la introducción de las terapias orales de duración fija para el tratamiento de la leucemia linfocítica crónica entre 2011 y 2025 supone un ahorro para el Sistema Nacional de Salud español de 564,9 millones de € (12,1% del total del coste de atención de los pacientes con leucemia linfocítica crónica durante el periodo evaluado).

          Translated abstract

          Abstract Objective: Chronic lymphocytic leukaemia places a considerable economic burden on the Spanish National Health System. This study estimated the direct costs of chronic lymphocytic leukaemia oral targeted therapies from 2011 to 2025, inclusive, in a scenario with fixed treatment oral targeted therapies and in a scenario without them. Method: The clinical course of adult chronic lymphocytic leukaemia patients was represented by a Markov model with four health states: watchful waiting, first-line treatment, relapse, and death. The treatment pattern was defined according to patient type by disease status or situation, age, presence or absence of deletion in the short arm of chromosome 17, immunoglobulin heavy chain mutation status, and year of treatment. The treatment algorithm was simulated from 2011 to 2025, and included therapies funded by the Spanish National Health System and their use in routine clinical practice, validated by leading experts. A single treatment option was assumed for each type of patient and time period (the most widely option used at each time point). Direct costs were included: pharmacological, administration, tests performed, routine visits, hospitalizations, and adverse events. Results: From 2011 to 2025, there would be a mean annual chronic lymphocytic leukaemia prevalence of 16,436 patients in the scenario without fixed treatment oral targeted therapies and 16,413 in the scenario with fixed treatment oral targeted therapies. In the same period, the total costs in the scenario without fixed treatment oral targeted therapies would be €4,676.7 million and in the scenario with fixed treatment oral targeted therapies they would be €4,111.8 million. Thus, the introduction of fixed treatment oral targeted therapies would entail a saving of €564.9 million (12.1% of the total cost of care of chronic lymphocytic leukaemia patients during the period assessed). In this period, the total cost per patient would decrease from €266,019 in the scenario without fixed treatment oral targeted therapies to €236,852 in the scenario with fixed treatment oral targeted therapies, representing a saving of €29,167 per patient. Conclusions: This study estimates that, between 2011 and 2025, the introduction of fixed treatment oral targeted therapies for the treatment of chronic lymphocytic leukaemia would entail €564.9 million cost savings for the Spanish National Health System (12.1% of the total cost of care of chronic lymphocytic leukaemia patients during the period assessed).

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          Most cited references19

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          Ibrutinib as Initial Therapy for Patients with Chronic Lymphocytic Leukemia.

          Chronic lymphocytic leukemia (CLL) primarily affects older persons who often have coexisting conditions in addition to disease-related immunosuppression and myelosuppression. We conducted an international, open-label, randomized phase 3 trial to compare two oral agents, ibrutinib and chlorambucil, in previously untreated older patients with CLL or small lymphocytic lymphoma.
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            Chronic lymphocytic leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

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              Chronic lymphocytic leukemia: 2015 Update on diagnosis, risk stratification, and treatment.

              Chronic lymphocytic leukemia (CLL) is the commonest leukemia in western countries. The disease typically occurs in elderly patients and has a highly variable clinical course. Leukemic transformation is initiated by specific genomic alterations that impair apoptosis of clonal B-cells.
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                Author and article information

                Journal
                fh
                Farmacia Hospitalaria
                Farm Hosp.
                Grupo Aula Médica (Toledo, Toledo, Spain )
                1130-6343
                2171-8695
                April 2022
                : 46
                : 2
                : 72-79
                Affiliations
                [4] Almería orgnameHospital de Torrecárdenas orgdiv1Servicio de Farmacia Hospitalaria España
                [5] Oviedo orgnameHospital Universitario Central de Asturias orgdiv1Servicio de Hematología España
                [2] Madrid orgnameHospital La Paz orgdiv1Servicio de Farmacia España
                [3] Málaga orgnameHospital Costa del Sol orgdiv1Servicio de Hematología España
                [1] Castellón Villarreal orgnameHospital Universitario de La Plana de Villareal orgdiv1Servicio de Farmacia España
                Article
                S1130-63432022000200005 S1130-6343(22)04600200005
                10.7399/fh.11783
                556c85d1-5445-4c81-ba8d-439ea36207de

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 01 July 2021
                : 04 November 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 8
                Product

                SciELO Spain

                Categories
                Originales

                España,Leucemia linfocítica crónica,Minimización de costes,Modelos económicos,Sistema Nacional de Salud,Spain,Chronic lymphocytic leukaemia,Cost-minimisation,Economic models,National Health System

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