Economic evaluation of lenalidomide (Revlimid®) for the treatment of mielodysplastic syndrome with 5q deletion at low/intermediate-1 risk

Evaluación Económica de Lenalidomida (Revlimid®) Para el Tratamiento Del Síndrome Mielodisplásico Con Deleción 5q de Riesgo Bajo/Intermedio-1

Abstract

Background Lenalidomide is an effective treatment for patients with lower risk myelodysplastic syndrome (MDS) del5q. It reduces disease-related transfusion requirements, inhibits the malignant clone and causes a delay in tumor growth. There are also benefits in terms of quality of life and use of other health care resources. Objective To perform an economic evaluation of lenalidomide for transfusion-dependent patients with Low/Intermediate-1-risk MDS del 5q from the perspective of the public health care sector in Mexico. Material and methods We developed a cost-effectiveness analysis using a Markov model of 5 stages: MDS transfusion-dependence, MDS transfusion-independence, complications from transfusion, acute myeloid leukemia, and death. The analyzed period was 5 years. Discount rate of 5% after year 1 was applied. Efficacy was elicited from a phase III clinical trial, MDS-004, which shows lenalidomide benefit in patients achieving transfusion-independence. There were also benefits with lenalidomide related to extended overall survival and decreased risk of acute myeloid leukemia. Unitary cost are from public price list of IMSS, and resources use was calculated from a Delphi panel methodology with clinical hematologists. A multivariate sensitivity analysis using a Monte Carlo technique was performed. Results Over a 5-year period, each patient on lenalidomide avoided 487 days of transfusion, on average. The incremental cost per life-year without transfusion dependence is USD$14,072 (Exchange Rate = 1USD = 17.55 MXN). According to the sensitivity analysis the model is robust. If all expected patients are treated, their cost would be wUSD$19.7 million, which represents 0.18% of the total budget in the public health sector. Conclusions Lenalidomide provides important clinical benefits in the treatment of patients with lower risk myelodysplastic syndromes with del5q, with a limited economic impact and with a cost per life living without blood transfusions is within 3 times of the Mexican GDP (Gross Domestic Product).