Güray Saydam
1
,
Ahmet Emre Eşkazan
1
,
Birol Güvenç
1
,
Mehmet Sönmez
1
,
Selami Koçak Toprak
1
,
Mehtap Tatar
1
,
Burçin Kahveci Kaplan
1
,
Barış Uçar
1
,
Özlem Gür
1
,
İbrahim Haznedaroğlu
1
,
4
Ege University Faculty of Medicine
4
İstanbul University Cerrahpaşa Faculty of Medicine
4
Çukurova University Faculty of Medicine
4
Karadeniz Technical University Faculty of Medicine
4
Ankara University Faculty of Medicine
4
Polar Health Economics and Policy Consultancy
4
Novartis Türkiye
4
Novartis Türkiye
4
Novartis Türkiye
4
Hacettepe University Faculty of Medicine
Abstract
Background: Chronic myeloid leukemia (CML) is a slowly progressing blood-cell cancer that originates in the bone marrow. The disease is classified into three different phases: chronic phase (CP), accelerated phase and blast phase. The standard treatment for chronic phase CML (CP-CML) is tyrosine kinase inhibitors (TKIs) and the introduction of the first generation of TKI, imatinib, has shifted the treatment paradigm of the disease. Despite the introduction of other TKIs for patients with resistance or intolerance, the high cost of these products is a cause for concern for healthcare systems and payer organizations.
Aim: This study aims to estimate the financial burden of CP-CML on the Social Security Institution (SSI) of Türkiye.
Methodology: A modified Delphi Panel approach was used to estimate the cost of CP-CML to the SSI. The panel was comprised of six leading hematologists who answered a Health Care Resource Utilization Questionnaire to identify the type, patient ratio and frequency of resources used in the diagnosis and treatment of the disease. The answers to these questions were discussed in a face-to-face meeting with the experts and a final consensus was reached. Following this, the costs of treatment at each treatment line and for patients with the T315I mutation were calculated based on the reimbursement prices and rules of the SSI.
Results: The annual total cost of CP-CML to SSI was estimated to be 1,283,203,114TRY (€36,643,159). The share of second line treatment in total costs is 38%, for the first line 31% and for the 3+line 21%. In terms of annual per patient costs, the highest cost per patient was for those with the T315I mutation (at 1,405,281 TRY, €40,129). The annual cost per patient for first line treatment was 100,142 TRY (€2,859), while for second and third + line treatments the annual costs per patient were 320,490 (€9,151) and 357,870 (€10,219) respectively. These results indicate that the share of CP-CML treatment within the total expenditures of SSI in 2023 was 0.2%.
Conclusion: Our findings suggest that there is still a room to include more recent and effective TKIs on the SSI’s reimbursement list.
📄Agrawal R, Vieira J, Ryan J, Negi H, Rajput T, Corbin R, et al. A Systematic Literature Review of the Economic Evaluations of Treatments for Patients with Chronic Myeloid Leukemia. PharmacoEconomics. 2022 Dec;40(12):1159–86.
📄Held N, Atallah EL. Real-world Management of CML: Outcomes and Treatment Patterns. Curr Hematol Malig Rep. 2023 Oct;18(5):167–75.
📄Hughes T, South Australian Health and Medical Research Institute, North Terrace, Adelaide, Australia, Saglio G, University of Turin, Turin, Italy. Expert Opinion on the Treatment of Refractory Chronic Phase Chronic Myeloid Leukaemia. Eur Oncol Haematol. 2017;13(01):17.
📄Şahin F, Saydam G, Cömert M, Uz B, Yavuz AS. Turkish Chronic Myeloid Leukemia Study: Retrospective Sectional Analysis of CML Patients. Turk J Hematol. 2013;30:351–8.
📄Stempel JM, Shallis RM, Wong R, Podoltsev NA. Challenges in management of older patients with chronic myeloid leukemia. Leuk Lymphoma. 2024 Apr 23;1–14.
📄Erçalışkan A, Seyhan Erdoğan D, Eşkazan AE. Current evidence on the efficacy and safety of generic imatinib in CML and the impact of generics on health care costs. Blood Adv. 2021 Sep 14;5(17):3344–53.
📄Hochhaus A, Breccia M, Saglio G, García-Gutiérrez V, Réa D, Janssen J, et al. Expert opinion—management of chronic myeloid leukemia after resistance to second-generation tyrosine kinase inhibitors. Leukemia. 2020;34(6):1495–502.
📄Akard L, Hill C, Pinilla-Ibarz J. The “hit hard and hit early” approach to the treatment of chronic myeloid leukemia: implications of the updated National Comprehensive Cancer Network clinical practice guidelines for routine practice. Clin Adv Hematol Oncol. 2013;11(7):421–32.
📄Saydam G, Ali R, Demir AM, Eskazan AE, Guvenc B, Haznedaroglu IC, et al. The Effect of Comorbidities on the Choice of Tyrosine Kinase Inhibitors in Patients with Chronic Myeloid Leukemia. Int J Hematol Oncol. 2022 Mar;11(1):IJH38.
📄Akay FE, Koçyiğit B, Tan B, Atlı Eİ, Bas V, Kırkızlar HO. RETROSPECTIVE ANALYSIS OF CHRONIC MYELOID LEUKEMIA PATIENTS IN TRAKYA UNIVERSITY SCHOOL OF MEDICINE. Turk Med Stud J. 2019 Oct 31;6(3):70–4.
📄Eşkazan AE, Ali R, Alnıgeniş E, Ayyıldız O, Haznedaroğlu İ, Kırkızlar O, et al. Patient characteristics and management practices in chronic myeloid leukemia in Turkey: reflections from an expert meeting. Expert Rev Hematol. 2022 Feb 1;15(2):97–106.
📄Beiderbeck D, Frevel N, Von der Gracht HA, Schmidt SA, Schweitzer VM. Preparing, conducting, and analyzing Delphi surveys: Cross-disciplinary practices, new directions, and advancements. MethodsX. 2021;8.
📄Koçkaya G, Yenilmez FB, Ergin G, Atikeler K, Tatar M. Cost effectiveness and economic value of obesity surgery for Turkey (CEVOS-T). Obes Med. 2016;1:33–7.
📄Tatar M, Şentürk A, Oğuzhan GE, Tuna E, Mat C, Başkan EB, et al. Cost of Treatment of Chronic Spontaneous Urticaria in Turkey. Health (N Y). 2016;08(11):1098–103.
📄Tatar M, Senturk A, Tuna E, Karabulut E, Caliskan Z, Arsava E, et al. Direct Treatment Costs Of Stroke In Turkey. Value Health. 2015;18(7):A388.
📄Turgay S, Aksu K, Dokuyucu O, Ertenli A, Gul A, Karaaslan Y, et al. Epidemiology of colchicine resistant Familial Mediterranean Fever disease (CrFMF) in Turkey. Pediatr Rheumatol. 2015;13(S1):P90, 1546-0096-13-S1-P90.
📄Tatar M, Senturk A, Tuna E, Bilginer B, Ulus A, Buyuktuna N, et al. Local Cost Study Of Treatment Of Venous Thromboembolism In Turkey. Value Health. 2015;18(7):A388–9.
📄Aksu K, Dokuyucu O, Ertenli A, Gul A, Karaaslan Y, Kasapcopur O, et al. Cost of Familial Mediterranean Fever (Fmf) Disease In Turkey. Value Health. 2015 Nov;18(7):A666.
📄Tatar M, Senturk A, Tuna E, Gurses C, Caglayan B, Firidin A. Direct Costs Of Epilepsy In Turkey: A Panel Approach. Value Health. 2016 Nov;19(7):A431.
📄Çavuşoğlu Y, Altay H, Aras D, Çelik A, Ertaş FS, Kılıçaslan B, et al. Cost-of-disease of Heart Failure in Turkey: A Delphi Panel-based Analysis of Direct and Indirect Costs. Balk Med J. 2022 Jul 22;39(4):282–9.
📄Eubank BH, Mohtadi NG, Lafave MR, Wiley JP, Bois AJ, Boorman RS, et al. Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology. BMC Med Res Methodol. 2016;16(1):56.
📄King PR, Beehler GP, Donnelly K, Funderburk JS, Wray LO. A practical guide to applying the Delphi technique in mental health treatment adaptation: The example of Enhanced Problem-Solving Training (E-PST). Prof Psychol Res Pract. 2021;52(4):376–86.
📄Breccia M, Chiodi F, Nardozza AP, Valsecchi D, Perrone V, Sangiorgi D, et al. The Economic Burden of Chronic Myeloid Leukemia in Patients with Later Lines: Findings from a Real-World Analysis in Italy. Adv Ther. 2023 Mar;40(3):961–74.
📄Hochhaus A, Baccarani M, Silver RT, Schiffer C, Apperley JF, Cervantes F, et al. European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia. Leukemia. 2020 Apr;34(4):966–84.
📄Lin Q, Mao L, Shao L, Zhu L, Han Q, Zhu H, et al. Global, Regional, and National Burden of Chronic Myeloid Leukemia, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017. Front Oncol. 2020 Dec 15;10:580759.
📄Lipton JH. Maximizing the Value of Chronic Myeloid Leukemia Management Using Tyrosine Kinase Inhibitors in the USA: Potential Determinants and Consequences of Healthcare Resource Utilization and Costs, with Proposed Optimization Approaches. Clin Drug Investig [Internet]. 2024 Jan 5 [cited 2024 Jun 17]; Available from: https://link.springer.com/10.1007/s40261-023-01329-9
📄Yamamoto C, Nakashima H, Ikeda T, Kawaguchi S ichiro, Toda Y, Ito S, et al. Analysis of the cost-effectiveness of treatment strategies for CML with incorporation of treatment discontinuation. Blood Adv. 2019 Nov 12;3(21):3266–77.
📄Sosyal Güvenlik Kurumu. Sosyal Güvenlik Kurumu Faaliyet Raporu 2023. Ankara; 2024.
📄Wan Puteh SE, Mohamad Selamat E, Aizuddin AN, Tumian NR, Sathar J. Inequality in Drug Utilization among Chronic Myeloid Leukaemia Patients in Malaysia: A Cost-Utility Analysis. Asian Pac J Cancer Prev. 2022 Dec 1;23(12):4253–60.
📄Merin D, Krishna A, Jayakumar S, Mahima A, Anila KN, Sidharthan N. Assessment of Imatinib as a Primary Treatment of Chronic Myeloid Leukemia in Chronic Phase: a Cohort Study. J Oncol Pharm Pract. 2023 Apr;29(3):547–56.
How to Cite
Saydam, G. ., Eşkazan, A. E., Güvenç, B., Sönmez, M. ., Koçak Toprak, S., Tatar, M., Kahveci Kaplan, B., Uçar, B., Gür, Özlem, & Haznedaroğlu, İbrahim. (2024). COST OF CHRONIC MYELOID LEUKEMIA FROM THE PAYER’S PERSPECTIVE IN TÜRKIYE: RESULTS OF A DELPHI PANEL ANALYSIS. Global Journal of Medical and Pharmaceutical Sciences, 3(12), 5-15. https://doi.org/10.55640/gjmps/Volume03Issue12-02A