Verification of imatinib cost-effectiveness in advanced gastrointestinal stromal tumor in British Columbia (VINCE-BC study).

摘要

BACKGROUND: This cost-effectiveness analysis of imatinib in British Columbia Cancer Agency (BCCA) patients with advanced gastrointestinal stromal tumors (GIST) was performed to justify funding.Patients and METHODS: A pragmatic, retrospective review identified BCCA patients with advanced GIST who received imatinib or historical treatment during successive, pre-specified time periods. Primary outcome was the cost-effectiveness (CE) of imatinib based on median overall survival (MOS). Secondary outcomes were cost-effectiveness based on median progression-free survival (PFS) and comparison to literature efficacy. This study took the BCCA perspective. Sensitivity analyses varying effectiveness over the 95% confidence interval (CI), cost to its extremes, discounting level at 0, 3, and 5%, and substituting life expectancy for MOS were performed. RESULTS: Forty-six and 47 patients in the imatinib and historical groups respectively showed MOS with imatinib to be 66.7 months (95%CI 61.7- infinity) compared to 7.7(95%CI 6.0-12.6) in the historical group. Median-PFS were 45.3 months (95%CI 24.4-infinity) and 5.6 (95%CI 3.5-8.5) respectively. Imatinib effectiveness was similar to literature reports. The annual incremental CE ratio for imatinib was Dollars 15,882 CDN per median life year gained and Dollars 23,603 CDN per median year of PFS. CONCLUSIONS: Imatinib for advanced GIST seems cost-effective in BC. RESULT: were robust across a range of sensitivity analyses.