Hagop KantarjianLeukemia research and cancer drug policy

Cost-benefit considerations for TKI selection in CML

8 Sept 2023 · 2 min

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1:39

In this talk, the speaker outlines the shifting economic landscape of tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML) as several agents become generic. Imatinib is already generic at roughly $500 per year, while dasatinib is expected to go generic in 2024 and nilotinib, ponatinib, and bosutinib by 2027. The speaker argues that the choice of TKI should be driven by the therapeutic goal: for overall survival, the low‑cost generic imatinib ($500/yr, ~$15,000 over a 30‑year horizon) is highly cost‑effective; for treatment‑free remission (TFR), dasatinib (50‑100 mg daily) is required, costing about $160,000 per year. Additionally, the speaker notes that once patients achieve a deep molecular response, dose reductions are feasible, further decreasing the cost of care. The overall message emphasizes aligning TKI selection with clinical endpoints and cost considerations as generics enter the market.

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So this is an important talk because the tyrosine kinase inhibitors in CML are becoming generic, particularly imatinib, but soon we're going to have generic dasatinib in 2024, and we will have the other generic formulations of nilotinib, ponatinib, and bosutinib in 2027. So it becomes then very important to choose the best TKIs for the aims, the particular aims of CML. So if survival is the endpoint, then imatinib generic, which is at $500 a year, would be an excellent choice in terms of the survival improvement. Because if you take a patient with CML who will live another 30 years with imatinib at $500 a year, The total cost of care is $15,000, which is very reasonable. On the other hand, if you choose treatment-free remission as the endpoint, then you have to use Disatinib either at 50 or 100 milligrams daily, and that increases the cost to about $160,000 a year. So it's important to start looking at the cost of care of each of those TKIs and choose accordingly. Also, we know that in many of those TKIs, once the patients achieve a good molecular response, we do not have to stay at the full dose. We can reduce the dose, and that will reduce the cost of care also.