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Cost-Effectiveness of Interferon-α as Maintenance Therapy in Chronic Myelogenous Leukemia
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TO THE EDITOR:
In their study on the cost-effectiveness of interferon-α in chronic myelogenous leukemia [1], Kattan and colleagues describe a baseline analysis in which the monthly cost of interferon-α is $1500 per patient and a sensitivity test wherein this cost is reduced to $1000.
Interferon-α costs approximately $10 per million U, with small international variations [2, 3]. In evaluating this drug in chronic myelogenous leukemia, both the German and the Italian trials ([2, 3] in Kattan and colleagues' article) used a target dose of 62 million U per week (corresponding to 270 million U per month). This yields a cost of $2700 per patient per month.
Kattan and coworkers did not consider a sensitivity test in which the cost of interferon-α is increased to this value of about $3000. On the basis of the data in their Figure 4, a simple linear extrapolation indicates that at these increased costs, the marginal cost-effectiveness worsens to about $80 000 per quality-adjusted life-year (QALY) gained. Because current benchmarks in cost–utility analysis [4] suggest that the cutoff between favorable and unfavorable ratios is approximately $50 000 per QALY, Kattan and colleagues' baseline scenario gives a “favorable” cost–utility ratio ($34 000 per QALY), but our alternate scenario yields an “unfavorable” result ($80 000 per QALY). These data confirm that the statistical variance of the authors' results is high.
Although the “true” interferon-α dosage was 16% higher than the target dose in the Italian trial and 42% higher in the German trial (because of dosage individualization and noncompliance), other sources of cost [3] not considered by Kattan and colleagues (for example, physician's time for adjustment of medication and periodical laboratory examinations such as testing of liver function and assay of anti-interferon antibodies) can contribute to an increase in the cost of interferon-α treatment. Thus, a cost of $3000 per patient per month is as realistic as Kattan and colleagues' figure of $1500.
Andrea Messori
Paola Becagli
Sabrina Trippoli
Azienda Ospedaliera Careggi; Florence, Italy
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
