Costo efectividad del dasatinib en el tratamiento de la leucemia mieloide crónica en pacientes resistentes al imatinibs

objective: based on a previously performed economic evaluation, we adapted a cost-effectiveness model for venezuela and colombia, after a data transferability analysis. we compared the costs and cost-effectiveness ratio of using 100mg/day and 140 mg/day doses of dasatinib versus 800 mg/day doses of nilotinib or an increased dose of imatinib (800mg/day), for each phase of the disease, in patients who developed resistance to habitual doses of imatinib. methods: to adapt the economic evaluation, we assumed the transition probabilities based on the markov model used for this economic evaluation, which considered a cohort of 10.000 cml patients in its three phases (chronic, accelerated or blast phase), a lifetime horizon and a 3.5 % discount rate for costs and benefits. model results included the costs of each treatment alternative with dasatinib, nilotinib or imatinib, and the quality adjusted life years (qalys) gained. costs were measured in colombian pesos and bolivares fuertes (bsf) of year 2009. results: in the chronic phase of the disease, dasatinib 100 mg/day yielded the highest amount of qalys both for colombia and venezuela (6,88 and 6,54 respectively) and the lowest cost-effectiveness ratio. in the accelerated phase, dasatinib 140 mg/day also showed the lowest cost-effectiveness compared to nilotinib and imatinib. in the blast phase, dasatinib showed lower cost-effectiveness ratio than imatinib. conclusions: dasatinib 100 mg/day and 140 mg/ day showed the lowest cost-effectiveness ratios than doses of 800 mg/day of nilotinib for the treatment of patients with cml resistant to usual imatinib doses in the chronic phase, as well as in the accelerated and blast phases. although there was an overall cost increase, especially due to the cost of dasatinib in 140 mg/day doses, this fact was explained by the increase in years of life gained and, consequently, the use of medical resources and drugs in the timeline of treatment.