Blinatumomab for treatment of children with acute lymphoblastic leukaemia in Hong Kong: A cost-effectiveness analysis.

To assess the cost-effectiveness of blinatumomab plus chemotherapy for paediatric patients from Hong Kong public healthcare provider's perspective, a 10-year Markov model was designed to simulate outcomes in paediatric patients with newly diagnosed standard-risk B-cell ALL at: (1) average risk and (2) high risk of relapse. Three treatment strategies were evaluated: (1) blinatumomab plus chemotherapy as first-line therapy; (2) blinatumomab plus chemotherapy as second-line therapy for patients who failed first-line chemotherapy; (3) chemotherapy alone. Model outcomes included direct medical cost, life-year gained (LYG), quality-adjusted life-year (QALY) gained and incremental cost-effectiveness ratio (ICER). Comparing to the next less costly strategy, the ICERs of blinatumomab second-line therapy (10 534 and 12 375 USD/QALY) and blinatumomab first-line therapy (50 312 and 54 799 USD/QALY) were below the willingness-to-pay threshold (162 721 USD/QALY) for high and average risk of relapse groups respectively. One-way sensitivity analysis found that exponential rates of survival with blinatumomab as first-line and blinatumomab drug cost were influential factors. In probabilistic sensitivity analysis, blinatumomab first-line group was the preferred option in 71.4% and 90.3% of simulations in the high and average risk of relapse groups, correspondingly. In conclusion, adding blinatumomab to first-line therapy appears to be cost-effective for paediatric patients with newly diagnosed standard-risk B-cell ALL.