Cost-effectiveness of blinatumomab as post-remission therapy in adults with measurable residual disease-negative, Philadelphia chromosome-negative B-cell acute lymphoblastic leukaemia.

This study evaluated the cost-effectiveness of blinatumomab for adult Philadelphia chromosome-negative (Ph-negative) patients with B-cell acute lymphoblastic leukaemia (B-ALL) who were in measurable residual disease (MRD)-negative first remission, according to the ECOG1910 trial. A Markov model was created to compare the cost-effectiveness of four cycles of blinatumomab alternating with chemotherapy versus standard-of-care chemotherapy (SOC), in both Japan and the United States. The analysis was conducted over a lifetime horizon. Incremental cost-effectiveness ratios (ICERs) were calculated, with willingness-to-pay (WTP) thresholds set at ¥7 500 000 in Japan and $150 000 in the United States. A discount rate was set at 3%. In Japan, blinatumomab led to incremental costs of ¥27 472 739 and yielded 3.82 quality-adjusted life years (QALYs), resulting in an ICER of ¥7 193 601 per QALY. In the United States, incremental costs were $463 539 with 3.45 QALYs, yielding an ICER of $134 298 per QALY. When the 3-year progression-free survival (PFS) with blinatumomab was assumed as 80%, it was cost-effective unless the 3-year PFS for SOC exceeded 64.9% in Japan and 65.6% in the United States. Blinatumomab was less cost-effective for patients older than 51.6 years in Japan and 55.6 years in the United States. Blinatumomab is cost-effective as consolidation therapy for MRD-negative Ph-negative B-ALL patients, with sensitivity to age and PFS gains.