Cost-utility analysis of Besremi to manage low-risk patients with PV as compared to phlebotomy only

[Manouche]

 »RopegIFNα was cost-effective for low-risk PV patients in Austria, implying that its early adoption could help optimize longer term healthcare resource allocation. By preventing costly thrombotic events and delaying or halting progression to MF (and AML), the Austrian healthcare system can avoid the higher long-term costs associated with treating these severe complications. These findings support a policy argument for ensuring early access to ropegIFNα as a clinically effective and cost-effective intervention in the context of a resource-limited healthcare setting »

link.springer.com/content/p...

[EPguy]

This is not surprisingly from the company that sells it. Most is mathematical simulations. But the concept should be valid, with a proposed rewording

"These findings support a policy argument for ensuring early access to [ropegIFNα] either of the two available Pegylated IFN α2's as a clinically effective and cost-effective intervention in the context of a resource-limited healthcare setting".

By their cost criteria, the cheaper Pegasys should be first line, with Bes reserved for those who don't tolerate any effective PEG dose.

They have also revealed a continuing pattern, wherein median response has a peak and then a decline. (HCT is the criteria vs CHR)

I've added the one year result from the separate study summary

ashpublications.org/blood/a...

1 Year Bes = 81%,---Plb= 51%

2 year------- 63.9%, -------47.3%

5 year -------52.3----------40

10 year------38.9----------31.6

The median trend is loss of response toward a response convergence with plb, but it is over a very long time.

(note the 2 year response in the ash report has 83% vs 63.9, but these pts were selected as responders at 1 year while the above table is all pts on Bes.)

More worrying, thrombosis events also increased and converged from a signif 2 year difference (1.9 vs 4.3%) (IFN vs Plb) to a "smaller difference" (7.9 vs 10.8) at 5 year. From other reports we know VAF response has an influence here.

This was the Low PV trial with 100mcg for all IFN pts. With dosing restricted to a value rather than a result the Low PV seems to have inferior results as in another recent post. But loss of blood response is seen for all the treatments I know of and deserves more attention to understand and address it.

[Bluetop]

Thanks for this. Amongst other things, I guess it also depends on the price in UK. Interesting

[Bluetop in reply to Bluetop]

Thanks for this further analysis.

[ainslie]

interesting and possibly correct but it is a model as opposed to reality as far as I read, I suppose it also depends on the cost of the meds in different countries

[EPguy in reply to ainslie]

I read mostly as an advertisement. But the data it leads to is enlightening.

[ainslie in reply to EPguy]

If you scroll down the paper the authors are all getting paid by the pharma company, money talks

[EPguy in reply to ainslie]

I saw AOP, didn't realize it was that overt. Anyway some of the data on Low PV was new.