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

Summary 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.