Imatinib at escalated doses of 600 mg/day or 800 mg/day

Imatinib at escalated doses of 600mg/day or 800mg/day for the treatment of people with unresectable and/or metastatic gastrointestinal stromal tumours whose disease has progressed on treatment with imatinib at a dose of 400mg/day: systematic review and economic evaluation (TAR Project)

The study provided evidence on clinical and cost-effectiveness of using imatinib at an escalated dose of 600mg per day or 800mg per day to treat patients with GISTs, compared with treating them with sunitinib and best supportive care. An economic model was developed to compare the cost-effectiveness and cost-utility of use of imatinib at a dose of 600mg per day or 800mg per day, or use of sunitinib, or best supportive care only, for treating people with unresectable gastrointestinal tumours (GISTs). The model was based on insufficient effectiveness data. The economic evaluation determined the incremental cost per quality adjusted life year (QALY) gained with escalated doses of imatinib. It was found that best supportive care was the least costly and least effective. It would be the care pathway most likely to be cost-effective when the cost per quality-adjusted life-year threshold was < £25,000. Imatinib at 600mg/day was most likely to be cost-effective at a threshold between £25,000 and £45,000. Imatinib at 600mg/day followed by further escalation followed by sunitinib was most likely to be cost-effective at a threshold > £45,000.

Outcome and Translation

The review and economic evaluation provided evidence to NICE to make recommendations about the best way of treating GIST for people whose disease has progressed on treatment with imatinib at a dose of 400mg per day. The results of the study informed the NICE technology appraisal guidance [TA209] ‘Imatinib for the treatment of unresectable and/or metastatic gastrointestinal stromal tumours’ (http://www.nice.org.uk/guidance/ta209).

HERU researchers involved in this research project: Zahidul Quayyum and Luke Vale (HERU/HSRU)

External Collaborators: J Hislop and G Mowatt (HSRU, University of Aberdeen)

Publications

Hislop, J., Quayyum, Z., Elders, A., Fraser, C., Jenkinson, D., Mowatt, G., Sharma, P., Vale, L. and Petty, R. (2011) 'Clinical effectiveness and cost-effectiveness of imatinib dose escalation for the treatment of unresectable and/or metastatic gastrointestinal stromal tumours that have progressed on treatment at a dose of 400 mg/day: a systematic review and economic evaluation', Health Technology Assessment, 15(25).

Hislop, J., Mowatt, G., Sharma, P., Fraser, C., Elders, A., Jenkinson, D., Vale, L. and Petty, R. (2012) 'Systematic review of escalated imatinib doses compared with sunitinib or best supportive care, for the treatment of people with unresectable/metastatic gastrointestinal stromal tumours whose disease has progressed on the standard imatinib dose', Journal of Gastrointestinal Cancer, 43(2), 168-176.