COST OF CHRONIC MYELOID LEUKEMIA FROM THE PAYER’S PERSPECTIVE IN TÜRKIYE: RESULTS OF A DELPHI PANEL ANALYSIS

Background: Chronic myeloid leukemia (CML) is a slowly progressing blood-cell cancer that originates in the bone marrow. The disease is classified into three different phases: chronic phase (CP), accelerated phase and blast phase. The standard treatment for chronic phase CML (CP-CML) is tyrosine kinase inhibitors (TKIs) and the introduction of the first generation of TKI, imatinib, has shifted the treatment paradigm of the disease. Despite the introduction of other TKIs for patients with resistance or intolerance, the high cost of these products is a cause for concern for healthcare systems and payer organizations. Aim: This study aims to estimate the financial burden of CP-CML on the Social Security Institution (SSI) of Türkiye. Methodology: A modified Delphi Panel approach was used to estimate the cost of CP-CML to the SSI. The panel was comprised of six leading hematologists who answered a Health Care Resource Utilization Questionnaire to identify the type, patient ratio and frequency of resources used in the diagnosis and treatment of the disease. The answers to these questions were discussed in a face-to-face meeting with the experts and a final consensus was reached. Following this, the costs of treatment at each treatment line and for patients with the T315I mutation were calculated based on the reimbursement prices and rules of the SSI. Results: The annual total cost of CP-CML to SSI was estimated to be 1,283,203,114TRY (€36,643,159). The share of second line treatment in total costs is 38%, for the first line 31% and for the 3+line 21%. In terms of annual per patient costs, the highest cost per patient was for those with the T315I mutation (at 1,405,281 TRY, €40,129). The annual cost per patient for first line treatment was 100,142 TRY (€2,859), while for second and third + line treatments the annual costs per patient were 320,490 (€9,151) and 357,870 (€10,219) respectively. These results indicate that the share of CP-CML treatment within the total expenditures of SSI in 2023 was 0.2%. Conclusion: Our findings suggest that there is still a room to include more recent and effective TKIs on the SSI’s reimbursement list.