Budget impact of dasatinib compared to nilotinib as first- and second-line therapies for chronic myeloid leukemia in Colombia

Impacto presupuestal de dasatinib comparado con nilotinib como terapias en primera y segunda línea de tratamiento en leucemia mieloide crónica en Colombia

Introduction: Chronic Myeloid Leukemia (CML) is a hematologic neoplasm treated with tyrosine kinase inhibitors (TKIs), which have improved survival but pose financial challenges for healthcare systems. Objective: Conduct a Budget Impact Analysis (BIA) from the Colombian healthcare system perspective, comparing Dasatinib and Nilotinib, two leading second-generation TKIs used in first- and second-line CML treatment. Methods: A budget impact analysis was conducted from the Colombian healthcare system perspective using a Markov model and decision tree over a 10-year horizon. Dasatinib and Nilotinib were compared as first- and second-line treatments for chronic-phase Philadelphia-positive CML. Costs of treatment, administration, and monitoring were included. Model robustness was assessed through sensitivity analysis using data from local sources, literature, and expert input. Results: A cohort of 507 chronic-phase CML patients was analyzed. Increasing Dasatinib use by 20% resulted in substantial savings: COP 9.7 billion in first-line and COP 11.8 billion in second-line treatment, compared to Nilotinib. Conclusions: Dasatinib is a budget-favorable alternative to Nilotinib due to its lower annual cost and comparable efficacy. Savings could be maximized using its lowest market price. Appropriate patient selection enhances treatment-free remission (TFR) outcomes, generating additional benefits for the Colombian healthcare system.