Cost-Effectiveness of Momelotinib for Treatment of Myelofibrosis in Taiwan

OBJECTIVES: Anemia remains a challenge in myelofibrosis (MF) management, causing substantial health and economic burden. Momelotinib, a novel JAK inhibitor (JAKi), has demonstrated efficacy in anemia. We sought to determine the cost-effectiveness of momelotinib for MF from the perspective of Taiwan’s National Health Insurance Authority.

METHODS: A Markov model with four health states (transfusion-independent, transfusion-requiring, transfusion-dependent, and death) was adapted to estimate healthcare costs and quality-adjusted life years (QALYs) of momelotinib versus ruxolitinib and the best available therapy (BAT) among JAKi-naïve and JAKi-experienced patients, respectively, in a 4-week cycle length over a lifetime simulation. QALYs and healthcare costs were rewarded in each cycle and discounted at 3% annually over the simulation horizon. A blended cohort with 50% of JAKi-naïve and 50% of JAKi-experienced was assumed in analysis. Transition probabilities between health states, the probabilities of adverse events and health utilities were derived from the SIMPLIFY-1 and SIMPLIFY-2 trials, while cost data was from Taiwan's National Health Insurance program. Primary outcome measure was incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were conducted to examine study robustness.

RESULTS: Use of momelotinib versus the blended comparator (i.e., ruxolitinib and BAT) yielded 0.186 QALY gained and an incremental cost of US$10,506 (in 2023), resulting in US$56,482 per QALY gained. The overall proportion of ruxolitinib in BAT and time to treatment discontinuation of ruxolitinib were the top influential drivers for ICER values in JAKi-experienced and JAKi-naïve patients, respectively. Use of momelotinib was considered cost-effective in 70.6% of the model iterations using a willingness-to-pay threshold of US$96,981/QALY (i.e., three times Taiwan’s gross domestic product per capita).

CONCLUSIONS: Use of momelotinib versus the blended comparator (i.e., ruxolitinib and BAT) is cost-effective for MF, suggesting momelotinib as an economically rational alternative over existing treatments in Taiwan.