Primary Risk Drivers
Below is a snapshot of domains that materially influence the MARA Rating.
Clinical effectiveness
Asciminib shows moderate clinical effectiveness compared to bosutinib, with higher rates of major molecular response and complete cytogenic response at 24 weeks. However, the survival benefit remains unclear due to immature data on overall survival and progression-free survival, which limits the strength of the evidence.
Cost effectiveness
Asciminib is likely to be cost-effective, with ICER estimates below £30,000 per QALY gained compared to bosutinib, nilotinib, and dasatinib. The committee concluded that the cost-effectiveness results are acceptable, especially with the commercial arrangement in place.
Quality of life
The evidence indicates that chronic myeloid leukaemia significantly impacts quality of life, and asciminib is expected to provide a new treatment option that could improve patient outcomes. However, specific HRQoL data from validated instruments is not detailed in the document.
Supporting Domains
Safety and Adverse Effects
Asciminib has a favorable safety profile, with adverse effects primarily being manageable and comparable to existing treatments. The document indicates that the treatment is generally well-tolerated, although specific adverse event rates are not detailed.
Comparator Selection
The primary comparator, bosutinib, is appropriate as it is commonly used after two or more TKIs. The committee recognized that while other TKIs are potential comparators, bosutinib is the most relevant for the patient population targeted by asciminib.
Patient Population and Subgroups
The trial population is representative of the intended patient population, specifically adults with chronic-phase Philadelphia chromosome-positive CML who have been treated with multiple TKIs. The document discusses the importance of considering individual patient factors in treatment decisions.
Care Pathway Integration
Asciminib can be integrated into existing treatment pathways with minor adjustments. The document indicates that it fits within the current clinical practice for CML treatment, although some planning may be required for its implementation.
Resource Use and Cost Implications
The economic model suggests that asciminib has a manageable budget impact, with potential cost savings compared to ponatinib. The committee noted that the treatment is likely to be resource-efficient given the commercial arrangement.
Evidence Quality and Robustness
The evidence is based on a well-conducted RCT (ASCEMBL) with some limitations regarding survival data. While the trial provides strong evidence for molecular and cytogenic responses, the uncertainty surrounding survival outcomes affects the overall robustness.
Uncertainty, Sensitivity, and Broader Impacts
There is moderate uncertainty regarding the survival benefit of asciminib, but the context of unmet need and the potential for improved quality of life support its use. The committee acknowledged the uncertainties but found them manageable within the context of the treatment pathway.
