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Wang P, Chow SC. Innovative thinking of clinical investigation for rare disease drug development. Orphanet J Rare Dis 2023; 18:299. [PMID: 37740206 PMCID: PMC10517458 DOI: 10.1186/s13023-023-02909-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
For the development of a test treatment or drug product, it is necessary to conduct composite hypothesis testing to test for effectiveness and safety simultaneously, since some approved drug products have been recalled due to safety concerns. One of the major issues in conducting a composite hypothesis testing for effectiveness and safety is the requirement of a huge sample size to achieve the desired power for detecting clinically meaningful differences in both safety and effectiveness. Situation can be much difficult in orphan drug development. In this article, a generalized two-stage innovative approach to test for effectiveness and safety simultaneously is proposed. Additionally, to alleviate the requirement of a large randomized clinical trial (RCT) and revealing effectiveness, real-world data is suggested to use in conjunction with RCT data for orphan drug development. The proposed approach can help investigators test for effectiveness and safety at the same time without worrying about the sample size. It also helps reduce the probability of approving a drug product with safety concerns.
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Affiliation(s)
- Peijin Wang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
| | - Shein-Chung Chow
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
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Pasello G, Lorenzi M, Calvetti L, Oliani C, Pavan A, Favaretto A, Palazzolo G, Giovanis P, Zustovich F, Bonetti A, Bernardi D, Mandarà M, Aprile G, Crivellaro G, Sinigaglia G, Tognazzo S, Morandi P, Bortolami A, Marino V, Bonanno L, Guarneri V, Conte P. OUP accepted manuscript. Oncologist 2022; 27:e484-e493. [PMID: 35429394 PMCID: PMC9177098 DOI: 10.1093/oncolo/oyac051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Giulia Pasello
- Corresponding author: Giulia Pasello, University of Padova DiSCOG and Istituto Oncologico Veneto IRCCS, Via Gattamelata 64, 35128 Padova, Italy. Tel: +390498215608; Fax: +390498215932;
| | - Martina Lorenzi
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Lorenzo Calvetti
- Department of Oncology, San Bortolo General Hospital, AULSS8 Berica, Vicenza, Italy
| | | | - Alberto Pavan
- Medical Oncology Department, ULSS 3 Serenissima, Sant’Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Adolfo Favaretto
- Department of Medical Oncology, AULSS 2 Marca Trevigiana, Ca’Foncello Hospital, Treviso, Italy
| | - Giovanni Palazzolo
- Medical Oncology, AULSS 6 Euganea, Cittadella – Camposampiero Hospital, Camposampiero, Italy
| | - Petros Giovanis
- Department of Oncology, Unit of Oncology, Santa Maria del Prato Hospital, Azienda ULSS 1 Dolomiti, Feltre, Italy
| | - Fable Zustovich
- Clinical Oncology Department, AULSS 1 Dolomiti, San Martino Hospital, Belluno, Italy
| | - Andrea Bonetti
- Department of Oncology, AULSS 9 of the Veneto Region, Mater Salutis Hospital, Legnago, Italy
| | - Daniele Bernardi
- Medical Oncology, ULSS 4 “Veneto Orientale”, San Donà di Piave (VE), Italy
| | - Marta Mandarà
- Department of Medical Oncology, AULSS 9 Scaligera, Verona, Italy
| | - Giuseppe Aprile
- Department of Oncology, San Bortolo General Hospital, AULSS8 Berica, Vicenza, Italy
| | - Giovanna Crivellaro
- Rete Oncologica Veneta (ROV), Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | | | - Sandro Tognazzo
- Rete Oncologica Veneta (ROV), Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Paolo Morandi
- Medical Oncology Department, ULSS 3 Serenissima, Sant’Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Alberto Bortolami
- Rete Oncologica Veneta (ROV), Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Valentina Marino
- Department of Medical Oncology, AULSS 2 Marca Trevigiana, Ca’Foncello Hospital, Treviso, Italy
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
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Luyendijk M, Vernooij RWM, Blommestein HM, Siesling S, Uyl-de Groot CA. Assessment of Studies Evaluating Incremental Costs, Effectiveness, or Cost-Effectiveness of Systemic Therapies in Breast Cancer Based on Claims Data: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1497-1508. [PMID: 33127021 DOI: 10.1016/j.jval.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/10/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Large secondary databases, such as those containing insurance claims data, are increasingly being used to compare the effects and costs of treatments in routine clinical practice. Despite their appeal, however, caution must be exercised when using these data. In this study, we aimed to identify and assess the methodological quality of studies that used claims data to compare the effectiveness, costs, or cost-effectiveness of systemic therapies for breast cancer. METHODS We searched Embase, the Cochrane Library, Medline, Web of Science, and Google Scholar for English-language publications and assessed the methodological quality using the Good Research for Comparative Effectiveness principles. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under number CRD42018103992. RESULTS We identified 1251 articles, of which 106 met the inclusion criteria. Most studies were conducted in the United States (74%) and Taiwan (9%) and were based on claims data sets (35%) or claims data linked to cancer registries (58%). Furthermore, most included large samples (mean 17 130 patients) and elderly patients, and they covered various outcomes (eg, survival, adverse events, resource use, and costs). Key methodological shortcomings were the lack of information on relevant confounders, the risk of immortal time bias, and the lack of information on the validity of outcomes. Only a few studies performed sensitivity analyses. CONCLUSIONS Many comparative studies of cost, effectiveness, and cost-effectiveness have been published in recent decades based on claims data, and the number of publications has increased over time. Despite the availability of guidelines to improve quality, methodological issues persist and are often inappropriately addressed or reported.
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Affiliation(s)
- Marianne Luyendijk
- Department of Research and Development, Netherlands Comprehensive Cancer Center, Utrecht, The Netherlands; Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
| | - Robin W M Vernooij
- Department of Research and Development, Netherlands Comprehensive Cancer Center, Utrecht, The Netherlands
| | - Hedwig M Blommestein
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Center, Utrecht, The Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
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What Is the Value of Innovative Pharmaceutical Therapies in Oncology and Hematology? A Willingness-to-Pay Study in Bulgaria. Value Health Reg Issues 2019; 19:157-162. [PMID: 31109901 DOI: 10.1016/j.vhri.2019.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To analyze the views of Bulgarian oncologists and hematologists regarding the value of innovative pharmaceutical treatments in their clinical area. METHODS Physicians were invited to review a life-prolonging scenario and to indicate what minimum improvement in median survival a new treatment would have to generate for them to recommend it over the standard of care. Respondents were also asked to state the highest cost at which they would recommend a new therapy that would improve patient's health-related quality of life (HRQoL) but would have no impact on survival. In addition, physicians were asked whether they would consider different responses under certain circumstances. Responses were used to calculate incremental cost-effectiveness ratios (ICERs) for each scenario. RESULTS In the life-prolonging scenario, participants required a median of 12-month improvement in the survival to reimburse a new therapy at an incremental cost of €50 000, implying a willingness-to-pay of €50 000 per QALY gained. In the HRQoL-enhancing scenario, respondents indicated a €100 000 median cost per QALY gained. We observed a significant variation in responses. Although the median ICER for better HRQoL was twice as high as the median ICER for longer survival, 5% trimmed mean values were almost equal. Physicians did not believe that a higher ICER should be used for the treatment of children or for rare diseases. CONCLUSIONS We found a high willingness-to-pay for innovative drugs in oncology and hematology. The wide range of responses observed, however, indirectly implies a lack of consensus on the use of explicit ICER thresholds in Bulgaria.
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Csontos JK, Fitzsimmons D, Jones M, Wilkinson WM, Horton J, Love-Gould L, Tee A, Watts T. Realist evaluation of cancer rehabilitation services in South Wales (REEACaRS): a mixed methods study protocol. BMJ Open 2019; 9:e025953. [PMID: 31015271 PMCID: PMC6500344 DOI: 10.1136/bmjopen-2018-025953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Long-term and late effects of cancer treatments can cause functional limitations and reduce quality of life. Cancer rehabilitation services, which can comprise physical exercise, psychological support and educational interventions depending on the individual's needs, have been found to have a positive effect on health-related quality of life worldwide. However, accessibility or the lack of awareness on available help can act as barriers and influence the uptake of services, resulting in people having unmet rehabilitation needs. In Wales, UK, 41% of people, who have had health and social care needs resulting from cancer and its treatments, reported that they did not receive care when needed. The reason for this lack of support has not yet been fully investigated. The aim of this study is to investigate the conditions in which cancer rehabilitation services work and their underpinning mechanisms in South Wales, UK, specifically addressing barriers, facilitators and costs. METHODS AND ANALYSIS Realist evaluation, which explains for whom a service works in what circumstances and how through context-mechanism-outcome pattern conjunctions, will be used in three phases to investigate the conditions in which cancer rehabilitation services work and their underpinning mechanisms. Phase 1 will be secondary analysis of a cancer rehabilitation database from a local Health Board to give context to who are accessing rehabilitation. Phase 2 will be thematic analysis of face-to-face, semistructured rehabilitation participant (n=20) and healthcare professional (n=20) interviews to explore the mechanisms of how cancer rehabilitation works. Phase 3 will be two case studies and cost-consequences analysis of cancer rehabilitation services. ETHICS AND DISSEMINATION This study received favourable ethical opinion from London South-East Research Ethics Committee (17/LO/2123) in December 2017. This project is part of the author's PhD thesis and it is expected that the findings will be disseminated in academic journals and at local and international conferences.
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Affiliation(s)
| | | | | | | | - Joanne Horton
- Abertawe Bro Morgannwg University Health Board, Port Talbot, UK
| | | | - Anna Tee
- Macmillan Cancer Support, Bridgend, UK
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Geldof T, Huys I, Van Dyck W. Real-World Evidence Gathering in Oncology: The Need for a Biomedical Big Data Insight-Providing Federated Network. Front Med (Lausanne) 2019; 6:43. [PMID: 30906740 PMCID: PMC6418003 DOI: 10.3389/fmed.2019.00043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/18/2019] [Indexed: 11/16/2022] Open
Abstract
Moving toward new adaptive pathways for the development and access to innovative medicines implies that real-world data (RWD) collected throughout the medicinal product life cycle is becoming increasingly important. Big data analytics on RWD can obtain new and powerful insights into medicines' effectiveness. However, the healthcare ecosystem still faces many sector-specific challenges that hamper the use of big data analytics delivering real world evidence (RWE). We distinguish between exploratory (ExTE) and hypotheses-evaluating (HETE) studies testing treatment effectiveness in the real world. From our experience and in the context of the four V's of data management, we show that to get meaningful results data Variety and Veracity are needed regardless of the type of study conducted. More so, for ExTE studies high data Volume is needed while for HETE studies high Velocity becomes essential. Next, we highlight what are needed within the biomedical big data ecosystem, being: (a) international data reusability; (b) real-time RWD processing information systems; and (c) longitudinal RWD. Finally, in an effort to manage the four V's whilst respecting patient privacy laws we argue for the development of an underlying federated RWD infrastructure on a common data model, capable of bringing the centrally-conducted big data analysis to the de-centrally kept biomedical data.
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Affiliation(s)
- Tine Geldof
- Healthcare Management Centre, Vlerick Business School, Ghent, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, Research Centre for Pharmaceutical Care and Pharmaco-economics, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, Research Centre for Pharmaceutical Care and Pharmaco-economics, KU Leuven, Leuven, Belgium
| | - Walter Van Dyck
- Healthcare Management Centre, Vlerick Business School, Ghent, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, Research Centre for Pharmaceutical Care and Pharmaco-economics, KU Leuven, Leuven, Belgium
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Du X, Khamitova A, Kyhlstedt M, Sun S, Sengoelge M. Utilisation of real-world data from heart failure registries in OECD countries - A systematic review. IJC HEART & VASCULATURE 2018; 19:90-97. [PMID: 29955668 PMCID: PMC6020857 DOI: 10.1016/j.ijcha.2018.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/25/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Heart failure represents a major public health issue that impacts 26 million people globally. Currently, real-world data represents a key instrument for providing the verification of both internal and external validity, yet there is still a lack of understanding regarding its scope in complementing evidence of treatments for heart failure. This study aims to increase understanding of the utilisation of real-word data from heart failure registries in Organisation for Economic Co-operation and Development (OECD) countries. METHOD This was a systematic review of existing observational studies from heart failure registries in 35 OECD member countries. Studies from 2000 to March 2017 were identified through electronic databases (MEDLINE (Ovid), EMBASE, Web of Science Core Collection, CINAHL (Ebsco), Cochrane CENTRAL) and appraised according to eligibility criteria. RESULTS Two-hundred and two studies met the inclusion criteria, in which the majority were published from 2013 to 2016. All 202 studies were observational, among which 98% were cohort studies (198). The median sample size of all studies was 5152 (2417 to 32,890) and median study period 55 months (33.0 to 72.0). Swedish heart failure registry had the most publications (24, 12%). CONCLUSION Since 2000 there has been an upward trend in the number of published observational studies on heart failure registries in OECD countries with increasingly diverse outcomes and advanced statistical methods to improve their validity and reliability. This indicates that the utilisation of real-world data has experienced a significant upsurge in complementing the findings of clinical trials for improved research of heart failure treatments.
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Affiliation(s)
- Xiaoyang Du
- Department of Learning, Information, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Adina Khamitova
- Department of Learning, Information, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | | | - Sun Sun
- Department of Learning, Information, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Synergus AB, Stockholm, Sweden
- Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mathilde Sengoelge
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Garside J, Healy N, Besson H, Hermans R, MacDougall F, Lestelle D, Diels J, Iraqi W. PHEDRA: using real-world data to analyze treatment patterns and ibrutinib effectiveness in hematological malignancies. J Comp Eff Res 2018; 7:29-38. [DOI: 10.2217/cer-2017-0046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: PHEDRA (Platform for Haematology in EMEA: Data for Real World Analysis) is a unique, noninterventional project based on secondary data collection from real-world (RW) patient-level (health record) databases to understand treatment patterns in hematological malignancies. It compares ibrutinib's effectiveness with alternative treatments using RW data (RWD) and randomized clinical trials data. Materials & methods: RWD are cleaned, validated, harmonized into a Common Data Model, and analyzed statistically alongside randomized clinical trial data. Treatment outcomes include overall and progression-free survival. Results: To date, RWD (four databases) are available for 2840 patients in three indications, collected between 1990 and 2017. Conclusion: PHEDRA is an innovative approach to generate evidence to inform optimal treatment decisions in RW settings.
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Affiliation(s)
| | | | - Hervé Besson
- Janssen EU HEMAR Statistics & Modelling, Beerse, Belgium
| | | | | | | | - Joris Diels
- Janssen EU HEMAR Statistics & Modelling, Beerse, Belgium
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Evidence, value and hope — Allocating resources for cancer. J Cancer Policy 2017. [DOI: 10.1016/j.jcpo.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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