1
|
Lian D, Gan Y, Xiao D, Xuan D, Chen Y, Yang Y. Toripalimab plus chemotherapy in American patients with recurrent or metastatic nasopharyngeal carcinoma: A cost-effectiveness analysis. Cancer Med 2024; 13:e7243. [PMID: 38752448 PMCID: PMC11097128 DOI: 10.1002/cam4.7243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/19/2024] [Accepted: 04/27/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Toripalimab, combined with gemcitabine and cisplatin, has been approved as the first-line treatment for recurrent or metastatic nasopharyngeal carcinoma (RM-NPC), representing a significant milestone as the first FDA-approved innovative therapy for this condition. Despite this achievement, there's a lack of data on the cost-effectiveness of toripalimab for RM-NPC patients in the American context. METHODS To assess the cost-effectiveness of toripalimab plus chemotherapy versus chemotherapy alone, a 3-state partitioned survival model was constructed. The study involved participants with characteristics matching those in the JUPITER-02 trial. Cost and utility inputs were collected from literature. Main outcomes measured were quality-adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER). Univariate and probabilistic sensitivity analyses, subgroup analyses, and scenario analyses were conducted to verify the robustness of results. RESULTS The study found that the toripalimab regimen resulted in 4.390 QALYs at a cost of $361,813, while the chemotherapy-only regimen yielded 1.685 QALYs at a cost of $161,632. This translates to an ICER of $74,004/QALY, below the willingness-to-pay threshold of $150,000/QALY. Sensitivity analyses indicated that utility values, discount rate, and the price of toripalimab significantly impact INMB. With an 87.10% probability of being cost-effective at a $150,000/QALY threshold, the probabilistic sensitivity analysis supports toripalimab plus chemotherapy as a viable option. Scenario analysis showed that toripalimab remains cost-effective unless its price increases by 125%. Additionally, a simulated 15-year study period increases the ICER to $88,026/QALY. Subgroup analysis revealed ICERs of $76,538/QALY for PD-L1 positive and $70,158/QALY for PD-L1 negative groups. CONCLUSIONS Toripalimab in combination with chemotherapy is likely to be a cost-effective alternative to standard chemotherapy for American patients with RM-NPC. This evidence can guide clinical and reimbursement decision-making in treating RM-NPC patients.
Collapse
Affiliation(s)
- Dai Lian
- School of Public HealthFudan UniversityShanghaiChina
- National Health Commission Key Laboratory of Health Technology AssessmentFudan UniversityShanghaiChina
| | - Yuling Gan
- School of Public HealthFudan UniversityShanghaiChina
- National Health Commission Key Laboratory of Health Technology AssessmentFudan UniversityShanghaiChina
| | - Dunming Xiao
- School of Public HealthFudan UniversityShanghaiChina
- National Health Commission Key Laboratory of Health Technology AssessmentFudan UniversityShanghaiChina
| | - Dennis Xuan
- School of Public Health and Tropical MedicineTulane UniversityNew OrleansLouisianaUSA
| | - Yingyao Chen
- School of Public HealthFudan UniversityShanghaiChina
- National Health Commission Key Laboratory of Health Technology AssessmentFudan UniversityShanghaiChina
| | - Yi Yang
- School of Public HealthFudan UniversityShanghaiChina
- National Health Commission Key Laboratory of Health Technology AssessmentFudan UniversityShanghaiChina
| |
Collapse
|
2
|
Isla D, Lopez-Brea M, Espinosa M, Arrabal N, Pérez-Parente D, Carcedo D, Bernabé-Caro R. Cost-effectiveness of atezolizumab versus pembrolizumab as first-line treatment in PD-L1-positive advanced non-small-cell lung cancer in Spain. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:6. [PMID: 36647072 PMCID: PMC9841669 DOI: 10.1186/s12962-023-00417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/08/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Atezolizumab has recently been approved for first-line treatment of high PD-L1 expression metastatic Non-Small-Cell Lung Cancer (NSCLC) patients with no EGFR or ALK mutations, on the basis of the IMpower110 trial. This study aims to estimate the cost-effectiveness of atezolizumab compared with pembrolizumab among these patients in Spanish settings, based on the results of the two cut-offs of the IMpower110 study. METHODS A three-state partitioned-survival model was adapted to Spanish settings to calculate health outcomes and costs over a lifetime horizon. Clinical data for atezolizumab were collected from the interim and the exploratory results (data cut-off: Sept'18 and Feb'20, respectively) of the IMpower110 trial while a network meta-analysis was used to model pembrolizumab treatment. Utility data were collected from the trial. Direct medical costs were considered based on resources identified by experts. Costs and outcomes were discounted at 3% per year. Health outcomes were expressed as cost per Life Year (LY) and cost per Quality-Adjusted Life Year (QALY). Both deterministic and probabilistic sensitivity analyses were performed to assess the robustness of results. RESULTS Over a lifetime horizon, the incremental results showed that atezolizumab generated similar health outcomes (LYs and QALYs) to pembrolizumab, with minimal differences depending on the cut-off used (+ 0.70 and + 0.42 LYs and QALYs with Sept'18 cut-off and - 0.80 and - 0.72 LYs and QALYs with Feb'20 cut-off). However, for both cut-offs, atezolizumab produced meaningfully less costs than pembrolizumab (€ - 54,261 with Sept'18 cut-off and € - 81,907 with Feb'20 cut-off). The sensitivity analyses carried out confirmed the robustness of the base-case results. CONCLUSIONS The cost-effectiveness analysis, comparing the two cut-off of IMpower110, shows that atezolizumab provides similar health gains to pembrolizumab but at a lower cost for the first-line treatment of metastasic NSCLC patients in Spain.
Collapse
Affiliation(s)
- Dolores Isla
- grid.411050.10000 0004 1767 4212Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Marta Lopez-Brea
- grid.411325.00000 0001 0627 4262Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María Espinosa
- grid.411457.2Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Natalia Arrabal
- grid.476717.40000 0004 1768 8390Roche Farma S.A, Madrid, Spain
| | | | | | - Reyes Bernabé-Caro
- grid.411109.c0000 0000 9542 1158Hospital Universitario Virgen del Rocío, Sevilla, Spain ,grid.9224.d0000 0001 2168 1229Universidad de Sevilla, Sevilla, Spain
| |
Collapse
|
3
|
Rodrigues-Oliveira L, Kowalski LP, Santos M, Marta GN, Bensadoun RJ, Martins MD, Lopes MA, Castro GD, William WN, Chaves ALF, Migliorati CA, Salloum RG, Rodrigues-Fernandes CI, Kauark-Fontes E, Brandão TB, Santos-Silva AR, Prado-Ribeiro AC. Direct costs associated with the management of mucositis: A systematic review. Oral Oncol 2021; 118:105296. [PMID: 33933777 DOI: 10.1016/j.oraloncology.2021.105296] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/26/2021] [Accepted: 04/04/2021] [Indexed: 11/26/2022]
Abstract
Mucositis is one of the more frequent and costly adverse events following cancer treatment. To evaluate and report the direct economic outcomes associated with the management of mucositis across several cancer treatments we conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Scopus, MEDLINE/PubMed, and Embase were searched electronically and a total of 37 relevant studies were included. The costs attributable to mucositis in the hematopoietic stem cell transplantation setting ranged from 1124,47 US dollars (USD) to 299 214,14 USD per patient. The radiotherapy/chemoradiotherapy/radiotherapy plus molecular targeted therapy accounted for mucositis costs that ranged from 51,23 USD to 33 560,58 USD per patient. Costs for mucositis in the chemotherapy setting ranged from 4,18 USD to 31 963,64 USD per patient. When the cancer treatment was not specified, costs of mucositis ranged from 565,85 USD to as high as 20 279, 12 USD per patient. Mucositis costs from multimodal therapy ranged from 12,42 USD to 5670,46 USD per patient. The molecular targeted therapy setting included only one study and depending on the healthcare providers' perspective of each country evaluated, mucositis' costs ranged from 45,78 USD to 3484,91 USD per patient. Mucositis is associated with increased resource use, consultations, hospitalizations and extended hospitalizations, leading to a substantial incremental cost that exacerbates the economic burden on the patient, health plan and health system across several cancer treatments and diagnosis. More studies with a prospective evaluation of the economic costs associated with mucositis management are needed.
Collapse
Affiliation(s)
- Leticia Rodrigues-Oliveira
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, University of Sao Paulo Medical School, Av. Dr. Arnaldo, 455, Cerqueira César, 01246-903 São Paulo, São Paulo, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Rua Tamandaré, 753, Liberdade, 01525-001 São Paulo, São Paulo, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil.
| | - Marcos Santos
- ISPOR - International Society for Pharmacoeconomics and Outcomes Research, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil
| | - Gustavo Nader Marta
- Division of Radiation Oncology, São Paulo State Cancer Institute (ICESP-FMUSP), Av. Dr. Arnaldo, 251, Cerqueira César, 01246-000 São Paulo, São Paulo, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 115, Bela Vista, 01308-050 São Paulo, São Paulo, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil.
| | - René-Jean Bensadoun
- Centre de Haute Energie (CHE), 10, Boulevard Pasteur, 06000 Nice, Nice, France.
| | - Manoela Domingues Martins
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil; Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Santa Cecilia, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil
| | - Gilberto de Castro
- Department of Medical Oncology, São Paulo State Cancer Institute (ICESP-FMUSP), Av. Dr. Arnaldo, 251, Cerqueira César, 01246-000 São Paulo, São Paulo, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil.
| | - William Nassib William
- Centro Oncológico BP, Beneficência Portuguesa de São Paulo, Rua Maestro Cardim, 769, Bela Vista, 01323-001 São Paulo, São Paulo, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil
| | - Aline Lauda Freitas Chaves
- DOM Oncology Group, Av. Antônio Olímpio de Morais, 1990, Santa Clara, 35500-071 Divinópolis, Minas Gerais, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil
| | | | - Ramzi G Salloum
- College of Medicine, University of Florida, 600 SW Archer Rd, Gainesville, FL 32610, USA.
| | - Carla Isabelly Rodrigues-Fernandes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil
| | - Elisa Kauark-Fontes
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil
| | - Thaís Bianca Brandão
- Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), Av. Dr. Arnaldo, 251, Cerqueira César, 01246-000 São Paulo, São Paulo, Brazil.
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil; Latin American Cooperative Oncology Group, Brazilian Group of Head and Neck Cancer, Brazil.
| | - Ana Carolina Prado-Ribeiro
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Bairro Areião, 13414-903 Piracicaba, São Paulo, Brazil; Dental Oncology Service, São Paulo State Cancer Institute (ICESP-FMUSP), Av. Dr. Arnaldo, 251, Cerqueira César, 01246-000 São Paulo, São Paulo, Brazil.
| |
Collapse
|
4
|
Kunnumakkara AB, Bordoloi D, Sailo BL, Roy NK, Thakur KK, Banik K, Shakibaei M, Gupta SC, Aggarwal BB. Cancer drug development: The missing links. Exp Biol Med (Maywood) 2019; 244:663-689. [PMID: 30961357 DOI: 10.1177/1535370219839163] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPACT STATEMENT The success rate for cancer drugs which enter into phase 1 clinical trials is utterly less. Why the vast majority of drugs fail is not understood but suggests that pre-clinical studies are not adequate for human diseases. In 1975, as per the Tufts Center for the Study of Drug Development, pharmaceutical industries expended 100 million dollars for research and development of the average FDA approved drug. By 2005, this figure had more than quadrupled, to $1.3 billion. In order to recover their high and risky investment cost, pharmaceutical companies charge more for their products. However, there exists no correlation between drug development cost and actual sale of the drug. This high drug development cost could be due to the reason that all patients might not respond to the drug. Hence, a given drug has to be tested in large number of patients to show drug benefits and obtain significant results.
Collapse
Affiliation(s)
- Ajaikumar B Kunnumakkara
- 1 Cancer Biology Laboratory, DBT-AIST International Laboratory for Advanced Biomedicine (DAILAB), Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, India
| | - Devivasha Bordoloi
- 1 Cancer Biology Laboratory, DBT-AIST International Laboratory for Advanced Biomedicine (DAILAB), Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, India
| | - Bethsebie Lalduhsaki Sailo
- 1 Cancer Biology Laboratory, DBT-AIST International Laboratory for Advanced Biomedicine (DAILAB), Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, India
| | - Nand Kishor Roy
- 1 Cancer Biology Laboratory, DBT-AIST International Laboratory for Advanced Biomedicine (DAILAB), Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, India
| | - Krishan Kumar Thakur
- 1 Cancer Biology Laboratory, DBT-AIST International Laboratory for Advanced Biomedicine (DAILAB), Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, India
| | - Kishore Banik
- 1 Cancer Biology Laboratory, DBT-AIST International Laboratory for Advanced Biomedicine (DAILAB), Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, India
| | - Mehdi Shakibaei
- 2 Faculty of Medicine, Institute of Anatomy, Ludwig Maximilian University of Munich, Munich D-80336, Germany
| | - Subash C Gupta
- 3 Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi 221005, India
| | | |
Collapse
|
5
|
Isla D, De Castro J, Juan O, Grau S, Orofino J, Gordo R, Rubio-Terrés C, Rubio-Rodríguez D. Costs of adverse events associated with erlotinib or afatinib in first-line treatment of advanced EGFR-positive non-small cell lung cancer. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 9:31-38. [PMID: 28115857 PMCID: PMC5221482 DOI: 10.2147/ceor.s121093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are an established treatment for advanced non-small cell lung cancer (NSCLC) with EGFR mutation. According to published meta-analyses, no significant efficacy differences have been demonstrated between erlotinib and afatinib. However, the incidence of EGFR-TKI-related adverse events (AEs) was lower with erlotinib. This study compares the cost of management of the AEs associated with these two drugs from the perspective of the Spanish National Health System (NHS). METHODS The frequency of AEs was established from a recently published meta-analysis. In Spain, the daily cost of both drugs can be considered similar; as a result, only the costs of management of the AEs were considered. Costs and resource utilization in the management of the AEs were estimated by a panel of Spanish oncologists and from studies previously carried out in Spain. A probabilistic analysis was performed based on a Monte Carlo simulation. RESULTS The model generated 1,000 simulations. The total cost per patient treated with erlotinib and afatinib was €657.44 and €1,272.15, respectively. With erlotinib, the cost per patient and per AE of grades ≤2 and ≥3 was €550.86 and €106.58, respectively, whereas the cost with afatinib was €980.63 and €291.52, respectively. The reduction in the number of AEs with erlotinib could avoid a mean cost for the NHS of €614.71 (95% CI: €342.57-881.29) per patient. CONCLUSION In advanced EGFR mutation-positive NSCLC patients, first-line treatment with erlotinib could reduce health care costs for the NHS, due to a decrease in the AE rate compared with afatinib. In long-term treatments, the avoidance of complications and the lowering of costs associated with the management of AEs are relevant factors that contribute to the sustainability of the health system.
Collapse
Affiliation(s)
- Dolores Isla
- Medical Oncology Department, Clinical Universitary Hospital Lozano Blesa, Zaragoza
| | - Javier De Castro
- Medical Oncology Department, Universitary Hospital La Paz, Madrid
| | - Oscar Juan
- Medical Oncology Department, Universitary and Polytechnic Hospital La Fe, Valencia
| | | | | | | | | | | |
Collapse
|
6
|
Grau S, Azanza JR, Ruiz I, Vallejo C, Mensa J, Maertens J, Heinz WJ, Barrueta JA, Peral C, Mesa FJ, Barrado M, Charbonneau C, Rubio-Rodríguez D, Rubio-Terrés C. Cost-effectiveness analysis of combination antifungal therapy with voriconazole and anidulafungin versus voriconazole monotherapy for primary treatment of invasive aspergillosis in Spain. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 9:39-47. [PMID: 28115858 PMCID: PMC5221484 DOI: 10.2147/ceor.s122177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective According to a recent randomized, double-blind clinical trial comparing the combination of voriconazole and anidulafungin (VOR+ANI) with VOR monotherapy for invasive aspergillosis (IA) in patients with hematologic disease or with hematopoietic stem cell transplant, mortality was lower after 6 weeks with VOR+ANI than with VOR monotherapy in a post hoc analysis of patients with galactomannan-based IA. The objective of this study was to compare the cost-effectiveness of VOR+ANI with VOR, from the perspective of hospitals in the Spanish National Health System. Methods An economic model with deterministic and probabilistic analyses was used to determine costs per life-year gained (LYG) for VOR+ANI versus VOR in patients with galactomannan-based IA. Mortality, adverse event rates, and life expectancy were obtained from clinical trial data. The costs (in 2015 euros [€]) of the drugs and the adverse event-related costs were obtained from Spanish sources. A Tornado plot and a Monte Carlo simulation (1,000 iterations) were used to assess uncertainty of all model variables. Results According to the deterministic analysis, for each patient treated with VOR+ANI compared with VOR monotherapy, there would be a total of 0.348 LYG (2.529 vs 2.181 years, respectively) at an incremental cost of €5,493 (€17,902 vs €12,409, respectively). Consequently, the additional cost per LYG with VOR+ANI compared with VOR would be €15,785. Deterministic sensitivity analyses confirmed the robustness of these findings. In the probabilistic analysis, the cost per LYG with VOR+ANI was €15,774 (95% confidence interval: €15,763–16,692). The probability of VOR+ANI being cost-effective compared with VOR was estimated at 82.5% and 91.9%, based on local cost-effectiveness thresholds of €30,000 and €45,000, respectively. Conclusion According to the present economic study, combination therapy with VOR+ANI is cost-effective as primary therapy of IA in galactomannan-positive patients in Spain who have hematologic disease or hematopoietic stem cell transplant, compared with VOR monotherapy.
Collapse
Affiliation(s)
- Santiago Grau
- Pharmacy Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona
| | - Jose Ramon Azanza
- Clinical Pharmacology Department, Clínica Universidad de Navarra, Pamplona
| | - Isabel Ruiz
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona
| | - Carlos Vallejo
- Hematology Department, Hospital Universitario Donostia, San Sebastián
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Johan Maertens
- Hematology Department, University Hospital Gasthuisberg, Leuven, Belgium
| | - Werner J Heinz
- Hematology/Oncology Department, Medizinische Klinik und Poliklinik II, Universitätsklinikum, Würzburg, Germany
| | | | - Carmen Peral
- Economics and Outcomes Research Department, Pfizer S.L.U, Alcobendas
| | | | - Miguel Barrado
- Clinical Trials Department, Trial Form Support, Madrid, Spain
| | - Claudie Charbonneau
- Pharmacoeconomics Department, Pfizer International Operations, Paris, France
| | | | | |
Collapse
|
7
|
Casado LF, Burgos A, González-Haba E, Loscertales J, Krivasi T, Orofino J, Rubio-Terres C, Rubio-Rodríguez D. Economic evaluation of obinutuzumab in combination with chlorambucil in first-line treatment of patients with chronic lymphocytic leukemia in Spain. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:475-484. [PMID: 27703384 PMCID: PMC5036824 DOI: 10.2147/ceor.s114524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the cost-effectiveness of obinutuzumab in combination with chlorambucil (GClb) versus rituximab plus chlorambucil (RClb) in the treatment of adults with previously untreated chronic lymphocytic leukemia (CLL) and with comorbidities that make them unsuitable for full-dose fludarabine-based therapy, from the perspective of the Spanish National Health System. Methods A Markov model was developed with three mutually exclusive health states: progression-free survival (with or without treatment), progression, and death. Survival time for the two treatments was modeled based on the results of CLL11 clinical trial and external sources. Each health state was associated with a utility value and direct medical costs. The utilities were obtained from a utility elicitation study conducted in the UK. Costs and general background mortality data were obtained from published Spanish sources. Deterministic and probabilistic analyses were conducted, with a time frame of 20 years. The health outcomes were measured as life years (LYs) gained and quality-adjusted life years (QALYs) gained. Efficiency was measured as the cost per LY or per QALY gained of the most effective regimen. Results In the deterministic base case analysis, each patient treated with GClb resulted in 0.717 LYs gained and 0.673 QALYs gained versus RClb. The cost per LY and per QALY gained with GClb versus RClb was €23,314 and €24,838, respectively. The results proved stable in most of the univariate and probabilistic sensitivity analyses, with a probabilistic cost per QALY gained of €24,734 (95% confidence interval: €21,860–28,367). Conclusion Using GClb to treat patients with previously untreated CLL for whom full-dose fludarabine-based therapy is unsuitable allows significant gains in terms of LYs and QALYs versus treatment with RClb. Treatment with GClb versus RClb can be regarded as efficient when considered the willingness to pay thresholds commonly used in Spain.
Collapse
Affiliation(s)
| | - Amparo Burgos
- Pharmacy Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Eva González-Haba
- Pharmacy Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Loscertales
- Hematology Deparment, Hospital Universitario De La Princesa, Madrid, Spain
| | | | | | | | | |
Collapse
|
8
|
Edwards SJ, Barton S, Thurgar E, Trevor N. Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for advanced recurrent or refractory ovarian cancer: a systematic review and economic evaluation. Health Technol Assess 2015; 19:1-480. [PMID: 25626481 DOI: 10.3310/hta19070] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Ovarian cancer is the fifth most common cancer in the UK, and the fourth most common cause of cancer death. Of those people successfully treated with first-line chemotherapy, 55-75% will relapse within 2 years. At this time, it is uncertain which chemotherapy regimen is more clinically effective and cost-effective for the treatment of recurrent, advanced ovarian cancer. OBJECTIVES To determine the comparative clinical effectiveness and cost-effectiveness of topotecan (Hycamtin(®), GlaxoSmithKline), pegylated liposomal doxorubicin hydrochloride (PLDH; Caelyx(®), Schering-Plough), paclitaxel (Taxol(®), Bristol-Myers Squibb), trabectedin (Yondelis(®), PharmaMar) and gemcitabine (Gemzar(®), Eli Lilly and Company) for the treatment of advanced, recurrent ovarian cancer. DATA SOURCES Electronic databases (MEDLINE(®), EMBASE, Cochrane Central Register of Controlled Trials, Health Technology Assessment database, NHS Economic Evaluations Database) and trial registries were searched, and company submissions were reviewed. Databases were searched from inception to May 2013. METHODS A systematic review of the clinical and economic literature was carried out following standard methodological principles. Double-blind, randomised, placebo-controlled trials, evaluating topotecan, PLDH, paclitaxel, trabectedin and gemcitabine, and economic evaluations were included. A network meta-analysis (NMA) was carried out. A de novo economic model was developed. RESULTS For most outcomes measuring clinical response, two networks were constructed: one evaluating platinum-based regimens and one evaluating non-platinum-based regimens. In people with platinum-sensitive disease, NMA found statistically significant benefits for PLDH plus platinum, and paclitaxel plus platinum for overall survival (OS) compared with platinum monotherapy. PLDH plus platinum significantly prolonged progression-free survival (PFS) compared with paclitaxel plus platinum. Of the non-platinum-based treatments, PLDH monotherapy and trabectedin plus PLDH were found to significantly increase OS, but not PFS, compared with topotecan monotherapy. In people with platinum-resistant/-refractory (PRR) disease, NMA found no statistically significant differences for any treatment compared with alternative regimens in OS and PFS. Economic modelling indicated that, for people with platinum-sensitive disease and receiving platinum-based therapy, the estimated probabilistic incremental cost-effectiveness ratio [ICER; incremental cost per additional quality-adjusted life-year (QALY)] for paclitaxel plus platinum compared with platinum was £24,539. Gemcitabine plus carboplatin was extendedly dominated, and PLDH plus platinum was strictly dominated. For people with platinum-sensitive disease and receiving non-platinum-based therapy, the probabilistic ICERs associated with PLDH compared with paclitaxel, and trabectedin plus PLDH compared with PLDH, were estimated to be £25,931 and £81,353, respectively. Topotecan was strictly dominated. For people with PRR disease, the probabilistic ICER associated with topotecan compared with PLDH was estimated to be £324,188. Paclitaxel was strictly dominated. LIMITATIONS As platinum- and non-platinum-based treatments were evaluated separately, the comparative clinical effectiveness and cost-effectiveness of these regimens is uncertain in patients with platinum-sensitive disease. CONCLUSIONS For platinum-sensitive disease, it was not possible to compare the clinical effectiveness and cost-effectiveness of platinum-based therapies with non-platinum-based therapies. For people with platinum-sensitive disease and treated with platinum-based therapies, paclitaxel plus platinum could be considered cost-effective compared with platinum at a threshold of £30,000 per additional QALY. For people with platinum-sensitive disease and treated with non-platinum-based therapies, it is unclear whether PLDH would be considered cost-effective compared with paclitaxel at a threshold of £30,000 per additional QALY; trabectedin plus PLDH is unlikely to be considered cost-effective compared with PLDH. For patients with PRR disease, it is unlikely that topotecan would be considered cost-effective compared with PLDH. Randomised controlled trials comparing platinum with non-platinum-based treatments might help to verify the comparative effectiveness of these regimens. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003555. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
| | - Samantha Barton
- Senior Health Technology Assessment Analyst, BMJ-TAG, London, UK
| | | | | |
Collapse
|
9
|
Villa G, Hernández-Pastor LJ, Guix M, Lavernia J, Cuesta M. Cost-effectiveness analysis of pazopanib in second-line treatment of advanced soft tissue sarcoma in Spain. Clin Transl Oncol 2014; 17:24-33. [PMID: 24981588 DOI: 10.1007/s12094-014-1191-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 05/26/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE To assess the efficiency of pazopanib compared with trabectedin in the treatment of adult patients with selective subtypes of advanced soft-tissue sarcoma (STS) after chemotherapy failure. METHODS The progression of STS was modeled using a partitioned survival analysis model. Survival curves for pazopanib and trabectedin were modeled using data from PALETTE phase III clinical trial and based on unadjusted indirect comparison. Effectiveness was measured in quality-adjusted life years (QALY). The Spanish National Health System perspective was considered over a 10-year time horizon, including direct health care costs (<euro>, 2014). A discount rate of 3% was applied to both costs and outcomes. The robustness of the results was evaluated using univariate and probabilistic sensitivity analyses (PSA). RESULTS Pazopanib was associated with better health outcomes than trabectedin (0.705 versus 0.686 QALY). Pazopanib also showed lower direct health care costs (<euro>21,861 versus <euro>45,338), mainly due to lower cost of pharmacological treatment (<euro>13,762 versus <euro>33,392), administration (<euro>57 versus <euro>2,955) and AE management (<euro>658 versus <euro>1,695) costs. PSA confirmed that pazopanib was a dominant option in 71% of the simulations performed. CONCLUSIONS In this analysis, and from a health economics perspective, pazopanib was the option of choice versus trabectedin in the treatment of adult patients with advanced soft-tissue sarcoma after chemotherapy failure.
Collapse
Affiliation(s)
- G Villa
- Health Economics, GlaxoSmithKline, Madrid, Spain
| | | | | | | | | |
Collapse
|
10
|
Alba E, Ciruelos E, López R, López-Vega JM, Lluch A, Martín M, Muñoz M, Sánchez-Rovira P, Seguí MÁ, COSTABRAX Working Group, Liria MR, Pérez-Alcántara F. Cost–utility analysis of nanoparticle albumin-bound paclitaxel versus paclitaxel in monotherapy in pretreated metastatic breast cancer in Spain. Expert Rev Pharmacoecon Outcomes Res 2014; 13:381-91. [DOI: 10.1586/erp.13.18] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
11
|
Pearce A, Haas M, Viney R. Are the true impacts of adverse events considered in economic models of antineoplastic drugs? A systematic review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:619-637. [PMID: 24129649 DOI: 10.1007/s40258-013-0058-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Antineoplastic drugs for cancer are often associated with adverse events, which influence patients' physical health, quality of life and survival. However, the modelling of adverse events in cost-effectiveness analyses of antineoplastic drugs has not been examined. AIMS This article reviews published economic evaluations that include a calculated cost for adverse events of antineoplastic drugs. The aim is to identify how existing models manage four issues specific to antineoplastic drug adverse events: the selection of adverse events for inclusion in models, the influence of dose modifications on drug quantity and survival outcomes, the influence of adverse events on quality of life and the consideration of multiple simultaneous or recurring adverse events. METHODS A systematic literature search was conducted using MESH headings and key words in multiple electronic databases, covering the years 1999-2009. Inclusion criteria for eligibility were papers covering a population of adults with solid tumour cancers, the inclusion of at least one adverse event and the resource use and/or costs of adverse event treatment. RESULTS From 4,985 citations, 26 eligible articles were identified. Studies were generally of moderate quality and addressed a range of cancers and treatment types. While the four issues specific to antineoplastic drug adverse events were addressed by some studies, no study addressed all of the issues in the same model. CONCLUSION This review indicates that current modelling assumptions may restrict our understanding of the true impact of adverse events on cost effectiveness of antineoplastic drugs. This understanding could be improved through consideration of the selection of adverse events, dose modifications, multiple events and quality of life in cost-effectiveness studies.
Collapse
Affiliation(s)
- Alison Pearce
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, PO BOX 123, Broadway, NSW, 2007, Australia,
| | | | | |
Collapse
|
12
|
Gentile E, Cilurzo F, Di Marzio L, Carafa M, Anna Ventura C, Wolfram J, Paolino D, Celia C. Liposomal chemotherapeutics. Future Oncol 2013; 9:1849-59. [DOI: 10.2217/fon.13.146] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Currently, six liposomal chemotherapeutics have received clinical approval and many more are in clinical trials or undergoing preclinical evaluation. Liposomes exhibit low toxicity and improve the biopharmaceutical features and therapeutic index of drugs, thereby increasing efficacy and reducing side effects. In this review we discuss the advantages of using liposomes for the delivery of chemotherapeutics. Gemcitabine and paclitaxel have been chosen as examples to illustrate how the performance of a metabolically unstable or poorly water-soluble drug can be greatly improved by liposomal incorporation. We look at the beneficial effects of liposomes in a variety of solid and blood-borne tumors, including thyroid cancer, pancreatic cancer, breast cancer and multiple myeloma.
Collapse
Affiliation(s)
- Emanuela Gentile
- Department of Health Sciences, University ‘Magna Graecia‘ of Catanzaro, University Campus ‘S. Venuta‘, Building of BioSciences, V.le ‘S. Venuta‘ 88100 Germaneto – Catanzaro, Italy
- Department of Nanomedicine, The Methodist Hospital Research Institute, 6670 Bertner Ave., Houston, TX 77030, USA
| | - Felisa Cilurzo
- Department of Health Sciences, University ‘Magna Graecia‘ of Catanzaro, University Campus ‘S. Venuta‘, Building of BioSciences, V.le ‘S. Venuta‘ 88100 Germaneto – Catanzaro, Italy
| | - Luisa Di Marzio
- Department of Pharmacy, University ‘G. d‘Annunzio‘ of Chieti - Pescara, Via dei Vestini 31, 66013 Chieti, Italy
| | - Maria Carafa
- Department of Drug Chemistry & Technologies, University ‘La Sapienza‘ of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Cinzia Anna Ventura
- Department of Drug Science & Health Products, University of Messina, Viale Annunziata, 98168 Messina, Italy
| | - Joy Wolfram
- Department of Nanomedicine, The Methodist Hospital Research Institute, 6670 Bertner Ave., Houston, TX 77030, USA
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety, National Center for Nanoscience & Technology of China, Beijing 100190, China
| | - Donatella Paolino
- Department of Health Sciences, University ‘Magna Graecia‘ of Catanzaro, University Campus ‘S. Venuta‘, Building of BioSciences, V.le ‘S. Venuta‘ 88100 Germaneto – Catanzaro, Italy
| | - Christian Celia
- Department of Nanomedicine, The Methodist Hospital Research Institute, 6670 Bertner Ave., Houston, TX 77030, USA
| |
Collapse
|
13
|
Bosetti R, Marneffe W, Vereeck L. Assessing the need for quality-adjusted cost-effectiveness studies of nanotechnological cancer therapies. Nanomedicine (Lond) 2013; 8:487-97. [PMID: 23477338 DOI: 10.2217/nnm.13.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
New therapies, such as nanotechnology-based cancer treatments, typically entail high acquisition costs. Their use can be justified, however, by their superior cost-effectiveness. This article assesses the quality of cost-effectiveness analyses of nanotechnological cancer therapies by screening nine major studies. They conclude that nanotherapies are cost effective for the treatment of ovarian and breast cancer, as well as multiple myeloma, but not for other types of cancer. However, these studies have some serious methodological flaws. Typically, the results are not quality adjusted, although both length and quality of life are affected. Moreover, only fragmented direct medical costs are included, neglecting indirect costs that impose a significant economic burden on patients and society. Finally, cost definitions differ widely making any comparison between studies virtually impossible. This article concludes that economic research of nanotechnology-based therapeutics is still in its infancy. It warns that incomplete economic analysis may lead to inefficient policy recommendations.
Collapse
Affiliation(s)
- Rita Bosetti
- Hasselt University, Department of Applied Economics, Martelarenlaan 42, BE3500 Hasselt, Belgium.
| | | | | |
Collapse
|
14
|
Villa G, Hernández-Pastor LJ. Budget impact analysis of first-line treatment with pazopanib for advanced renal cell carcinoma in Spain. BMC Cancer 2013; 13:399. [PMID: 24004638 PMCID: PMC3856525 DOI: 10.1186/1471-2407-13-399] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 04/12/2013] [Indexed: 01/09/2023] Open
Abstract
Background Due to economic constraints, cancer therapies are under close scrutiny by clinicians, pharmacists and payers alike. There is no published pharmacoeconomic evidence guiding the choice of first-line therapy for advanced renal cell carcinoma (RCC) in the Spanish setting. We aimed to develop a model describing the natural history of RCC that can be used in healthcare decision-making. We particularly analyzed the budget impact associated with the introduction of pazopanib compared to sunitinib under the Spanish National Healthcare System (NHS) perspective. Methods We developed a Markov model to estimate the future number of cases of advanced RCC (patients with favorable or intermediate risk) resulting either from initial diagnosis or disease progression after surgery. The model parameters were obtained from the literature. We assumed that patients would receive either pazopanib or sunitinib as first-line therapy until disease progression. Pharmacological costs and costs associated with the management of adverse events (AE) were considered. A univariate sensitivity analysis was undertaken in order to test the robustness of the results. Results The model predicted an adult RCC prevalence of 7.5/100,000 (1-year), 20.7/100,000 (3-year) and 32.5/100,000 (5-year). These figures are very close to GLOBOCAN reported RCC prevalence estimates of 7.6/100,000, 20.2/100,000 and 31.1/100,000, respectively. The model predicts 1,591 advanced RCC patients with favorable or intermediate risk in Spain in 2013. Annual per patient pharmacological costs were €32,365 and €39,232 with pazopanib and sunitinib, respectively. Annual costs associated with the management of AE were €662 and €974, respectively. Overall annual per patient costs were €7,179 (18%) lower with pazopanib compared to sunitinib. For every point increase in the percentage of patients treated with pazopanib, the NHS would save €67,236. If all the 1,591 patients predicted were treated with pazopanib, the NHS would save €6,723,622 in 2013. Results were robust according to the sensitivity analysis. Conclusions We developed a model that accurately reproduces the natural history of RCC and can be thus used in healthcare decision-making. When applied to the Spanish case, the introduction of pazopanib results in savings for the NHS, as a consequence of both reduced pharmacological costs and lower costs associated with the management of AE compared to sunitinib.
Collapse
Affiliation(s)
- Guillermo Villa
- Departamento de Evaluación de Medicamentos y Gestión Sanitaria, GlaxoSmithKline España, Severo Ochoa, 2, 28760, Tres Cantos, Madrid, Spain.
| | | |
Collapse
|
15
|
Lee HY, Yang BM, Hong JM, Lee TJ, Kim BG, Kim JW, Kim YT, Kim YM, Kang S. Cost-utility analysis for platinum-sensitive recurrent ovarian cancer therapy in South Korea: results of the polyethylene glycolated liposomal doxorubicin/carboplatin sequencing model. CLINICOECONOMICS AND OUTCOMES RESEARCH 2013; 5:297-307. [PMID: 23869171 PMCID: PMC3706255 DOI: 10.2147/ceor.s42170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective We performed a cost–utility analysis to assess the cost-effectiveness of a chemotherapy sequence including a combination of polyethylene glycolated liposomal doxorubicin (PLD)/carboplatin versus paclitaxel/carboplatin as a second-line treatment in women with platinum-sensitive ovarian cancer. Methods A Markov model was constructed with a 10-year time horizon. The treatment sequence consisted of first- to sixth-line chemotherapies and best supportive care (BSC) before death. Cycle length, a time interval for efficacy evaluation of chemotherapy, was 9 weeks. The model consisted of four health states: responsive, progressive, clinical remission, and death. At any given time, a patient may have remained on a current therapy or made a transition to the next therapy or death. Median time to progressions and overall survivals data were obtained through a systematic literature review and were pooled using a meta-analytical approach. If unavailable, this was elicited from an expert panel (eg, BSC). These outcomes were converted to transition probabilities using an appropriate formula. Direct costs included drug-acquisition costs for chemotherapies, premedication, adverse-event treatment and monitoring, efficacy evaluation, BSC, drug administration, and follow-up tests during remission. Indirect costs were transportation expenses. Utilities were also derived from the literature. Costs and utilities were discounted at an annual rate of 5% per cycle. Results PLD/carboplatin combination as the second line in the sequence is more effective and costly than paclitaxel/carboplatin combination, showing an additional US$21,658 per quality-adjusted life years. This result was robust in a deterministic sensitivity analysis except when median time to progression of second-line therapies and administration cost of PLD/carboplatin per administration cycle were varied. The probability of cost-effectiveness for PLD/carboplatin combination was 49.4% at a willingness to pay $20,000. Conclusion A PLD/carboplatin combination is an economically valuable option as second-line chemotherapy for the treatment of platinum-sensitive ovarian cancer in South Korea.
Collapse
Affiliation(s)
- Hwa-Young Lee
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Analysis of economic evaluations of pharmacological cancer treatments in Spain between 1990 and 2010. Clin Transl Oncol 2012. [DOI: 10.1007/s12094-012-0934-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
17
|
Liberato N, Rognoni C, Rubrichi S, Quaglini S, Marchetti M, Gorlia T, Licitra L, Vermorken J. Adding docetaxel to cisplatin and fluorouracil in patients with unresectable head and neck cancer: a cost–utility analysis. Ann Oncol 2012; 23:1825-32. [DOI: 10.1093/annonc/mdr545] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
18
|
Banz K, Bischoff H, Brunner M, Chouaid C, de Castro Carpeño J, de Marinis F, Grossi F, Vergnenègre A, Walzer S. Comparison of treatment costs of grade 3/4 adverse events associated with erlotinib or pemetrexed maintenance therapy for patients with advanced non-small-cell lung cancer (NSCLC) in Germany, France, Italy, and Spain. Lung Cancer 2011; 74:529-34. [DOI: 10.1016/j.lungcan.2011.04.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/17/2011] [Accepted: 04/16/2011] [Indexed: 11/17/2022]
|
19
|
Paz-Ares L, del Muro JG, Grande E, Díaz S. A cost-effectiveness analysis of sunitinib in patients with metastatic renal cell carcinoma intolerant to or experiencing disease progression on immunotherapy: perspective of the Spanish National Health System. J Clin Pharm Ther 2010; 35:429-38. [PMID: 20831545 DOI: 10.1111/j.1365-2710.2009.01135.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To investigate the cost-effectiveness of sunitinib (50 mg/day, schedule 4/2) vs. best supportive care (BSC) in patients with cytokine-refractory metastatic renal cell carcinoma (mRCC), from the perspective of the Spanish National Health Service. MATERIAL AND METHODS A Markov model compared the cost-effectiveness (taking into account drugs; medical visits; laboratory tests; X-rays; terminal care; adverse event management) of sunitinib and BSC across three disease states: no progression, survival with progression and death from mRCC or other causes. RESULTS The monthly incremental cost-effectiveness ratio (ICER) values for sunitinib treatment were €6073/progression-free survival month, €25,199/life years and €34,196/quality-adjusted life years (QALY) gained. In 95% of cases, the ICER/QALY values were below the accepted €45,000/QALY threshold. Efficacy and cost of sunitinib had the greatest impact on cost-effectiveness. CONCLUSION Sunitinib has a good cost-effectiveness profile in mRCC. The cost per life year and QALY gained is affordable according to current effectiveness thresholds in developed countries.
Collapse
Affiliation(s)
- L Paz-Ares
- Oncology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | | | | |
Collapse
|
20
|
Retèl VP, Hummel MJ, van Harten WH. Review on early technology assessments of nanotechnologies in oncology. Mol Oncol 2009; 3:394-401. [PMID: 19540817 PMCID: PMC5527538 DOI: 10.1016/j.molonc.2009.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 05/11/2009] [Accepted: 05/11/2009] [Indexed: 12/23/2022] Open
Abstract
Nanotechnology is expected to play an increasingly important role in the diagnostics, prognostics, and management of targeted cancer treatments. While papers have described promising results for nanotechnology in experimental settings, the translation of fundamental research into clinical applications has yet to be widely adopted. In future, policy makers will need to anticipate new developments for clinical implementation and introduce technology assessments. Here we present an overview of the literature on the technology assessments that have already been undertaken on early stage nanotechnology in cancer care, with particular emphasis placed on clinical efficacy, efficiency, logistics, patient-related features and technology dynamics. Owing to the current stage of development of most nanotechnologies, we found only a limited number of publications describing the application of either Health Technology Assessment (HTA) or Constructive Technology Assessment (CTA). In spite of the promising conclusions of most papers concerning the benefits of clinical implementation, actual clinically relevant applications were rarely encountered, and so far only a few publications report application of systematic forms of technology assessment. Most articles consider aspects of environmental safety, regulation and ethics, often mentioning the need to investigate such issues more thoroughly. Evaluation of financial and organizational aspects is often missing. In order to obtain a realistic perspective on the translation and implementation process there is a need for a broad and systematic evaluation of nanotechnologies at early stages of development. Assessment methods taking technology dynamics into account, such as Constructive Technology Assessment (CTA) should be considered for evaluation purposes.
Collapse
Affiliation(s)
- Valesca P. Retèl
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
| | - Marjan J.M. Hummel
- School of Governance and Management, University of Twente, MB-HTSR, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Wim H. van Harten
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands
- School of Governance and Management, University of Twente, MB-HTSR, P.O. Box 217, 7500 AE Enschede, The Netherlands
| |
Collapse
|
21
|
Delgado J, Febrer L, Nieves D, Piñol C, Brosa M. Análisis de minimización de costes de fludarabina (Beneflur®) oral vs. vía intravenosa en España. FARMACIA HOSPITALARIA 2009. [DOI: 10.1016/s1130-6343(09)72463-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
22
|
Cost-effectiveness analysis of sunitinib in patients with metastatic and/or unresectable gastrointestinal stroma tumours (GIST) after progression or intolerance with imatinib. Clin Transl Oncol 2008; 10:831-9. [DOI: 10.1007/s12094-008-0297-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
23
|
Wethington SL, Wright JD, Herzog TJ. Key role of topoisomerase I inhibitors in the treatment of recurrent and refractory epithelial ovarian carcinoma. Expert Rev Anticancer Ther 2008; 8:819-31. [PMID: 18471053 DOI: 10.1586/14737140.8.5.819] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ovarian cancer remains one of the most difficult gynecologic cancers to treat, owing to its aggressive biology and high relapse rate, as well as the toxic side effects of available chemotherapeutic agents used to treat recurrent disease. Topoisomerase I inhibitors, including topotecan and irinotecan, are some of the most effective and tolerable treatment options for recurrent ovarian cancer. The ideal dosing, timing of administration, role in combination with other chemotherapies or biologics and potential role in up-front therapy remains an area of active research. This article reviews the mechanism of action of topoisomerase I inhibitors and the efficacy, dosing, schedule and toxicity for topotecan, irinotecan, 9-nitrocamptothecin, DX-8951 and 9-aminocamptothecin. Conclusions include a discussion of future avenues of research and ongoing projects.
Collapse
Affiliation(s)
- Stephanie L Wethington
- Columbia University College of Physician and Surgeons, Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, 161 Fort Washington Ave, 8th Floor, Room 838, New York, NY 10032, USA.
| | | | | |
Collapse
|
24
|
Koon EC, Ma PC, Salgia R, Welch WR, Christensen JG, Berkowitz RS, Mok SC. Effect of a c-Met-specific, ATP-competitive small-molecule inhibitor SU11274 on human ovarian carcinoma cell growth, motility, and invasion. Int J Gynecol Cancer 2007; 18:976-84. [PMID: 18021219 DOI: 10.1111/j.1525-1438.2007.01135.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Increased expression of the receptor tyrosine kinase c-Met has been shown to correlate with enhanced cell proliferation, motility, and invasion. The objectives of this study were to characterize total and activated c-Met expression in both normal and malignant human ovarian epithelial cells and to determine the effects of inhibiting the activation of c-Met on ovarian epithelial cell growth, motility, and invasion. Total c-Met was overexpressed in 82 (68%) of 119 ovarian carcinomas, as shown by immunohistochemistry. Quantitative reverse transcription-polymerase chain reaction and Western blot analyses revealed that ovarian carcinoma cell lines had higher levels of c-Met messenger RNA, total protein, and activated protein expression compared to normal ovarian epithelial cell cultures. Using a specific adenosine triphosphate-competitive small-molecule inhibitor, SU11274, activated c-Met was decreased in normal and ovarian carcinoma cell lines. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays showed that cell growth inhibition directly correlated to the level of activated c-Met detected in each cell line (r =-0.87, P = 0.012). Using modified Boyden chamber assays, ovarian carcinoma cells treated with SU11274 demonstrated significantly decreased cell motility and invasion compared to untreated cells (P = 0.003 and P < 0.001, respectively). These data indicate that c-Met is overexpressed in the majority of malignant ovarian epithelial cells both in vivo and in vitro and that decreasing activated c-Met in vitro can significantly decrease ovarian carcinoma cell growth, motility, and invasion. Developing therapies that specifically inhibit the activation of c-Met may represent a novel therapeutic modality for patients with ovarian carcinomas expressing high levels of c-Met.
Collapse
Affiliation(s)
- E C Koon
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | | | |
Collapse
|
25
|
Colombo N, Gore M. Treatment of recurrent ovarian cancer relapsing 6-12 months post platinum-based chemotherapy. Crit Rev Oncol Hematol 2007; 64:129-38. [PMID: 17566758 DOI: 10.1016/j.critrevonc.2007.04.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 04/17/2007] [Accepted: 04/26/2007] [Indexed: 11/15/2022] Open
Abstract
Platinum-containing regimens are the mainstay of initial treatment for ovarian cancer and for platinum-sensitive recurrent disease. In recurrent ovarian cancer, the effectiveness of platinum retreatment is dependent on the relapse-free and treatment-free intervals. Platinum agents can be effectively re-administered to patients with disease that relapses >12 months after completion of a platinum regimen. Ovarian cancer that relapses 6-12 months after treatment with a platinum regimen is considered partially platinum sensitive. Phase III studies of combination regimens versus platinum monotherapy and comparing various non-platinum agents administered as monotherapy generally do not report separate data for partially platinum-sensitive patients. Studies reporting data in patients with a platinum-free interval > or =6 months demonstrate advantages for pegylated liposomal doxorubicin (PLD) versus paclitaxel and PLD versus topotecan. A platinum-taxane combination or single-agent PLD is recommended for the treatment of partially platinum-sensitive disease by the UK National Institute for Health and Clinical Excellence.
Collapse
Affiliation(s)
- Nicoletta Colombo
- European Institute of Oncology, University of Milan, Bicocca, Milan, Italy.
| | | |
Collapse
|
26
|
Pérez-López ME, Curiel T, Gómez JG, Jorge M. Role of pegylated liposomal doxorubicin (Caelyx) in the treatment of relapsing ovarian cancer. Anticancer Drugs 2007; 18:611-7. [PMID: 17414631 DOI: 10.1097/cad.0b013e32802623fc] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The most significant factor predicting response to second-line chemotherapy is the time interval elapsed from the end of chemotherapy to relapse occurrence. Two types of situations may be considered: patients with platinum-sensitive relapse (relapse-free interval longer than 6 months) and patients with platinum-refractory relapse (progression during treatment or relapse-free interval under 6 months). Pegylated liposomal doxorubicin is a doxorubicin formulation. Encapsulation in liposomes confers it different pharmacokinetic characteristics and a more favorable toxicity profile. The following review examines the efficacy and safety of pegylated liposomal doxorubicin for the treatment of relapsing epithelial ovarian cancer.
Collapse
Affiliation(s)
- María Eva Pérez-López
- Department of Clinical Oncology, Orense Hospital Complex, and Department of Clinical Oncology, Santiago de Compostela University Hospital Complex, Spain
| | | | | | | |
Collapse
|
27
|
Abstract
Pharmacoeconomic analyses are being used with greater frequency in clinical oncology trials. These analyses provide guidelines for prioritizing competing interventions and allocating health care resources, particularly when deciding whether to use a drug with a higher acquisition cost. For liposomal anthracyclines, the competing treatments are other liposomal anthracyclines and nonliposomal chemotherapy agents with similar activity. Pharmacoeconomic analyses of data from clinical trials in patients with Kaposi's sarcoma determined that the overall cost to achieve objective response was substantially lower with pegylated liposomal doxorubicin (Doxil/Caelyx [PLD]) than with liposomal daunorubicin (DaunoXome [DNX]). Additional economic analyses in patients with ovarian cancer showed that PLD has lower overall treatment costs than topotecan because it is administered less frequently and requires fewer interventions for toxicity. The decision to allocate health care resources to liposomal anthracycline treatment must therefore include consideration of cost-effectiveness and potential cost savings owing to improved tolerability.
Collapse
Affiliation(s)
- Charles L Bennett
- Veterans Affairs Chicago Healthcare System-Lakeside, Institute of Health Services and Policy Studies, Northwestern University, Chicago, IL, USA.
| | | |
Collapse
|