1
|
Hatswell AJ, Burns D, Baio G, Wadelin F. Frequentist and Bayesian meta-regression of health state utilities for multiple myeloma incorporating systematic review and analysis of individual patient data. HEALTH ECONOMICS 2019; 28:653-665. [PMID: 30790379 DOI: 10.1002/hec.3871] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 10/31/2018] [Accepted: 12/28/2018] [Indexed: 06/09/2023]
Abstract
This analysis presents the results of a systematic review for health state utilities in multiple myeloma, as well as analysis of over 9,000 observations taken from registry and trial data. The 27 values identified from 13 papers are then synthesised in a frequentist nonparametric bootstrap model and a Bayesian meta-regression. Results were similar between the frequentist and Bayesian models with low utility on disease diagnosis (approximately 0.55), raising to approximately 0.65 on first line treatment and declining slightly with each subsequent line. Stem cell transplant was also found to be a significant predictor of health-related quality of life in both individual patient data and meta-regression, with an increased utility of approximately 0.06 across different models. The work presented demonstrates the feasibility of Bayesian methods for utility meta-regression, whilst also presenting an internally consistent set of data from the analysis of registry data. To facilitate easy updating of the data and model, data extraction tables and model code are provided as Data S1. The main limitations of the model relate to the low number of studies available, particularly in highly pretreated patients.
Collapse
Affiliation(s)
- Anthony J Hatswell
- Department of Statistical Science, University College London, London, UK
- Delta Hat Limited, University Nottingham University Hospital, Nottingham, UK
| | - Darren Burns
- BresMed, University Nottingham University Hospital, Sheffield, UK
| | - Gianluca Baio
- Department of Statistical Science, University College London, London, UK
| | | |
Collapse
|
2
|
Robin P, Kumar S, Salaun PY, Le Roux PY, Couturaud F, Planquette B, Merah A, Roy PM, Thavorn K, Le Gal G. In patients with unprovoked VTE, does the addition of FDG PET/CT to a limited occult cancer screening strategy offer good value for money? A cost-effectiveness analysis from the publicly funded health care systems. Thromb Res 2018; 171:97-102. [PMID: 30268859 DOI: 10.1016/j.thromres.2018.09.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/16/2018] [Accepted: 09/17/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Unprovoked venous thromboembolism (VTE) may be the first manifestation of an undiagnosed cancer. We assessed the cost-effectiveness of 18F-Fluorodesoxyglucose Positron Emission/Computed Tomography (FDG PET/CT) plus limited screening and limited screening strategies in patients with unprovoked VTE from the perspectives of the Ontario (Canada) and French health care systems. METHODS We conducted a cost-effectiveness analysis based on a published randomized controlled trial of 394 patients aged 18 years or older who were diagnosed with unprovoked VTE. We obtained data with respect to efficacy and health care utilization from the published trial. The primary measure of effectiveness was the number of avoided cases of delayed cancer diagnosis and the secondary measure of effectiveness was the quality adjusted life year (QALY) at the end of the study in each group. We used generalized linear models to estimate incremental cost-effectiveness ratios (ICER) while controlling for patient demographic and clinical characteristics. Results were presented as the incremental cost to avoid one case of delayed cancer diagnosis and the incremental cost per QALY gained. The 95% confidence intervals (CIs) were estimated using bootstrap re-sampling procedures with 5000 iterations. RESULTS Compared to a limited screening strategy, the ICER of limited strategy plus FDG PET/CT scan was C$ 26,840.19 (95% CI: C$ 24,046.51; C$ 34,581.53) per one avoided case of delayed cancer diagnosis from the Ontario health system perspective and €16,370.45 (95% CI: € 9904.48; € 39,578.91) per one avoided case of delayed cancer diagnosis from the French health system perspective. The probabilities that addition of FDG PET/CT to limited screening is cost-effective rose with increasing willingness to pay values. Compared with the limited screening, the extensive screening was associated with C$ 3412.85 per QALY gained (95% CI: 1463.89; -13,935.88) from the Ontario health system perspective and €2162.83 per QALY gained (95% CI 958.78; -10,544.42) from the French health system perspective. CONCLUSION Addition of a FDG PET/CT for occult cancer diagnosis was associated with better health outcomes (fewer cases of delayed cancer diagnosis and greater QALYs) and a higher cost from the perspective of publicly funded health care systems; the cost-effectiveness results are however highly uncertain.
Collapse
Affiliation(s)
- Philippe Robin
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Thrombosis Research Group, Ottawa, Canada; Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France; EA3878 GETBO, Université de Bretagne Occidentale, Brest, France.
| | - Srishti Kumar
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.
| | - Pierre-Yves Salaun
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France; EA3878 GETBO, Université de Bretagne Occidentale, Brest, France.
| | - Pierre-Yves Le Roux
- Service de Médecine Nucléaire, Centre Hospitalier Régional Universitaire de Brest, Brest, France; EA3878 GETBO, Université de Bretagne Occidentale, Brest, France.
| | - Francis Couturaud
- EA3878 GETBO, Université de Bretagne Occidentale, Brest, France; Département de Médecine Interne et Pneumologie, Centre Hospitalier Régional Universitaire de Brest, Brest, France.
| | - Benjamin Planquette
- Service de Pneumologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR-S 1140, Paris, France.
| | - Adel Merah
- Service de médecine vasculaire et thérapeutique, Inserm CIC 1408, Centre Hospitalier Universitaire de Saint-Etienne, Saint- Etienne, France.
| | - Pierre-Marie Roy
- Département de médecine d'urgences, Centre Hospitalo-Universitaire d'Angers, Angers, France.
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Institute of Clinical and Evaluative Sciences, Ottawa, Ontario, Canada.
| | - Grégoire Le Gal
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Thrombosis Research Group, Ottawa, Canada; EA3878 GETBO, Université de Bretagne Occidentale, Brest, France.
| |
Collapse
|