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Chang JYA, Chilcott JB, Latimer NR. Challenges and Opportunities in Interdisciplinary Research and Real-World Data for Treatment Sequences in Health Technology Assessments. PHARMACOECONOMICS 2024; 42:487-506. [PMID: 38558212 DOI: 10.1007/s40273-024-01363-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 04/04/2024]
Abstract
With an ever-increasing number of treatment options, the assessment of treatment sequences has become crucial in health technology assessment (HTA). This review systematically explores the multifaceted challenges inherent in evaluating sequences, delving into their interplay and nuances that go beyond economic model structures. We synthesised a 'roadmap' of literature from key methodological studies, highlighting the evolution of recent advances and emerging research themes. These insights were compared against HTA guidelines to identify potential avenues for future research. Our findings reveal a spectrum of challenges in sequence evaluation, encompassing selecting appropriate decision-analytic modelling approaches and comparators, deriving appropriate clinical effectiveness evidence in the face of data scarcity, scrutinising effectiveness assumptions and statistical adjustments, considering treatment displacement, and optimising model computations. Integrating methodologies from diverse disciplines-statistics, epidemiology, causal inference, operational research and computer science-has demonstrated promise in addressing these challenges. An updated review of application studies is warranted to provide detailed insights into the extent and manner in which these methodologies have been implemented. Data scarcity on the effectiveness of treatment sequences emerged as a dominant concern, especially because treatment sequences are rarely compared in clinical trials. Real-world data (RWD) provide an alternative means for capturing evidence on effectiveness and future research should prioritise harnessing causal inference methods, particularly Target Trial Emulation, to evaluate treatment sequence effectiveness using RWD. This approach is also adaptable for analysing trials harbouring sequencing information and adjusting indirect comparisons when collating evidence from heterogeneous sources. Such investigative efforts could lend support to reviews of HTA recommendations and contribute to synthesising external control arms involving treatment sequences.
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Affiliation(s)
- Jen-Yu Amy Chang
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - James B Chilcott
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Nicholas R Latimer
- Sheffield Centre for Health and Related Research (SCHARR), Division of Population Health, School of Medicine and Population Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
- Delta Hat Limited, Nottingham, UK
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2
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Gu YF, Lin FP, Epstein RJ. How aging of the global population is changing oncology. Ecancermedicalscience 2022; 15:ed119. [PMID: 35211208 PMCID: PMC8816510 DOI: 10.3332/ecancer.2021.ed119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Population aging is causing a demographic redistribution with implications for the future of healthcare. How will this affect oncology? First, there will be an overall rise in cancer affecting older adults, even though age-specific cancer incidences continue to fall due to better prevention. Second, there will be a wider spectrum of health functionality in this expanding cohort of older adults, with differences between “physiologically older” and “physiologically younger” patients becoming more important for optimal treatment selection. Third, greater teamwork with supportive care, geriatric, mental health and rehabilitation experts will come to enrich oncologic decision-making by making it less formulaic than it is at present. Success in this transition to a more nuanced professional mindset will depend in part on the development of user-friendly computational tools that can integrate a complex mix of quantitative and qualitative inputs from evidence-based medicine, functional and cognitive assessments, and the personal priorities of older adults.
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Affiliation(s)
- Yan Fei Gu
- New Hope Cancer Center, United Family Hospitals, 9 Jiangtai W Rd, Chaoyang, Beijing 100015, China
| | - Frank P Lin
- Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, Sydney 2010, Australia.,NH&MRC Clinical Trials Centre, 92 Parramatta Rd, Camperdown, Sydney 2050, Australia
| | - Richard J Epstein
- New Hope Cancer Center, United Family Hospitals, 9 Jiangtai W Rd, Chaoyang, Beijing 100015, China.,Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, Sydney 2010, Australia.,UNSW Clinical School, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney 2010, Australia.,https://orcid.org/0000-0002-4640-0195
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3
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Russell HV, Chi YY, Okcu MF, Bernhardt MB, Rodriguez-Galindo C, Gupta AA, Hawkins DS. Rising drug cost impacts on cost-effectiveness of 2 chemotherapy regimens for intermediate-risk rhabdomyosarcoma: A report from the Children's Oncology Group. Cancer 2022; 128:317-325. [PMID: 34623638 PMCID: PMC8738099 DOI: 10.1002/cncr.33917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/05/2021] [Accepted: 08/09/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Children's Oncology Group clinical trial for intermediate risk rhabdomyosarcoma randomized participants to a combination of vincristine, dactinomycin, and cyclophosphamide (VAC) alone or VAC alternating with vincristine plus irinotecan (VAC/VI). Clinical outcomes were similar, but toxicity profiles differed. This study estimates the cost differences between arms from the health care system's perspective. METHODS A decision-analytic model was used to estimate the incremental cost-effectiveness ratio (ICER) of VAC versus VAC/VI. Protocol-required or recommended medications and laboratory studies were included. Costs were obtained from national databases or supporting literature and inflated to 2019 US dollars. Demographic and outcome data were obtained from the clinical trial and directed chart reviews. Life-years (LY) were estimated from life-expectancy tables and discounted by 3% annually. Probabilistic sensitivity analyses and alternative clinical scenarios identified factors driving costs. RESULTS Mean direct medical costs of VAC and VAC/VI were $164,757 and $102,303, respectively. VAC was associated with an additional 0.97 LY and an ICER of $64,386/LY compared with VAC/VI. The ICER was sensitive to survival estimations and to alternative clinical scenarios including outpatient cyclophosphamide delivery (ICER $49,037/LY) or substitution of alternative hematopoietic growth factor schedules (ICER $73,191-$91,579/LY). Applying drug prices from 2012 decreased the total costs of VAC by 20% and VAC/VI by 15% because of changes in dactinomycin and pegfilgrastim prices. CONCLUSIONS Neither arm was clearly more cost-effective. Pharmaceutical pricing and location of treatment drove costs and may inform future treatment decisions. Rising pharmaceutical costs added $30,000 per patient, a finding important for future drug-pricing policy decisions. LAY SUMMARY Two chemotherapy regimens recently tested side-by-side for rhabdomyosarcoma had similar tumor outcomes, but different side effects. The health care costs of each regimen were compared; neither was clearly more cost-effective. However, the costs of each treatment changed dramatically with choices of supportive medicines and location of treatment. Costs of treatment rose by 15% to 20% because of rising US drug costs not associated with the clinical trial.
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Affiliation(s)
- Heidi V. Russell
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston Texas,Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston Texas
| | - Yueh-Yun Chi
- Department of Pediatrics and Preventative Medicine, University of Southern California, Los Angeles, California
| | - M. Fatih Okcu
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston Texas
| | | | | | | | - Douglas S. Hawkins
- Seattle Children’s Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington
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4
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Weymann D, Pollard S, Chan B, Titmuss E, Bohm A, Laskin J, Jones SJM, Pleasance E, Nelson J, Fok A, Lim H, Karsan A, Renouf DJ, Schrader KA, Sun S, Yip S, Schaeffer DF, Marra MA, Regier DA. Clinical and cost outcomes following genomics-informed treatment for advanced cancers. Cancer Med 2021; 10:5131-5140. [PMID: 34152087 PMCID: PMC8335838 DOI: 10.1002/cam4.4076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Single-arm trials are common in precision oncology. Owing to the lack of randomized counterfactual, resultant data are not amenable to comparative outcomes analyses. Difference-in-difference (DID) methods present an opportunity to generate causal estimates of time-varying treatment outcomes. Using DID, our study estimates within-cohort effects of genomics-informed treatment versus standard care on clinical and cost outcomes. METHODS We focus on adults with advanced cancers enrolled in the single-arm BC Cancer Personalized OncoGenomics program between 2012 and 2017. All individuals had a minimum of 1-year follow up. Logistic regression explored baseline differences across patients who received a genomics-informed treatment versus a standard care treatment after genomic sequencing. DID estimated the incremental effects of genomics-informed treatment on time to treatment discontinuation (TTD), time to next treatment (TTNT), and costs. TTD and TTNT correlate with improved response and survival. RESULTS Our study cohort included 346 patients, of whom 140 (40%) received genomics-informed treatment after sequencing and 206 (60%) received standard care treatment. No significant differences in baseline characteristics were detected across treatment groups. DID estimated that the incremental effect of genomics-informed versus standard care treatment was 102 days (95% CI: 35, 167) on TTD, 91 days (95% CI: -9, 175) on TTNT, and CAD$91,098 (95% CI: $46,848, $176,598) on costs. Effects were most pronounced in gastrointestinal cancer patients. CONCLUSIONS Genomics-informed treatment had a statistically significant effect on TTD compared to standard care treatment, but at increased treatment costs. Within-cohort evidence generated through this single-arm study informs the early-stage comparative effectiveness of precision oncology.
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Affiliation(s)
| | - Samantha Pollard
- Cancer Control ResearchBC CancerVancouverCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
| | | | - Emma Titmuss
- Canada's Michael Smith Genome Sciences CentreBC CancerVancouverCanada
| | - Alexandra Bohm
- Canada's Michael Smith Genome Sciences CentreBC CancerVancouverCanada
| | - Janessa Laskin
- Division of Medical OncologyBC CancerVancouverCanada
- Department of MedicineFaculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Steven J. M. Jones
- Canada's Michael Smith Genome Sciences CentreBC CancerVancouverCanada
- Department of Medical GeneticsFaculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Erin Pleasance
- Canada's Michael Smith Genome Sciences CentreBC CancerVancouverCanada
| | - Jessica Nelson
- Canada's Michael Smith Genome Sciences CentreBC CancerVancouverCanada
| | - Alexandra Fok
- Canada's Michael Smith Genome Sciences CentreBC CancerVancouverCanada
| | - Howard Lim
- Division of Medical OncologyBC CancerVancouverCanada
- Department of MedicineFaculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Aly Karsan
- Canada's Michael Smith Genome Sciences CentreBC CancerVancouverCanada
- Division of Medical OncologyBC CancerVancouverCanada
- Department of Pathology & Laboratory MedicineFaculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Daniel J. Renouf
- Division of Medical OncologyBC CancerVancouverCanada
- Department of MedicineFaculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Kasmintan A. Schrader
- Department of Medical GeneticsFaculty of MedicineUniversity of British ColumbiaVancouverCanada
- Department of Molecular OncologyBC CancerVancouverCanada
- Hereditary Cancer ProgramBC CancerVancouverCanada
| | - Sophie Sun
- Division of Medical OncologyBC CancerVancouverCanada
- Department of MedicineFaculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Stephen Yip
- Department of Pathology & Laboratory MedicineFaculty of MedicineUniversity of British ColumbiaVancouverCanada
- Department of PathologyBC CancerVancouverCanada
| | - David F. Schaeffer
- Division of Anatomical PathologyVancouver General HospitalUniversity of British ColumbiaVancouverCanada
| | - Marco A. Marra
- Canada's Michael Smith Genome Sciences CentreBC CancerVancouverCanada
- Department of Medical GeneticsFaculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Dean A. Regier
- Cancer Control ResearchBC CancerVancouverCanada
- School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
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Okwundu N, Grossman D, Hu-Lieskovan S, Grossmann KF, Swami U. The dark side of immunotherapy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1041. [PMID: 34277841 PMCID: PMC8267325 DOI: 10.21037/atm-20-4750] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/28/2020] [Indexed: 12/13/2022]
Abstract
Immunotherapy has broadened the therapeutic scope and response for many cancer patients with drugs that are generally of higher efficacy and less toxicity than prior therapies. Multiple classes of immunotherapies such as targeted antibodies and immune checkpoint inhibitors (ICI), cell-based immunotherapies, immunomodulators, vaccines, and oncolytic viruses have been developed to help the immune system target and destroy malignant tumors. ICI targeting programmed cell death protein-1 (PD-1) or its ligand (PD-L1) are among the most effective immunotherapy agents and are a major focus of current investigations. They have received approval for at least 16 different tumor types as well as for unresectable or metastatic tumors with microsatellite instability-high (MSI-H) or mismatch repair deficiency or with high tumor mutational burden (defined as ≥10 mutations/megabase). However, it is important to recognize that immunotherapy may be associated with significant adverse events. To summarize these events, we conducted a PubMed and Google Scholar database search through April 2020 for manuscripts evaluating treatment-related adverse events and knowledge gaps associated with the use of immunotherapy. Reviewed topics include immune-related adverse events (irAEs), toxicities on combining immunotherapy with other agents, disease reactivation such as tuberculosis (TB) and sarcoid-like granulomatosis, tumor hyperprogression (HPD), financial toxicity, challenges in special patient populations such as solid organ transplant recipients and those with auto-immune diseases. We also reviewed reports of worse or even lethal outcomes compared to other oncologic therapies in certain scenarios and summarized biomarkers predicting adverse events.
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Affiliation(s)
- Nwanneka Okwundu
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Douglas Grossman
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Siwen Hu-Lieskovan
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Kenneth F Grossmann
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Umang Swami
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA
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6
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Comparing Manufacturer Submitted and Pan-Canadian Oncology Drug Review Reanalysed Incremental Cost-Effectiveness Ratios for Novel Oncology Drugs. ACTA ACUST UNITED AC 2021; 28:606-618. [PMID: 33498460 PMCID: PMC7924399 DOI: 10.3390/curroncol28010060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/24/2020] [Accepted: 01/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND To determine the magnitude of difference between manufacturer-submitted and pan-Canadian Oncology Drug Review (pCODR) calculated incremental cost-effectiveness ratios (ICERs), incremental cost (ΔC), and incremental effectiveness (ΔE); to examine whether there is a significant difference in the proportion of ICERs deemed cost-effective; to evaluate trends in the ICERs over time; and to identify methodological issues in manufacturer-submitted economic models. METHODS Economic guidance reports for all drug indications submitted from July 2011-November 2018 were extracted from the pCODR database. Cumulative distribution plots were constructed to compare the manufacturer-submitted economic values with both the pCODR lower- and upper-reanalyzed estimates. The proportion of drug reviews considered cost-effective at varying willingness-to-pay (WTP) thresholds by the manufacturer and pCODR were calculated. Manufacturer changes in ICERs over time from 2012 to 2018 were determined. Recurring methodological issues with manufacturer submissions were tallied. RESULTS There were 73 unique indications that were included. Manufacturer-submitted ICERs were consistently lower than pCODR estimates for most indications. Manufacturer-submitted ICERs were generally more cost-effective over a range of WTP thresholds. From 2012 to 2018, manufacturer and economic guidance panel (EGP) lower limit reanalyzed ICERs did not change significantly over time. However, EGP upper limit re-analyses did show decreasing cost-effectiveness (increasing ICERs). The two most common issues identified in the manufacturer-submitted models were related to survival time horizon and utility estimates. CONCLUSIONS Manufacturers tend to overestimate the cost-effectiveness of their therapies when submitting economic models to pCODR. Although certain methodological issues are still common in manufacturer-submitted models, revision rates are high for most issues raised by pCODR.
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Mozessohn L, Cheung MC, Mittmann N, Earle CC, Liu N, Buckstein R. Real-World Costs of Azacitidine Treatment in Patients With Higher-Risk Myelodysplastic Syndromes/Low Blast-Count Acute Myeloid Leukemia. JCO Oncol Pract 2020; 17:e517-e525. [PMID: 32956005 DOI: 10.1200/op.20.00446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Azacitidine (AZA) is a standard of care for higher-risk myelodysplastic syndrome (MDS)/low blast-count acute myeloid leukemia (AML). Despite this, there is a paucity of data on the real-world health care resource utilization costs of AZA in this population. METHODS We linked the Ontario AZA MDS registry-higher-risk MDS/low blast-count AML-to population-based health system administrative databases. Patients were observed for 24 months after first AZA and censored at the earliest of 90 days after last AZA, date of death, time of AML induction/stem-cell transplantation, or March 31, 2016. Costs (2015 Canadian dollars) were expressed as standardized mean and median 28-day costs. Univariable quantile regression was used to explore the association of baseline patient and disease characteristics and median cost. Multivariable quantile regression was used to explore predictors of median costs. RESULTS Among 877 patients in the registry, mean standardized 28-day cost per patient was $17,638 (median, $15,272; interquartile range [IQR], $11,869-$19,580) and $13,450 (median, $11,043; IQR, $7,981-$14,882) excluding the cost of AZA. Major nondrug drivers of cost were cancer clinic visits and inpatient care (mean standardized 28-day cost, $4,631; median, $1,558; IQR, $238-$4,961). Transfusion dependence at AZA initiation (P = .001) and greater comorbid disease burden (P = .009) were independently associated with increased cost. CONCLUSION Our cohort of patients with uniformly higher-risk MDS/low blast-count AML treated with AZA demonstrates substantial costs of care above and beyond the cost of AZA alone. These results provide insight into the costs of AZA in the real world with implications for resource allocation.
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Affiliation(s)
- Lee Mozessohn
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Matthew C Cheung
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Nicole Mittmann
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, and Institute for Health, Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Craig C Earle
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Rena Buckstein
- Division of Hematology/Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Cheng S, Cheung MC, Jiang DM, McDonald E, Arciero VS, Ezeife DA, Rahmadian A, Chambers A, Sabarre KA, Parmar A, Chan KKW. Are Surrogate Endpoints Unbiased Metrics in Clinical Benefit Scores of the ASCO Value Framework? J Natl Compr Canc Netw 2020; 17:1489-1496. [PMID: 31805528 DOI: 10.6004/jnccn.2019.7333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 06/18/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clinical benefit scores (CBS) are key elements of the ASCO Value Framework (ASCO-VF) and are weighted based on a hierarchy of efficacy endpoints: hazard ratio for death (HR OS), median overall survival (mOS), HR for disease progression (HR PFS), median progression-free survival (mPFS), and response rate (RR). When HR OS is unavailable, the other endpoints serve as "surrogates" to calculate CBS. CBS are computed from PFS or RR in 39.6% of randomized controlled trials. This study examined whether surrogate-derived CBS offer unbiased scoring compared with HR OS-derived CBS. METHODS Using the ASCO-VF, CBS for advanced disease settings were computed for randomized controlled trials of oncology drug approvals by the FDA, European Medicines Agency, and Health Canada in January 2006 through December 2017. Mean differences of surrogate-derived CBS minus HR OS-derived CBS assessed the tendency of surrogate-derived CBS to overestimate or underestimate clinical benefit. Spearman's correlation evaluated the association between surrogate- and HR OS-derived CBS. Mean absolute error assessed the average difference between surrogate-derived CBS relative to HR OS-derived CBS. RESULTS CBS derived from mOS, HR PFS, mPFS, and RR overestimated HR OS-derived CBS in 58%, 68%, 77%, and 55% of pairs and overall by an average of 5.62 (n=90), 6.86 (n=110), 29.81 (n=101), and 3.58 (n=108), respectively. Correlation coefficients were 0.80 (95% CI, 0.70-0.86), 0.38 (0.20-0.53), 0.20 (0.00-0.38), and 0.01 (-0.18 to 0.19) for mOS-, HR PFS-, mPFS-, and RR-derived CBS, respectively, and mean absolute errors were 11.32, 12.34, 40.40, and 18.63, respectively. CONCLUSIONS Based on the ASCO-VF algorithm, HR PFS-, mPFS-, and RR-derived CBS are suboptimal surrogates, because they were shown to be biased and poorly correlated to HR OS-derived CBS. Despite lower weighting than OS in the ASCO-VF algorithm, PFS still overestimated CBS. Simple rescaling of surrogate endpoints may not improve their validity within the ASCO-VF given their poor correlations with HR OS-derived CBS.
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Affiliation(s)
- Sierra Cheng
- aOdette Cancer Centre, Sunnybrook Health Sciences Centre, and
| | - Matthew C Cheung
- aOdette Cancer Centre, Sunnybrook Health Sciences Centre, and.,bDepartment of Medicine, University of Toronto
| | | | - Erica McDonald
- aOdette Cancer Centre, Sunnybrook Health Sciences Centre, and
| | | | | | | | | | | | - Ambika Parmar
- aOdette Cancer Centre, Sunnybrook Health Sciences Centre, and
| | - Kelvin K W Chan
- aOdette Cancer Centre, Sunnybrook Health Sciences Centre, and.,bDepartment of Medicine, University of Toronto.,dCanadian Centre for Applied Research in Cancer Control, Toronto, Ontario, Canada
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Bentley C, Sundquist S, Dancey J, Peacock S. Barriers to conducting cancer trials in Canada: an analysis of key informant interviews. ACTA ACUST UNITED AC 2020; 27:e307-e312. [PMID: 32669937 DOI: 10.3747/co.27.5707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background In Canada, there is growing evidence that oncology clinical trials units (ctus) and programs face serious financial challenges. Investment in cancer research in Canada has declined almost 20% in the 5 years since its peak in 2011, and the costs of conducting leading-edge trials are rising. Clinical trials units must therefore be strategic about which studies they open. We interviewed Canadian health care professionals responsible for running cancer trials programs to identify the barriers to sustainability that they face. Methods One-on-one telephone interviews were conducted with clinicians and clinical research professionals at oncology ctus in Canada. We asked for their perspectives about the barriers to conducting trials at their institutions, in their provinces, and nationwide. Interviews were digitally recorded, transcribed, anonymized, and coded in the NVivo software application (version 11: QSR International, Melbourne, Australia). The initial coding structure was informed by the interview script, with new concepts drawn out and coded during analysis, using a constant comparative approach. Results Between June 2017 and November 2018, 25 interviews were conducted. Key barriers that participants identified were■ insufficient stable funding to support trials infrastructure and retain staff;■ the need to adopt strict cost-recovery policies, leading to fewer academic trials in portfolios; and■ an overreliance on industry to fund clinical research in Canada. Conclusions Funding uncertainties have led ctus to increasingly rely on industry sponsorship and more stringent feasibility thresholds to remain solvent. Retaining skilled trials staff can create efficiencies in opening and running studies, with spillover effects of more trials being open to patients. More academic studies are needed to curb industry's influence.
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Affiliation(s)
- C Bentley
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC.,Department of Cancer Control Research, BC Cancer, Vancouver, BC
| | - S Sundquist
- Canadian Cancer Clinical Trials Network, Toronto, ON.,Ontario Institute for Cancer Research, Toronto, ON
| | - J Dancey
- Canadian Cancer Clinical Trials Network, Toronto, ON.,Ontario Institute for Cancer Research, Toronto, ON.,Department of Oncology, School of Medicine, Queens University, Kingston, ON.,Canadian Cancer Trials Group, Kingston, ON
| | - S Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC.,Department of Cancer Control Research, BC Cancer, Vancouver, BC.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
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10
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Affiliation(s)
- Steven G Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Suerie Moon
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
- Harvard T H Chan School of Public Health, Boston, MA, USA
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Abstract
Introduction: More than 8 times as many new cancer drugs were approved during 2005-2015 as were approved during 1975-1985 (66 vs. 8). The average annual 2010-2014 growth rate of U.S. cancer drug expenditure was 7.6%. This has contributed to a lively debate about the value and cost-effectiveness of new cancer drugs.Areas covered: We assess the average cost-effectiveness in the U.S. in 2014 of new cancer drugs approved by the FDA during 2000-2014, by performing an original econometric investigation (rather than a literature review) of whether there were larger declines in premature mortality and hospitalization, and larger increases in survival, from the cancers that had larger increases in the number of drugs ever approved, controlling for the change in cancer incidence and mean age at time of diagnosis.Expert opinion: Cancer drugs approved during 2000-2014 are estimated to have reduced the number of potential years of life lost before age 75 in 2014 by 719,133. Cancer drugs approved during 1989-2005 are estimated to have reduced hospital cost in 2013 by $4.8 billion. Our baseline estimate of the cost per life-year gained in 2014 from cancer drugs approved during 2000-2014 is $7853.
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Affiliation(s)
- Frank R Lichtenberg
- Courtney C. Brown Professor of Business, Columbia University, New York, NY, USA.,Graduate School of Business, National Bureau of Economic Research, Cambridge, MA, USA
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12
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Gotfrit J, Shin JJ, Mallick R, Stewart DJ, Wheatley‐Price P. Potential Life-Years Lost: The Impact of the Cancer Drug Regulatory and Funding Process in Canada. Oncologist 2020; 25:e130-e137. [PMID: 31506392 PMCID: PMC6964142 DOI: 10.1634/theoncologist.2019-0314] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/06/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Canada has an established publicly funded health care system with a complex drug approval and funding process. After proof of efficacy (POE; key publication/presentation) and before becoming publicly accessible, each drug undergoes a Health Canada approval process, a health technology assessment (HTA), a pricing negotiation, and finally individual provincial funding agreements. We quantified potential life-years lost during this process. METHODS We analyzed drugs for advanced lung, breast, and colorectal cancer that underwent the HTA process between 2011 and 2016. Life-years lost were calculated by multiplying documented improvement in progression-free and overall survival, number of eligible patients, and time from POE to first public funding. For conservative calculation, we assumed all eligible patients in Canada had access at the time of first public funding, whereas in reality provinces fund at different time points. RESULTS We analyzed 21 drugs. Of these, 15 have been funded publicly. The time from POE to first public funding ranged from 14.0 to 99.2 months (median 26.6 months). Total overall life-years lost from POE to first public funding were 39,067 (lung 32,367; breast 6,691). Progression-free life-years lost from POE to first public funding were 48,037 (lung 9,139, breast 15,827, colorectal 23,071). CONCLUSION The number of potential life-years lost during the drug regulatory and funding process in Canada is substantial, largely driven by delays to funding of colorectal cancer drugs. Recognizing that interprovincial differences exist and that eligible patients may not all receive a given drug, if even a fraction does so, the impact of delays remains substantive. Collaborative national initiatives are required to address this major barrier to treatment access. IMPLICATIONS FOR PRACTICE Patients may spend lengthy periods of time awaiting access to new and effective cancer drugs. Patients with private drug insurance or personal funds or who reside in certain Canadian provinces may obtain some drugs sooner than others, potentially creating a two-tiered access system. The cancer drug access and public funding system must be expedited to improve equity.
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Affiliation(s)
- Joanna Gotfrit
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre and the University of OttawaOttawaOntarioCanada
| | | | | | - David J. Stewart
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre and the University of OttawaOttawaOntarioCanada
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Paul Wheatley‐Price
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre and the University of OttawaOttawaOntarioCanada
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
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13
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Teramae F, Yamaguchi N, Makino T, Sengoku S, Kodama K. Holistic cost-effectiveness analysis of anticancer drug regimens in Japan. Drug Discov Today 2019; 25:269-273. [PMID: 31782999 DOI: 10.1016/j.drudis.2019.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/08/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
Japan officially introduced cost-effectiveness analysis (CEA) in 2019, whereas some countries, such as England, Sweden, Canada, and Australia, have experience with health technology assessment (HTA). Therefore, there are few reports that comprehensively examine the situation of health economic evaluation in Japan. In this paper, we review the health economic evaluation systems among those countries. We also conducted a case study that investigated the time-trend of cost, effectiveness, and incremental cost-effectiveness ratio (ICER) for anticancer drug regimens in Japan. We found a time-trend ICER for breast cancer (BC). Additionally, molecular targeting drugs for BC had a positive effect on the ICER, and both small molecular-targeting drugs and monoclonal antibodies (mAb) had a higher ICER for BC compared with conventional drugs. Finally, we discuss a possible way to implement a health economic evaluation system in Japan.
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Affiliation(s)
- Fumio Teramae
- Graduate School of Technology Management, Ritsumeikan University, Osaka, Japan; Eli Lilly Japan, Tokyo, Japan.
| | - Naoya Yamaguchi
- Graduate School of Technology Management, Ritsumeikan University, Osaka, Japan; Novartis Pharma, Tokyo, Japan
| | - Tomohiro Makino
- Graduate School of Technology Management, Ritsumeikan University, Osaka, Japan
| | - Shintaro Sengoku
- School of Environment and Society, Tokyo Institute of Technology, Tokyo, Japan
| | - Kota Kodama
- Graduate School of Technology Management, Ritsumeikan University, Osaka, Japan.
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14
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Peacock SJ, Regier DA, Raymakers AJN, Chan KKW. Evidence, values, and funding decisions in Canadian cancer systems. Healthc Manage Forum 2019; 32:293-298. [PMID: 31645144 DOI: 10.1177/0840470419870831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Expenditure on cancer therapies is rising rapidly in many countries, particularly for cancer drugs. In recent years, this has stimulated a global debate among the public, patients, clinicians, decision-makers, and the pharmaceutical industry on value, affordability, and sustainability propositions relating to cancer therapies. In this article, we discuss some recent developments in evidence-based approaches to priority setting and resource allocation in Canadian cancer systems. These developments include new methods for deliberative public engagement, generating and using real-world evidence, multi-criteria decision analysis, and handling uncertainty with evidence for gene therapies.
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Affiliation(s)
- Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam J N Raymakers
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Kelvin K W Chan
- Canadian Centre for Applied Research in Cancer Control (ARCC), Vancouver, British Columbia, Canada
- Cancer Care Ontario, Toronto, Ontario, Canada
- Sunnybrook Hospital Research Institute, Toronto, Ontario, Canada
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15
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Ye K, Xu C, Hui T. MiR-34b inhibits the proliferation and promotes apoptosis in colon cancer cells by targeting Wnt/β-catenin signaling pathway. Biosci Rep 2019; 39:BSR20191799. [PMID: 31467172 PMCID: PMC6822525 DOI: 10.1042/bsr20191799] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/16/2019] [Accepted: 07/24/2019] [Indexed: 12/18/2022] Open
Abstract
Colon cancer is one of the leading cause of cancer deaths that is severely threatening human health. Several microRNAs (miRNAs) have been found to be associated with the tumor genesis of colon cancer. The present study determined the expression of miR-34b in patients with colon cancer and studied the molecular mechanism of miR-34b in the proliferation and apoptosis of human colon cancer Caco-2 cells in vitro. In colon cancer patients, the expression of miR-34b was decreased in tumor tissues when compared with the adjacent non-tumor tissues. Furthermore, overexpression of miR-34b inhibited proliferation, migration and invasion, while promoted apoptosis in colon cancer cells. The online bioinformatics sites predicted possible regulatory genes of miR-34b and luciferase reporter assay verify that β-catenin was a direct target of miR-34b. Furthermore, miR-34b overexpression significantly decreased the expression of genes associated with Wnt/β-catenin signaling pathway. In conclusion, our results suggest that miR-34b may inhibit migration and invasion of human colon cancer cells by regulating Wnt/β-catenin signaling and miR-34b may be a key target for the treatment and diagnosis of colon cancer.
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Affiliation(s)
- Kailun Ye
- Department of Surgery, First People’s Hospital of Tonglu, Hangzhou 311500, Zhejiang, China
| | - Chunhua Xu
- Department of Surgery, First People’s Hospital of Tonglu, Hangzhou 311500, Zhejiang, China
| | - Tongguan Hui
- Department of Surgery, First People’s Hospital of Tonglu, Hangzhou 311500, Zhejiang, China
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16
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Public perspectives on disinvestments in drug funding: results from a Canadian deliberative public engagement event on cancer drugs. BMC Public Health 2019; 19:977. [PMID: 31331312 PMCID: PMC6647147 DOI: 10.1186/s12889-019-7303-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 07/10/2019] [Indexed: 11/16/2022] Open
Abstract
Background Decisions relating to the funding of new drugs are becoming increasingly challenging due to a combination of aging populations, rapidly increasing list prices, and greater numbers of drug-indication pairs being brought to market. This is especially true in cancer, where rapid list price inflation is coupled with steeply rising numbers of incident cancer cases. Within a publicly funded health care system, there is increasing recognition that resource allocation decisions should consider the reassessment of, and potential disinvestment from, currently funded interventions alongside new investments. Public input into the decision-making process can help legitimize the outcomes and ensure priority-setting processes are aligned with public priorities. Methods In September 2014, a public deliberation event was held in Vancouver, Canada, to obtain public input on the topic of cancer drug funding. Twenty-four members of the general public were tasked with making collective recommendations for policy-makers about the principles that should guide funding decisions for cancer drugs in the province of British Columbia. Deliberative questions and decision aids were used to elicit individuals’ willingness to make trade-offs between expenditures and health outcomes. Results Participants discussed the implications of disinvestment decisions from cancer drugs in terms of its impact on patient choice, fairness and quality of life. Their discussions indicate that in order for a decision to disinvest from currently-funded cancer drugs to be acceptable, it must align with three main principles: the decision must be accompanied by significant gains, described both in terms of cost savings and opportunities to re-invest elsewhere in the health care system; those who are currently prescribed a cancer drug should be allowed to continue their course of treatment (referred to as a continuance clause, or “grandfathering” approach); and it must consider how access to care for specialized populations is impacted. Conclusions The results from this deliberation event provide insight into what is acceptable to British Columbians with respect to disinvestment decisions for cancer drugs. These recommendations can be considered within wider health system decision-making frameworks for funding decisions relating to all drugs, as well as for cancer drugs.
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17
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Costa S, Scott DW, Steidl C, Peacock SJ, Regier DA. Real-world costing analysis for diffuse large B-cell lymphoma in British Columbia. ACTA ACUST UNITED AC 2019; 26:108-113. [PMID: 31043812 DOI: 10.3747/co.26.4565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Diffuse large B-cell lymphoma (dlbcl) accounts for 30%-40% of all non-Hodgkin lymphomas. Approximately 60% of patients are cured with standard treatment. Targeted treatments are being investigated and might improve disease outcomes; however, their effect on cancer drug budgets will be significant. For the present study, we conducted an analysis of real-world costs for dlbcl patients treated in British Columbia, useful for health care system planning. Methods Patient records from a retrospective cohort of patients diagnosed with dlbcl in British Columbia during 2004-2013 were anonymously linked across multiple administrative data sources: systemic therapy, radiotherapy, hospitalizations, oncologist services, outpatient medications, and fee-for-service physician services. Using generalized linear modelling regression, time-dependent costs (in 2015 Canadian dollars) were estimated in 6-month intervals over a 5-year period. The inverse probability weighting method was applied to account for censored observations. Nonparametric bootstrapping was used to estimate standard errors for the mean cost at each time interval. Results The cohort consisted of 678 patients (5-year overall survival: 67%). Mean age at diagnosis was 64 ± 14 years; median follow-up was 3.2 years. Mean total cost of care was highest in the first 6 months after diagnosis ($29,120; 95% confidence interval: $28,986 to $29,170) and after disease progression ($18,480; 95% confidence interval: $15,187 to $24,772). Systemic therapy and hospitalization costs were the largest cost drivers. At each time interval, costs were observed to be positively skewed. Conclusions Our results depict real-world costs for the treatment of dlbcl patients with standard chop-r therapy. Cost-model parameters are also provided for economic modelling of dlbcl interventions.
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Affiliation(s)
- S Costa
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC.,Cancer Control Research, BC Cancer, Vancouver, BC
| | - D W Scott
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC.,Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - C Steidl
- Centre for Lymphoid Cancer, BC Cancer, Vancouver, BC.,Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - S J Peacock
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC.,Cancer Control Research, BC Cancer, Vancouver, BC.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
| | - D A Regier
- Canadian Centre for Applied Research in Cancer Control, Vancouver, BC.,Cancer Control Research, BC Cancer, Vancouver, BC.,School of Population and Public Health, University of British Columbia, Vancouver, BC
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18
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Zheng X, Chen L, Zhou Y, Wang Q, Zheng Z, Xu B, Wu C, Zhou Q, Hu W, Wu C, Jiang J. A novel protein encoded by a circular RNA circPPP1R12A promotes tumor pathogenesis and metastasis of colon cancer via Hippo-YAP signaling. Mol Cancer 2019; 18:47. [PMID: 30925892 PMCID: PMC6440158 DOI: 10.1186/s12943-019-1010-6] [Citation(s) in RCA: 307] [Impact Index Per Article: 61.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background It has been well established that circular RNAs (circRNAs) play an important regulatory role during tumor progression. Recent studies have indicated that even though circRNAs generally regulate gene expression through miRNA sponges, they may encode small peptides in tumor pathogenesis. However, it remains largely unexplored whether circRNAs are involved in the tumorigenesis of colon cancer (CC). Methods The expression profiles of circRNAs in CC tissues were assessed by circRNA microarray. Quantitative real-time PCR, RNase R digestion assay and tissue microarray were used to confirm the existence and expression pattern of circPPP1R12A. The subcellular distribution of circPPP1R12A was analyzed by nuclear mass separation assay and fluorescence in situ hybridization (FISH). SDS-PAGE and LC/MS were employed to evaluate the protein-coding ability of circPPP1R12A. CC cells were stably transfected with lentivirus approach, and cell proliferation, migration and invasion, as well as tumorigenesis and metastasis in nude mice were assessed to clarify the functional roles of circPPP1R12A and its encoded protein circPPP1R12A-73aa. RNA-sequencing and Western blotting analysis were furthered employed to identify the critical signaling pathway regulated by circPPP1R12A-73aa. Results We firstly screened the expression profiles of human circRNAs in CC tissues and found that the expression of hsa_circ_0000423 (termed as circPPP1R12A) was significantly increased in CC tissues. We also found that circPPP1R12A was mostly localized in the cytoplasm of CC cells. Kaplan–Meier analysis showed that patients with higher levels of circPPP1R12A had a significantly shorter overall survival. By gain- and loss-of-function approaches, the results suggested that circPPP1R12A played a critical role in proliferation, migration and invasion of CC cells. Furthermore, we showed that circPPP1R12A carried an open reading frame (ORF), which encoded a functional protein (termed as circPPP1R12A-73aa). Next, we found that PPP1R12A-C, not circPPP1R12A, promoted the proliferation, migration and invasion abilities of CC in vitro and in vivo. Finally, we identified that circPPP1R12A-73aa promoted the growth and metastasis of CC via activating Hippo-YAP signaling pathway. In addition, the YAP specific inhibitor Peptide 17 dramatically alleviated the promotive effect of circPPP1R12A-73aa on CC cells. Conclusions In the present study, we illustrated the coding-potential of circRNA circPPP1R12A in the progression of CC. Moreover, we identified that circPPP1R12A-73aa promoted the tumor pathogenesis and metastasis of CC via activating Hippo-YAP signaling pathway. Our findings might provide valuable insights into the development of novel potential therapeutic targets for CC. Electronic supplementary material The online version of this article (10.1186/s12943-019-1010-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiao Zheng
- Department of Tumor Biological Treatment, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China.,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, People's Republic of China.,Institute of Cell Therapy, Soochow University, Changzhou, 213003, People's Republic of China
| | - Lujun Chen
- Department of Tumor Biological Treatment, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China.,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, People's Republic of China.,Institute of Cell Therapy, Soochow University, Changzhou, 213003, People's Republic of China
| | - You Zhou
- Department of Tumor Biological Treatment, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China.,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, People's Republic of China.,Institute of Cell Therapy, Soochow University, Changzhou, 213003, People's Republic of China
| | - Qi Wang
- Department of Tumor Biological Treatment, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China.,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, People's Republic of China.,Institute of Cell Therapy, Soochow University, Changzhou, 213003, People's Republic of China
| | - Zhuojun Zheng
- Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, People's Republic of China.,Department of Hematology, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China
| | - Bin Xu
- Department of Tumor Biological Treatment, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China.,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, People's Republic of China.,Institute of Cell Therapy, Soochow University, Changzhou, 213003, People's Republic of China
| | - Chen Wu
- Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, People's Republic of China.,Institute of Cell Therapy, Soochow University, Changzhou, 213003, People's Republic of China.,Department of Oncology, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China
| | - Qi Zhou
- Department of Oncology, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China
| | - Wenwei Hu
- Department of Tumor Biological Treatment, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China.,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, People's Republic of China.,Department of Oncology, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China
| | - Changping Wu
- Department of Tumor Biological Treatment, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China.,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, People's Republic of China.,Department of Oncology, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China
| | - Jingting Jiang
- Department of Tumor Biological Treatment, the Third Affiliated Hospital of Soochow University, Changzhou, 213003, People's Republic of China. .,Jiangsu Engineering Research Center for Tumor Immunotherapy, Changzhou, 213003, People's Republic of China. .,Institute of Cell Therapy, Soochow University, Changzhou, 213003, People's Republic of China.
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Bentley C, Peacock S, Abelson J, Burgess MM, Demers-Payette O, Longstaff H, Tripp L, Lavis JN, Wilson MG. Addressing the affordability of cancer drugs: using deliberative public engagement to inform health policy. Health Res Policy Syst 2019; 17:17. [PMID: 30732616 PMCID: PMC6367823 DOI: 10.1186/s12961-019-0411-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health system expenditure on cancer drugs is rising rapidly in many OECD countries given the costly new treatments and increased rates of use due to a growing and ageing population. These factors put considerable strain on the sustainability of health systems worldwide, sparking public debate among clinicians, pharmaceutical companies, policy-makers and citizens on issues of affordability and equity. We engaged Canadians through a series of deliberative public engagement events to determine their priorities for making cancer drug funding decisions fair and sustainable in Canada's publicly financed health system. METHODS An approach to deliberation was developed based on the McMaster Health Forum's citizen panels and the established Burgess and O'Doherty model of deliberative public engagement. Six deliberations were held across Canada in 2016. Transcripts were coded in NVivo and analysed to determine where participants' views converged and diverged. Recommendations were grouped thematically. RESULTS A total of 115 Canadians participated in the deliberative events and developed 86 recommendations. Recommendations included the review and regular re-review of approved drugs using 'real-world' evidence on effectiveness and cost-effectiveness; prioritisation of treatments that restore patients' independence, mental health and general well-being; ensuring that decision processes, results and their rationales are transparent; and commitment to people with similar needs receiving the same care regardless of where in Canada they live. CONCLUSIONS The next steps for policy-makers should be to develop mechanisms for (1) re-reviewing effectiveness and cost-effectiveness data for all cancer drugs; (2) making disinvestments in cancer drugs that satisfy requirements relating to grandfathering and compassionate access; (3) ensuring fair and equitable access to cancer drugs for all Canadians; and (4) fostering a pan-Canadian approach to cancer drug funding decisions.
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Affiliation(s)
- Colene Bentley
- Canadian Centre for Applied Research in Cancer Control (ARCC), 675 West 10th Avenue, Vancouver, British Columbia, V5Z 1L3, Canada.
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), 675 West 10th Avenue, Vancouver, British Columbia, V5Z 1L3, Canada
| | - Julia Abelson
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West (CRL 203), Hamilton, Ontario, L8S 4K1, Canada
| | - Michael M Burgess
- School of Population and Public Health, University of British Columbia, 239 RHS, 1088 Discovery Avenue, Kelowna, British Columbia, V1V 1V7, Canada
| | - Olivier Demers-Payette
- Institute National d'Excellence en Santé et en Services Sociaux (INESSS), 2021 avenue Union, 12th Floor, bureau 1200, Montreal, Quebec, H3A 2S9, Canada
| | - Holly Longstaff
- Engage Associates Consulting Firm, Vancouver, British Columbia, Canada
| | - Laura Tripp
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West (CRL 203), Hamilton, Ontario, L8S 4K1, Canada
| | - John N Lavis
- McMaster Health Forum, 1280 Main Street West, MML-417, Ontario, Hamilton, L8S 4L6, Canada
| | - Michael G Wilson
- McMaster Health Forum, 1280 Main Street West, MML-417, Ontario, Hamilton, L8S 4L6, Canada
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Francois C, Zhou J, Pochopien M, Achour L, Toumi M. Oncology from an HTA and Health Economic Perspective. Recent Results Cancer Res 2019; 213:25-38. [PMID: 30543005 DOI: 10.1007/978-3-030-01207-6_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In this chapter, we will present and discuss the challenges of assessing oncology products from a health economic perspective. We will provide a brief introduction on the need for economic evaluation in health care and focus on cost-effectiveness and comparative aspects of the evaluation of oncology products, which are of paramount interest to HTA decision-making bodies using economic evaluation in their decision-making framework. As the burden of oncology is well-documented, we do not discuss it in detail here. Before we address the specific issue of oncology, we will briefly define the critical aspects of HTA assessment and also define what a cost-effectiveness analysis is and why economic modelling is the most appropriate tool to assess the cost-effectiveness of oncology products. We will touch upon the prices of oncology drugs and the questions that high prices raise regarding funding and availability. We then present an overview of the general structure of an oncology cost-effectiveness model. Usually, this is quite simple, representing response, progression, advanced-stage disease and death. Despite the relative simplicity of these models, some issues may render the evaluation more complex; we will touch upon these in this chapter: Issue with clinical inputs due to the design of randomised clinical trials (e.g. cross-over designs involving a treatment switch) Need for survival extrapolation and limitations of current parametric models Rare conditions with limited economic and comparative evidence available High pace of clinical development Finally, we will conclude with a discussion of the uncertainty around the evaluation of oncology products and the major evolution expected in health economics in oncology.
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Affiliation(s)
- Clement Francois
- Public Health Department, Research Unit EA 3279, Aix-Marseille University, Marseille, France
| | - Junwen Zhou
- Public Health Department, Research Unit EA 3279, Aix-Marseille University, Marseille, France
| | - Michał Pochopien
- Public Health Department, Research Unit EA 3279, Aix-Marseille University, Marseille, France
| | | | - Mondher Toumi
- Public Health Department, Research Unit EA 3279, Aix-Marseille University, Marseille, France.
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21
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Galve-Calvo E, González-Haba E, Gostkorzewicz J, Martínez I, Pérez-Mitru A. Cost-effectiveness analysis of ribociclib versus palbociclib in the first-line treatment of HR+/HER2- advanced or metastatic breast cancer in Spain. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:773-790. [PMID: 30532569 PMCID: PMC6241542 DOI: 10.2147/ceor.s178934] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the cost-effectiveness of ribociclib compared to palbociclib, both in combination with letrozole, in the first-line treatment of postmenopausal women with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) advanced or metastatic breast cancer (ABC) from the perspective of the Spanish National Health System (NHS). PATIENTS AND METHODS Disease progression was simulated with a partitioned survival model developed from the parameterization and extrapolation of survival curves of postmenopausal women with HR+/HER2- ABC from clinical trials with ribociclib or palbociclib, both in combination with letrozole. The model was structured on the basis of three health states (progression-free, progressed disease, and death), with a 1-month cycle length and inclusion of subsequent treatments administered for disease progression, over a time horizon of 15 years. Clinical, economic, and quality of life parameters were drawn from clinical trials and the literature. The use of resources and clinical practice in the Spanish setting was validated by a panel of experts. The Spanish NHS perspective was adopted, taking into account exclusively direct health costs from 2017 expressed in Euros. Drug prices used were the reported ex-factory prices. Uncertainty of the parameters and robustness of the results were evaluated using deterministic and probabilistic sensitivity analyses (2,000 iterations). RESULTS This cost-effectiveness analysis showed a greater benefit (0.437 and 0.285 life-years gained [LYGs] and quality-adjusted life years [QALYs] gained, respectively) and a slightly higher cost (€439.86) for ribociclib+letrozole compared to palbociclib+letrozole. The resulting incremental cost-effectiveness and cost-utility ratios were €1,007.69 per LYG and €1,543.62 per QALY gained, respectively. The results of the multiple sensitivity analyses showed limited dispersion of the outcomes, thus corroborating their robustness. CONCLUSION From the NHS perspective, considering the most commonly established willingness-to-pay thresholds in the Spanish setting, ribociclib+letrozole would represent a cost-effective therapeutic option compared to palbociclib+letrozole in the first-line treatment of HR+/HER2- ABC in postmenopausal women.
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Affiliation(s)
- Elena Galve-Calvo
- Medical Oncology Service, Basurto University Hospital, Bilbao, Spain
| | - Eva González-Haba
- Pharmacy Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Joana Gostkorzewicz
- Novartis Farmacéutica, S.A., Health Economics and Outcomes Research, Madrid, Spain
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22
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Pataky R, Tran DA, Coronado A, Alvi R, Boehm D, Regier DA, Peacock S. Cancer drug expenditure in British Columbia and Saskatchewan: a trend analysis. CMAJ Open 2018; 6:E292-E299. [PMID: 30054297 PMCID: PMC6182106 DOI: 10.9778/cmajo.20170161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Expenditure on systemic therapy for cancer has been increasing quickly owing to population growth, increased use, both in the number of users and in prescription volume, and rising drug prices. Our objective was to describe trends in expenditure in British Columbia and Saskatchewan's cancer care systems and to elucidate these drivers of growth. METHODS In this trend analysis, we obtained pharmacy dispensing records from the BC Cancer and Saskatchewan Cancer Agency pharmacies for all anticancer therapies dispensed in 2006-2013. We calculated total annual expenditure directly from the data and conducted a trend analysis of crude and standardized annual expenditure using generalized linear models. We estimated trends in the following components of total expenditure: cancer incidence, number of systemic therapy users per incident case, number of dispensed prescriptions per user and cost per prescription. Analysis was stratified by patient age group, cancer site and route of administration (oral or intravenous/other). RESULTS Expenditure on systemic therapies, adjusted for population growth and aging, increased an average of 9.2% (95% confidence interval [CI] 7.2 to 11.2) per year in Saskatchewan and 6.4% (95% CI 5.3 to 7.6) per year in BC. Growth in expenditure on orally administered agents was more than 2 times higher than growth in expenditure on intravenous/other agents. Growth rates varied significantly by cancer site. In both provinces, rising cost per prescription was the largest contributor to overall growth. INTERPRETATION Price is the primary driver of growth in systemic therapy expenditure in both BC and Saskatchewan. Understanding the mechanisms of expenditure growth may inform system planning and support policy-makers' efforts to manage rising costs.
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Affiliation(s)
- Reka Pataky
- Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - David A Tran
- Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Andrea Coronado
- Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Riaz Alvi
- Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Darryl Boehm
- Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Dean A Regier
- Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control (Pataky, Regier, Peacock), BC Cancer; School of Population and Public Health (Pataky, Regier), University of British Columbia, Vancouver, BC; Saskatchewan Cancer Agency (Tran, Alvi, Boehm), Saskatoon and Regina, Sask.; Canadian Partnership Against Cancer (Coronado), Toronto, Ont.; Faculty of Health Sciences (Peacock), Simon Fraser University, Burnaby, BC
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DeCensi A, Numico G, Ballatori E, Artioli F, Clerico M, Fioretto L, Livellara V, Ruggeri B, Tomirotti M, Verusio C, Roila F. Conflict of interest among Italian medical oncologists: a national survey. BMJ Open 2018; 8:e020912. [PMID: 29961019 PMCID: PMC6042593 DOI: 10.1136/bmjopen-2017-020912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 04/03/2018] [Accepted: 05/04/2018] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To assess Italian medical oncologists' opinion on the implications of conflict of interest (COI) on medical education, care and research, and to evaluate their direct financial relationships. DESIGN National cross-sectional survey conducted between March and April 2017 among Italian oncologists. SETTING Online survey sponsored by the Italian College of Medical Oncology Chiefs through its website. PARTICIPANTS Italian oncologists who filled out an anonymous questionnaire including 19 items and individual and working characteristics. MAIN OUTCOME MEASURE The proportion of medical oncologists perceiving COI as an outstanding issue and those receiving direct payments from industry. RESULTS There were 321 respondents, representing 13% of Italian tenured medical oncologists. Overall, 62% declared direct payments from the pharmaceutical industry in the last 3 years. Sixty-eight per cent felt the majority of Italian oncologists have a COI with industry, but 59% suppose this is not greater than that of other specialties. Eighty-two per cent consider that most oncology education is supported by industry. More than 75% believe that current allocation of industry budget on marketing and promotion rather than research and development is unfair, but 75% consider it appropriate to receive travel and lodging hospitality from industry. A median net profit margin of €5000 per patient enrolled in an industry trial was considered appropriate for the employee institution. Sixty per cent agree to receive a personal fee for patients enrolled in industry trials, but 79% state this should be reported in the informed consent. Over 90% believe that scientific societies should publish a financial report of industry support. Finally, 79% disagree to being a coauthor of an article written by a medical writer when no substantial scientific contribution is made. CONCLUSIONS Among Italian oncologists COI is perceived as an important issue influencing costs, education, care and science. A more rigorous policy on COI should be implemented.
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Affiliation(s)
- Andrea DeCensi
- Division of Medical Oncology, Galliera Hospital, Genova, Italy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Gianmauro Numico
- Division of Medical Oncology, SS Antonio e Biagio Hospital, Alessandria, Italy
| | | | - Fabrizio Artioli
- Department of Oncology, Carpi and Mirandola Hospitals, Carpi e Mirandola, Italy
| | - Mario Clerico
- Department of Medical Oncology, Hospital of Biella, Biella, Italy
- CIPOMO, Milan, Italy
| | - Luisa Fioretto
- Department of Oncology, SM Annunziata Hospital, Florence, Italy
| | | | - Benedetta Ruggeri
- Clinical Governance, Area Vasta 5, ASUR Marche, Ascoli Piceno, Italy
| | | | - Claudio Verusio
- Division of Medical Oncology, ASST Valle Olona, Saronno, Italy
| | - Fausto Roila
- Division of Medical Oncology, Ospedale Santa Maria, Terni, Italy
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Vergnenègre A, Chouaïd C. Review of economic analyses of treatment for non-small-cell lung cancer (NSCLC). Expert Rev Pharmacoecon Outcomes Res 2018; 18:519-528. [PMID: 29869900 DOI: 10.1080/14737167.2018.1485099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION During the past few years, medical-economic evaluation of lung cancers (LCs) has become unavoidable. Total management costs have been rising constantly, with values almost doubling every 10 years. The financial impact will be even greater with the new molecules now marketed. The methodology for these studies conforms with international recommendations but must be adapted to the new stakes of LC management. AREAS COVERED This review provides an overview of the available literature concerning the economics of treating non-small-cell lung cancer (NSCLC). We first address the global costs of LCs. Detailed analyses were then computed for the different LC stages: localized, locally advanced and metastatic. For metastatic NSCLC, subsections are devoted to targeted therapies and immunotherapies. EXPERT COMMENTARY Drug costs are one of the major challenges of LC management. The multiplication of medical-economic analyses will assure better access to the marketing of these new and expensive therapeutic agents, but also to the selection of the best management strategy for these cancers.
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Affiliation(s)
- Alain Vergnenègre
- a Unité d'Oncologie Thoracique et Cutanée , Hôpital Dupuytren , Limoges , France
| | - Christos Chouaïd
- b Service de Pathologie Respiratoire , Centre Hospitalier Intercommunal de Créteil , Créteil , France
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Bentley C, Costa S, Burgess MM, Regier D, McTaggart-Cowan H, Peacock SJ. Trade-offs, fairness, and funding for cancer drugs: key findings from a deliberative public engagement event in British Columbia, Canada. BMC Health Serv Res 2018; 18:339. [PMID: 29739463 PMCID: PMC5941483 DOI: 10.1186/s12913-018-3117-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 04/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Spending on cancer drugs has risen dramatically in recent years compared to other areas of health care, due in part to higher prices associated with newly approved drugs and increased demand for these drugs. Addressing this situation requires making difficult trade-offs between cost, harms, and ability to benefit when using public resources, making it important for policy makers to have input from many people affected by the issue, including citizens. METHODS In September 2014, a deliberative public engagement event was conducted in Vancouver, British Columbia (BC), on the topic of priority setting and costly cancer drugs. The aim of the study was to gain citizens' input on the topic and have them generate recommendations that could inform cancer drug funding decisions in BC. A market research company was engaged to recruit members of the BC general public to deliberate over two weekends (four days) on how best to allocate resources for expensive cancer treatments. Participants were stratified based on the 2006 census data for BC. Participants were asked to discuss disinvestment, intravenous versus oral chemotherapy delivery, and decision governance. All sessions were audio recorded and transcribed. Transcripts were analyzed using NVivo 11 software. RESULTS Twenty-four individuals participated in the event and generated 30 recommendations. Participants accepted the principle of resource scarcity and the need of governments to make difficult trade-offs when allocating health-care resources. They supported the view that cost-benefit thresholds must be set for high-cost drugs. They also expected reasonable health benefits in return for large expenditures, and supported the view that some drugs do not merit funding. Participants also wanted drug funding decisions to be made in a non-partisan and transparent way. CONCLUSION The recommendations from the Vancouver deliberation can provide guidance to policy makers in BC and may be useful in challenging pricing by pharmaceutical companies.
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Affiliation(s)
- Colene Bentley
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.
| | - Sarah Costa
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Michael M Burgess
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, Medical Genetics, Southern Medical Program, University of British Columbia, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Dean Regier
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Helen McTaggart-Cowan
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Faculty of Health Science, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Stuart J Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada.,Faculty of Health Science, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
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Tran G, Zafar SY. Financial toxicity and implications for cancer care in the era of molecular and immune therapies. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:166. [PMID: 29911114 DOI: 10.21037/atm.2018.03.28] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Molecular and immune therapies have revolutionized cancer treatment and improved patient outcomes and survival. However, the pricing of these drugs has become an issue as the cost of cancer care continues to rise significantly. Cost sharing policies have increased out-of-pocket expenses for patients, leading to poorer financial well-being, quality of life, psychosocial health, and treatment adherence. In this review, we briefly examine some factors affecting the pricing of these new targeted therapies; the effects of financial toxicity on patients; and highlight potential health policy and patient-provider level interventions to address these issues.
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Affiliation(s)
- George Tran
- Duke University School of Medicine, Durham, NC, USA
| | - S Yousuf Zafar
- Duke University School of Medicine, Durham, NC, USA.,Duke Cancer Institute, Duke-Margolis Center for Health Policy, Durham, NC, USA
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Arrospide A, Idigoras I, Mar J, de Koning H, van der Meulen M, Soto-Gordoa M, Martinez-Llorente JM, Portillo I, Arana-Arri E, Ibarrondo O, Lansdorp-Vogelaar I. Cost-effectiveness and budget impact analyses of a colorectal cancer screening programme in a high adenoma prevalence scenario using MISCAN-Colon microsimulation model. BMC Cancer 2018; 18:464. [PMID: 29695234 PMCID: PMC5918894 DOI: 10.1186/s12885-018-4362-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 04/11/2018] [Indexed: 02/07/2023] Open
Abstract
Background The Basque Colorectal Cancer Screening Programme began in 2009 and the implementation has been complete since 2013. Faecal immunological testing was used for screening in individuals between 50 and 69 years old. Colorectal Cancer in Basque country is characterized by unusual epidemiological features given that Colorectal Cancer incidence is similar to other European countries while adenoma prevalence is higher. The object of our study was to economically evaluate the programme via cost-effectiveness and budget impact analyses with microsimulation models. Methods We applied the Microsimulation Screening Analysis (MISCAN)-Colon model to predict trends in Colorectal Cancer incidence and mortality and to quantify the short- and long-term effects and costs of the Basque Colorectal Cancer Screening Programme. The model was calibrated to the Basque demographics in 2008 and age-specific Colorectal Cancer incidence data in the Basque Cancer Registry from 2005 to 2008 before the screening begun. The model was also calibrated to the high adenoma prevalence observed for the Basque population in a previously published study. The multi-cohort approach used in the model included all the cohorts in the programme during 30 years of implementation, with lifetime follow-up. Unit costs were obtained from the Basque Health Service and both cost-effectiveness analysis and budget impact analysis were carried out. Results The goodness-of-fit of the model adaptation to observed programme data was evidence of validation. In the cost-effectiveness analysis, the savings from treatment were larger than the added costs due to screening. Thus, the Basque programme was dominant compared to no screening, as life expectancy increased by 29.3 days per person. The savings in the budget analysis appeared 10 years after the complete implementation of the programme. The average annual budget was €73.4 million from year 2023 onwards. Conclusions This economic evaluation showed a screening intervention with a major health gain that also produced net savings when a long follow-up was used to capture the late economic benefit. The number of colonoscopies required was high but remain within the capacity of the Basque Health Service. So far in Europe, no other population Colorectal Cancer screening programme has been evaluated by budget impact analysis. Electronic supplementary material The online version of this article (10.1186/s12885-018-4362-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arantzazu Arrospide
- Gipuzkoa Primary Care - Integrated Health Care Organizations Research Unit, Alto Deba Integrated Health Care Organisation, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain. .,Health Services Research on Chronic Patients Network (REDISSEC), Arrasate - Mondragón, Gipuzkoa, Spain. .,Biodonostia Health Research Institute, Donostia - San Sebastian, Gipuzkoa, Spain.
| | - Isabel Idigoras
- Basque Country Colorectal Cancer Screening Programme, Basque Health Service, Bilbao, Bizkaia, Spain
| | - Javier Mar
- Gipuzkoa Primary Care - Integrated Health Care Organizations Research Unit, Alto Deba Integrated Health Care Organisation, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Arrasate - Mondragón, Gipuzkoa, Spain.,Biodonostia Health Research Institute, Donostia - San Sebastian, Gipuzkoa, Spain.,Clinical Management Unit, Alto Deba Integrated Health Care Organisation, Arrasate - Mondragón, Gipuzkoa, Spain
| | - Harry de Koning
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Miriam van der Meulen
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Myriam Soto-Gordoa
- Gipuzkoa Primary Care - Integrated Health Care Organizations Research Unit, Alto Deba Integrated Health Care Organisation, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Arrasate - Mondragón, Gipuzkoa, Spain.,Biodonostia Health Research Institute, Donostia - San Sebastian, Gipuzkoa, Spain
| | | | - Isabel Portillo
- Basque Country Colorectal Cancer Screening Programme, Basque Health Service, Bilbao, Bizkaia, Spain
| | | | - Oliver Ibarrondo
- Gipuzkoa Primary Care - Integrated Health Care Organizations Research Unit, Alto Deba Integrated Health Care Organisation, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Measuring value and benefit—a matter of perspective. Lancet Oncol 2017; 18:839-840. [DOI: 10.1016/s1470-2045(17)30423-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/19/2017] [Indexed: 11/19/2022]
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Hoch JS, Beca J, Chamberlain C, Chan KK. The right amount of chemotherapy in non-curable disease: Insights from health economics. J Cancer Policy 2016. [DOI: 10.1016/j.jcpo.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pelosi G, Scarpa A, Forest F, Sonzogni A. The impact of immunohistochemistry on the classification of lung tumors. Expert Rev Respir Med 2016; 10:1105-21. [PMID: 27617475 DOI: 10.1080/17476348.2017.1235975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION To highlight the role of immunohistochemistry to lung cancer classification on the basis of existing guidelines and future perspectives. AREAS COVERED Four orienting key-issues were structured according to an extensive review on the English literature: a) cancer subtyping; b) best biomarkers and rules to follow; c) negative and positive profiling; d) suggestions towards an evidence-based proposal for lung cancer subtyping. A sparing material approach based on a limited number of specific markers is highly desirable. It includes p40 for squamous cell carcinoma ('no p40, no squamous'), TTF1 for adenocarcinoma, synaptophysin for neuroendocrine tumors and vimentin for sarcomatoid carcinoma. A close relationship between genotype and phenotype also supports a diagnostic role for negative profiles. Expert commentary: Highly specific and sensitive IHC markers according to positive and negative diagnostic algorithms seem appropriate for individual patients' lung cancer subtyping.
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Affiliation(s)
- Giuseppe Pelosi
- a Department of Oncology and Hemato-Oncology , Università degli Studi di Milano , Milan , Italy
| | - Aldo Scarpa
- b Department of Pathology and Diagnostics , University and Hospital Trust of Verona , Verona , Italy.,c ARC-Net Research Centre , University and Hospital Trust of Verona , Verona , Italy
| | - Fabien Forest
- d Department of Pathology , University Hospital Center (CHU), North Hospital , Saint Etienne , France
| | - Angelica Sonzogni
- e Department of Pathology and Laboratory Medicine , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
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Vitry A, Mintzes B, Lipworth W. Access to new cancer medicines in Australia: dispelling the myths and informing a public debate. J Pharm Policy Pract 2016; 9:13. [PMID: 27057313 PMCID: PMC4823878 DOI: 10.1186/s40545-016-0062-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/31/2016] [Indexed: 11/10/2022] Open
Abstract
Despite the high level of spending on cancer medicines in Australia, consumer organisations and the pharmaceutical industry often make claims of delayed or lack of access to new cancer medicines-claims that are frequently supported by prominent coverage in the Australian media. These claims, while morally and psychologically compelling, tend to ignore the complexity of medicines funding decisions. In this commentary we summarise the current situation regarding the registration and funding of cancer medicines in Australia, elucidate the main challenges associated with access to cancer medicines in the Australian context, and describe some of the steps that have been taken to address these challenges.
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Affiliation(s)
- Agnes Vitry
- />School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Barbara Mintzes
- />Faculty of Pharmacy, Bias and Research Integrity Node, Charles Perkins Centre, University of Sydney, Johns Hopkins Drive, Camperdown, NSW 2050 Australia
| | - Wendy Lipworth
- />Centre for Values, Ethics and the Law in Medicine, School of Public Health, Medical Foundation Building K25, The University of Sydney, Sydney, NSW 2006 Australia
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Schwenkglenks M, Matter-Walstra K. Is the EQ-5D suitable for use in oncology? An overview of the literature and recent developments. Expert Rev Pharmacoecon Outcomes Res 2016; 16:207-19. [PMID: 26808097 DOI: 10.1586/14737167.2016.1146594] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The European Quality of Life-5 Dimensions (EQ-5D) questionnaire is widely used in oncology to generate quality of life weights (utilities). The typical purpose is to inform health economic evaluation studies. The EQ-5D is generally suitable for this purpose; it has shown a reasonable degree of reliability, content validity, construct validity and responsiveness in the majority of the available studies. In situations of doubt, combination with other quality-of-life instruments may be an option. The authors expect that the five-level version of the EQ-5D will gradually replace the three-level version, due to reduced ceiling effects and more appropriate responsiveness. Further research should address the benefits achievable through additional dimensions or patient-based valuation, and the validity of EQ-5D versions for proxy respondents.
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Affiliation(s)
- Matthias Schwenkglenks
- a Institute of Pharmaceutical Medicine (ECPM) , University of Basel , Basel , Switzerland.,b Epidemiology, Biostatistics and Prevention Institute , University of Zürich , Zürich , Switzerland
| | - Klazien Matter-Walstra
- a Institute of Pharmaceutical Medicine (ECPM) , University of Basel , Basel , Switzerland.,c Network Outcomes Research , Swiss Group for Clinical Cancer Research Coordination Center , Bern , Switzerland
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