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Zhao J, Du S, Zhu Y, Liang Y, Lu J, Chang F. A Systematic Review of Health Economic Evaluation on Targeted Therapies for First-Line Treatment of Metastatic Non-Small Cell Lung Cancer (NSCLC): Quality Evaluation. Cancer Manag Res 2020; 12:4357-4368. [PMID: 32606931 PMCID: PMC7293415 DOI: 10.2147/cmar.s248471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/04/2020] [Indexed: 01/16/2023] Open
Abstract
Background Evolving practices in non-small cell lung cancer (NSCLC) therapy inevitably affect health care budgets, especially through the introduction of targeted therapies. This results in a rise of health economic evaluations (HEEs) in this domain. This article reviews the quality of the economic evidence of targeted therapies used in metastatic NSCLC. Methods A literature search was conducted using PubMed, Cochrane, Embase and CRD (University of York Centre for Reviews and Dissemination) databases to identify topical original articles published between 1/1/2000 and 3/31/2019. A quality of reporting assessment using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards statement) checklist was converted into a quantitative score and compared with the results of a QHES (Quality of Health Economic Studies) evaluation. Components of QHES were also used to analyze the validity of primary outcomes, consideration of heterogeneity and rationality of main assumptions of models in modeling studies. Results In total, 25 HEEs were obtained and analyzed. From the CHEERS assessment, it was found that method description integrity (including setting, perspective, time horizon and discount rate), justification of data sources and a heterogeneity description were often absent or incomplete. Only five examined studies met the accepted standard of good quality. Modeled articles were examined with the QHES instrument, and a lack of illustrated structure, population variability, formula of the transitioning probability and justification for the choice of the model were the most frequently observed problems in the selected studies. After quantification, the CHEERS scores and QHES scores did not differ significantly. Conclusion Current NSCLC models generally lack consideration for demographic heterogeneity and transparency of data description, and it would be difficult to transfer or generalize from the scientific literature to real-world evidence-based decision-making. Frameworks of future models should be informed and justified based on the validity of model results and the improvement of modeling accuracy.
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Affiliation(s)
- Jie Zhao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, People's Republic of China.,Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Shuzhang Du
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yumei Zhu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, People's Republic of China
| | - Yan Liang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jingli Lu
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Feng Chang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, People's Republic of China
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Nguyen CTT, Petrelli F, Scuri S, Nguyen BT, Grappasonni I. A systematic review of pharmacoeconomic evaluations of erlotinib in the first-line treatment of advanced non-small cell lung cancer. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:763-777. [PMID: 30840166 DOI: 10.1007/s10198-019-01040-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To review and assess the quality of the available evidence on the cost-effectiveness of erlotinib in the first-line treatment of advanced non-small cell lung cancer (NSCLC). METHODS A systematic review was conducted to identify full-text original economic evaluations of erlotinib in the first-line treatment of advanced NSCLC written in English and published from the year 2000 onwards. Study characteristics and results were recorded and compared. The quality of the studies was assessed by the Quality of Health Economic Studies (QHES) questionnaire. RESULTS Eleven out of 130 papers were chosen for this review. Comparative regimens consisted of a best supportive care, reverse strategy, bevacizumab, cisplatin plus pemetrexed, carboplatin plus gemcitabine or gefitinib. The methods most used in these studies were modeling and sensitivity analysis and cost-effectiveness analysis. All of the studies evaluated direct costs and used quality-adjusted life-year (QALY) and life-years gained (LYG) as outcome, with 3% and 3.5% discount rate. The studies assigned ICER that ranged from dominant to I$305,510.31/QALY and from I$31,209.55/LYG to I$66,540.20/LYG. Based on the willingness to pay threshold, seven studies concluded that erlotinib was cost-effective, two studies showed that erlotinib was cost-effective on specific patients with certain conditions, and two studies comparing erlotinib with reverse strategy did not find a difference in cost-effectiveness. The high quality of these studies was confirmed using the QHES tool: the mean score was 75.77 out of 100 (SD 9.38). CONCLUSION Most of these high-quality studies suggested that erlotinib was cost-effective in the first-line treatment of advanced NSCLC.
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Affiliation(s)
- Cuc Thi Thu Nguyen
- Department of Pharmaceutical Administration and Economics, Hanoi University of Pharmacy, Hanoi, Vietnam.
| | - Fabio Petrelli
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Marche, Italy
| | - Stefania Scuri
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Marche, Italy
| | - Binh Thanh Nguyen
- Department of Pharmaceutical Administration and Economics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Iolanda Grappasonni
- School of Medicinal and Health Products Sciences, University of Camerino, Camerino, Marche, Italy
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Abstract
This article sets out to describe different value frameworks in the field of new developments in oncology. Since the costs of new oncological therapies follow a steep path, their implementation and financing demand a thorough assessment. This is an ambitious task due to the complex nature of oncological treatments within overall health policy. Five value frameworks were reviewed: European Society for Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale, American Society of Clinical Oncology (ASCO) Value Framework (version 2.0), National Comprehensive Cancer Network (NCCN) Evidence Blocks, Memorial Sloan Kettering Cancer Center DrugAbacus, and the Institute for Clinical and Economic Review Value Assessment Framework. They are all based on a large set of criteria. However, all these frameworks differ considerably in their outcomes. Among the main differences one has to cite are the inclusion of costs and the use of different outcomes, as well as the fact that they address different target stakeholders, etc. Despite these shortcomings, the value frameworks serve the necessity to introduce more rationality in health decision making seen from the perspective of physicians, patients, and financing bodies.
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Affiliation(s)
- Evelyn Walter
- Institute for Pharmaeconomic Research, Vienna, Austria.
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Albaba H, Lim C, Leighl NB. Economic Considerations in the Use of Novel Targeted Therapies for Lung Cancer: Review of Current Literature. PHARMACOECONOMICS 2017; 35:1195-1209. [PMID: 28861770 DOI: 10.1007/s40273-017-0563-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Lung cancer remains the leading cause of cancer-related death and economic burden worldwide. Despite the heavy toll of lung cancer, multiple new advances have improved patient outcomes, largely through precision medicine and targeted therapy. The associated rising economic burden however may impact the uptake of novel therapeutic agents in lung cancer, thereby limiting patient access. This article identifies and reviews economic evaluations of targeted agents in lung cancer in the era of precision medicine. Articles evaluating biomarker-directed test-and-treat strategies are also reviewed to evaluate the cost impact of novel therapeutic agents at a population level. The Quality of Health Economic Studies instrument is applied to assess the quality of included studies. Forty-six studies are reviewed and encompass studies of epidermal growth factor receptor inhibitors and monoclonal antibodies, anaplastic lymphoma kinase inhibitors, vascular endothelial growth factor and vascular endothelial growth factor receptor inhibitors and immunotherapy (programmed death-1 inhibitors). Key factors influencing results of economic analyses include comparators chosen, perspective used, magnitude of clinical benefit, utility weighting of outcomes and drug acquisition costs. Biomarker-driven decision making should be integrated into cost evaluations given the important role of molecular testing for individualising treatment for non-small-cell lung cancer. We conclude that despite major clinical advances in lung cancer therapeutics, cost remains an important consideration in the adoption of novel therapies.
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Affiliation(s)
- Hamzeh Albaba
- Princess Margaret Cancer Center, University Health Network, c/o 700 University Avenue, Room 7-913, Toronto, ON, M5G 1Z5, Canada
- University of Toronto, Toronto, ON, Canada
| | - Charles Lim
- Princess Margaret Cancer Center, University Health Network, c/o 700 University Avenue, Room 7-913, Toronto, ON, M5G 1Z5, Canada
- University of Toronto, Toronto, ON, Canada
| | - Natasha B Leighl
- Princess Margaret Cancer Center, University Health Network, c/o 700 University Avenue, Room 7-913, Toronto, ON, M5G 1Z5, Canada.
- University of Toronto, Toronto, ON, Canada.
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Azar FE, Azami-Aghdash S, Pournaghi-Azar F, Mazdaki A, Rezapour A, Ebrahimi P, Yousefzadeh N. Cost-effectiveness of lung cancer screening and treatment methods: a systematic review of systematic reviews. BMC Health Serv Res 2017; 17:413. [PMID: 28629461 PMCID: PMC5477275 DOI: 10.1186/s12913-017-2374-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 06/09/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Due to extensive literature in the field of lung cancer and their heterogeneous results, the aim of this study was to systematically review of systematic reviews studies which reviewed the cost-effectiveness of various lung cancer screening and treatment methods. METHODS In this systematic review of systematic reviews study, required data were collected searching the following key words which selected from Mesh: "lung cancer", "lung oncology", "lung Carcinoma", "lung neoplasm", "lung tumors", "cost- effectiveness", "systematic review" and "Meta-analysis". The following databases were searched: PubMed, Cochrane Library electronic databases, Google Scholar, and Scopus. Two reviewers (RA and A-AS) evaluated the articles according to the checklist of "assessment of multiple systematic reviews" (AMSTAR) tool. RESULTS Overall, information of 110 papers was discussed in eight systematic reviews. Authors focused on cost-effectiveness of lung cancer treatments in five systematic reviews. Targeted therapy options (bevacizumab, Erlotinib and Crizotinib) show an acceptable cost-effectiveness. Results of three studies failed to show cost-effectiveness of screening methods. None of the studies had used the meta-analysis method. The Quality of Health Economic Studies (QHES) tool and Drummond checklist were mostly used in assessing the quality of articles. Most perspective was related to the Payer (64 times) and the lowest was related to Social (11times). Most cases referred to Incremental analysis (82%) and also the lowest point of referral was related to Discounting (in 49% of the cases). The average quality score of included studies was calculated 9.2% from 11. CONCLUSIONS Targeted therapy can be an option for the treatment of lung cancer. Evaluation of the cost-effectiveness of computerized tomographic colonography (CTC) in lung cancer screening is recommended. The perspective of the community should be more taken into consideration in studies of cost-effectiveness. Paying more attention to the topic of Discounting will be necessary in the studies.
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Affiliation(s)
| | - Saber Azami-Aghdash
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Pournaghi-Azar
- Dental and Periodental Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Mazdaki
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Parvin Ebrahimi
- Department of Health service Management, School of Health Management and Information Sciences & Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Negar Yousefzadeh
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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Chouaïd C, Crequit P, Borget I, Vergnenegre A. Economic evaluation of first-line and maintenance treatments for advanced non-small cell lung cancer: a systematic review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2014; 7:9-15. [PMID: 25548525 PMCID: PMC4271788 DOI: 10.2147/ceor.s43328] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
During these last years, there have been an increased number of new drugs for non-small cell lung cancer (NSCLC), with a growing financial effect on patients and society. The purpose of this article was to review the economics of first-line and maintenance NSCLC treatments. We reviewed economic analyses of NSCLC therapies published between 2004 and 2014. In first-line settings, in unselected patients with advanced NSCLC, the cisplatin gemcitabine doublet appears to be cost-saving compared with other platinum doublets. In patients with nonsquamous NSCLC, the incremental cost-effectiveness ratios (ICERs) per life-year gained (LYG) were $83,537, $178,613, and more than $300,000 for cisplatin-pemetrexed compared with, respectively, cisplatin-gemcitabine, cisplatin-carboplatin-paclitaxel, and carboplatin-paclitaxel-bevacizumab. For all primary chemotherapy agents, use of carboplatin is associated with slightly higher costs than cisplatin. In all the analysis, bevacizumab had an ICER greater than $150,000 per quality-adjusted life-year (QALY). In epidermal growth factor receptor mutated advanced NSCLC, compared with carboplatin-paclitaxel doublet, targeted therapy based on testing available tissue yielded an ICER of $110,644 per QALY, and the rebiopsy strategy yielded an ICER of $122,219 per QALY. Compared with the triplet carboplatin-paclitaxel-bevacizumab, testing and rebiopsy strategies had ICERs of $25,547 and $44,036 per QALY, respectively. In an indirect comparison, ICERs per LYG and QALY of erlotinib versus gefitinib were $39,431 and $62,419, respectively. In anaplastic lymphoma kinase-positive nonsquamous advanced NSCLC, the ICER of first-line crizotinib compared with that of chemotherapy was $255,970 per QALY. For maintenance therapy, gefitinib had an ICER of $19,214 per QALY, erlotinib had an ICER of $127,343 per LYG, and pemetrexed had an ICER varying between $183,589 and $205,597 per LYG. Most recent NSCLC strategies are based on apparently no cost-effective strategies if we consider an ICER below $50,000 per QALY an acceptable threshold. We need, probably on a countrywide level, to have a debate involving public health organizations and pharmaceutical companies, as well as clinicians and patients, to challenge the rising costs of managing lung cancer.
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Affiliation(s)
- Christos Chouaïd
- Service de Pneumologie et de Pathologie Professionnelle, Centre Hospitalier Intercommunal Créteil et Université de Paris Est Créteil, Paris, France
| | - Perinne Crequit
- Service de Pneumologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Borget
- Service de Biostatistique et d'Epidémiologie, Institut Gustave Roussy, Villejuif, France
| | - Alain Vergnenegre
- Unité d'Oncologie Thoracique et Cutanée, Centre Hospitalier Universitaire Limoges, Limoges, France
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Lange A, Prenzler A, Frank M, Golpon H, Welte T, von der Schulenburg JM. A systematic review of the cost-effectiveness of targeted therapies for metastatic non-small cell lung cancer (NSCLC). BMC Pulm Med 2014; 14:192. [PMID: 25471553 PMCID: PMC4269853 DOI: 10.1186/1471-2466-14-192] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/20/2014] [Indexed: 12/30/2022] Open
Abstract
Background Non-small cell lung cancer (NSCLC) imposes a substantial burden on patients, health care systems and society due to increasing incidence and poor survival rates. In recent years, advances in the treatment of metastatic NSCLC have resulted from the introduction of targeted therapies. However, the application of these new agents increases treatment costs considerably. The objective of this article is to review the economic evidence of targeted therapies in metastatic NSCLC. Methods A systematic literature review was conducted to identify cost-effectiveness (CE) as well as cost-utility studies. Medline, Embase, SciSearch, Cochrane, and 9 other databases were searched from 2000 through April 2013 (including update) for full-text publications. The quality of the studies was assessed via the validated Quality of Health Economic Studies (QHES) instrument. Results Nineteen studies (including update) involving the MoAb bevacizumab and the Tyrosine-kinase inhibitors erlotinib and gefitinib met all inclusion criteria. The majority of studies analyzed the CE of first-line maintenance and second-line treatment with erlotinib. Five studies dealt with bevacizumab in first-line regimes. Gefitinib and pharmacogenomic profiling were each covered by only two studies. Furthermore, the available evidence was of only fair quality. Conclusion First-line maintenance treatment with erlotinib compared to Best Supportive Care (BSC) can be considered cost-effective. In comparison to docetaxel, erlotinib is likely to be cost-effective in subsequent treatment regimens as well. The insights for bevacizumab are miscellaneous. There are findings that gefitinib is cost-effective in first- and second-line treatment, however, based on only two studies. The role of pharmacogenomic testing needs to be evaluated. Therefore, future research should improve the available evidence and consider pharmacogenomic profiling as specified by the European Medicines Agency. Upcoming agents like crizotinib and afatinib need to be analyzed as well. Electronic supplementary material The online version of this article (doi:10.1186/1471-2466-14-192) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ansgar Lange
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Otto-Brenner-Str, 1, D-30159 Hannover, Germany.
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Ishii H, Azuma K, Yamada K, Kinoshita T, Imamura Y, Hoshino T. Predictive factors in patients with EGFR mutation-negative non-small cell lung cancer treated with erlotinib. Oncol Lett 2014; 8:2699-2704. [PMID: 25364452 PMCID: PMC4214475 DOI: 10.3892/ol.2014.2548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 08/29/2014] [Indexed: 11/06/2022] Open
Abstract
Factors predicting the efficacy of erlotinib treatment in patients with EGFR mutation-negative non-small-cell lung cancer (NSCLC) have not been well studied. This retrospective study investigates whether patient characteristics, such as site of metastasis, can predict the efficacy of erlotinib treatment in NSCLC patients. In total, 53 EGFR mutation-negative NSCLC patients treated with erlotinib were enrolled, and the associations between clinicopathological characteristics and patient survival were analyzed. The EGFR mutation status was determined using the peptide nucleic acid-locked nucleic acid polymerase chain reaction clamp method. Survival curves were obtained using the Kaplan-Meier method. Among the NSCLC patients treated with erlotinib, 27 patients with pulmonary metastasis exhibited significantly longer progression-free survival (PFS) and overall survival (OS) times than those without pulmonary metastasis (median PFS time, 2.9 versus 1.2 months; P=0.0010 and median OS time, 12.4 versus 4.1 months; P=0.0007). Multivariate analyses also revealed that pulmonary metastasis independently correlated with PFS and OS times (hazard ratio, 0.39; P=0.0055 and hazard ratio, 0.33; P=0.0022, respectively). Patients with pulmonary metastasis exhibited significantly longer PFS and OS times than those without pulmonary metastasis. The presence of pulmonary metastasis may be a predictive factor in patients with EGFR mutation-negative NSCLC treated with erlotinib.
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Affiliation(s)
- Hidenobu Ishii
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Koichi Azuma
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Kazuhiko Yamada
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Takashi Kinoshita
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Youhei Imamura
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
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Lee JK, Kim DW, Keam B, Kim TM, Lee SH, Kim YJ, Heo DS. The Impact of Molecularly Targeted Treatment on Direct Medical Costs in Patients with Advanced Non-small Cell Lung Cancer. Cancer Res Treat 2014; 47:182-8. [PMID: 25544584 PMCID: PMC4398109 DOI: 10.4143/crt.2013.227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 03/20/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose To investigate the impact of targeted treatment on direct medical costs of patients with advanced non-small cell lung cancer (NSCLC). Materials and Methods Medical records of 108 stage IIIB/IV NSCLC patients treated in Seoul National University Hospital between 2003 and 2009, were reviewed to collect medical resources utilization data from the diagnosis of stage IIIB/IV NSCLC to the end of active anti-cancer treatment. The direct medical costs were calculated by multiplying the number of medical resources used by the unit price. All costs were expressed in US dollars for each patient. Results The mean total direct medical costs were $34,732 (standard deviation, 21,168) in the study cohort. The mean total direct medical costs were higher in epidermal growth factor receptor (EGFR) mutation (EGFR MT)–positive patients than EGFR wild-type (EGFR WT) patients ($41,403 vs. $30,146, p=0.005). However, the mean monthly direct medical costs did not differ significantly between EGFR MT–positive patients and EGFR WT patients ($2,120 vs. $2,702, p=0.119) because of the longer duration of active anti-cancer treatment in EGFR MT–positive patients. This discrepancy was mainly attributable to EGFR MT–positive patients’ lower non-chemotherapy costs ($948 vs. $1,522, p=0.007). The total and monthly direct medical costs of ALK fusion–positive patients who did not receive ALK inhibitors did not differ from WT/WT patients. Conclusion This study suggests that the availability of targeted agents for EGFR MT–positive patients lowers the mean monthly medical costs by prolonging survival and diminishing the use of other medical resources, despite the considerable drug costs.
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Affiliation(s)
- June-Koo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Se-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Joo Kim
- Outcomes Research/Evidence Based Medicine Team, Pfizer Pharmaceuticals Korea Ltd., Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Smieliauskas F, Chien CR, Shen C, Geynisman DM, Shih YCT. Cost-effectiveness analyses of targeted oral anti-cancer drugs: a systematic review. PHARMACOECONOMICS 2014; 32:651-680. [PMID: 24821281 DOI: 10.1007/s40273-014-0160-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Over the last 15 years, a paradigm shift in oncology has led to the approval of dozens of targeted oral anti-cancer medications (OAMs), which have become the standard of care for certain cancers. While more convenient for patients than infused drugs, the possibility of non-adherence and the frequently high costs of targeted OAMs have proven controversial. OBJECTIVE Our objective was to perform the first comprehensive review of cost-effectiveness analyses (CEAs) of targeted OAMs. METHODS A literature search in PubMed, The Cochrane Library, and the Health Technology Assessment (HTA) reports published by the National Institute for Health Research HTA Programme in the UK was performed, covering articles published in the 5 years prior to 30 September 2013. Our inclusion criteria were peer-reviewed English-language full-text original research articles with a primary focus on CEA related to targeted OAMs. We categorized these articles by treatment setting (i.e. cancer site/type, line of therapy, and treatment and comparator) and synthesized information from the articles into summary tables. RESULTS We identified 41 CEAs covering nine of the 18 targeted OAMs approved by the US FDA as of December 2012. These medications were studied in seven cancers, most often as second-line therapy for advanced-stage patients. In over half of treatment settings where a targeted OAM was compared with treatment that was not a targeted OAM, targeted OAMs were considered cost effective. Limitations in interpreting these findings include the risk of bias due to author conflicts of interest, cross-country variation, and difficulties in generalizing clinical trial evidence to community practice. CONCLUSIONS Several types of cost-effectiveness studies remain under-represented in the literature on targeted OAMs, including those for follow-on indications approved after the initial indication for a drug and for off-label indications, head-to-head comparisons of targeted OAMs with other targeted OAMs and targeted intravenous therapies, and studies that adopt a perspective other than the payer's. Keeping up with the increasing number of approved targeted OAMs will also prove an important challenge for economic evaluation.
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Zeng X, Li J, Peng L, Wang Y, Tan C, Chen G, Wan X, Lu Q, Yi L. Economic outcomes of maintenance gefitinib for locally advanced/metastatic non-small-cell lung cancer with unknown EGFR mutations: a semi-Markov model analysis. PLoS One 2014; 9:e88881. [PMID: 24586426 PMCID: PMC3930593 DOI: 10.1371/journal.pone.0088881] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 01/12/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Maintenance gefitinib significantly prolonged progression-free survival (PFS) compared with placebo in patients from eastern Asian with locally advanced/metastatic non-small-cell lung cancer (NSCLC) after four chemotherapeutic cycles (21 days per cycle) of first-line platinum-based combination chemotherapy without disease progression. The objective of the current study was to evaluate the cost-effectiveness of maintenance gefitinib therapy after four chemotherapeutic cycle's stand first-line platinum-based chemotherapy for patients with locally advanced or metastatic NSCLC with unknown EGFR mutations, from a Chinese health care system perspective. METHODS AND FINDINGS A semi-Markov model was designed to evaluate cost-effectiveness of the maintenance gefitinib treatment. Two-parametric Weibull and Log-logistic distribution were fitted to PFS and overall survival curves independently. One-way and probabilistic sensitivity analyses were conducted to assess the stability of the model designed. The model base-case analysis suggested that maintenance gefitinib would increase benefits in a 1, 3, 6 or 10-year time horizon, with incremental $184,829, $19,214, $19,328, and $21,308 per quality-adjusted life-year (QALY) gained, respectively. The most sensitive influential variable in the cost-effectiveness analysis was utility of PFS plus rash, followed by utility of PFS plus diarrhoea, utility of progressed disease, price of gefitinib, cost of follow-up treatment in progressed survival state, and utility of PFS on oral therapy. The price of gefitinib is the most significant parameter that could reduce the incremental cost per QALY. Probabilistic sensitivity analysis indicated that the cost-effective probability of maintenance gefitinib was zero under the willingness-to-pay (WTP) threshold of $16,349 (3 × per-capita gross domestic product of China). The sensitivity analyses all suggested that the model was robust. CONCLUSIONS Maintenance gefitinib following first-line platinum-based chemotherapy for patients with locally advanced/metastatic NSCLC with unknown EGFR mutations is not cost-effective. Decreasing the price of gefitinib may be a preferential choice for meeting widely treatment demands in China.
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Affiliation(s)
- Xiaohui Zeng
- PET-CT Center, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Jianhe Li
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
- School of Pharmaceutical Sciences, Central South University, Changsha, Hunan, People’s Republic of China
| | - Liubao Peng
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
- * E-mail:
| | - Yunhua Wang
- PET-CT Center, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Chongqing Tan
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
- School of Pharmaceutical Sciences, Central South University, Changsha, Hunan, People’s Republic of China
| | - Gannong Chen
- Department of Surgery, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Xiaomin Wan
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
- School of Pharmaceutical Sciences, Central South University, Changsha, Hunan, People’s Republic of China
| | - Qiong Lu
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
| | - Lidan Yi
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
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Solomon MT, Miranda N, Jorrín E, Chon I, Marinello JJ, Alert J, Lorenzo-Luaces P, Crombet T. Nimotuzumab in combination with radiotherapy in high grade glioma patients: a single institution experience. Cancer Biol Ther 2014; 15:504-9. [PMID: 24521695 DOI: 10.4161/cbt.28021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Nimotuzumab, a humanized antibody targeting epidermal growth factor receptor, has potent anti-proliferative, anti-angiogenic, and pro-apoptotic effects in vitro and in vivo. It also reduces the number of radio-resistant CD133(+) glioma stem cells. The antibody has been extensively evaluated in patients with advanced head and neck, glioma, lung, esophageal, pancreatic, and gastric cancer. In this single institution experience, 35 patients with anaplastic astrocytoma (AA) or glioblastoma multiforme (GBM) were treated with irradiation and 200 mg doses of nimotuzumab. The first 6 doses were administered weekly, together with radiotherapy, and then treatment continued every 21 days until 1 year. The median number of doses was 12, and the median cumulative dose was thus 2400 mg of nimotuzumab. The most frequent treatment-related toxicities were increase in liver function tests, fever, nausea, anorexia, asthenia, dizziness, and tremors. These adverse reactions were classified as mild and moderate. The median survival time was 12.4 mo or 27.0 mo for patients with GBM or AA patients, respectively, who received curative-intent radiotherapy in combination with the antibody. The survival time of a matched population treated at the same hospital with irradiation alone was decreased (median 8.0 and 12.2 mo for GBM and AA patients, respectively) compared with that of the patients who received nimotuzumab and curative-intent radiotherapy. We have thus confirmed that nimotuzumab is a very well-tolerated drug, lacking cumulative toxicity after maintenance doses. This study, in a poor prognosis population, validates the previous data of survival gain after combining nimotuzumab and radiotherapy, in newly diagnosed high-grade glioma patients.
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Affiliation(s)
| | | | | | - Ivonne Chon
- National Institute of Oncology and Radiobiology; Havana, Cuba
| | | | - José Alert
- National Institute of Oncology and Radiobiology; Havana, Cuba
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Jazieh AR, Al Sudairy R, Abu-Shraie N, Al Suwairi W, Ferwana M, Murad MH. Erlotinib in wild type epidermal growth factor receptor non-small cell lung cancer: A systematic review. Ann Thorac Med 2013; 8:204-8. [PMID: 24250733 PMCID: PMC3821279 DOI: 10.4103/1817-1737.118503] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 07/03/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND: Targeting epidermal growth factor receptors (EGFR) is an innovative approach to managing non-small cell lung cancer (NSCLC) which harbors EGFR mutation. However, the efficacy of these agents like erlotinib in patients without the mutation is not known. METHODS: This systematic review included Phase III randomized clinical trials that compared single agent erlotinib to other management options in the setting of NSCLC with reported outcome data on patients with EGFR wild type (EGFRWT) tumors. Outcome data include overall survival (OS), progression free survival (PFS) and response rate (RR). Random effects meta-analysis was used to pool outcomes across studies. RESULTS: Three studies met the inclusion criteria. These studies included a total of 2044 patients with outcome data on 674 patients with EGFRWT tumors (33%). Meta-analysis revealed a statistically significant improvement in OS with erlotinib (hazard ratio of 0.780; 95% confidence interval: 0.654-0.930, P = 0.006). Data were not available to perform PFS or RR analysis. The quality of this evidence is considered to be moderate to high. CONCLUSION: Our study revealed a significant benefit of erlotinib in patient with EGFRWT tumors compared with other approaches. These findings add another therapeutic option to patients generally considered difficult to treat.
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Affiliation(s)
- Abdul-Rahman Jazieh
- Department of Oncology, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Wang S, Peng L, Li J, Zeng X, Ouyang L, Tan C, Lu Q. A trial-based cost-effectiveness analysis of erlotinib alone versus platinum-based doublet chemotherapy as first-line therapy for Eastern Asian nonsquamous non-small-cell lung cancer. PLoS One 2013; 8:e55917. [PMID: 23520448 PMCID: PMC3592875 DOI: 10.1371/journal.pone.0055917] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 01/03/2013] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Lung cancer, the most prevalent malignant cancer in the world, remains a serious threat to public health. Recently, a large number of studies have shown that an epidermoid growth factor receptor-tyrosine kinase inhibitor (EGFR TKI), Erlotinib, has significantly better efficacy and is better tolerated in advanced non-small cell lung cancer (NSCLC) patients with a positive EGFR gene mutation. However, access to this drug is severely limited in China due to its high acquisition cost. Therefore, we decided to conduct a study to compare cost-effectiveness between erlotinib monotherapy and carboplatin-gemcitabine (CG) combination therapy in patients with advanced EGFR mutation-positive NSCLC. METHODS A Markov model was developed from the perspective of the Chinese health care system to evaluate the cost-effectiveness of the two treatment strategies; this model was based on data from the OPTIMAL trial, which was undertaken at 22 centres in China. The 10-year quality-adjusted life years (QALYs), direct costs, and incremental cost-effectiveness ratio (ICER) were estimated. To allow for uncertainties within the parameters and to estimate the model robustness, one-way sensitivity analysis and probabilistic sensitivity analysis were performed. RESULTS The median progression-free survival (PFS) obtained from Markov model was 13.2 months (13.1 months was reported in the trial) in the erlotinib group while and 4.64 months (4.6 months was reported in the trial) in the CG group. The QALYs were 1.4 years in the erlotinib group and 1.96 years in the CG group, indicating difference of 0.56 years. The ICER was most sensitive to the health utility of DP ranged from $58,584.57 to $336,404.2. At a threshold of $96,884, erlotinib had a 50% probability of being cost-effective. CONCLUSIONS Erlotinib monotherapy is more cost-effective compared with platinum-based doublets chemotherapy as a first-line therapy for advanced EGFR mutation- positive NSCLC patients from within the Chinese health care system.
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Affiliation(s)
- Siying Wang
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, China
- School of Pharmaceutical Sciences, Central South University, Changsha Hunan, China
| | - Liubao Peng
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, China
- * E-mail:
| | - Jianhe Li
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, China
- School of Pharmaceutical Sciences, Central South University, Changsha Hunan, China
| | - Xiaohui Zeng
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, China
- School of Pharmaceutical Sciences, Central South University, Changsha Hunan, China
| | - Lihui Ouyang
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, China
- School of Pharmaceutical Sciences, Central South University, Changsha Hunan, China
| | - Chongqing Tan
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, China
- School of Pharmaceutical Sciences, Central South University, Changsha Hunan, China
| | - Qiong Lu
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, China
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