1
|
Rezaee M, Karimzadeh I, Hashemi-Meshkini A, Zeighami S, Bazyar M, Lotfi F, Keshavarz K. Cost-Effectiveness Analysis of Triptorelin, Goserelin, and Leuprolide in the Treatment of Patients With Metastatic Prostate Cancer: A Societal Perspective. Value Health Reg Issues 2024; 42:100982. [PMID: 38663058 DOI: 10.1016/j.vhri.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVES Metastatic prostate cancer is the most common malignant cancer and the second leading cause of death due to various types of cancer among men after lung cancer. This study aimed to analyze the cost-effectiveness of triptorelin, goserelin, and leuprolide in the treatment of the patients with metastatic prostate cancer from the societal perspective in Iran in 2020. METHODS This is a cost-effectiveness study in which a 20-year Markov transition modeling was applied. In this study, local cost and quality-of-life data of each health state were gathered from cohort of patients. The TreeAge pro 2020 and Microsoft Excel 2016 software were used to simulate cost-effectiveness of each treatment in the long term. The one-way and probabilistic sensitivity analyses were also performed to measure robustness of the model outputs. RESULTS The findings indicated that the mean costs and utility gained over a 20-year horizon for goserelin, triptorelin, and leuprolide treatments were $ 13 539.13 and 6.365 quality-adjusted life-years (QALY), $ 18 124.75 and 6.658 QALY, and $ 26 006.92 and 6.856 QALY, respectively. Goserelin was considered as a superior treatment option, given the estimated incremental cost-effectiveness ratio. The one-way and probabilistic sensitivity analyses confirmed the robustness of the study outcomes. CONCLUSIONS According to the results of the present study, goserelin was the most effective and cost-effective strategy versus 2 other options. It could be recommended to policy makers of the Iran healthcare system to prioritize it in clinical guidelines and reimbursement policies.
Collapse
Affiliation(s)
- Mehdi Rezaee
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran; Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Iman Karimzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Amir Hashemi-Meshkini
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy and Evidence-Based Medicine Group, Tehran University of Medical Sciences, Tehran, Tehran, Iran
| | - Shahryar Zeighami
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Mohammad Bazyar
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Farhad Lotfi
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Fars, Iran; Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran.
| |
Collapse
|
2
|
Hettle R, Mihai A, Lang SH, Tatman S, Swift SL. Real-world outcomes for first line next-generation hormonal agents in metastatic prostate cancer: a systematic review. Future Oncol 2023; 19:2425-2443. [PMID: 37681288 DOI: 10.2217/fon-2023-0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Aim: This review aims to summarize published evidence on the real-world (RW) outcomes of abiraterone or enzalutamide in first-line metastatic castration-resistant prostate cancer. Materials & methods: Studies reporting on RW effectiveness, safety, economic and/or health-related quality of life outcomes were identified by systematic literature review (2011-2021, incl. Embase®, MEDLINE®) and presented in a qualitative synthesis. Risk of bias was assessed using ROBINS-I or the Molinier checklist. Results: 88 studies (n = 83,427 patients) were included. Median progression-free (40 studies) and overall survival (38 studies) ranged from 3.7 to 20.9 months and 9.8 to 45 months, respectively. Survival, safety and economic outcomes were similar across individual treatments, while limited health-related quality of life evidence suggested improvements with abiraterone. Risk of bias was moderate to high. Conclusion: RW outcomes in first-line metastatic castration-resistant prostate cancer remain poor despite treatment, highlighting an unmet need for new regimens. This review was supported by AstraZeneca and Merck Sharp & Dohme.
Collapse
Affiliation(s)
- Robert Hettle
- Payer Simulation & Analytics, Oncology Market Access and Pricing, AstraZeneca, Cambridge, Cambridgeshire, CB2 8PA, UK
| | - Adela Mihai
- Health Economics & Payer Evidence, Oncology Market Access and Pricing, AstraZeneca, Cambridge, Cambridgeshire, CB2 8PA, UK
| | - Shona H Lang
- Mtech Access, York, North Yorkshire, YO10 5NY, UK
| | | | | |
Collapse
|
3
|
Leaning D, Kaur G, Morgans AK, Ghouse R, Mirante O, Chowdhury S. Treatment landscape and burden of disease in metastatic castration-resistant prostate cancer: systematic and structured literature reviews. Front Oncol 2023; 13:1240864. [PMID: 37829336 PMCID: PMC10565658 DOI: 10.3389/fonc.2023.1240864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/09/2023] [Indexed: 10/14/2023] Open
Abstract
Purpose Metastatic castration-resistant prostate cancer (mCRPC) is a lethal disease that imposes a major burden on patients and healthcare systems. Three structured literature reviews (treatment guidelines, treatment landscape, and human/clinical/patient burden) and one systematic literature review (economic burden) were conducted to better understand the disease burden and unmet needs for patients with late-stage mCRPC, for whom optimal treatment options are unclear. Methods Embase®, MEDLINE®, MEDLINE® In-Process, the CENTRAL database (structured and systematic reviews), and the Centre for Reviews and Dissemination database (systematic review only) were searched for English-language records from 2009 to 2021 to identify mCRPC treatment guidelines and studies related to the treatment landscape and the humanistic/economic burden of mCRPC in adult men (aged ≥18 years) of any ethnicity. Results In total, six records were included for the treatment patterns review, 14 records for humanistic burden, nine records for economic burden, three records (two studies) for efficacy, and eight records for safety. Real-world treatment patterns were broadly aligned with treatment guidelines and provided no optimal treatment sequencing beyond second line other than palliative care. Current post-docetaxel treatments in mCRPC are associated with adverse events that cause relatively high rates of treatment discontinuation or disruption. The humanistic and economic burdens associated with mCRPC are high. Conclusion The findings highlight a lack of treatment options with novel mechanisms of action and more tolerable safety profiles that satisfy a risk-to-benefit ratio aligned with patient needs and preferences for patients with late-stage mCRPC. Treatment approaches that improve survival and health-related quality of life are needed, ideally while simultaneously reducing costs and healthcare resource utilization.
Collapse
Affiliation(s)
- Darren Leaning
- Department of Radiology and Oncology, James Cook University Hospital, South Tees NHS Trust, Middlesbrough, United Kingdom
| | - Gagandeep Kaur
- Parexel Access Consulting, Parexel International, Mohali, Punjab, India
| | - Alicia K. Morgans
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Ray Ghouse
- Advanced Accelerator Applications, a Novartis Company, Genève, Switzerland
| | - Osvaldo Mirante
- Advanced Accelerator Applications, a Novartis Company, Genève, Switzerland
| | - Simon Chowdhury
- Department of Urological Cancer, Guy’s, King’s, and St. Thomas’ Hospitals, and Sarah Cannon Research Institute, London, United Kingdom
| |
Collapse
|
4
|
Yan J, Li C, Zhang X, Cheng L, Ding R, Zhang L. Degarelix vs. leuprorelin for the treatment of prostate cancer in China: A cost-utility analysis. Front Public Health 2022; 10:942800. [PMID: 35923949 PMCID: PMC9339785 DOI: 10.3389/fpubh.2022.942800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To explore the cost-effectiveness of degarelix acetate for injection (degarelix) compared to leuprorelin in prostate cancer (Pca) castration treatment from Chinese healthcare system perspective. Methods A Markov model, adapted from the one established in Finland was conducted for the cost-effectiveness analysis of degarelix and leuprorelin for Pca treatment. The main data were derived from global phase III clinical trials of degarelix (CS21), published study and expert surveys. Outcomes, utility and costs of prostate cancer patients were calculated on a 30-year time horizon. The CS21 study based population of intention-to-treat (ITT) population and three scenarios were modeled. Taking three times of the Gross domestic product (GDP) per capita (242,928 yuan, 2021) as the acceptable threshold for cost-effectiveness. One-way and probabilistic sensitivity analyses were performed on key parameters, including transition probabilities, costs, utility, and discount rate to test the robustness of the model. Results Base case analysis for ITT population revealed that total costs of degarelix and leuprorelin were 566,226 yuan and 489,693 yuan, while the total quality-adjusted life years (QALYs) were 5.19 and 4.51 during the 30-year time horizon, resulting an incremental cost effectiveness ratio (ICER) of 112,674 yuan/QALY which was 1.39 times the GDP per capita, lower than willingness-to-pay level of three times the GDP per capita. The results for scenario analyses revealed that compared to leuprorelin, degarelix for Pca treatment in China was cost-effective. One-way sensitivity analysis showed that the model was most sensitive to price of 80 mg degarelix, utility of 1st-line therapy, hazard ratio of PSA recurrence, price of 3.75 mg leuprorelin, response rate of docetaxel per cycle, and discount rate of cost. In probabilistic sensitivity analysis, compared to leuprorelin, the probability of degarelix to be cost-effective was 53 and 81% for willingness-to-pay threshold of one and three times the GDP per capita. Conclusion Compared to leuprorelin, degarelix for prostate cancer treatment is cost-effective. Moreover, scenario, one-way, and probabilistic sensitivity analyses revealed that the model was robust.
Collapse
Affiliation(s)
- Jianzhou Yan
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- The Research Center of National Drug Policy and Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Caiyun Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- The Research Center of National Drug Policy and Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Xuefang Zhang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- The Research Center of National Drug Policy and Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Luyan Cheng
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- The Research Center of National Drug Policy and Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Ruilin Ding
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- The Research Center of National Drug Policy and Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Lingli Zhang
- School of Pharmacy, Nanjing Medical University, Nanjing, China
- *Correspondence: Lingli Zhang
| |
Collapse
|
5
|
Yang D, Bin N, Zhou Z, Li Z, Shen M, Yang C, Qin Y, Wang R, Lv W, Wei B, Zhou L, Kang M. Demographics and Economic Burden of Nasopharyngeal Carcinoma Inpatients. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6958806. [PMID: 35757475 PMCID: PMC9217537 DOI: 10.1155/2022/6958806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022]
Abstract
Objective Nasopharyngeal carcinoma is particularly prevalent in Guangdong and Guangxi (southern China); the economic burden of nasopharyngeal cancer patients is heavy in China. This study is aimed at retrospectively analyzing the basic features and economic burden of newly diagnosed nasopharyngeal carcinoma patients admitted to the First Affiliated Hospital of Guangxi Medical University and at providing a scientific basis for nasopharyngeal carcinoma prevention and control strategies. Methods The data of 3,727 nasopharyngeal carcinoma inpatients diagnosed from January 2012 to December 2020 were extracted from the Guangxi Nasopharyngeal Carcinoma Healthcare Big Data Management Information Platform. Basic demographic characteristics, duration of hospital stay, and hospitalization cost of nasopharyngeal carcinoma patients were collected and analyzed statistically. Results The incidence period of nasopharyngeal carcinoma was primarily from 30 to 69 years of age, with the 40-49-year age group comprising the largest proportion of nasopharyngeal carcinoma patients, accounting for 34.18% of the patients with newly diagnosed nasopharyngeal carcinoma in the hospital. The male-to-female ratio was 2.87 : 1. There were 2,223 cases from rural areas, 2,153 from the Han ethnic group, and 1,460 from the Zhuang ethnic group, accounting for 59.65%, 55.77%, and 39.17% of the total number of cases, respectively. The average duration of hospitalization decreased whereas the average hospitalization cost increased annually. Multivariate analysis of hospitalization cost showed that the duration of hospital stay, rural/urban, and ethnicity was the main influencing factors: the longer the duration of hospital stay, the higher the hospitalization cost; patients from rural incurred lower costs than from urban; ethnic Zhuang patients incurred significantly lower costs than patients from other ethnicities. Conclusion Early diagnosis and treatment should be actively carried out to reduce the incidence of nasopharyngeal carcinoma, especially for rural, ethnic Zhuang, and males in the 40-49-year age group patients. The future research on nasopharyngeal carcinoma will focus on exploring the pathogenesis of nasopharyngeal carcinoma, improving the screening system, and reducing the burden on patients, in order to further improve the survival rate and quality of life of patients with nasopharyngeal carcinoma.
Collapse
Affiliation(s)
- Dong Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- The First Affiliated Hospital, Department of Radiation Oncology, Hengyang Medical School, University of South China, Hengyang, 421001 Hunan, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021 Guangxi, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021 Guangxi, China
| | - Nengfu Bin
- Health Statistics information Center of Guangxi Zhuang Autonomous Region, Nanning, 530021 Guangxi, China
| | - Ziyan Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021 Guangxi, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021 Guangxi, China
| | - Zhiru Li
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021 Guangxi, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021 Guangxi, China
| | - Mingjun Shen
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021 Guangxi, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021 Guangxi, China
| | - Chaolin Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021 Guangxi, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021 Guangxi, China
| | - Yating Qin
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021 Guangxi, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021 Guangxi, China
| | - Rensheng Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021 Guangxi, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021 Guangxi, China
| | - Wei Lv
- Health Statistics information Center of Guangxi Zhuang Autonomous Region, Nanning, 530021 Guangxi, China
| | - Bo Wei
- Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi, China
| | - Lifang Zhou
- The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545005, Guangxi, China
- Liuzhou Center for Disease Prevention and Control, Liuzhou 545005, Guangxi, China
| | - Min Kang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021 Guangxi, China
- Guangxi Key Laboratory of Immunology and Metabolism for Liver Diseases, Nanning, 530021 Guangxi, China
| |
Collapse
|
6
|
Iguchi T, Nakamura Y, Akiyama T, Chand K, Yu E. Descriptive study on burden and communication of fatigue among castration-resistant prostate cancer patients in Japan. Curr Med Res Opin 2022; 38:417-426. [PMID: 34918590 DOI: 10.1080/03007995.2021.2006534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Prostate cancer is a common malignancy and patients may progress to castration-resistant prostate cancer (CRPC). Among patients with CRPC, fatigue is a common symptom associated with current treatments. The aim of this real-world study was to describe patient-reported fatigue in Japanese patients treated with androgen receptor-axis-targeted therapies for CRPC. METHODS Data of this observational study were collected in a quantitative phase for the description of patient-reported fatigue, and a qualitative phase for elicitation of fatigue perception and barriers to reporting fatigue. RESULTS In the quantitative phase (N = 22), fatigue was investigated in two formats: symptoms report and Brief Fatigue Inventory (BFI). In the report of the symptoms, 12 patients reported tiredness, and four moderate-to-severe tiredness during treatment. In the BFI, all patients reported fatigue; eight reported moderate-to-severe fatigue. The most affected BFI domain was mood: five patients reporting moderate-to-severe impact. In interviews (qualitative phase; N = 8), diverse patient experience on fatigue was observed, including apathetic feelings, affected speed and distance during the walk, negative impact on profession, housework, or driving, reduced outgoing activity, and difficulty in enjoying time with grandchildren or travel. Five out of eight patients communicated fatigue to their physicians but received diverse reactions. CONCLUSION Patient interviews highlighted the impact of fatigue on patients' lives and difficulties in communicating fatigue to physicians. Fatigue frequency after medication may need to be monitored and its burden is considered to provide treatment that meets the needs, wishes, and circumstances of each patient. Further research is needed to elucidate how fatigue affects patients' lives, and underscore patient-physician communication difficulties.
Collapse
Affiliation(s)
- Taro Iguchi
- Department of Urology, Kanazawa Medical University, Ishikawa, Japan
| | - Yusuke Nakamura
- Market and Regional Access, Bayer Yakuhin, Ltd, Tokyo, Japan
| | - Takeshi Akiyama
- Real World Evidence Solutions, IQVIA Solutions Japan K.K, Tokyo, Japan
| | - Krishant Chand
- Real World Evidence Solutions, IQVIA Solutions Japan K.K, Tokyo, Japan
| | - Eric Yu
- Real World Evidence Solutions, IQVIA Solutions Japan K.K, Tokyo, Japan
| |
Collapse
|
7
|
Moussa M, Papatsoris A, Sryropoulou D, Chakra MA, Dellis A, Tzelves L. A pharmacoeconomic evaluation of pharmaceutical treatment options for prostate cancer. Expert Opin Pharmacother 2021; 22:1685-1728. [PMID: 34076542 DOI: 10.1080/14656566.2021.1925647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Prostate cancer is one of the most common neoplasms in men. For many years the mainstay of treatment was androgen deprivation therapy, but during last decade many novel agents have emerged, accompanied by increased costs for healthcare systems. AREAS COVERED In this literature review, the authors provide a pharmacoeconomic review of several pharmaceutical agents used in several disease stages, by summarizing evidence from cost-analysis, cost-effectiveness, cost-utility, cost-saving, cost-benefit and budgetary impact analysis studies. EXPERT OPINION The rapid development of therapeutic agents for prostate cancer has put a great budgetary burden on healthcare systems, since these drugs are prolonging survival and improving quality of life . Since existing data are now mature enough from a number of clinical trials with long-term follow-up, policy makers should propose not only the most clinically effective but also the most cost-effective agents, in order for every patient to gain access at least to some of these therapies. Docetaxel addition seems to be a cost-effective option, when compared to both abiraterone and enzalutamide (due to costs related to acquisition and side effects). Cabazitaxel is a strong candidate after docetaxel failure, while both denosumab and bisphosphonates are cost-effective for reducing skeletal-related events in metastatic disease.
Collapse
Affiliation(s)
- Mohamad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Mohamed Abou Chakra
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios Dellis
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Tzelves
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
8
|
Kreis K, Horenkamp-Sonntag D, Schneider U, Zeidler J, Glaeske G, Weissbach L. Treatment-Related Healthcare Costs of Metastatic Castration-Resistant Prostate Cancer in Germany: A Claims Data Study. PHARMACOECONOMICS - OPEN 2021; 5:299-310. [PMID: 32474839 PMCID: PMC8160066 DOI: 10.1007/s41669-020-00219-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE Treatments for patients with metastatic castration-resistant prostate cancer (mCRPC) have expanded rapidly. They include the chemotherapies docetaxel and cabazitaxel, hormonal drugs abiraterone and enzalutamide, and best supportive care (BSC). Cabazitaxel has proven to be the last life-prolonging option, associated with a significant risk of serious adverse events. Given the lack of real-world evidence, we aimed to compare healthcare resource utilization (HRU) and costs in patients with mCRPC treated with cabazitaxel, docetaxel, abiraterone, enzalutamide, and BSC. METHODS We used 2014-2017 claims data from a large German statutory health insurance fund, the Techniker Krankenkasse, to identify patients with mCRPC. Patient allocation to individual therapy regimens was based on clinical knowledge and included therapy cycles, duration of therapy, and continuous treatment. The study period lasted from the first claim until death, the end of data availability, a drug switch, or discontinuation of therapy, whichever came first. Multivariate regression models were used to compare monthly all-cause and mCRPC-related HRU and costs across cohorts by adjusting for baseline covariates (including age and comorbidities). RESULTS The 3944 identified patients with mCRPC initiated treatment with cabazitaxel (n = 240), docetaxel (n = 539), abiraterone (n = 486), enzalutamide (n = 351), or BSC (n = 2328). In most domains, HRU was highest in the cabazitaxel cohort and lowest in the BSC group. Accordingly, the highest all-cause and mCRPC-related costs per month, respectively, were observed in patients receiving cabazitaxel (€7631/€6343), followed by abiraterone (€5226/€4579), enzalutamide (€5079/€4416), docetaxel (€2392/€1580), and BSC (€959/€438). Cost variations were mostly attributable to drugs, inpatient treatment, and sick leave payments. CONCLUSION mCRPC treatment imposes a high economic burden on statutory health insurance. Cabazitaxel is associated with substantially higher expenses, resulting from higher drug costs and a greater need for inpatient treatment. As mCRPC continues to be incurable, decision makers and clinician leaders should carefully evaluate public access to innovative agents and optimal treatment strategies.
Collapse
Affiliation(s)
- Kristine Kreis
- Center for Health Economics Research Hannover (CHERH), Gottfried Wilhelm Leibniz Universität Hannover, Otto-Brenner-Straße 7, 30159, Hannover, Germany.
| | - Dirk Horenkamp-Sonntag
- Versorgungsmanagement, Techniker Krankenkasse, Bramfelder Straße 140, 22305, Hamburg, Germany
| | - Udo Schneider
- Versorgungsmanagement, Techniker Krankenkasse, Bramfelder Straße 140, 22305, Hamburg, Germany
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Gottfried Wilhelm Leibniz Universität Hannover, Otto-Brenner-Straße 7, 30159, Hannover, Germany
| | - Gerd Glaeske
- Forschungszentrum Ungleichheit und Sozialpolitik, Universität Bremen - SOCIUM, Mary-Somerville-Str. 5, 28359, Bremen, Germany
| | - Lothar Weissbach
- Gesundheitsforschung für Männer gGmbH, Muthesiusstr. 7, 12163, Berlin, Germany
| |
Collapse
|
9
|
Romero M, Vásquez E, Montoya G, Huerfano L. Análisis retrospectivo de las características y utilización de los recursos de salud en pacientes con cáncer de próstata resistente a la castración metastásico tratados con Enzalutamida o Acetato de Abiraterona en Colombia. UROLOGÍA COLOMBIANA 2021. [DOI: 10.1055/s-0040-1714725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Resumen
Objetivo Describir las características demográficas, clínicas, los recursos de salud utilizados y los costos directos del tratamiento del cáncer de próstata resistente a la castración metastásico (CPRCm), tratados con enzalutamida o acetato de abiraterona en Colombia.
Métodos Mediante un estudio de corte transversal se analizaron datos de utilización de servicios de una EPS (entidad promotora de salud) colombiana. Para ello, se identificaron los pacientes que durante el 1 de julio de 2016 y 30 de junio de 2017 (fecha índice) presentaron registro de uso de enzalutamida o acetato de abiraterona y se confirmaron sus antecedentes de castración química o quirúrgica (6 meses previos a la fecha índice). Se establecieron las frecuencias de uso de servicios en dicha población y se extrajo el consumo reportado asociado a consultas (urgencias, consulta externa), procedimientos y medicamentos en el periodo de análisis. Los costos se organizaron por categorías y se reportaron en pesos colombianos (COP) 2016.
Resultados se identificaron 161 pacientes con CPRCm con edad media de 77 años, se determinó que el departamento colombiano con más población de CPRCm en esta cohorte fue el Valle del Cauca, que 98,1% de los pacientes pertenecen al régimen contributivo y que 1,9% al subsidiado. El cálculo de la supervivencia con el índice de comorbilidad de Charlson mostró que esos pacientes tendrían una tasa de supervivencia de 0% a 10 años. Las comorbilidades más frecuentes encontradas fueron hipertensión, diabetes mellitus, insuficiencia renal y otras patologías tumorales relacionadas. El costo total de manejo de un paciente con CPRCm, que recibe de manera continua durante 12 meses abiraterona o enzalutamida es promedio $131.942.292 COP año. Esa cifra incluye tanto el uso de servicios como el consumo de medicamentos, y ese último representa cerca del 90% del costo.
Conclusiones los pacientes con cáncer en estadio metastásico se caracterizan por presentar alta demanda de medicamentos, laboratorios, imágenes diagnósticas, visitas ambulatorias e ingresos hospitalarios. Debido a que es una muestra pequeña de pacientes, se requiere desarrollar una valoración posterior que permita corroborar los hallazgos encontrados en este estudio retrospectivo.
Collapse
|
10
|
Ten Ham RMT, van Nuland M, Vreman RA, de Graaf LG, Rosing H, Bergman AM, Huitema ADR, Beijnen JH, Hövels AM. Cost-Effectiveness Assessment of Monitoring Abiraterone Levels in Metastatic Castration-Resistant Prostate Cancer Patients. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:121-128. [PMID: 33431146 DOI: 10.1016/j.jval.2020.04.1838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/28/2020] [Accepted: 04/26/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Abiraterone acetate is registered for the treatment of metastatic castration-sensitive and resistant prostate cancer (mCRPC). Treatment outcome is associated with plasma trough concentrations (Cmin) of abiraterone. Patients with a plasma Cmin below the target of 8.4 ng/mL may benefit from treatment optimization by dose increase or concomitant intake with food. This study aims to investigate the cost-effectiveness of monitoring abiraterone Cmin in patients with mCRPC. METHODS A Markov model was built with health states progression-free survival, progressed disease, and death. The benefits of monitoring abiraterone Cmin followed by a dose increase or food intervention were modeled via a difference in the percentage of patients achieving adequate Cmin taking a healthcare payer perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainties and their impac to the incremental cost-effectiveness ratio (ICER). RESULTS Monitoring abiraterone followed by a dose increase resulted in 0.149 incremental quality-adjusted life-years (QALYs) with €22 145 incremental costs and an ICER of €177 821/QALY. The food intervention assumed equal effects and estimated incremental costs of €7599, resulting in an ICER of €61 019/QALY. The likelihoods of therapeutic drug monitoring (TDM) with a dose increase or food intervention being cost-effective were 8.04%and 81.9%, respectively. CONCLUSIONS Monitoring abiraterone followed by a dose increase is not cost-effective in patients with mCRPC from a healthcare payer perspective. Monitoring in combination with a food intervention is likely to be cost-effective. This cost-effectiveness assessment may assist decision making in future integration of abiraterone TDM followed by a food intervention into standard abiraterone acetate treatment practices of mCRPC patients.
Collapse
Affiliation(s)
- Renske M T Ten Ham
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Merel van Nuland
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Laurens G de Graaf
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hilde Rosing
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - André M Bergman
- Division of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jos H Beijnen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands; Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anke M Hövels
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
11
|
Bai L, Wushouer H, Huang C, Luo Z, Guan X, Shi L. Health Care Utilization and Costs of Patients With Prostate Cancer in China Based on National Health Insurance Database From 2015 to 2017. Front Pharmacol 2020; 11:719. [PMID: 32587512 PMCID: PMC7299164 DOI: 10.3389/fphar.2020.00719] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/30/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In terms of medical costs, prostate cancer is on the increase as one of the most costly cancers, posing a tremendous economic burden, but evidence on the health care utilization and medical expenditure of prostate cancer has been absent in China. OBJECTIVE This study aimed to analyze health care utilization and direct medical costs of patients with prostate cancer in China. METHODS Health care service data with a national representative sample of basic medical insurance beneficiaries between 2015 and 2017 were obtained from the China Health Insurance Association database. We conducted descriptive and statistical analyses of health care utilization, annual direct medical costs, and composition based on cancer-related medical records. Health care utilization was measured by the number of hospital visits and the length of stay. RESULTS A total of 3,936 patients with prostate cancer and 24,686 cancer-related visits between 2015 and 2017 were identified in the database. The number of annual outpatient and inpatient visits per patient differed significantly from 2015 to 2017. There was no obvious change in length of stay and annual direct medical costs from 2015 to 2017. The number of annual visits per patient (outpatient: 3.0 vs. 4.0, P < 0.01; inpatient: 1.5 vs. 2.0, P < 0.001) and the annual medical direct costs per patient (US$2,300.1 vs. US$3,543.3, P < 0.001) of patients covered by the Urban Rural Resident Basic Medical Insurance (URRBMI) were both lower than those of patients covered by the Urban Employee Basic Medical Insurance (UEBMI), and the median out-of-pocket expense of URRBMI was higher than that of UEBMI (US$926.6 vs. US$594.0, P < 0.001). The annual direct medical costs of patients with prostate cancer in Western regions were significantly lower than those of patients in Eastern and Central regions (East: US$4011.9; Central: US$3458.6; West: US$2115.5) (P < 0.001). CONCLUSIONS There was an imbalanced distribution of health care utilization among regions in China. The direct medical costs of Chinese patients with prostate cancer remained stable, but the gap in health care utilization and medical costs between two different insurance schemes and among regions still needed to be further addressed.
Collapse
Affiliation(s)
- Lin Bai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Haishaerjiang Wushouer
- Center for Strategic Studies, Chinese Academy of Engineering, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Cong Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Zhenhuan Luo
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| |
Collapse
|
12
|
Barqawi YK, Borrego ME, Roberts MH, Abraham I. Cost-effectiveness model of abiraterone plus prednisone, cabazitaxel plus prednisone and enzalutamide for visceral metastatic castration resistant prostate cancer therapy after docetaxel therapy resistance. J Med Econ 2019; 22:1202-1209. [PMID: 31452414 DOI: 10.1080/13696998.2019.1661581] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: Among patients diagnosed with prostate cancer, 10-20% will develop castration-resistant prostate cancer (CRPC) within 5 years; for 70%, CRPC will metastasize, mostly to the lungs and/or liver. We performed a cost-effectiveness model comparing abiraterone plus prednisone (ABI + PRD), cabazitaxel plus prednisone (CAB + PRD) and enzalutamide (ENZ) for visceral metastatic CRPC post-docetaxel therapy resistance. Methods: A three-state (Progression-Free, Progression, Death) lifetime Markov model was constructed to compare ABI + PRD, CAB + PRD, and ENZ from a United States healthcare payer perspective (2019 US$; discount rate 3%/yr.). Effectiveness was measured in life-years (LYs) and quality-adjusted life years (QALYs). Inputs included treatment costs, grade III/IV adverse events with incidence ≥5%, physician follow-up, lab and imaging tests. Phase III trial Kaplan-Meier curves were extrapolated to estimate overall survival and Progression-Free transition probabilities. Incremental cost-effectiveness ratios (ICERs) and utility ratios (ICURs), probabilistic sensitivity analyses (PSAs) and cost-effectiveness acceptability curves at willingness-to-pay (WTP) thresholds were estimated. Results: Models estimated 3-year overall survival rates of 1.3% for patients treated with ABI + PRD, 16.2% for CAB + PRD, and 13.2% for ENZ. Estimated Progression-Free rates at 1.5 years were 0.51% for ABI + PRD, 0.27% for CAB + PRD, and 14.47% for ENZ. LYs and QALYs were 1.20 and 0.58 respectively for ABI + PRD, 1.48 and 0.56 for CAB + PRD, and 1.58 and 0.79 for ENZ. Total treatment costs were: $115,433 for ABI + PRD, $85,337 for CAB + PRD and $109,213 for ENZ. CAB + PRD and ENZ dominated ABI + PRD due to higher LYs gained. Incremental QALYs for ENZ vs. CAB + PRD were larger than incremental LYs. The ICUR for ENZ was $103,674/QALY compared to CAB + PRD. Conclusions: This analysis found ENZ provided greater LYs and QALYs than both ABI + PRD and CAB + PRD, at a lower cost than ABI + PRD, but at a higher cost compared to CAB + PRD. For patients with visceral mCRPC after docetaxel therapy resistance, ENZ was cost-effective 92% of the time with a WTP threshold of $100,000/QALY.
Collapse
Affiliation(s)
- Yazan K Barqawi
- College of Pharmacy, University of New Mexico , Albuquerque , NM , USA
| | - Matthew E Borrego
- College of Pharmacy, University of New Mexico , Albuquerque , NM , USA
| | - Melissa H Roberts
- College of Pharmacy, University of New Mexico , Albuquerque , NM , USA
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona , Tucson , AZ , USA
| |
Collapse
|
13
|
Salehi B, Fokou PVT, Yamthe LRT, Tali BT, Adetunji CO, Rahavian A, Mudau FN, Martorell M, Setzer WN, Rodrigues CF, Martins N, Cho WC, Sharifi-Rad J. Phytochemicals in Prostate Cancer: From Bioactive Molecules to Upcoming Therapeutic Agents. Nutrients 2019; 11:E1483. [PMID: 31261861 PMCID: PMC6683070 DOI: 10.3390/nu11071483] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/22/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022] Open
Abstract
Prostate cancer is a heterogeneous disease, the second deadliest malignancy in men and the most commonly diagnosed cancer among men. Traditional plants have been applied to handle various diseases and to develop new drugs. Medicinal plants are potential sources of natural bioactive compounds that include alkaloids, phenolic compounds, terpenes, and steroids. Many of these naturally-occurring bioactive constituents possess promising chemopreventive properties. In this sense, the aim of the present review is to provide a detailed overview of the role of plant-derived phytochemicals in prostate cancers, including the contribution of plant extracts and its corresponding isolated compounds.
Collapse
Affiliation(s)
- Bahare Salehi
- Student Research Committee, School of Medicine, Bam University of Medical Sciences, Bam 44340847, Iran
| | - Patrick Valere Tsouh Fokou
- Antimicrobial and Biocontrol Agents Unit, Department of Biochemistry, Faculty of Science, University of Yaounde I, Ngoa Ekelle, Annex Fac. Sci, Yaounde 812, Cameroon
| | | | - Brice Tchatat Tali
- Antimicrobial Agents Unit, Laboratory for Phytobiochemistry and Medicinal Plants Studies, Department of Biochemistry, Faculty of Science, University of Yaoundé I, Messa-Yaoundé 812, Cameroon
| | - Charles Oluwaseun Adetunji
- Applied Microbiology, Biotechnology and Nanotechnology Laboratory, Department of Microbiology, Edo University, Iyamho, Edo State 300271, Nigeria
| | - Amirhossein Rahavian
- Department of Urology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1989934148, Iran
| | - Fhatuwani Nixwell Mudau
- Department of Agriculture and Animal Health, University of South Africa, Private Bag X6, Florida 1710, South Africa
| | - Miquel Martorell
- Department of Nutrition and Dietetics, Faculty of Pharmacy, University of Concepcion, Concepcion 4070386, Chile.
| | - William N Setzer
- Department of Chemistry, University of Alabama in Huntsville, Huntsville, AL 35899, USA
| | - Célia F Rodrigues
- LEPABE-Department of Chemical Engineering, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal.
| | - Natália Martins
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
- Institute for Research and Innovation in Health (i3S), University of Porto, 4200-135 Porto, Portugal.
| | - William C Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China.
| | - Javad Sharifi-Rad
- Zabol Medicinal Plants Research Center, Zabol University of Medical Sciences, Zabol 61615-585, Iran.
| |
Collapse
|
14
|
Bretoni A, Ferrario L, Foglia E. HTA and innovative treatments evaluation: the case of metastatic castration-resistant prostate cancer. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:283-300. [PMID: 31114269 PMCID: PMC6489625 DOI: 10.2147/ceor.s189436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/13/2019] [Indexed: 01/22/2023] Open
Abstract
Purpose: To investigate the implications of the introduction of two hormonal therapies, abiraterone acetate + prednisone (AA+P) and enzalutamide (ENZA), for the treatment of naïve patients with metastatic castration-resistant prostate cancer (mCRPC) in the Italian setting. Methods: In 2017–2018, a Health Technology Assessment was conducted in Italy, considering the National Healthcare Service (NHS) perspective. Data were retrieved from literature evidence, economic evaluations, and qualitative questionnaires, considering the 9 EUnetHTA dimensions, and a final multi-criteria approach. Results: On the basis of mCRPC prevalence and incidence rates in Italy, the analysis considered 11,212 males eligible to either AA+P or ENZA treatments. Both drugs led to an improvement of the patients' overall survival, with respect to the standard of care, composed of docetaxel chemotherapy. However, AA+P showed a higher rate of drug-related moderate adverse events and a monitoring activities incidence superior to ENZA (+70%, p-value=0.00), which led to a major resources absorption (€ 1,056.02 vs € 316.25, p-value=0.00), whereas ENZA showed a better cost-effectiveness average value (CEV: 54,586.12 vs 57,624.15). Economic savings ranging from 1.46% to 1.61% emerged for the NHS, as well as organizational advantages, with fewer minutes required for the mCRPC management (AA+P: 815 mins vs ENZA: 500 mins). According to experts’ perceptions, based on a 7-item Likert scale (ranging from −3 to +3), similar results emerged on ethical and social impact (ENZA: 1.35 vs AA+P: 1.48, p-value>0.05), and on legal dimension (ENZA: 0.67 vs AA+P: 0.67, p-value>0.05), since both drugs improved the patients’ quality of life and received approval for use. High-level perceptions related to ENZA adoption emerged with regard to equity (ENZA: 0.69 vs AA+P: 0.25, p-value<0.05), since it is cortisone-free. Multi-criteria approach analysis highlighted a higher score of ENZA than comparator (0.79 vs 0.60, p-value=0.00). Conclusion: The evidence-based information underlined the advantages of ENZA and AA+P treatments as therapeutic options for mCRPC patients. In the appraisal phase, the higher score than the comparator suggested ENZA as the preferred treatment for mCRPC.
Collapse
Affiliation(s)
- Alberto Bretoni
- Centre for Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Italy
| | - Lucrezia Ferrario
- Centre for Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Italy
| | - Emanuela Foglia
- Centre for Health Economics, Social and Health Care Management, LIUC - Università Cattaneo, Castellanza, Italy
| |
Collapse
|
15
|
Imai H, Saijo K, Komine K, Kawamura Y, Hiraide S, Umegaki S, Okada Y, Ohuchi K, Sato Y, Takahashi M, Takahashi S, Shirota H, Takahashi M, Ishioka C. Predictive factors for the efficacy of the second taxane treatment in patients with advanced cancer. Cancer Manag Res 2018; 10:3629-3636. [PMID: 30271211 PMCID: PMC6149899 DOI: 10.2147/cmar.s170948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose Research has revealed that some patients who develop resistance to the first taxane treatment exhibit a moderate response to the second taxane treatment (incomplete cross-resistance between paclitaxel and docetaxel). However, which patients are most likely to respond to the second treatment remains unclear. The aim of this study was to determine the predictive factors for the efficacy of the second taxane treatment in patients resistant to the first. Patients and methods We enrolled patients treated with paclitaxel and docetaxel (n=31) in this study. Using univariate and multivariate analyses, we determined the predictive factors for the efficacy of the second taxane treatment. Then, we assigned patients to one of the three groups: 1) those with a partial response (PR) to the first taxane treatment who subsequently became refractory (PR group); 2) those whose response was stable disease (SD) and subsequently became refractory (SD group); and 3) those whose response was the progression of the disease with the first taxane treatment (progression disease [PD] group). Furthermore, the response rates were assessed for each group. All statistical analyses were performed using JMP 11. Results Responses to the first taxane treatment considerably correlated with the efficacy of the second treatment in patients with a PR to the first taxane treatment (P=0.0061, univariate analysis; P=0.0056, multivariate analysis). In addition, response rates to the second taxane treatment in the PR, SD, and PD groups were 33.3%, 0%, and 0%, respectively. Conclusion The response to the first taxane treatment was a predictive factor for the efficacy of the second taxane treatment in patients with a PR to the first. Thus, the second treatment is highly recommended for patients who exhibit tumor shrinkage (a PR) by the first treatment.
Collapse
Affiliation(s)
- Hiroo Imai
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| | - Ken Saijo
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| | - Keigo Komine
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| | - Yoshifumi Kawamura
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| | - Sakura Hiraide
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| | - Sho Umegaki
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| | - Yoshinari Okada
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| | - Kota Ohuchi
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| | - Yuko Sato
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| | - Masahiro Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| | - Shin Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| | - Hidekazu Shirota
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| | - Masanobu Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| | - Chikashi Ishioka
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan,
| |
Collapse
|