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Marfatia AA, Botteman MF, Foley I, Brandman J, Langer CJ. Economic value of zoledronic acid compared with placebo in the treatment of skeletal metastases in patients with solid tumors: The case of the United Kingdom (UK). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.6603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6603 Background: Zoledronic acid (ZA) reduces the risk of skeletal-related events (SREs) in patients with solid tumors (i.e., renal cell carcinoma, thyroid, head and neck, small cell lung, or others cancers, excluding breast, prostate and non small cell lung [NSCLC] cancers) and bone metastases. This analysis assessed, from the perspective of the UK National Health Service, the economic impact of ZA in this patient population. Methods: A literature-based decision-analytic model was developed to compare the direct costs and quality adjusted life years (QALY) of patients with bone metastases secondary to solid tumors receiving ZA or placebo. Survival, SRE incidence, and number of infusions administered were obtained from a clinical trial comparing patients randomized to 4 mg ZA or placebo for up to 21 months. Drug acquisition and administration costs and SRE costs were estimated using published sources and national fee schedules (e.g., NHS reference costs, British National Formulary). The impact of SREs on quality of life was estimated using the literature. Consistent with previous economic analyses of bisphosphonates in cancers (e.g., Hillner et al, 2000), patients were assumed to experience quality of life improvements lasting 1 month for each SRE avoided. Results: The average remaining life expectancy was conservatively assumed equal in both groups and was 9.54 months (median, 6.61 months). Patients receiving placebo were projected to experience 2.64 SREs on average v. 1.64 SREs among ZA patients. QALYs were estimated at 0.3917 per patient (pp) and 0.3728 pp in the ZA and placebo groups, respectively. ZA drug- related costs were estimated at £1,386 pp, based on an average of 5.52 infusions pp. The use of ZA was associated with a reduction of £1,830 pp in SRE costs. Overall, ZA saved costs and increased QALYs v. no therapy, by £445 pp and 0.0189 QALYs pp, respectively. In sensitivity analyses, ZA cost £25,000 or less per QALY under a wide range of assumptions. Conclusions: The use of ZA leads to fewer SREs, better estimated quality of life, and lower costs relative to placebo in UK patients with bone metastases secondary to solid tumors other than breast, prostate or NSCLC cancer. ZA appears therefore highly cost effective in this population. No significant financial relationships to disclose.
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Affiliation(s)
- A. A. Marfatia
- Novartis Pharmaceuticals Corporation, Florham Park, NJ; Pharmerit North America LLC, Bethesda, MD; Fox Chase Cancer Center, Philadelphia, PA
| | - M. F. Botteman
- Novartis Pharmaceuticals Corporation, Florham Park, NJ; Pharmerit North America LLC, Bethesda, MD; Fox Chase Cancer Center, Philadelphia, PA
| | - I. Foley
- Novartis Pharmaceuticals Corporation, Florham Park, NJ; Pharmerit North America LLC, Bethesda, MD; Fox Chase Cancer Center, Philadelphia, PA
| | - J. Brandman
- Novartis Pharmaceuticals Corporation, Florham Park, NJ; Pharmerit North America LLC, Bethesda, MD; Fox Chase Cancer Center, Philadelphia, PA
| | - C. J. Langer
- Novartis Pharmaceuticals Corporation, Florham Park, NJ; Pharmerit North America LLC, Bethesda, MD; Fox Chase Cancer Center, Philadelphia, PA
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Botteman MF, Foley I, Marfatia AA, Brandman J, Langer CJ. Economic value of zoledronic acid versus placebo in the treatment of skeletal metastases in patients with lung cancer: The case of the United Kingdom (UK). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.6617] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6617 Objectives: Zoledronic acid (ZA) reduces the risk of skeletal-related events (SREs) in lung cancer patients with bone metastases and may improve survival among those patients with high levels of bone metabolism. This analysis assessed, from the UK National Health Service's perspective, the economic impact of ZA therapy in patients with bone metastases secondary to lung cancer. Methods: A literature-based decision analytic model was developed to compare the direct costs and quality adjusted life years (QALY) experienced by lung cancer patients with bone metastases receiving placebo or ZA. Survival, SRE incidence, and number of infusions administered were obtained from a randomized clinical trial comparing 4 mg ZA with placebo. Drug acquisition and administration costs and SRE costs were estimated using published sources and national fee schedules (i.e., NHS reference costs, British National Formulary, Personal Social Services Research Unit reference costs). The impact of SREs on quality of life was estimated using the literature. Consistent with previous economic analyses of bisphosphonates in cancers (e.g., Hillner et al, 2000), patients avoiding SREs were assumed to experience quality of life improvements for 1 month. Results: The average remaining life expectancy was conservatively assumed equal in both groups and was 8.50 months (median, 5.89 months). During those months, patients receiving placebo were projected to experience 2.07 SREs on average compared to 1.32 SREs among ZA patients. QALYs were estimated at 0.3523 per patient (pp) and 0.3350 pp in the ZA and placebo groups, respectively. ZA drug-related costs were estimated at £1,473 pp, based on 5.87 infusions pp and a cost of £251.01 per infusion. The use of ZA was associated with a reduction of £1,562 pp in SRE costs. Overall, ZA saved costs and increased QALYs compared to no therapy, by £89 pp and 0.0173 QALYs pp, respectively. In sensitivity analyses, ZA cost £25,000 or less per QALY under a wide range of assumptions. Conclusions: The use of ZA leads to fewer SREs, better estimated quality of life, and lower costs relative to placebo in UK lung cancer patients with bone metastases. The use of ZA in this population therefore appears highly cost effective. No significant financial relationships to disclose.
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Affiliation(s)
- M. F. Botteman
- PharMerit North America, Bethesda, MD; Novartis Pharmaceuticals Corporation, Florham Park, NJ; Fox Chase Cancer Center, Philadelphia, PA
| | - I. Foley
- PharMerit North America, Bethesda, MD; Novartis Pharmaceuticals Corporation, Florham Park, NJ; Fox Chase Cancer Center, Philadelphia, PA
| | - A. A. Marfatia
- PharMerit North America, Bethesda, MD; Novartis Pharmaceuticals Corporation, Florham Park, NJ; Fox Chase Cancer Center, Philadelphia, PA
| | - J. Brandman
- PharMerit North America, Bethesda, MD; Novartis Pharmaceuticals Corporation, Florham Park, NJ; Fox Chase Cancer Center, Philadelphia, PA
| | - C. J. Langer
- PharMerit North America, Bethesda, MD; Novartis Pharmaceuticals Corporation, Florham Park, NJ; Fox Chase Cancer Center, Philadelphia, PA
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El Ouagari K, Karnon J, Delea T, Talbot W, Brandman J. Cost-Effectiveness of Letrozole in the Extended Adjuvant Treatment of Women with Early Breast Cancer. Breast Cancer Res Treat 2006; 101:37-49. [PMID: 16821085 DOI: 10.1007/s10549-006-9262-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 04/24/2006] [Indexed: 11/28/2022]
Abstract
Adjuvant tamoxifen therapy for 5 years reduces recurrence in hormone receptor positive, post-menopausal women with early breast cancer, but offers no advantage when prolonged to another 5 years, during which the risk of recurrence remains high. Treating patients, who remain disease-free after 5 years of tamoxifen, with letrozole significantly reduces recurrence, regardless of nodal status. This study evaluated the life-time cost-utility of extended adjuvant letrozole therapy in 62-year-old patients from a third-party payer perspective. A Markov model incorporated locoregional, contralateral, and metastatic recurrences. The comparator was placebo. Event rates were based on published trials. Utility values were taken from a clinical trial and published literature. Costs were obtained from published literature, provincial payment schedules, cancer agencies, and drug plans formularies. Resource use reflected Canadian treatment patterns. Robustness of the model was tested using deterministic and probabilistic sensitivity analyses. Extended adjuvant letrozole therapy of a cohort consisting of 50% node-negative and 50% node-positive patients prolonged their lives on average by 0.466 years or 0.267 quality-adjusted life years (QALYs) at an additional cost of Can$8,031 per patient, yielding an incremental cost-utility ratio (ICUR) of $34,058 per QALY. Letrozole was more cost-effective in node-positive than in node-negative patients (Can$26,553 vs Can$46,049 per QALY). Results were robust to variations in age, healthcare costs, and utilities. The degree of confidence that the cost per QALY would be below Can$50,000 reached 100% for node-positive and 77% for node-negative patients. Extended adjuvant letrozole is cost-effective in both node-negative and node-positive patients having ICURs below Can$50,000/QALY.
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Affiliation(s)
- Khalid El Ouagari
- Novartis Pharmaceuticals Canada Inc., 385 boul. Bouchard, H9S 1A9, Dorval, QC, Canada.
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Delea TE, Karnon J, Smith RE, Johnston SRD, Brandman J, Sung JCY, Gross PE. Cost-effectiveness of extended adjuvant letrozole therapy after 5 years of adjuvant tamoxifen therapy in postmenopausal women with early-stage breast cancer. Am J Manag Care 2006; 12:374-86. [PMID: 16834524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To estimate the cost-effectiveness of extended adjuvant letrozole in postmenopausal women with early breast cancer and estrogen or progesterone receptor-positive tumors who had completed 5 years of adjuvant tamoxifen. STUDY DESIGN Cost-effectiveness analysis using a Markov model. METHODS Using a Markov model, we estimated the incremental cost per quality-adjusted life-year (QALY) gained with extended adjuvant letrozole vs no extended adjuvant therapy. Probabilities of breast cancer recurrence or new contralateral tumor adverse effects and death were estimated using data from the MA.17 study and other secondary sources. Costs (in 2004 US dollars) and quality-of-life effects (utilities) of breast cancer events and adverse effects were derived from the literature. RESULTS In base-case analyses, extended adjuvant letrozole vs no extended adjuvant therapy results in an expected gain of 0.34 QALYs per patient (13.62 vs 13.28 QALYs), at an additional lifetime cost of 9699 dollars per patient (55,254 dollars vs 45,555 dollars). The incremental cost per QALY gained with letrozole is 28,728 dollars. Cost-effectiveness is sensitive to the assumed reduction in risk of breast cancer events with letrozole but is insensitive to the risks, costs, and quality-of-life effects of osteoporosis and hip fracture. Cost-effectiveness is less than 100,000 dollars per QALY for node-positive patients younger than 81 years and for node-negative patients younger than 73 years. CONCLUSION For postmenopausal women with early breast cancer who have completed 5 years of adjuvant tamoxifen, the cost-effectiveness of extended adjuvant letrozole is within the range of other generally accepted medical interventions in the United States.
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Affiliation(s)
- Thomas E Delea
- Policy Analysis Inc, 4 Davis Court, Brookline, MA 02245, USA.
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Delea TE, McKiernan J, Brandman J, Edelsberg J, Sung J, Raut M, Oster G. Impact of skeletal complications on total medical care costs among patients with bone metastases of lung cancer. J Thorac Oncol 2006; 1:571-6. [PMID: 17409919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Previous studies have estimated the costs of skeletal-related events (SREs) for patients with bone metastases of solid tumors by tallying costs for services specifically attributable to these events. This approach may underestimate costs if SREs indirectly increase use of other services. METHODS This is a retrospective observational study using a large health insurance claims database. Patients with bone metastases of lung cancer who experienced > or =1 SRE were matched to similar patients without SREs based on propensity scores. Kaplan-Meier estimated total medical care costs were compared for propensity-matched samples of patients with SREs and without SREs. RESULTS We identified 534 patients with lung cancer and bone metastases, including 295 (55%) with > or =1 SRE. After matching, there were 162 patients each in the SRE and no-SRE groups with mean follow-up of 5.3 and 3.9 months, respectively. In the SRE group, costs of treatment of SREs were $9,480 (95% CI $7,625 to $11,374) per patient. Total medical care costs were $27,982 (95% CI $15,921 to $40,625) greater for SRE versus no-SRE patients (p < 0.001). CONCLUSIONS The costs of SREs in patients with lung cancer and bone metastases are substantial and potentially greater than previously estimated.
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Delea T, McKiernan J, Brandman J, Edelsberg J, Sung J, Raut M, Oster G. Retrospective study of the effect of skeletal complications on total medical care costs in patients with bone metastases of breast cancer seen in typical clinical practice. J Support Oncol 2006; 4:341-7. [PMID: 16892696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Intravenous bisphosphonates are effective in reducing the incidence of skeletal-related events (SREs) in women with bone metastases of breast cancer. The cost-effectiveness of such therapy depends in part on the potential cost savings achieved by preventing these events. However, estimates of the costs of SREs in women with bone metastases of breast cancer in typical US clinical practice are unavailable. The purpose of this study was to estimate the treatment costs of clinically significant SREs and the impact of these events on total medical care costs in patients with bone metastases of breast cancer. Data were gathered from a large US health insurance claims database. Patients with bone metastases of breast cancer who experienced one or more clinically significant SREs in typical clinical practice were matched to similar patients without SREs based on propensity scores. Kaplan-Meier estimated total medical care costs were compared over 60 months for propensity-matched samples of patients with SREs and without SREs. We identified 617 patients with breast cancer and bone metastases, including 321 (52%) with > or = 1 clinically significant SRE. After matching, there were 201 patients each in the SRE and no-SRE groups, with mean follow-up of 13.8 and 11.0 months, respectively. In the SRE group, costs of treatment of SREs were $13,940 (95% CI, $11,240-$16,856) per patient. Total medical care costs were $48,173 (95% CI, $19,068-$77,684) greater in SRE versus no-SRE patients (P = 0.001). The costs of clinically significant SREs in patients with breast cancer and bone metastases seen in typical clinical practice are substantial. Treatments that reduce the incidence of SREs, such as intravenous bisphosphonates, should reduce these costs.
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Affiliation(s)
- Thomas Delea
- Policy Analysis Inc. (PAI), Brookline, Massachusetts 02245-7629, USA.
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Botteman M, Barghout V, Stephens J, Hay J, Brandman J, Aapro M. Cost effectiveness of bisphosphonates in the management of breast cancer patients with bone metastases. Ann Oncol 2006; 17:1072-82. [PMID: 16670202 DOI: 10.1093/annonc/mdl093] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Bisphosphonates are recommended to prevent skeletal related events (SREs) in patients with breast cancer and bone metastases (BCBM). However, their clinical and economic profiles vary from one agent to the other. MATERIALS AND METHODS Using modeling techniques, we simulated from the perspective of the UK's National Health Service (NHS) the cost and quality adjusted survival (QALY) associated with five commonly-used bisphosphonates or no therapy in this patient population. The simulation followed patients into several health states (i.e. alive or dead, experiencing an SRE or no SRE, and receiving first or second line therapy). Drugs costs, infusion costs, SREs costs, and utility values were estimated from published sources. Utilities were applied to time with and without SREs to capture the impact on quality of life. RESULTS Compared to no therapy, all bisphosphonates are either cost saving or highly cost-effective (with a cost per QALY < or = 6126 pounds sterlings). Within this evaluation, zoledronic acid was more effective and less expensive than all other options. CONCLUSIONS Based on our model, the use of bisphosphonates in breast cancer patients with bone metastases should lead to improved patient outcomes and cost savings to the NHS and possibly other similar entities.
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Smith MR, Boyce SP, Moyneur E, Duh MS, Raut MK, Brandman J. Risk of clinical fractures after gonadotropin-releasing hormone agonist therapy for prostate cancer. J Urol 2006; 175:136-9; discussion 139. [PMID: 16406890 DOI: 10.1016/s0022-5347(05)00033-9] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Indexed: 12/21/2022]
Abstract
PURPOSE We assessed the relationship between GnRH agonists and the risk of clinical fractures in men with prostate cancer. MATERIALS AND METHODS Using a database of medical claims from 16 large American companies we identified a study group of 3,779 men with prostate cancer who received treatment with a GnRH agonist and a control group of 8,341 with prostate cancer who were not treated with a GnRH agonist. Men with 1 or more medical claims for bone metastases were excluded. The rates of any clinical fracture, hip fracture and vertebral fracture were compared between the groups. RESULTS The rate of any fracture was 7.91/100 vs 6.55/100 person-years at risk in men who received vs did not receive a GnRH agonist (relative risk 1.21, 95% CI 1.09 to 1.34). The rates of hip fracture (relative risk 1.76, 95% CI 1.33 to 2.33) and vertebral fracture (relative risk 1.18, 95% CI 0.94 to 1.48) were also higher in men who received a GnRH agonist. GnRH agonist treatment was independently associated with fracture risk on multivariate analyses. CONCLUSIONS GnRH agonists increase the risk of clinical fracture in men with prostate cancer.
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Affiliation(s)
- Matthew R Smith
- Hematology-Oncology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Karnon J, Delea T, Johnston SRD, Smith R, Brandman J, Sung J, Goss PE. Cost effectiveness of extended adjuvant letrozole in postmenopausal women after adjuvant tamoxifen therapy: the UK perspective. Pharmacoeconomics 2006; 24:237-50. [PMID: 16519546 DOI: 10.2165/00019053-200624030-00004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND MA17 was a randomised placebo-controlled trial of letrozole 2.5 mg/day in 5187 estrogen receptor-positive, 50% node-negative, postmenopausal women (median age 62 years at enrollment) with early breast cancer, post-5 years' adjuvant tamoxifen therapy. The objective of this evaluation was to extrapolate the findings from the MA17 trial to estimate the lifetime cost effectiveness of letrozole in this setting. METHODS A Markov model was used to estimate the incremental cost per QALY gained with extended adjuvant letrozole versus no therapy. Probabilities of disease progression and death were estimated using data from the MA17 study and other secondary sources. Costs of breast cancer care (letrozole therapy, surveillance, recurrences, terminal care) and treatment of osteoporosis and utilities were derived from literature. A full probabilistic sensitivity analysis was undertaken. The analysis was conducted from the perspective of the UK National Health Service (NHS) and cost estimates reflect 2004 values. All costs and outcomes were discounted at 3.5%. RESULTS Extended adjuvant letrozole resulted in a gain of 0.36 QALYs per patient (13.66 vs 13.30 with no therapy). These benefits were obtained at an additional expected lifetime cost of 3732 pounds per patient (10,833 pounds letrozole vs 7101 pounds with no therapy). Cost effectiveness was estimated at 10,338 pounds per QALY gained (95% CI 5276, 43,828). The results were robust to sensitivity analyses. CONCLUSION Five years of letrozole therapy appears to be cost effective from the NHS perspective and should be considered in women with early breast cancer, following tamoxifen adjuvant therapy.
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Affiliation(s)
- Jonathan Karnon
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
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10
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Smith MR, Lee WC, Brandman J, Wang Q, Botteman M, Pashos CL. Gonadotropin-releasing hormone agonists and fracture risk: a claims-based cohort study of men with nonmetastatic prostate cancer. J Clin Oncol 2005; 23:7897-903. [PMID: 16258089 DOI: 10.1200/jco.2004.00.6908] [Citation(s) in RCA: 248] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Gonadotropin-releasing hormone (GnRH) agonists decrease bone mineral density, a surrogate for fracture risk, in men with prostate cancer. We conducted a claims-based cohort study to characterize the relationship between GnRH agonists and risk for clinical fractures in men with nonmetastatic prostate cancer. PATIENTS AND METHODS Using medical claims data from a 5% national random sample of Medicare beneficiaries, we identified a study group of men with nonmetastatic prostate cancer who initiated GnRH agonist treatment from 1992 to 1994 (n = 3,887). A comparison group of men with nonmetastatic prostate cancer who did not receive GnRH agonist treatment during the study period (n = 7,774) was matched for age, race, geographic location, and comorbidity. Clinical fractures were identified using inpatient, outpatient, and physician claims during 7 years of follow-up. RESULTS In men with nonmetastatic prostate cancer, GnRH agonists significantly increased fracture risk. The rate of any clinical fracture was 7.88 per 100 person-years at risk in men receiving a GnRH agonist compared with 6.51 per 100 person-years in matched controls (relative risk, 1.21; 95% CI, 1.14 to 1.29; P < .001). Rates of vertebral fractures (relative risk, 1.45; 95% CI, 1.19 to 1.75; P < .001) and hip/femur fractures (relative risk, 1.30; 95% CI, 1.10 to 1.53; P = .002) were also significantly higher in men who received a GnRH agonist. GnRH agonist treatment independently predicted fracture risk in multivariate analyses. Longer duration of treatment conferred greater fracture risk. CONCLUSION GnRH agonists significantly increase risk for any clinical fracture, hip fractures, and vertebral fractures in men with prostate cancer.
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Delea T, McKiernan J, Gokhale M, Edelsberg J, Brandman J, Sung J, Raut M, Oster G. O-061 Frequency and costs of multiple skeletal complications inpatients with bone metastases of lung cancer. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- D. Göl
- IGES Inst für Gesundheits-und Sozialforschung, Berlin, Germany; Novartis Pharm Corp, East Hanover, NJ
| | - A. Höer
- IGES Inst für Gesundheits-und Sozialforschung, Berlin, Germany; Novartis Pharm Corp, East Hanover, NJ
| | - G. Schiffhorst
- IGES Inst für Gesundheits-und Sozialforschung, Berlin, Germany; Novartis Pharm Corp, East Hanover, NJ
| | - J. Brandman
- IGES Inst für Gesundheits-und Sozialforschung, Berlin, Germany; Novartis Pharm Corp, East Hanover, NJ
| | - B. Häussler
- IGES Inst für Gesundheits-und Sozialforschung, Berlin, Germany; Novartis Pharm Corp, East Hanover, NJ
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Stephens JM, Aapro MS, Botteman MF, Hay JW, Brandman J. A Markov model to evaluate the cost effectiveness of intravenous (IV) zoledronic acid vs IV generic pamidronate or oral ibandronate in the prevention of bone complications in breast cancer patients with bone metastases. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.664] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. M. Stephens
- PharMerit North America, Bethesda, MD; Clin de Genolier, Genolier, Switzerland; Univ of Southern CA, Los Angeles, CA; Novartis Pharm Corp, East Hanover, NJ
| | - M. S. Aapro
- PharMerit North America, Bethesda, MD; Clin de Genolier, Genolier, Switzerland; Univ of Southern CA, Los Angeles, CA; Novartis Pharm Corp, East Hanover, NJ
| | - M. F. Botteman
- PharMerit North America, Bethesda, MD; Clin de Genolier, Genolier, Switzerland; Univ of Southern CA, Los Angeles, CA; Novartis Pharm Corp, East Hanover, NJ
| | - J. W. Hay
- PharMerit North America, Bethesda, MD; Clin de Genolier, Genolier, Switzerland; Univ of Southern CA, Los Angeles, CA; Novartis Pharm Corp, East Hanover, NJ
| | - J. Brandman
- PharMerit North America, Bethesda, MD; Clin de Genolier, Genolier, Switzerland; Univ of Southern CA, Los Angeles, CA; Novartis Pharm Corp, East Hanover, NJ
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Delea TE, McKiernan JM, Brandman J, Sung J, Raut M, Oster G. Effects of skeletal complications on total medical care costs in patients with bone metastases of solid tumors. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T. E. Delea
- Policy Analysis Inc. (PAI), Brookline, MA; Columbia Univ Coll Physicians & Surgeons, New York, NY; Novartis Pharmaceuticals Corp, East Hanover, NJ
| | - J. M. McKiernan
- Policy Analysis Inc. (PAI), Brookline, MA; Columbia Univ Coll Physicians & Surgeons, New York, NY; Novartis Pharmaceuticals Corp, East Hanover, NJ
| | - J. Brandman
- Policy Analysis Inc. (PAI), Brookline, MA; Columbia Univ Coll Physicians & Surgeons, New York, NY; Novartis Pharmaceuticals Corp, East Hanover, NJ
| | - J. Sung
- Policy Analysis Inc. (PAI), Brookline, MA; Columbia Univ Coll Physicians & Surgeons, New York, NY; Novartis Pharmaceuticals Corp, East Hanover, NJ
| | - M. Raut
- Policy Analysis Inc. (PAI), Brookline, MA; Columbia Univ Coll Physicians & Surgeons, New York, NY; Novartis Pharmaceuticals Corp, East Hanover, NJ
| | - G. Oster
- Policy Analysis Inc. (PAI), Brookline, MA; Columbia Univ Coll Physicians & Surgeons, New York, NY; Novartis Pharmaceuticals Corp, East Hanover, NJ
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Duh MS, Smith MR, Boyce SP, Moyneur E, Raut MR, Brandman J, Sung JC. Risk factors for clinical fractures among men with non-metastatic prostate cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M.-S. Duh
- Analysis Group, Inc., Boston, MA; MA Gen Hosp, Boston, MA; Novartis Pharmaceuticals Corp, East Hanover, NJ
| | - M. R. Smith
- Analysis Group, Inc., Boston, MA; MA Gen Hosp, Boston, MA; Novartis Pharmaceuticals Corp, East Hanover, NJ
| | - S. P. Boyce
- Analysis Group, Inc., Boston, MA; MA Gen Hosp, Boston, MA; Novartis Pharmaceuticals Corp, East Hanover, NJ
| | - E. Moyneur
- Analysis Group, Inc., Boston, MA; MA Gen Hosp, Boston, MA; Novartis Pharmaceuticals Corp, East Hanover, NJ
| | - M. R. Raut
- Analysis Group, Inc., Boston, MA; MA Gen Hosp, Boston, MA; Novartis Pharmaceuticals Corp, East Hanover, NJ
| | - J. Brandman
- Analysis Group, Inc., Boston, MA; MA Gen Hosp, Boston, MA; Novartis Pharmaceuticals Corp, East Hanover, NJ
| | - J. C. Sung
- Analysis Group, Inc., Boston, MA; MA Gen Hosp, Boston, MA; Novartis Pharmaceuticals Corp, East Hanover, NJ
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Botteman MF, Aapro MS, Hay JW, Stephens JM, Brandman J. Cost effectiveness of intravenous (IV) zoledronic acid vs other IV bisphosphonates for the prevention of bone complications in breast cancer patients with bone metastases: A Markov model from the UK perspective. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. F. Botteman
- PharMerit North America, Bethesda, MD; Clin de Genolier, Genolier, Switzerland; Univ of Southern CA, Los Angeles, CA; Novartis Pharm Corp, East Hanover, NJ
| | - M. S. Aapro
- PharMerit North America, Bethesda, MD; Clin de Genolier, Genolier, Switzerland; Univ of Southern CA, Los Angeles, CA; Novartis Pharm Corp, East Hanover, NJ
| | - J. W. Hay
- PharMerit North America, Bethesda, MD; Clin de Genolier, Genolier, Switzerland; Univ of Southern CA, Los Angeles, CA; Novartis Pharm Corp, East Hanover, NJ
| | - J. M. Stephens
- PharMerit North America, Bethesda, MD; Clin de Genolier, Genolier, Switzerland; Univ of Southern CA, Los Angeles, CA; Novartis Pharm Corp, East Hanover, NJ
| | - J. Brandman
- PharMerit North America, Bethesda, MD; Clin de Genolier, Genolier, Switzerland; Univ of Southern CA, Los Angeles, CA; Novartis Pharm Corp, East Hanover, NJ
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Boyce SP, Mincey BA, Duh MS, Marynchenko M, Raut MK, Brandman J, Perez EA. Risk of osteoporosis/osteopenia among women with breast cancer receiving anti-cancer therapy (ACT). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. P. Boyce
- Analysis Group, Inc., Boston, MA; Mayo Clinic, Jacksonville, FL; Novartis Pharmaceuticals, East Hanover, NJ
| | - B. A. Mincey
- Analysis Group, Inc., Boston, MA; Mayo Clinic, Jacksonville, FL; Novartis Pharmaceuticals, East Hanover, NJ
| | - M.-S. Duh
- Analysis Group, Inc., Boston, MA; Mayo Clinic, Jacksonville, FL; Novartis Pharmaceuticals, East Hanover, NJ
| | - M. Marynchenko
- Analysis Group, Inc., Boston, MA; Mayo Clinic, Jacksonville, FL; Novartis Pharmaceuticals, East Hanover, NJ
| | - M. K. Raut
- Analysis Group, Inc., Boston, MA; Mayo Clinic, Jacksonville, FL; Novartis Pharmaceuticals, East Hanover, NJ
| | - J. Brandman
- Analysis Group, Inc., Boston, MA; Mayo Clinic, Jacksonville, FL; Novartis Pharmaceuticals, East Hanover, NJ
| | - E. A. Perez
- Analysis Group, Inc., Boston, MA; Mayo Clinic, Jacksonville, FL; Novartis Pharmaceuticals, East Hanover, NJ
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Delea T, Langer C, McKiernan J, Liss M, Edelsberg J, Brandman J, Sung J, Raut M, Oster G. The Cost of Treatment of Skeletal-Related Events in Patients with Bone Metastases from Lung Cancer. Oncology 2005; 67:390-6. [PMID: 15713995 DOI: 10.1159/000082923] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2004] [Accepted: 10/15/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE Patients with bone metastases from lung cancer often experience skeletal-related events (SREs) including pathological fracture, spinal cord compression, hypercalcemia or pain requiring surgery, radiotherapy or opioid analgesics. These complications result in impaired mobility and reduced quality of life and have a significant negative impact on survival. The economic consequences of SREs in patients with lung cancer have not been examined. METHODS We conducted a retrospective analysis using a large US health insurance claims database to estimate the incidence and costs of treatment of SREs in patients with bone metastases of lung cancer treated in a naturalistic setting. Study subjects had >/=2 encounters with a diagnosis of primary lung cancer and >/=2 encounters with a diagnosis of metastases to bone. SREs were identified based on the occurrence on or after the date of first diagnosis of bone metastases, of (1) >/=1 encounter with a diagnosis of pathological fracture, spinal cord compression or hypercalcemia, (2) >/=1 bone surgery or radiotherapy procedure, or (3) the initiation of opioid analgesic therapy. Survival and costs of SRE-related care in patients with SREs were estimated using Kaplan-Meier methods. RESULTS We identified 534 patients with lung cancer and bone metastases, including 295 (55%) with >/=1 SRE. Radiotherapy (68%) and fracture (35%) were the most common SREs. Median survival after the first identified SRE was 4.1 months (95% confidence interval: 3.6-5.5 months). The estimated lifetime SRE-related cost per patient was USD 11,979 (95% confidence interval: USD 10,193-13,766). Radiotherapy accounted for the greatest proportion of cost (61%) by SRE type. CONCLUSION The economic burden of SREs in patients with bone metastases of lung cancer is substantial. Intravenous bisphosphonates, such as zoledronic acid, which have been shown to prevent these events, may reduce these costs.
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Affiliation(s)
- Thomas Delea
- Policy Analysis Inc. (PAI), Brookline, Mass., USA.
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Krupski TL, Smith MR, Lee WC, Pashos CL, Brandman J, Wang Q, Botteman M, Litwin MS. Natural history of bone complications in men with prostate carcinoma initiating androgen deprivation therapy. Cancer 2004; 101:541-9. [PMID: 15274067 DOI: 10.1002/cncr.20388] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND As evidence accumulates in favor of androgen deprivation therapy (ADT) in patients with recurrent or metastatic prostate carcinoma, concern has increased regarding bone loss associated with therapeutic hypogonadism. The current study described the natural history of bone complications in men with prostate carcinoma who have initiated ADT. METHODS Using 1992-2001 claims data from a 5% national random sample of Medicare beneficiaries, the authors identified men with prostate carcinoma who initiated ADT between 1992 and 1994. They analyzed inpatient, outpatient, and physician claims for bone complications over 7 subsequent years. They stratified the quartile of patients who survived longest into 2 cohorts: those who had received ADT for longer than and those who had received ADT for shorter than the median of 697 days. They evaluated the cumulative proportions of patients in each cohort with claims for pathologic fractures, osteoporosis/osteopenia, and nonpathologic fractures. RESULTS In the 1992-1994 sample, 4494 men with prostate carcinoma initiated ADT. Of these, 1126 survived > 2028 days (5.5 years). During the first 3 years of evaluation, the proportion of bone events was similar for men with shorter durations of ADT and men with longer durations of ADT. However, by 7 years, more men in the longer ADT cohort (45%) had sustained at least 1 pathologic or nonpathologic fracture compared with men in the shorter ADT cohort (40%). CONCLUSIONS In the current study, men with prostate carcinoma were found to be at risk for adverse bone effects from both the disease and the treatment. These longitudinal data revealed that fractures are common in this patient population and appear to be linked to the duration of ADT.
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Affiliation(s)
- Tracey L Krupski
- Department of Urology, David Geffen School of Medicine and School of Public Health, University of California, Los Angeles, Los Angeles, California 90095, USA
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Krupski TL, Smith MR, Lee WC, Pashos CL, Brandman J, Wang Q, Botteman M, Litwin MS. Profile of men with prostate cancer on androgen deprivation therapy at greatest risk of bone complications. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T. L. Krupski
- UCLA, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Abt Associates Clinical Trials, Bethesda, MD; Novartis Pharmaceuticals Corporation, Florham Park, NJ
| | - M. R. Smith
- UCLA, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Abt Associates Clinical Trials, Bethesda, MD; Novartis Pharmaceuticals Corporation, Florham Park, NJ
| | - W. C. Lee
- UCLA, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Abt Associates Clinical Trials, Bethesda, MD; Novartis Pharmaceuticals Corporation, Florham Park, NJ
| | - C. L. Pashos
- UCLA, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Abt Associates Clinical Trials, Bethesda, MD; Novartis Pharmaceuticals Corporation, Florham Park, NJ
| | - J. Brandman
- UCLA, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Abt Associates Clinical Trials, Bethesda, MD; Novartis Pharmaceuticals Corporation, Florham Park, NJ
| | - Q. Wang
- UCLA, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Abt Associates Clinical Trials, Bethesda, MD; Novartis Pharmaceuticals Corporation, Florham Park, NJ
| | - M. Botteman
- UCLA, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Abt Associates Clinical Trials, Bethesda, MD; Novartis Pharmaceuticals Corporation, Florham Park, NJ
| | - M. S. Litwin
- UCLA, Los Angeles, CA; Massachusetts General Hospital, Boston, MA; Abt Associates Clinical Trials, Bethesda, MD; Novartis Pharmaceuticals Corporation, Florham Park, NJ
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21
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McKiernan JM, Delea TE, Liss M, Edelsberg JS, Brandman J, Sung JC, Raut MK, Oster G. Impact of skeletal complications on total medical care costs in prostate cancer patients with bone metastases. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. M. McKiernan
- Columbia University, New York, NY; Policy Analysis Inc (PAI), Brookline, MA; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - T. E. Delea
- Columbia University, New York, NY; Policy Analysis Inc (PAI), Brookline, MA; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - M. Liss
- Columbia University, New York, NY; Policy Analysis Inc (PAI), Brookline, MA; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - J. S. Edelsberg
- Columbia University, New York, NY; Policy Analysis Inc (PAI), Brookline, MA; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - J. Brandman
- Columbia University, New York, NY; Policy Analysis Inc (PAI), Brookline, MA; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - J. C. Sung
- Columbia University, New York, NY; Policy Analysis Inc (PAI), Brookline, MA; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - M. K. Raut
- Columbia University, New York, NY; Policy Analysis Inc (PAI), Brookline, MA; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - G. Oster
- Columbia University, New York, NY; Policy Analysis Inc (PAI), Brookline, MA; Novartis Pharmaceutical Corporation, East Hanover, NJ
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Smith MR, Lee WC, Krupsi T, Brandman J, Wang Q, Botteman M, Pashos C, Litwin M. Association between androgen deprivation therapy and fracture risk: A population-based cohort study in men with non-metastatic prostate cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. R. Smith
- Massachusetts General Hospital, Boston, MA; Abt Associates Inc, Bethesda, MD; UCLA, Los Angeles, CA; Novartis Pahrmaceutical Corporation, Florham Park, NJ
| | - W. C. Lee
- Massachusetts General Hospital, Boston, MA; Abt Associates Inc, Bethesda, MD; UCLA, Los Angeles, CA; Novartis Pahrmaceutical Corporation, Florham Park, NJ
| | - T. Krupsi
- Massachusetts General Hospital, Boston, MA; Abt Associates Inc, Bethesda, MD; UCLA, Los Angeles, CA; Novartis Pahrmaceutical Corporation, Florham Park, NJ
| | - J. Brandman
- Massachusetts General Hospital, Boston, MA; Abt Associates Inc, Bethesda, MD; UCLA, Los Angeles, CA; Novartis Pahrmaceutical Corporation, Florham Park, NJ
| | - Q. Wang
- Massachusetts General Hospital, Boston, MA; Abt Associates Inc, Bethesda, MD; UCLA, Los Angeles, CA; Novartis Pahrmaceutical Corporation, Florham Park, NJ
| | - M. Botteman
- Massachusetts General Hospital, Boston, MA; Abt Associates Inc, Bethesda, MD; UCLA, Los Angeles, CA; Novartis Pahrmaceutical Corporation, Florham Park, NJ
| | - C. Pashos
- Massachusetts General Hospital, Boston, MA; Abt Associates Inc, Bethesda, MD; UCLA, Los Angeles, CA; Novartis Pahrmaceutical Corporation, Florham Park, NJ
| | - M. Litwin
- Massachusetts General Hospital, Boston, MA; Abt Associates Inc, Bethesda, MD; UCLA, Los Angeles, CA; Novartis Pahrmaceutical Corporation, Florham Park, NJ
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Weinfurt KP, Anstrom KJ, Castel LD, Brandman J, Schulman KA. Effect of zoledronic acid on clinically meaningful changes in pain associated with metastatic prostate cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- K. P. Weinfurt
- Duke University Medical Center, Durham, NC; Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - K. J. Anstrom
- Duke University Medical Center, Durham, NC; Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - L. D. Castel
- Duke University Medical Center, Durham, NC; Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - J. Brandman
- Duke University Medical Center, Durham, NC; Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - K. A. Schulman
- Duke University Medical Center, Durham, NC; Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Delea TE, McKiernan JM, Liss M, Edelsberg JS, Brandman J, Sung JC, Raut MK, Oster G. Impact of skeletal complications on total medical care costs in lung cancer patients with bone metastases. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- T. E. Delea
- Policy Analysis Inc (PAI), Brookline, MA; Columbia University, New York City, NY; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - J. M. McKiernan
- Policy Analysis Inc (PAI), Brookline, MA; Columbia University, New York City, NY; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - M. Liss
- Policy Analysis Inc (PAI), Brookline, MA; Columbia University, New York City, NY; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - J. S. Edelsberg
- Policy Analysis Inc (PAI), Brookline, MA; Columbia University, New York City, NY; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - J. Brandman
- Policy Analysis Inc (PAI), Brookline, MA; Columbia University, New York City, NY; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - J. C. Sung
- Policy Analysis Inc (PAI), Brookline, MA; Columbia University, New York City, NY; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - M. K. Raut
- Policy Analysis Inc (PAI), Brookline, MA; Columbia University, New York City, NY; Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - G. Oster
- Policy Analysis Inc (PAI), Brookline, MA; Columbia University, New York City, NY; Novartis Pharmaceutical Corporation, East Hanover, NJ
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Karnon J, Johnston SRD, Delea TE, Smith RE, Brandman J, Sung JC, Goss PE. Cost-effectiveness of extended adjuvant letrozole after five years of tamoxifen in postmenopausal early breast cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. Karnon
- University of Sheffield, Sheffield, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Policy Analysis Inc. (PAI), Brookline, MA; South Carolina Oncology Associates, Columbia, SC; Novartis Pharmaceutical Corporation, Florham Park, NJ; Novartis Pharmaceutical Corporation, East Hanover, NJ; Princess Margaret Hospital, Toronto, ON, Canada
| | - S. R. D. Johnston
- University of Sheffield, Sheffield, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Policy Analysis Inc. (PAI), Brookline, MA; South Carolina Oncology Associates, Columbia, SC; Novartis Pharmaceutical Corporation, Florham Park, NJ; Novartis Pharmaceutical Corporation, East Hanover, NJ; Princess Margaret Hospital, Toronto, ON, Canada
| | - T. E. Delea
- University of Sheffield, Sheffield, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Policy Analysis Inc. (PAI), Brookline, MA; South Carolina Oncology Associates, Columbia, SC; Novartis Pharmaceutical Corporation, Florham Park, NJ; Novartis Pharmaceutical Corporation, East Hanover, NJ; Princess Margaret Hospital, Toronto, ON, Canada
| | - R. E. Smith
- University of Sheffield, Sheffield, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Policy Analysis Inc. (PAI), Brookline, MA; South Carolina Oncology Associates, Columbia, SC; Novartis Pharmaceutical Corporation, Florham Park, NJ; Novartis Pharmaceutical Corporation, East Hanover, NJ; Princess Margaret Hospital, Toronto, ON, Canada
| | - J. Brandman
- University of Sheffield, Sheffield, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Policy Analysis Inc. (PAI), Brookline, MA; South Carolina Oncology Associates, Columbia, SC; Novartis Pharmaceutical Corporation, Florham Park, NJ; Novartis Pharmaceutical Corporation, East Hanover, NJ; Princess Margaret Hospital, Toronto, ON, Canada
| | - J. C. Sung
- University of Sheffield, Sheffield, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Policy Analysis Inc. (PAI), Brookline, MA; South Carolina Oncology Associates, Columbia, SC; Novartis Pharmaceutical Corporation, Florham Park, NJ; Novartis Pharmaceutical Corporation, East Hanover, NJ; Princess Margaret Hospital, Toronto, ON, Canada
| | - P. E. Goss
- University of Sheffield, Sheffield, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Policy Analysis Inc. (PAI), Brookline, MA; South Carolina Oncology Associates, Columbia, SC; Novartis Pharmaceutical Corporation, Florham Park, NJ; Novartis Pharmaceutical Corporation, East Hanover, NJ; Princess Margaret Hospital, Toronto, ON, Canada
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Delea T, McKieman J, Liss M, Edelsberg J, Brandman J, Sung J, Raut M, Oster G. 1056 Cost of skeletal complications in patients with bone metastases of solid tumors. EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)91082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Simon JA, Wysocki S, Brandman J, Axelsen K. A comparison of therapy continuation rates of different hormone replacement agents: a 9-month retrospective, longitudinal analysis of pharmacy claims among new users. Menopause 2003; 10:37-44. [PMID: 12544675 DOI: 10.1097/00042192-200310010-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the rate of therapy continuation among women using six different hormone replacement therapies (HRTs). DESIGN A retrospective, longitudinal analysis of pharmacy claims data was conducted for 7,120 women who were new users of six HRT regimens. Continuation rates of therapies were examined at the end of the 9-month period. In addition, the odds ratio of continuation for each product was determined using a logistic model, which controlled for the potential influence of a patient's age and a provider's age, gender, specialty, and geographical location. RESULTS Treatment continuation rates at the end of the 9-month period were significantly higher among patients prescribed oral 1 mg norethindrone acetate/5 microgram ethinyl estradiol (EE) (femhrt, Pfizer Inc, New York, NY, USA) compared with other HRT regimens. Patients prescribed 1 mg norethindrone acetate/5 microgram EE were 52% more likely to continue therapy compared with patients prescribed 0.625 mg conjugated equine estrogens/2.5 mg or 5 mg medroxyprogesterone acetate (Prempro, Wyeth, Madison, NJ, USA). Significantly higher rates of therapy continuation were seen in women aged 55 years or older, those who did not switch HRT during the analysis, those who received care in the central and northeast regions of the United States, and those who were seen by obstetricians/gynecologists (v primary care physicians) or female (v male) providers. CONCLUSIONS The higher rates of treatment continuation seen with newer continuous combined HRTs, such as 1 mg norethindrone acetate/5 microgram EE, may lead to improved long-term compliance and, therefore, better protection against osteoporosis in postmenopausal women.
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Affiliation(s)
- James A Simon
- Department of Obstetrics and Gynecology, George Washington University School of Medicine, Washington, DC, USA
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McLeod LD, Fehnel SE, Brandman J, Symonds T. Evaluating minimal clinically important differences for the acne-specific quality of life questionnaire. Pharmacoeconomics 2003; 21:1069-1079. [PMID: 14596626 DOI: 10.2165/00019053-200321150-00001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND The Acne-Specific Quality of Life Questionnaire (Acne-QoL) is a responsive, reliable and valid instrument developed to measure the impact of facial acne across four dimensions of patient QOL. Score changes on this instrument have been used to report statistically significant treatment advantages for a low-dose oral contraceptive (Estrostep, containing norethisterone (norethindrone) acetate (NA) 1mg and ethinylestradiol (EE) [20, 30, 35 mg] as compared with placebo in women with moderate acne vulgaris. However, the question remained if these statistically significant results were also clinically meaningful. OBJECTIVES To evaluate the statistically significant Acne-QoL benefits observed with NA/EE in terms of their clinical significance, and to compare the three different approaches for defining a minimal clinically important difference (MCID) for the Acne-QoL instrument. METHODS Since the optimum method for estimating MCIDs has yet to be established, three different published approaches for determining MCIDs were applied and compared using data from two randomised, double-blind, placebo- controlled studies of the efficacy of NA/EE in the treatment of facial acne. RESULTS Although the approaches differed substantially, the resulting MCID estimates were comparable. Specifically, the MCID estimates ranged from 0.50-10.3 mean change per item, depending on the domain. The results showed that the statistically significant treatment advantages for NA/EE were also clinically significant. CONCLUSION When applied to the change scores present, the results showed that the statistically significant treatment advantages for NA/EE were also clinically significant.
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Affiliation(s)
- Lori D McLeod
- RTI Health Solutions, Research Triangle Institute, North Carolina 27709-2194, USA.
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29
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Fehnel SE, McLeod LD, Brandman J, Arbit DI, McLaughlin-Miley CJ, Coombs JH, Martin AR, Girman CJ. Responsiveness of the Acne-Specific Quality of Life Questionnaire (Acne-QoL) to treatment for acne vulgaris in placebo-controlled clinical trials. Qual Life Res 2002; 11:809-16. [PMID: 12482164 DOI: 10.1023/a:1020880005846] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Acne-Specific Quality of Life Questionnaire (Acne-QoL) was developed to measure the impact of facial acne across four dimensions of patient quality of life. The main objective of the current study was to evaluate the responsiveness of this instrument. Secondarily, this study provided an opportunity to extend the developer's psychometric validation. The Acne-QoL was utilized in two randomized, double-blind, placebo-controlled studies of the efficacy of Estrostep (norethindrone acetate/ethinyl estradiol) in the treatment of facial acne; a total of 296 Estrostep and 295 placebo patients were evaluated. The Acne-QoL was completed at the beginning, middle (cycle 3), and end (cycle 6) of the 6-month treatment period. The responsiveness of the Acne-QoL was demonstrated through its ability to detect both small (baseline to mid-study) and moderate (baseline to study end) treatment advantages for Estrostep patients. Confirmatory factor analysis supported the subscale structure, and internal consistency estimates were excellent. Convergent and discriminant validity were supported by correlations between Acne-QoL scores and clinical measures that were both in the direction and relative magnitude hypothesized. Finally, item response theory analyses confirmed that each item is highly related to its subscale's latent construct and that each subscale is sensitive across a broad range of the underlying continuum. The results of this evaluation confirm that the Acne-QoL is responsive, internally consistent, and valid.
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Affiliation(s)
- S E Fehnel
- RTI Health Solutions, Research Triangle Institute, Research Triangle Park, NC 27709-2194, USA.
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Day D, Brandman J, Lubowski TJ, Ambegaonkar A, Livengood K, Nobles-Knight D, Van Vleet J, Yamaga C. Therapy cost 2000: an electronic tool for evaluating the cost-effectiveness of therapeutic regimens. Front Biosci 1998; 3:L3-4. [PMID: 9835648 DOI: 10.2741/a386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Providing quality care to patients at the lowest cost is of primary concern to hospitals, clinics, managed care organizations, integrated health systems, and other health care providers operating in a prospective payment environment. Therapy Cost 2000 can help health care providers and decision-makers in a variety of settings reach the goal of cost-effective, high-quality patient care.
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Abstract
The medical records of 94 consecutive patients with acute nonlymphocytic leukemia (ANLL) were reviewed to identify significant prognostic factors. The data were analyzed using 1) Cox's linear hazard and linear logistic models, 2) chi-square comparison of the groups living longer than 2 years and those living less than 2 years, and 3) the Gehan-Breslow test of equal survival curves. The only statistically significant finding was that the presence of promyelocytic cell type and complete remission correlated with increased survival (p less than .05), but this was negated by the small number of patients with this cell type. There was a suggestive association between higher initial hemoglobin and survival (p = .09). The Gehan-Breslow test revealed a possible difference in survival between those patients more than 51 years of age and those less than 51 (p = .10). Thus none of the commonly accepted prognostic factors in acute nonlymphocytic leukemia was definitely shown to be useful. The findings of this study support an aggressive approach toward all patients with this disease.
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MESH Headings
- Adolescent
- Adult
- Age Factors
- Aged
- Antineoplastic Agents/administration & dosage
- Drug Therapy, Combination
- Female
- Humans
- Leukemia, Erythroblastic, Acute/drug therapy
- Leukemia, Erythroblastic, Acute/mortality
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/mortality
- Male
- Middle Aged
- Prognosis
- Remission, Spontaneous
- Time Factors
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Malcomson K, Brandman J, Alpert M. An evaluation of the effect of nurses wearing street clothes on socialization patterns. J Psychiatr Nurs Ment Health Serv 1977; 15:18-21. [PMID: 189015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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