Cost-Effectiveness of Blinatumomab in Pediatric Patients with High-Risk First-Relapse B-Cell Precursor Acute Lymphoblastic Leukemia in France

BACKGROUND

Based on the results of the phase III randomized 20120215 trial, the European Medicines Agency granted the approval of blinatumomab for the treatment of pediatric patients with high-risk first-relapsed Philadelphia chromosome-negative B-cell precursor acute lymphoblastic leukemia (ALL). In France, blinatumomab received reimbursement for this indication in May 2022. This analysis assessed the cost effectiveness of blinatumomab compared with high-risk consolidation chemotherapy (HC3) in this indication from a French healthcare and societal perspective.

METHODS

A partitioned survival model with three health states (event-free, post-event and death) was developed to estimate life-years (LYs), quality-adjusted life-years (QALYs) and costs over a lifetime horizon. Patients who were alive after 5 years were considered to be cured. An excess mortality rate was applied to capture the late effects of cancer therapy. Utility values were based on the TOWER trial using French tariffs, and cost input data were identified from French national public health sources. The model was validated by clinical experts.

RESULTS

Treatment with blinatumomab over HC3 was estimated to provide gains of 8.39 LYs and 7.16 QALYs. Total healthcare costs for blinatumomab and HC3 were estimated to be €154,326 and €102,028, respectively, resulting in an increment of €52,298. The incremental cost-effectiveness ratio was estimated to be €7308 per QALY gained from a healthcare perspective. Results were robust to sensitivity analyses, including analysis from the societal perspective.

CONCLUSIONS

Blinatumomab administered as part of consolidation therapy in pediatric patients with high-risk first-relapsed ALL is cost effective compared with HC3 from the French healthcare and societal perspective.

[Abdominal aorta aneurysms discovered in cardiac rehabilitation]

We reported two cases of unusual discovery of asymptomatic surgical abdominal aortic aneurysm (AAA) after a coronary artery bypass graft and a valve surgery. Attending cardiac rehabilitation, the patients were transferred for prompt surgery. Beyond these observations, it is of great importance that screening of AAA could be done during echocardiography.

[Cardiac rehabilitation in "sports" patients]

BACKGROUND

Cardiac rehabilitation (CR) addresses for the greater part a middle-aged sedentary population. Nevertheless, some patients referred in CR are active or sportive, and care for these patients is less known.

AIM OF THE STUDY

To compare the results of CR between a little or not active population and an active or athletic population.

PATIENTS AND METHODS

Every patient referred in a CR department in Loire-Atlantique between 2010 and 2016 were included either in the group 1 (sedentary or little active) or in the group 2 (at least once a week physical training).) RESULTS: Among 2916 patients included, 2288 patients did two exercise tests, the functional capacity in the group 1 (n=2117) increased from 4.7±1.2 to 5.6±1.3 METs versus 6.5±1.7 to 7.6±1.8 METs in the group 2 (n=171), the gain was similar in both groups from 19±13% to 18±14% (P=0.16). The 6minutes Walking Test respectively increased from 445±91 to 517±89 versus 518±87 to 603±73 meters with a gain of 18±18 versus 18±16% (P=0.93). The prognosis is yet to be best in the group 2 in accordance to a best maximal functional capacity (P<0.01).

CONCLUSION

Cardiac rehabilitation is useful in active or athletic patients and should be prescribed based on the current recommendations.

[The daily living activities of the cardiac patient: Monocentre study]

BACKGROUND

The main aim of cardiac rehabilitation is for the patient to sustain physical activity at home. The daily living activities (DLA) are important to take into account.

AIM OF THE STUDY

Analyze the DLA of patients in CR.

PATIENTS AND METHODS

One thousand seven hundred and eighty patients (mean age: 60.9±11 years) followed a CR programme between 2010 and 2015. They were tested for several DLA with their cardiac frequency (CF). The observed CF was included in the Karvonen's formula, used for the prescription of physical activity.

RESULTS

The coefficient of Karvonen was situated between 0.54 to 0.69, which was compatible with the prescribed physical training. Nevertheless, when the maximal exercise capacity was less than 5 METs, the coefficients were higher (0.53-0.89).

CONCLUSION

It was useful to test the cardiac patients for DLA during a CR programme. The use of Karvonen's formula allowed to compare these exercises with recommended physical training. We must be prudent when the maximal physical capacity is less than 5 METs.

[Cardiac rehabilitation after myocardial infarction in France: still not prescribed enough]

Despite well-documented benefits for patients after myocardial infarction, cardiac rehabilitation is underutilized in most countries. In France, a recent study showed a participation rate of 22.7 %, with huge regional disparities for unknown reasons. In this paper, we analyze some demographic particularities for explaining these curious results. Then, we review in the literature the complex factors influencing patient's referral in cardiac rehabilitation (patient's believes, role of the physician, health system's organization…), and the best ways of improving cardiac rehabilitation rate or finding adequate alternatives.

[Nutritional education of the coronary patient in practice]

BACKGROUND

The Mediterranean diet is one of the food models which showed its ability at the patient at high cardiovascular risk in numerous cohort studies and two major interventional studies: Lyon Heart Study in 1999 and PREDIMED in 2013.

AIM OF THE STUDY

Propose a practical assistance in the analysis of the dietary habits of the coronary patient with a simplified food frequency questionnaire.

PATIENTS AND METHODS

Hundred coronary patients followed a program of cardiac rehabilitation and benefited from a nutritional education. The analysis of their dietary habits was made with the questionnaire of frequency of consumption of Rennes upon their arrival and 6months later. We have coded again these data by means of a simplified questionnaire with 15 items and compared the results and their evolution in 6months.

RESULTS

On studied 200 questionnaires, the score of Rennes was 10.6±4.5 and the simplified score 8.2±3.4 with a coefficient of correlation of Pearson r=0.94 (0.91-0.95) at risk P<0.0001. Initial scores were respectively 8.0±4.4 and 6.3±3.4 (r=0.93) and the scores at 6months 13.1±2.9 and 10.1±2.2 (r=0.86). The evolution of the scores of 100 patients were respectively 14.2±11.7% and 12.6±11% (P<0.26).

CONCLUSION

The use of a simplified questionnaire allows to analyze the dietary habits of the coronary patient and to estimate their evolution during a therapeutic educational program.

[Effects of a cardiac rehabilitation programme in coronary patient according to age]

BACKGROUND

Benefits of cardiac rehabilitation (CR) are well established in coronary heart disease. The effects according to age are less known, especially in France.

AIM OF THE STUDY

Evaluation at 6 months of a CR programme in three groups of patients with different age.

PATIENTS AND METHODS

Two hundred and two coronary patients were included in the CR department in Machecoul between 2007 and 2009. They attended the CR programme and were examined at six months. Patients were divided into three groups: group 1, n=103 (<65 years), group 2, n=71 (65 to 75 years) and group 3, n=28 (>75 years). We analysed the exercise capacity (exercise stress testing and six minutes walk-test or 6MWT), two questionnaires (dietary and physical activity) and bio-clinical data.

RESULTS

Exercise capacity improved respectively by 24, 27 and 18% (P<0.004 between G2 and G3). The 6MWT improved by 19, 22 and 25% (P<0.01 between G1 and G3). At 6 months, the 6MWT remain stable, the dietary and physical activity scales improved in the three groups, the body mass index (BMI) was unchanged, HDL cholesterol increased, smoking prevalence was respectively 16, 0 and 0% and medical treatment were optimal in 90, 82 and 79% (NS).

CONCLUSION

If the impact of CR was almost similar in the three groups, a more prolonged physical training seems desirable in patients over 75 years.

[The coronary patient six months after cardiac rehabilitation: rehabilitation evaluation research (RER study)]

AIMS OF THE STUDY

The aims of the study are to elaborate and test, in a coronary population admitted in a cardiac rehabilitation (CR) department, an evaluative method 6 months after a cardiac rehabilitation programme, with emphasis on modified cardiac risk factors.

PATIENTS AND METHODS

Every coronary patient admitted in the CR department in Machecoul between 2007 October and 2009 October, who's home were not over 50 km far away and without mental inability, were included. At the start of the programme, he was suggested to complete the training course by a phone interview at 3 months and a multidisciplinary consult at 6 months. It used dietary and physical activity questionnaires, and a 6-minute walk test (6mnWT).

RESULTS

Two hundred and two patients were included (mean age 63,4 ± 10 years, 93% men), 17% after an acute coronary syndrome, 23% after angioplasty and 75% after coronary artery bypass graft. The cardioprotective dietary score increased from 7.8 ± 4.3 to 12.7 ± 3 (on a scale from-17 to+19) and the physical activity score from 15.4 ± 7.7 to 19.5 ± 4.8 (on a scale from 5 to 40). The 6mnWT increased in CR (from 431 ± 90m to 511 ± 91m) and was maintained at 6 months (513 ± 88m). The European recommendation goals were achieved by 76% of patients for LDL (<1g/L), 64% for blood pressure (<140/90), 82% for a BMI less than 30 and 36% a BMI less than 25, 67% central obesity (<102cm by men and 88 cm by women) and 82% for no smoking. Four non-fatal cardiac events and seven vascular events were reported by a mean delay of 190 ± 30 days.

CONCLUSION

A six monthly evaluation of CR programme can be used in a cardiac rehabilitation department routinely activity.