scholarly journals Cost-utility of two minimally-invasive surgical techniques for operable oropharyngeal cancer: Transoral robotic surgery versus transoral laser microsurgery

2021 ◽  
Author(s):  
Enea Parimbelli ◽  
Federico Soldati ◽  
Lorry Duchoud ◽  
Gian Luca Armas ◽  
John R. de Almeida ◽  
...  
Keyword(s):  
Adjuvant Treatment ◽  
Case Analysis ◽  
Cost Effective ◽  
Cost Utility ◽  
Transoral Robotic Surgery ◽  
Base Case ◽  
Base Case Analysis ◽  
Hospital Perspective ◽  
Decision Analytical Model ◽  
The Cost

AbstractImportanceTransoral robotic surgery (TORS) and transoral laser micro-surgery (TLM) are two different but competing minimally invasive techniques to surgically remove operable oropharyngeal squamous cell cancers (OPSCC). As of now, no comparative analysis as to the cost-utility of these techniques exists.ObjectiveRecent population-level data suggest for TORS and TLM equivalent tumor control, but different total costs, need for adjuvant chemoradiation, and learning curves. Therefore, the objective of this study was to compare TORS and TLM from the cost-utility (C/U) point of view using a decision-analytical model from a Swiss hospital perspective.DesignOur decision-analytical model combines decision trees and a Markov model to compare TORS and TLM strategies. Model parameters were quantified using available literature, original cost data from two Swiss university tertiary referral centers, and utilities elicited directly from a Swiss population sample using standard gamble. C/U and sensitivity analyses were used to generate results and gauge model robustness.SettingSwiss hospital perspectiveInterventionCost-utility analysisMain outcome measureComparative cost-utility data from TLM and TORSResultsIn the base case analysis TLM dominates TORS. This advantage remains robust, even if the costs for TORS would reduce by up to 25%. TORS begins to dominate TLM, if less than 59,7% patients require adjuvant treatment (pTorsAlone>0.407), whereby in an interval between 55%-62% (pTorsAlone 0.38-0.45) cost effectiveness of TORS is sensitive to the prescription of adjuvant CRT. Also, exceeding 29% of TLM patients requiring a re-operation for inadequate margins renders TORS more cost-effective.ConclusionTLM is more cost-effective than TORS. However, this advantage is sensitive to various parameters i.e. the number of re-operations and adjuvant treatment.Key pointsQuestionCompare cost-utility of TORS versus TLMFindingsIn the base case analysis TLM dominates TORS, even if the costs for TORS would reduce by up to 25%. TORS begins to dominate TLM, if less than 59,7% patients require adjuvant treatment, whereby in an interval between 55%-62% cost effectiveness of TORS is sensitive to the prescription of adjuvant CRT. Exceeding 29% of TLM patients requiring a re-operation for inadequate margins renders TORS more cost-effective.MeaningTLM is more cost-effective than TORS. However, this advantage is sensitive to the number of re-operations and adjuvant treatment

scholarly journals The Cost-Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine in Seven Chinese Cities

Vaccines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1368
Author(s):  
Yan Li ◽  
Huaqing Wang ◽  
Wesley Furnback ◽  
Bruce C. M. Wang ◽  
Shuiqing Zhu ◽  
...  
Keyword(s):  
Steady State ◽  
Cost Effectiveness ◽  
Indirect Effects ◽  
Pneumococcal Conjugate Vaccine ◽  
Case Analysis ◽  
Cost Effective ◽  
Vaccination Rate ◽  
Base Case ◽  
Base Case Analysis ◽  
The Cost

Objective: This study estimates the cost-effectiveness of vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) among infants in Beijing, Shanghai, Shenzhen, Chengdu, Karamay, Qingdao, and Suzhou. Methods: A previously published cost-effectiveness model comparing vaccination with PCV13 to no vaccination was localized to the included Chinese cities. A systematic literature review was undertaken to identify age-specific incidence rates for pneumococcal bacteremia, pneumococcal meningitis, pneumonia, and otitis media (AOM). Age-specific direct medical costs of treating the included pneumococcal diseases were taken from the Chinese Health Insurance Association database. The base case analysis evaluated vaccine efficacy using direct effect and indirect effects (DE+ IDE). A subsequent scenario analysis evaluated the model outcomes if only DE was considered. A vaccination rate of 70% was used. The model reported outcomes over a one-year period after it was assumed the vaccine effects had reached a steady state (5–7 years after vaccine introduction) to include the direct and indirect effects of vaccination. Health outcomes were discounted at 5% during the steady-state period. Results: Vaccination with PCV13 was cost-effective in the base case analysis for all included cities with the incremental cost-effectiveness ratio (ICER) ranging from 1145 CNY(Shenzhen) to 15,422 CNY (Qingdao) per quality-adjusted life-year (QALY) gained. PCV13 was the dominant strategy in Shanghai with lower incremental costs and higher incremental QALYs. PCV13 remained cost-effective in the DE-only analysis with all ICERs falling below a cost-effectiveness threshold of three times GDP per capita in each city. Conclusions: Vaccination with PCV13 was a cost-effective strategy in the analyzed cities for both the DE-only and DE + IDE analyses. PCV13 became very cost-effective when a vaccination rate was reached where IDE is observed.

scholarly journals The COST-UTILITY ANALYSIS OF FOUR CHELATION REGIMENS FOR Β-THALASSEMIA MAJOR: A CHINESE PERSPECTIVE

2020 ◽  
Vol 12 (1) ◽  
pp. e2020029
Author(s):  
Jialian Li
Keyword(s):  
Healthcare System ◽  
Cost Effective ◽  
Thalassemia Major ◽  
Cost Utility ◽  
Base Case ◽  
Chinese Government ◽  
System Perspective ◽  
Mortality And Morbidity ◽  
Markov Decision Model ◽  
The Cost

Background: The four most commonly used chelation regimens for β-thalassemia major patients in China are a combination therapy of deferoxamine and deferiprone (DFO+DFP), deferoxamine(DFO) monotherapy, deferiprone(DFP) monotherapy and deferasirox(DFX) monotherapy. Such patients use iron chelators their whole lives, resulting in enormous treatment costs. This study analyses the cost-utility of these four regimens from the Chinese healthcare system perspective. Methods: A Markov decision model was used over a 70-year time horizon and was populated using clinical data from a systematic literature review. We obtained utility data from local and previous research. Costs were estimated using Chinese national sources. Results: From the base-case analysis results, DFP was the most cost-effective chelation regimen, followed by DFO+DFP, DFO and DFX. DFP had a 99.60%, 78.10% and 64.40% likelihood of being cost-effective versus DFX, DFO and DFO+DFP, respectively, at a payment threshold of 193,932.00 CNY/QALY. Conclusions: DFP was the most cost-effective chelation regimen for β-thalassemia major patients, followed by DFO+DFP, DFO and DFX. Using DFP as the primary treatment regimen may potentially result in cost-savings and QALY gains for the Chinese healthcare system. To increase these benefits, the Chinese government and clinicians should lower drug costs, increase drug utility and reduce mortality and morbidity. Changes in influential parameters easily affect the results of DFO+DFP versus DFP and of DFP versus DFO; clinicians should focus on such parameters and adjust the regimens accordingly.

Comparison of Cost-Effectiveness of Anticoagulation with Dabigatran, Rivaroxaban and Apixaban in Patients with Non-Valvular Atrial Fibrillation Across Countries

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1164-1164 ◽  
Author(s):  
Martin Krejczy ◽  
Job Harenberg ◽  
Svetlana Marx ◽  
Konrad Obermann ◽  
Martin Wehling
Keyword(s):  
Cost Effectiveness ◽  
Markov Model ◽  
Case Analysis ◽  
Base Case ◽  
German Population ◽  
Base Case Analysis ◽  
Chads2 Score ◽  
Increased Risk ◽  
Markov Decision Model ◽  
The Cost

Abstract Abstract 1164 The three new oral anticoagulants (NOAC) dabigatran 110mg bid and 150mg bid, investigated in the RE-LY trial, rivaroxaban 20mg od of the ROCKET trial, and apixaban 5mg bid of the ARISTOTLE trial showed equivalent or superior efficacy and safety compared to warfarin in these patients. We performed a cost-effectiveness analysis for these NOACs in Germany and compared the quality of life (QALY), incremental cost effectiveness ratios (ICER), and total costs across those countries form where these data are published. The base case population was a hypothetical cohort of patients 65 years or older with AF who were at increased risk for stroke (CHADS2-score >1) and had no contraindications to anticoagulation. The time horizon was based on the life expectancy of the German population. The QALYs, health insurance costs, and ICER for the NOACs compared with warfarin were calculated for each study. The sensitivity analysis was performed for different base case prices. The Markov decision model was adopted using the TreeAge Pro 2011 program. The data of the outcomes of ischemic stroke and cerebral embolism, major and intracerebral haemorrhage, myocardial infarction, and mortality were taken from the 3 studies comparing the NOAC with INR-adjusted warfarin. Prices for clinical events and for outpatient care were taken from the institute for payment regulations in German hospitals (InEK). The base-case analysis of a 65 years old person with a >2 CHADS2 score using the data from the RE-LY study resulted in 11.41 QALYs for warfarin, 11.53 QALYs for dabigatran 110mg bid, 11.66 QALYs for dabigatran 150 mg bid. ICERs per QALY were 49640€ for dabigatran 110 mg bid and 49590€ for dabigatran 150 mg bid versus warfarin. The same base-case analysis using the data from the ROCKET AF study resulted in 10.79 QALYs for warfarin versus 11.05 QALYs for rivaroxaban. ICERs per QALY were 48980€ for rivaroxaban versus warfarin. The base-case analysis using the data from the ARISTOTLE study resulted and 11.04 QALYs for warfarin versus 11.38 QALYs for apixaban. ICERs per QALY were 49720€ for apixaban versus warfarin. According the Markov Model the daily value based daily prices were 1.25€ for dabigatran 110 mg bid, 2.50€ for dabigatran 150 mg bid, 2.60€ for rivaroxaban, and 3.10€ for apixaban in Germany. The model was highly sensitive to the daily costs for the NOACs but relatively insensitive to other model inputs. Calculating the range of NOAC prices from 0.2 to 10 Euro versus the ICERs dabigatran 110 mg bid produced the highest increase of ICERs over this range of daily costs (Tukey-Kramer test, p<0.05) Comparing these data across countries using the published data shows that the willingness to pay per QALY as well as differences in treatment costs between substantially influences the daily prices of the NOACs. The data demonstrate the necessity to analyse the cost-effectiveness separately for every study due to differences in the INR-adjusted warfarin treated control group. The better the outcome during treatment with warfarin the lower is the benefit of the NOAC. The tendency of the cost-effectiveness calculated by the Markov model is comparable across countries. Disclosures: No relevant conflicts of interest to declare.

Nivolumab in the treatment of metastatic renal cell carcinoma: A cost-utility analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18331-e18331
Author(s):  
Jacques Raphael ◽  
Zhuolu Sun ◽  
Georg A. Bjarnason ◽  
Beate Sander ◽  
David M Naimark
Keyword(s):  
Renal Cell Carcinoma ◽  
Incremental Cost ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Cost Effective ◽  
Cost Utility ◽  
Base Case ◽  
Previously Treated ◽  
The Cost ◽  
Quality Adjusted Life

e18331 Background: Nivolumab was recently shown to improve overall survival (OS) and health-related quality of life compared to Everolimus in metastatic renal cell carcinoma (mRCC) patients previously treated with antiangiogenic therapies (CheckMate-025 trial). The aim of this study is to assess the cost-utility of Nivolumab versus Everolimus from the perspective of the Canadian publicly funded healthcare system. Methods: To evaluate the cost-utility of Nivolumab versus Everolimus, a Markov cohort model that incorporated data from the phase 3 CheckMate-025 trial and other sources was developed. The outcomes of interest were healthcare costs, life-months and quality-adjusted life-months (QALMs) gained with Nivolumab as well as the incremental cost-effectiveness ratio (ICER), and the incremental net monetary benefit. A lifetime time horizon was used in the base case with costs and outcomes discounted 5% annually. The probabilities of progression and death from cancer and utility values were captured from the CheckMate-025 trial. Expected costs were based on Ontario fees and other sources. Scenario and sensitivity analyses (SAs) were conducted to assess uncertainty. Results: Compared to Everolimus, treatment with Nivolumab provided an additional 3.9 QALMs at an incremental cost of 33,386 Canadian dollars (CAD). The resulting ICER was 8,608CAD per QALM gained. With a willingness-to-pay (WTP) of 50,000CAD per Quality-adjusted life-year (QALY) ( = 4,167CAD per QALM), Nivolumab was not cost-effective in the base case. In one-way SAs, Nivolumab cost, median OS and treatment duration on Nivolumab were sensitive to changes with plausible threshold values. Assuming a WTP of 100,000CAD per QALY ( = 8,334CAD per QALM) and a scenario of Nivolumab cost with no drug wastage, Nivolumab became a cost-effective strategy with an ICER of 7,881CAD per QALM. Conclusions: With its current price , Nivolumab is unlikely to be cost-effective compared with Everolimus for previously treated mRCC patients from a Canadian healthcare payer perspective. While mRCC patients derive a meaningful clinical benefit from Nivolumab, considerations should be given to reduce drug wastage and increase the WTP threshold to render this strategy more affordable.

scholarly journals Cost-utility Analysis of Trabecular Micro-bypass Stents (TBS) in Patients With Mild-to-moderate Open-angle Glaucoma in Italy

2021 ◽  
Author(s):  
Antonio Maria Fea ◽  
Francesco Cattel ◽  
Stefano Gandolfi ◽  
Giorgio Buseghin ◽  
Gianluca Furneri ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cataract Surgery ◽  
Open Angle Glaucoma ◽  
Cost Effective ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Utility Analysis ◽  
Istent Inject ◽  
The Cost

Abstract BackgroundGlaucoma is a disease characterized by progressive damage of the optic nerve. Several therapeutic options are available to lower intraocular pressure (IOP). In primary open-angle glaucoma (POAG) patients with inadequate IOP control (or controlled with multiple medical therapies or for whom medical therapy is contraindicated), the implantation of micro-invasive glaucoma surgery devices (MIGS) and concomitant cataract surgery has proved to be more effective in reducing intraocular pressure (IOP), as compared to cataract surgery alone. The objective of this study is to assess the cost-effectiveness of iStent inject® device with concurrent cataract surgery vs. cataract surgery alone, in patients with mild-to-moderate POAG, adopting the Italian National Health Service (NHS) perspective.MethodsSimulation of outcomes and costs was undertaken using a Markov model with 4 health states and one-month cycles, that is used to simulate the prognosis of these patients. Efficacy data were obtained from the randomized clinical trial (RCT). A lifetime horizon was adopted in the analysis. A discount rate of 3.5% was applied to both costs and effects. The Italian National Healthcare Service (NHS) perspective was considered, therefore only healthcare direct costs (acquisition of main interventions and subsequent procedures; medications; monitoring and follow-up; adverse events). Model robustness was tested through sensitivity analyses. ResultsResults of the base-case analysis showed that the total lifetime costs were higher in the iStent inject® + concurrent cataract surgery, compared with the cataract surgery alone group (€8,368.51 vs. €7,134.71 respectively). iStent inject® + concurrent cataract surgery was cost-effective vs. cataract surgery alone, with an incremental cost-effectiveness ratio of €13,037.01 per quality-adjusted life year (QALY) gained. Both one-way deterministic and probabilistic sensitivity analyses confirmed robustness of base-case results. The acceptability curve of cost-effectiveness (CEAC) analysis showed that iStent inject® + cataract surgery would have a 98% probability of being cost-effective, compared to cataract surgery alone, when the willingness to pay (WTP) is equal to €50,000 per QALY gained.ConclusionsThe results of the cost-utility analysis confirm that iStent inject® + cataract surgery is a cost-effective option for the treatment of patients affected by mild-to-moderate POAG, compared with cataract surgery alone, when evaluated from the Italian NHS perspective. Trial registration: Not applicable

Cost-effectiveness of primary prophylaxis (PP) with colony-simulating factor (CSF) when compared with secondary prophylaxis (SP) in elderly patients with diffuse aggressive lymphoma undergoing curative chemotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6558-6558
Author(s):  
K. K. Chan ◽  
K. R. Imrie ◽  
S. M. Alibhai
Keyword(s):  
Cost Effectiveness ◽  
Elderly Patients ◽  
Cost Minimization ◽  
Cost Effective ◽  
Primary Prophylaxis ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Aggressive Lymphoma ◽  
Base Case ◽  
The Cost

6558 Background: The 2006 ASCO guideline recommends PP with CSF for elderly patients with diffuse aggressive lymphoma, partially based on previous cost-minimization analyses showing that CSF saved costs when compared with no CSF by reducing hospitalization from febrile neutropenia (FN) when the risk of FN was > 20%. However, these studies examined only one cycle of chemotherapy and did not account for costs of CSF in subsequent cycles, did not consider SP, and did not consider patients’ preferences. Methods: We conducted a cost-utility analysis to compare PP with SP in this setting using a Markov model for a time horizon of 8 cycles of chemotherapy with a government payer perspective. Costs were adjusted to 2006 $CAD. Ontario health economic data were used. The cost of hospitalization for FN was obtained from Ontario Case Costing Initiative. Data for efficacies of CSF, probabilities and utilities were obtained from published literature. Sensitivity analyses were conducted using a threshold of $100,000/QALY. Results: The base case costs for PP and SP were $22,077 and $17,641. The QALYs of PP and SP were 0.254 and 0.248. The incremental cost effectiveness ratio of PP to SP was $739,999/QALY. One-way sensitivity analyses showed that in order for PP to be cost-effective, the cost of hospitalization per episode of FN had to be > $31,138 (i.e. 2.5 times > base case), the cost of CSF per cycle had to be < $896 (base case = $1,960), the risk of FN in the 1st cycle had to be > 48% (base case = 24%), or the relative risk reduction of FN with CSF had to be > 97% (base case = 41%). Our result was robust to all other cost, probability and utility variables. First order microsimulation showed that < 17% of simulations were cost-effective. Conclusions: PP is not cost-effective when compared with SP for this population under most assumptions. PP only becomes attractive in places where the cost of hospitalization for FN is much more than that of Ontario, or the cost of CSF is under $896 per cycle. The costs of CSF and hospitalization in all cycles (instead of just one cycle) should be accounted for in any economic evaluation of CSF. Current guidelines recommending PP in this population should be revisited. No significant financial relationships to disclose.

The Cost-Effectiveness of Oral Triptan Therapy in Sweden

Cephalalgia ◽  
2007 ◽  
Vol 27 (1) ◽  
pp. 54-62 ◽  
Author(s):  
J Ramsberg ◽  
M Henriksson
Keyword(s):  
Cost Effectiveness ◽  
Scientific Literature ◽  
Cost Effective ◽  
Base Case ◽  
Migraine Treatment ◽  
Base Case Analysis ◽  
Effectiveness Model ◽  
Meta Analyses ◽  
The Cost ◽  
Substantial Uncertainty

The literature suggests that triptans are cost effective compared with older types of migraine treatment. However, which of the triptans that is most cost effective has not been established. We compared the costs and effects of triptan treatment from a Swedish societal perspective, using evidence from the literature. A probabilistic cost-effectiveness model was constructed to investigate the costs and effects of treating a single attack in a typical migraine patient. The end-point used in the base-case analysis was sustained pain free without any adverse events (SNAE). We searched the scientific literature for meta-analyses reporting the efficacy of oral triptans. All treatments except rizatriptan 10 mg and eletriptan 40 mg were dominated. The incremental cost per SNAE of rizatriptan 10 mg compared with eletriptan 40 mg was approximately €100. There was substantial uncertainty concerning the results, but probabilistic analysis showed that rizatriptan 10 mg and eletriptan 40 mg had the highest probability of being cost-effective.

Cost-effectiveness analysis of magnetic resonance-guided focused ultrasound ablation for palliation of refractory painful bone metastases

2020 ◽  
pp. 1-7
Author(s):  
Matthew D. Bucknor ◽  
Frandics P. Chan ◽  
Jessica Y. Matuoka ◽  
Patti K. Curl ◽  
James G. Kahn
Keyword(s):  
Cost Effectiveness ◽  
Bone Metastases ◽  
Time Horizon ◽  
Focused Ultrasound ◽  
Case Analysis ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Base Case Analysis ◽  
Painful Bone Metastases

Abstract Objective The aim of this study was to determine if magnetic resonance-guided focused ultrasound (MRgFUS) is cost-effective compared with medication, for refractory pain from bone metastases in the United States. Methods We constructed a Markov state transition model using TreeAge Pro software (TreeAge Software, Inc., Williamstown, MA, USA) to model costs, outcomes, and the cost-effectiveness of a treatment strategy using MRgFUS for palliative treatment of painful bone metastases compared with a Medication Only strategy (Figure 1). Model transition state probabilities, costs (in 2018 US$), and effectiveness data (quality-adjusted life-years [QALYs]) were derived from available literature, local expert opinion, and reimbursement patterns at two U.S. tertiary academic medical centers actively performing MRgFUS. Costs and QALYs, discounted at three percent per year, were accumulated each month over a 24-month time horizon. One-way and probabilistic sensitivity analyses were performed. Results In the base-case analysis, the MRgFUS treatment strategy costs an additional $11,863 over the 2-year time horizon to accumulate additional 0.22 QALYs, equal to a $54,160/QALY ICER, thus making MRgFUS the preferred strategy. One-way sensitivity analyses demonstrate that for the base-case analysis, the crossover point at which Medication Only would instead become the preferred strategy is $23,341 per treatment. Probabilistic sensitivity analyses demonstrate that 67 percent of model iterations supported the conclusion of the base case. Conclusions Our model demonstrates that MRgFUS is cost-effective compared with Medication Only for palliation of painful bone metastases for patients with medically refractory metastatic bone pain across a range of sensitivity analyses.

scholarly journals The Value and Sustainability of Ocrelizumab in Relapsing Multiple Sclerosis: A Cost-Effectiveness and Budget Impact Analysis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Paolo Angelo Cortesi ◽  
Damiano Paolicelli ◽  
Marco Capobianco ◽  
Paolo Cozzolino ◽  
Lorenzo Giovanni Mantovani
Keyword(s):  
Multiple Sclerosis ◽  
Cost Effectiveness ◽  
Economic Impact ◽  
Impact Analysis ◽  
Budget Impact ◽  
Case Analysis ◽  
Base Case ◽  
Base Case Analysis ◽  
Effectiveness Analysis ◽  
The Cost

INTRODUCTION: The availability of ocrelizumab for the relapsing forms of multiple sclerosis (MS) in the Italian markets raised some questions about its economic impact and value compared to the alternative treatment options available.AIM: To assess the cost-effectiveness and budget impact of ocrelizumab compared to the most used second line disease modifying therapies (DMTs) in Italy.METHODS: The study was divided in two phases: Phase 1 – based on the development of a decision analytical Markov model to assess the cost-effectiveness of ocrelizumab compared to natalizumab and fingolimod, and Phase 2 – based on the development of a budget impact model to assess the economic impact of ocrelizumab in Italy. Both models used the National Health System perspective; a lifetime horizon was applied in the cost-effectiveness analysis and a 3-year time horizon in the budget impact. The cost-effectiveness analysis results were reported as incremental cost-effectiveness ratio (ICER) expressed as € per Quality Adjusted Life Year (QALY) gained, the budget impact analysis results were reported as difference in the overall budget (€) between a scenario with and without ocrelizumab.RESULTS: The two analyses reported ocrelizumab as a cost-effective option compared to natalizumab and fingolimod with a positive impact on the overall NHS budget. In the base-case analysis, the ICER was € 2,023 for ocrelizumab compared to fingolimod; while ocrelizumab resulted cost-saving compared to natalizumab. The sensitivity analysis confirmed the base-case analysis results. Further, the use of ocrelizumab was associated to a budget decrease of € 21 million (-2.6%) in a 3-year time horizon.CONCLUSION: The results of our cost-effectiveness and budget impact models reported ocrelizumab as an effective and efficient treatment in patients with relapsing forms of MS who failed a first line DMTs from the Italian NHS perspective.

Adjusting For Drug Wastage In Economic Evaluations Of New Therapies For Hematologic Malignancies: A Systematic Review Of The Literature and Implications

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2928-2928
Author(s):  
Matthew C. Cheung ◽  
Maureen E. Trudeau ◽  
Anca Prica ◽  
Rena Buckstein ◽  
Kelvin KW Chan
Keyword(s):  
Drug Acquisition ◽  
Case Analysis ◽  
Hematologic Malignancies ◽  
Sensitivity Analyses ◽  
Economic Evaluations ◽  
Base Case ◽  
Base Case Analysis ◽  
Drug Wastage ◽  
Acquisition Costs ◽  
The Cost

Abstract The cost of cancer care is rising to levels that appear unsustainable, in large part driven by a rapid increase in expenditures for novel therapies. In 2005, the direct costs of cancer care in the United States were $74 billion, with a prediction that these figures will double this decade as the population ages and we enter an age of biologically-tailored drug development. Historically, the evaluation of the cost-effectiveness of new drug therapies presumes that every milligram of drug is effectively utilized. With manufacturers dictating the availability of vial sizes for parenteral drugs, however, this may not be the case. A recent single-institution study in Canada estimated that an annual loss of $150 000 ($CDN) could be attributed to drug wastage of a parenteral therapy for myelodysplasia (Walker et al., Can J Hosp Pharm 2012). Whether current economic evaluations routinely model the potential for drug wastage, or the strategies to mitigate wastage, has not previously been determined. We sought to identify the frequency of drug wastage modeling in economic evaluations of modern parenteral therapies for hematologic malignancies. All US Food and Drug Administration (FDA) approved parenteral therapies from 2006-2013 (n=14) were identified for review. A systematic review of published English-language economic evaluations for these therapies was conducted and data on the conduct of the cost-analyses were extracted in duplicate. The primary outcome was the proportion of studies that explicitly modeled drug wastage in the base-case analysis, with results presented descriptively. Where possible, we calculated the impact of wastage on incremental cost-effectiveness ratios (ICERs) and drug acquisition costs. Thirty-three publications were retrieved; five of these studies were excluded (3 were non-English language and 2 were review articles). Of the remaining 27 reports, 3 were publicly-funded health technology assessments (HTAs) to inform funding decisions by the UK National Institute for Health and Care Excellence (NICE) and the remainder (n=24) were peer-reviewed publications. Sixteen economic evaluations were of rituximab-based regimens and 6 were bortezomib-based. Drug wastage was considered in the primary or base-case analysis in one third of the publications (9 of 27; 33%); wastage was considered in 2 of the 3 HTAs (67%) and 7 of the 24 peer-reviewed reports (29%). Of the 9 models that considered wastage in the base-case analysis, 2 completed sensitivity analyses in which no drug wastage occurred (i.e. vial sharing between patients). In both studies, consideration of wastage changed the calculated ICER. In one study, the ICER increased by 32% when wastage was incorporated into drug acquisition costs. In the second study, azacitidine (AZA) was compared to decitabine (DEC) for myelodysplasia, with both drugs provided as single-use vials and subject to substantial wastage. When no drug wastage was modeled, AZA was associated with higher costs than DEC (+$2 655 USD) and yielded an ICER of $15 528/QALY. When wastage for both drugs was considered, AZA was associated with lower costs (-$15 890) and AZA dominated DEC. Of the 18 publications that did not model wastage in the primary analysis, no study went on to model wastage in sensitivity analyses. In 4 of these 18 studies, the potential effect of wastage on drug acquisition costs could be calculated from data provided in the publication. The calculated drug acquisition costs if wastage occurred would potentially be +5-16% higher (mean +9%) than the costs modeled in the base-case analyses of these 4 studies. The potential costs associated with drug wastage are considered in only one third of modern cost-effectiveness models. The impact of wastage on calculated ICERs and drug acquisition costs is potentially substantial. The modeling of wastage in base-case and sensitivity analyses is recommended for future economic evaluations of new intravenous therapies for hematologic malignancies. Disclosures: No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document