scholarly journals Health economics of targeted intraoperative radiotherapy (TARGIT-IORT) for early breast cancer: a cost-effectiveness analysis in the United Kingdom

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e014944 ◽  
Author(s):  
Anil Vaidya ◽  
Param Vaidya ◽  
Brigitte Both ◽  
Chris Brew-Graves ◽  
Max Bulsara ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Early Breast Cancer ◽  
Time Horizon ◽  
Intraoperative Radiotherapy ◽  
Dominant Strategy ◽  
Sensitivity Analyses ◽  
External Beam Radiation ◽  
Health State

ObjectiveThe clinical effectiveness of targeted intraoperative radiotherapy (TARGIT-IORT) has been confirmed in the randomised TARGIT-A (targeted intraoperative radiotherapy-alone) trial to be similar to a several weeks’ course of whole-breast external-beam radiation therapy (EBRT) in patients with early breast cancer. This study aims to determine the cost-effectiveness of TARGIT-IORT to inform policy decisions about its wider implementation.SettingTARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy.MethodsCost-utility analysis using decision analytic modelling by a Markov model. A cost-effectiveness Markov model was developed using TreeAge Pro V.2015. The decision analytic model compared two strategies of radiotherapy for breast cancer in a hypothetical cohort of patients with early breast cancer based on the published health state transition probability data from the TARGIT-A trial. Analysis was performed for UK setting and National Health Service (NHS) healthcare payer’s perspective using NHS cost data and treatment outcomes were simulated for both strategies for a time horizon of 10 years. Model health state utilities were drawn from the published literature. Future costs and effects were discounted at the rate of 3.5%. To address uncertainty, one-way and probabilistic sensitivity analyses were performed.Main outcome measuresQuality-adjusted life-years (QALYs).ResultsIn the base case analysis, TARGIT-IORT was a highly cost-effective strategy yielding health gain at a lower cost than its comparator EBRT. Discounted TARGIT-IORT and EBRT costs for the time horizon of 10 years were £12 455 and £13 280, respectively. TARGIT-IORT gained 0.18 incremental QALY as the discounted QALYs gained by TARGIT-IORT were 8.15 and by EBRT were 7.97 showing TARGIT-IORT as a dominant strategy over EBRT. Model outputs were robust to one-way and probabilistic sensitivity analyses.ConclusionsTARGIT-IORT is a dominant strategy over EBRT, being less costly and producing higher QALY gain.Trial registration numberISRCTN34086741; post results

Cost-effectiveness of docetaxel compared to paclitaxel in metastatic breast cancer: A UK health economic analysis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 1081-1081
Author(s):  
S. E. Jones ◽  
A. Benedict ◽  
D. Cameron ◽  
S. Jourdan
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Cost Effectiveness ◽  
Time Horizon ◽  
Metastatic Breast ◽  
Sensitivity Analyses ◽  
Patient Level Data ◽  
Patient Level ◽  
Level Data ◽  
Life Years

1081 Background: Docetaxel was shown to be superior to paclitaxel in OS and TTP (median OS: 1.28 vs 1.06 yr, HR=1.41; median TTP: 0.47 vs 0.30 yr, HR= 1.64) for the treatment of patients with metastatic breast cancer progressing after an anthracycline-based regimen (Jones et al. J Clin Oncol. 2005;23:5542). A cost-effectiveness analysis based on this head-to-head comparison was performed considering clinical effectiveness, quality-adjusted life-years, and direct medical costs in the UK. Methods: A probabilistic Markov model was developed to examine results over a 10-yr long time-horizon. Patient level data were available on PFS and OS, treatment cycles and doses, number of cycles affected by adverse events, G-CSF use and post-failure treatment. Generalized gamma regression, fitting patient-level data best were used to model baseline PFS and OS in the paclitaxel arm. HRs adjusting for all covariates were applied to the baseline hazards to generate the docetaxel arm. Resource use and utility values for health states were obtained from published literature and practicing UK oncologists. Unit costs came from 2005 NHS reference costs; drug costs from the British National Formulary 2006 without hospital discount. Costs and benefits were discounted at 3.5%. A Monte-Carlo simulation and extensive 1-way sensitivity analyses were conducted. Results: Docetaxel is more costly (£13,500 vs £10,600), but yields higher health benefits than paclitaxel (2.01 vs 1.48 LYs and 1.18 vs 0.85 QALYs for docetaxel and paclitaxel, respectively) over a 10-yr time horizon. The discounted Incremental Cost-Effectivness Ratio (ICER) of docetaxel vs paclitaxel 3-weekly was estimated to be £5,532/LY gained (95% CI 2,250–12,700) and £8,741/QALY gained (95% CI 3,400–17,300). The ICER was most sensitive to the HR for PFS, OS and the cost of docetaxel and paclitaxel. However, ICERs remained below £20,000/QALY at extreme values of the parameters. Conclusions: Compared with paclitaxel 3-weekly, over a 10-yr time horizon docetaxel provides survival and quality-adjusted survival benefit to metastatic breast cancer patients failing anthracycline regimens at an acceptable cost in a UK setting. Docetaxel is cost-effective compared to paclitaxel. No significant financial relationships to disclose.

scholarly journals Are Novel Therapies Worth the Cost for Young Patients?: A Cost-Effectiveness Analysis of Frontline Therapies with or without Radiation for Early-Stage Unfavourable Hodgkin Lymphoma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 662-662
Author(s):  
Abi Vijenthira ◽  
David C. Hodgson ◽  
Matthew Cheung ◽  
Michael Crump ◽  
Anca Prica
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Cost Effectiveness ◽  
Hodgkin Lymphoma ◽  
Early Stage ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Health State ◽  
Effective Regimen

Abstract Background: A variety of frontline treatment regimens exist for early-stage unfavourable Hodgkin lymphoma (HL), offering personalization of risk versus benefit in this primarily young population of patients. While radiation therapy has been a mainstay of treatment due to improved progression-free survival (PFS), recent studies have challenged this paradigm, using a PET-driven approach (HD17) or incorporating novel agents (nivolumab-AVD (N-AVD), brentuximab-AVD (A-AVD)). Long term risks of radiation and chemotherapy include secondary breast and other cancers, and heart failure; however novel regimens are more costly with uncertainty surrounding long-term efficacy. Methods: A cost-effectiveness and cost-utility analysis was conducted to compare five published frontline approaches for early-stage unfavourable HL: HD17, two H10 approaches, N-AVD, and A-AVD without radiation (Table 1). A Markov model was constructed with a lifetime horizon using TreeAge Pro 2021 (Figure 1). The base case was a 20-year-old female with a mediastinal mass who would require chest field radiation. Baseline estimates in the model were derived from the literature, including risk of relapse after each line of therapy, risk of late complications (breast cancer, secondary cancer, and/or heart failure), risk of death (from complications, lymphoma, and background mortality), and health state utilities. A Canadian public health care payer's perspective was taken, and costs are estimated in 2021 Canadian dollars. Global discounting of 3% was used. Results: Probabilistic sensitivity analyses were performed (10,000 simulations). First, we evaluated the uncertainty of long-term PFS using novel regimens (N-AVD or A-AVD); at a willingness-to-pay of $50,000/QALY, N-AVD was the most cost-effective regimen when 5-year PFS was at least 92% (Table 2). If 5-year PFS with N-AVD was <92%, HD17 became the most cost-effective approach. There was no PFS threshold at which A-AVD was the most cost-effective regimen. Holding the 5-year PFS of novel regimens at 92%, the model remained robust to multiple deterministic sensitivity analyses testing key variables including health state utilities (of relapse post-transplant, breast cancer, second malignancy, heart failure), costs (of radiation, autologous stem cell transplant, breast cancer, second malignancy, heart failure), and risks (of breast cancer after radiation, cardiovascular disease after radiation and/or chemotherapy,). However, if the risk of developing second cancer was less than 2% after 5 years with HD17 approach (current estimates 1% at 48 months in HD17 to 2% at 43 months in HD14 (which used a similar regimen)), or if the median overall survival after secondary cancer was over 9 years, HD17 became the most cost-effective regimen. The threshold cost for brentuximab to make A-AVD the most cost-effective regimen was <$5000 per dose (current price $14,520 CAD). Conclusions: If the long term PFS of nivolumab-AVD is greater than 92%, it could be the most cost-effective regimen when treating a young female patient with early-stage unfavourable Hodgkin lymphoma. This model accounts for increased costs with nivolumab added to chemotherapy, due to potential reduced incidence of late effects. However, there remain uncertainties in efficacy and risk regarding novel therapies as only non-randomized Phase II studies with short follow-up durations have been published; further trials of these approaches are being planned. HD17 remains the most cost-effective approach among published Phase III regimens. Long term follow-up of HD17 will also be meaningful to understand the risk of second cancer with this approach, which may impact its cost-effectiveness. Figure 1 Figure 1. Disclosures Crump: Epizyme: Research Funding; Kyte/Gilead: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; Roche: Research Funding. Prica: Astra-Zeneca: Honoraria; Kite Gilead: Honoraria.

scholarly journals Cost-effectiveness of Chloride-liberal versus Chloriderestrictive Intravenous Fluids among Patients Hospitalized in the United States

10.36469/9829 ◽  
2016 ◽  
Vol 4 (1) ◽  
pp. 90-102
Author(s):  
Louise Perrault ◽  
Dilip Makhija ◽  
Idal Beer ◽  
Suzanne Laplante ◽  
Sergio Iannazzo ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Decision Tree ◽  
Markov Model ◽  
The United States ◽  
Sensitivity Analyses ◽  
Major Surgery ◽  
Health State ◽  
Health States ◽  
Life Years ◽  
The Us

Background: Patients developing acute kidney injury (AKI) during critical illness or major surgery are at risk for renal sequelae such as costly and invasive acute renal replacement therapy (RRT) and chronic dialysis (CD). Rates of renal injury may be reduced with use of chloride-restrictive intravenous (IV) resuscitation fluids instead of chloride-liberal fluids. Objectives: To compare the cost-effectiveness of chloride-restrictive versus chloride-liberal crystalloid fluids used during fluid resuscitation or for the maintenance of hydration among patients hospitalized in the US for critical illnesses or major surgery. Methods: Clinical outcomes and costs for a simulated patient cohort (starting age 60 years) receiving either chloride-restrictive or chloride-liberal crystalloids were estimated using a decision tree for the first 90-day period after IV fluid initiation followed by a Markov model over the remainder of the cohort lifespan. Outcomes modeled in the decision tree were AKI development, recovery from AKI, progression to acute RRT, progression to CD, and death. Health states included in the Markov model were dialysis free without prior AKI, dialysis-free following AKI, CD, and death. Estimates of clinical parameters were taken from a recent meta-analysis, other published studies, and the US Renal Data System. Direct healthcare costs (in 2015 USD) were included for IV fluids, RRT, and CD. US-normalized health-state utilities were used to calculate quality-adjusted life years (QALYs). Results: In the cohort of 100 patients, AKI was predicted to develop in the first 90 days in 36 patients receiving chloride-liberal crystalloids versus 22 receiving chloride-restrictive crystalloids. Higher costs of chloride-restrictive crystalloids were offset by savings from avoided renal adverse events. Chloride-liberal crystalloids were dominant over chloride-restrictive crystalloids, gaining 93.5 life-years and 81.4 QALYs while saving $298 576 over the cohort lifespan. One-way sensitivity analyses indicated results were most sensitive to the relative risk for AKI development and relatively insensitive to fluid cost. In probabilistic sensitivity analyses with 1000 iterations, chloride-restrictive crystalloids were dominant in 94.7% of iterations, with incremental cost-effectiveness ratios below $50 000/QALY in 99.6%. Conclusions: This analysis predicts improved patient survival and fewer renal complications with chloriderestrictive IV fluids, yielding net savings versus chloride-liberal fluids. Results require confirmation in adequately powered head-to-head randomized trials.

scholarly journals Economic Evaluation of Sacituzumab Govitecan for the Treatment of Metastatic Triple-Negative Breast Cancer in China and the US

2021 ◽  
Vol 11 ◽  
Author(s):  
Jigang Chen ◽  
Mingyang Han ◽  
Aihua Liu ◽  
Bo Shi
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Single Agent ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Cost Effective Treatment ◽  
The Us

BackgroundThe effectiveness of Sacituzumab Govitecan (SG) for metastatic triple-negative breast cancer (mTNBC) has been demonstrated. We aimed to evaluate its cost-effectiveness on mTNBC from the Chinese and United States (US) perspective.MethodsA partitioned survival model was developed to compare the cost and effectiveness of SG versus single-agent chemotherapy based on clinical data from the ASCENT phase 3 randomized trial. Cost and utility data were obtained from the literature. The incremental cost-effectiveness ratio (ICER) was measured, and one-way and probabilistic sensitivity analyses (PSA) were performed to observe model stability. A Markov model was constructed to validate the results.ResultsIn China, SG yielded an additional 0.35 quality-adjusted life-year (QALY) at an additional cost of Chinese Renminbi ¥2257842. The ICER was ¥6375856 ($924037)/QALY. In the US, SG yielded the same additional QALY at an extra cost of $175393 and the ICER was $494479/QALY. Similar results were obtained from the Markov model. One-way sensitivity analyses showed that SG price had the greatest impact on the ICER. PSA showed the probability of SG to be cost-effective when compared with chemotherapy was zero at the current willing-to-pay threshold of ¥217341/QALY and $150000/QALY in China and the US, respectively. The probability of cost-effectiveness of SG would approximate 50% if its price was reduced to ¥10.44/mg in China and $3.65/mg in the US.ConclusionSG is unlikely to be a cost-effective treatment of mTNBC at the current price both in China and the US.

scholarly journals Cost-effectiveness of paclitaxel, doxorubicin, cyclophosphamide and trastuzumab versus docetaxel, cisplatin and trastuzumab in new adjuvant therapy of breast cancer in china

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Qiaoping Xu ◽  
Li Yuanyuan ◽  
Zhu Jiejing ◽  
Liu Jian ◽  
Li Qingyu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Partial Response ◽  
Cancer Patients ◽  
Transition Probabilities ◽  
Complete Response ◽  
Sensitivity Analyses ◽  
Half Cycle ◽  
Breast Cancer Patients ◽  
Grade 3

Abstract Background Breast cancer is the most common cancer among women in China. Amplification of the Human epidermal growth factor receptor type 2 (HER2) gene is present and overexpressed in 18–20% of breast cancers and historically has been associated with inferior disease-related outcomes. There has been increasing interest in de-escalation of therapy for low-risk disease. This study analyzes the cost-effectiveness of Doxorubicin/ Cyclophosphamide/ Paclitaxel/ Trastuzumab (AC-TH) and Docetaxel/Carboplatin/Trastuzumab(TCH) from payer perspective over a 5 year time horizon. Methods A half-cycle corrected Markov model was built to simulate the process of breast cancer events and death occurred in both AC-TH and TCH armed patients. Cost data came from studies based on a Chinese hospital. One-way sensitivity analyses as well as second-order Monte Carlo and probabilistic sensitivity analyses were performed.The transition probabilities and utilities were extracted from published literature, and deterministic sensitivity analyses were conducted. Results We identified 41 breast cancer patients at Hangzhou First People’s Hospital, among whom 15 (60%) had a partial response for AC-TH treatment and 13 (81.25%) had a partial response for TCH treatment.No cardiac toxicity was observed. Hematologic grade 3 or 4 toxicities were observed in 1 of 28 patients.Nonhematologic grade 3 or 4 toxicities with a reverse pattern were observed in 6 of 29 patients. The mean QALY gain per patient compared with TCH was 0.25 with AC-TH, while the incremental costs were $US13,142. The incremental cost-effectiveness ratio (ICER) of AC-TH versus TCH was $US 52,565 per QALY gained. Conclusions This study concluded that TCH neoadjuvant chemotherapy was feasible and active in HER2-overexpressing breast cancer patients in terms of the pathological complete response, complete response, and partial response rates and manageable toxicities.

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