scholarly journals Test-and-Treat Strategies forHelicobacter pyloriin Uninvestigated Dyspepsia: A Canadian Economic Anaylsis

2000 ◽  
Vol 14 (5) ◽  
pp. 379-388 ◽  
Author(s):  
John K Marshall ◽  
David Armstrong ◽  
Bernie J O’Brien
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Third Party ◽  
Base Case ◽  
Model Parameters ◽  
Local Conditions ◽  
Ulcer Disease ◽  
Test And Treat ◽  
H Pylori ◽  
The Cost

BACKGROUND: Recognition of the pivotal role ofHelicobacter pyloriin the pathogenesis of peptic ulcer disease has revolutionized primary care approaches to dyspepsia. Decision analysis was used to compare the cost effectiveness of empirical ranitidine with a test and treat strategy using eitherH pyloriserology or the13carbon-urea breath test (13C-UBT).PATIENTS AND METHODS: A cohort of patients under age 50 years presenting with uninvestigated dyspepsia was evaluated. Three initial strategies were compared with respect to direct medical costs and effectiveness in curingH pylori-related ulcers - empirical ranitidine,H pyloriserology and UBT. A one-year time horizon and third-party payer perspective were adopted in a Canadian health care setting.RESULTS: UBT was more costly than either serology or ranitidine but was the most effective strategy and required the fewest endoscopies. No strategy demonstrated dominance over another in the base case. The incremental cost effectiveness ratio (ICER) of serology versus ranitidine was $118/cure, and sensitivity analysis induced dominance of serology in several plausible scenarios. The baseline ICER of UBT versus serology was $885/cure but showed substantial variation in sensitivity analysis. Each ICER was highly sensitive to variation in the cost of the tests themselves. At a serology cost of $25, UBT became dominant when its cost fell to $39.CONCLUSIONS: In low risk patients with uninvestigated dyspepsia, testing forH pyloriusing serology appears to be economically attractive.13C-UBT may be a cost effective alternative to serology if local conditions closely approximate the model parameters. Future changes in the costs of serology and13C-UBT may determine the optimal approach.

scholarly journals Cost Effectiveness Analysis of Fecal Transplant Delivery Methods for Recurrent Clostridium difficile Infections in Outpatients

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S386-S386 ◽  
Author(s):  
Jeremey Walker ◽  
Nathan Gundacker ◽  
Martin Rodriguez ◽  
Ellen Eaton
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Clostridium Difficile ◽  
Medical Center ◽  
Cost Effective ◽  
Third Party ◽  
Base Case ◽  
Delivery Methods ◽  
The Cost ◽  
Cure Rates

Abstract Background Clostridium difficile infection (CDI) accounts for more than $1 billion annually in US health care costs. Recurrent CDI (RCDI, recurrence within 8 weeks of initial treatment) contributes substantially to this cost. The objective of the study was to compare the cost effectiveness of FMT delivered via colonoscopy vs. blind nasogastric tube (NGT) in outpatients. We hypothesized that FMT by NGT would be cost-effective given its low risk and simplicity. Methods A decision-analytic simulation model compared the cost effectiveness of FMT by colonoscopy vs. NGT from a third-party payer perspective. Our base case cure rates were derived from a cohort receiving outpatient RCDI treatment at our institution. Cure was defined as resolution of symptoms for ≥ 90 days. Procedural cost and consultation was defined by average reimbursement to a large southeastern medical center in 2016 USD based on current procedural terminology (CPT) codes, and cost of disease states were derived from published literature. Health utilities were defined by quality of life year (QALY) based on published literature. Incremental Cost Effectiveness ratio (ICER) was defined as the cost per additional QALY gained. We assumed a 90 day time horizon. One-way sensitivity analysis was performed on all variables using ranges defined by published literature. We used TreeAge Software (Williamstown, MA). Results In the base case, FMT by colonoscopy was dominant (more effective and less costly) than NGT, with cost of $1,568/QALY vs. $1,910/QALY respectively. Cure rates of FMT by colonoscopy vs. NGT (100% vs. 87%) had the largest impact on ICER based on one-way sensitivity analysis. Therefore, a subsequent two-way sensitivity analysis was conducted to compare cure rates of both delivery methods and found that NGT delivery is cost effective as cure rates approach colonoscopy delivery cure rates within 5 percentage points. Conclusion Contrary to our hypothesis, our decision model supports FMT by colonoscopy as the preferred delivery method in outpatients with RCDI relative to NGT delivery. Additional costs of colonoscopy delivery are off-set by the improved cure rate leading to lower overall costs. As cure rates from NGT delivery are optimized, NGT may become the preferred method for FMT delivery. Disclosures All authors: No reported disclosures.

scholarly journals Cost-effectiveness of TAS-102 plus bevacizumab versus TAS-102 monotherapy in patients with metastatic colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kiyoaki Sugiura ◽  
Yuki Seo ◽  
Takayuki Takahashi ◽  
Hideyuki Tokura ◽  
Yasuhiro Ito ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Model Parameters ◽  
Combination Regimen ◽  
The Cost

Abstract Background TAS-102 plus bevacizumab is an anticipated combination regimen for patients who have metastatic colorectal cancer. However, evidence supporting its use for this indication is limited. We compared the cost-effectiveness of TAS-102 plus bevacizumab combination therapy with TAS-102 monotherapy for patients with chemorefractory metastatic colorectal cancer. Method Markov decision modeling using treatment costs, disease-free survival, and overall survival was performed to examine the cost-effectiveness of TAS-102 plus bevacizumab combination therapy and TAS-102 monotherapy. The Japanese health care payer’s perspective was adopted. The outcomes were modeled on the basis of published literature. The incremental cost-effectiveness ratio (ICER) between the two treatment regimens was the primary outcome. Sensitivity analysis was performed and the effect of uncertainty on the model parameters were investigated. Results TAS-102 plus bevacizumab had an ICER of $21,534 per quality-adjusted life-year (QALY) gained compared with TAS-102 monotherapy. Sensitivity analysis demonstrated that TAS-102 monotherapy was more cost-effective than TAS-102 and bevacizumab combination therapy at a willingness-to-pay of under $50,000 per QALY gained. Conclusions TAS-102 and bevacizumab combination therapy is a cost-effective option for patients who have metastatic colorectal cancer in the Japanese health care system.

scholarly journals Sustained acoustic medicine as a non-surgical and non-opioid knee osteoarthritis treatment option: a health economic cost-effectiveness analysis for symptom management

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Thomas M. Best ◽  
Stephanie Petterson ◽  
Kevin Plancher
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Symptom Management ◽  
Treatment Options ◽  
Base Case ◽  
Treatment Pathways ◽  
Knee Oa ◽  
Cost Effective Treatment ◽  
The Cost

Abstract Background Patients diagnosed with osteoarthritis (OA) and presenting with symptoms are seeking conservative treatment options to reduce pain, improve function, and avoid surgery. Sustained acoustic medicine (SAM), a multi-hour treatment has demonstrated improved clinical outcomes for patients with knee OA. The purpose of this analysis was to compare the costs and effectiveness of multi-hour SAM treatment versus the standard of care (SOC) over a 6-month timeframe for OA symptom management. Methods A decision tree analysis was used to compare the costs and effectiveness of SAM treatment versus SOC in patients with OA. Probabilities of success for OA treatment and effectiveness were derived from the literature using systematic reviews and meta-analyses. Costs were derived from Medicare payment rates and manufacturer prices. Functional effectiveness was measured as the effect size of a therapy and treatment pathways compared to a SOC treatment pathway. A sensitivity analysis was performed to determine which cost variables had the greatest effect on deciding which option was the least costly. An incremental cost-effectiveness plot comparing SAM treatment vs. SOC was also generated using 1000 iterations of the model. Lastly, the incremental cost-effectiveness ratio (ICER) was calculated as the (cost of SAM minus cost of SOC) divided by (functional effectiveness of SAM minus functional effectiveness of SOC). Results Base case demonstrated that over 6 months, the cost and functional effectiveness of SAM was $8641 and 0.52 versus SOC at: $6281 and 0.39, respectively. Sensitivity analysis demonstrated that in order for SAM to be the less expensive option, the cost per 15-min session of PT would need to be greater than $88, or SAM would need to be priced at less than or equal to $2276. Incremental cost-effectiveness demonstrated that most of the time (84%) SAM treatment resulted in improved functional effectiveness but at a higher cost than SOC. Conclusion In patients with osteoarthritis, SAM treatment demonstrated improved pain and functional gains compared to SOC but at an increased cost. Based on the SAM treatment ICER score being ≤ $50,000, it appears that SAM is a cost-effective treatment for knee OA.

scholarly journals Cost-Effectiveness Analysis of Direct Oral Anticoagulants Versus Vitamin K Antagonists for Venous Thromboembolism in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Ke-Xin Sun ◽  
Bin Cui ◽  
Shan-Shan Cao ◽  
Qi-Xiang Huang ◽  
Ru-Yi Xia ◽  
...  
Keyword(s):  
Decision Making ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Clinical Decision Making ◽  
Cost Effective ◽  
Clinical Decision ◽  
Base Case ◽  
Effectiveness Analysis ◽  
The Cost

Background: The drug therapy of venous thromboembolism (VTE) presents a significant economic burden to the health-care system in low- and middle-income countries. To understand which anticoagulation therapy is most cost-effective for clinical decision-making , the cost-effectiveness of apixaban (API) versus rivaroxaban (RIV), dabigatran (DAB), and low molecular weight heparin (LMWH), followed by vitamin K antagonist (VKA), in the treatment of VTE in China was assessed.Methods: To access the quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs), a long-term cost-effectiveness analysis was constructed using a Markov model with 5 health states. The Markov model was developed using patient data collected from the Xijing Hospital from January 1, 2016 to January 1, 2021. The time horizon was set at 30 years, and a 6-month cycle length was used in the model. Costs and ICERs were reported in 2020 U.S. dollars. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were used to test the uncertainties. A Chinese health-care system perspective was used.Results: In the base case, the data of 231 VTE patients were calculated in the base case analysis retrospectively. The RIV group resulted in a mean VTE attributable to 95% effective treatment. API, DAB, and VKA have a negative ICER (−187017.543, −284,674.922, and −9,283.339, respectively) and were absolutely dominated. The Markov model results confirmed this observation. The ICER of the API and RIV was negative (−216176.977), which belongs to the absolute inferiority scheme, and the ICER value of the DAB and VKA versus RIV was positive (110,577.872 and 836,846.343). Since the ICER of DAB and VKA exceeds the threshold, RIV therapy was likely to be the best choice for the treatment of VTE within the acceptable threshold range. The results of the sensitivity analysis revealed that the model output varied mostly with the cost in the DAB on-treatment therapy. In a probabilistic sensitivity analysis of 1,000 patients for 30 years, RIV has 100% probability of being cost-effective compared with other regimens when the WTP is $10973 per QALY. When WTP exceeded $148,000, DAB was more cost-effective than RIV.Conclusions: Compared with LMWH + VKA and API, the results proved that RIV may be the most cost-effective treatment for VTE patients in China. Our findings could be helpful for physicians in clinical decision-making to select the appropriate treatment option for VTE.

scholarly journals Cost-effectiveness of docetaxel in high-volume hormone-sensitive metastatic prostate cancer

2019 ◽  
Vol 13 (12) ◽  
Author(s):  
Jaclyn Beca ◽  
Habeeb Majeed ◽  
Kelvin K.W. Chan ◽  
Sebastian J. Hotte ◽  
Andrew Loblaw ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Survival Data ◽  
High Volume ◽  
Base Case ◽  
Castration Resistant Prostate Cancer ◽  
Life Years ◽  
Hormone Sensitive ◽  
The Cost

Introduction: Three pivotal trials have considered the addition of docetaxel (D) chemotherapy to conventional androgen-deprivation therapy (ADT) for the treatment of metastatic hormone-sensitive prostate cancer (HSPC). While an initial small trial was inconclusive, two larger trials demonstrated significant clinical benefit, including pronounced survival benefits (added 17 months) among patients with high-volume metastatic disease. Given the evolving clinical evidence, the cost-effectiveness of this approach warrants exploration. Methods: The cost-effectiveness of six cycles of ADT+D compared to ADT alone to treat patients with high-volume metastatic HSPC was assessed from a Canadian public payer perspective. We included three health states: HSPC, metastatic castration-resistant prostate cancer (CRPC), and death. Survival data were obtained from the CHAARTED trial, which reported outcomes specifically for high-volume disease. We used Ontario costs data and utilities from the literature. Results: In the base case analysis, ADT+D cost an additional $25 757 and produced an extra 1.06 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $24 226/QALY gained. Results from one-way sensitivity analysis across wide ranges of estimates and a range of scenarios, including an alternate model structure, produced ICERs below $35 000/QALY gained in all cases. Conclusions: The use of D with ADT in high-volume metastatic HSPC appears to be an economically attractive treatment approach. The findings were consistent with other studies and robust in sensitivity analysis across a variety of scenarios.

The cost-effectiveness of a H. pylori test and treat approach in primary care uninvestigated dyspepsia patients

2001 ◽  
Vol 120 (5) ◽  
pp. A89-A89 ◽  
Author(s):  
N CHIBA ◽  
S VELDHUYZENVANZANTEN ◽  
E GRACE ◽  
P SINCLAIR ◽  
R SIMONS ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Test And Treat ◽  
H Pylori ◽  
The Cost

Cost Effectiveness Analysis of Sertraline Versus Amitriptyline in Depression Management in a Psychiatric Hospital in South Southern Nigeria.

2020 ◽  
Vol 1 (5) ◽  
pp. 34-45
Author(s):  
J.W. Edefo ◽  
◽  
A.W. Udezi ◽  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Psychiatric Hospital ◽  
Monte Carlo Model ◽  
Depression Scale ◽  
Cost Effective ◽  
Pharmacoeconomic Evaluation ◽  
Third Party ◽  
Depression Management ◽  
The Cost

Background: In Nigeria, cost effectiveness data is rare therefore, resources allocated to the management of patients with depression can hardly be said to be optimized. Objective: The study aimed to determine the cost-effectiveness of sertraline versus amitriptyline in the management of depression. Methods: It is a prospective study of patients suffering from depression and who are receiving treatment from Psychiatric Hospital, Benin City, Nigeria. Costs were collected with the aid of a data collection sheet, while clinical improvement in depression was assessed by Hospital Anxiety Depression Scale- Depression (HADS-D) subscale instrument. Graph Pad Instat version 3.10 was used for inferential analysis. Markov Chain Monte Carlo model with sensitivity analysis of ± 50% on the effects of the antidepressants was used for pharmacoeconomic evaluation which was conducted from a third-party payers’ perspective with the real-world sample bootstrapped to 1000 respondents. Cost-Effectiveness Ratios (CER) was gotten, and Incremental Cost-Effectiveness Ratios (ICER) was calculated. Results: Females accounted for 60.8 % (84) of the total sample. First scenario of sensitivity analysis of sertraline 50mg versus amitriptyline 50mg gave ICER of NGN10847 which means sertraline will be more cost effective if the cost of making one depression free person in a month is worth more than NGN10847 (USD 27.12) and this amount is enough to treat 10 persons on amitriptyline. The second scenario of the sensitivity analysis gave ICER of -NGN16346 (-USD40.87) meaning that sertraline is more expensive and less effective than amitriptyline. Conclusion: Sertraline is more effective but from a third payer perspective it is less cost effective than amitriptyline in depression management.

COST Effectiveness of FRONT Nilotinib or Dasatinib VS IMATINIB AS FIRST LINE TREATMENT of CHRONIC Myeloid LEUKEMIA In Colombia,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4193-4193
Author(s):  
Martin Emilio Romero ◽  
Nelson Alvis ◽  
Magali de Acevedo ◽  
Diana Rocio Chávez
Keyword(s):  
Cost Effectiveness ◽  
Disease Progression ◽  
Chronic Phase ◽  
Third Party ◽  
Base Case ◽  
First Line ◽  
First Line Therapy ◽  
Payer Perspective ◽  
Efficacy Outcome ◽  
The Cost

Abstract Abstract 4193 Objective: To evaluate the cost-effectiveness of nilotinib 300 mg bid and dasatinib 100 mg qd, each compared to imatinib 400 mg qd, as first line therapy in chronic myeloid leukemia in Colombia, from third party payer perspective. Methods: We used a markov model to evaluate a hypothetical cohort of 100 patients, aged 55 years, with newly diagnosed CML in chronic phase, in a 10 year time horizon. Progression free life years saved (PF-LYS) were considered the primary efficacy outcome. Transition probabilities for major molecular response (MMR), disease progression (AP/BC) and CML related death, were analyzed in the model for each arm (nilotinib, imatinib and dasatinib) according to literature review and clinical experts validation. A 3% discount rate was applied to all costs and patient outcomes. In the absence of any head to head trials to compare nilotinib and dasatinib, comparisons were made independently for each one vs imatinib. Final comparison between both nilotinib and dasatinib was made indirectly. Costs analysis included direct medical costs for patient care at different stages of the disease as well as progression and hematology adverse events management, obtained from local health care providers databases at prices for year 2010. Transplantation costs were excluded, due to the age of the base case (55 years old). Prices for medicines were estimated from official government top reimbursement prices. Model robustness was evaluated through univariate and multivariate Montecarlo sensibility analysis. In the abscense of an official reference cost-effectiveness threshold in Colombia, all comparisons in the sensitivity analysis were made taking as reference the estimated average costs to treat patient disease progression during three months (cycle). Results: For the model cohort of 100 patients, nilotinib was projected to result in greater expected PF-LYS (15,376 for nilotinib vs 14,643 for imatinib), followed by dasatinib (15,108 vs 14,789 for imatinib). Imatinib had lower total lifetime costs, due in part to lower efficacy rates and shorter survival. The incremental cost-effectiveness ratio (ICER) was USD $12,640 per PF-LYS in the nilotinib arm and USD $46,348 per PF-LYS for dasatinib arm, each compared to imatinib. When analyzing indirectly nilotinib vs dasatinib, nilotinib was found to be dominant due to higher efficacy (267 PF-LYS) and less costs (USD $5,225) in the base case. The multivariate sensitivity analysis after 1000 iterations showed that nilotinib maintained its cost-effectiveness against imatinib in more than 85% of scenarios and proved dominant against dasatinib in 82% of scenarios. The average estimated cost to manage disease progression per cycle (three months) was USD $16,109 which was considered as the cost effectiveness threshold. Conclusions: From a third party payer perspective in Colombia, using PF-LYS as the efficacy outcome, nilotinib is highly cost-effective when compared to imatinib and dominant vs dasatinib in first line therapy for CML in chronic phase. Disclosures: de Acevedo: Novartis Colombia: Consultancy; Pfizer Colombia: Consultancy.

scholarly journals Real-World Cost-Effectiveness Analysis of Gemcitabine and Cisplatin Compared to Docetaxel and Cisplatin Plus Fluorouracil Induction Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma

2020 ◽  
Vol 10 ◽  
Author(s):  
Jiangping Yang ◽  
Jiaqi Han ◽  
Jinlan He ◽  
Baofeng Duan ◽  
Qiheng Gou ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Nasopharyngeal Carcinoma ◽  
Incremental Cost ◽  
Real World ◽  
Cost Effective ◽  
Model Parameters ◽  
The Cost ◽  
The Impact ◽  
Gemcitabine And Cisplatin

BackgroundAddition of gemcitabine and cisplatin (GP) or docetaxel and cisplatin plus fluorouracil (TPF) to concurrent chemoradiotherapy (CCRT) significantly improved survival in locoregionally advanced nasopharyngeal carcinoma (NPC). However, an economic evaluation of these regimens remains unknown. The purpose of this study is to compare the cost-effectiveness of GP versus TPF regimen in the treatment of locoregionally advanced NPC in China.Materials and methodsA comprehensive Markov model was developed to evaluate the health and economic outcomes of GP versus TPF regimen for patients with locoregionally advanced NPC. Baseline and clinical outcome were derived from 158 patients with newly diagnosed stage III-IVA NPC between 2010 and 2015. We evaluated the quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) from the perspective of the Chinese healthcare system. One-way sensitive analysis explored the impact of uncertainty in key model parameters on results, and probabilistic uncertainty was assessed through a Monte Carlo probabilistic sensitivity analysis.ResultsGP regimen provided an additional 0.42 QALYs with incremental cost of $3,821.99, resulting in an ICER of $9,099.98 per QALY versus TPF regimen at the real-world setting. One-way sensitivity analysis found that the results were most sensitive to the cost and proportion of receiving subsequent treatment in two groups. The probability that GP regimen being cost-effective compared with TPF regimen was 86.9% at a willingness-to-pay (WTP) of $31,008.16 per QALY.ConclusionUsing real-world data, GP regimen was demonstrated a cost-effective alternative to TFP regimen for patients with locoregionally advanced NPC in China. It provides valuable evidence for clinicians when making treatment decisions to improve the cost-effectiveness of treatment.

scholarly journals Sunitinib for the treatment of gastrointestinal stromal tumours: a critique of the submission from Pfizer

2009 ◽  
Vol 13 (Suppl 2) ◽  
pp. 69-74
Author(s):  
M Bond ◽  
M Hoyle ◽  
T Moxham ◽  
M Napier ◽  
R Anderson
Keyword(s):  
Sensitivity Analysis ◽  
Overall Survival ◽  
Cohort Study ◽  
Cost Effectiveness ◽  
Hazard Ratio ◽  
Base Case ◽  
Gastrointestinal Stromal Tumours ◽  
Entire Study ◽  
Significant Difference ◽  
The Cost

The submission’s evidence for the clinical effectiveness and cost-effectiveness of sunitinib for the treatment of gastrointestinal stromal tumours (GISTs) is based on a randomised controlled trial (RCT) comparing sunitinib with placebo for people with unresectable and/or metastatic GIST after failure of imatinib and with Eastern Cooperative Oncology Group (ECOG) progression status 0–1, and an ongoing, non-comparative cohort study of a similar population but with ECOG progression status 0–4. The searches are appropriate and include all relevant studies and the RCT is of high quality. In the RCT sunitinib arm overall survival was 73 median weeks [95% confidence interval (CI) 61 to 83] versus 75 median weeks (95% CI 68 to 84) for the cohort study. However, time to tumour progression in the cohort study was different from that in the RCT sunitinib arm [41 (95% CI 36 to 47) versus 29 (95% CI 22 to 41) median weeks respectively]. Median progression-free survival with sunitinib was 24.6 weeks (95% CI 12.1 to 28.4) versus 6.4 weeks (95% CI 4.4 to 10.0) on placebo (hazard ratio 0.333, 95% CI 0.238 to 0.467, p < 0.001). The manufacturer used a three-state Markov model to model the cost-effectiveness of sunitinib compared with best supportive care for GIST patients; the modelling approach and sources and justification of estimates are reasonable. The base-case incremental cost-effectiveness ratio (ICER) was £27,365 per quality-adjusted life-year (QALY) with the first cycle of sunitinib treatment not costed; when we included the cost of the first treatment cycle we estimated a base-case ICER of £32,636 per QALY. Pfizer’s sensitivity analysis produced a range of ICERs from £15,536 per QALY to £59,002 per QALY. Weaknesses of the manufacturer’s submission include that the evidence is based on only one published RCT; that 84% of the RCT control population crossed over to the intervention group, giving rise to the use of unusual rank preserved structural failure time (RPSFT) analysis to correct for possible bias; and that a number of errors and omissions were made in the probabilistic sensitivity analysis, meaning that it is not possible to come to firm conclusions about the cost-effectiveness of sunitinib for GIST in this patient population. In conclusion, during the blinded phase of the RCT, overall survival was significantly longer in the sunitinib arm than in the placebo arm (hazard ratio 0.491, 95% CI 0.290 to 0.831, p <0.007). However, intention-to-treat analysis of the entire study showed no statistically significant difference in overall survival for those who received sunitinib (73 weeks) versus those who received placebo (65 weeks) (hazard ratio 0.876, 95% CI 0.679 to 1.129, p = 0.306).

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