scholarly journals The Cost-Effectiveness of Lenvatinib in the Treatment of Advanced or Unresectable Hepatocellular Carcinoma from a Canadian Perspective

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Brandon M. Meyers ◽  
Arndt Vogel ◽  
Paul Marotta ◽  
Petr Kavan ◽  
Laveena Kamboj ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cost Effectiveness ◽  
Phase Iii ◽  
Line Treatment ◽  
First Line ◽  
Unresectable Hepatocellular Carcinoma ◽  
Canadian Perspective ◽  
The Cost ◽  
First Line Treatment

Lenvatinib is an oral multikinase inhibitor indicated for the first-line treatment of unresectable hepatocellular carcinoma (uHCC). In the Phase III REFLECT trial, lenvatinib was noninferior in the primary endpoint of overall survival versus sorafenib, the only systemic therapy funded in Canada prior to the introduction of lenvatinib. Lenvatinib also demonstrated statistically significant improvement compared to sorafenib in secondary endpoint progression-free survival, time to progression, and objective response rate. The aim of this analysis was to estimate the cost-effectiveness of lenvatinib versus sorafenib for the first-line treatment of patients with uHCC from a Canadian perspective. A cost-utility analysis was conducted using partitioned survival modelling, with health states representing progression-free disease, progressed disease, and death. Health effects were measured using quality-adjusted life years (QALYs), and costs were represented in Canadian dollars. Clinical inputs were derived from the REFLECT trial, with outcomes extrapolated using parametric survival models. EQ-5D data collected in REFLECT were used to determine health state utility values, and estimates of resource use came from a survey of clinicians. The model predicted incremental costs of-$5,021 and incremental QALYs of 0.17, making lenvatinib dominant over sorafenib. The model demonstrates lenvatinib to be a cost-effective use of resources versus sorafenib in Canada for the treatment of uHCC. Overall costs are lower compared with sorafenib, while health benefits are greater, with modelled progression-free and overall survival extended by 4.1 and 2.6 months in the lenvatinib arm, respectively.

The cost effectiveness of lenvatinib versus atezolizumab and bevacizumab or sorafenib in patients with unresectable hepatocellular carcinoma (uHCC) in Canada.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 4098-4098
Author(s):  
David Trueman ◽  
Yifeng Liu ◽  
Marc Geadah ◽  
Nicholas Hon ◽  
Suthakar Sabapathy ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cost Effectiveness ◽  
Phase Iii ◽  
Base Case ◽  
Health State ◽  
Line Treatment ◽  
Relative Efficacy ◽  
First Line ◽  
The Cost ◽  
First Line Treatment

4098 Background: Hepatocellular carcinoma (HCC) represents 72% of liver cancers in Canada. In the phase III REFLECT trial, lenvatinib met the primary endpoint of non-inferiority in overall survival (OS) versus sorafenib and demonstrated superiority in secondary endpoints of progression free-survival (PFS), time to progression and objective response rate. Based on the REFLECT trial, lenvatinib has become the standard of care in the treatment of Canadian patients with unresectable HCC (uHCC). In the Phase III IMbrave150 trial, the use of the combination of atezolizumab and bevacizumab (atezo+bev) resulted in statistically significant improvement in OS and PFS versus sorafenib for patients with uHCC. The aim of this analysis was to estimate the cost-effectiveness of lenvatinib versus atezo+bev or sorafenib as first-line treatment for patients with uHCC from the perspective of Ministry of Health in Canada. Methods: A cost-utility analysis was conducted using a partitioned survival analysis. Health state membership for lenvatinib and sorafenib were estimated based on patient level data and clinical inputs from REFLECT and extrapolated using parametric survival models. Relative efficacy for atezo+bev was estimated from a de novo network meta-analysis. In the base-case analysis, estimates from REFLECT used in the NMA were adjusted for imbalances in baseline characteristics. Sensitivity analyses included the use of alternative approaches to determine relative efficacy. Health state utility values were determined with EQ-5D data collected in REFLECT. Drug acquisition costs were obtained from publicly available sources and medical resource utilization was based on a survey of Canadian clinicians. The time horizon was 10 years. Results of the incremental analysis were calculated sequentially. Results: In the base case lenvatinib was associated with cost savings of CAD$4,640 and CAD$120,095 and a QALY difference of 0.15 and -0.28 vs sorafenib and atezo+bev, respectively. The base case deterministic analysis resulted in lenvatinib being dominant over sorafenib and cost-effective vs. atezo+bev (sequential ICER for atezo+bev was CAD$425,754 per QALY). Results of the probabilistic sensitivity analysis (PSA) were consistent with the base case findings with lenvatinib being the optimal treatment strategy in >99% of iterations. Conclusions: Results of this analysis demonstrate that lenvatinib represents the optimal use of healthcare resources as a first-line treatment for uHCC in Canada.

Cost-effectiveness of rituximab plus CVP for first-line treatment of advanced indolent lymphoma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6583-6583
Author(s):  
J. Hornberger ◽  
C. Reyes ◽  
E. Verhulst ◽  
D. Lubeck ◽  
N. Valente
Keyword(s):  
Overall Survival ◽  
Cost Effectiveness ◽  
Follicular Lymphoma ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Line Treatment ◽  
First Line ◽  
Economic Implications ◽  
The Cost ◽  
First Line Treatment

6583 Background: The addition of rituximab (RTX) to CVP (cyclophosphamide, vincristine, prednisone) in the treatment of advanced follicular lymphoma increases median time to progression by 17 months (15 month v 32 months; p < 0.0001) (Marcus et al, Blood 2005). A societal cost-effectiveness analysis was performed to estimate projected lifetime clinical and economic implications of this treatment. Methods: The cost-effectiveness (CE) of RTX + CVP versus CVP was estimated for a 50 yr old patient. Kaplan-Meier estimates of progression-free and overall survival, up to 4 years, were obtained from the M39021 trial. After 4 years, transition rates from initiation of treatment to progression or death were assumed to be the same in both arms. The clinical and economic implications of relapse and its treatment were included in the model. Incremental costs associated with addition of RTX were estimated using Medicare reimbursement rates and published retail price data. Costs included drug and administration costs, adverse events, treatment of relapses, and end-of-life costs. Utility estimates were derived from the literature and a 3% discount rate was employed. Results: Projected mean overall survival is 1.5 yrs longer for patients assigned to RTX+ CVP versus only CVP (13.7 v 12.2 yrs). The addition of RTX to CVP is estimated to cost an additional $26,439 on average, with an expected gain of 0.85 year of quality-adjusted survival. Over a lifetime, the cost per QALY gained is $31,329. Sensitivity analyses revealed that the variables that most influenced cost-effectiveness were the time horizon (range: $18,800- $31,240) and the unit drug cost of RTX (range: $24,000-$38,000). Conclusion: The model estimates a cost-to-QALY gained ratio that is below that of many treatments used for oncology patients. The use of RTX + CVP for first-line treatment of advanced follicular lymphoma is projected to be cost-effective compared to CVP alone under a range of sensitivity analyses. No significant financial relationships to disclose.

Cost-Effectiveness of Imatinib in Comparison with Bone Marrow Transplant in Chronic Phase (CP) Chronic Myeloid Leukaemia (CML) in China.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2474-2474
Author(s):  
Zhixiang Shen ◽  
Xiaojun Huang ◽  
Samara Mendes de Costa ◽  
Zi Chen ◽  
Xiaoping Xu ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Overall Survival ◽  
Cost Effectiveness ◽  
Chinese Population ◽  
Line Treatment ◽  
Survival Curves ◽  
First Line ◽  
Life Years ◽  
The Cost ◽  
First Line Treatment

Abstract Abstract 2474 Poster Board II-451 Background Imatinib is associated with significant long-term survival benefits in CP CML patients versus bone marrow transplantation (BMT). Despite the proven benefits of imatinib and its position in first line treatment of chronic CML in several countries, BMT remains a treatment option in first line treatment of CML China. This modelling study was designed to explore the cost-effectiveness of imatinib in the Chinese setting. Methods A model was built in Microsoft Excel, with quarterly time intervals for overall survival over a 2-year period due to the lack of longer term follow up cost data for BMT. Published survival curves for the Chinese population were not available for either imatinib or BMT; however survival data for both imatinib and BMT from previous published literature were found to be broadly consistent with those reported in an unpublished survival meta-analysis of imatinib and BMT in Chinese population. The overall survival curve for imatinib sourced from the IRIS study (Druker et al 2006) was reconstructed in order to populate the imatinib arm of the model, and transplantation survival curves from Hasford et al (ASH 2008) were used to populate the BMT arm in the model. It was assumed that all patients surviving in each cycle remained in remission. Costs were based on the Chinese payment system. Due to the lack of publicly available cost data in China, a retrospective analysis of patient billings was conducted in 3 top tier hospitals in China (2 in Shanghai and 1 in Beijing) using a paper-based data collection questionnaire, with a target of 60 patients in total. Costs included in the model were: average cost of transplantation (including pre-operative and post-operative care and the transplantation procedure, as well as donor costs), complications associated with BMT and imatinib, quarterly cost of imatinib to the patients, and average quarterly charges for tests and monitoring. Utilities used in the model were sourced from IRIS; the utility for imatinib patients in remission was 0.854. Due to lack of published utility values in BMT patients, it was assumed that transplantation patients in remission would experience the same utility as interferon plus low-dose cytarabine (0.71). The outcomes of the model were total costs of treatment, life years, quality adjusted life years (QALY). A discount rate of 5% was used for costs and 0% for outcomes (utilities and life-years). Results Based on a cohort of 500 patients in each arm, the use of imatinib in CP CML yielded 497 and 971 life years (424 and 829 QALYs) at 1 and 2 years for imatinib vs. 485 and 898 for BMT (345 and 637 QALYs). Incremental life years (QALYs) were 12 (80) and 73 (192) at 1 and 2 years comparing imatinib with BMT. Total costs for imatinib were 73,194,400 RMB and 143,380,400 RMB at 1 and 2 years vs. 134,789,745 RMB and 143,552,071 RMB for BMT. Therefore, the cost savings for imatinib vs. BMT were 61,595,345 RMB and 171,671 RMB at 1 and 2 years. Imatinib is a dominant strategy to BMT (i.e., lower cost and higher efficacy) at 1 and 2 years. The model results were most sensitive to varying costs of BMT and discounting rates. Conclusion The results of the model demonstrate that imatinib is associated with improved overall survival and lower costs compared with BMT for the first 2 years in treating CP CML patients in the Chinese setting. Imatinib should be the first line treatment in CP CML based on both clinical and economic evidence. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Lenvatinib as the key component of first-line therapy for patients with unresectable hepatocellular carcinoma

2020 ◽  
Vol 22 (3) ◽  
pp. 142-148
Author(s):  
L. V. Bolotina
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Second Line Therapy ◽  
First Line Therapy ◽  
Line Therapy ◽  
Unresectable Hepatocellular Carcinoma ◽  
First Line Treatment

Throughout the last 10 years, liver cancer mortality rate in the Russian Federation consistently exceeded the morbidity rate, which is related to the complexity of early diagnostics, absence of effective screening and oncological alertness of allied-profession doctors. In the situation when late disease intelligence does not frequently allow radical treatment, palliative methods remain the only option of survivability enhancement and improving the patients quality of life. Lenvatinib was approved as the first-line drug in the treatment of unresectable hepatocellular carcinoma based on the data of the REFLECT trial, in which the drug demonstrated achieving the patients overall survival (OS) comparable to the activity of sorafenib (13.6 months for lenvatinib vs 12.3 months for sorafenib; hazard ratio HR 0.92; 95% confidence interval CI 0.791.06). At the same time, significant inferiority of lenvatinib was observed for secondary endpoints: progression-free survival PFS (7.4 months for lenvatinib vs 3.7 months for sorafenib; HR 0.66; 95% CI 0.570.77;р0.0001), time to progression (8.9 months for lenvatinib vs 3.7 months for sorafenib; HR 0.63; 95% CI 0.530.73;р0.0001) and objective response rate ORR (24.1% for lenvatinib vs 9.2% for sorafenib). The further analysis of the results of the REFLECT study revealed the additional factors impacting patients survival, such as the level of a-fetoprotein (AFP) before treatment, treatment ORR, performance of subsequent antitumor therapy and procedures after completion of the target first-line therapy. In patients responding to lenvatinib in the first line and further receiving any second-line therapy, the mOS was 25.7 months as compared with the median overall survival (mOS) of 22.3 months in patients responding to sorafenib and receiving further second-line therapy. Additionally, in responders switching from lenvatinib to sorafenib, the mOS was 26.2 months. In the recently published comparative study of lenvatinib and transarterial chemoembolization on the BCLC B stage, inferiority of lenvatinib was demonstrated in terms of OS, PFS and ORR in certain patient categories. Considering the data obtained in the REFLECT population, where in patients achieving the RR to the first-line treatment with lenvatinib and further receiving the local antitumor procedures the mOS increased to 27.2 months (95% CI 20.729.8), prescribing target and locoregional therapy in certain cases in this very sequence is possible. The recently published data about administration of lenvatinib outside of the inclusion criteria for the REFLECT trial, have proved the efficacy and safety of this drug administration in real clinical practice, thus significantly expanding our understanding of the key role of lenvatinib in the first-line treatment of unresectable hepatocellular carcinoma.

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