Indirect Costs of Oral Versus Non-Oral Therapies in Hematologic Malignancies: A Systematic Literature Review

Introduction: The treatment landscape for hematologic malignancies is evolving rapidly, and a range of therapeutic options with differing routes of administration is now available. The shifting dynamics of these novel therapies and increasing total treatment costs highlight the importance of value-based healthcare decisions that take patient, payer, and societal perspectives into account. It is therefore increasingly important to consider both direct and indirect costs when evaluating therapeutic options. Reducing healthcare visits for administration of non-oral therapies (injectable and/or mixed therapies) results in indirect cost savings and is of particular relevance during the current coronavirus disease (COVID-19) pandemic where there are distinct challenges with respect to visiting hospital settings. However, the indirect cost savings of utilizing oral versus non-oral treatments have yet to be fully assessed from a patient and societal perspective. The objective of this review was to assess the differences in indirect non-treatment-related costs between oral and non-oral therapies for hematologic malignancies. Methods: A systematic literature review (SLR) was conducted by searching the Embase®, MEDLINE®, EconLit, and Health Technology Assessment/National Health Service economic evaluation (HTA/NHS EED) databases from inception to June 2020. Additionally, literature searches of proceedings from the 2018-2020 American Society of Clinical Oncology (ASCO), American Society of Hematology (ASH), and The Professional Society for Health Economics and Outcomes Research (ISPOR) conferences were performed to capture recent studies not indexed in the main databases. A manual search of the reference list from all included study publications was also performed. Eligibility criteria for study identification were developed using the Population, Intervention, Comparator, and Outcome (PICO) framework. Eligible studies included cost models and observational studies reporting indirect costs from a patient and/or societal perspective for oral versus non-oral therapies. Results: A total of 4,012 records were identified by the searches. Following title/abstract screening, the full text of 25 publications was reviewed, and 5 studies conducted in the USA (n = 3), Italy (n = 1), and Finland (n = 1) were identified as eligible and selected for qualitative evidence synthesis (Table). Although the SLR protocol included all hematologic malignancies, only studies including patients with multiple myeloma (MM) were identified. The indirect costs reported across the selected studies varied and included costs such as loss of productivity, transportation, and patient and/or caregiver time. Among all 5 studies, total indirect costs for patients with MM were lower for oral versus non-oral regimens. In the USA-based studies, indirect costs were USD 70-1,202 per month for oral regimens versus USD 432-1,526 per month for non-oral regimens. In Europe-based studies, indirect cost estimates were EUR 1,800 versus EUR 17,000 per year for oral versus non-oral regimens (Italian study), and EUR 114 versus EUR 358 per 28-day cycle for oral versus non-oral regimens (Finnish study; averages calculated from ranges in Table). Conclusions: This SLR demonstrates a paucity of data on the indirect costs to patients and society of oral versus non-oral therapies for hematologic malignancies. The studies included in this review assessed differing types of indirect costs, including loss of productivity, transportation costs, and patient and/or caregiver time; however, all indicated that the administration of oral regimens is associated with lower indirect costs compared with non-oral regimens. This finding is compelling given the current global health crisis due to COVID-19, where prioritizing the concept of "value" means assessing more complex issues, such as indirect costs that may have a meaningful impact on patients and society. Disclosures Fazeli: Evidinno Outcomes Research Inc.: Current Employment. Pushkarna:Evidinno Outcomes Research Inc.: Current Employment. Howarth:Evidinno Outcomes Research Inc.: Current Employment. Hux:Evidinno Outcomes Research Inc.: Consultancy. Pourrahmat:Evidinno Outcomes Research Inc.: Current Employment. Chen:Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company.

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Making sense of K‐12 competency‐based education: A systematic literature review of implementation and outcomes research from 2000 to 2019

The Journal of Competency-Based Education ◽

10.1002/cbe2.1228 ◽

2020 ◽

Vol 5 (4) ◽

Author(s):

Carla M. Evans ◽

Erika Landl ◽

Jeri Thompson

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Outcomes Research ◽

Competency Based Education ◽

Making Sense ◽

Competency Based ◽

K 12

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The Indirect Cost Burden of Cancer Care in Canada: A Systematic Literature Review

Applied Health Economics and Health Policy ◽

10.1007/s40258-020-00619-z ◽

2020 ◽

Cited By ~ 1

Author(s):

Nicolas Iragorri ◽

Claire de Oliveira ◽

Natalie Fitzgerald ◽

Beverley Essue

Keyword(s):

Literature Review ◽

Indirect Cost ◽

Systematic Literature Review ◽

Cancer Care ◽

Cost Burden

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Talent development: a systematic literature review of empirical studies

European Journal of Training and Development ◽

10.1108/ejtd-09-2017-0076 ◽

2018 ◽

Vol 42 (1/2) ◽

pp. 75-90 ◽

Cited By ~ 3

Author(s):

Fatemeh Rezaei ◽

Michael Beyerlein

Keyword(s):

Literature Review ◽

Organizational Development ◽

Systematic Literature Review ◽

Empirical Studies ◽

Talent Development ◽

Content Type ◽

Individual Level ◽

Development Interventions ◽

The Usa ◽

The Individual

Purpose The purpose of this study is to identify and examine findings from empirical research regarding organizations’ talent development (TD) strategies, taking into consideration the countries in which the studies were conducted and the TD-approach organizations adopted, and recognize the positive outcomes of TD implementation, as well as potential issues and challenges. Design/methodology/approach This systematic literature review used Garrard’s matrix method to organize the review of publications. It identified 31 empirical articles from the total of 551 publications. Findings The findings indicate that a majority of the studies were conducted in countries other than the USA and that they were all published recently, after 2007. The results show that organizations have mostly applied organizational development interventions at the individual level for developing talented employees, followed by formal training and development. Additionally, managerial issues were identified as the most common issue on the way of implementing TD interventions. Research limitations/implications Trying to define TD as a discrete concept from HRD could be considered as both differentiating the current literature review and a limitation. Originality/value This article is among the first to identify TD interventions through a systematic literature review and provides a model of TD’s intervention antecedents and outcomes for the follow-up empirical works.

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Risk of Skin Rash in Proteasome Inhibitor Bortezomib: A Systematic Literature Review and Meta-Analysis

Blood ◽

10.1182/blood.v118.21.5120.5120 ◽

2011 ◽

Vol 118 (21) ◽

pp. 5120-5120

Author(s):

Emily C Case ◽

Shenhong Wu ◽

John Gerecitano ◽

Mario E Lacouture

Keyword(s):

Literature Review ◽

Skin Rash ◽

Systematic Literature Review ◽

Proteasome Inhibitor ◽

Fixed Effects ◽

Meta Analysis ◽

Phase Iii ◽

High Grade ◽

Increased Risk ◽

American Society

Abstract Abstract 5120 Background: Bortezomib (VELCADE) is the first proteasome inhibitor to be approved by regulatory agencies for treatment of multiple myeloma and mantle cell lymphoma. Maculopapular rash is a common, adverse event to bortezomib. Because the summary incidence of bortezomib-induced skin rash is not well known, we performed a systematic literature review and meta-analysis to determine the incidence and overall risk. Methods: We searched PubMed and Web of Science databases and abstracts presented at the American Society of Clinical Oncology and The American Society of Hematology annual meetings from 1998 to July 2011, to identify relevant clinical studies. Eligible studies included prospective clinical phase II and phase III trials, with data on the incidence of rash in patients taking 1.3mg/m2, 1.5mg/m2, or 1.6 mg/m2 of bortezomib twice weekly for two weeks followed by one week off, in a 21-day cycle. The incidence of rash and relative risk (RR) were calculated using random-effects or fixed-effects model, depending on the heterogeneity of included studies. Results: A total of 2,469 patients with various hematologic and solid malignancies from 32 clinical trials were included for analysis. Among patients receiving bortezomib, the summary incidences of all-grade and high-grade rash were 18.8 % (95% CI: 14.9% to 23.5%) and 3.6 % (95% CI: 2.3% to 5.7%), respectively. We found no significant increase in rash incidence with higher doses of bortezomib. In addition, bortezomib was associated with an increased risk in both all grade (RR:19.703, 95% CI: 8.734 to 44.446, p<0.001) and high-grade rash (RR: 5.354, 95% CI: 2.158 to 13.285, p<0.001), in comparison with controls. Conclusion: Bortezomib is associated with a significant risk of developing rash. Management of bortezomib-induced rash is critical to prevent a negative effect on quality of life and dose modifications, both of which may affect clinical outcome. Disclosures: Wu: Onyx: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Amgen: Consultancy, Speakers Bureau; Janssen: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Genentech: Speakers Bureau. Gerecitano:Millenium: Research Funding.

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Systematic Literature Review of the Economic Burden and Cost of Illness in Patients with Myelofibrosis

Blood ◽

10.1182/blood-2019-122919 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2184-2184

Author(s):

Derek Tang ◽

Ankush Taneja ◽

Preety Rajora ◽

Renu Patel

Keyword(s):

Bone Marrow ◽

Literature Review ◽

Systematic Literature Review ◽

Resource Use ◽

Economic Burden ◽

Healthcare Costs ◽

Productivity Losses ◽

Annual Productivity ◽

Independent Reviewer ◽

The Usa

Introduction: Myelofibrosis (MF) is a rare bone marrow cancer classified as a myeloproliferative neoplasm in which bone marrow is replaced by fibrous (scar) tissue, impairing the production of normal blood cells. MF has a global incidence of approximately 0.58 new cases per 100,000 person-years, with many patients experiencing short survival (approximately 6 years). Most patients with MF are found to have either intermediate-2 or high-risk MF, as per their prognostic score (International Prognostic Scoring System [IPSS] or Dynamic IPSS). The economic impact of MF has been studied in individual real-world settings, each of which may have limited generalizability; however, the holistic economic burden of MF is not well understood. The objective of this systematic literature review (SLR) was to describe economic evidence for patients with MF including cost and resource use data. Methods: A SLR was conducted in Embase®, MEDLINE®, the National Health Service Economic Evaluation Database (NHS EED), and the American Economic Association (AEA) EconLit® to identify evidence published from database inception to July 2018. Conference proceedings and bibliographies were also searched. Studies were included if they were published in the English language and reported economic burden associated with adult patients with MF. The evidence was not restricted by any country or time limits. Two reviewers assessed each citation against predefined eligibility criteria, with discrepancies reconciled by a third independent reviewer. All the extracted data were quality checked by a second independent reviewer. A descriptive qualitative analysis was conducted to identify the patterns of economic burden in MF across different countries. Results: A total of 771 potentially relevant abstracts were identified and screened, of which 23 studies were included in the final analysis. Eleven studies reported cost data only, 10 studies reported both cost and resource use data, and 2 studies reported on the budget impact of treatment for MF. Eight of the included studies were conducted in the USA, 2 each in the UK, Canada, and Ireland, and the remaining 9 reported data from other countries. Eight of the included studies reported total MF costs, 4 studies reported productivity losses related to employment, and 3 studies reported indirect costs related to productivity and informal care. The remaining studies reported cost-effectiveness data for the treatment of MF. Of the 5 studies that reported categorical costs, 3 reported that outpatient costs were the major driver of costs, followed by inpatient costs. Among the studies conducted in the USA, total medical healthcare costs associated with MF ranged from USD 21,000 to USD 66,000 per patient. Three European studies reported that the annual productivity losses per patient ranged from EUR 7,774 to EUR 11,000, with total annual productivity losses as high as EUR 217,975. Two US studies compared the total MF-related healthcare costs with age- and sex-matched controls; costs were significantly higher in the MF cohort compared with matched controls (P < 0.05), especially for inpatient costs, outpatient costs, and pharmacy costs (Figure). Four studies, with a majority of the MF patients aged > 50 years, reported that 20-60% of the patients were absent from work, with a mean of 6.2 hours of work missed in the past 7 days. Among the hospitalized patients, 3 studies reported that the median length of stay for patients with MF ranged from 2.5 to 6.6 days, with 46% of patients utilizing emergency room visits and services. Conclusions: MF is associated with significant economic burden and work productivity loss to the health system, patients, and their families. Sustained efforts to develop more effective treatments are required in order to reduce the economic burden associated with MF and help patients and physicians improve disease management. Disclosures Tang: Celgene Corporation: Employment, Equity Ownership. Taneja:BresMed Health Solutions Ltd: Employment. Rajora:BresMed Health Solutions Ltd: Employment. Patel:BresMed: Employment.

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