Cost-Effectiveness of Rituximab Post CVP Induction for the Treatment of Low-Grade NHL.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4486-4486
Author(s):  
John C. Hornberger ◽  
Carolina Reyes ◽  
Ashwini Shewade ◽  
David Loecke ◽  
Nancy Valente
Keyword(s):  
Cost Effectiveness ◽  
B Cell ◽  
Progression Free Survival ◽  
The United States ◽  
Sensitivity Analyses ◽  
Low Grade ◽  
Health States ◽  
Economic Implications ◽  
Expected Gain ◽  
Life Years

Abstract Background: Extended Rituximab (R) therapy after CVP (cyclophosphamide, vincristine, prednisone) induction in the first-line treatment of low-grade, CD20-positive, B-cell NHL significantly prolongs progression-free survival (PFS). A societal cost-effectiveness analysis is performed to estimate projected lifetime clinical and economic implications of this treatment. Methods: A Markov model with 3 health states (progression-free, post-progression, and death) was developed to estimate the direct medical costs and quality-adjusted life-years (QALYs) for a representative patient cohort with low-grade, CD20-positive, B-cell NHL. Kaplan-Meier estimates of PFS and overall survival (OS) up to 4 years are obtained from the ECOG/CALGB intergroup E1496 trial. After 4 years, transition rates are assumed to be the same in both arms. Costs include drug and administration costs, adverse events, treatment of relapses, and end-of-life costs. Incremental costs associated with R are based on Medicare reimbursement rates and published drug prices. Utilities are derived from the literature and a 3% discount rate is employed. Results: Projected mean OS is 1.2-yrs longer for patients assigned to extended R therapy versus observation alone (15.2 v 14.0 yrs). Extended R therapy is estimated to cost $42,822 on average, with an expected gain of 0.85 years of quality-adjusted survival. Over a lifetime, the cost per QALY gained is $57,515. Sensitivity analyses performed on all variables contributing to the model results showed that utility for follicular NHL patients (range: 0.68–1) and number of R infusions (range: 8–17) most influence the incremental cost-effectiveness ratio (ICER). Conclusion: The ICER of extended R dosing following CVP induction remains well below the threshold considered acceptable for oncology in the United States. Additional analysis of long term follow-up data will be useful for further evaluation of clinical and economic implications of this treatment for low-grade, CD20-positive, B-cell NHL patients.

Cost-effectiveness of once weekly carfilzomib 70 mg/m2 plus dexamethasone in patients with relapsed and refractory multiple myeloma in the United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18356-e18356
Author(s):  
Shaji Kumar ◽  
Istvan Majer ◽  
Sumeet Panjabi ◽  
Jean Malacan ◽  
Rohan Medhekar ◽  
...  
Keyword(s):  
Health Care ◽  
Multiple Myeloma ◽  
Cost Effectiveness ◽  
Progression Free Survival ◽  
Cost Effective ◽  
The United States ◽  
Sensitivity Analyses ◽  
Refractory Multiple Myeloma ◽  
Life Years ◽  
Lifetime Costs

e18356 Background: Carfilzomib plus dexamethasone (Kd) dosed once weekly at 70 mg/m2 (QW Kd70) was recently approved in the US for treating patients with relapsed and refractory multiple myeloma (RRMM). To assess the cost-effectiveness (CE) of QW Kd70 vs twice weekly Kd dosed at 27 mg/m2 (BIW Kd27), data from the phase 3 ARROW trial, which directly compared these regimens in patients with 2-3 prior lines of therapy were used. Methods: A partitioned survival model was developed for the CE analysis. Time to treatment discontinuation, progression-free survival, and overall survival (OS) were estimated from the ARROW trial. Long-term OS was extrapolated using Surveillance Epidemiology and End Results registry data after matching characteristics of patients in the registry and ARROW trial. Direct costs were estimated from a US health care payer perspective. Utilities collected in the ARROW trial using the five-level version of the EuroQol questionnaire (EQ-5D-5L) were applied to estimate the quality-adjusted life years (QALYs). Uncertainty was explored using sensitivity analyses. Two subgroups of patients refractory to lenalidomide or bortezomib were assessed. Main outcomes were mean life-years (LYs), QALYs, lifetime costs, and incremental cost-effectiveness ratios (ICERs). Results: For QW Kd70 and BIW Kd27, the model predicted mean LYs of 4.17 and 3.07 years, QALYs of 2.98 and 2.03 years, and mean total lifetime costs of $444,563 and $373,364, respectively. The incremental LYs gain, QALY gain, and incremental costs of QW Kd70 vs BIW Kd27 were estimated to be 1.10 years, 0.95 year, and $71,199, respectively, resulting in an ICER of $64,595 per LY gained and $75,204 per QALY gained. For patients refractory to lenalidomide and bortezomib, similar results were found with ICERs of $79,988 and $76,793, respectively. Conclusions: In line with ARROW trial results, this CE analysis showed that QW Kd70 is expected to provide considerable additional benefit in terms of LYs and QALYs gained compared with BIW Kd27. In the RRMM setting, QW Kd70 is cost-effective with ICERs below accepted willingness to pay thresholds in US and represents an efficient utilization of the health care budget.

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.

Cost effectiveness of carfilzomib (CAR), ixazomib (IXA), elotuzumab (ELO), or daratumumab (DAR) with lenalidomide and dexamethasone (LEN+DEX) vs LEN+DEX in relapsed/refractory multiple myeloma (R/R MM).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 8030-8030 ◽  
Author(s):  
Nimer Alsaid ◽  
Ali McBride ◽  
Amit Balkrishna Agarwal ◽  
Abdulaali Mutairi ◽  
Faiz Anwer ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Meta Analysis ◽  
Indirect Comparison ◽  
Progression Free Survival ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Health States ◽  
Chemotherapy Administration ◽  
Life Years

8030 Background: CAR, IXA, ELO, and DAR in triplet combination with LEN+DEX have shown superior efficacy over LEN+DEX in R/R MM, but their comparative efficacy and cost effectiveness has not been estimated. Methods: Network meta-analysis [NMA] and Bücher method were used to indirectly estimate comparative progression-free survival (PFS) efficacy. A 2-state Markov model (progression-free, progressed or death) was specified. Inputs included: cost of chemotherapy, administration, adverse events (AE) management, disease monitoring; utilities for health states; and disutilities for AEs. Incremental cost effectiveness (ICER) and cost utility ratios (ICUR) were calculated for resp. PFS life years (PFS LY) and quality adjusted life years (PFS QALY) gained in base case and probabilistic sensitivity analyses (PSA). Results: NMA and Bücher indirect comparison methods yielded similar PFS hazard ratios (HR), revealing superiority of DAR+LEN+DEX over other triplets in terms of PFS (Table). Using the exponential distribution to fit PFS data, our cost effectiveness analysis indicated that all 4 triplet regimens were associated with additional PFS LY and QALY gained over LEN+DEX at additional cost. DAR+LEN+DEX was associated with the greatest PFS LY and QALY gained at the lowest relative cost, yielding superior ICER and ICUR estimates compared to other triplet regimens. Conclusions: The superior PFS efficacy of DAR+LEN+DEX is associated with positive cost effectiveness and cost utility in the setting of R/R MM. [Table: see text]

scholarly journals Cost-Effectiveness of the FDA Menu Labeling to Reduce Obesity-Associated Cancer Burden in the United States

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1712-1712
Author(s):  
Mengxi Du ◽  
Christina Griecci ◽  
Frederick Cudhea ◽  
Heesun Eom ◽  
John Wong ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Healthcare Costs ◽  
The United States ◽  
Sensitivity Analyses ◽  
Calorie Intake ◽  
Menu Labeling ◽  
Life Years ◽  
Industry Response ◽  
Meta Analyses

Abstract Objectives The FDA menu labeling policy requires chain restaurants with ≥20 outlets to list total calories on menus or menu boards. While obesity is a known risk factor for 13 cancers, the potential impact of this policy on cancer burdens and healthcare costs in the US is unknown. Methods Using a probabilistic cohort state-transition model, we estimated the health impacts, costs, and cost-effectiveness of the FDA menu labeling policy on reducing calorie intake, subsequent weight change, and obesity-related cancer cases among US adults over a lifetime. Baseline demographics and calorie intake from restaurants were estimated using NHANES 2013–2016. Based on published meta-analyses, we assumed that labeling would reduce calorie intake per meal by 7.3%, evaluated with and without an additional 5% reduction through industry reformulations; and assumed only half of these calorie reductions would be sustained by individuals throughout their day (i.e., to account for potential calorie compensation outside restaurants). Changes in BMI were derived from published energy models (0.45 kg lower long-term weight per 55 kcal/d calorie reduction). National cancer rates and healthcare costs were obtained from published sources. Uncertainties of inputs were incorporated in probabilistic sensitivity analyses using 1000 simulations. Results The FDA menu labeling policy was estimated to prevent 31,300 (95% UI: 27,600–35,500) new cancer cases and 18,700 (16,400–21,300) cancer deaths, gaining 134,000 (117,000–153,000) quality-adjusted life years (QALYs) among US adults over a lifetime. Top three cancers prevented were endometrial, post-menopausal breast, and kidney. Accounting for policy implementation and healthcare costs, the policy was net cost saving at $1.74B ($1.55–$1.95B) and $1.76B ($1.46–$2.09B) from healthcare and societal perspectives, respectively. A modest industry response (5% calorie reduction) would prevent a total of 51,800 new cancer cases (47,900–56,400) and 30,900 cancer deaths (28,600–34,000) and increase net savings to $2.87B ($2.68–$3.12B) and $3.19B ($2.86–$3.54B), respectively. Conclusions Our model suggests implementation of the FDA menu calorie labeling policy would substantially reduce incident cancers and deaths and be cost-saving, with even larger effects if accompanied by modest industry reformulation. Funding Sources NIH/NIMHD.

scholarly journals COST-EFFECTIVENESS OF POST-AUTOTRANSPLANT LENALIDOMIDE IN PERSONS WITH MULTIPLE MYELOMA.

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Monia Marchetti ◽  
Robert Peter Gale ◽  
Giovanni Barosi
Keyword(s):  
Cost Effectiveness ◽  
Progression Free Survival ◽  
Published Data ◽  
Fixed Duration ◽  
Health States ◽  
Life Years ◽  
The Us ◽  
Markov Decision Model ◽  
Eu And Us ◽  
The Eu

Considerable data indicate posttransplant lenalidomide prolongs progression-free survival and probably survival after an autotransplant for plasma cell myeloma (PCM).  However, optimal therapy duration is unknown, controversial and differs in the EU and US.  We compared outcomes and cost-effectiveness of 3 posttransplant lenalidomide strategies in EU and US settings: (1) none; (2) until failure; and (3) 2-year fixed duration.  We used a Markov decision model which included 6 health states and informed by published data.  The model estimated the strategy of lenalidomide given to failure achieved 1.06 quality-adjusted life years (QALYs) at costs per QALY gained of €29,232 in the EU   and $133,401 in the US settings.  Two-year fixed-duration lenalidomide averted €7,286 per QALY gained in the EU setting and saved 0.84 QALYs at $60,835 per QALY gained in the US setting.  These extremely divergent costs per QALY in the EU and US settings resulted from large differences in costs of posttransplant lenalidomide and of 2nd-line therapies driven by whether posttransplant failure was on- or off-lenalidomide.  In Monte Carlo simulation analyses which allowed us to account for variability of inputs, 2-year fixed-duration lenalidomide remained the preferred strategy for improving health-care sustainability in the EU and US settings.

scholarly journals Estimation of Survival Probabilities for Use in Cost-effectiveness Analyses: A Comparison of a Multi-state Modeling Survival Analysis Approach with Partitioned Survival and Markov Decision-Analytic Modeling

2016 ◽  
Vol 37 (4) ◽  
pp. 427-439 ◽  
Author(s):  
Claire Williams ◽  
James D. Lewsey ◽  
Daniel F. Mackay ◽  
Andrew H. Briggs
Keyword(s):  
Cost Effectiveness ◽  
A Priori ◽  
Progression Free Survival ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Lymphocytic Leukemia ◽  
Health States ◽  
Analytic Modeling ◽  
Life Years ◽  
Markov Decision

Modeling of clinical-effectiveness in a cost-effectiveness analysis typically involves some form of partitioned survival or Markov decision-analytic modeling. The health states progression-free, progression and death and the transitions between them are frequently of interest. With partitioned survival, progression is not modeled directly as a state; instead, time in that state is derived from the difference in area between the overall survival and the progression-free survival curves. With Markov decision-analytic modeling, a priori assumptions are often made with regard to the transitions rather than using the individual patient data directly to model them. This article compares a multi-state modeling survival regression approach to these two common methods. As a case study, we use a trial comparing rituximab in combination with fludarabine and cyclophosphamide v. fludarabine and cyclophosphamide alone for the first-line treatment of chronic lymphocytic leukemia. We calculated mean Life Years and QALYs that involved extrapolation of survival outcomes in the trial. We adapted an existing multi-state modeling approach to incorporate parametric distributions for transition hazards, to allow extrapolation. The comparison showed that, due to the different assumptions used in the different approaches, a discrepancy in results was evident. The partitioned survival and Markov decision-analytic modeling deemed the treatment cost-effective with ICERs of just over £16,000 and £13,000, respectively. However, the results with the multi-state modeling were less conclusive, with an ICER of just over £29,000. This work has illustrated that it is imperative to check whether assumptions are realistic, as different model choices can influence clinical and cost-effectiveness results.

scholarly journals Comparing Prednisone and Methotrexate to Off-label Biologic Infliximab for Management of Ocular Uveitis: A Cost-minimization Analysis

10.36469/9895 ◽  
2015 ◽  
Vol 2 (2) ◽  
pp. 131-146
Author(s):  
William V. Padula ◽  
Miguel Cordero-Coma ◽  
Taygan Yilmaz ◽  
William V. Padula ◽  
Michéal J. Gallagher ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
The United States ◽  
Posterior Uveitis ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Off Label ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Successful Recovery

Background: Approximately 3.75% of cases of blindness in the United States are caused by uveitis. Incurred clinical costs and lost productivity related to vision loss in these cases totals $3.58 billion annually. Objective: To evaluate whether infliximab, a modern off-label biologic, is cost-effective for treating posterior uveitis and panuveitis compared to current standards of care, methotrexate and prednisone. Methods: A cost-effectiveness analysis using a Markov model to simulate a patient cohort with posterior uveitis or panuveitis. The model followed patients’ therapy from the onset of posterior uveitis or panuveitis using the U.S. societal perspective. The lifetime model simulated health states that could lead to successful reversal of uveitis with standard or intensified treatment with prednisone, methotrexate, or infliximab. Probabilities, health utilities, and costs were included in the model based on findings from the literature. We conducted univariate sensitivity analyses and a Bayesian multivariate probablistic sensitivity analysis to estimate uncertainty in results. Outcomes were measured in terms of costs ($US, 2010) and effects (qualityadjusted life years; QALYs) discounted at 3% per year were estimated for each simulated treatment. An incremental cost-effectiveness ratio (ICER) for pairwise results was interpretted assuming a predetermined willingness-to-pay threshold of $100,000/QALY. Results: Average lifetime costs and QALYs for each drug were ($306.95; 15.80 QALYs) for prednisone, methotrexate ($36,232.24; 16.21 QALYs), and inflixmab ($74,762.63; 15.04 QALYs). Methotrexate was on average compared to prednisone, with an ICER of $86,901.16/QALY. Prednisone and methotrexate dominated infliximab. Sensitivity analyses suggested that the model was most sensitive to the utility for successful recovery from uveitis. The probabilistic sensitivity analysis returned results similar to the base case. Conclusion: This cost-effectiveness analysis suggests that despite advances in the use of biologics for treating sight-threatening posterior uveitis and panuveitis, infliximab had lower effectiveness and higher costs compared to both prednisone and methotrexate. As compared to prednisone, methotrexate was associated with increased costs and QALYs and was found to be a good value. Clinical trials of infliximab in the uveitis population are needed to reduce the uncertain estimates of inflixmab treatment success and the drug’s cost-effectiveness.

Health Impact and Cost-Effectiveness of Achieving the National Salt and Sugar Reduction Initiative Voluntary Sugar Reduction Targets in the United States: A Micro-Simulation Study

Circulation ◽  
2021 ◽  
Author(s):  
Siyi Shangguan ◽  
Dariush Mozaffarian ◽  
Stephen Sy ◽  
Yujin Lee ◽  
Junxiu Liu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Sensitivity Analyses ◽  
Potential Health ◽  
Added Sugar ◽  
Health Gains ◽  
Life Years ◽  
Sugar Reduction

Background: High intake of added sugar is linked to weight gain and cardiometabolic risk. In 2018, the US National Salt and Sugar Reduction Initiative (NSSRI) proposed government supported voluntary national sugar reduction targets. This intervention's potential health and equity impacts, and cost-effectiveness are unclear. Methods: A validated microsimulation model, CVD-PREDICT, coded in C++, was used to estimate incremental changes in type 2 diabetes, cardiovascular disease (CVD), quality-adjusted life-years (QALYs), costs and cost-effectiveness of the NSSRI policy. The model was run at the individual-level, incorporating the annual probability of each person's transition between health status based on their risk factors. The model incorporated national demographic and dietary data from the National Health and Nutrition Examination Survey across 3 cycles (2011-2016), added sugar-related diseases from meta-analyses, and policy costs and health-related costs from established sources. A simulated nationally representative US population was created and followed until age 100 years or death, with 2019 as the year of intervention start. Findings were evaluated over 10 years and a lifetime from healthcare and societal perspectives. Uncertainty was evaluated in a one-way analysis by assuming 50% industry compliance, and probabilistic sensitivity analyses via a second-order Monte Carlo approach. Model outputs included averted diabetes cases, CVD events and CVD deaths, QALYs gained, and formal healthcare cost savings, stratified by age, race, income and education. Results: Achieving the NSSRI sugar reduction targets could prevent 2.48 million CVD events, 0.49 million CVD deaths, and 0.75 million diabetes cases; gain 6.67 million QALYs; and save $160.88 billion net costs from a societal perspective over a lifetime. The policy became cost-effective (<150K/QALYs) at 6 years, highly cost-effective (< 50K/QALYs) at 7 years, and cost-saving at 9 years. Results were robust from a healthcare perspective, with lower (50%) industry compliance, and in probabilistic sensitivity analyses. The policy could also reduce disparities, with greatest estimated health gains per million adults among Black and Hispanic, lower income, and less educated Americans. Conclusions: Implementing and achieving the NSSRI sugar reformation targets could generate substantial health gains, equity gains and cost-savings.

Cost-effectiveness of rituximab maintenance therapy for patients with follicular lymphoma: The Spanish perspective

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8092-8092
Author(s):  
J. Gómez Codina ◽  
M. Provencio ◽  
A. Rueda ◽  
F. Capote ◽  
F. Carbonell ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Maintenance Therapy ◽  
Follicular Lymphoma ◽  
Maintenance Treatment ◽  
Progression Free Survival ◽  
Base Case ◽  
Health States ◽  
Free Survival ◽  
Rituximab Maintenance ◽  
Life Years

8092 Background: In patients with relapsed or refractory follicular lymphoma (FL) who attain a response with either cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) alone or Rituximab + CHOP, maintenance treatment with Rituximab has shown to significantly improve overall survival (OS) (85% at 3 years vs. 77%, p=0.011) and progression free survival (PFS) (51,5 vs. 14.9 months, p<0.001) as compared to observation alone (OA). We analyzed the cost-effectiveness, from a Spanish perspective, of Rituximab maintenance therapy (375mg/m2 every 3 months until progression or for 2 years) versus OA according to the population and data described for the European Organization for Research Treatment of Cancer (EORTC) 20981 study (van Oers MHJ Blood 2006). Methods: Incremental cost-effectiveness was assessed through a deterministic, three health states model (disease-free, progression and death) transition model. Base case model: PFS and OS were extrapolated from EORTC 20981 data using a Weibull distribution, Rituximab maintenance benefit was assumed to last 5 years, 10 years time horizon, 3.5% discount rate on costs and benefits, and Spanish National Health Service perspective (direct costs only). Resource use was estimated from a Spanish expert panel and EORTC 20981 study. Unit costs were obtained from local databases (May 2006 €). Health states utility values were derived from an ad hoc study. Sensitivity analyses were performed for all mentioned variables. Results: For the base case, more quality-adjusted life years (QALY), life-years (LY) and progression-free survival years per patient on maintenance therapy were obtained versus OA (incremental values of 0.85, 0.94 and 1.46, respectively). Total cost per patient was higher with Rituximab than with OA (+8,026€). Incremental cost per QALY gained was 9,358€, with a cost per LY gained of 8.493€ and a cost per PFS year gained of 5,485€. In the sensitivity analysis, values ranged between 7.263€ and 22.160€ per QALY gained. Conclusions: This study confirms that in patients with relapsed /refractory FL who attain a response with further therapy, maintenance treatment with Rituximab compared to observation alone is cost-effective. No significant financial relationships to disclose.

The economic assessment of eribulin compared to treatment of physician's choice (TPC) in Australia.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17552-e17552 ◽  
Author(s):  
Trefor Jones ◽  
W. Robert Simons
Keyword(s):  
Overall Survival ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Group Versus ◽  
Metastatic Breast ◽  
Progression Free Survival ◽  
Logistic Function ◽  
Sensitivity Analyses ◽  
Health State ◽  
Life Years

e17552 Background: The Eisai Metastatic Breast Cancer Study Assessing Physician’s Choice Versus E7389 (EMBRACE) established clinical benefits. This study evaluates its translation into comparative economic value. Methods: Because of superior survival benefits and a non-inferior safety profile, we use a cost-effectiveness analysis. Costs include medication and administration costs, cost of toxicity management, and indirect cost. The primary endpoint is the ratio of incremental means of costs and quality adjusted life years (QALY) yielding an incremental cost effectiveness ratio (ICER). Partitioned survival analyses were evaluated using a log-logistic function for overall survival, progression free survival, response duration, and toxicity time. Health state utilities or quality weights are applied to each component and aggregated. Sensitivity analyses assessed the influence of variability in a number of parameters. Results: Overall survival based on the log-logistic extrapolation was 686 days in the eribulin group compared to 550 days in the TPC group for a difference of 136 days. Mean time without progressive disease was 214 days and 160 days, respectively, for a difference of 59 days. Time spent with Grade 3 and 4 toxicity were 3.62 and 2.25 days in the eribulin group versus 2.25 and 0.98 days in the TPC group. Response times were 15.62 and 9.64 days, 5.98 days longer in the eribulin group. After weight components of overall survival with corresponding utilities and converting to years, the QALY were 1.166 in the eribulin group compared to 0.926 in the TPC group for a mean incremental improvement of 0.24 years. Mean treatment costs were $14,302.80 AUD and $1,672.02 AUD for a difference of $12,630.78 AUD. Total incremental cost is $13,794.35 AUD. The ICER with and without discounting is $48,134.29 AUD and $45,770.97 AUD, respectively. Survival time and drug cost were the most influential variables on the ICER. Conclusions: At a threshold of $50,000 AUD per QALY, eribulin is good value at $48,134 AUD per QALY. Clinical trial information: NCT00388726.

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