scholarly journals Modeling the Cost-Effectiveness of Adjuvant Chemotherapy for Stage III Colon Cancer in South African Public Hospitals

2021 ◽  
pp. 1730-1741
Author(s):  
Yoanna Pumpalova ◽  
Alexandra M. Rogers ◽  
Sarah Xinhui Tan ◽  
Candice-lee Herbst ◽  
Paul Ruff ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cost Effectiveness ◽  
Adjuvant Chemotherapy ◽  
South African ◽  
Cost Effective ◽  
Public Hospitals ◽  
Stage Iii ◽  
Cost Effectiveness Ratio ◽  
Stage Iii Colon Cancer ◽  
The Cost

PURPOSE Cancer incidence is rising in low- and middle-income countries, where resource constraints often complicate therapeutic decisions. Here, we perform a cost-effectiveness analysis to identify the optimal adjuvant chemotherapy strategy for patients with stage III colon cancer treated in South African (ZA) public hospitals. METHODS A decision-analytic Markov model was developed to compare lifetime costs and outcomes for patients with stage III colon cancer treated with six adjuvant chemotherapy regimens in ZA public hospitals: fluorouracil, leucovorin, and oxaliplatin for 3 and 6 months; capecitabine and oxaliplatin (CAPOX) for 3 and 6 months; capecitabine for 6 months; and fluorouracil/leucovorin for 6 months. Transition probabilities were derived from clinical trials to estimate risks of toxicity, disease recurrence, and survival. Societal costs and utilities were obtained from literature. The primary outcome was the incremental cost-effectiveness ratio in international dollars (I$) per disability-adjusted life-year (DALY) averted, compared with no therapy, at a willingness-to-pay (WTP) threshold of I$13,006.56. RESULTS CAPOX for 3 months was cost-effective (I$5,381.17 and 5.74 DALYs averted) compared with no adjuvant chemotherapy. Fluorouracil, leucovorin, and oxaliplatin for 6 months was on the efficiency frontier with 5.91 DALYs averted but, with an incremental cost-effectiveness ratio of I$99,021.36/DALY averted, exceeded the WTP threshold. CONCLUSION In ZA public hospitals, CAPOX for 3 months is the cost-effective adjuvant treatment for stage III colon cancer. The optimal strategy in other settings may change according to local WTP thresholds. Decision analytic tools can play a vital role in selecting cost-effective cancer therapeutics in resource-constrained settings.

Cost-effectiveness of adjuvant chemotherapy for stage III colon cancer in the South African public healthcare setting.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18849-e18849
Author(s):  
Yoanna S Pumpalova ◽  
Alexandra M. Rogers ◽  
Sarah Xinhui Tan ◽  
Candice-Lee Herbst ◽  
Paul Ruff ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cost Effectiveness ◽  
Adjuvant Chemotherapy ◽  
Healthcare System ◽  
Cost Effective ◽  
Stage Iii ◽  
Public Healthcare ◽  
Administration Cost ◽  
Public Healthcare System ◽  
Stage Iii Colon Cancer

e18849 Background: Colon cancer incidence and mortality rates are increasing in low- and middle-income countries, such as South Africa (SA). Adjuvant chemotherapy after curative resection for stage III colon cancer prolongs overall survival, but it is unclear which regimen is most cost-effective in resource-constrained settings, such as the SA public healthcare system. Methods: A decision-analytic Markov model was developed to compare lifetime costs and health outcomes for 60-year-old stage III colon cancer patients treated with six adjuvant chemotherapy regimens in a public hospital in SA: fluorouracil, leucovorin, and oxaliplatin (FOLFOX) for 3 and 6 months, capecitabine and oxaliplatin (CAPOX) for 3 and 6 months, capecitabine for 6 months, and fluorouracil/leucovorin (5-FU/LV; Mayo regimen) for 6 months. Transition probabilities were derived from clinical trials to estimate risks of toxicity, disease recurrence, and survival. Costs from a SA societal perspective and utility estimates were obtained from literature and local expert opinion. The primary outcome was the incremental cost-effectiveness ratio (ICER) in international dollars (I$) per disability-adjusted life year (DALY) averted, with a willingness-to-pay (WTP) threshold of one times the 2020 GDP per capita of SA (I$13,006.57; ZAR89,225). Results: Our model found CAPOX for 3 months to be the most cost-effective strategy, at a lifetime cost below the local WTP threshold (I$5,380.82; ZAR36,912.44) and 5.74 DALYs averted, compared to no chemotherapy. FOLFOX for 6 months was also on the efficiency frontier, with a higher total cost (I$22,747.47; ZAR156,047.64) and 0.18 additional DALYs averted (ICER = I$99,021.35/DALY averted). All other strategies were absolutely dominated. One-way sensitivity analyses found that FOLFOX for 6 months is optimal when the administration cost (i.e.: port and pump) falls to 20% of the base case price. Conclusions: In the SA public healthcare system, CAPOX for 3 months is the most cost-effective adjuvant treatment for stage III colon cancer. FOLFOX for 6 months, with a greater effectiveness, may be cost-effective if the administration cost decreases significantly. The optimal strategy in other settings may vary according to the local WTP threshold.[Table: see text]

Cost-effectiveness of adjuvant capecitabine, Mayo Clinic and de Gramont regimens for stage III colon cancer in the French setting

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 13506-13506
Author(s):  
P. R. Dufour ◽  
J. Douillard ◽  
M. Ychou ◽  
J. Seitz ◽  
G. Perrocheau ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Clinical Trials ◽  
Cost Effectiveness ◽  
Adjuvant Treatment ◽  
Mayo Clinic ◽  
Stage Iii ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Stage Iii Colon Cancer ◽  
The Cost

13506 Background: The oral fluoropyrimidine capecitabine is as effective but better tolerated than i.v. 5-FU/LV as first-line treatment in patients (pts) with metastatic colorectal cancer. Costs associated with the administration route could vary widely according to national rules and medical practice. We compared costs and outcomes of capecitabine, the Mayo Clinic, and de Gramont regimens as adjuvant treatment for stage III colon cancer. Methods: We assessed the cost-effectiveness of the three regimens using the third-party payer perspective, time horizon and efficacy/safety data (adjusted for indirect comparisons) from two published clinical trials [Twelves et al. N Engl J Med 2005; Andre et al. J Clin Oncol 2003]. The costs of chemotherapy and the treatment of side effects were estimated from the clinical trials and expert opinion. We applied French standard costs to resources consumed and evaluated cost-effectiveness using relapse-free survival (RFS), defined in X-ACT study, as an efficacy indicator. One-way sensitivity analyses were performed varying the cost estimates for each treatment. Results: Capecitabine-treated pts had a mean life duration increase without treatment failure of 1.3 months vs. Mayo (see table). De Gramont was considered as effective as Mayo. In the base-case analysis capecitabine appeared to be dominant, more effective and less costly than either Mayo Clinic or de Gramont. In the sensitivity analyses, capecitabine remained dominant except for the minimum costs scenario vs. de Gramont. In this case, the cost-effectiveness ratio was estimated at 8997.55€ per year without relapse. Conclusions: As adjuvant treatment for colon cancer, capecitabine decreases medical resources consumed, mainly in hospitals. Its approval in this setting is expected to bring cost savings and better outcomes. [Table: see text] [Table: see text]

scholarly journals Simplified Mathematical Modelling of Uncertainty: Cost-Effectiveness of COVID-19 Vaccines in Spain

Mathematics ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 566
Author(s):  
Julio Emilio Marco-Franco ◽  
Pedro Pita-Barros ◽  
Silvia González-de-Julián ◽  
Iryna Sabat ◽  
David Vivas-Consuelo
Keyword(s):  
Cost Effectiveness ◽  
Health Planning ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Reliable Data ◽  
Simplified Model ◽  
Fatality Rate ◽  
Cost Effectiveness Ratio ◽  
Funeral Homes ◽  
The Cost

When exceptional situations, such as the COVID-19 pandemic, arise and reliable data is not available at decision-making times, estimation using mathematical models can provide a reasonable reckoning for health planning. We present a simplified model (static but with two-time references) for estimating the cost-effectiveness of the COVID-19 vaccine. A simplified model provides a quick assessment of the upper bound of cost-effectiveness, as we illustrate with data from Spain, and allows for easy comparisons between countries. It may also provide useful comparisons among different vaccines at the marketplace, from the perspective of the buyer. From the analysis of this information, key epidemiological figures, and costs of the disease for Spain have been estimated, based on mortality. The fatality rate is robust data that can alternatively be obtained from death registers, funeral homes, cemeteries, and crematoria. Our model estimates the incremental cost-effectiveness ratio (ICER) to be 5132 € (4926–5276) as of 17 February 2021, based on the following assumptions/inputs: An estimated cost of 30 euros per dose (plus transport, storing, and administration), two doses per person, efficacy of 70% and coverage of 70% of the population. Even considering the possibility of some bias, this simplified model provides confirmation that vaccination against COVID-19 is highly cost-effective.

scholarly journals Estimating the optimal rate of adjuvant chemotherapy utilization for stage III colon cancer

2019 ◽  
Vol 8 (12) ◽  
pp. 5590-5599
Author(s):  
Safiya Karim ◽  
Christopher M. Booth ◽  
Kelly Brennan ◽  
Yingwei Peng ◽  
D. Robert Siemens ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Optimal Rate ◽  
Stage Iii ◽  
Stage Iii Colon Cancer

Intensity of adjuvant chemotherapy regimens and grade III–V toxicities among elderly stage III colon cancer patients

2016 ◽  
Vol 61 ◽  
pp. 1-10 ◽  
Author(s):  
F.N. van Erning ◽  
L.G.E.M. Razenberg ◽  
V.E.P.P. Lemmens ◽  
G.J. Creemers ◽  
J.F.M. Pruijt ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Stage Iii ◽  
Stage Iii Colon Cancer ◽  
Grade Iii

Impact of Physical Activity on Cancer Recurrence and Survival in Patients With Stage III Colon Cancer: Findings From CALGB 89803

2006 ◽  
Vol 24 (22) ◽  
pp. 3535-3541 ◽  
Author(s):  
Jeffrey A. Meyerhardt ◽  
Denise Heseltine ◽  
Donna Niedzwiecki ◽  
Donna Hollis ◽  
Leonard B. Saltz ◽  
...  
Keyword(s):  
Physical Activity ◽  
Colon Cancer ◽  
Adjuvant Chemotherapy ◽  
Cancer Recurrence ◽  
Stage Iii ◽  
Index Number ◽  
Free Survival ◽  
Stage Iii Colon Cancer ◽  
Activity Assessment ◽  
Risk Of Cancer

Purpose Regular physical activity reduces the risk of developing colon cancer, however, its influence on patients with established disease is unknown. Patients and Methods We conducted a prospective observational study of 832 patients with stage III colon cancer enrolled in a randomized adjuvant chemotherapy trial. Patients reported on various recreational physical activities approximately 6 months after completion of therapy and were observed for recurrence or death. To minimize bias by occult recurrence, we excluded patients who experienced recurrence or died within 90 days of their physical activity assessment. Results Compared with patients engaged in less than three metabolic equivalent task (MET) -hours per week of physical activity, the adjusted hazard ratio for disease-free survival was 0.51 (95% CI, 0.26 to 0.97) for 18 to 26.9 MET-hours per week and 0.55 (95% CI, 0.33 to 0.91) for 27 or more MET-hours per week. The adjusted P for trend was .01. Postdiagnosis activity was associated with similar improvements in recurrence-free survival (P for trend = .03) and overall survival (P for trend = .01). The benefit associated with physical activity was not significantly modified by sex, body mass index, number of positive lymph nodes, age, baseline performance status, or chemotherapy received. Moreover, the benefit remained unchanged even after excluding participants who developed cancer recurrence or died within 6 months of activity assessment. Conclusion Beyond surgical resection and postoperative adjuvant chemotherapy for stage III colon cancer, for patients who survive and are recurrence free approximately 6 months after adjuvant chemotherapy, physical activity appears to reduce the risk of cancer recurrence and mortality.

Cost–effectiveness analysis of ribociclib plus fulvestrant for hormone receptor-positive/human EGF receptor 2-negative breast cancer

Immunotherapy ◽  
2021 ◽  
Author(s):  
Wei Jiang ◽  
Zhichao He ◽  
Tiantian Zhang ◽  
Chongchong Guo ◽  
Jianli Zhao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Hormone Receptor ◽  
Egf Receptor ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Cost Effectiveness Ratio ◽  
Hormone Receptor Positive ◽  
The Cost ◽  
Quality Adjusted Life

Aim: To evaluate the cost–effectiveness of ribociclib plus fulvestrant versus fulvestrant in hormone receptor-positive/human EGF receptor 2-negative advanced breast cancer. Materials & methods: A three-state Markov model was developed to evaluate the costs and effectiveness over 10 years. Direct costs and utility values were obtained from previously published studies. We calculated incremental cost–effectiveness ratio to evaluate the cost–effectiveness at a willingness-to-pay threshold of $150,000 per additional quality-adjusted life year. Results: The incremental cost–effectiveness ratio was $1,073,526 per quality-adjusted life year of ribociclib plus fulvestrant versus fulvestrant. Conclusions: Ribociclib plus fulvestrant is not cost-effective versus fulvestrant in the treatment of advanced hormone receptor-positive/human EGF receptor 2-negative breast cancer. When ribociclib is at 10% of the full price, ribociclib plus fulvestrant could be cost-effective.

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