Estimating the real cost of adjuvant (adj) trastuzumab (T) in patients (pts) with HER-2+ (H+) early stage breast cancer (ESBC): Potential impact of reduced use of expensive oncology drugs (EOD) in metastatic breast cancer (MBC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6534-6534
Author(s):  
R. O'Cearbhaill ◽  
E. Wilson ◽  
A. deFrein ◽  
Z. Qadir ◽  
D. McDonnell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Metastatic Breast ◽  
Cost Effective ◽  
Societal Cost ◽  
University Hospital ◽  
The Real ◽  
Real Cost ◽  
The Mean ◽  
The Cost

6534 Background: Pts with H+ early stage BC have an approximately 35% risk of developing MBC (BCIRG001). T has been reported to reduce this risk by 33–50%, but costs approximately €;30k per pt, a burden some health systems deem unsustainable. This risk reduction might however result in decreased utilization of EOD in MBC, lowering the societal cost of adjT. We attempted to estimate the cost per relapse prevented (Crp), and the real cost of adjT, allowing for potential savings in prevented cases of MBC. Methods: We conducted a retrospective analysis of the mean cost per pt of AdjT (1 year) and of EOD in MBC in St. Vincent's University Hospital. We devised an equation to calculate the Crp for adj T. Crp=[A-M(NRA/104)]/[NRA/104] where A = cost per pt for adjT, M = EOD cost per pt with MBC, N = % of pts relapsing after standard adj treatment, RA = % reduction in the risk of relapse after adjT (over standard adj). Results: H+ pts with MBC received T (average 34 cycles €;2,400 each) with a combination of the following drugs: docetaxel (x8 €;1,500), gemcitabine (x5 €;1,215), capecitabine (x8 €;400), vinorelbine ( x19 €;187). Only 2 pts received bevacizumab (Bev) (x15 €;3,000). In our unit the mean EOD cost per pt with MBC was €;108k. The cost per relapse prevented for a 33% and a 50% reduction in relapse rate would be €;152k and €;63k, respectively. Furthermore, assuming a 50% reduction in the rate of relapse (from 35 to 17.5%) the real cost of adjT per pt treated is not €;30k, but approximates €;11k (€;30k×100-{17.5x €;108k}). Conclusions: The reduced utilization of EOD in MBC likely has a very beneficial impact on the societal cost of adjT. Confirmation of the efficacy of shorter adjT (e.g. FinnHer) would produce further benefit. The increasing use of novel EOD in MBC e.g. Bev would make adjT even more cost-effective. No significant financial relationships to disclose.

Estimating the real cost of adjuvant (A) trastuxumab (T) in patients(pts) with HER-2+ (H+) early stage breast cancer (ESBC)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6081-6081
Author(s):  
E. Wilson ◽  
J. Crown ◽  
J. Ballot ◽  
D. McDonnell ◽  
E. Sheehan ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Relapse Rate ◽  
Early Stage ◽  
The Real ◽  
Real Cost ◽  
Molecular Therapies ◽  
Cost Efficient ◽  
Dose Dense ◽  
The Cost ◽  
Risk Of Relapse

6081 Background: Pts with H+ metastatic (M) ESBC have a high risk of relapse. T has been reported to reduce the risk of relapse for pts with H+ESBC by approximately 50% when combined with A chemotherapy (CT). We attempted to study the real cost of AT in the context of current use of T in MBC (MT), and of the predicted reduction in the risk of relapse. Methods: We conducted a retrospective analysis of the mean per pt cost of AT and MT, and standard ACT in St. Vincent’s Hospital. The costs/pt for AT and MT were €34k, and €47k respectively, and for the listed agents in standard A: docetaxel(D)-8.8k, paclitaxel(P)-7.4 k, filgrastim(G)-9.3 k. Based on published/presented data (BCIRG 001), we assumed a 35% risk for relapse at five years for pts with H+BC receiving conventional A, and a 50% risk reduction (RR) for AT, giving an absolute benefit of 17.5%. We then devised an equation to calculate the Crp for AT: Crp=[a-M(NRA/104)]/[NRA/104] where a = cost per pt for treatment (Tx) with AT, M = cost per pt for Tx with T in MBC, N = % of pts relapsing after standard A, RA = % reduction in the risk of relapse after Tx with AT (over standard A). Results: The corresponding real T costs/100 pts for the following reductions in relapse rate would be:25%-€3.4m 50%-€2.6m-, 80%-€2.1m, 100%-€1.8m. The Crp for AT with a 50% reduction in relapse rate is €147k. With a 100% reduction in the RR we estimate the Crp to be €50k. We studied D (D-BCIRG 001), P (P-CALGB 9344) and G (G-CALGB 9741 dose-dense), and noted the following published absolute relapse reductions for these tx: D-7%, P-5% and G-4%. The following costs per relapse prevented were calculated: P-148 k; G-231k; D-126k. Conclusions: Using the equation, the real cost per relapse prevented of AT can be calculated, and comparisons made with the cost-effectiveness of other accepted A. Assuming no re-treatment with MT, AT appears to be a relatively cost-efficient means of reducing relapses. Reports of the efficacy of short AT regimens suggest the possibility of even greater cost-effectiveness. This equation could possibly be used to calculate the cost effectiveness of other novel A molecular therapies. [Table: see text]

International comparison of the cost-effectiveness of 5 years letrozole or anastrozole compared to 5 years tamoxifen for early breast cancer in hormone receptor-positive postmenopausal women: Belgium, Canada, UK, and US analyses

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 556-556 ◽  
Author(s):  
S. Kaura ◽  
J. Karnon ◽  
F. di Trapani
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Postmenopausal Women ◽  
Hormone Receptor ◽  
Early Stage ◽  
Cost Effective ◽  
Hormone Receptor Positive ◽  
The Uk ◽  
The Cost ◽  
Country Specific

556 Background: The BIG1–98 and ATAC trials have proven the effectiveness of 5 years letrozole (LET) and anastrozole (ANA), respectively, compared to 5 years tamoxifen (TAM) for the treatment of postmenopausal women with hormone receptor positive (HR+) early stage breast cancer. This analysis uses similar assumptions to those used in the NICE appraisal in the UK, and country specific input data to estimate the cost-effectiveness of LET vs TAM and ANA vs. TAM from the Belgian, Canadian, UK, and US health care perspective (8 analyses). Methods: The same Markov model was used to estimate the incremental cost per quality-adjusted life year (QALY) gained (ICQ) across the 8 analyses in postmenopausal women with HR+ early stage breast cancer. Model events and assumptions were based on the analysis undertaken by the NICE appraisal team in the UK. Probabilities of breast cancer events (contralateral; locoregional; and metastases) were based on the latest early breast cancer (Lancet) overview. Country-specific cost, utility, and adverse event parameter values were informed by relevant population-based studies. LET and ANA effects were informed by published results of the BIG 1–98 and ATAC trials, which were assumed to cease after therapy discontinuation (other than fracture risk that continued for 5 further years). Costs and QALYs were estimated over the remaining lifetime of a cohort of HR+ women aged 60 yrs, discounted at 3.5% annually. Conclusion: Compared to TAM, adjuvant treatment of postmenopausal HR+ women with LET or ANA for 5 years is a cost-effective use of resources in all of the countries included in this analysis. Based on the model assumptions used by the NICE appraisal team in the UK, the mean results indicate that LET is more cost-effective than ANA, though the confidence intervals are wide. [Table: see text] No significant financial relationships to disclose.

The cost of adverse events in metastatic breast cancer in taxane- and capecitabine-based regimens.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 261-261
Author(s):  
Anthony Masaquel ◽  
Ryan N. Hansen ◽  
Scott David Ramsey ◽  
Deepa Lalla ◽  
Melissa Brammer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Adverse Events ◽  
Metastatic Breast ◽  
Payer Perspective ◽  
The Us ◽  
Monthly Total ◽  
The Mean ◽  
Nationally Representative ◽  
The Cost

261 Background: Over 155,000 women are living with metastatic breast cancer (mBC) in the US. Chemotherapies can prolong survival for women with mBC, but adverse events (AEs) stemming from their use are common and costly to manage. We compared the healthcare costs for taxane- (TAX) and capecitabine-based (CAP) treatments for mBCpatients as either first- or second-line (FL or SL) therapy in the US. Methods: Using the Marketscan Commercial Database, a nationally representative database of over 52 million people, we selected mBC patients diagnosed from 2008-2011. Patients were categorized into FL and SL chemotherapy including either a TAX (paclitaxel or docetaxel) or CAP using an algorithm based on pharmacy and medical claims data. Chemotherapy-related AEs were identified by ICD-9 codes. Costs were tabulated from a payer perspective. Average monthly costs were stratified by treatment and the presence/absence of AEs. Results: Among 15,535 mBCpatients we identified 15,472 FL and 6,809 SL cases treated with TAX or CAP. The mean age of patients was 51 years (SD 8). At least one AE was experienced during FL treatment by 74% (SD 44%) and 68% (SD 46%) of TAX and CAP users and during SL treatment 60% (SD 49%) and 59% (SD 49%), respectively. Average monthly total costs during the FL period were $2,385 higher (p <0.0001) and $1,679 higher (p=0.28) for TAX- and CAP-treated patients who experienced at least one AE. In SL, costs for patients with at least one AE had were $2,995 (p<0.0001) higher for TAX-treated patients and $4,870 (p=0.0026) higher for CAP-treated patients. Conclusions: Among community-treated patients, AEs are common in women with mBC receiving TAX- and CAP-based chemotherapy regimens. These AEs are associated with higher costs in FL and SL. When possible, prevention or earlier management of AEs may represent an opportunity to reduce costs and improve outcomes for women with mBC. [Table: see text]

Implantable intravenous devices (“ports”) as a survivorship issue.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 9-9
Author(s):  
Aman Opneja ◽  
Amit Rout ◽  
Joseph Abraham ◽  
Gurkirat Gill ◽  
Kenneth David Miller
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Psychological Impact ◽  
Hormone Receptor Status ◽  
Stage I ◽  
Breast Cancer Patients ◽  
Treatment Type ◽  
The Mean ◽  
One Year ◽  
The Cost

9 Background: Women with early stage breast cancer often receive chemotherapy through implantable intravenous access devices (ports). There is little information on the duration of port use for breast cancer patients who have completed treatment. Methods: The EMR was searched for women who received adjuvant chemotherapy using a port for Stage I-III breast cancer between 2007- 2012. Data abstracted from the EMR included demographics, duration and type of chemotherapy, duration of port use and complications. Results: During the years 2007-2012, a total of 167 patients qualified for the study. 28 (16.8%) patients were excluded as complete data was not available. The Mean age of the remaining 127 women was 60 (SD: 1) years. The distribution of cancer stage was 18.1%, 59.1%, 22.8% of stage I, II, and III respectively. The median total length of duration of indwelling port was 506 days and median duration from chemotherapy completion to port removal was 299 days. The duration of time after completing treatment that the port remained in place was 0-6 months (31.5%), 6-12 months (25.2%), 12-24 months (24.4%), and > 24 months (18.9%). Patients with stage III cancer had significantly longer time to port removal relative to patients with stage I and stage II cancer (p < 0.005). Complications of ports (n = 4), all occurred during active treatment and included non-functioning/mispositioning (n = 2), and thrombosis (n = 2). Assuming the cost of port maintenance was $225 per visit and port maintenance was required every four weeks, the estimated average cost of maintaining the port after the completion of chemotherapy was $3,494 for this group of patients. Conclusions: Oncologists typically do not use the word “cure”; maintaining a port in place after chemotherapy may reinforce concerns about the risk of recurrence. This is highlighted by the fact that treatment type and hormone receptor status were not significantly associated with time of port removal. We found that 43% of patients still have their port in place one year after completing treatment and almost 19% of patients have their port in place greater than two years after completing treatment. The high cost and the possible psychological impact of leaving a port in place for long periods of time needs further study.

Cost-effectiveness of routine radiation therapy following conservative surgery for early-stage breast cancer.

1998 ◽  
Vol 16 (3) ◽  
pp. 1022-1029 ◽  
Author(s):  
J A Hayman ◽  
B E Hillner ◽  
J R Harris ◽  
J C Weeks
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Radiation Therapy ◽  
Cost Effectiveness ◽  
Local Recurrence ◽  
Early Stage ◽  
Cost Effective ◽  
Conservative Surgery ◽  
The Cost

PURPOSE To examine the cost-effectiveness of radiation therapy following conservative surgery for early-stage breast cancer. METHODS Using a Markov model, a cost-utility analysis was performed to compare a strategy of radiation therapy versus no radiation therapy in a hypothetical cohort of 60-year-old women following conservative surgery. Local recurrence, distant recurrence, and survival rates used in the model were derived from randomized trial data. Utilities for the nonmetastatic health states were collected from actual patients. Direct medical costs were estimated using data from a single institution. Transportation and time costs were also estimated. Years of life, quality-adjusted life-years (QALYs), costs, and incremental cost/QALY over a 10-year time horizon were calculated by the model for each strategy. RESULTS The addition of radiation therapy results in a cost increase of $9,800 per patient, no change in life expectancy, and an increase of 0.35 QALYs per patient, which leads to an incremental cost-effectiveness ratio of $28,000/QALY, which is well below $50,000/QALY, a commonly cited threshold for cost-effective care. Sensitivity analysis shows the ratio to be heavily influenced by the cost of radiation therapy and the quality-of-life benefit that results from decreased risk of local recurrence. CONCLUSION Radiation therapy following conservative surgery is cost-effective compared with other accepted medical interventions. This study illustrates the importance of considering an intervention's effect on quality of life, as well as survival in defining cost-effectiveness.

Cost–effectiveness of BRCA1/2 mutation profiling to target olaparib use in patients with metastatic breast cancer

2019 ◽  
Vol 16 (6) ◽  
pp. 439-448 ◽  
Author(s):  
Shota Saito ◽  
Kyoko Nakazawa ◽  
Masayuki Nagahashi ◽  
Takashi Ishikawa ◽  
Kouhei Akazawa
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Metastatic Breast ◽  
Progression Free Survival ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
The Cost ◽  
Mutation Profiling

Aim: Olaparib monotherapy improves progression-free survival in patients with metastatic breast cancer and BRCA1/2 mutations. We evaluated the cost–effectiveness of BRCA1/2 mutation profiling to target olaparib use. Methods: A Markov cohort model was generated to compare the 5-year cost–effectiveness of BRCA1/2 mutation profiling to target olaparib use. Results: The incremental cost–effectiveness ratio of BRCA1/2 mutation profiling plus olaparib monotherapy was JPY14,677,259/quality-adjusted life year (QALY) (US$131,047/QALY), compared with standard chemotherapy alone. Conclusion: BRCA1/2 mutation profiling to target olaparib use is not a cost-effective strategy for metastatic breast cancer. The strategy provides minimal incremental benefit at a high incremental cost per QALY. Hence, further cost reductions in the cost of both BRCA1/2 mutation profiling and olaparib are required.

scholarly journals Cost Effectiveness of Transbronchial Needle Aspiration

1999 ◽  
Vol 6 (4) ◽  
pp. 332-335 ◽  
Author(s):  
Jennifer A Crocket ◽  
Eric YL Wong ◽  
Dale C Lien ◽  
Khanh Gia Nguyen ◽  
Michelle R Chaput ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Benign Disease ◽  
University Hospital ◽  
High Yield ◽  
Transbronchial Needle Aspiration ◽  
Computed Tomographic ◽  
The Cost

OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.DESIGN: Retrospective study.SETTING: A university hospital.POPULATION STUDIED: Ninety-six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy.RESULTS: Ninety-nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented.CONCLUSIONS: TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.

scholarly journals Seasonal Influenza and Low Flu Vaccination Coverage as Important Factors Modifying the Costs and Availability of Hospital Services in Poland: A Retrospective Comparative Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5173
Author(s):  
Robert Susło ◽  
Piotr Pobrotyn ◽  
Lidia Brydak ◽  
Łukasz Rypicz ◽  
Urszula Grata-Borkowska ◽  
...  
Keyword(s):  
Influenza Season ◽  
Influenza Infection ◽  
Hospital Staff ◽  
University Hospital ◽  
Control Group ◽  
Admission Rates ◽  
Risk Of Death ◽  
The Mean ◽  
Retrospective Comparative Study ◽  
The Cost

Introduction: Influenza infection is associated with potential serious complications, increased hospitalization rates, and a higher risk of death. Materials and Methods: A retrospective comparative analysis of selected indicators of hospitalization from the University Hospital in Wroclaw, Poland, was carried out on patients with confirmed influenza infection in comparison to a control group randomly selected from among all other patients hospitalized on the respective wards during the 2018–2019 influenza season. Results: The mean laboratory testing costs for the entire hospital were 3.74-fold higher and the mean imaging test costs were 4.02-fold higher for patients with confirmed influenza than for the control group; the hospital expenses were additionally raised by the cost of antiviral therapy, which is striking when compared against the cost of a single flu vaccine. During the 2018–2019 influenza season, influenza infections among the hospital patients temporarily limited the healthcare service availability in the institution, which resulted in reduced admission rates to the departments related to internal medicine; the mean absence among the hospital staff totaled approximately 7 h per employee, despite 7.3% of the staff having been vaccinated against influenza at the hospital’s expense. Conclusions: There were significant differences in the hospitalization indicators between the patients with confirmed influenza and the control group, which markedly increased the hospital care costs in this multi-specialty university hospital.

The cost-effectiveness of atezolizumab in first-line for metastatic triple negative breast cancer is heavily linked to PD-L1 level

2021 ◽  
pp. 107815522110194
Author(s):  
Jacopo Giuliani ◽  
Beatrice Mantoan ◽  
Andrea Bonetti
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Controlled Trial ◽  
Metastatic Breast ◽  
Cost Effective ◽  
Phase Iii ◽  
Line Treatment ◽  
First Line ◽  
Pivotal Phase ◽  
First Line Treatment

The present analysis was conducted to assess the pharmacological costs of atezolizumab as first-line treatment in triple negative metastatic breast cancer (mBC). Pivotal phase III randomized controlled trial (RCT) was considered. Nine hundred and two patients were included. Differences in costs between the 2 arms (atezolizumab plus nabpaclitaxel versus placebo plus nab-paclitaxel) was 17 398 €, with a cost of 7564 €per month of OS-gain in the overall population and 2485 €per month of OS-gain in PD-L1-positive (≥1) population. Combining pharmacological costs of drugs with the measure of efficacy represented by the OS, atezolizumab could be considered cost-effective in first-line treatment for triple-negative mBC only in PD-L1-positive population, but a reduction of costs is mandatory.

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