scholarly journals The cost-effectiveness of treatment of relapsed/refractory chronic lymphocytic leukemia with a combination of venetoclax and rituximab

2019 ◽  
Vol 21 (2) ◽  
pp. 29-32
Author(s):  
Alla V Rudakova ◽  
Vladimir V Strugov
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Chronic Lymphocytic Leukemia ◽  
Time Horizon ◽  
Indirect Comparison ◽  
Weighted Average ◽  
Lymphocytic Leukemia ◽  
High Rate ◽  
Base Case ◽  
The Cost

Background. Current treatment of relapsed/refractory chronic lymphocytic leukemia implies the use of regimens that include innovative drugs such as ibrutinib and a combination of venetoclax with rituximab. Herewith the combination of venetoclax with rituximab provides a high rate of eradication of minimal residual disease and, in contrast to ibrutinib, in the standard version it is canceled after 2 years from the start of therapy. Aim. Evaluation of the cost-effectiveness of treatment of relapsed/refractory chronic lymphocytic leukemia with a combination of venetoclax + rituximab and ibrutinib. Materials and methods. The evaluation was carried out from a position of the health care system using the Markov model. The study’s time horizon was 4 years. There were no statistically significant differences in overall and progression-free survival according to data of an indirect comparison of the study MURANO for the combination of venetoclax + rituximab and the studies RESONATE and HELIOS for ibrutinib. Venetoclax price (excluding VAT) used for calculation was corresponded to the manufacturer's price list and it was: film coated tablets, 10 mg №14 - 5830.2 rubles; 50 mg №7 - 14 576.86 rubles; 100 mg №7 - 29 152.65 rubles; 100 mg №14 - 58 306.37 rubles; 100 mg №112 - 466 446.67 rubles. Prices for rituximab and ibrutinib were corresponded to a median of the prices quoted. In all cases the analysis considered VAT and weighted average wholesale surcharge given population size in the Russian Federation. In the base case, costs of therapy after a transition to progression were not considered. When carrying out the sensitivity analysis, the option of monotherapy with venetoclax in patients who had progression on ibrutinib and monotherapy with ibrutinib in patients who had progression on venetoclax + rituximab was also evaluated. As part of the sensitivity analysis, a decrease and increase in the price of venetoclax by 15% and a decrease in the price of ibrutinib by 30% were also evaluated. In addition, an increase in a proportion of patients who moved to progression followed venetoclax withdrawal after 2 years of therapy was evaluated, by 15% per year, as well as a change in a frequency of progression by 15% compared with the base case and a decrease in the study’s time horizon to 3 years. The analysis was performed with discounting at 3.5% per year. Results. The analysis showed that the use of a regimen that includes venetoclax reduces the cost volume by on average of 31.3% compared to ibrutinib (the cost volume for 1 patient per 4 years - 13.341 million rubles and 19.413 million rubles, respectively). The sensitivity analysis demonstrated a reliability of the data obtained (with all analyzed modeling options, including options with an increase in venetoclax price by 15%, a decrease in ibrutinib price by 30% and a decrease in the study’s time horizon to 3 years, the combination of venetoclax + rituximab reduces costs by 1.9-41.0%). Conclusions. Treatment of relapsed / refractory chronic lymphocytic leukemia with a combination of venetoclax and rituximab is comparable in clinical efficacy with ibrutinib monotherapy and can reduce the cost and, therefore, increase the availability of innovative therapy for this group of patients. The main contribution to cost reduction is made by the fact that treatment with venetoclax and rituximab in the absence of progression stops 2 years after the start of treatment, and is not performed until the response is lost, as in the case of ibrutinib.

scholarly journals Pharmacoeconomic aspects of recurrent / refractory chronic lymphocytic leukemia treatment

2020 ◽  
Vol 15 (1) ◽  
pp. 73-82
Author(s):  
A. V. Rudakova ◽  
E. A. Stadnik
Keyword(s):  
Sensitivity Analysis ◽  
Chronic Lymphocytic Leukemia ◽  
Disease Progression ◽  
Healthcare System ◽  
Time Horizon ◽  
Budget Impact ◽  
Lymphocytic Leukemia ◽  
Number Of Patients ◽  
The Cost ◽  
Basic Version

Background. Currently, treatment of recurrent / refractory chronic lymphocytic leukemia (CLL) involves the appointment of regimens with innovative drugs, which include ibrutinib and a combination of venetoclax and rituximab. Wherein said combination provides continuing over time high frequency eradication of minimal residual disease. Thereby, this regimen can be canceled if patients do not progress after 2 years from therapy start.The objective of the study was to assess the pharmacoeconomic aspects of therapy with venetoclax and rituximab combination in patients with recurrent / refractory CLL compared with ibrutinib monotherapy.Materials and methods. Analysis was performed by a simulation method from a position of the health care system. In accordance with network meta-analysis results of clinical studies in the recurrent / refractory CLL treatment (MURANO for venetoclax + rituximab combination and RESONATE and HELIOS for ibrutinib), which showed the absence of statistically significant differences in progression-free and overall survival between these treatment options, the cost-minimization method was used in the analysis. In the basic version, the model time horizon is 4 years. The price of venetoclax, rituximab and ibrutinib in the calculation corresponded to that registered (for rituximab – the median of the registered prices) with the value-added tax and the weighted average wholesale allowance taking into account the population in Russia.When analyzing the healthcare system budget impact, the time horizon of the study was 4 years. Therapy with combination of venetoclax + rituximab starting from the first year was suggested in 100 % of newly identified recurrent / refractory CLL patients. In the base case, it was estimated that 100 patients would need therapy every year.In the basic version of analysis, the cost of therapy after progression was not taken into account. In sensitivity analysis, an option taking into account therapy cost after progression, suggesting the appointment of venetoclax in the ibrutinib group and ibrutinib in the venetoclax + rituximab group, was also evaluated. In addition, variants with disease progression were additionally evaluated in 15 % of patients per year in the venetoclax therapy group at the end of the 2-year treatment course, as well as with an increase and decrease in the disease progression rate by 15 % in both comparison groups.As part of the sensitivity analysis, an assessment is made of a 15 % decrease and increase in Venetoclax price, a 30 % decrease in Ibrutinib price compared to registered price and the option with a 3-year study time horizon. When analyzing the budget impact, options with an increase in the number of patients annually identified and requiring treatment by 10, 20, 30 and 50 % were evaluated. Clinical and economic analysis was carried out with a discount rate of 3.5 % per year. A budget impact analysis was performed without discounting.Results. According to the results of cost-effectiveness analysis in the basic version, a regimen including venetoclax can reduce costs by 46.3 % compared with ibrutinib (cost for 4 years per patient is 10.422 and 19.413 million rubles, respectively). Therapy with combination of venetoclax + rituximab in 100 newly identified recurrent / refractory CLL patients annually instead of ibrutinib monotherapy will result in a reduction in therapy costs by 29.0 %, or by 1.579 billion rubles for 4 years per 100 patients starting therapy annually. The sensitivity analysis demonstrated the high reliability of the results. Conclusion. The treatment of recurrent / refractory CLL with a combination of venetoclax and rituximab is comparable in clinical efficacy with ibrutinib monotherapy and can significantly reduce the cost of the healthcare system, and therefore increase the availability of innovative therapy for this group of patients.

Abstract 200: Cost-Effectiveness of Newer Anticoagulants for Stroke Prevention in Atrial Fibrillation

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Brendan L Limone ◽  
William L Baker ◽  
Craig I Coleman
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Stroke Prevention ◽  
Indirect Comparison ◽  
Cost Effective ◽  
The United States ◽  
Base Case ◽  
Treatment Comparison ◽  
Newer Anticoagulants ◽  
The Cost

Background: A number of new anticoagulants for stroke prevention in atrial fibrillation (SPAF) have gained regulatory approval or are in late-stage development. We sought to conduct a systematic review of economic models of dabigatran, rivaroxaban and apixaban for SPAF. Methods: We searched the Medline, Embase, National Health Service Economic Evaluation Database and Health Technology Assessment database along with the Tuft’s Registry through October 10, 2012. Included models assessed the cost-effectiveness of dabigatran (150mg, 110mg, sequential), rivaroxaban or apixaban for SPAF using a Markov model or discrete event simulation and were published in English. Results: Eighteen models were identified. All models utilized a lone randomized trial (or an indirect comparison utilizing a single study for any given direct comparison), and these trials were clinically and methodologically heterogeneous. Dabigatran 150mg was assessed in 9 of models, dabigatran 110mg in 8, sequential dabigatran in 9, rivaroxaban in 4 and apixaban in 4. Adjusted-dose warfarin (either trial-like, real-world prescribing or genotype-dosed) was a potential first-line therapy in 94% of models. Models were conducted from the perspective of the United States (44%), European countries (39%) and Canada (17%). In base-case analyses, patients typically were at moderate-risk of ischemic stroke, initiated anticoagulation between 65 and 73 years of age, and were followed for or near a lifetime. All models reported cost/quality-adjusted life-year (QALY) gained, and while 22% of models reported using a societal perspective, no model included costs of lost productivity. Four models reported an incremental cost-effectiveness ratio (ICER) for a newer anticoagulant (dabigatran 110mg (n=4)/150mg (n=2); rivaroxaban (n=1)) vs. warfarin above commonly reported willingness-to-pay thresholds. ICERs (in 2012US$) vs. warfarin ranged from $3,547-$86,000 for dabigatran 150mg, $20,713-$150,000 for dabigatran 110mg, $4,084-$21,466 for sequentially-dosed dabigatran and $23,065-$57,470 for rivaroxaban. In addition, apixaban was demonstrated to be an economically dominant strategy compared to aspirin and to be dominant or cost-effective ($11,400-$25,059) vs. warfarin. Based on separate indirect treatment comparison meta-analyses, 3 models compared the cost-effectiveness of these new agents and reported conflicting results. Conclusions: Cost-effectiveness models of newer anticoagulants for SPAF have been extensively published. Models have frequently found newer anticoagulants to be cost-effective, but due to the lack of head-to-head trial comparisons and heterogeneity in clinical characteristic of underlying trials and modeling methods, it is currently unclear which of these newer agents is most cost-effective.

scholarly journals Sustained acoustic medicine as a non-surgical and non-opioid knee osteoarthritis treatment option: a health economic cost-effectiveness analysis for symptom management

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Thomas M. Best ◽  
Stephanie Petterson ◽  
Kevin Plancher
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Symptom Management ◽  
Treatment Options ◽  
Base Case ◽  
Treatment Pathways ◽  
Knee Oa ◽  
Cost Effective Treatment ◽  
The Cost

Abstract Background Patients diagnosed with osteoarthritis (OA) and presenting with symptoms are seeking conservative treatment options to reduce pain, improve function, and avoid surgery. Sustained acoustic medicine (SAM), a multi-hour treatment has demonstrated improved clinical outcomes for patients with knee OA. The purpose of this analysis was to compare the costs and effectiveness of multi-hour SAM treatment versus the standard of care (SOC) over a 6-month timeframe for OA symptom management. Methods A decision tree analysis was used to compare the costs and effectiveness of SAM treatment versus SOC in patients with OA. Probabilities of success for OA treatment and effectiveness were derived from the literature using systematic reviews and meta-analyses. Costs were derived from Medicare payment rates and manufacturer prices. Functional effectiveness was measured as the effect size of a therapy and treatment pathways compared to a SOC treatment pathway. A sensitivity analysis was performed to determine which cost variables had the greatest effect on deciding which option was the least costly. An incremental cost-effectiveness plot comparing SAM treatment vs. SOC was also generated using 1000 iterations of the model. Lastly, the incremental cost-effectiveness ratio (ICER) was calculated as the (cost of SAM minus cost of SOC) divided by (functional effectiveness of SAM minus functional effectiveness of SOC). Results Base case demonstrated that over 6 months, the cost and functional effectiveness of SAM was $8641 and 0.52 versus SOC at: $6281 and 0.39, respectively. Sensitivity analysis demonstrated that in order for SAM to be the less expensive option, the cost per 15-min session of PT would need to be greater than $88, or SAM would need to be priced at less than or equal to $2276. Incremental cost-effectiveness demonstrated that most of the time (84%) SAM treatment resulted in improved functional effectiveness but at a higher cost than SOC. Conclusion In patients with osteoarthritis, SAM treatment demonstrated improved pain and functional gains compared to SOC but at an increased cost. Based on the SAM treatment ICER score being ≤ $50,000, it appears that SAM is a cost-effective treatment for knee OA.

scholarly journals Cost-Effectiveness Analysis of Direct Oral Anticoagulants Versus Vitamin K Antagonists for Venous Thromboembolism in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Ke-Xin Sun ◽  
Bin Cui ◽  
Shan-Shan Cao ◽  
Qi-Xiang Huang ◽  
Ru-Yi Xia ◽  
...  
Keyword(s):  
Decision Making ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Clinical Decision Making ◽  
Cost Effective ◽  
Clinical Decision ◽  
Base Case ◽  
Effectiveness Analysis ◽  
The Cost

Background: The drug therapy of venous thromboembolism (VTE) presents a significant economic burden to the health-care system in low- and middle-income countries. To understand which anticoagulation therapy is most cost-effective for clinical decision-making , the cost-effectiveness of apixaban (API) versus rivaroxaban (RIV), dabigatran (DAB), and low molecular weight heparin (LMWH), followed by vitamin K antagonist (VKA), in the treatment of VTE in China was assessed.Methods: To access the quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs), a long-term cost-effectiveness analysis was constructed using a Markov model with 5 health states. The Markov model was developed using patient data collected from the Xijing Hospital from January 1, 2016 to January 1, 2021. The time horizon was set at 30 years, and a 6-month cycle length was used in the model. Costs and ICERs were reported in 2020 U.S. dollars. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were used to test the uncertainties. A Chinese health-care system perspective was used.Results: In the base case, the data of 231 VTE patients were calculated in the base case analysis retrospectively. The RIV group resulted in a mean VTE attributable to 95% effective treatment. API, DAB, and VKA have a negative ICER (−187017.543, −284,674.922, and −9,283.339, respectively) and were absolutely dominated. The Markov model results confirmed this observation. The ICER of the API and RIV was negative (−216176.977), which belongs to the absolute inferiority scheme, and the ICER value of the DAB and VKA versus RIV was positive (110,577.872 and 836,846.343). Since the ICER of DAB and VKA exceeds the threshold, RIV therapy was likely to be the best choice for the treatment of VTE within the acceptable threshold range. The results of the sensitivity analysis revealed that the model output varied mostly with the cost in the DAB on-treatment therapy. In a probabilistic sensitivity analysis of 1,000 patients for 30 years, RIV has 100% probability of being cost-effective compared with other regimens when the WTP is $10973 per QALY. When WTP exceeded $148,000, DAB was more cost-effective than RIV.Conclusions: Compared with LMWH + VKA and API, the results proved that RIV may be the most cost-effective treatment for VTE patients in China. Our findings could be helpful for physicians in clinical decision-making to select the appropriate treatment option for VTE.

scholarly journals Infliximab for the treatment of adults with psoriasis

2009 ◽  
Vol 13 (Suppl 1) ◽  
pp. 55-60
Author(s):  
E Loveman ◽  
D Turner ◽  
D Hartwell ◽  
K Cooper ◽  
A Clegg
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Plaque Psoriasis ◽  
Indirect Comparison ◽  
Response To Treatment ◽  
Base Case ◽  
Infliximab Treatment ◽  
Single Technology Appraisal ◽  
Severe Plaque Psoriasis ◽  
Pasi Score

This paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of infliximab for the treatment of moderate to severe plaque psoriasis, in accordance with the licensed indication, based on the evidence submission from Schering-Plough to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The outcomes stated in the manufacturer’s definition of the decision problem were severity [Psoriasis Area and Severity Index (PASI) score], remission rates, relapse rates and health-related quality of life. The main evidence in the submission comes from four randomised controlled trials (RCT) comparing infliximab with placebo and eight RCTs comparing either etanercept or efalizumab with placebo. At week 10, patients on infliximab had a significantly higher likelihood of attaining a reduction in PASI score than placebo patients. There were also statistically significant differences between infliximab and placebo in the secondary outcomes. In the comparator trials both the efalizumab and etanercept arms included a significantly higher proportion of patients who achieved a reduction in PASI score at week 12 than the placebo arms. No head-to-head studies were identified directly comparing infliximab with etanercept or efalizumab. The manufacturer carried out an indirect comparison, but the ERG had reservations about the comparison because of the lack of information presented and areas of uncertainty in relation to the included data. The economic model presented by the manufacturer was appropriate for the disease area and given the available data. The cost-effectiveness analysis estimates the mean length of time that an individual would respond to infliximab compared with continuous etanercept and the utility gains associated with this response. The base-case incremental cost-effectiveness ratio (ICER) for infliximab compared with continuous etanercept for patients with severe psoriasis was £26,095 per quality-adjusted life-year. A one-way sensitivity analysis, a scenario analysis and a probabilistic sensitivity analysis were undertaken by the ERG. The ICER is highly sensitive to assumptions about the costs and frequency of inpatient stays for non-responders of infliximab. The guidance issued by NICE in August 2007 as a result of the STA states that infliximab within its licensed indication is recommended for the treatment of adults with very severe plaque psoriasis, or with psoriasis that has failed to respond to standard systematic therapies. Infliximab treatment should be continued beyond 10 weeks in people whose psoriasis has shown an adequate response to treatment within 10 weeks. In addition, when using the Dermatology Life Quality Index (DLQI), care should be taken to take into account the patient’s disabilities, to ensure DLQI continues to be an accurate measure.

scholarly journals Cost-effectiveness of docetaxel in high-volume hormone-sensitive metastatic prostate cancer

2019 ◽  
Vol 13 (12) ◽  
Author(s):  
Jaclyn Beca ◽  
Habeeb Majeed ◽  
Kelvin K.W. Chan ◽  
Sebastian J. Hotte ◽  
Andrew Loblaw ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Survival Data ◽  
High Volume ◽  
Base Case ◽  
Castration Resistant Prostate Cancer ◽  
Life Years ◽  
Hormone Sensitive ◽  
The Cost

Introduction: Three pivotal trials have considered the addition of docetaxel (D) chemotherapy to conventional androgen-deprivation therapy (ADT) for the treatment of metastatic hormone-sensitive prostate cancer (HSPC). While an initial small trial was inconclusive, two larger trials demonstrated significant clinical benefit, including pronounced survival benefits (added 17 months) among patients with high-volume metastatic disease. Given the evolving clinical evidence, the cost-effectiveness of this approach warrants exploration. Methods: The cost-effectiveness of six cycles of ADT+D compared to ADT alone to treat patients with high-volume metastatic HSPC was assessed from a Canadian public payer perspective. We included three health states: HSPC, metastatic castration-resistant prostate cancer (CRPC), and death. Survival data were obtained from the CHAARTED trial, which reported outcomes specifically for high-volume disease. We used Ontario costs data and utilities from the literature. Results: In the base case analysis, ADT+D cost an additional $25 757 and produced an extra 1.06 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $24 226/QALY gained. Results from one-way sensitivity analysis across wide ranges of estimates and a range of scenarios, including an alternate model structure, produced ICERs below $35 000/QALY gained in all cases. Conclusions: The use of D with ADT in high-volume metastatic HSPC appears to be an economically attractive treatment approach. The findings were consistent with other studies and robust in sensitivity analysis across a variety of scenarios.

scholarly journals Cost Effectiveness Analysis of Fecal Transplant Delivery Methods for Recurrent Clostridium difficile Infections in Outpatients

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S386-S386 ◽  
Author(s):  
Jeremey Walker ◽  
Nathan Gundacker ◽  
Martin Rodriguez ◽  
Ellen Eaton
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Clostridium Difficile ◽  
Medical Center ◽  
Cost Effective ◽  
Third Party ◽  
Base Case ◽  
Delivery Methods ◽  
The Cost ◽  
Cure Rates

Abstract Background Clostridium difficile infection (CDI) accounts for more than $1 billion annually in US health care costs. Recurrent CDI (RCDI, recurrence within 8 weeks of initial treatment) contributes substantially to this cost. The objective of the study was to compare the cost effectiveness of FMT delivered via colonoscopy vs. blind nasogastric tube (NGT) in outpatients. We hypothesized that FMT by NGT would be cost-effective given its low risk and simplicity. Methods A decision-analytic simulation model compared the cost effectiveness of FMT by colonoscopy vs. NGT from a third-party payer perspective. Our base case cure rates were derived from a cohort receiving outpatient RCDI treatment at our institution. Cure was defined as resolution of symptoms for ≥ 90 days. Procedural cost and consultation was defined by average reimbursement to a large southeastern medical center in 2016 USD based on current procedural terminology (CPT) codes, and cost of disease states were derived from published literature. Health utilities were defined by quality of life year (QALY) based on published literature. Incremental Cost Effectiveness ratio (ICER) was defined as the cost per additional QALY gained. We assumed a 90 day time horizon. One-way sensitivity analysis was performed on all variables using ranges defined by published literature. We used TreeAge Software (Williamstown, MA). Results In the base case, FMT by colonoscopy was dominant (more effective and less costly) than NGT, with cost of $1,568/QALY vs. $1,910/QALY respectively. Cure rates of FMT by colonoscopy vs. NGT (100% vs. 87%) had the largest impact on ICER based on one-way sensitivity analysis. Therefore, a subsequent two-way sensitivity analysis was conducted to compare cure rates of both delivery methods and found that NGT delivery is cost effective as cure rates approach colonoscopy delivery cure rates within 5 percentage points. Conclusion Contrary to our hypothesis, our decision model supports FMT by colonoscopy as the preferred delivery method in outpatients with RCDI relative to NGT delivery. Additional costs of colonoscopy delivery are off-set by the improved cure rate leading to lower overall costs. As cure rates from NGT delivery are optimized, NGT may become the preferred method for FMT delivery. Disclosures All authors: No reported disclosures.

scholarly journals Test-and-Treat Strategies forHelicobacter pyloriin Uninvestigated Dyspepsia: A Canadian Economic Anaylsis

2000 ◽  
Vol 14 (5) ◽  
pp. 379-388 ◽  
Author(s):  
John K Marshall ◽  
David Armstrong ◽  
Bernie J O’Brien
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Third Party ◽  
Base Case ◽  
Model Parameters ◽  
Local Conditions ◽  
Ulcer Disease ◽  
Test And Treat ◽  
H Pylori ◽  
The Cost

BACKGROUND: Recognition of the pivotal role ofHelicobacter pyloriin the pathogenesis of peptic ulcer disease has revolutionized primary care approaches to dyspepsia. Decision analysis was used to compare the cost effectiveness of empirical ranitidine with a test and treat strategy using eitherH pyloriserology or the13carbon-urea breath test (13C-UBT).PATIENTS AND METHODS: A cohort of patients under age 50 years presenting with uninvestigated dyspepsia was evaluated. Three initial strategies were compared with respect to direct medical costs and effectiveness in curingH pylori-related ulcers - empirical ranitidine,H pyloriserology and UBT. A one-year time horizon and third-party payer perspective were adopted in a Canadian health care setting.RESULTS: UBT was more costly than either serology or ranitidine but was the most effective strategy and required the fewest endoscopies. No strategy demonstrated dominance over another in the base case. The incremental cost effectiveness ratio (ICER) of serology versus ranitidine was $118/cure, and sensitivity analysis induced dominance of serology in several plausible scenarios. The baseline ICER of UBT versus serology was $885/cure but showed substantial variation in sensitivity analysis. Each ICER was highly sensitive to variation in the cost of the tests themselves. At a serology cost of $25, UBT became dominant when its cost fell to $39.CONCLUSIONS: In low risk patients with uninvestigated dyspepsia, testing forH pyloriusing serology appears to be economically attractive.13C-UBT may be a cost effective alternative to serology if local conditions closely approximate the model parameters. Future changes in the costs of serology and13C-UBT may determine the optimal approach.

Cost-effectiveness of pazopanib as first-line treatment of metastatic renal cell carcinoma from National Health Service United Kingdom perspective.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16088-e16088
Author(s):  
Barbara Elizabeth Ratto ◽  
Ankur Khare ◽  
Kapil Gudala ◽  
Praveen Gunda
Keyword(s):  
Renal Cell Carcinoma ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
National Health Service ◽  
Time Horizon ◽  
Cost Effective ◽  
Line Treatment ◽  
First Line ◽  
The Cost ◽  
First Line Treatment

e16088 Background: Recently, several therapies have been approved for treatment of metastatic renal cell carcinoma (mRCC) in the United Kingdom (UK); however, there is scarcity of comparative evidence to assist treatment decisions. We evaluated the cost-effectiveness of pazopanib as first-line treatment of mRCC from a UK National Health Service perspective. Methods: A partitioned-survival analysis model with 3 health states (alive with no progression, alive with progression, or dead) was used to evaluate the cost-effectiveness of pazopanib compared to sunitinib, tivozanib and cabozantinib in treatment-naive mRCC patients with treatment cycle length of 1 week and time horizon of 10 years. The model was populated with clinical effectiveness data obtained from network meta-analysis of pivotal trials and data on costs and utilities collected from UK-specific resources. The key model outcomes were quality-adjusted life years (QALY) and incremental cost-effectiveness ratio (ICER). Probabilistic and one-way sensitivity analyses were performed to test the uncertainty regarding model results. Results: Base-case analysis found that pazopanib was dominant (i.e. less costly and more effective) compared to sunitinib and tivozanib. Pazopanib had lower total costs (£69,861 vs £71,398 and £73,530) and higher QALYs (1.901 vs 1.835 and 1.669, respectively) compared to sunitinib and tivozanib. When compared with cabozantinib, pazopanib was found to be less costly (£174,735 vs £69,861) and less effective (total QALYs, 2.213 vs 1.901, respectively). Results of the probabilistic sensitivity analysis showed that at a willingness-to-pay (WTP) threshold of £30,000 per QALY, the probability of pazopanib being cost-effective was highest as compared to all comparators (84% vs sunitinib, 98% vs tivozanib and 100% vs cabozantinib). One-way sensitivity analysis revealed that effectiveness inputs, time horizon and others are model influencers. Conclusions: Based on a WTP threshold of £30,000/QALY gained, pazopanib is the most cost-effective treatment option compared to sunitinib, tivozanib and cabozantinib, for mRCC patients in UK.

scholarly journals Sunitinib for the treatment of gastrointestinal stromal tumours: a critique of the submission from Pfizer

2009 ◽  
Vol 13 (Suppl 2) ◽  
pp. 69-74
Author(s):  
M Bond ◽  
M Hoyle ◽  
T Moxham ◽  
M Napier ◽  
R Anderson
Keyword(s):  
Sensitivity Analysis ◽  
Overall Survival ◽  
Cohort Study ◽  
Cost Effectiveness ◽  
Hazard Ratio ◽  
Base Case ◽  
Gastrointestinal Stromal Tumours ◽  
Entire Study ◽  
Significant Difference ◽  
The Cost

The submission’s evidence for the clinical effectiveness and cost-effectiveness of sunitinib for the treatment of gastrointestinal stromal tumours (GISTs) is based on a randomised controlled trial (RCT) comparing sunitinib with placebo for people with unresectable and/or metastatic GIST after failure of imatinib and with Eastern Cooperative Oncology Group (ECOG) progression status 0–1, and an ongoing, non-comparative cohort study of a similar population but with ECOG progression status 0–4. The searches are appropriate and include all relevant studies and the RCT is of high quality. In the RCT sunitinib arm overall survival was 73 median weeks [95% confidence interval (CI) 61 to 83] versus 75 median weeks (95% CI 68 to 84) for the cohort study. However, time to tumour progression in the cohort study was different from that in the RCT sunitinib arm [41 (95% CI 36 to 47) versus 29 (95% CI 22 to 41) median weeks respectively]. Median progression-free survival with sunitinib was 24.6 weeks (95% CI 12.1 to 28.4) versus 6.4 weeks (95% CI 4.4 to 10.0) on placebo (hazard ratio 0.333, 95% CI 0.238 to 0.467, p < 0.001). The manufacturer used a three-state Markov model to model the cost-effectiveness of sunitinib compared with best supportive care for GIST patients; the modelling approach and sources and justification of estimates are reasonable. The base-case incremental cost-effectiveness ratio (ICER) was £27,365 per quality-adjusted life-year (QALY) with the first cycle of sunitinib treatment not costed; when we included the cost of the first treatment cycle we estimated a base-case ICER of £32,636 per QALY. Pfizer’s sensitivity analysis produced a range of ICERs from £15,536 per QALY to £59,002 per QALY. Weaknesses of the manufacturer’s submission include that the evidence is based on only one published RCT; that 84% of the RCT control population crossed over to the intervention group, giving rise to the use of unusual rank preserved structural failure time (RPSFT) analysis to correct for possible bias; and that a number of errors and omissions were made in the probabilistic sensitivity analysis, meaning that it is not possible to come to firm conclusions about the cost-effectiveness of sunitinib for GIST in this patient population. In conclusion, during the blinded phase of the RCT, overall survival was significantly longer in the sunitinib arm than in the placebo arm (hazard ratio 0.491, 95% CI 0.290 to 0.831, p <0.007). However, intention-to-treat analysis of the entire study showed no statistically significant difference in overall survival for those who received sunitinib (73 weeks) versus those who received placebo (65 weeks) (hazard ratio 0.876, 95% CI 0.679 to 1.129, p = 0.306).

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