scholarly journals Cost-Effectiveness of Pembrolizumab Plus Chemotherapy Versus Pembrolizumab Monotherapy in Metastatic Non-Squamous and Squamous NSCLC Patients With PD-L1 Expression ≥ 50%

2022 ◽  
Vol 12 ◽  
Author(s):  
Qiao Liu ◽  
Zhen Zhou ◽  
Xia Luo ◽  
Lidan Yi ◽  
Liubao Peng ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Life Expectancy ◽  
Cost Effective ◽  
Base Case ◽  
First Line ◽  
Term Survival ◽  
First Line Therapy ◽  
Line Therapy ◽  
Nsclc Patients

Objective To compare the cost-effectiveness of the combination of pembrolizumab and chemotherapy (Pembro+Chemo) versus pembrolizumab monotherapy (Pembro) as the first-line treatment for metastatic non-squamous and squamous non-small-cell lung cancer (NSCLC) with PD-L1expression ≥50%, respectively, from a US health care perspective.Material and Methods A comprehensive Makrov model were designed to compare the health costs and outcomes associated with first-line Pembro+Chemo and first-line Pembro over a 20-years time horizon. Health states consisted of three main states: progression-free survival (PFS), progressive disease (PD) and death, among which the PFS health state was divided into two substates: PFS while receiving first-line therapy and PFS with discontinued first-line therapy. Two scenario analyses were performed to explore satisfactory long-term survival modeling.Results In base case analysis, for non-squamous NSCLC patients, Pembro+Chemo was associated with a significantly longer life expectancy [3.24 vs 2.16 quality-adjusted life-years (QALYs)] and a substantially greater healthcare cost ($341,237 vs $159,055) compared with Pembro, resulting in an ICER of $169,335/QALY; for squamous NSCLC patients, Pembro+Chemo was associated with a slightly extended life expectancy of 0.22 QALYs and a marginal incremental cost of $3,449 compared with Pembro, resulting in an ICER of $15,613/QALY. Our results were particularly sensitive to parameters that determine QALYs. The first scenario analysis yielded lower ICERs than our base case results. The second scenario analysis founded Pembro+Chemo was dominated by Pembro.Conclusion For metastatic non-squamous NSCLC patients with PD-L1 expression ≥50%, first-line Pembro+Chemo was not cost-effective when compared with first-line Pembro. In contrast, for the squamous NSCLC patient population, our results supported the first-line Pembro+Chemo as a cost-effective treatment. Although there are multiple approaches that are used for extrapolating long-term survival, the optimal method has yet to be determined.

Cost-effectiveness of first-line therapy for advanced renal cell carcinoma in the immunotherapy era.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19392-e19392
Author(s):  
Divya Ahuja Parikh ◽  
Paul Irvin Serrato ◽  
Sandy Srinivas ◽  
Tess Sophie Ryckman ◽  
Joshua Salomon ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cost Effectiveness ◽  
Life Expectancy ◽  
Renal Cell ◽  
Cost Effective ◽  
Line Treatment ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
First Line Treatment

e19392 Background: The treatment landscape for advanced renal cell carcinoma (RCC) has transformed in the past two years. Both Nivolumab plus Ipilimumab and Pembrolizumab plus Axitinib are approved regimens for first-line treatment of intermediate to poor-risk patients with advanced RCC. The choice between these immunotherapy-based combinations for first-line therapy is highly debated; no prior study has evaluated the cost-effectiveness of both combinations compared to Sunitinib. Methods: We used a decision analytic Markov model informed by the recent Checkmate-214 and Keynote-426 phase 3 randomized controlled clinical trials to evaluate costs and effectiveness of Nivolumab plus Ipilimumab, Pembrolizumab plus Axitinib, and Sunitinib in the first-line treatment of advanced RCC from a US health payer perspective. We used the model to extrapolate survival beyond the closure of the trials and examined the robustness of our findings with sensitivity analyses. Main outcomes were life expectancy, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios, all discounted at 3% annually. Results: Nivolumab plus Ipilimumab increased life expectancy by 0.58 years at cost of approximately $190,000 per QALY gained compared to Sunitinib. Pembrolizumab plus Axitinib increased life expectancy by 0.39 years at a cost of approximately $861,000 per QALY gained compared to Nivolumab plus Ipilimumab. The results were not sensitive to reasonable changes in drug costs and quality of life estimates. Both combinations cost more than the traditional willingness-to-pay threshold (WTP) of $150,000 per QALY gained. A 20% price reduction is required for Nivolumab and Ipilimumab to be cost-effective and a 48% price reduction is required for Pembrolizumab plus Axitinib to be cost-effective. Conclusions: Both Nivolumab plus Ipilumumab and Pembrolizumab plus Axitinib provide increased longevity and reduced morbidity relative to Sunitinib. However, the prolonged duration of treatment and doublet-drug pricing results in high-costs. Price reductions are required for both of the immunotherapy-based combinations to be cost-effective. [Table: see text]

scholarly journals The New ELN Recommendations for Treating CML

2020 ◽  
Vol 9 (11) ◽  
pp. 3671
Author(s):  
Rüdiger Hehlmann
Keyword(s):  
Kinase Inhibitors ◽  
Chronic Phase ◽  
Cost Effective ◽  
Low Grade ◽  
Molecular Response ◽  
First Line ◽  
Term Survival ◽  
First Line Therapy ◽  
Line Therapy

After normal survival has been achieved in most patients with chronic myeloid leukemia (CML), a new goal for treating CML is survival at good quality of life, with treatment discontinuation in sustained deep molecular response (DMR; MR4 or deeper) and treatment-free remission (TFR). Four tyrosine kinase inhibitors (TKIs) have been approved for first-line therapy: imatinib, dasatinib, nilotinib, bosutinib. Unexpectedly, the outcome of long-term randomized trials has shown that faster response as achieved by higher doses of imatinib, imatinib in combination, or second-generation (2G)-TKIs, does not translate into a survival advantage. Serious and frequent, and in part cumulative long-term toxicities, have led to a reevaluation of the role of 2G-TKIs in first-line therapy. Generic imatinib is the current most cost-effective first-line therapy in the chronic phase. A change of treatment is recommended when intolerance cannot be ameliorated or molecular milestones are not reached. Patient comorbidities and contraindications of all TKIs must be considered. Risk profile at diagnosis should be assessed with the EUTOS score for long-term survival (ELTS). Monitoring of response is by polymerase chain reaction (PCR). Cytogenetics is still required in the case of atypical translocations, atypical transcripts, and additional chromosomal aberrations. TKIs are contraindicated during pregnancy. Since the majority of patients are at risk of lifelong exposure to TKIs, amelioration of chronic low-grade side effects is important.

scholarly journals First-Line Atezolizumab Plus Bevacizumab versus Sorafenib in Hepatocellular Carcinoma: A Cost-Effectiveness Analysis

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 931
Author(s):  
Chi-Leung Chiang ◽  
Sik-Kwan Chan ◽  
Shing-Fung Lee ◽  
Horace Cheuk-Wai Choi
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cost Effectiveness ◽  
Lifetime Cost ◽  
Cost Effective ◽  
First Line ◽  
First Line Therapy ◽  
Payer Perspective ◽  
Life Years ◽  
Using Data

Background: The IMbrave 150 trial revealed that atezolizumab plus bevacizumab (atezo–bev) improves survival in patients with unresectable hepatocellular carcinoma (HCC) (1 year survival rate: 67.2% vs. 54.6%). We assessed the cost-effectiveness of atezo–bev vs. sorafenib as first-line therapy in patients with unresectable HCC from the US payer perspective. Methods: Using data from the IMbrave 150, we developed a Markov model to compare the lifetime cost and efficacy of atezo–bev as first-line systemic therapy in HCC with those of sorafenib. The main outcomes were life-years, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratio (ICER). Results: Atezo–bev demonstrated a gain of 0.44 QALYs, with an additional cost of USD 79,074. The ICER of atezo–bev was USD 179,729 per QALY when compared with sorafenib. The model was most sensitive to the overall survival hazard ratio and body weight. If we assumed that all patients at the end of the IMbrave 150 trial were cured of HCC, atezo–bev was cost-effective (ICER USD 53,854 per QALY). However, if all patients followed the Surveillance, Epidemiology, and End Results data, the ICER of atezo–bev was USD 385,857 per QALY. Reducing the price of atezo–bev by 20% and 29% would satisfy the USD 150,000/QALY and 100,000/QALY willingness-to-pay threshold. Moreover, capping the duration of therapy to ≤12 months or reducing the dosage of bev to ≤10 mg/kg would render atezo–bev cost-effective. Conclusions: The long-term effectiveness of atezo–bev is a critical but uncertain determinant of its cost-effectiveness. Price reduction would favorably influence cost-effectiveness, even if long-term clinical outcomes were modest. Further studies to optimize the duration and dosage of therapy are warranted.

Determining optimal first-line chemotherapy for good and intermediate prognosis testicular germ cell tumors using decision analysis.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 209-209
Author(s):  
Sky Breeden Vanderburg ◽  
A. Lindsay Frazier ◽  
Jane Kim
Keyword(s):  
Life Expectancy ◽  
Germ Cell Tumors ◽  
Disease Free Survival ◽  
First Line ◽  
Testicular Germ Cell ◽  
Free Survival ◽  
First Line Therapy ◽  
Line Therapy ◽  
Disease Free

209 Background: Since 80-90% of testicular germ cell tumors (GCTs) are cured after first line therapy alone, minimizing toxicity should be an important consideration in the initial treatment decision between cisplatin and carboplatin. Cisplatin has been shown to be superior in 5-year disease-free survival, but cisplatin use confers a higher risk of key long-term toxicities. This study aims to quantify this trade-off between disease-free survival and toxicities using decision analysis. Methods: We developed a mathematical decision-analytic model that simulates competing strategies of initial treatment with cisplatin or carboplatin in terms of treatment response, long-term toxicity, and mortality associated with first, second, and third line therapies for patients with good and intermediate prognosis testicular GCTs and a median age of 20 years at diagnosis. Treatment toxicities included ototoxicity, neurotoxicity, and nephrotoxicity. Monthly probabilities were weighted means derived from a systematic review of total follow-up data reported in seminal clinical trials. The model projected life expectancies for each strategy. Sensitivity analysis was conducted to examine the impact of uncertain inputs and assumptions. Results: The life expectancies at diagnosis for cisplatin and carboplatin strategies were 436.1 months (36.3 years) and 663.2 months (55.3 years) respectively. Sensitivity analyses revealed life expectancy figures largely dependent on the risk of nephrotoxicity occurrence from first line therapy and death from nephrotoxicity. Unless these base monthly probabilities were reduced by 87% and 99% respectively, carboplatin consistently yielded higher life expectancy than cisplatin. Conclusions: Under the current model, first line carboplatin therapy yields longer life expectancy than cisplatin, but this difference is highly sensitive to variables concerning nephrotoxicity. These preliminary results suggest that first line carboplatin therapy could yield higher life expectancy, though this result may be mediated by inclusion of other factors in future analyses, including updated estimates of mortality from nephrotoxicity or other toxicities.

scholarly journals Primary Pelvic Exenteration for Advanced Gynaecological Malignancies

2020 ◽  
Vol 25 (2) ◽  
pp. 52-54
Author(s):  
Dragoș Constantin Cucoranu ◽  
Raluca Niculescu ◽  
Mihai Emil Căpîlna
Keyword(s):  
Pelvic Exenteration ◽  
Levator Ani ◽  
First Line ◽  
Term Survival ◽  
First Line Therapy ◽  
Line Therapy ◽  
Pelvic Malignancies ◽  
Advanced Stages ◽  
Gynaecological Malignancies

AbstractIntroduction: Indication of primary pelvic exenteration, without previous radiotherapy, is questionable in advanced stages of gynaecological malignancies.Materials and Methods: 24 patients who underwent primary pelvic exenteration for pelvic malignancies were studied retrospectively. The indications were cervical (n=17), vaginal (n=4), bladder (n=2) and endometrial cancer (n=1).Results: According to the type of exenteration, 14 were anterior and 10 total. Relying on the resection lines in relation with levator ani muscles, 14 were supralevatorial and 10 infralevatorial, of which five involved vulvectomy. Early complications occurred in 7 patients with 1 perioperative death.Conclusions: Primary pelvic exenterantion as first line therapy for advanced gynaecological malignancies can lead to long-term survival and it can even be curative in suitable selected patients. Still, postoperative complications are frequent, which can be lethal.

scholarly journals Cost-effectiveness of ibrutinib as first-line therapy for chronic lymphocytic leukemia in older adults without deletion 17p

2018 ◽  
Vol 2 (15) ◽  
pp. 1946-1956 ◽  
Author(s):  
James I. Barnes ◽  
Vasu Divi ◽  
Adrian Begaye ◽  
Russell Wong ◽  
Steven Coutre ◽  
...  
Keyword(s):  
Older Adults ◽  
Cost Effectiveness ◽  
Older Patients ◽  
Cost Effective ◽  
Lymphocytic Leukemia ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Key Points ◽  
The Cost

Key Points At current prices, ibrutinib is not a cost-effective initial CLL therapy in older patients without 17p deletion. The cost of ibrutinib would need to be <$6800 per month to be cost-effective.

scholarly journals S-1 plus leucovorin and oxaliplatin versus S-1 plus cisplatin as first-line therapy in patients with advanced gastric cancer: a cost-effectiveness analysis

2020 ◽  
Author(s):  
Mingyang Feng ◽  
Weiting Liao ◽  
Yang Yang ◽  
Qiu Li
Keyword(s):  
Gastric Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Advanced Gastric Cancer ◽  
Cost Effective ◽  
Chinese Society ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
The Impact

Abstract Background: A multicenter, open-label, randomized, phase 3 trial (SOLAR) conducted in 62 centers across Japan and South Korea showed that S-1 plus leucovorin and oxaliplatin showed improved overall response rate, progression-free survival (PFS), and overall survival (OS) compared with S-1 plus cisplatin. This study aimed to investigate whether S-1 plus leucovorin and oxaliplatin is cost-effective compared with S-1 plus cisplatin as the first-line therapy of advanced gastric cancer from the perspective of Chinese society.Materials and methods: The clinical data for this model was derived from the SOLAR trial. Costs and utility were either derived from the standard fee database or extracted from previously published literature. A Markov model was developed to simulate the disease process of patients with advanced gastric cancer. One-way sensitivity analyses were conducted to investigate the impact of variables on the analysis model. A second-order probabilistic sensitivity analysis was performed based on 1,000 Monte-Carlo simulations.Results: S-1 plus leucovorin and oxaliplatin cohort provided an incremental 0.02 QALYs with an incremental cost of $1,527.31, compared with the S-1 plus cisplatin cohort, resulting in the incremental cost-effectiveness ratio (ICER) of $61,331.63/QALY, which beyond the willingness to pay threshold. Costs of drugs in the PFS state in both cohorts and utility of PFS state were the most influential factors in this study.Conclusion: S-1 plus leucovorin and oxaliplatin is not cost-effective compared with S-1 plus cisplatin as first-line therapy in patients with advanced gastric cancer from the Chinese society perspective.

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