scholarly journals Disease Management and Resource Use for the Management of Melanoma stage IIIc or IV Positive for BRAF V600 Mutations in Greece

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Carayanni V ◽  
Gogas H ◽  
Bafaloukos D ◽  
Boukovinas I ◽  
Latsou D ◽  
...  
Keyword(s):  
Resource Use ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Cost Of Treatment ◽  
Management Scenario ◽  
Third Line ◽  
The Cost ◽  
Third Line Treatment ◽  
First Line Treatment

Objective: Melanoma is one of the most aggressive cancers and is responsible for the majority of skin cancer deaths, with the presence of metastases prognostic for poor survival. At a time when most cancer incidences are falling, the annual incidence of melanoma has risen as rapidly as 4-6% in many European countries, with a substantial economic burden in advanced stages. The objective of this study is the investigation of treatment pathways and healthcare resource use related to advanced BRAF-mutated melanoma in Greece. Methods: This study is based on the information collected by an expert panel comprising of 3 oncologists of major public and private melanoma clinics around Greece. A 3-round survey was undertaken, according to a modified Delphi method. The treatment phases studied were: pre-progression; disease progression and terminal care. Oncology drug costs, medical visits, laboratory tests, imaging examinations, hospitalization and concomitant medications were the resources considered in the context of the Greek National Services Organization (EOPYY). Results: Τhe most common management scenario (80% of cases) in Greece for patients of stage IV BRAF V600 mutated melanoma was: targeted therapies as first line treatment at 95%, followed by immunotherapies at 100% as second line as well as third line treatment at 65% of cases. The weighted annual cost of treatment was 89.215,78 €, (90%CI:62,451.05; 115,980.51) for first line treatment at list price and around 41.584,50 (90%CI:29,109.15; 54,059.85) based on the negotiated price. At second line, the cost of treatment has been estimated between 15,704.272 (90%CI:10,992.990; 20,415.553) and 19,800.92€, (90%CI: 16,489; 30,622) for the two most common management scenarios for immunotherapies. For third line treatment the cost was 37,778.93 (90%CI 26,445.25; 49,112.61€) for the mostly used management scenario (50% ipilimumab). Conclusions: Μetastatic BRAF mutant melanoma requires prolonged and costly treatment with new therapies shown to substantially increase life expectancy. Identifying the appropriate treatment options in order to optimize health outcomes should be an important priority in healthcare system.

Efficacy of bevacizumab in combination with irinotecan or oxaliplatin as second-line, third-line or later treatment in metastatic colorectal cancer (MCRC) patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14558-14558 ◽  
Author(s):  
A. Lièvre ◽  
E. Samalin ◽  
P. Senesse ◽  
C. Boyer-Gestin ◽  
E. Mitry ◽  
...  
Keyword(s):  
Tumor Response ◽  
Severe Hypertension ◽  
Evaluation Agency ◽  
Significant Activity ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Third Line ◽  
Metastatic Sites ◽  
First Line Treatment

14558 Introduction: Bevacizumab (Bev) is efficient in MCRC patients (pts) as first-line treatment (L1) with 5FU±irinotecan, and with FOLFOX as second-line (L2). It has no efficacy in 3rd or later-line, alone or with 5FU. In Europe, Bev was approved by the EMEA (European Medicines Evaluation Agency) in 2005 and many patients could not received it in L1 before this date. This study evaluated the efficacy of Bev combined to polychemotherapy (CT) in L2, L3 or later-line in CT refractory pts. Methods: Between May 2005 and October 2006, 38 pts (median age: 54.5 years, range:25–82) received Bev combined with CT as L2 (n=18), L3 (n=6), L4 (n=7), L5 or later-line (n=7). Tumor response (OR) was assessed according to RECIST criteria by CT-scan. Results: Tumor sites: 28 colon and 10 rectum. Number of metastatic sites were 1, 2 and more in 16, 13 and 9 cases, mostly hepatic (89%) or pulmonary (42%). Bev (5mg/kg/2weeks) was combined with FOLFIRI (n=24) or FOLFOX (n=14); 299 cycles were administered, mean: 7.9 cycles/pt (range:2–14). OR rate was 42,1%, stabilization 42,1% and was not different according to the line or the CT regimen (table). Initial progressions were rare. Tolerance was acceptable (no perforation and no severe Hypertension). Conclusion: This study reports a significant activity of Bev at the dose of 5mg/kg combined with FOLFOX and/or FOLFIRI in CT refractory pts. These results warrant prospective studies of Bev combined with active CT in CT refractory pts who could not received Bev in the setting of the EMEA authorization. [Table: see text] No significant financial relationships to disclose.

Cost-effectiveness Analysis of Caspofungin and Fluconazole for Primary Treatment of Invasive Candidiasis and Candidemia in Ethiopia

2022 ◽  
Author(s):  
Gebremedhin Beedemariam Gebretekle ◽  
Atalay Mulu Fentie ◽  
Girma Tekle Gebremariam ◽  
Eskinder Eshetu Ali ◽  
Daniel Asfaw Erku ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Invasive Candidiasis ◽  
Cost Effective ◽  
Primary Treatment ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
System Perspective ◽  
The Cost ◽  
First Line Treatment

Abstract Background: Caspofungin was shown to be more effective than fluconazole in treating patients with invasive candidiasis and/or candidaemia (IC/C). However, cost-effectiveness of caspofungin for treating IC/C in Ethiopia remains unknown. We aimed to assess the cost-effectiveness of caspofungin compared to fluconazole as primary treatment of IC/C in Ethiopia.Methods: A Markov cohort model was developed to compare the cost-utility of caspofungin versus fluconazole antifungal agents as first-line treatment for adult inpatients with IC/C from the Ethiopian health system perspective. Treatment outcome was categorized as either a clinical success or failure, with clinical failure being switched to a different antifungal medication. Liposomal amphotericin B (L-AmB) was used as a rescue agent for patients who had failed caspofungin treatment, while caspofungin or L-AmB were used for patients who had failed fluconazole treatment. Primary outcomes were expected quality-adjusted life years (QALYs), costs (US$2021), and the incremental cost-effectiveness ratio (ICER). QALYs and costs were discounted at 3% annually. Cost data was obtained from Addis Ababa hospitals while locally unavailable data were derived from the literature. Cost-effectiveness was assessed against the recommended threshold of 50% of Ethiopia’s gross domestic product/capita. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the findings.Results: In the base-case analysis, treatment of IC/C with caspofungin as first-line treatment resulted in better health outcomes (12.86 QALYs) but higher costs (US$7,714) compared to fluconazole-initiated treatment followed by caspofungin (12.30 QALYs; US$3,217) or L-AmB (10.92 QALYs; US$2,781) as second-line treatment. Caspofungin as primary treatment for IC/C was not cost-effective when compared to fluconazole-initiated therapies. Fluconazole-initiated treatment followed by caspofungin was cost-effective for the treatment of IC/C compared to fluconazole with L-AmB as second-line treatment, at US$316/QALY gained. Our findings were sensitive to medication costs, drug effectiveness, infection recurrence, and infection-related mortality rates. Probabilistic sensitivity analysis confirmed the stability of our findings.Conclusions: Our study showed that the use of caspofungin as primary treatment for IC/C in Ethiopia was not cost-effective when compared with fluconazole-initiated treatment alternatives. The findings supported the use of fluconazole-initiated therapy with caspofungin as a second-line treatment to treat IC/C in Ethiopia and other low-income countries.

scholarly journals Therapeutic Efficacy and Safety of Lenvatinib for Unresectable Hepatocellular Carcinoma Beyond Progression with Sorafenib

2020 ◽  
Author(s):  
Tetsu Tomonari ◽  
Yasushi Sato ◽  
Hironori Tanaka ◽  
Takahiro Tanaka ◽  
Yasuteru Fujino ◽  
...  
Keyword(s):  
Signal Transduction ◽  
Signal Transduction Pathways ◽  
Line Treatment ◽  
Second Line ◽  
Efficacy And Safety ◽  
First Line ◽  
Array Analysis ◽  
Third Line ◽  
Protein Array Analysis ◽  
Third Line Treatment

AbstractBackground & AimsThe efficacy and safety of lenvatinib (LEN) as a second/third-line treatment for unresectable hepatocellular carcinoma (HCC) after sorafenib (SOR) therapy remains unknown. We evaluated the outcomes of second/third-line treatment of LEN, investigated the sensitivity of SOR-resistant HCC cell line (PLC/PRF5-R2) to LEN, and their signal transduction pathway by protein array analysis.MethodsWe retrospectively enrolled 57 unresectable HCC patients. Radiologic responses in 53 patients were evaluated by modified Response Evaluation Criteria in Solid Tumors. Active signal transduction pathways in cells were identified by protein array analysis, including 1205 proteins.ResultsPatients comprised 34 tyrosine kinase inhibitor (TKI)-naive (first-line), nine SOR-intolerant (second-line), and ten resistant to regorafenib (third-line). Objective response rates (ORRs) were 61.8% (21/34) in TKI-naive, 33.3% (3/9) in second-line, and 20.0% (2/10) in third-line groups. The overall survival (OS) and the progression free survival (PFS) in the first-line was significantly longer than those in third-line group (p<0.05). Patients with better liver functional reserve (Child score, ALBI grade) exhibited higher ORR and longer OS. LEN was well-tolerated as second/third-line treatment. The IC50 value of LEN against PLC/PRF5-R2 cells (30 μM) was significantly higher than that against PLC/PRF5 cells (6.4 μM). LEN inhibited significantly more signal transduction pathways related to FRS2, a crucial FGFR downstream molecule, in PLC/PRF5 than PLC/PRF5-R2 cells.ConclusionsLEN was active and safe as a second/third-line treatment for unresectable HCC. LEN seems to be more effective for HCC patients with better hepatic reserve function or before TKI-resistance is acquired because of partial cross-resistance to SOR.

Efficacy and safety of taxane-monotherapy in advanced gastric cancer refractory to triplet chemotherapy with docetaxel, cisplatin, and S-1: A multicenter retrospective study.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 154-154
Author(s):  
Sadayuki Kawai ◽  
Sakura Iizumi ◽  
Atsuo Takashima ◽  
Yukiya Narita ◽  
Masahiro Tajika ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Line Treatment ◽  
Second Line ◽  
Efficacy And Safety ◽  
First Line ◽  
The Third ◽  
Third Line ◽  
Ecog Ps ◽  
Third Line Treatment

154 Background: While taxane-monotherapy following fluoropyrimidine plus platinum is recognized as the standard treatment strategy for advanced gastric cancer, triplet chemotherapy with docetaxel, cisplatin and S-1 (DCS) is another option for first-line therapy in Japan. However, efficacy of taxane after DCS therapy has not been sufficiently evaluated. Methods: We retrospectively evaluated the efficacy and safety of taxane-monotherapy after DCS between January 2010 and April 2015 for advanced gastric cancer. The taxane-monotherapy included weekly paclitaxel (PTX) (80 mg/m2, day 1, 8 and 15 of a 28-day cycle) and triweekly nab-PTX (260 mg/m2, day 1). Other selection criteria were: ECOG PS < 2; adequate organ function; no severe ascites; HER2-negative. Results: Thirty of 92 patients who had been treated with DCS received taxane-monotherapy. Fifteen and 15 patients received taxane-monotherapy as the second and third-line treatment, respectively. Patients characteristics of each group (2nd/3rd) were; median age: 64/62 (range 27-75/42-75); ECOG PS ≤ 1: 14/13; number of metastatic sites ≥ 2: 9/12; median taxane-free interval from first-line treatment: 1.6/3.4 (range 0.9-2.3/2.2-8.3) months; median total dose of prior DTX: 349/208 (range 39-844/141-685) mg/m2. Number of patients who received PTX/nab-PTX were 10/5 and 13/2 in the second and third line treatment. Median relative dose intensity of taxane was 96.4% (range 57.6-172.9%) in the second-line, 98.5% (44.0-166.8%) in the third-line group. Response rate and disease control rate were 0% and 37.5% in the second-line, and 0% and 38.5% in the third-line group. Median progression free survival and overall survival were 3.4 and 5.8 months in the second-line group, and 2.0 and 4.5 months in the third-line. Grade 3 or 4 neutropenia, anemia, and anorexia, occurred in 33%, 13% and 13% in the second-line group, and 6.7%, 13% and 6.7% in the third–line group, associated with no treatment related death. Conclusions: It is suggested that taxane-monotherapy has acceptable toxicities but insufficient efficacy in advanced gastric cancer patients after DCS therapy.

scholarly journals Two Cases of Long-Term Control of Metastatic Colorectal Cancer via FTD/TPI plus Bevacizumab in Elderly Patients

2018 ◽  
Vol 11 (3) ◽  
pp. 800-805 ◽  
Author(s):  
Masatsune Shibutani ◽  
Kiyoshi Maeda ◽  
Hisashi Nagahara ◽  
Tatsunari Fukuoka ◽  
Yasuhito Iseki ◽  
...  
Keyword(s):  
Adverse Events ◽  
Elderly Patients ◽  
Intensive Chemotherapy ◽  
Line Treatment ◽  
First Line ◽  
Severe Adverse Events ◽  
Third Line ◽  
Third Line Treatment ◽  
First Line Treatment

With advances in new cytotoxic drugs and molecular-targeted drugs, the prognosis of patients with metastatic colorectal cancer (mCRC) has improved. However, physicians often hesitate to administer intensive standard regimens to elderly patients with mCRC. Recently, first-line regimens that are effective in and well-tolerated by patients who are not eligible for intensive chemotherapy have been established. However, the therapeutic strategies to adopt after the failure of first-line treatment for patients who are not eligible for intensive chemotherapy remain unclear. We herein report two cases of long-term control of mCRC via FTD/TPI+bevacizumab (Bmab) as second- or third-line treatment in elderly patients without severe adverse events. In case 1, first-line treatment with Tegafur-Uracil, which is a prodrug of 5-FU, caused disease progression in a short period after the initiation of chemotherapy. In case 2, intensive first-line treatment caused severe adverse events, and treatment was discontinued. However, in both cases, disease control was obtained for a long time without severe adverse events by subsequent treatment with FTD/TPI+Bmab. The success in these present cases indicates that FTD/TPI+Bmab as a second- or third-line treatment is a therapeutic option for elderly patients with mCRC who are not eligible for intensive chemotherapy, even after failure of treatment with 5-FU.

scholarly journals Cost-effectiveness of ribociclib plus letrozole versus palbociclib plus letrozole or letrozole as monotherapy in first-line treatment of postmenopausal women with HR+/HER2− locally advanced or metastatic breast cancer: a Brazilian private payer perspective

2021 ◽  
Vol 13 ◽  
pp. 175883592110005
Author(s):  
Anna Maria Buehler ◽  
Gabriela Castilho ◽  
Pierre-Alexandre Dionne ◽  
Stephen Stefani
Keyword(s):  
Cost Effectiveness ◽  
Postmenopausal Women ◽  
Locally Advanced ◽  
Line Treatment ◽  
First Line ◽  
Cost Of Treatment ◽  
Total Cost ◽  
Private Healthcare ◽  
The Cost ◽  
First Line Treatment

Background: The global burden of breast cancer (BC) is high, especially in advanced stages. CDK 4/6 inhibitors represent a paradigm shift in the treatment of advanced BC HR+/HER2−, given the clinically and statistically significant gain in overall survival associated with this new class of medications. Nevertheless, as an innovation, the incorporation of these drugs impacts healthcare budgets, requiring cost-effectiveness analyses for decision-making. The aim of this study was to evaluate the cost-effectiveness of ribociclib plus letrozole compared with palbociclib plus letrozole or letrozole as monotherapy for first-line treatment of postmenopausal women with HR+/HER2− locally advanced or metastatic BC (aBC) from a Brazilian private healthcare system perspective. Methods: A model including progression-free survival (PFS), progressed disease, and death health states was used to simulate lifetime costs and outcomes. PFS and overall survival were derived from the MONALEESA-2 trial (lifetime horizon). Healthcare costs included drug acquisition and monitoring, subsequent therapies, adverse events, and end-of-life costs. Effectiveness was measured in quality-adjusted life-years (QALYs). Deterministic and probabilistic sensitivity analyses were performed. Results: The total cost of treatment with ribociclib plus letrozole was USD 72,091.82 versus USD 92,749.64 for palbociclib plus letrozole. Total QALYs were 3.30 and 3.16, respectively. Base-case analysis showed ribociclib as dominant over palbociclib in first-line treatment of women with HR+/HER2− aBC, associated with cost savings and QALY gains. The total cost of treatment with ribociclib plus letrozole was USD 83,058.73 versus USD 29,215.10 for letrozole. Total QALYs were 3.84 and 2.61, respectively. Compared with letrozole, ribociclib plus letrozole was associated with an incremental cost of USD 53,843.64 and an incremental QALY gain of 1.23, with incremental cost-effectiveness ratio of USD 43,826.91 per QALY gained. Conclusions: As demonstrated by the cost-effectiveness dominance over palbociclib, ribociclib results in savings when used as first-line treatment in postmenopausal women with HR+/HER2− aBC, warranting incorporation in the private healthcare system.

Safety and Efficacy of Bortezomib and Dexamethasone (BD) in Multiple Myeloma as First-Line, Second-Line or Third-Line Treatment.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4817-4817
Author(s):  
Juan Li ◽  
Beihui Huang ◽  
Ying Zhao ◽  
Dong Zheng ◽  
Shaokai Luo
Keyword(s):  
Multiple Myeloma ◽  
Peripheral Neuropathy ◽  
Median Time ◽  
Median Number ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Line Therapy ◽  
Third Line ◽  
Third Line Treatment

Abstract Purpose: To compare efficacy and safety of BDbortezomib and dexamethasone in multiple myeloma as first-line, second-line or third-line treatment. Patients and methods: 18 patients(pts) treated with BD (bortezomig 1.3mg/m2 on d 1,4,8,11 and dexamethasone 20mg on d 1–4 in a 21-day cycle). Responses were evaluated by the criteria of EBMT but a nCR was included. Adverse events were graded by the WHO criteria. Results: The median age was 52.5 years, and 13 (72.2%) were male. Ig subtypes were IgG, (8 pts, 44.4%), IgA (4 pts, 22.2%), light chain (2 pts, 11.1%), and IgD (1 pts, 5.9%). Durine/Salmon staging: IIA 5.9% (1/18), IIB 5.9% (1/18), IIIA 72.2% (13/18), IIIB16.6% (3/18). BD was administered in first-line (4 pts, 22.2%), second-line (7 pts 38.9%) and third-line (7 pts, 38.9%). The median number of BD cycles was 2.5 (range, 1–6 cycles). 17 pts could be evaluated, overall response was 88.3%, including CR in 2 pts (11.7%), nCR in 5 pts (29.4%), PR in 7 pts (41.2%), MR in 1 pts(5.9%), NC in 1 pts(5.9%), PD in 1 pts(5.9%). Pts in the first-line group received a response of 100%(4/4), including nCR in 1 pts (25.0%), PR in 2 pts (50.0%), MR in 1 pts(25.0%). The second-line group received a response of 100%(7/7), including CR in 1 pts(14.3%), nCR in 3 pts (42.9%), PR in 3 pts (42.9%). Those received BD as third-line or more got a response of 66.7% (4/6), including CR in 1 pts(16.7%), nCR in 1 pts (16.7%), PR in 2 pts (33.3%). Aderse events included diarrhea 44.4% (8/18; grade IV: 2/18), thrombocytopenia 44.4% (8/18; grade III–IV: 7/18), fatigue 44.4% (8/18; grade IV: 1/18), peripheral neuropathy 33.3% (6/18, grade II:1/18), pyrexia 22.2%, infection 16.7% (3/18), headache 11.1%(2/18), parageusis 11.1%(2/18), hypotension 5.9%(1/18), hypoglycemia 5.9%(1/18) while combining with glipizide. The median time to minimum counts of platets was 14 days. The median time to most serious peripheral neuropathy appeared after treatment of 3 cycles. In 1 pts the therapy was disrupted by toxicity. Conclusion: BD demonstrated better response as first-line or second-line therapy than as third or more line therapy. Toxicities were torelated and manegable. There were no treatment related deaths.

The Evolution Between 2001 and 2010 In the Uk Costs of Resolving a Mild to Moderate Bleeding Episode with Pd-aPCC Versus rFVIIa In Haemophilia A Patients with inhibitors.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1518-1518
Author(s):  
Paresh Sewpaul ◽  
Donna Ashley ◽  
Paul Riley
Keyword(s):  
Bleeding Episode ◽  
Haemophilia A ◽  
Line Treatment ◽  
First Line ◽  
Treatment Regimens ◽  
Bypassing Agents ◽  
Third Line ◽  
The Uk ◽  
Third Line Treatment ◽  
First Line Treatment

Abstract Abstract 1518 Introduction: Haemophilia A is a rare inherited bleeding disorder characterised by spontaneous or trauma-related bleeding, most commonly into the joints, leading to pain, swelling and limited movement. Some 30–50% of patients with haemophilia A develop inhibitors to their standard treatment, comprised of FVIII concentrates. There are two bypassing agents used for the management of bleeding episodes in patients with haemophilia A with inhibitors in the UK: recombinant factor VII (rFVIIa, NovoSeven®) and plasma-derived activated prothrombin complex concentrate (pd-aPCC, Feiba®). Objective: A systematic review of the cost-effectiveness of pd-aPCC versus rFVIIa was published in 2003. Since the analysis, costs of bypassing agents in the UK have changed significantly (pd-aPCC +30% from ≤0.57/U to ≤0.74/U; rFVIIa -11% from ≤0.51/mcg to ≤0.46/mcg). The present study examines the evolution in costs of resolving a mild to moderate bleeding episode with treatment initiated outside hospital. Methods: A decision analytic model estimated the expected costs and outcomes of resolving a mild-moderate bleeding episode in patients with haemophilia A with inhibitors. The model compared three treatment regimens in patients with a mean weight 70kg. Each regimen comprised first-, second- and third-line treatment: (1) pd-aPCC-pd-aPCC-rFVIIa; (2) pd-aPCC-rFVIIa-rFVIIa; and (3) rFVIIa-rFVIIa-rFVIIa. Efficacy and dosing of pd-aPCC and rFVIIa were estimated from the published literature, with rFVIIa assumed to resolve 92% of mild-moderate bleeds when used as first and second line treatment and pd-aPCC resolving 79% and 88% of mild-moderate bleeds when used first and second line respectively. Patients whose bleeding episodes were not resolved with first-line treatment were admitted to hospital for second- and third-line treatment. Costs included in the economic model were bypassing agent costs and hospitalisation costs. Results: The different treatment regimens result in different total costs for the resolution of a single mild-moderate bleeding episode with up to three lines of treatment: (1) GBP 13,542 (EUR 15,180); (2) GBP 12,985 (EUR 14,556); and (3) GBP 8,569 (EUR 9,605). Since 2001, the costs of regimens 1 and 2 have increased by 26% and 18%, but regimen 3 has decreased by 11% in the UK. Conclusion: Divergence in the price of pd-aPCC and rFVIIa since 2001 has increased the cost-effectiveness of rFVIIa. The results reinforce the fact that effective first-line treatment with rFVIIa results in lower overall treatment costs due to a reduced need for further treatment and associated hospitalisation costs. Adopting rFVIIa as first-line treatment is cost-saving and more effective compared to reserving rFVIIa as a second- or third-line treatment option. Disclosures: Sewpaul: Novo Nordisk : Employment. Ashley:Novo Nordisk : Employment. Riley:Novo Nordisk Ltd: Employment.

Economic analysis of ceritinib used as second-line versus third-line treatment for patients with ALK-rearranged non-small-cell lung cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18355-e18355
Author(s):  
Bin Wu ◽  
Hongchao Li
Keyword(s):  
Lung Cancer ◽  
Small Cell ◽  
Line Treatment ◽  
Second Line ◽  
Small Cell Lung ◽  
Life Years ◽  
Third Line ◽  
Line Setting ◽  
The Cost ◽  
Third Line Treatment

e18355 Background: Targeted therapy with ceritinib notably improves survival in patients with advanced non–small-cell lung cancer (NSCLC) harboring anaplastic lymphoma kinase (ALK) rearrangement tumors after the failure of chemotherapy and crizotinib. However, the economic outcome of ceritinib used as the second-line versus third-line treatment is still unclear. Methods: A mathematical model was constructed to project 21-day patient transitions. The clinical data were primarily extracted from the ASCEND-5 trial. The health resource consumption data were estimated from the perspective of the Chinese health care system. The cost, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) was measured in a 10-year time horizon. Sensitivity analyses were conducted to test the impact of uncertainties. Results: Comparing with the 3rd-line strategy, ceritinib 2nd-line strategy achieved the comparable life years and additional 0.06 QALYs with the less cost of $6,694 (Table), which suggested that ceritinib used as 2nd-line treatment is a dominant strategy. The utility of disease-free survival and the cost of ceritinib were the factors that had the considerable impact on the model outcomes. Conclusions: These results indicate that ceritinib used in 2nd-line setting is a more favorable treatment option than in the 3rd-line setting. [Table: see text]

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