scholarly journals Cost-efficacy analysis of hormonal treatments for advanced prostate cancer

2008 ◽  
Vol 9 (3) ◽  
pp. 147-156
Author(s):  
Sergio Iannazzo ◽  
Lorenzo Pradelli
Keyword(s):  
Prostate Cancer ◽  
Life Expectancy ◽  
Advanced Prostate Cancer ◽  
Cost Effective ◽  
Cost Utility ◽  
Italian Population ◽  
Efficacy Analysis ◽  
Lhrh Agonists ◽  
Life Years ◽  
Androgen Suppression

Introduction: prostatic cancer is the second more frequent cancer in Italy (after lung cancer) and is the third cancer-related death cause. Age is the principal risk factor and, given the ageing process undergoing in the Italian population, it seems clear that the public sanitary expenditure to treat the disease is bound to increase, arising the need to perform pharmacoeconomic evaluations of the therapeutic strategies available. Methods: we performed a cost/utility analysis, through a Markov model, of several hormonal therapies in patients with advanced prostate cancer who underwent radical prostatectomy, from the biochemical recurrence to death. Nine androgen suppression therapies were considered: orchiectomy, two nonsteroidal antiandrogens (NSAA), four luteinizing hormone-releasing hormone (LHRH) agonists, cyproterone acetate and the association of a NSAA and a LHRH (BAT). In the simulation the androgen suppression therapies were started at the PSA recurrence and never stopped until death. The model used the Italian NHS prospective and a time horizon corresponding to patient’s lifetime. Drug costs were calculated for each therapy, considering the less costly brand. Results: all the considered therapies produced a life expectancy (LE) of about 12 life years (LYs) with a small variability ranging from 12.3 LYs for BAT (the most effective) to 11.37 LYs for NSAA-flutamide (the least effective). Quality adjusted life expectancy ranged from 9.98 QALYs for BAT to 9.28 QALYs for NSAA-flutamide. The average cost per patient presented a more enhanced variability, from 12,538 Euro for orchiectomy to 59,496 Euro for NSAA-bicalutamide. Among all the alternatives orchiectomy resulted the most cost/effective alternative with a cost/utility ratio of about 1,300 Euro/QALY. In the LHRH-agonists class leuprorelin was the most cost/effective with about 2,200 Euro/QALY. A one-way sensitivity analysis showed a substantial stability of the results. Conclusions: BAT resulted the most effective therapy, but also the one associated with the highest expected cost. Orchiectomy was marginally less effective but at the same time generated the lowest cost and, thus, represented the most cost/effective strategy. Nonetheless, its application in actual clinical practice is difficult and quite always refused by patients. Among the class of LHRH-agonists leuprorelin (considering the less costly brand, Eligard®) dominated the alternatives and, thus, could provide an excellent therapeutic strategy.

A cost-utility analysis of open A1 pulley release for the treatment of trigger finger

2020 ◽  
Vol 45 (10) ◽  
pp. 1083-1086 ◽  
Author(s):  
Paul H. C. Stirling ◽  
Nicholas D. Clement ◽  
Paul J. Jenkins ◽  
Andrew D. Duckworth ◽  
Jane E. McEachan
Keyword(s):  
Life Expectancy ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Level Of Evidence ◽  
Life Years ◽  
The Mean ◽  
The Cost ◽  
Quality Adjusted Life ◽  
A1 Pulley

The United Kingdom National Institute for Health and Care Excellence considers a procedure to be cost-effective if the cost per quality-adjusted life year gained falls below a threshold of £20,000–£30,000 (€22,600–33,900; US$24,600–$36,900). This study used cost per quality-adjusted life year methodology to determine the cost-utility ratio of A1 pulley release. Pre- and postoperative EuroQol 5 Dimensions 5 Likert scores were collected prospectively over 6 years from 192 patients. The median pre- and postoperative indices derived from the EuroQol 5 Dimensions 5 Likert scores were significantly different at 0.77 and 0.80. The mean life expectancy was 21 years. The mean number of quality-adjusted life years gained was 1 per patient. The mean cost-utility ratio per patient was £32,308 (€36,508; US$39,730) and £16,154 (€18,254; US$19,869) at 1 and 2 years, respectively. Provided the benefit of surgery was maintained over the remaining life expectancy, the cost-utility ratio decreased to £1537 (€1737; US$1891) per patient. A1 pulley release is cost-effective provided the benefit is maintained for 2 years. The procedure is also associated with a statistically significant improvement in quality of life. Level of evidence: III

scholarly journals A cost-utility analysis of apalutamide for metastatic castration-sensitive prostate cancer

2021 ◽  
Vol 16 (3) ◽  
Author(s):  
Ambica Parmar ◽  
Narhari Timilshina ◽  
Urban Emmenegger ◽  
Martin Smoragiewicz ◽  
Beate Sander ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Therapeutic Option ◽  
Lifetime Cost ◽  
Cost Effective ◽  
Cost Utility ◽  
Base Case ◽  
Scenario Analyses ◽  
Life Years

Introduction: Earlier application of oral androgen receptor-axis-targeted therapies in patients with metastatic castration-sensitive prostate cancer (mCSPC) has established improvements in overall survival, as compared to androgen deprivation therapy (ADT) alone. Recently, the use of apalutamide plus ADT has demonstrated improvement in mCSPC-related mortality, vs. ADT alone, with an acceptable toxicity profile. However, the cost-effectiveness of this therapeutic option remains unknown. Methods: We used a state-transition model with probabilistic analysis to compare apalutamide + ADT, as compared to ADT alone for mCSPC patients over a time horizon of 20 years. Primary outcomes included expected life-years (LY), quality-adjusted life-years (QALY), lifetime cost (2020 Canadian dollars), and incremental cost-effectiveness ratio (ICER). Parameter and model uncertainties were assessed through scenario analyses. Health outcomes and cost were discounted at 1.5%, as per Canadian guidelines. Results: For the base-case analysis, expected LY for ADT and apalutamide plus ADT were 4.11 and 5.56, respectively (incremental LY 1.45). Expected QALYs were 3.51 for ADT and 4.84 for apalutamide plus ADT (incremental QALYs 1.33); expected lifetime cost was $36 582 and $255 633, respectively (incremental cost $219,051). ICER for apalutamide plus ADT, as compared to ADT alone, was $164 700/QALY. Through scenario analysis, price reductions >50% were required for apalutamide in combination with ADT to be considered cost-effective, at a cost-effectiveness threshold of $100 000/QALY. Conclusions: Apalutamide plus ADT is unlikely to be cost-effective from the Canadian healthcare perspective unless there are substantial reductions in the price of apalutamide treatment.

scholarly journals Individualized Strategy for Dosing Luteinizing Hormone–Releasing Hormone Agonists for Androgen-Independent Prostate Cancer: Identification of Outcomes and Costs

2006 ◽  
Vol 2 (2) ◽  
pp. 57-66 ◽  
Author(s):  
Jennifer A. Wagmiller ◽  
Jennifer J. Griggs ◽  
Andrew W. Dick ◽  
Deepak M. Sahasrabudhe
Keyword(s):  
Prostate Cancer ◽  
Luteinizing Hormone ◽  
Societal Perspective ◽  
Cost Utility ◽  
Base Case ◽  
Luteinizing Hormone Releasing Hormone ◽  
Releasing Hormone ◽  
Life Years ◽  
Androgen Suppression ◽  
Androgen Independent

Purpose Continuing androgen suppression is the current standard in men with androgen-independent prostate cancer (AIPC). An individualized strategy, wherein luteinizing hormone–releasing hormone agonists (LH-RHas) are redosed when serum testosterone approaches a non-castrate level, may decrease costs without worsening outcomes. To understand possible outcomes, we performed a cost-utility analysis comparing individualized and fixed LH-RHa dosing strategies in men with AIPC. Methods The model used a societal perspective, a 5-year time horizon, and 3% annual cost discounting. The model accounted for direct costs of androgen suppression. Utilities were varied in accordance with published preference data. Results Under base-case assumptions, individualized LH-RHa dosing yielded 1.089 expected quality-adjusted life years (QALYs), compared with 1.094 expected QALYs for fixed LH-RHa dosing. In cost analysis, lifetime per-patient costs for androgen suppression were estimated to be $5,694 for individualized LH-RHa dosing and $9,157 for fixed LH-RHa dosing. Applied to the total population, a strategy of individualized LH-RHa dosing would cost $170 million for androgen suppression, compared with $274 million for fixed LH-RHa dosing. Under these assumptions, adopting the individualized strategy resulted in $692,600 gained from a societal perspective for each QALY lost (the decremental cost utility). Conclusion The results suggest that an individualized LH-RHa dosing strategy would be associated with moderate savings on an individual basis but substantial savings on a population basis, and would not adversely affect quality of life or life expectancy. Further research is needed to establish the effects of this strategy on symptoms and survival, as well as patient satisfaction and true costs.

scholarly journals Economic evaluation of robot-assisted radical prostatectomy compared to open radical prostatectomy for prostate cancer treatment in Ontario, Canada

2020 ◽  
Vol 14 (8) ◽  
Author(s):  
Anna Parackal ◽  
Jean-Eric Tarride ◽  
Feng Xie ◽  
Gord Blackhouse ◽  
Jennifer Hoogenes ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Radical Prostatectomy ◽  
Time Horizon ◽  
Cost Effective ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Base Case ◽  
Robot Assisted ◽  
Open Radical Prostatectomy ◽  
Life Years

Introduction: Recent health technology assessments (HTAs) of robot-assisted radical prostatectomy (RARP) in Ontario and Alberta, Canada, resulted in opposite recommendations, calling into question whether benefits of RARP offset the upfront investment. Therefore, the study objectives were to conduct a cost-utility analysis from a Canadian public payer perspective to determine the cost-effectiveness of RARP. Methods: Using a 10-year time horizon, a five-state Markov model was developed to compare RARP to open radical prostatectomy (ORP). Clinical parameters were derived from Canadian observational studies and a recently published systematic review. Costs, resource utilization, and utility values from recent Canadian sources were used to populate the model. Results were presented in terms of increment costs per quality-adjusted life years (QALYs) gained. A probabilistic analysis was conducted, and uncertainty was represented using cost-effectiveness acceptability curves (CEACs). One-way sensitivity analyses were also conducted. Future costs and QALYs were discounted at 1.5%. Results: Total cost of RARP and ORP were $47 033 and $45 332, respectively. Total estimated QALYs were 7.2047 and 7.1385 for RARP and ORP, respectively. The estimated incremental cost-utility ratio (ICUR) was $25 704 in the base-case analysis. At a willingness-to-pay threshold of $50 000 and $100 000 per QALY gained, the probability of RARP being cost-effective was 0.65 and 0.85, respectively. The model was most sensitive to the time horizon. Conclusions: The results of this analysis suggest that RARP is likely to be cost-effective in this Canadian patient population. The results are consistent with Alberta’s HTA recommendation and other economic evaluations, but challenges Ontario’s reimbursement decision.

Androgen suppression of advanced prostate cancer: intermittent or continuous therapy?

2001 ◽  
Vol 37 ◽  
pp. S218 ◽  
Author(s):  
E.M.C. Schasfoort ◽  
P. Heathcote ◽  
M.T.W.T. Lock ◽  
M. Zerbib ◽  
D.W.W. Newling
Keyword(s):  
Prostate Cancer ◽  
Advanced Prostate Cancer ◽  
Continuous Therapy ◽  
Androgen Suppression

Ixazomib (IXA), carfilzomib (CAR), elotuzumab (ELO) or daratumumab (DAR) with lenalidomide and dexamethasone (LEN+DEX) versus LEN+DEX only in relapsed/refractory multiple myeloma (R/R MM): A comparative cost-effectiveness analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 8043-8043
Author(s):  
Mavis Obeng-Kusi ◽  
Daniel Arku ◽  
Neda Alrawashdh ◽  
Briana Choi ◽  
Nimer S. Alkhatib ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Effectiveness Analysis ◽  
The Other ◽  
Sensitivity Analyses ◽  
Treatment Comparison ◽  
Comparative Cost ◽  
Effectiveness Analysis ◽  
Life Years

8043 Background: IXA, CAR, ELO and DARin combination with LEN+DEXhave been found superior in efficacy compared to LEN+DEX in the management of R/R MM. Applying indirect treatment comparisons from a network meta-analysis (NMA), this economic evaluation aimed to estimate the comparative cost-effectiveness and cost-utility of these four triplet regimens in terms of progression-free survival (PFS). Methods: In the absence of direct treatment comparison from a single clinical trial, NMA was used to indirectly estimate the comparative PFS benefit of each regimen. A 2-state Markov model simulating the health outcomes and costs was used to evaluate PFS life years (LY) and quality-adjusted life years (QALY) with the triplet regimens over LEN+DEX and expressed as the incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR). Probability sensitivity analyses were conducted to assess the influence of parameter uncertainty on the model. Results: The NMA revealed that DAR+LEN+DEX was superior to the other triplet therapies, which did not differ statistically amongst them. As detailed in the Table, in our cost-effectiveness analysis, all 4 triplet regimens were associated with increased PFSLY and PFSQALY gained (g) over LEN+DEX at an additional cost. DAR+LEN+DEX emerged the most cost-effective with ICER and ICUR of $667,652/PFSLYg and $813,322/PFSQALYg, respectively. The highest probability of cost-effectiveness occurred at a willingness-to-pay threshold of $1,040,000/QALYg. Conclusions: Our economic analysis shows that all the triplet regimens were more expensive than LEN +DEX only but were also more effective with respect to PFSLY and PFSQALY gained. Relative to the other regimens, the daratumumab regimen was the most cost-effective.[Table: see text]

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