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Xu R, Li S, Mu T, Xie X, Xu C, Lv X. Substantial Increase in Accessibility to Essential Anticancer Medicines in Anhui, China: A Longitudinal Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231151783. [PMID: 36722617 PMCID: PMC9893346 DOI: 10.1177/00469580231151783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The study aimed to evaluate the change in accessibility of essential anticancer medicines, from 2015 to 2018 in a pilot province for health care reform in China. Data on access to 23 essential anticancer medicines was obtained from 6 provincial tertiary hospitals. A comprehensive analysis was applied to explore these trends. The total utilization of anticancer medicines had increased by an average of 2.57 times (P < .001) during the study period, of which targeted anticancer medicines had the fastest growth rate of 6.45 times (P < .001). The prices of all targeted medicines and original brands (OBs) were showing a downward trend, with the average change rate of -32% and -28% respectively (both P < .001). In contrast, the price of non-targeted medicines and lowest-price generics (LPG) increased by an average of 98% (P < .001) and 117% (P < .004) respectively. All targeted anticancer medicines were found to be unaffordable under this standard of this study, but the affordability of these medicines is on the rise. The study suggested positive changes in the utilization, price, and affordability of the most essential anticancer medicines. In the future, comprehensive strategies need to be conducted to further increase the affordability of targeted anticancer medicines.
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Affiliation(s)
- Rixiang Xu
- School of Huamanities and Management,
Zhejiang Chinese Medical University, Zhejiang Province, China,School of pharmacy, Anhui Medical
University, Anhui Province, China
| | - Shuting Li
- School of pharmacy, Anhui Medical
University, Anhui Province, China
| | - Tingyu Mu
- School of Nursing, Zhejiang Chinese
Medical University, Zhejiang Province, China
| | - Xuefeng Xie
- School of pharmacy, Anhui Medical
University, Anhui Province, China
| | - Caiming Xu
- School of Huamanities and Management,
Zhejiang Chinese Medical University, Zhejiang Province, China,School of Law, Zhejiang University City
College, Zhejiang Province, China
| | - Xiongwen Lv
- School of pharmacy, Anhui Medical
University, Anhui Province, China,Xiongwen Lv, School of Pharmacy, Anhui
Medical University, Hefei 230032 China.
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Smale EM, van Vlijmen B, Colen HBB, van den Heuvel MM, Desar IME, van den Bemt BJF, Bekker CL. Feasibility of an Individualized Dispensing Program for Patients Prescribed Oral Anticancer Drugs to Prevent Waste. JCO Oncol Pract 2023; 19:e618-e629. [PMID: 36626700 DOI: 10.1200/op.22.00553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Waste of oral anticancer drugs (OACDs) causes financial and environmental burdens. This study evaluates the feasibility of an individualized dispensing program to prevent waste of OACDs. METHODS Adult patients were dispensed individualized quantities of niraparib, abiraterone, enzalutamide, ruxolitinib, osimertinib, or imatinib as standard care, during the first 6 months of treatment. The first 50 patients participated in an feasibility evaluation conform five domains of Bowen's Framework. (1) implementation: reach (eligible patients included) and protocol fidelity (executions following protocol) assessed from pharmacy data, (2) acceptability: rated from 1 to 10 and agreement with theoretical framework acceptability domains via a survey among patients and pharmacy technicians, (3) practicality: program's costs, (4) effect: compared with previous practice (full package supply per month), defined as difference in unused OACD unit doses and net cost-savings, and (5) demand: potential scale-up of the program by including more OACDs. RESULTS Participants' median age was 67 (interquartile range [IQR], 58-71) years, and 76% was male. (1) Implementation: reach and protocol fidelity were 89% and 90%, respectively. (2) Acceptability was high among patients (median, 9; IQR, 8-9) and pharmacy technicians (median, 7; IQR, 6-8). All acceptability domains were agreed on. (3) Practicality: program costs were €4,289. (4) Effect: unused OACD unit doses were reduced by 34%, causing net cost-savings of €693 per discontinued patient. (5) Demand: the program could be scaled up to seven times by including all OACDs. CONCLUSION Individualized dispensing for patients prescribed OACDs is feasible for preventing waste in terms of implementation, acceptability, practicality, effect, and demand.
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Affiliation(s)
- Elisabeth M Smale
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Bas van Vlijmen
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Hadewig B B Colen
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Michel M van den Heuvel
- Department of Pulmonary Diseases, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Nijmegen, the Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Department of Pharmacy, Sint Maartenskliniek, Ubbergen, the Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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Davidoff AJ, Akif K, Halpern MT. Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature. J Natl Cancer Inst Monogr 2022; 2022:12-20. [PMID: 35788372 DOI: 10.1093/jncimonographs/lgac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/21/2022] [Indexed: 01/16/2023] Open
Abstract
We reviewed current literature reviews regarding economics of cancer-related health care to identify focus areas and gaps. We searched PubMed for systematic and other reviews with the Medical Subject Headings "neoplasms" and "economics" published between January 1, 2010, and April 1, 2020, identifying 164 reviews. Review characteristics were abstracted and described. The majority (70.7%) of reviews focused on cost-effectiveness or cost-utility analyses. Few reviews addressed other types of cancer health economic studies. More than two-thirds of the reviews examined cancer treatments, followed by screening (15.9%) and survivorship or end-of-life (13.4%). The plurality of reviews (28.7%) cut across cancer site, followed by breast (20.7%), colorectal (11.6%), and gynecologic (8.5%) cancers. Specific topics addressed cancer screening modalities, novel therapies, pain management, or exercise interventions during survivorship. The results indicate that reviews do not regularly cover other phases of care or topics including financial hardship, policy, and measurement and methods.
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Affiliation(s)
- Amy J Davidoff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kaitlin Akif
- Office of the Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michael T Halpern
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Yue X, Hincapie AL, Li Y, Guo JJ. Safety and cost-effectiveness of ponatinib versus other tyrosine kinase inhibitors as second-line therapy in patients with chronic myeloid leukemia in the United States. Leuk Lymphoma 2021; 63:946-954. [PMID: 34775888 DOI: 10.1080/10428194.2021.2002320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To evaluate the cost-effectiveness of ponatinib compared with second-line TKIs in the treatment of adult patients with CML who failed, or were intolerant to, first-line TKIs. A Markov state transition model was conducted. Model transition, adverse-effect probabilities, utility data and medical costs were obtained from clinical trials and literature. Measurements included medications, follow-ups, adverse events, allogeneic stem cell transplantation and quality-adjusted life years (QALYs). Univariable and Bayesian multivariable probabilistic sensitivity analyses were conducted using Monte Carlo simulations. Dasatinib resulted in an ICER of $79,086/QALY compared to nilotinib. Ponatinib yielded an ICER of $176,278/QALY and $141,563/QALY compared to dasatinib and nilotinib, respectively. Dasatinib was the optimal treatment at a $100,000/QALY threshold. The probability (36%-40%) for ponatinib or dasatinib optimal treatment was associated with thresholds of $160,000-$180,000/QALY. Dasatinib and ponatinib can be considered cost-effective options and provide clinical benefits compared to other second-line TKIs for CML in the US.
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Affiliation(s)
- Xiaomeng Yue
- The James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ana L Hincapie
- The James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA
| | - Yuxiang Li
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeff J Guo
- The James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA
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van Dyk M, Bulamu N, Boylan C, Mc Laughlin AM, Kichenadasse G, May N, Michelet R, Kloft C, Kaambwa B. Cost-effectiveness of oral anticancer drugs and associated individualised dosing approaches in patients with cancer: protocol for a systematic review. BMJ Open 2021; 11:e047173. [PMID: 34404700 PMCID: PMC8372804 DOI: 10.1136/bmjopen-2020-047173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Oral anticancer drugs (OADs) have rapidly expanded with more than 70 OADs targeting several molecular targets. Many of the OADs exert an exposure-response relationship but still, a 'one-size fits-all' dose is used, ignoring interindividual variability. Several of these OADs share similar mechanisms of actions and thus target the same cancer and has resulted in a substantial research focus on comparing the health benefit of each. However, significantly less is known about the cost-benefit associated with OADs. This paper will provide a protocol to systematically review studies that have evaluated the cost-effectiveness of OADs and their associated individualised dosing interventions. METHODS AND ANALYSIS Systematic review methodology will be applied to identify, select and extract data from published economic evaluation (costs and outcomes/benefits) studies of OADs and their associated individualised dosing interventions. Bibliographic databases (eg, Ovid EMBASE, Ovid MEDLINE) will be used to perform the systematic literature search (between 1 January 2000 and October 2020). Only full economic evaluations will be included, but no restrictions on study outcomes will be applied. The quality of included primary studies will be assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist for reporting economic evaluations. Studies with low-quality evidence will be excluded. A narrative synthesis of the results from the included studies will be undertaken, with a subgroup analysis where appropriate. ETHICS AND DISSEMINATION This systematic review will not require ethics approval as there will not be any collection of primary data. Findings of this review will be disseminated through publications in peer-reviewed journals, presentations at workshops or conferences and sharing through a media release. Findings from this review will provide evidence to direct and inform policy-makers where cost-neutral strategies may be effective or where dose individualising strategies may be economically beneficial. Additionally, gaps will be identified in the current literature to inform future-related research. PROSPERO REGISTRATION NUMBER CRD42020218170. ELECTRONIC SUPPLEMENTAL MATERIAL The online version of this article contains supplemental material, which is available to authorised users.
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Affiliation(s)
- Madelé van Dyk
- Flinders Health & Medical Research Institute- Cancer, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
- Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
| | - Norma Bulamu
- Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
- Health Economics, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
| | - Chelsea Boylan
- Flinders Health & Medical Research Institute- Cancer, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
- Flinders Centre for Innovation in Cancer, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
| | - Anna M Mc Laughlin
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
- Postdam/Berlin, PharMetrX Graduate Research Training Program, Postdam/Berlin, Germany
| | - Ganessan Kichenadasse
- Flinders Health & Medical Research Institute- Cancer, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
- Medical Oncology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Nikki May
- SA Health Library Service, Bedford Park, South Australia, Australia
| | - Robin Michelet
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
- PharMetrX Graduate Research Training Program, Postdam/Berlin, Germany
| | - Charlotte Kloft
- Department of Clinical Pharmacy and Biochemistry, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
- PharMetrX Graduate Research Training Program, Postdam/Berlin, Germany
| | - Billingsley Kaambwa
- Health Economics, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
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Efficacy and cost analysis of eltrombopag in thrombocytopenia and poor graft function post allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2021; 56:2471-2476. [PMID: 34108675 DOI: 10.1038/s41409-021-01362-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/09/2021] [Accepted: 05/18/2021] [Indexed: 11/08/2022]
Abstract
Eltrombopag has shown efficacy in the treatment of thrombocytopenia and poor graft function (PGF) after allogeneic hematopoietic cell transplantation (HCT) in retrospective observational studies, but is not approved for this indication. The cost of this drug is also a major concern in publicly funded health care systems. We collected data about patients who received eltrombopag for thrombocytopenia or PGF after HCT. Post-HCT thrombocytopenia, PGF, and eltrombopag response were defined as per previously published criteria. Primary outcome was treatment efficacy and secondary outcome was cost comparison between estimated treatment cost prior to and after initiation of eltrombopag. Seventeen patients (males 70.6%; median age = 58) received eltrombopag. Isolated thrombocytopenia was present in 11.8% (n = 2) patients while PGF was present in 88.2% (n = 15) of patients. After 8 weeks of treatment at the maximum dose of 150 mg orally daily, overall response rate (ORR) was seen in 76.5% (13/17) of patients: complete response (CR) in 10/13 patients and partial response (PR) in 3/13 patients. The use of eltrombopag was associated with an overall decrease in the total weekly care costs (5021 vs 2,524 CA$; P = 0.04). Thus, Eltrombopag is an efficacious and possibly cost-effective therapy for thrombocytopenia and PGF after allogeneic HCT.
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Long noncoding RNA KTN1 antisense RNA 1exerts an oncogenic function in lung adenocarcinoma by regulating DEP domain containing 1 expression via activating epithelial-mesenchymal transition. Anticancer Drugs 2021; 32:614-625. [PMID: 33491970 DOI: 10.1097/cad.0000000000001035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Long noncoding RNA (lncRNA) KTN1 antisense RNA 1 (KTN1-AS1) is a novel promoter in the progression of some cancers. However, the knowledge of its role in lung adenocarcinoma is still limited. The current study aimed to examine the biological functions of KTN1-AS1 and its coexpressed protein in lung adenocarcinoma. The RNA sequencing expression profiles from The Cancer Genome Atlas (TCGA) database were downloaded to evaluate the expression of KTN1-AS1 and its coexpressed protein, as well as assess their prognostic values. The correlation between DEP domain containing 1 (DEPDC1) and KTN1-AS1 levels was verified using Pearson's correlation coefficient. Real-time qPCR and western blot were adopted to determine the mRNA and protein levels of the corresponding molecules. Cell viability, invasiveness and motility were assayed by cell counting kit-8, clone formation and Transwell assays, appropriately. High levels of KTN1-AS1 were observed and led to a poorer prognosis in lung adenocarcinoma patients, according to the public dataset. DEPDC1 was found to be a downstream protein associated with KTN1-AS1. Moreover, DEPDC1 was also upregulated in lung adenocarcinoma tissues and can be seen as an independent prognosticator for patients with lung adenocarcinoma. Besides, DEPDC1 expression was positively correlated with KTN1-AS1 expression, which was verified by real-time qPCR and western blot. Functional experiments indicated that KTN1-AS1-knockdown inhibited cells proliferation, migration and invasion, whereas DEPDC1-overexpression could diminish this inhibition. Conversely, overexpression of KTN1-AS1 presented a promoting effect on these phenotypes, whereas silencing DEPDC1 could reduce these accelerations. Further evidence supported that KTN1-AS1/DEPDC1 plays the carcinogenic role by activating the epithelial-mesenchymal transition process and elevating MMP9 expression in lung adenocarcinoma cells. These data suggested that the KTN1-AS1/DEPDC1 axis may involve in the tumorigenesis in lung adenocarcinoma by activating the epithelial-mesenchymal transition process.
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Jiang DM, Chan KKW, Jang RW, Booth C, Liu G, Amir E, Mason R, Everest L, Elimova E. Anticancer drugs approved by the Food and Drug Administration for gastrointestinal malignancies: Clinical benefit and price considerations. Cancer Med 2019; 8:1584-1593. [PMID: 30848108 PMCID: PMC6488126 DOI: 10.1002/cam4.2058] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The cost of new anticancer drugs is rising. We aimed to assess the clinical benefit and price of anti-cancer drugs approved by the US Food and Drug Administration (FDA) for advanced gastrointestinal cancers. METHODS Drugs approved between 2006 and 2017 for advanced GI malignancies were identified from FDA.gov, and their updated supporting trial data were searched. Incremental clinical benefit was quantified by using ESMO Magnitude of Clinical Benefit Scale version 1.1 (grade 0-5) and ASCO Value Framework version 2 (score range -20 to 180). Higher scores indicate larger net benefit, and substantial benefit was defined as score 4 or 5 by the European Society for Medical Oncology (ESMO). The Micromedex REDBOOK was used to estimate the monthly average wholesale price (AWP) and total drug price (TDP) over the median treatment duration per patient. Clinical benefit, AWP and TDP of each drug class were assessed. RESULTS In total, 16 GI cancer drugs received FDA approval for 24 indications, including five monoclonal antibodies (mAbs), five oral targeted therapies (TT), two immunotherapeutics (IO), three cytotoxic chemotherapies (CT), and one recombinant fusion protein (aflibercept). Most supporting trials (82%) reported overall survival benefit of less than 3 months and no significant improvement in quality of life. Only five agents (including one TT and one IO) with 21% the of approved indications met the ESMO's threshold of substantial clinical benefit. Median incremental benefit scores of TT and IO were comparable to other drug classes. However their median TDP was much higher at $153 402 and $98 208, respectively, compared to $30 330 USD per patient for CT. The estimated TDP did not correlate with clinical benefit scores. CONCLUSION Most FDA-approved gastrointestinal cancer drugs do not meet the ESMO threshold of substantial clinical benefit. TT and IO are estimated to carry significant drug costs, and further cost analysis of these drugs is urgently needed.
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Affiliation(s)
- Di Maria Jiang
- Division of Medical Oncology, Princess Margaret Cancer CentreUniversity Health Network, University of TorontoTorontoCanada
| | - Kelvin K. W. Chan
- Division of Medical Oncology & Hematology, Odette Cancer Centre, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
- Canadian Centre for Applied Research in Cancer ControlTorontoCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
| | - Raymond W. Jang
- Division of Medical Oncology, Princess Margaret Cancer CentreUniversity Health Network, University of TorontoTorontoCanada
| | - Christopher Booth
- Department of OncologyQueen’s UniversityKingstonOntarioCanada
- Division of Cancer Care and EpidemiologyQueen’s Cancer Research InstituteKingstonOntarioCanada
| | - Geoffrey Liu
- Division of Medical Oncology, Princess Margaret Cancer CentreUniversity Health Network, University of TorontoTorontoCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
| | - Eitan Amir
- Division of Medical Oncology, Princess Margaret Cancer CentreUniversity Health Network, University of TorontoTorontoCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
| | - Robert Mason
- Division of Medical Oncology & Hematology, Odette Cancer Centre, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
| | - Louis Everest
- Division of Medical Oncology & Hematology, Odette Cancer Centre, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
| | - Elena Elimova
- Division of Medical Oncology, Princess Margaret Cancer CentreUniversity Health Network, University of TorontoTorontoCanada
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Crawford SY, Boyd AD, Nayak AK, Venepalli NK, Cuellar S, Wirth SM, Hsu GIH. Patient-centered design in developing a mobile application for oral anticancer medications. J Am Pharm Assoc (2003) 2019; 59:S86-S95.e1. [PMID: 30745188 DOI: 10.1016/j.japh.2018.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/28/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To develop and test the usability and feasibility of a customizable mobile application (app) designed to help educate patients about their oral anticancer medications (OAMs) and regimens. SETTING Outpatient cancer center and oncology pharmacy for urban, Midwestern academic health system. PRACTICE DESCRIPTION Clinically-supervised educational intervention to support patients learning about OAMs. PRACTICE INNOVATION With input from patient partners, our interdisciplinary team designed the first known tablet-based educational app that can interface with a patient's electronic medical record. The app is based on learning style and adherence theories and is customizable for individually prescribed OAMs. The app can accommodate multiple learning styles through text at 6th-grade reading level, pictures, animations, and audio voiceovers. Functionalities include interactive educational modules on 11 OAMs and case-based patient stories on common barriers to OAM adherence. EVALUATION Early phase testing provided the opportunity to observe the user interface with the app and app functionality. Data were summarized descriptively from observations and comments of patient subjects. RESULTS Thirty patient subjects provided input-19 in phase 1 usability testing and 11 in phase 2 feasibility testing. Comments provided by patient subjects during usability testing were largely positive. Responses included self-identification with patient stories, usefulness of drug information, preferences for text messages, and app limitations (e.g., perceived generational digital divide in technology use and potential patient inability to receive text messages). Using their feedback, modifications were made to the prototype app. Responses in feasibility testing demonstrated the app's usefulness across a wide range of ages. Highest opinion ratings on app usefulness were stated by patients who were newer to OAM therapy. CONCLUSION User feedback suggests the potential benefit of the app as a tool to help patients with cancer, particularly after the first months for those starting new OAM regimens. Processes and lessons learned are transferable to other settings.
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Shelby RA, Dorfman CS, Bosworth HB, Keefe F, Sutton L, Owen L, Corsino L, Erkanli A, Reed SD, Arthur SS, Somers T, Barrett N, Huettel S, Gonzalez JM, Kimmick G. Testing a behavioral intervention to improve adherence to adjuvant endocrine therapy (AET). Contemp Clin Trials 2019; 76:120-131. [PMID: 30472215 PMCID: PMC6346744 DOI: 10.1016/j.cct.2018.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 02/01/2023]
Abstract
Adjuvant endocrine therapy (AET) is used to prevent recurrence and reduce mortality for women with hormone receptor positive breast cancer. Poor adherence to AET is a significant problem and contributes to increased medical costs and mortality. A variety of problematic symptoms associated with AET are related to non-adherence and early discontinuation of treatment. The goal of this study is to test a novel, telephone-based coping skills training that teaches patients adherence skills and techniques for coping with problematic symptoms (CST-AET). Adherence to AET will be assessed in real-time for 18 months using wireless smart pill bottles. Symptom interference (i.e., pain, vasomotor symptoms, sleep problems, vaginal dryness) and cost-effectiveness of the intervention protocol will be examined as secondary outcomes. Participants (N = 400) will be recruited from a tertiary care medical center or community clinics in medically underserved or rural areas. Participants will be randomized to receive CST-AET or a general health education intervention (comparison condition). CST-AET includes ten nurse-delivered calls delivered over 6 months. CST-AET provides systematic training in coping skills for managing symptoms that interfere with adherence. Interactive voice messaging provides reinforcement for skills use and adherence that is tailored based on real-time adherence data from the wireless smart pill bottles. Given the high rates of non-adherence and recent recommendations that women remain on AET for 10 years, we describe a timely trial. If effective, the CST-AET protocol may not only reduce the burden of AET use but also lead to cost-effective changes in clinical care and improve breast cancer outcomes. Trials registration: ClinicalTrials.gov, NCT02707471, registered 3/3/2016.
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Affiliation(s)
- Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Hayden B Bosworth
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States; Department of Population Health Sciences, Duke University, Durham, NC, United States; Department of Medicine, Duke University, Durham, NC, United States.
| | - Francis Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Linda Sutton
- Duke Cancer Network, Duke University, Durham, NC, United States.
| | - Lynda Owen
- Duke Cancer Network, Duke University, Durham, NC, United States.
| | - Leonor Corsino
- Division of Endocrinology, Duke University, Durham, NC, United States.
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States.
| | - Shelby D Reed
- Department of Population Health Sciences, Duke University, Durham, NC, United States; Department of Medicine, Duke University, Durham, NC, United States.
| | - Sarah S Arthur
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Tamara Somers
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
| | - Nadine Barrett
- Office of Health Equity and Disparities, Duke Cancer Institute, Duke University, Durham, NC, United States.
| | - Scott Huettel
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States.
| | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University, Durham, NC, United States.
| | - Gretchen Kimmick
- Division of Medical Oncology, Duke University, Durham, NC, United States.
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Vergnenègre A, Chouaïd C. Review of economic analyses of treatment for non-small-cell lung cancer (NSCLC). Expert Rev Pharmacoecon Outcomes Res 2018; 18:519-528. [PMID: 29869900 DOI: 10.1080/14737167.2018.1485099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION During the past few years, medical-economic evaluation of lung cancers (LCs) has become unavoidable. Total management costs have been rising constantly, with values almost doubling every 10 years. The financial impact will be even greater with the new molecules now marketed. The methodology for these studies conforms with international recommendations but must be adapted to the new stakes of LC management. AREAS COVERED This review provides an overview of the available literature concerning the economics of treating non-small-cell lung cancer (NSCLC). We first address the global costs of LCs. Detailed analyses were then computed for the different LC stages: localized, locally advanced and metastatic. For metastatic NSCLC, subsections are devoted to targeted therapies and immunotherapies. EXPERT COMMENTARY Drug costs are one of the major challenges of LC management. The multiplication of medical-economic analyses will assure better access to the marketing of these new and expensive therapeutic agents, but also to the selection of the best management strategy for these cancers.
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Affiliation(s)
- Alain Vergnenègre
- a Unité d'Oncologie Thoracique et Cutanée , Hôpital Dupuytren , Limoges , France
| | - Christos Chouaïd
- b Service de Pathologie Respiratoire , Centre Hospitalier Intercommunal de Créteil , Créteil , France
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Adherence to Oral Anticancer Medications: Evolving Interprofessional Roles and Pharmacist Workforce Considerations. PHARMACY 2018. [PMID: 29518017 PMCID: PMC5874562 DOI: 10.3390/pharmacy6010023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Interprofessional care is exhibited in outpatient oncology practices where practitioners from a myriad of specialties (e.g., oncology, nursing, pharmacy, health informatics and others) work collectively with patients to enhance therapeutic outcomes and minimize adverse effects. Historically, most ambulatory-based anticancer medication therapies have been administrated in infusion clinics or physician offices. Oral anticancer medications (OAMs) have become increasingly prevalent and preferred by patients for use in residential or other non-clinic settings. Self-administration of OAMs represents a significant shift in the management of cancer care and role responsibilities for patients and clinicians. While patients have a greater sense of empowerment and convenience when taking OAMs, adherence is a greater challenge than with intravenous therapies. This paper proposes use of a qualitative systems evaluation, based on theoretical frameworks for interdisciplinary team collaboration and systems science, to examine the social interactionism involved with the use of intravenous anticancer treatments and OAMs (as treatment technologies) by describing patient, organizational, and social systems considerations in communication, care, control, and context (i.e., Kaplan’s 4Cs). This conceptualization can help the healthcare system prepare for substantial workforce changes in cancer management, including increased utilization of oncology pharmacists.
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Oral Chemotherapy in Patients with Hematological Malignancies-Care Process, Pharmacoeconomic and Policy Implications. Curr Hematol Malig Rep 2017; 11:288-94. [PMID: 27086140 DOI: 10.1007/s11899-016-0325-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with hematologic malignancies are increasing being prescribed oral anticancer medications (OAMs) and/or biologics. These newer targeted OAMs are associated with a host of practical and pharmacoeconomic implications for patients and healthcare providers. Issues such as safety, procurement challenges, and the need for proactive involvement of all stakeholders to optimize adherence for successful use of these agents are increasingly being recognized. The current reactive model is negatively impacting the patient experience through delays in care, financial toxicity, and decreased safety. It also impacts the healthcare providers in the form of lost revenue and staff burnout due to labor-intensive procurement and patient financial assistance burdens. In this review, we describe some of the issues identified and discuss potential strategies to improve patient access, minimize healthcare burden, and review current policy initiatives and patient advocacy efforts to reduce financial toxicity.
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Seal BS, Anderson S, Shermock KM. Factors Associated with Adherence Rates for Oral and Intravenous Anticancer Therapy in Commercially Insured Patients with Metastatic Colon Cancer. J Manag Care Spec Pharm 2016; 22:227-35. [PMID: 27003552 PMCID: PMC10397912 DOI: 10.18553/jmcp.2016.22.3.227] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Over the past decade, oncology therapies have trended toward orally administered regimens, and there has been growing attention on evaluation of factors that affect adherence. There has not been a rigorous investigation of factors associated with adherence to intravenous (i.v.) and oral anticancer drugs in the setting of metastatic colorectal cancer (mCRC). OBJECTIVES To (a) assess potential patient-specific factors related to adherence to mCRC chemotherapy regimens and (b) compare adherence with IV versus oral dosage forms. METHODS A retrospective analysis was performed using the Optum Oncology Management claims database. Patients aged 18 years and older diagnosed with mCRC between July 1, 2004, and December 31, 2010, who were insured by a commercial health plan were included in the study. Adherence to i.v. and oral chemotherapy regimens was assessed using the National Comprehensive Cancer Network (NCCN) guidelines as the standard for expected cycle/regimen duration. The most commonly prescribed chemotherapy regimens were assessed. Adherence was evaluated using the medication possession ratio (MPR), calculated as the number of days a patient was covered by their chemotherapy regimen, according to NCCN guidelines, divided by the number of days elapsed from the first to the last infusion of that regimen. For most analyses, the MPR was considered a continuous variable that could take on values between 0 and 1. In other analyses, a dichotomous categorical variable designated if the MPR was at least 0.8 versus less than 0.8. The Wilcoxon rank sum, Kruskal-Wallis, and Student's t-test were used to detect differences in continuous measures between patients receiving oral capecitabine therapy versus i.v. chemotherapy. The chi square test (X(2) test) or Fisher's exact test was used to assess differences in the dichotomous MPR variable. Generalized estimating equation (GEE) models were used for regimen-level analyses to account for correlated responses within individuals. RESULTS A total of 6,780 patients were included in the analysis, virtually all (98%) with commercial insurance coverage and the remaining (2%) with Medicare Advantage. Patients with mCRC received 17,095 regimens of chemotherapy, including 2,252 regimens of oral capecitabine. Of the 17,095 regimens, 6,780 (40%) were first-line regimens (i.e., the first time mCRC was treated for a given patient). The most common chemotherapy regimen, regardless of line of therapy, was FOLFOX (2,991 regimens, 17.5% of all regimens used). FOLFOX-based therapies with or without bevacizumab were the most common regimens for first- and second-line chemotherapy, while oral capecitabine treatment was the most commonly prescribed regimen for patients in third- or fourth-line therapy. Overall, medication adherence across all regimens was relatively high, with a mean MPR of 0.87 (SD = 0.17). Evaluation of the distribution of i.v. and oral capecitabine regimens revealed that 28% of all regimens were associated with an MPR of less than 0.8. The average MPR was clinically similar, but statistically higher for i.v. chemotherapy regimens (0.881) compared with oral capecitabine regimens (0.799; P < 0.0001). In the multivariable GEE model, lung or liver metastases were associated with a higher MPR, while lower Charlson Comorbidity Index and oral anticancer therapy were associated with lower MPR. Furthermore, as line of therapy increased, the difference in MPR between patients receiving oral capecitabine and i.v. chemotherapy increased. CONCLUSIONS This analysis determined that adherence with i.v. chemotherapy regimens was clinically similar, but statistically higher, compared to oral capecitabine therapy. The difference in adherence rates between the 2 routes of administration increased as the line of anticancer regimen increased. These results suggest that there should be an increased focus on improving adherence rates in patients receiving oral capecitabine.
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Affiliation(s)
- Brian S Seal
- 1 Executive Director, Global Health Outcomes, Takeda Pharmaceutical Company, Boston, Massachussetts
| | - Sibyl Anderson
- 2 Director, U.S. Medical Science/Oncology, Bayer HealthCare Pharmaceuticals, Whippany, New Jersey
| | - Kenneth M Shermock
- 3 Director, Center for Medication Quality and Outcomes, The Johns Hopkins Hospital, Baltimore, Maryland
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15
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Kiesewetter B, Raderer M, Steger GG, Bartsch R, Pirker R, Zöchbauer-Müller S, Prager G, Krainer M, Preusser M, Schmidinger M, Zielinski CC. The European Society for Medical Oncology Magnitude of Clinical Benefit Scale in daily practice: a single institution, real-life experience at the Medical University of Vienna. ESMO Open 2016; 1:e000066. [PMID: 27843624 PMCID: PMC5070236 DOI: 10.1136/esmoopen-2016-000066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/09/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The European Society for Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale (MCBS) has been designed to stratify the therapeutic benefit of a certain drug registered for the treatment of cancer. However, though internally validated, this tool has not yet been evaluated for its feasibility in the daily practice of a major center of medical oncology. METHODS The practicability of the MCBS for advanced oncological diseases at the Clinical Division of Oncology, Medical University of Vienna, which constitutes one of the largest oncological centres in Europe, was analysed in a three-step approach. First, retrospectively collected data were analysed to gain an overview of treatments in regular use. Second, data were scored by using the MCBS. Third, the ensuing results were evaluated within corresponding programme directorships to assess feasibility in a real-life clinical context. RESULTS In the majority of tumour entities, the MCBS results reported earlier are consistent with daily clinical practice. Thus, in metastatic breast cancer or advanced lung cancer, there was a high level of clinical benefit for first-line treatment standards, and these results reflected well real-life experience. However, analyses based on the first version of the MCBS are limited if it comes to salvage treatment in tumour entities in which optimal sequencing of potential treatment options is of major importance, as in metastatic colorectal or renal cell cancer. In contrast to this, it is remarkable that certain novel therapies such as nivolumab assessed for heavily pretreated advanced renal cancer reached the highest level of clinical benefit due to prolongation in survival and a favourable toxicity profile. The MCBS clearly underlines the potential benefit of these compounds. CONCLUSIONS The MCBS is an excellent tool for daily clinical practice of a tertiary referral centre. It supports treatment decisions based on the clinical benefit to be expected from a novel approach such as immunotherapy in as yet untested indications.
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Affiliation(s)
- Barbara Kiesewetter
- Clinical Division of Oncology, Department of Medicine I , Comprehensive Cancer Center, Medical University of Vienna-General Hospital , Vienna , Austria
| | - Markus Raderer
- Clinical Division of Oncology, Department of Medicine I , Comprehensive Cancer Center, Medical University of Vienna-General Hospital , Vienna , Austria
| | - Günther G Steger
- Clinical Division of Oncology, Department of Medicine I , Comprehensive Cancer Center, Medical University of Vienna-General Hospital , Vienna , Austria
| | - Rupert Bartsch
- Clinical Division of Oncology, Department of Medicine I , Comprehensive Cancer Center, Medical University of Vienna-General Hospital , Vienna , Austria
| | - Robert Pirker
- Clinical Division of Oncology, Department of Medicine I , Comprehensive Cancer Center, Medical University of Vienna-General Hospital , Vienna , Austria
| | - Sabine Zöchbauer-Müller
- Clinical Division of Oncology, Department of Medicine I , Comprehensive Cancer Center, Medical University of Vienna-General Hospital , Vienna , Austria
| | - Gerald Prager
- Clinical Division of Oncology, Department of Medicine I , Comprehensive Cancer Center, Medical University of Vienna-General Hospital , Vienna , Austria
| | - Michael Krainer
- Clinical Division of Oncology, Department of Medicine I , Comprehensive Cancer Center, Medical University of Vienna-General Hospital , Vienna , Austria
| | - Matthias Preusser
- Clinical Division of Oncology, Department of Medicine I , Comprehensive Cancer Center, Medical University of Vienna-General Hospital , Vienna , Austria
| | - Manuela Schmidinger
- Clinical Division of Oncology, Department of Medicine I , Comprehensive Cancer Center, Medical University of Vienna-General Hospital , Vienna , Austria
| | - Christoph C Zielinski
- Clinical Division of Oncology, Department of Medicine I , Comprehensive Cancer Center, Medical University of Vienna-General Hospital , Vienna , Austria
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Indole molecules as inhibitors of tubulin polymerization: potential new anticancer agents, an update (2013–2015). Future Med Chem 2016; 8:1291-316. [DOI: 10.4155/fmc-2016-0047] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Discovery of new indole-based tubulin polymerization inhibitors will continue to dominate the synthetic efforts of many medicinal chemists working in the field. The indole ring system is an essential part of several tubulin inhibitors identified in the recent years. The present review article will update the synthesis, anticancer and tubulin inhibition activities of several important new indole classes such as 2-phenylindoles (28, 29 & 30), oxindoles (35 & 38), indole-3-acrylamides (44), indolines (46), aroylindoles (49), carbozoles (75, 76 & 82), azacarbolines (87) and annulated indoles (100–105).
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Lin CY, Fang HY, Feng CL, Li CC, Chien CR. Cost-effectiveness of neoadjuvant concurrent chemoradiotherapy versus esophagectomy for locally advanced esophageal squamous cell carcinoma: A population-based matched case-control study. Thorac Cancer 2015; 7:288-95. [PMID: 27148413 PMCID: PMC4846616 DOI: 10.1111/1759-7714.12326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 09/25/2015] [Indexed: 12/25/2022] Open
Abstract
Background Neoadjuvant concurrent chemoradiotherapy (NCCRT) is often considered for locally‐advanced esophageal squamous cell carcinoma (LA‐ESCC) patients; however, no data regarding the cost‐effectiveness of this treatment is available. Our study aimed to evaluate the cost‐effectiveness of NCCRT versus esophagectomy for LA‐ESCC at population level. Methods We identified LA‐ESCC patients diagnosed within 2008–2009 and treated with either NCCRT or esophagectomy through the Taiwan Cancer Registry. We included potential confounding covariables (age, gender, residency, comorbidity, social‐economic status, disease stage, treating hospital level and surgeon's experience, and the use of endoscopic ultrasound before treatment) and used propensity score (PS) to construct a 1:1 population. The duration of interest was three years within the date of diagnosis. Effectiveness was measured as overall survival. We took the payer's perspective and converted the cost to 2014 United States dollars (USD). In sensitivity analysis, we evaluated the potential impact of an unmeasured confounder on the statistical significance of incremental net benefit at suggested willingness‐to‐pay. Results Our study population constituted 150 PS matched subjects. The mean cost (2014 USD) and survival (year) were higher for NCCRT compared with esophagectomy (US$91,460 vs. $75,836 for cost; 2.2 vs. 1.8 for survival) with an estimated incremental cost‐effectiveness ratio of US$39,060/life‐year. Conclusions When compared to esophagectomy, NCCRT is likely to improve survival and is probably more cost‐effective. Cost‐effectiveness results should be interpreted with caution given our results were sensitive to potential unmeasured confounder(s) in sensitivity analysis.
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Affiliation(s)
- Chen-Yuan Lin
- Division of Hematology and Oncology China Medical University Hospital Taichung Taiwan
| | - Hsin-Yuan Fang
- Department of Chest Surgery China Medical University Hospital Taichung Taiwan; School of Medicine College of Medicine China Medical University Taichung Taiwan
| | - Chun-Lung Feng
- Division of Gastroenterology and Hepatology China Medical University Hospital Taichung Taiwan
| | - Chia-Chin Li
- Cancer Center China Medical University Hospital Taichung Taiwan
| | - Chun-Ru Chien
- School of Medicine College of Medicine China Medical University Taichung Taiwan; Department of Radiation Oncology China Medical University Hospital Taichung Taiwan
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Hsia TC, Tu CY, Fang HY, Liang JA, Li CC, Chien CR. Cost and effectiveness of image-guided radiotherapy for non-operated localized lung cancer: a population-based propensity score-matched analysis. J Thorac Dis 2015; 7:1643-9. [PMID: 26543613 DOI: 10.3978/j.issn.2072-1439.2015.09.36] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Image-guided radiotherapy (IGRT) is a novel technology to enhance RT delivery accuracy. However, the clinical effectiveness and cost-effectiveness are less clear. The aim of our study is to compare the cost and effectiveness of conventional fractionated RT for non-operated localized lung cancer delivered with vs. without IGRT via this population-based propensity score (PS) matched analysis. METHODS We identified eligible patients diagnosed within 2007-2010 through a comprehensive population-based database containing cancer, death registries, and reimbursement data in Taiwan. The primary duration of interest (DOI) was 2 years within diagnosis. Effectiveness was measured as survival whereas direct medical cost was measured from the payers' perspective. In supplementary analysis (SA), we estimated the cost-effectiveness in consider of out-of-pocket (OOP) payment and 4 years as DOI. RESULTS Our study population constituted 124 patients. Within 2 years, both the mean cost (2014 USD) and survival (life-year, LY) were higher for IGRT ($60,774 vs. $60,554; 1.43 vs. 1.37). The incremental cost-effectiveness ratio (ICER) when IGRT was compared to non-IGRT was 3,667 (USD/LY). The chance for IGRT to be cost-effective was around 68% & 70% at willingness-to-pay threshold 50,000 USD/LY and 150,000 USD/LY respectively. IGRT remained cost-effective in SA. CONCLUSIONS We provide the first empirical evidence that when compared to non-IGRT, IGRT was potentially cost-effective.
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Affiliation(s)
- Te-Chun Hsia
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan ; 2 Department of Respiratory Therapy, College of Health Care, 3 School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan ; 4 Department of Chest Surgery, 5 Department of Radiation Oncology, 6 Cancer Center, China Medical University Hospital, Taichung 40402, Taiwan
| | - Chih-Yen Tu
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan ; 2 Department of Respiratory Therapy, College of Health Care, 3 School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan ; 4 Department of Chest Surgery, 5 Department of Radiation Oncology, 6 Cancer Center, China Medical University Hospital, Taichung 40402, Taiwan
| | - Hsin-Yuan Fang
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan ; 2 Department of Respiratory Therapy, College of Health Care, 3 School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan ; 4 Department of Chest Surgery, 5 Department of Radiation Oncology, 6 Cancer Center, China Medical University Hospital, Taichung 40402, Taiwan
| | - Ji-An Liang
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan ; 2 Department of Respiratory Therapy, College of Health Care, 3 School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan ; 4 Department of Chest Surgery, 5 Department of Radiation Oncology, 6 Cancer Center, China Medical University Hospital, Taichung 40402, Taiwan
| | - Chia-Chin Li
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan ; 2 Department of Respiratory Therapy, College of Health Care, 3 School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan ; 4 Department of Chest Surgery, 5 Department of Radiation Oncology, 6 Cancer Center, China Medical University Hospital, Taichung 40402, Taiwan
| | - Chun-Ru Chien
- 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40402, Taiwan ; 2 Department of Respiratory Therapy, College of Health Care, 3 School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan ; 4 Department of Chest Surgery, 5 Department of Radiation Oncology, 6 Cancer Center, China Medical University Hospital, Taichung 40402, Taiwan
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Poonawalla IB, Parikh RC, Du XL, VonVille HM, Lairson DR. Cost Effectiveness of Chemotherapeutic Agents and Targeted Biologics in Ovarian Cancer: A Systematic Review. PHARMACOECONOMICS 2015; 33:1155-1185. [PMID: 26072142 DOI: 10.1007/s40273-015-0304-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Adjuvant chemotherapy is a key component of advanced ovarian cancer treatment, when surgery alone is not sufficient. Recurrence is common in ovarian cancer patients and most women require prolonged second-line and higher-line chemotherapy. With newer targeted therapies, modest improvements in survival and quality of life may be attained at substantial cost, but the relative economic efficiency of these newer agents remains unknown. OBJECTIVE We undertook this systematic review to comprehensively evaluate the cost-effectiveness of various chemotherapeutic and targeted therapy alternatives for ovarian cancer. METHODS We searched Medline, PubMed, and Embase databases to identify economic evaluations published over the last 18 years (1996-2014). From the 2513 unique papers retrieved, 74 full texts were selected for full-text review based on a priori eligibility criteria. Two authors independently reviewed these articles to determine eligibility for final review. The quality of the included studies was assessed using the Quality of Health Economic Studies (QHES). RESULTS A total of 28 studies were included for reporting. Administration of intravenous cisplatin-paclitaxel combination chemotherapy for first-line treatment was the most cost-effective alternative (2014 US dollars [USD] equivalent incremental cost-effectiveness ratio [ICER] ~US$17,000-US$27,000 per life year gained [LYG]), while the use of bevacizumab did not demonstrate similar value for money (2014 USD equivalent ICER was greater than US$200,000 per quality-adjusted life-year [QALY]). For second-line treatment, the use of platinum-paclitaxel combination or platinum monotherapy was cost-effective compared with platinum monotherapy or best supportive care, respectively, in women with recurrent platinum-sensitive disease. For patients with partial platinum sensitivity, pegylated liposomal doxorubicin (PLD) plus trabectedin may be cost-effective (2014 USD equivalent ICER was ~US$57,000-US$62,000 per QALY) compared with PLD alone. For recurrent platinum-resistant cases, there was limited evidence to conclude the most valuable treatment; though one study showed that best supportive care was most cost-effective, while second-line monotherapy with doxorubicin (2014 USD equivalent ICER was ~US$90,000 per LYG) may also be cost-effective compared with best supportive care. CONCLUSIONS Despite varying methodological approaches and multiple sources for cost and effectiveness inputs, this systematic review demonstrated that standard platinum-taxane combination chemotherapy for first-line treatment was most cost-effective. There was unanimous agreement that bevacizumab was not a cost-effective front-line therapy compared with platinum-taxane combination for the overall ovarian cancer population, though its use in the high-use population may yield better value. For second-line treatment, platinum-based chemotherapy remained cost-effective among patients with recurrent platinum-sensitive disease, while there was limited evidence to conclude the most valuable treatment alternative among patients with recurrent platinum-resistant disease. Future research incorporating real-world data is essential to corroborate findings from trial-based economic evaluations. In addition, for improving consistency in reporting and quality of studies, incorporating QALYs in this population is important, especially since chemotherapy is administered for lengthy periods of time.
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Affiliation(s)
- Insiya B Poonawalla
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rohan C Parikh
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xianglin L Du
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Helena M VonVille
- Library, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David R Lairson
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
- , 1200 Pressler Street, RAS E-307, Houston, TX, 77030, USA.
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Barillet M, Prevost V, Joly F, Clarisse B. Oral antineoplastic agents: how do we care about adherence? Br J Clin Pharmacol 2015; 80:1289-302. [PMID: 26255807 DOI: 10.1111/bcp.12734] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/24/2015] [Accepted: 08/03/2015] [Indexed: 12/30/2022] Open
Abstract
AIMS Oral therapies, including hormone-based or targeted therapies, have recently taken an increasing place in cancer treatment. In this context, a state of the art of the available studies dealing with the adherence of adult patients to oral anticancer treatment is warranted. The purpose of this review is to address (i) the association between assessment methods and measured adherence, (ii) the putative factors related to adherence and (iii) new ways of improving adherence to oral cancer therapies. METHODS We conducted a literature-based narrative review of studies obtained from Pubmed using medical subject heading terms and free-text terms combining concepts related to oral anticancer medication and adherence. RESULTS The analysis is based on 48 studies published since 1990, mostly assessing hormone-based therapy in breast cancer and targeted therapies in chronic myeloid leukaemia. Various methods of adherence were reported including self-report, medication measurement or combinations of methods. Adherence rates were found to vary from 14% to 100%. Beside patient related-factors, adherence rate discrepancies were found to be dependent on the method used. Furthermore, there was no consensual definition of adherence even regarding the same methods, some of them tolerating a period of interruption during the treatment period. Finally, several studies addressing persistence found a progressive decrease in adherence with time. CONCLUSION Adherence to novel oral therapies is a major issue and further research is warranted to standardize adherence assessment in clinical studies better and to define better the most appropriate approaches to improve long term adherence in oncology practice.
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Affiliation(s)
- Marie Barillet
- Centre Hospitalier J Monod, rue Eugène Garnier BP 219, 61104, Flers cedex
| | - Virginie Prevost
- Université de Caen Basse-Normandie EA 3936, Esplanade de la Paix, BP 5186, 14032, Caen Cedex 05.,INSERM U1086, Cancers et Préventions, Avenue de la Côte de Nacre, F-14000, Caen.,Centre Régional de Lutte Contre le Cancer François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - Florence Joly
- Université de Caen Basse-Normandie EA 3936, Esplanade de la Paix, BP 5186, 14032, Caen Cedex 05.,INSERM U1086, Cancers et Préventions, Avenue de la Côte de Nacre, F-14000, Caen.,Centre Régional de Lutte Contre le Cancer François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - Bénédicte Clarisse
- Centre Régional de Lutte Contre le Cancer François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
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Fang HY, Hsiao FY, Huang HC, Lin YS, Chen CY, Shieh SH, Chen PR, Chen CK, Chien CR. Cost and effectiveness of video-assisted thoracoscopic surgery for clinical stage I non-small cell lung cancer: a population-based analysis. J Thorac Dis 2015; 6:1690-6. [PMID: 25589961 DOI: 10.3978/j.issn.2072-1439.2014.10.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/25/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) is a minimally invasive alternative to conventional surgery (CS). We aimed to estimate the short-term cost-effectiveness of VATS vs. CS for clinical stage I non-small cell lung cancer (NSCLC-c-stage-I) patients from the payer's perspective (National Health Insurance). METHODS We identified NSCLC-c-stage-I patients diagnosed and received surgery within 2007-2009 through a comprehensive population-based database containing cancer and death registries, and reimbursement data. The duration of interest was 1 year. We included potential confounding covariables through literature searching and our own experience, and used a propensity score to construct a 1:1 population for adjustment. RESULTS Our study population constituted 966 patients. The mean hospital stay [days, standard deviation (SD)] were 14.4 [7] and 16.1 (7.7) for VATS and CS respectively (P=0.002). The mean cost (2013 USD) and survival (year) was $22,316 vs. $21,976 and 0.98 vs. 0.974 for VATS vs. CS. The probability for VATS to be cost-effective (i.e., positive net benefit) was 0.49 & 0.56 at willingness-to-pay (WTP) 50,000 & 100,000 USD/life-year, respectively. CONCLUSIONS We provide the first empirical evidence that when compared to CS, VATS was potentially cost-effective in the short term (1 year) within the common WTP levels in Taiwan.
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Affiliation(s)
- Hsin-Yuan Fang
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Fei-Yuan Hsiao
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Hsu-Chih Huang
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Sen Lin
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yi Chen
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Shwn-Huey Shieh
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Pin-Ru Chen
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chein-Kuang Chen
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Ru Chien
- 1 Department of Chest Surgery, China Medical University Hospital, Taichung, Taiwan ; 2 School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan ; 3 Graduate Institute of Clinical Pharmacy, College of Medicine, 4 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan ; 5 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan ; 6 Division of Trauma, Emergency Surgery, and Critical Care, China Medical University Hospital, Taichung, Taiwan ; 7 Department of Health Services Administration, College of Health Care, China Medical University, Taichung, Taiwan ; 8 Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
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