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Khoirunnisa SM, Suryanegara FDA, Setiawan D, Postma MJ. Quality-adjusted life years for HER2-positive, early-stage breast cancer using trastuzumab-containing regimens in the context of cost-effectiveness studies: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2024; 24:613-629. [PMID: 38738869 DOI: 10.1080/14737167.2024.2352006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION This study aims to provide a comprehensive assessment of economic and health-related quality of life (HRQoL) outcomes for human epidermal growth factor receptor 2 (HER2)-positive, early-stage breast cancer patients treated with trastuzumab-containing regimens, by focusing on both Incremental Cost-Effectiveness Ratios (ICERs) and quality-adjusted life years (QALYs). METHODS A systematic search was conducted across PubMed, Embase, and Scopus databases without language or publication year restrictions. Two independent reviewers screened eligible studies, extracted data, and assessed methodology and reporting quality using the Drummond checklist and Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022), respectively. Costs were converted to US dollars (US$) for 2023 for cross-study comparison. RESULTS Twenty-two articles, primarily from high-income countries (HICs), were included, with ICERs ranging from US$13,176/QALY to US$254,510/QALY, falling within country-specific cost-effectiveness thresholds. A notable association was observed between higher QALYs and lower ICERs, indicating a favorable cost-effectiveness and health outcome relationship. EQ-5D was the most utilized instrument for assessing health state utility values, with diverse targeted populations. CONCLUSIONS Studies reporting higher QALYs tend to have lower ICERs, indicating a positive relationship between cost-effectiveness and health outcomes. However, challenges such as methodological heterogeneity and transparency in utility valuation persist, underscoring the need for standardized guidelines and collaborative efforts among stakeholders. REGISTRATION PROSPERO ID: CRD42021259826.
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Affiliation(s)
- Sudewi Mukaromah Khoirunnisa
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Institute Science in Healthy Aging and healthcaRE, Groningen, the Netherlands
- Department of Pharmacy, Institut Teknologi Sumatera, Lampung Selatan, Indonesia
| | - Fithria Dyah Ayu Suryanegara
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Institute Science in Healthy Aging and healthcaRE, Groningen, the Netherlands
- Department of Pharmacy, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - Didik Setiawan
- Faculty of Pharmacy, Universitas Muhammadiyah Purwokerto, Banyumas, Indonesia
- Center for Health Economic Studies, Universitas Muhammadiyah Purwokerto, Banyumas, Indonesia
| | - Maarten Jacobus Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Research Institute Science in Healthy Aging and healthcaRE, Groningen, the Netherlands
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, the Netherlands
- Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
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Chen BK, Dunsiger SI, Pinto BM. Cost-effectiveness of peer-delivered physical activity promotion and maintenance programs for initially sedentary breast cancer survivors. Transl Behav Med 2023; 13:683-693. [PMID: 37155603 PMCID: PMC10496440 DOI: 10.1093/tbm/ibad026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
The evidence for the survival and health benefits of physical activity (PA) among cancer survivors is well documented. However, it has been challenging to maintain PA among cancer survivors. To evaluate the cost-effectiveness of peer support to encourage maintenance of moderate-to-vigorous physical activity (MVPA) among breast cancer survivors. Participants were randomized into Reach Plus Message (weekly text/email messages), Reach Plus Phone (monthly phone calls) or Reach Plus (a self-monitoring intervention) over 6 months after an initial adoption phase. We calculated the incremental cost-effectiveness ratios (ICER) in terms of quality-adjusted years life years (QALYs) and self-reported MVPA, from the payer's budgetary and societal perspectives over 1 year. Intervention costs were collected via time logs from the trainers and peer coaches, and participant costs from the participants via surveys. For our sensitivity analyses, we bootstrapped costs and effects to construct cost-effectiveness planes and acceptability curves. The intervention that provides weekly messages from peer coaches has an ICER of $14,446 per QALY gained and $0.95 per extra minute of MVPA per day over Reach Plus. Reach Plus Message has a 49.8% and 78.5% probability of cost-effectiveness respectively when decision makers are willing to pay approximately $25,000 per QALY and $10 per additional minute of MVPA. Reach Plus Phone, which requires tailored monthly telephone calls, costs more than Reach Plus Message but yields less QALY and self-reported MVPA at 1 year. Reach Plus Message may be a viable and cost-effective intervention strategy to maintain MVPA among breast cancer survivors.
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Affiliation(s)
- Brian K Chen
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, 915 Green Street Suite 354, Columbia, SC 29208, USA
| | - Shira I Dunsiger
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University, Box G-121-8 Providence, RI 02912, USA
| | - Bernardine M Pinto
- Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Room 302B, Columbia, SC 29208, USA
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Huang X, Pei X, Jian W, Xu M. Socioeconomic Disparities in Individual-Level Quality-Adjusted Life Years throughout Remaining Lifetimes: A National Representative Longitudinal Survey in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4612. [PMID: 36901620 PMCID: PMC10001792 DOI: 10.3390/ijerph20054612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
Socioeconomic disparities in health within and across low- and middle-income countries pose a significant global public health concern. While prior research has demonstrated the importance of socioeconomic status on health outcomes, few studies have employed comprehensive measures of individual-level health such as quality-adjusted life years (QALYs) in exploring the quantitative relationship. In our study, we employed QALYs to measure individual-level health, using health-related quality of life scores based on the Short Form 36 and predicted remaining life years through individual-specific Weibull survival analysis. We then constructed a linear regression model to explore the socioeconomic factors that influence QALYs, providing a predictive model of individual-level QALYs throughout remaining lifetimes. This practical tool can help individuals predict their remaining healthy life years. Using data from the China Health and Retirement Longitudinal Study between 2011 and 2018, we found that education and occupation were the primary factors influencing health outcomes among individuals aged 45 and above, while income appeared to have less of an impact when education and occupation were simultaneously controlled for. To promote the health status of this population, low- and middle-income countries should prioritize the long-term advancement of their population's education while controlling unemployment rates in the short term.
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Affiliation(s)
- Xinyi Huang
- School of Public Health (Shenzhen), Sun Yat-sen University, Gongchang Road 66, Shenzhen 518107, China
| | - Xingtong Pei
- School of Public Health (Shenzhen), Sun Yat-sen University, Gongchang Road 66, Shenzhen 518107, China
| | - Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University, Xueyuan Road 38, Haidian District, Beijing 100191, China
| | - Mingming Xu
- School of Public Health (Shenzhen), Sun Yat-sen University, Gongchang Road 66, Shenzhen 518107, China
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Measuring the Wellbeing of Cancer Patients with Generic and Disease-Specific Instruments. Cancers (Basel) 2023; 15:cancers15041351. [PMID: 36831692 PMCID: PMC9954597 DOI: 10.3390/cancers15041351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023] Open
Abstract
Different wellbeing measures have been used among cancer patients. This study aimed to first investigate the sensitivity of health state utility (HSU), capability, and subjective wellbeing (SWB) instruments in cancer. A cancer-specific instrument (QLQ-C30) was included and transferred onto the cancer-specific HSU scores. Furthermore, it examined the relative importance of key life domains explaining overall life satisfaction. Data were drawn from the Multi-instrument Comparison survey. Linear regression was used to explore the extent to which the QLQ-C30 sub-scales explain HSU and SWB. Kernel-based Regularized Least Squares (KRLS), a machine learning method, was used to explore the life domain importance of cancer patients. As expected, the QLQ-C30 sub-scales explained the vast majority of the variance in its derived cancer-specific HSU (R2 = 0.96), followed by generic HSU instruments (R2 of 0.65-0.73) and SWB and capability instruments (R2 of 0.33-0.48). The cancer-specific measure was more closely correlated with generic HSU than SWB measures, owing to the construction of these instruments. In addition to health, life achievements, relationships, the standard of living, and future security all play an important role in explaining the overall life satisfaction of cancer patients.
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Zaim R, Redekop WK, Uyl-de Groot CA. Incorporating risk preferences of patients in the valuation of immune checkpoint inhibitors for non-small cell lung cancer. Front Oncol 2023; 13:1027659. [PMID: 36969040 PMCID: PMC10032401 DOI: 10.3389/fonc.2023.1027659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/06/2023] [Indexed: 03/29/2023] Open
Abstract
Immunotherapy offers a distinctive mechanism of action compared to traditional treatments, arising from additional value dimensions that may not be captured in standard health technology assessments. Cancer patients may have the expectation that immunotherapy provides durable, long-term survival gains. Moreover, some patients may be willing to take a 'risk' to undergo immunotherapy to achieve better survival outcomes. We reviewed quantitative methods that explored patients' risk preferences in their non-small cell lung cancer (NSCLC) treatment choices, in PubMed (MEDLINE), from January 1, 2015, until July 1, 2022. The consideration of a value dimension ('hope') based on patients' risk-seeking preferences is specifically addressed for the valuation of immune checkpoint inhibitors in NSCLC. We reported that the quantitative methods that aim to measure patients' risk preferences or 'hope' empirically are emerging. Value assessments should not only comprise survival improvements for the mean or median patient but also consider methods that reflect durable, long-term overall survival gains for risk-seeking patients. However, the published evidence for incorporating 'hope' based on patients' stated preferences for uncertain treatment profiles is not strong, and future research could strengthen this evidence base. We encourage further research on the development and validation of quantification methods to incorporate 'hope' and risk preferences of patients treated with immunotherapy for NSCLC and beyond.
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Kangwanrattanakul K. A systematic review of health state utility values in Thai cancer patients. Expert Rev Pharmacoecon Outcomes Res 2022; 22:1171-1186. [DOI: 10.1080/14737167.2022.2123796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Quinn KL, Krahn M, Stukel TA, Grossman Y, Goldman R, Cram P, Detsky AS, Bell CM. No Time to Waste: An Appraisal of Value at the End of Life. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:S1098-3015(22)01966-0. [PMID: 35690518 DOI: 10.1016/j.jval.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/13/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The use of economic evaluations of end-of-life interventions may be limited by an incomplete appreciation of how patients and society perceive value at end of life. The objective of this study was to evaluate how patients, caregivers, and society value gains in quantity of life and quality of life (QOL) at the end of life. The validity of the assumptions underlying the use of the quality-adjusted life-years (QALY) as a measure of preferences at end of life was also examined. METHODS MEDLINE, Embase, CINAHL, PsycINFO, and PubMed were searched from inception to February 22, 2021. Original research studies reporting empirical data on healthcare priority setting at end of life were included. There was no restriction on the use of either quantitative or qualitative methods. Two reviewers independently screened, selected, and extracted data from studies. Narrative synthesis was conducted for all included studies. The primary outcomes were the value of gains in quantity of life and the value of gains in QOL at end of life. RESULTS A total of 51 studies involving 53 981 participants reported that gains in QOL were generally preferred over quantity of life at the end of life across stakeholder groups. Several violations of the underlying assumptions of the QALY to measure preferences at the end of life were observed. CONCLUSIONS Most patients, caregivers, and members of the general public prioritize gains in QOL over marginal gains in life prolongation at the end of life. These findings suggest that policy evaluations of end-of-life interventions should favor those that improve QOL. QALYs may be an inadequate measure of preferences for end-of-life care thereby limiting their use in formal economic evaluations of end-of-life interventions.
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Affiliation(s)
- Kieran L Quinn
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, Sinai Health System, Toronto, ON, Canada.
| | - Murray Krahn
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada
| | - Thérèse A Stukel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada
| | - Yona Grossman
- Arts and Science Program, McMaster University, Hamilton, ON, Canada
| | - Russell Goldman
- Interdepartmental Division of Palliative Care, Sinai Health System, Toronto, ON, Canada; Temmy Latner Centre for Palliative Care, Toronto, ON, Canada
| | - Peter Cram
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Allan S Detsky
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, Sinai Health System, Toronto, ON, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, Sinai Health System, Toronto, ON, Canada
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Health Technology Assessment Process for Oncology Drugs: Impact of CADTH Changes on Public Payer Reimbursement Recommendations. Curr Oncol 2022; 29:1514-1526. [PMID: 35323327 PMCID: PMC8947453 DOI: 10.3390/curroncol29030127] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 11/17/2022] Open
Abstract
Public reimbursement systems face the challenge of balancing provision of needed treatments and the reality of limited resources. Canada has a complex system for drug approval and public reimbursement, with jurisdiction divided between the federal government and the provinces/territories. A pivotal role is that of health technology assessment (HTA), which relies primarily on health economic principles to analyze the value of drugs on a population health basis and make recommendations about public reimbursement. The Canadian Agency for Drugs and Technologies in Health (CADTH) provides recommendations to all provinces but Quebec. This article provides an overview of Canada’s approval and public reimbursement pathway, including the role of HTA and the economic principles on which it relies. Starting in late 2020, CADTH reduced the cost per quality-adjusted life year (QALY) threshold, the metric relied upon in making recommendations to public payers. An analysis of all 56 oncology drug final recommendations issued from January 2020 to January 2022 was conducted and confirms this reduction in the cost per QALY threshold. As a result of this threshold reduction, recommendations to the provinces include, in a number of cases, substantially greater price reductions. The potential implications for successful price negotiation with the pan-Canadian Pharmaceutical Alliance (pCPA), the public negotiating body for the provinces, are discussed.
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Stewart DJ, Bradford JP, Batist G. Treatment Access, Health Economics, and the Wave of a Magic Wand. Curr Oncol 2022; 29:1176-1189. [PMID: 35200599 PMCID: PMC8870945 DOI: 10.3390/curroncol29020100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
New drugs are expensive, in part due to excessive drug development costs. Governments are trying to reduce drug prices. This can delay access to effective agents. A country’s access to new drugs correlates with prices they agree to pay. After Health Canada approves a drug, the Canadian Agency for Drug and Technologies in Health (CADTH) assesses it. CADTH’s approval is usually contingent on it costing ≤CAD 50,000 per quality adjusted life year (QALY) gained. This value (unchanged from the 1970s) is inappropriately low. An inflation-adjusted CAD 50,000 1975 QALY should translate into a CAD 250,000 2021 QALY. CADTH’s target also does not consider that drug development costs have risen much faster than inflation or that new precision therapies may only be used in small populations. In a separate process, proposals from the Patented Medicines Price Review Board (PMPRB) would decrease initial Canadian drug prices by 20%, but prices would fall further as sales increased, with ultimate price reductions of up to 80%. PMPRB claims its proposal would not reduce drug access, but multiple analyses strongly suggest otherwise. Government price controls target the symptom (high prices), not the disease. They translate into shortages without solving the problem. CADTH and PMPRB approaches both threaten access to effective drugs.
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Affiliation(s)
- David J. Stewart
- Department of Medicine, Faculty of Medicine, The Ottawa Hospital, University of Ottawa, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada
- Life Saving Therapies Network, 173 Heath St., Ottawa, ON K1H 5E6, Canada;
- Correspondence: ; Tel.: +613-737-7700
| | | | - Gerald Batist
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada;
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Meunier A, Soare A, Chevrou-Severac H, Myren KJ, Murata T, Longworth L. Indirect and Direct Mapping of the Cancer-Specific EORTC QLQ-C30 onto EQ-5D-5L Utility Scores. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:119-131. [PMID: 34554442 DOI: 10.1007/s40258-021-00682-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this study was to develop a response mapping algorithm to predict EQ-5D-5L utilities from European Organisation for Research and Treatment Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) scores and compare performance with direct mapping approaches to identify the best performing algorithm. METHODS The Multi-Instrument Comparison dataset contains responses to both the EQ-5D-5L and QLQ-C30 questionnaires from 692 individuals with a broad range of cancers. Response mapping was conducted, fitting ordered logistic regressions to predict response levels for each of the five EQ-5D dimensions and utilities were predicted using the US and Japanese EQ-5D-5L value sets to test the algorithm performance. Various direct mapping models were fitted: ordinary least squares, tobit, two-part (TPM), adjusted limited dependent variable mixture and beta mixture models. Model assessment and recommendations regarding the best mapping algorithm was based on goodness-of-fit statistics, predictive ability (measures of error, distribution of predicted utilities) and in sample cross-validation. RESULTS The response mapping model performed well in terms of predictive ability and measurement error using the US or Japanese value set, with mean absolute error ranging from 0.0708 to 0.0988, and comparably to the TPM, which was the best performing direct algorithm. CONCLUSION The developed mapping algorithms enable the prediction of EQ-5D-5L utilities from QLQ-C30 scores when EQ-5D-5L data have not been directly collected in clinical trials. The response mapping model offers the possibility of predicting EQ-5D-5L utility values using any national value set and can be generalised to multiple countries and oncology settings.
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Affiliation(s)
- Aurelie Meunier
- PHMR Limited, Berkeley Works, Berkley Grove, London, NW1 8XY, UK.
| | - Alexandra Soare
- PHMR Limited, Berkeley Works, Berkley Grove, London, NW1 8XY, UK
| | | | | | | | - Louise Longworth
- PHMR Limited, Berkeley Works, Berkley Grove, London, NW1 8XY, UK
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Henstock L, Wong R, Tsuchiya A, Spencer A. Behavioral Theories That Have Influenced the Way Health State Preferences Are Elicited and Interpreted: A Bibliometric Mapping Analysis of the Time Trade-Off Method With VOSviewer Visualization. FRONTIERS IN HEALTH SERVICES 2022; 2:848087. [PMID: 36925791 PMCID: PMC10012726 DOI: 10.3389/frhs.2022.848087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022]
Abstract
Aim The aim of this paper is to develop an understanding of how behavioral theories have influenced the way preferences for health-related quality of life are elicited and interpreted. We focus on the Time Trade-off (TTO) method given it represents the quality-adjusted life-year (QALY) concept-that survival in less-than-full health can be deemed equivalent to a shorter survival in full health. To our knowledge this is the first review using a combination of systematic scoping review, bibliometrics and VOSviewer visualization to map the development of ideas in health economics. Methods A priori, we selected three behavioral theories to explore within our review, referred to here as Expected Utility Theory, Non-Expected Utility Theory and Probabilistic Choice Theory. A fourth topic, Order Effects, is defined broadly to encompass behavioral theories around timing/sequence of events. For the main search, Scopus was used to identify literature that had (a) elicited TTO values and/or (b) contributed to the way TTO values were elicited and interpreted, from inception to July 2021. Papers that focused on the latter category were given the label "behavioral" and underwent additional analyses. A two stage-screening was applied to assess eligibility. Co-citation, co-authorship and co-occurrence of keywords was used to chart the development of TTO over time. Results A total of 1,727 records were retrieved from Scopus and were supplemented by an additional 188 papers. There were 856 applied and 280 behavioral papers included in the final corpus, with the behavioral set split equally into four sets of 70 papers to chart the development of keywords over time: (1) 1972-1999; (2) 2000-2010, (3) 2010-2015 and (4) 2015-2021. Discussion The keyword analysis suggested that whilst some ideas transition quickly from economic theory to the TTO literature, such as the impact of Order Effects, others take longer to be assimilated, for example Non-Expected Utility models or failure of constant discounting. It is therefore important that researchers within health economics work more closely with those in mainstream economics and keep abreast of the wider economics and behavioral sciences to expedite the uptake of new and relevant ideas.
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Affiliation(s)
- Luke Henstock
- University of Birmingham, Birmingham, United Kingdom
| | - Ruth Wong
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Aki Tsuchiya
- Department of Economics and School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Anne Spencer
- Department of Health and Community Sciences, University of Exeter, Exeter, United Kingdom
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Soare IA, Leeuwenkamp O, Longworth L. Estimation of Health-Related Utilities for 177Lu-DOTATATE in GEP-NET Patients Using Utilities Mapped from EORTC QLQ-C30 to EQ-5D-3L and QLU-C10D Utilities. PHARMACOECONOMICS - OPEN 2021; 5:715-725. [PMID: 34260017 PMCID: PMC8611167 DOI: 10.1007/s41669-021-00280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Gastroenteropancreatic neuroendocrine tumours (GEP-NET) are a rare, life-threatening type of cancer. The survival benefit of 177Lu-DOTATATE has been demonstrated in GEP-NET patients. Health technology assessment bodies require data on health-related utility impacts of treatment. A cancer-specific instrument, EORTC QLQ-C30, was used to collect the data for 177Lu-DOTATATE within clinical studies, but utility-based instruments were not included. OBJECTIVE The main aim of this study was to compare EQ-5D-3L and QLU-C10D utilities obtained from EORTC QLQ-C30 using two different approaches. A secondary aim was to analyse the EQ-5D-3L and QLU-C10D utilities of patients treated with 177Lu-DOTATATE versus best supportive care. A supplementary aim was to evaluate the effect of 177Lu-DOTATATE on patients' health-related utility over time. METHODS Three datasets were used for the analysis. NETTER-1 is a clinical trial, whilst ERASMUS and Guy's and St. Thomas (GStT) are real-world datasets. Two mapping algorithms (response mapping and ordinary least square regression) were applied to generate EQ-5D-3L utilities from EORTC QLQ-C30. An algorithm was used to obtain QLU-C10D utilities from EORTC QLQ-C30. RESULTS In all studies, EQ-5D-3L utilities were higher than QLU-C10D utilities at most time points measured, although the magnitude of the differences was small. In NETTER-1, EQ-5D-3L and QLU-C10D utilities were higher in the 177Lu-DOTATATE arm compared with the octreotide long-acting release (LAR) arm, overall and pre-progression. In all studies, patients' health-related utilities seem to be maintained over time. CONCLUSION There were small differences between EQ-5D-3L and QLU-C10D utilities, but these did not translate to relative differences over time or between groups. In NETTER-1, patients in the 177Lu-DOTATATE arm had higher health-related utilities than patients in the octreotide LAR arm. Health-related utility may at least remain maintained in patients with GEP-NET receiving 177Lu-DOTATATE.
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Affiliation(s)
| | - Oscar Leeuwenkamp
- Advanced Accelerator Applications, a Novartis company, Geneva, Switzerland
| | - Louise Longworth
- PHMR Limited, Berkeley Works, Berkley Grove, London, NW1 8XY, UK
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Shah KK, Bennett B, Lenny A, Longworth L, Brazier JE, Oppe M, Pickard AS, Shaw JW. Adapting preference-based utility measures to capture the impact of cancer treatment-related symptoms. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1301-1309. [PMID: 34142266 PMCID: PMC8526451 DOI: 10.1007/s10198-021-01337-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/08/2021] [Indexed: 06/12/2023]
Abstract
It is important that patient-reported outcome (PRO) measures used to assess cancer therapies adequately capture the benefits and risks experienced by patients, particularly when adverse event profiles differ across therapies. This study explores the case for augmenting preference-based utility measures to capture the impact of cancer treatment-related symptoms. Additional cancer treatment-related items could be specific (e.g., rash) or global. While specific items are easier to describe and understand, their use may miss rarer symptoms and those that are currently unknown but will arise from future medical advancements. The appropriate number of additional items, the independence of those items, and their impact on the psychometric properties of the core instrument require consideration. Alternatively, a global item could encompass all potential treatment-related symptoms, of any treatments for any disease. However, such an item may not be well understood by general public respondents in valuation exercises. Further challenges include the decision about whether to generate de novo value sets for the modified instrument or to map to existing tariffs. The fluctuating and transient nature of treatment-related symptoms may be inconsistent with the methods used in conventional valuation exercises. Fluctuating symptoms could be missed by sub-optimal measure administration timing. The addition of items also poses double-counting risks. In summary, the addition of treatment-related symptom items could increase the sensitivity of existing utility measures to capture known and unknown treatment effects in oncology, while retaining the core domains. However, more research is needed to investigate the challenges, particularly regarding valuation.
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Affiliation(s)
- Koonal K Shah
- PHMR, London, UK.
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | | | | | | | - John E Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Shaw JW, Bennett B, Trigg A, DeRosa M, Taylor F, Kiff C, Ntais D, Noon K, King MT, Cocks K. A Comparison of Generic and Condition-Specific Preference-Based Measures Using Data From Nivolumab Trials: EQ-5D-3L, Mapping to the EQ-5D-5L, and European Organisation for Research and Treatment of Cancer Quality of Life Utility Measure-Core 10 Dimensions. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1651-1659. [PMID: 34711366 DOI: 10.1016/j.jval.2021.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/02/2021] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES There is growing interest in condition-specific preference measures, including the European Organisation for Research and Treatment of Cancer Quality of Life Utility Measure-Core 10 Dimensions (QLU-C10D). This research assessed the implications of using utility indices on the basis of the EQ-5D-3L, a mapping of EQ-5D-3L to the EQ-5D-5L, and the QLU-C10D, and compared their psychometric properties. METHODS Data were taken from 8 phase 3 randomized controlled trials of nivolumab with or without ipilimumab for the treatment of solid tumors. Utilities for progression-related states were calculated using the UK and English value sets and incremental quality-adjusted life-years (QALYs) derived from established UK cost-effectiveness models. The psychometric properties of the utility indices were assessed using pooled trial data. RESULTS Compared with the EQ-5D-3L index, the mapped EQ-5D-5L index yielded an average of 6% more and the QLU-C10D index an average of 2% fewer incremental QALYs for nivolumab versus comparators. All indices could differentiate between groups defined by performance status, cancer stage, or self-reported health status at baseline and detect meaningful changes in performance status, tumor response, health status, and quality of life over approximately 12 weeks of treatment. CONCLUSIONS The lower QALY yield of the QLU-C10D was balanced by evidence of greater validity and responsiveness. Benefits gained from using the QLU-C10D may be apparent when treatments affect targeted symptoms and functional aspects, including sleep, bowel function, appetite, nausea, and fatigue. The observed differences in QALYs may not be sufficiently large to affect health technology assessment decisions.
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Affiliation(s)
- James W Shaw
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA.
| | - Bryan Bennett
- Bristol Myers Squibb Pharmaceuticals Ltd, Uxbridge, England, UK
| | - Andrew Trigg
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, England, UK
| | - Michael DeRosa
- Patient-Centered Outcomes, Adelphi Values, Boston, MA, USA
| | - Fiona Taylor
- Patient-Centered Outcomes, Adelphi Values, Boston, MA, USA
| | | | - Dionysios Ntais
- Bristol Myers Squibb Pharmaceuticals Ltd, Uxbridge, England, UK
| | - Katie Noon
- Bristol Myers Squibb Pharmaceuticals Ltd, Uxbridge, England, UK
| | | | - Kim Cocks
- Patient-Centered Outcomes, Adelphi Values Ltd, Bollington, England, UK
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15
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Outcome-Based Payment Schemes: What Outcomes Do Patients with Cancer Value? PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:599-610. [PMID: 32676997 PMCID: PMC7478942 DOI: 10.1007/s40271-020-00430-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Uncertainty about the benefits new cancer medicines will deliver in clinical practice risks delaying patient access to new treatment options in countries such as England, where the cost effectiveness of new medicines affects reimbursement decisions. Outcome-based payment (OBP) schemes, whereby the price paid for the drug is linked to patients’ real-world treatment outcome(s) has been put forward as a mechanism to accelerate access. Although OBP schemes have generally focused on clinical outcomes to determine reimbursement, the degree to which these represent the outcomes that are important to patients is unclear. Objective To advance the application of OBP we ask, what outcomes do patients with cancer value (most) that might form a practical basis for OBP? Methods A review of the literature on outcomes in cancer produced a long list of candidates. These were evaluated in a focus group with patients with cancer and were then, in a second focus group, distilled to a shortlist of ten outcomes using a card sort method. The ten outcomes were included in an online survey of patients with cancer and carers, who were asked to rank the importance of each outcome. Results The focus groups identified a range of both clinical and functional outcomes that are important to patients. Analyses of the 164 survey responses suggested that the four most important outcomes to patients and carers are survival; progression, relapse or recurrence; post-treatment side effects; and return to normal activities of daily life. Conclusion Commissioners of cancer services wishing to instigate an OBP scheme should prioritise collecting data on these outcomes as they are important to patients. Of these, only mortality data are routinely collected within the national health service (NHS). Progression and some morbidity data exist but are not currently linked, creating a challenge for OBP. Electronic supplementary material The online version of this article (10.1007/s40271-020-00430-x) contains supplementary material, which is available to authorized users.
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Knödler M, Buyel JF. Plant-made immunotoxin building blocks: A roadmap for producing therapeutic antibody-toxin fusions. Biotechnol Adv 2021; 47:107683. [PMID: 33373687 DOI: 10.1016/j.biotechadv.2020.107683] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/07/2020] [Accepted: 12/20/2020] [Indexed: 12/16/2022]
Abstract
Molecular farming in plants is an emerging platform for the production of pharmaceutical proteins, and host species such as tobacco are now becoming competitive with commercially established production hosts based on bacteria and mammalian cell lines. The range of recombinant therapeutic proteins produced in plants includes replacement enzymes, vaccines and monoclonal antibodies (mAbs). But plants can also be used to manufacture toxins, such as the mistletoe lectin viscumin, providing an opportunity to express active antibody-toxin fusion proteins, so-called recombinant immunotoxins (RITs). Mammalian production systems are currently used to produce antibody-drug conjugates (ADCs), which require the separate expression and purification of each component followed by a complex and hazardous coupling procedure. In contrast, RITs made in plants are expressed in a single step and could therefore reduce production and purification costs. The costs can be reduced further if subcellular compartments that accumulate large quantities of the stable protein are identified and optimal plant growth conditions are selected. In this review, we first provide an overview of the current state of RIT production in plants before discussing the three key components of RITs in detail. The specificity-defining domain (often an antibody) binds cancer cells, including solid tumors and hematological malignancies. The toxin provides the means to kill target cells. Toxins from different species with different modes of action can be used for this purpose. Finally, the linker spaces the two other components to ensure they adopt a stable, functional conformation, and may also promote toxin release inside the cell. Given the diversity of these components, we extract broad principles that can be used as recommendations for the development of effective RITs. Future research should focus on such proteins to exploit the advantages of plants as efficient production platforms for targeted anti-cancer therapeutics.
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Affiliation(s)
- M Knödler
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Forckenbeckstrasse 6, Aachen 52074, Germany; Institute for Molecular Biotechnology, RWTH Aachen University, Worringerweg 1, Aachen 52074, Germany.
| | - J F Buyel
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Forckenbeckstrasse 6, Aachen 52074, Germany; Institute for Molecular Biotechnology, RWTH Aachen University, Worringerweg 1, Aachen 52074, Germany.
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17
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Taylor DG. The political economics of cancer drug discovery and pricing. Drug Discov Today 2020; 25:2149-2160. [PMID: 32920059 PMCID: PMC7483036 DOI: 10.1016/j.drudis.2020.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/23/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
Drug discoveries can, when used appropriately, save lives. Since 1970, cancer death rates among people aged under 65 have halved in countries such as the USA and the UK. Despite pharmaceutical market imperfections and fears about the prices of new treatments, further progress should be possible during the 2020s. Anticancer medicine outlays account for 0.1-0.2% of the gross domestic product (GDP) of developed countries. Total cancer service spending typically stands at ∼0.8% of GDP. The affordability of these sums is a political calculation. Improvements in the efficiency of drug development and global access to effective therapies are desirable. However, from a public interest perspective, these goals should not be pursued in ways that understate the value of better treatment outcomes and threaten the funding available for ongoing innovation.
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Affiliation(s)
- David G Taylor
- UCL School of Pharmacy Offices, University College London, BMA House, Tavistock Square, London, WC1H 9JP, UK.
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18
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Coleridge EL, Dunn KE. Assessing the cost-effectiveness of DNA origami nanostructures for targeted delivery of anti-cancer drugs to tumours. Biomed Phys Eng Express 2020; 6. [DOI: 10.1088/2057-1976/abbe73] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/05/2020] [Indexed: 01/01/2023]
Abstract
Abstract
Chemotherapy drugs are generally cytotoxic and can cause major side effects, including vomiting/nausea, fatigue, hair loss and pain. The use of targeted nanostructures to deliver drugs directly to tumours has the potential to reduce the side effects by decreasing the exposure of healthy cells and reducing the amount of drug needed. DNA can be used as a structural material to build drug-delivering nanorobots, but questions remain over the practicality of this approach. Here we show that it is potentially feasible for DNA nanostructure drug delivery to be more cost-effective than the drug-only approach. Our result suggests that the barriers to the development of DNA nanostructure-based drug delivery are likely to be primarily technical, regulatory and ethical rather than financial, as the potential exists for this to be a profitable therapeutic approach.
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19
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Halling CMB, Wolf RT, Sjøgren P, Von Der Maase H, Timm H, Johansen C, Kjellberg J. Cost-effectiveness analysis of systematic fast-track transition from oncological treatment to specialised palliative care at home for patients and their caregivers: the DOMUS trial. BMC Palliat Care 2020; 19:142. [PMID: 32933489 PMCID: PMC7493170 DOI: 10.1186/s12904-020-00645-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While hospitals remain the most common place of death in many western countries, specialised palliative care (SPC) at home is an alternative to improve the quality of life for patients with incurable cancer. We evaluated the cost-effectiveness of a systematic fast-track transition process from oncological treatment to SPC enriched with a psychological intervention at home for patients with incurable cancer and their caregivers. METHODS A full economic evaluation with a time horizon of six months was performed from a societal perspective within a randomised controlled trial, the DOMUS trial ( Clinicaltrials.gov : NCT01885637). The primary outcome of the health economic analysis was a incremental cost-effectiveness ratio (ICER), which is obtained by comparing costs required per gain in Quality-Adjusted Life Years (QALY). The costs included primary and secondary healthcare costs, cost of intervention and informal care from caregivers. Public transfers were analysed in seperate analysis. QALYs were measured using EORTC QLQ-C30 for patients and SF-36 for caregivers. Bootstrap simulations were performed to obtain the ICER estimate. RESULTS In total, 321 patients (162 in intervention group, 159 in control group) and 235 caregivers (126 in intervention group, 109 in control group) completed the study. The intervention resulted in significantly higher QALYs for patients when compared to usual care (p-value = 0.026), while being more expensive as well. In the 6 months observation period, the average incremental cost of intervention compared to usual care was €2015 per patient (p value < 0.000). The mean incremental gain was 0.01678 QALY (p-value = 0.026). Thereby, the ICER was €118,292/QALY when adjusting for baseline costs and quality of life. For the caregivers, we found no significant differences in QALYs between the intervention and control group (p-value = 0.630). At a willingness to pay of €80,000 per QALY, the probability that the intervention is cost-effective lies at 15% in the base case scenario. CONCLUSION This model of fast-track SPC enriched with a psychological intervention yields better QALYs than usual care with a large increase in costs. TRIAL REGISTRATION The trial was prospectively registered 25.6.2013. Clinicaltrials.gov Identifier: NCT01885637 .
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Affiliation(s)
| | - Rasmus Trap Wolf
- VIVE - The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, København K, Denmark
| | - Per Sjøgren
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Hans Von Der Maase
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Helle Timm
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,The Danish Cancer Society, Copenhagen, Denmark
| | - Jakob Kjellberg
- VIVE - The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, København K, Denmark
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20
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Jatoi I, Gail MH. The Need for Combined Assessment of Multiple Outcomes in Noninferiority Trials in Oncology. JAMA Oncol 2020; 6:420-424. [PMID: 31830235 DOI: 10.1001/jamaoncol.2019.5361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Noninferiority trials in oncology assess novel therapies with the potential for slightly worse recurrence or death outcomes (ie, the margin of noninferiority) than standard therapies. This poses a dilemma because, in the absence of potential health outcome advantages, these trials may not provide the treatment equipoise required for an ethical study. Any new treatment with the potential for slightly worse recurrence or death outcomes should have countervailing health outcome advantages, but these are rarely taken into account in the design of noninferiority trials. This article presents the argument that not only the potentially worse health outcomes but also the potential benefits of the novel therapy should be considered when designing, analyzing, and reporting noninferiority trials. Some approaches to study design and analysis that consider both primary and secondary end points are discussed, and reporting the joint distributions of end points for the novel and standard treatments is recommended.
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Affiliation(s)
- Ismail Jatoi
- Division of Surgical Oncology and Endocrine Surgery, University of Texas Health, San Antonio
| | - Mitchell H Gail
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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21
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Chen AJ, Hu X, Conti RM, Jena AB, Goldman DP. Trends in the Price per Median and Mean Life-Year Gained Among Newly Approved Cancer Therapies 1995 to 2017. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1387-1395. [PMID: 31806195 PMCID: PMC7589784 DOI: 10.1016/j.jval.2019.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 07/22/2019] [Accepted: 08/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The prices of newly approved cancer drugs have risen over the past decades. A key policy question is whether the clinical gains offered by these drugs in treating specific cancer indications justify the price increases. OBJECTIVES To evaluate the price per median and mean life year gained among newly approved cancer therapies from 1995 to 2017. METHODS We collected data on the price (in 2017 USD) per life-year gained among cancer drug-indication pairs approved by the US Food and Drug Administration (FDA) between 1995 and 2017. We modeled trends using fractional polynomial and linear spline regression models that controlled for route of administration and cancer type fixed effects. RESULTS We found that between 1995 and 2012, price increases outstripped median survival gains, a finding consistent with previous literature. Nevertheless, price per mean life-year gained increased at a considerably slower rate, suggesting that new drugs have been more effective in achieving longer-term survival. Between 2013 and 2017, price increases reflected equally large gains in median and mean survival, resulting in a flat profile for benefit-adjusted launch prices in recent years. CONCLUSIONS Although drug costs have been rising more rapidly than median survival gains, they have been rising at about the same rate as mean survival gains. This suggests that when accounting for longer-term survival gains, the benefits of new drugs are roughly keeping pace with their costs, despite rapid cost growth.
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Affiliation(s)
- Alice J Chen
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
| | - Xiaohan Hu
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Rena M Conti
- Questrom School of Business, Boston University, Boston, MA, USA
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA; National Bureau of Economic Research, Cambridge, MA, USA
| | - Dana P Goldman
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA; National Bureau of Economic Research, Cambridge, MA, USA
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22
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Buckley R, Brough P, Hague L, Chauvenet A, Fleming C, Roche E, Sofija E, Harris N. Economic value of protected areas via visitor mental health. Nat Commun 2019; 10:5005. [PMID: 31719526 PMCID: PMC6851373 DOI: 10.1038/s41467-019-12631-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/24/2019] [Indexed: 11/08/2022] Open
Abstract
We evaluate methods to calculate the economic value of protected areas derived from the improved mental health of visitors. A conservative global estimate using quality-adjusted life years, a standard measure in health economics, is US$6 trillion p.a. This is an order of magnitude greater than the global value of protected area tourism, and two to three orders greater than global aggregate protected area management agency budgets. Future research should: refine this estimate using more precise methods; consider interactions between health and conservation policies and budgets at national scales; and examine links between personalities and protected area experiences at individual scale.
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Affiliation(s)
- Ralf Buckley
- Griffith University, Gold Coast, QLD, Australia, 4222.
| | - Paula Brough
- Griffith University, Gold Coast, QLD, Australia, 4222
| | - Leah Hague
- Griffith University, Gold Coast, QLD, Australia, 4222
| | | | - Chris Fleming
- Griffith University, Gold Coast, QLD, Australia, 4222
| | - Elisha Roche
- Griffith University, Gold Coast, QLD, Australia, 4222
| | | | - Neil Harris
- Griffith University, Gold Coast, QLD, Australia, 4222
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23
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Rosner GL. Bayesian Methods in Regulatory Science. Stat Biopharm Res 2019; 12:130-136. [PMID: 32489520 PMCID: PMC7265656 DOI: 10.1080/19466315.2019.1668843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 08/22/2019] [Accepted: 09/08/2019] [Indexed: 10/26/2022]
Abstract
Regulatory science comprises the tools, standards, and approaches that regulators use to assess safety, efficacy, quality, and performance of drugs and medical devices. A major focus of regulatory science is the design and analysis of clinical trials. Clinical trials are an essential part of clinical research programs that aim to improve therapies and reduce the burden of disease. These clinical experiments help us learn about what works clinically and what does not work. The results of clinical trials support therapeutic and policy decisions. When designing clinical trials, investigators make many decisions regarding various aspects of how they will carry out the study, such as the primary objective of the study, primary and secondary endpoints, methods of analysis, sample size, etc. This paper provides a brief review of the clinical development of new treatments and argues for the use of Bayesian methods and decision theory in clinical research.
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Affiliation(s)
- Gary L Rosner
- Division of Oncology Biostatistics & Bioinformatics, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore MD 21205
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24
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Multiple Criteria Decision Analysis for HTA across four EU Member States: Piloting the Advance Value Framework. Soc Sci Med 2019; 246:112595. [PMID: 31874372 DOI: 10.1016/j.socscimed.2019.112595] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/29/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
Abstract
Multiple Criteria Decision Analysis (MCDA) has emerged as a methodology for Health Technology Assessment (HTA). However, limited empirical evidence is available on its use by decision-makers; where available, it only comes from single-setting exercises, while cross-country comparative studies are unavailable. This study applies the Advance Value Framework (AVF), an MCDA methodology for HTA based on multi-attribute value theory, through a series of case studies with decision-makers in four countries, to explore its feasibility and compare decision-makers' value preferences and results. The AVF was applied in the evaluation of three drugs for metastatic, castrate resistant, prostate cancer (abiraterone, cabazitaxel and enzalutamide) in the post-chemotherapy indication. Decision conferences were organised in four European countries in collaboration with their HTA or health insurance organisations by involving relevant assessors and experts: Sweden (TLV), Andalusia/Spain (AETSA), Poland (AOTMiT) and Belgium (INAMI-RIZIV). Participants' value preferences, including performance scoring and criteria weighting, were elicited through a facilitated decision-analysis modelling approach using the MACBETH technique. Between 6 and 11 criteria were included in each jurisdiction's value model, allocated across four criteria domains; Therapeutic Benefit criteria consistently ranked first in relative importance across all countries. Consistent drug rankings were observed in all settings, with enzalutamide generating the highest overall weighted preference value (WPV) score, followed by abiraterone and cabazitaxel. Dividing drugs' overall WPV scores by their costs produced the lowest "cost per unit of value" for enzalutamide, followed by abiraterone and cabazitaxel. These results come in contrast with the actual country HTA recommendations and pricing decisions. Overall, although some differences in value preferences were observed between countries, drug rankings remained the same. The MCDA methodology employed could act as a decision support tool in HTA, due to the transparency in the construction of value preferences in a collaborative manner.
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Kaufman HL, Atkins MB, Subedi P, Wu J, Chambers J, Joseph Mattingly T, Campbell JD, Allen J, Ferris AE, Schilsky RL, Danielson D, Lichtenfeld JL, House L, Selig WKD. The promise of Immuno-oncology: implications for defining the value of cancer treatment. J Immunother Cancer 2019; 7:129. [PMID: 31101066 PMCID: PMC6525438 DOI: 10.1186/s40425-019-0594-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/15/2019] [Indexed: 12/23/2022] Open
Abstract
The rapid development of immuno-oncology (I-O) therapies for multiple types of cancer has transformed the cancer treatment landscape and brightened the long-term outlook for many patients with advanced cancer. Responding to ongoing efforts to generate value assessments for novel therapies, multiple stakeholders have been considering the question of "What makes I-O transformative?" Evaluating the distinct features and attributes of these therapies, and better characterizing how patients experience them, will inform such assessments. This paper defines ways in which treatment with I-O is different from other therapies. It also proposes key aspects and attributes of I-O therapies that should be considered in any assessment of their value and seeks to address evidence gaps in existing value frameworks given the unique properties of patient outcomes with I-O therapy. The paper concludes with a "data needs catalogue" (DNC) predicated on the belief that multiple key, unique elements that are necessary to fully characterize the value of I-O therapies are not routinely or robustly measured in current clinical practice or reimbursement databases and are infrequently captured in existing research studies. A better characterization of the benefit of I-O treatment will allow a more thorough assessment of its benefits and provide a template for the design and prioritization of future clinical trials and a roadmap for healthcare insurers to optimize coverage for patients with cancers eligible for I-O therapy.
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Affiliation(s)
- Howard L Kaufman
- Society for Immunotherapy of Cancer (SITC) Policy Committee, Replimune, Inc, 18 Commerce Way, Woburn, MA, USA
| | - Michael B Atkins
- Georgetown University, 3970 Reservoir Road NW, Washington, D.C, USA
| | | | - James Wu
- Amgen, Inc, One Amgen Center Drive, Thousand Oaks, CA, USA
| | | | | | | | - Jeff Allen
- Friends of Cancer Research, 1800 M St. NW, Washington, DC, USA
| | | | | | - Daniel Danielson
- Premera Blue Cross, 7001 220th St. SW, Mountlake Terrace, WA, USA
| | | | - Linda House
- Cancer Support Community, 734 15th St, NW, Washington, DC, USA
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Abstract
This article sets out to describe different value frameworks in the field of new developments in oncology. Since the costs of new oncological therapies follow a steep path, their implementation and financing demand a thorough assessment. This is an ambitious task due to the complex nature of oncological treatments within overall health policy. Five value frameworks were reviewed: European Society for Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale, American Society of Clinical Oncology (ASCO) Value Framework (version 2.0), National Comprehensive Cancer Network (NCCN) Evidence Blocks, Memorial Sloan Kettering Cancer Center DrugAbacus, and the Institute for Clinical and Economic Review Value Assessment Framework. They are all based on a large set of criteria. However, all these frameworks differ considerably in their outcomes. Among the main differences one has to cite are the inclusion of costs and the use of different outcomes, as well as the fact that they address different target stakeholders, etc. Despite these shortcomings, the value frameworks serve the necessity to introduce more rationality in health decision making seen from the perspective of physicians, patients, and financing bodies.
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Affiliation(s)
- Evelyn Walter
- Institute for Pharmaeconomic Research, Vienna, Austria.
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Tuffaha H, El-Saifi N, Chambers S, Scuffham P. New challenges in psycho-oncology: Economic evaluation of psychosocial services in cancer: Challenges and best practice recommendations. Psychooncology 2018; 28:3-10. [PMID: 30440112 DOI: 10.1002/pon.4933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Haitham Tuffaha
- Griffith University Menzies Health Institute Queensland, Nathan, Queensland, Australia.,Griffith University Centre for Applied Health Economics, Nathan, Queensland, Australia
| | - Najwan El-Saifi
- Griffith University Menzies Health Institute Queensland, Nathan, Queensland, Australia.,Griffith University Centre for Applied Health Economics, Nathan, Queensland, Australia
| | - Suzanne Chambers
- Griffith University Menzies Health Institute Queensland, Nathan, Queensland, Australia.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Paul Scuffham
- Griffith University Menzies Health Institute Queensland, Nathan, Queensland, Australia.,Griffith University Centre for Applied Health Economics, Nathan, Queensland, Australia
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Angelis A. Evaluating the Benefits of New Drugs in Health Technology Assessment Using Multiple Criteria Decision Analysis: A Case Study on Metastatic Prostate Cancer With the Dental and Pharmaceuticals Benefits Agency (TLV) in Sweden. MDM Policy Pract 2018; 3:2381468318796218. [PMID: 35187241 PMCID: PMC8855406 DOI: 10.1177/2381468318796218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 07/17/2018] [Indexed: 12/18/2022] Open
Abstract
Background. Multiple criteria decision analysis (MCDA) has been identified as a prospective methodology for assisting decision makers in evaluating the benefits of new medicines in health technology assessment (HTA); however, limited empirical evidence exists from real-world applications. Objective. To test in practice a recently developed MCDA methodological framework for HTA, the Advance Value Framework, in a proof-of-concept case study with decision makers. Methods. A multi-attribute value theory methodology was adopted applying the MACBETH questioning protocol through a facilitated decision-analysis modelling approach as part of a decision conference with four experts. Settings. The remit of the Swedish Dental and Pharmaceutical Benefits Agency (Tandvårds- och läkemedelsförmånsverket [TLV]) was adopted but in addition supplementary value dimensions were considered. Patients. Metastatic castrate-resistant prostate cancer patients were considered having received prior chemotherapy. Interventions. Abiraterone, cabazitaxel, and enzalutamide were evaluated as third-line treatments. Measurements. Participants’ value preferences were elicited involving criteria selection, options scoring, criteria weighting, and their aggregation. Results. Eight criteria attributes were finally included in the model relating to therapeutic impact, safety profile, socioeconomic impact, and innovation level with relative importance weights 44.5%, 33.3%, 14.8%, and 7.4% per cluster, respectively. Enzalutamide scored the highest overall weighted preference value score, followed by abiraterone and cabazitaxel. Dividing treatments’ overall weighted preference value scores by their costs derived “costs per unit of value” for ranking the treatments based on value-for-money grounds. Limitations. Study limitations included lack of comparative clinical effects across treatments and the small sample of participants. Conclusion. The Advance Value Framework has the prospects of facilitating the evaluation process in HTA and health care decision making; additional research is recommended to address technical challenges and optimize the use of MCDA for policy making.
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Affiliation(s)
- Aris Angelis
- Medical Technology Research Group, LSE Health and Department of Health Policy, London School of Economics and Political Science, London, UK
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Olofsson S, Gerdtham UG, Hultkrantz L, Persson U. Measuring the end-of-life premium in cancer using individual ex ante willingness to pay. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:807-820. [PMID: 28803265 DOI: 10.1007/s10198-017-0922-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 07/25/2017] [Indexed: 06/07/2023]
Abstract
For the assessment of value of new therapies in healthcare, Health Technology Assessment (HTA) agencies often review the cost per quality-adjusted life-year (QALY) gained. Some HTA agencies accept a higher cost per QALY gained when treatment is aimed at prolonging survival for patients with a short expected remaining lifetime, a so-called end-of-life (EoL) premium. The objective of this study is to elicit the existence and size of an EoL premium in cancer. Data was collected from 509 individuals in the Swedish general population 20-80 years old using a web-based questionnaire. Preferences were elicited using subjective risk estimation and the contingent valuation (CV) method. A split-sample design was applied to test for order bias. The mean value of a QALY was MSEK4.8 (€528,000), and there was an EoL premium of 4-10% at 6 months of expected remaining lifetime. Using subjective risk resulted in more robust and valid estimates of the value of a QALY. Order of scenarios did not have a significant impact on the WTP and the result showed scale sensitivity. Our result provides some support for the use of an EoL premium based on individual preferences when expected remaining lifetime is short and below 24 months. Furthermore, we find support for a value of a QALY that is above the current threshold of several HTA agencies.
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Affiliation(s)
- S Olofsson
- The Swedish Institute for Health Economics (IHE), IHE Box 2127, 220 02, Lund, Sweden.
- Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
| | - U-G Gerdtham
- The Swedish Institute for Health Economics (IHE), IHE Box 2127, 220 02, Lund, Sweden
- Health Economics Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
- School of Economics and Management, Institute of Economic Research, Lund University, Lund, Sweden
- Department of Economics, School of Economics and Management, Lund University, Lund, Sweden
| | - L Hultkrantz
- School of Business, Örebro University, Örebro, Sweden
| | - U Persson
- The Swedish Institute for Health Economics (IHE), IHE Box 2127, 220 02, Lund, Sweden
- School of Economics and Management, Institute of Economic Research, Lund University, Lund, Sweden
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Shafrin J, Skornicki M, Brauer M, Villeneuve J, Lees M, Hertel N, Penrod JR, Jansen J. An exploratory case study of the impact of expanding cost-effectiveness analysis for second-line nivolumab for patients with squamous non-small cell lung cancer in Canada: Does it make a difference? Health Policy 2018; 122:607-613. [DOI: 10.1016/j.healthpol.2018.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 04/05/2018] [Accepted: 04/19/2018] [Indexed: 12/31/2022]
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Andronis L, Goranitis I, Bayliss S, Duarte R. Cost-Effectiveness of Treatments for the Management of Bone Metastases: A Systematic Literature Review. PHARMACOECONOMICS 2018; 36:301-322. [PMID: 29224174 DOI: 10.1007/s40273-017-0595-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Metastatic cancers occur when cancer cells break away from the primary tumour. One of the most common sites of metastasis is the bone, with several therapeutic options currently available for managing bone metastases. In a resource-constrained environment, policy makers and practitioners need to know which options are cost effective. OBJECTIVE The aim of this systematic review was to review and appraise published economic evaluations on treatments for the management of bone metastases. METHODS We searched eight bibliographic databases (MEDLINE, MEDLINE in Process, EMBASE, CSDR, DARE, HTA, EED and CPCI) for relevant economic evaluations published from each database's inception date until March 2017. Study selection, quality assessment and data extraction were carried out according to published guidelines. RESULTS Twenty-four relevant economic analyses were identified. Seventeen of these studies focused on bone metastases resulting from a particular type of cancer, i.e. prostate (n = 8), breast (n = 7), lung (n = 1) or renal (n = 1), while seven report results for various primary tumours. Across types of cancer, evidence suggests that bisphosphonates result in lower morbidity and improved quality of life, for an additional cost, which is typically below conventional cost-effectiveness thresholds. While denosumab leads to health gains compared with zoledronic acid, it also results in substantial additional costs and is unlikely to represent value for money. The limited literature on the radiopharmaceutical strontium-89 (Sr89) and external beam radiotherapy (EBR) suggest that these treatments are cost effective compared with no treatment. CONCLUSIONS The reviewed evidence suggests that bisphosphonate treatments are cost-effective options for bone metastases, while denosumab is unlikely to represent value for money. Evidence on EBR and Sr89 is limited and less conclusive.
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Affiliation(s)
- Lazaros Andronis
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- Office A.103, Populations, Evidence and Technologies Group, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK.
| | - Ilias Goranitis
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Bayliss
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rui Duarte
- Liverpool Reviews and Implementation Group, Department of Health Services Research, University of Liverpool, Liverpool, UK
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Ghosh S, Baker S, de Castro DG, Kepka L, Kumar N, Sinaika V, Matiello J, Lomidze D, Dyttus-Cebulok K, Rosenblatt E, Fidarova E, Roa W. Improved cost-effectiveness of short-course radiotherapy in elderly and/or frail patients with glioblastoma. Radiother Oncol 2018; 127:114-120. [PMID: 29452901 DOI: 10.1016/j.radonc.2018.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 12/04/2017] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE Short-course radiotherapy (25 Gy in five fractions) was recently shown in a randomized phase III trial to be non-inferior to 40 Gy in 15 fractions in elderly and/or frail patients with glioblastoma multiforme. This study compared the cost-effectiveness of the two regimens. MATERIAL AND METHODS The direct unit costs of imaging, radiotherapy (RT), and dexamethasone were collected from the five primary contributing countries to the trial, constituting the data of 88% of all patients. Effectiveness was measured by the restricted mean overall survival (RMOS) and progression free survival (RMPFS). The incremental cost-effectiveness ratio (ICER) was calculated. Indirect costs were also estimated for comparison. RESULTS The median OSs for the short-course and commonly used RTs were 8.2 (95% confidence interval [CI] 6.1-10.3) and 7.7 (95% CI 5.5-9.9) months, respectively (log rank p = 0.340). Median PFSs were also not different (p = 0.686). The differences in the RMOS and the ICER, however, were +0.11 life-years and -$3062 United States dollars (USD) per life-year gained, respectively. The differences in the RMPFS and the ICER were +0.02 PFS and -$17,693 USD, respectively. CONCLUSION The ICER of -$3062 per life-year gained and -$17,693 per PFS gained indicates that the short-course RT is less costly compared to the longer RT regimen.
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Affiliation(s)
- Sunita Ghosh
- Cross Cancer Institute and University of Alberta, Edmonton, Canada
| | - Sarah Baker
- Cross Cancer Institute and University of Alberta, Edmonton, Canada
| | | | - Lucyna Kepka
- Independent Public Health Care Facility of the Ministry of the Interior and Warmian & Mazurian Oncology Centre, Olsztyn, Poland
| | - Narendra Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valery Sinaika
- N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
| | | | - Darejan Lomidze
- High Technology Medical Centre, University Clinic, Tbilisi, Georgia
| | | | | | | | - Wilson Roa
- Cross Cancer Institute and University of Alberta, Edmonton, Canada.
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Karnon J, Edney L, Afzali H. The political economy of the assessment of value of new health technologies. J Health Serv Res Policy 2018; 23:116-122. [PMID: 29320891 DOI: 10.1177/1355819617751816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health technology assessment provides a common framework for evaluating the costs and benefits of new health technologies to inform decisions on the public funding of new pharmaceuticals and other health technologies. In Australia and England, empirical analyses of the opportunity costs of government spending on new health technologies suggest more quality adjusted life years are being forgone than are being gained by a non-trivial proportion of funded health technologies. This essay considers the relevance of available empirical estimates of opportunity costs and explores the relationship between the public funding of health technologies and broader political and economic factors. We conclude that the benefits of a general reduction in the prices paid by governments for new technologies outweigh the costs, but evidence of informed public acceptance of reduced access to new health technologies may be required to shift the current approach to assessing the value of new health technologies.
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Affiliation(s)
- Jonathan Karnon
- 1 Professor of Health Economics, School of Public Health, University of Adelaide, Australia
| | - Laura Edney
- 2 Research Fellow, School of Public Health, University of Adelaide, Australia
| | - Hossein Afzali
- 3 Senior Research Fellow, School of Public Health, University of Adelaide, Australia
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Angelis A, Montibeller G, Hochhauser D, Kanavos P. Multiple criteria decision analysis in the context of health technology assessment: a simulation exercise on metastatic colorectal cancer with multiple stakeholders in the English setting. BMC Med Inform Decis Mak 2017; 17:149. [PMID: 29073892 PMCID: PMC5658981 DOI: 10.1186/s12911-017-0524-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 08/10/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Multiple criteria decision analysis (MCDA) has appeared as a methodology to address limitations of economic evaluation in health technology assessment (HTA), however there are limited empirical evidence from real world applications. The aim of this study is to test in practice a recently developed MCDA methodological framework known as Advance Value Framework (AVF) through a proof-of-concept case study engaging multiple stakeholders. METHODS A multi-attribute value theory methodological process was adopted involving problem structuring, model building, model assessment and model appraisal phases. A facilitated decision analysis modelling approach was used as part of a decision conference with thirteen participants. An expanded scope of the National Institute for Health and Care Excellence (NICE) remit acted as the study setting with the use of supplementary value concerns. Second-line biological treatments were evaluated for metastatic colorectal cancer (mCRC) patients having received prior chemotherapy, including cetuximab monotherapy, panitumumab monotherapy and aflibercept in combination with FOLFIRI chemotherapy. Initially 18 criteria attributes were considered spanning four value domains relating to therapeutic impact, safety profile, innovation level and socioeconomic impact. RESULTS Nine criteria attributes were finally included. Cetuximab scored the highest overall weighted preference value score of 45.7 out of 100, followed by panitumumab with 42.3, and aflibercept plus FOLFIRI with 14.4. The relative weights of the two most important criteria (overall survival and Grade 4 adverse events) added up to more than the relative weight of all other criteria together (52.1%). Main methodological limitation was the lack of comparative clinical effects across treatments and challenges included the selection of "lower" and "higher" reference levels on criteria attributes, eliciting preferences across attributes where participants had less experience, and ensuring that all attributes possess the right decision theory properties. CONCLUSIONS This first application of AVF produced transparent rankings for three mCRC treatments based on their value, by assessing an explicit set of evaluation criteria while allowing for the elicitation and construction of participants' value preferences and their trade-offs. It proved it can aid the evaluation process and value communication of the alternative treatments for the group participants. Further research is needed to optimise its use as part of policy-making.
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Affiliation(s)
- Aris Angelis
- Department of Health Policy and Medical Technology Research Group, LSE Health, London School of Economics and Political Science, London, UK
| | - Gilberto Montibeller
- School of Business and Economics, Management Science and Operations Group, Loughborough University, London, UK
| | | | - Panos Kanavos
- Department of Health Policy and Medical Technology Research Group, LSE Health, London School of Economics and Political Science, London, UK
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36
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Evidence, value and hope — Allocating resources for cancer. J Cancer Policy 2017. [DOI: 10.1016/j.jcpo.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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