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Marks DI, van Oostrum I, Mueller S, Welch V, Vandendries E, Loberiza FR, Böhme S, Su Y, Stelljes M, Kantarjian HM. Burden of hospitalization in acute lymphoblastic leukemia patients treated with Inotuzumab Ozogamicin versus standard chemotherapy treatment. Cancer Med 2019; 8:5959-5968. [PMID: 31436395 PMCID: PMC6792500 DOI: 10.1002/cam4.2480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Inotuzumab Ozogamicin (INO), has demonstrated an improvement in overall survival, high rate of complete remission, favorable patient-reported outcomes, and manageable safety profile vs standard of care (SoC; intensive chemotherapy) for relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL) in the phase 3 INO-VATE trial. With a one-hour weekly dosing schedule, INO might be associated with lower healthcare system burden. This study analyses hospitalizations for INO vs SoC. METHODS All patients receiving study treatment in the INO-VATE trial were included. The days hospitalized during study treatment was calculated. Due to different treatment durations for INO and SoC (median of 3 vs 1 cycles), number of hospital days was mainly reported per observed patient month. Hospital days per patient month were analyzed for different treatment cycles, subgroups, and main reasons for hospitalization. Differences between treatments were analyzed by the incidence rate ratio (IRR). RESULTS Overall, 82.9% and 94.4% INO and SoC patients experienced at least one hospitalization. The mean hospitalization days per patient month was 7.6 and 18.4 days for INO and SoC (IRR = 0.413, P < .001), which corresponds to patients spending 25.0% and 60.5% of their treatment time in a hospital. Main hospitalization reasons were R/R ALL treatment (5.2 (INO) vs 14.0 (SoC) days, IRR = 0.368, P < .001), treatment toxicities (1.4 vs 2.8 days, IRR = 0.516, P < .001) or other reasons (1.0 vs 1.6 days, IRR 0.629, P < .001). CONCLUSIONS Inotuzumab Ozogamicin treatment in R/R ALL is associated with a lower hospitalization burden compared with SoC. It is likely this lower burden has a favorable impact on healthcare budgets and cost-effectiveness considerations.
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Affiliation(s)
- David I. Marks
- Bristol Haematology and Oncology CentreUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | | | | | | | | | | | | | - Yun Su
- IndependentBridgewaterNJUSA
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Cox E, Wade R, Peron M, Dietz KC, Eastwood A, Palmer S, Griffin S. The Clinical and Cost Effectiveness of Inotuzumab Ozogamicin for the Treatment of Adult Relapsed or Refractory B-Cell Acute Lymphoblastic Leukaemia: An Evidence Review Group Evaluation of a NICE Single Technology Appraisal. PHARMACOECONOMICS 2019; 37:1081-1091. [PMID: 30887470 DOI: 10.1007/s40273-019-00779-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The National Institute for Health and Care Excellence (NICE) invited Pfizer, the manufacturer of inotuzumab ozogamicin (henceforth inotuzumab), to submit clinical- and cost-effectiveness evidence for inotuzumab as part of NICE's single technology appraisal process. The Centre for Reviews and Dissemination and the Centre for Health Economics, both at the University of York, were commissioned as the independent evidence review group (ERG). The clinical-effectiveness data were from a multicentre randomised controlled trial that compared inotuzumab with standard of care (SoC), where SoC was the investigator's choice of chemotherapy. Inotuzumab demonstrated statistically significant improvements in response rates or in the proportion of patients progressing to haematopoietic stem cell transplant (HSCT) but failed to meet the second primary objective of longer overall survival. Treatment-emergent adverse events were more frequent in the SoC arm, except veno-occlusive disease, which was more frequent in the inotuzumab arm. The company's economic model split patients into three post-hoc subgroups and used a partitioned survival approach within each group, with a cure assumption 3 years after receiving HSCT. In contrast with the trial results, the economic model estimated substantial improvement in survival with inotuzumab compared with SoC, providing an additional 5.2 life-years and 2.2 quality-adjusted life-years (QALYs) using a discount rate of 1.5% per annum. The ERG's critique highlighted a number of concerns, including the use of a post-hoc post-randomisation patient subset for extrapolation, the choice of a 1.5% discount rate, the complexity of the parametric modelling, the assumption of further treatment benefit post-HSCT, the nature of the cure assumption, and the length of inpatient stay while receiving treatment. The combination of the ERG's adjustments resulted in an incremental cost-effectiveness ratio (ICER) of £122,174 per QALY gained using Kaplan-Meier survival estimates and £114,078 per QALY gained with parametric survival models fit to the trial data. The final determination of the appraisal followed four NICE Appraisal Committee meetings, an appeal by the company and other stakeholders, two patient access schemes, and a company response to each appraisal consultation. The final ICER post-consultation was between £33,749 and £37,497 per QALY gained compared with SoC (excluding the confidential discount for blinatumomab received as subsequent therapy). The Appraisal Committee concluded that the ICER for inotuzumab was within the range usually considered cost effective for end-of-life care and recommended inotuzumab within its licensed indication.
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Affiliation(s)
- Edward Cox
- Centre for Health Economics, University of York, York, YO10 5DD, UK.
| | - Ros Wade
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Mathilde Peron
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | | | - Alison Eastwood
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Susan Griffin
- Centre for Health Economics, University of York, York, YO10 5DD, UK
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Boluda B, Rodríguez-Veiga R, Martínez-Cuadrón D, Lorenzo I, Sanz J, Regadera A, Sempere A, Senent L, Cervera JV, Solves P, Reitan J, Gea S, Sanz MA, Montesinos P. Time and Cost of Hospitalisation for Salvage Therapy in Adults with Philadelphia Chromosome-Negative B Cell Precursor Relapsed or Refractory Acute Lymphoblastic Leukaemia in Spain. PHARMACOECONOMICS - OPEN 2019; 3:229-235. [PMID: 30324566 PMCID: PMC6533337 DOI: 10.1007/s41669-018-0098-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Philadelphia chromosome-negative (Ph-) relapsed or refractory (R/R) B-cell precursor acute lymphoblastic leukaemia (ALL) is rare, and information on its impact on healthcare systems is scarce. OBJECTIVE To quantify the time and reimbursement associated with hospitalisations of patients with R/R ALL in a Spanish hospital. METHODS Retrospective review of medical charts identified patients aged ≥ 18 years with Ph- R/R ALL hospitalised between 1998 and 2014. Data were collected from the date of first diagnosis of R/R ALL (index) until death or loss to follow-up. The primary endpoint was the proportion of time hospitalised during chemotherapy. Reimbursement associated with hospitalisations (including associated chemotherapy) was also assessed. RESULTS Thirty-two patients were eligible for inclusion. Their median age was 41 years, and 50% had a first remission duration of ≤ 1 year; 34% had undergone allogeneic haematological stem-cell transplantation (alloHSCT). Overall, 31 patients had received intensive salvage chemotherapy, during which there were 42 hospitalisations (mean 1.4/patient; mean duration 26 days). Patients spent a mean of 71% of the chemotherapy period in hospital. Total mean reimbursement was €26,417 per patient, almost all (€25,723) attributable to inpatient stays (€18,986/hospitalisation). From the index date to death or loss to follow-up (excluding alloHSCT-related hospitalisations), there were 80 hospitalisations (mean duration 24 days); mean reimbursement was €16,692 per hospitalisation and €41,730 per patient. AlloHSCT (n = 8) involved 18 hospitalisations (mean reimbursement €39,782/hospitalisation; €89,510/patient). CONCLUSION Data from this sample of patients suggest that hospitalisations in R/R ALL are lengthy and associated with high costs in Spain.
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Affiliation(s)
- Blanca Boluda
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - Rebeca Rodríguez-Veiga
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - David Martínez-Cuadrón
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Ignacio Lorenzo
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - Jaime Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Ana Regadera
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - Amparo Sempere
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Leonor Senent
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
| | - Jose Vicente Cervera
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Pilar Solves
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | | | | | - Miguel Angel Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain
- CIBERONC, Instituto Carlos III, Madrid, Spain
| | - Pau Montesinos
- Haematology Department, Hospital Universitari i Politècnic La Fe, Avinguda de Fern ando Abril Martorell, 106, 46026, Valencia, Spain.
- CIBERONC, Instituto Carlos III, Madrid, Spain.
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Mayerhoff L, Lehne M, Hickstein L, Salimullah T, Prieur S, Thomas SK, Zhang J. Cost associated with hematopoietic stem cell transplantation: a retrospective claims data analysis in Germany. J Comp Eff Res 2018; 8:121-131. [PMID: 30517020 DOI: 10.2217/cer-2018-0100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIM Quantify hematopoietic stem cell transplantation (HSCT) costs in German patients with acute lymphoblastic leukemia (ALL), diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). METHODS The primary outcome was direct and indirect costs in patients with ALL/DLBCL/FL who received HSCT between 2010 and 2014. Costs were evaluated two to four quarters before to eight quarters after HSCT. RESULTS Among 258 patients with HSCT, direct costs were €290,125/patient (pediatric ALL), €246,266/patient (adult ALL), €230,399/patient (DLBCL/FL allogeneic) and €107,457/patient (DLBCL/FL autologous). Indirect costs with HSCT were €52,939/patient (adult ALL), €20,285/patient (DLBCL/FL allogeneic) and €29,881/patient (DLBCL/FL autologous). CONCLUSION Direct and indirect costs associated with HSCT are substantial for patients with ALL, DLBCL and FL. Novel therapies that reduce HSCT use could reduce medical costs.
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Affiliation(s)
| | | | | | | | | | - Simu K Thomas
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | - Jie Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
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Maertens J, Graux C, Breems D, Havelange V, Wittnebel S, Strens D, Hoefkens C. Retrospective chart review of hospitalizations and costs associated with the treatment of adults with Philadelphia-negative B-cell relapsed or refractory acute lymphoblastic leukemia in Belgium. Acta Clin Belg 2017; 72:429-433. [PMID: 28406385 DOI: 10.1080/17843286.2017.1314091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To quantify hospitalizations and costs among adults with Philadelphia-negative relapsed or refractory (R/R) B-cell acute lymphoblastic leukemia (ALL) who received current salvage chemotherapies in Belgium. METHODS A retrospective chart review identified patients aged ≥18 years and hospitalized between 2005 and 2015 for Ph-negative R/R B-cell ALL. Data were collected from the index date (first diagnosis of R/R ALL) until death or loss to follow-up. The salvage chemotherapy period was defined as the first chemotherapy hospitalization after the index date to the earliest of death, loss to follow-up, last chemotherapy dose plus 30 days, or initiation of hematological stem cell transplantation (HSCT). The primary endpoint was the percent of time in the hospital during the salvage chemotherapy period. Hospitalization costs were reported from the public health care payer perspective. RESULTS Nineteen patients were included, with median age of 37 years. The average proportion of time patients spent in the hospital during the salvage chemotherapy period was 50.5%. From the index date to death, patients received a mean of 1.8 lines of chemotherapy, most commonly hyper-CVAD (31%). There was a mean of 5.5 inpatient hospitalizations and 40.1 outpatient visits with 40.8 outpatient lab tests. Mean costs per patient were €79,973 for hospitalization (excluding HSCT), €26,337 for HSCT, €21,007 for chemotherapy drugs, and €6,341 for outpatient management, resulting in a total cost from the payer's perspective of €133,965 per patient. CONCLUSION Adults with Ph-negative R/R ALL spend half the time receiving salvage chemotherapy in the hospital. Their treatment is associated with large reimbursement costs in Belgium.
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Affiliation(s)
| | - Carlos Graux
- Department of Hematology, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Dimitri Breems
- Department of Hematology, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium
| | - Violaine Havelange
- Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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