1
|
Lazzaro C. On cost-effectiveness analysis, quality-adjusted life years, and cost-effectiveness threshold values of gemcitabine plus nab-paclitaxel versus gemcitabine alone in metastatic pancreatic cancer in the French setting. Ther Adv Med Oncol 2024; 16:17588359241276812. [PMID: 39229470 PMCID: PMC11369860 DOI: 10.1177/17588359241276812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 08/05/2024] [Indexed: 09/05/2024] Open
Affiliation(s)
- Carlo Lazzaro
- Studio di Economia Sanitaria, Via Stefanardo da Vimercate, 19, Milan 20128, Italy
- Biology and Biotechnologies Department “Lazzaro Spallanzani,” University of Pavia, Pavia 27100, Italy
| |
Collapse
|
2
|
Demaziere A, Mourgues C, Lambert C, Trevis S, Bertucat H, Grange I, Pezet D, Sautou V, Jary M, Gagnière J. French multi-institutional cost-effectiveness analysis of gemcitabine plus nab-paclitaxel versus gemcitabine alone as second-line treatment in metastatic pancreatic cancer patients. Ther Adv Med Oncol 2024; 16:17588359241259635. [PMID: 38882442 PMCID: PMC11179525 DOI: 10.1177/17588359241259635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024] Open
Abstract
Context In France, gemcitabine plus nab-paclitaxel (GEM-NAB) is heterogeneously used in metastatic pancreatic cancer due to disparities in its financial accessibility in the institutions. Objectives GEM-NAB conduct a French multi-institutional cost-effectiveness analysis of GEM-NAB versus gemcitabine alone (GEM) as second-line treatment in pancreatic cancer patients. Design All the unresected metastatic pancreatic ductal adenocarcinoma (PDAC) consecutive patients who received GEM-NAB (institution 1) or GEM alone (institutions 2 and 3) as second-line treatment after failure of a 5-fluorouracil based systemic chemotherapy regimen were screened. Methods This study was conducted from the French national healthcare insurance perspective. The primary endpoint was the overall survival (OS) expressed in months, calculated from the date of the first second-line chemotherapy administration to death. Only direct (medical and non-medical) costs have been considered for this analysis. Data were collected retrospectively in one university hospital and two general hospitals. Results The OS was significantly improved in patients receiving GEM-NAB (hazard ratio: 0.54, 95% confidence interval: 0.38-0.77, p = 0.001), with a median OS of 6.2 months (versus 4.1 months in patients receiving GEM alone). Taking into account the cost of GEM-NAB which was afforded by each institution, the incremental cost-effectiveness ratio was €1,449,231 by year of life (€40,256 per patient). In both groups, most of the costs were attributable to readmissions and outpatient chemotherapy administration. Conclusion The issues of the article is based on the trade-off between the benefit in terms of OS of patients treated with GEM-NAB, which is minor (a gain of 2 months of survival, with an accumulated rate of grade ⩾ 3 non-hematological adverse effects) and the additional institutional cost (€25k per year of life for each patient treated). The debate is complex and refers to an ethical component, which is the cost of human life when no other therapeutic alternative is offered to the patient.
Collapse
Affiliation(s)
- Amaury Demaziere
- Department of Pharmacy, CHU Clermont-Ferrand, 58 Rue Montalembert, Clermont-Ferrand 63000, France
| | - Charline Mourgues
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sophie Trevis
- Department of Pharmacy, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Isabelle Grange
- Department of Pharmacy, Hospital of Le Puy-en-Velay, Le Puy-en-Velay, France
| | - Denis Pezet
- Department of Digestive and Hepatobiliary Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Valérie Sautou
- Department of Pharmacy, CHU Clermont-Ferrand, Clermont-Ferrand, France
- CNRS, SIGMA Clermont-Ferrand, ICCF, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Marine Jary
- Department of Digestive and Hepatobiliary Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Johan Gagnière
- Department of Digestive and Hepatobiliary Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| |
Collapse
|
3
|
Fasseeh AN, Korra N, Elezbawy B, Sedrak AS, Gamal M, Eldessouki R, Eldebeiky M, George M, Seyam A, Abourawash A, Khalifa AY, Shaheen M, Abaza S, Kaló Z. Framework for developing cost-effectiveness analysis threshold: the case of Egypt. J Egypt Public Health Assoc 2024; 99:12. [PMID: 38825614 PMCID: PMC11144683 DOI: 10.1186/s42506-024-00159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/01/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Cost-effectiveness analyses rarely offer useful insights to policy decisions unless their results are compared against a benchmark threshold. The cost-effectiveness threshold (CET) represents the maximum acceptable monetary value for achieving a unit of health gain. This study aimed to identify CET values on a global scale, provide an overview of using multiple CETs, and propose a country-specific CET framework specifically tailored for Egypt. The proposed framework aims to consider the globally identified CETs, analyze global trends, and consider the local structure of Egypt's healthcare system. METHODS We conducted a literature review to identify CET values, with a particular focus on understanding the basis of differentiation when multiple thresholds are present. CETs of different countries were reviewed from secondary sources. Additionally, we assembled an expert panel to develop a national CET framework in Egypt and propose an initial design. This was followed by a multistakeholder workshop, bringing together representatives of different governmental bodies to vote on the threshold value and finalize the recommended framework. RESULTS The average CET, expressed as a percentage of the gross domestic product (GDP) per capita across all countries, was 135%, with a range of 21 to 300%. Interestingly, while the absolute value of CET increased with a country's income level, the average CET/GDP per capita showed an inverse relationship. Some countries applied multiple thresholds based on disease severity or rarity. In the case of Egypt, the consensus workshop recommended a threshold ranging from one to three times the GDP per capita, taking into account the incremental relative quality-adjusted life years (QALY) gain. For orphan medicines, a CET multiplier between 1.5 and 3.0, based on the disease rarity, was recommended. A two-times multiplier was proposed for the private reimbursement threshold compared to the public threshold. CONCLUSION The CET values in most countries appear to be closely related to the GDP per capita. Higher-income countries tend to use a lower threshold as a percentage of their GDP per capita, contrasted with lower-income countries. In Egypt, experts opted for a multiple CET framework to assess the value of health technologies in terms of reimbursement and pricing.
Collapse
Affiliation(s)
- Ahmad N Fasseeh
- Faculty of Pharmacy Alexandria University, Alexandria, Egypt
- Syreon Middle East, Alexandria, Egypt
| | | | | | - Amal S Sedrak
- Department of Public Health, Cairo University, Cairo, Egypt
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Mary Gamal
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Randa Eldessouki
- Department of Community Health, Fayoum University, Fayoum, Egypt
| | - Mariam Eldebeiky
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | | | - Ahmed Seyam
- Universal Health Insurance Authority, Cairo, Egypt
| | | | - Ahmed Y Khalifa
- World Health Organization Representative Office, Cairo, Egypt
| | | | | | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| |
Collapse
|
4
|
Hernandez D, Wagner F, Hernandez-Villafuerte K, Schlander M. Economic Burden of Pancreatic Cancer in Europe: a Literature Review. J Gastrointest Cancer 2023; 54:391-407. [PMID: 35474568 PMCID: PMC10435615 DOI: 10.1007/s12029-022-00821-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Pancreatic cancer is characterized by its high mortality, usually attributed to its diagnosis in already advanced stages. This article aims at presenting an overview of the economic burden of pancreatic cancer in Europe. METHODS A systematic literature review was conducted. It made use of the search engines EconLit, Google Scholar, PubMed and Web of Science, and retrieved articles published after December 31st, 1992, and before April 1st, 2020. Study characteristics and cost information were extracted. Cost per patient and cost per patient per month (PPM) were calculated, and drivers of estimate heterogeneity was analysed. Results were converted into 2019 Euros. RESULTS The literature review yielded 26 studies on the economic burden attributable to pancreatic cancer in Europe. Cost per patient was on average 40,357 euros (median 15,991), while figures PPM were on average 3,656 euros (median 1,536). Indirect costs were found to be on average 154,257 euros per patient or 14,568 euros PPM, while direct costs 20,108 euros per patient and 2,004 euros PPM. Nevertheless, variation on cost estimations was large and driven by study methodology, patient sample characteristics, such as type of tumour and cancer stage and cost components included in analyses, such as type of procedure. CONCLUSION Pancreatic cancer direct costs PPM are in the upper bound relative to other cancer types; however, direct per patient costs are likely to be lower because of shorter survival. Indirect costs are substantial, mainly attributed to high mortality.
Collapse
Affiliation(s)
- Diego Hernandez
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Fabienne Wagner
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| |
Collapse
|
5
|
Ingram MA, Lauren BN, Pumpalova Y, Park J, Lim F, Bates SE, Kastrinos F, Manji GA, Kong CY, Hur C. Cost-effectiveness of neoadjuvant FOLFIRINOX versus gemcitabine plus nab-paclitaxel in borderline resectable/locally advanced pancreatic cancer patients. Cancer Rep (Hoboken) 2022; 5:e1565. [PMID: 35122419 PMCID: PMC9458514 DOI: 10.1002/cnr2.1565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/11/2021] [Accepted: 09/21/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The 2020 National Comprehensive Cancer Network guidelines recommend neoadjuvant FOLFIRINOX or neoadjuvant gemcitabine plus nab-paclitaxel (G-nP) for borderline resectable/locally advanced pancreatic ductal adenocarcinoma (BR/LA PDAC). AIM The purpose of our study was to compare treatment outcomes, toxicity profiles, costs, and quality-of-life measures between these two treatments to further inform clinical decision-making. METHODS AND RESULTS We developed a decision-analytic mathematical model to compare the total cost and health outcomes of neoadjuvant FOLFIRINOX against G-nP over 12 years. The model inputs were estimated using clinical trial data and published literature. The primary endpoint was incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100 000 per quality-adjusted-life-year (QALY). Secondary endpoints included overall (OS) and progression-free survival (PFS), total cost of care, QALYs, PDAC resection rate, and monthly treatment-related adverse events (TRAE) costs (USD). FOLFIRINOX was the cost-effective strategy, with an ICER of $60856.47 per QALY when compared to G-nP. G-nP had an ICER of $44639.71 per QALY when compared to natural history. For clinical outcomes, more patients underwent an "R0" resection with FOLFIRINOX compared to G-nP (84.9 vs. 81.0%), but FOLFIRINOX had higher TRAE costs than G-nP ($10905.19 vs. $4894.11). A one-way sensitivity analysis found that the ICER of FOLFIRINOX exceeded the threshold when TRAE costs were higher or PDAC recurrence rates were lower. CONCLUSION Our modeling analysis suggests that FOLFIRNOX is the cost-effective treatment compared to G-nP for BR/LA PDAC despite having a higher cost of total care due to TRAE costs. Trial data with sufficient follow-up are needed to confirm our findings.
Collapse
Affiliation(s)
- Myles A. Ingram
- Division of General MedicineColumbia University Irving Medical Cancer and the Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Brianna N. Lauren
- Division of General MedicineColumbia University Irving Medical Cancer and the Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Yoanna Pumpalova
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Jiheum Park
- Division of General MedicineColumbia University Irving Medical Cancer and the Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Francesca Lim
- Division of General MedicineColumbia University Irving Medical Cancer and the Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Susan E. Bates
- Herbert Irving Comprehensive Cancer CenterColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Fay Kastrinos
- Herbert Irving Comprehensive Cancer CenterColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Division of Digestive and Liver DiseasesColumbia University Irving Medical Cancer and the Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Gulam A. Manji
- Herbert Irving Comprehensive Cancer CenterColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Chung Yin Kong
- Division of General MedicineMount Sinai School of MedicineNew YorkNew YorkUSA
| | - Chin Hur
- Division of General MedicineColumbia University Irving Medical Cancer and the Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Herbert Irving Comprehensive Cancer CenterColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Division of Digestive and Liver DiseasesColumbia University Irving Medical Cancer and the Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| |
Collapse
|
6
|
Lazzaro C, Bergamaschi R, Zaffaroni M, Totaro R, Paolicelli D. Cost-utility analysis of teriflunomide in naïve vs. previously treated patients with relapsing-remitting multiple sclerosis in Italy. Neurol Sci 2022; 43:4933-4944. [PMID: 35420360 PMCID: PMC9349140 DOI: 10.1007/s10072-022-06022-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 03/16/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) accounts for 176 cases per 100,000 inhabitants (female/male ratio = 2:1) in Italy. For most of the patients (67%), the disease course is relapsing-remitting MS (RRMS). OBJECTIVE To compare the costs and quality-adjusted life years (QALYs) of teriflunomide in RRMS naïve patients vs. RRMS patients previously treated (experienced) with other disease-modifying therapies in Italy. METHODS A four health states Markov model-supported cost-utility analysis (CUA) covering a 7-year timespan through annual cycles was developed, following the healthcare sector and the societal viewpoints. Part of the parameters that populated the Markov model was obtained from a questionnaire administered to four primary Italian MS centres. Costs of healthcare and non-healthcare resources, expressed in euro (€) 2019, and QALYs were discounted at 3% real social discount rate. One-way, scenario and probabilistic sensitivity analyses tested the uncertainty of the baseline findings. RESULTS Baseline CUA shows that teriflunomide in RRMS naïve patients is strongly dominant vs. experienced patients (healthcare sector perspective: - €1042.68 and + 0.480 QALYs; societal perspective: - €6782.81 and + 0.480 QALYs). Sensitivity analyses confirmed the robustness of the baseline results. CONCLUSION Teriflunomide in RRMS naïve vs. experienced patients is cost-effective and possibly strongly dominant from both the healthcare sector and the society viewpoints in Italy. Our findings need further confirmation from real-world studies.
Collapse
Affiliation(s)
- Carlo Lazzaro
- Studio di Economia Sanitaria, Via Stefanardo da Vimercate, 19, 20128, Milan, Italy.
| | | | - Mauro Zaffaroni
- Multiple Sclerosis Centre, Hospital of Gallarate, ASST Della Valle Olona, Gallarate, Italy
| | - Rocco Totaro
- Centro Malattie Demielinizzanti, Ospedale San Salvatore, L'Aquila, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| |
Collapse
|
7
|
Cost-Effectiveness of Nab-Paclitaxel and Gemcitabine Versus Gemcitabine Monotherapy for Patients with Unresectable Metastatic Pancreatic Cancer in Japan. Value Health Reg Issues 2021; 28:54-60. [PMID: 34800832 DOI: 10.1016/j.vhri.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/16/2021] [Accepted: 04/01/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the cost-effectiveness of nab-paclitaxel and gemcitabine (GnP) compared with gemcitabine monotherapy (G) for patients with unresectable metastatic pancreatic cancer in Japan from the perspective of healthcare payer. METHODS A partitioned survival analysis model was developed to predict costs and quality-adjusted life years (QALYs) for GnP and G. The time horizon of the model was set at 20 years. An annual discount rate of 2% for both costs and QALYs was applied. Data on overall survival and progression-free survival were derived from the Metastatic Pancreatic Adenocarcinoma Clinical Trial. Cost parameters were estimated from a Japanese medical claims database. The incremental cost-effectiveness ratio (ICER) of GnP compared with G was estimated. One-way sensitivity analysis was performed to assess the uncertainty in the parameter settings. In addition, scenario and probability sensitivity analyses were performed. RESULTS The incremental cost and QALY of GnP compared with G were US$25 089 and 0.13 QALY, respectively. The ICER of GnP was estimated to be US$192 992 per QALY gained. Although the ICER was influenced by utility parameters and the survival curves, the ICERs remained higher than the willingness to pay (WTP) threshold of US$68 000 (JPY 7.5 million). The probability that GnP becomes cost-effective compared with G was estimated to be 29.2%. CONCLUSIONS Applying the WTP threshold of US$68 000 per QALY, GnP was not cost-effective for patients with unresectable metastatic pancreatic cancer in Japan from the perspective of healthcare payer. Further research is needed to obtain utility data from Japanese patients with pancreatic cancer.
Collapse
|
8
|
Choi BM, Abraham RB, Halawah H, Calamia M, Obeng-Kusi M, Alrawashdh N, Arku D, Abraham I. Comparing jurisdiction-specific pharmaco-economic evaluations using medical purchasing power parities. J Med Econ 2021; 24:34-41. [PMID: 34866529 DOI: 10.1080/13696998.2021.2007705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To demonstrate how medical purchasing power parities (mPPP) may harmonize economic evaluations from different jurisdictions and enable comparisons across jurisdictions. METHODS We describe the use of mPPPs and illustrate this with an example of economic evaluations of nab-paclitaxel with gemcitabine (Nab-P + Gem) versus gemcitabine monotherapy in the setting of metastatic pancreatic cancer. Following a literature search, we extracted data from cost-effectiveness studies on these treatments performed in various countries. mPPPs from the Organization for Economic Co-operation and Development were used to convert reported costs in the jurisdiction of origins to US dollars for the most current year using two possible pathways: (1) reported costs first adjusted by mPPP then adjusted by exchange index; and (2) reported costs first adjusted by exchange index then adjusted by mPPP. RESULTS Despite many of the pharmaco-economic evaluations sharing similar assumptions and inputs, even after mPPP conversion, residual heterogeneity was attributable to perspectives, discount rate, outcomes, and costs, among others; including in studies conducted in the same jurisdiction. CONCLUSION Despite the methodological challenges and heterogeneity within and across jurisdictions, we demonstrated that mPPP offers a way to compare economic evaluations across jurisdictions.
Collapse
Affiliation(s)
- Briana M Choi
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
| | - Rachel B Abraham
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Hala Halawah
- Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Matthias Calamia
- Faculty of Pharmacy, Utrecht University, Utrecht, The Netherlands
| | - Mavis Obeng-Kusi
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
| | - Neda Alrawashdh
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
| | - Daniel Arku
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, Tucson, AZ, USA
| |
Collapse
|
9
|
Lazzaro C, Castagna L, Lanza F, Laszlo D, Milone G, Pierelli L, Saccardi R. Chemotherapy-based versus chemotherapy-free stem cell mobilization (± plerixafor) in multiple myeloma patients: an Italian cost-effectiveness analysis. Bone Marrow Transplant 2021; 56:1876-1887. [PMID: 33753907 PMCID: PMC8338551 DOI: 10.1038/s41409-021-01251-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 12/21/2022]
Abstract
Given the availability and efficacy of the mobilizing agent plerixafor in augmenting hematopoietic progenitor cell mobilization with granulocyte colony-stimulating factor (G-CSF), there is a strong case for comparing the cost-effectiveness of mobilization with G-CSF + cyclophosphamide versus G-CSF alone. This study investigated the cost and effectiveness (i.e., successful 4 million-CD34+ collection) of G-CSF alone versus high-dose cyclophosphamide (4 g/m2) + G-CSF mobilization (± on-demand plerixafor) in patients with multiple myeloma (MM) eligible for autograft in Italy. A decision tree-supported cost-effectiveness analysis (CEA) model in MM patients was developed from the societal perspective. The CEA model compared G-CSF alone with cyclophosphamide 4 g/m2 + G-CSF (± on-demand plerixafor) and was populated with demographic, healthcare and non-healthcare resource utilization data collected from a questionnaire administered to six Italian oncohematologists. Costs were expressed in Euro (€) 2019. The CEA model showed that G-CSF alone was strongly dominant versus cyclophosphamide + G-CSF ( ± on-demand plerixafor), with incremental savings of €1198.59 and an incremental probability of a successful 4 million-CD34+ apheresis (+0.052). Sensitivity analyses confirmed the robustness of the base-case results. In conclusion, chemotherapy-free mobilization (± on-demand plerixafor) is a “good value for money” option for MM patients eligible for autograft.
Collapse
Affiliation(s)
- Carlo Lazzaro
- Health Economist and Research Director, Studio di Economia Sanitaria, Milan, Italy.
| | - Luca Castagna
- Oncology and Haematology Unit, BMT section, Istituto Clinico Humanitas, Rozzano, Italy
| | - Francesco Lanza
- Hematology Section, Romagna Transplant Network, University Hospital "Santa Maria delle Croci", Ravenna, Italy
| | - Daniele Laszlo
- Stem Cell Mobilization and Collection Unit, IEO IRCCS, Milan, Italy
| | - Giuseppe Milone
- Hematology and BMT Unit, Azienda Policlinico Vittorio Emanuele, Catania, Italy
| | - Luca Pierelli
- Department of Experimental Medicine, University "Sapienza", Rome, Immune-hematology and Transfusion Medicine Unit, Azienda Ospedaliera San Camillo, Rome, Italy
| | - Riccardo Saccardi
- Department of Cellular Therapy and Transfusion Medicine, Careggi University Hospital, Florence, Italy
| |
Collapse
|
10
|
Vergote I, Bergfeldt K, Franquet A, Lisyanskaya AS, Bjermo H, Heldring N, Buyse M, Brize A. A randomized phase III trial in patients with recurrent platinum sensitive ovarian cancer comparing efficacy and safety of paclitaxel micellar and Cremophor EL-paclitaxel. Gynecol Oncol 2019; 156:293-300. [PMID: 31826802 DOI: 10.1016/j.ygyno.2019.11.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/21/2019] [Accepted: 11/24/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Paclitaxel micellar was developed to avoid Cremophor-EL (Cr-EL) associated dose limiting toxicity and to allow a shorter infusion time. The efficacy and safety of paclitaxel micellar (+carboplatin) was compared to Cr-EL paclitaxel (+carboplatin) in recurrent platinum-sensitive ovarian, fallopian tube or peritoneal carcinoma. METHODS This was a multicentre, open-label, randomized phase III trial. Adult patients with recurrent disease was assigned to six 3-week cycles of paclitaxel micellar (250 mg/m2) administered as 1-h infusion or Cr-EL paclitaxel (175 mg/m2) as 3-h infusion. Both arms received carboplatin (AUC 5-6). Primary objective was non-inferiority for progression free survival (PFS) using computed tomography scans. Overall survival (OS) was included as secondary endpoint. RESULTS Between 2009 and 2013, 789 patients were randomized to receive experimental (N = 397) or control (N = 392) treatment. PFS for paclitaxel micellar was non-inferior to Cr-EL paclitaxel with a hazard ratio of 0.86 (95% CI: 0.72;1.03) in the per protocol population (PP), favouring paclitaxel micellar (non-inferiority margin was 1.2). Non-inferiority of OS was shown in the PP population with a hazard ratio of 0.95 (95% CI: 0.78; 1.16), favouring paclitaxel micellar (non-inferiority margin was 1.185). The most common adverse event was neutropenia (grade ≥ 3); 245 patients (79%) for paclitaxel micellar vs 213 patients (66%) for Cr-EL paclitaxel. The frequency of peripheral sensory neuropathy (any grade) was similar between the arms; 16% for paclitaxel micellar and 20% for Cr-EL paclitaxel. CONCLUSION Paclitaxel micellar (+ carboplatin) is non-inferior to Cr-EL paclitaxel (+ carboplatin) in terms of PFS and OS in the studied population. It provides a treatment option of a higher paclitaxel dose with a shorter infusion time without mandatory premedication. TRIAL REGISTRATION NUMBER 2008-002668-32 (EudraCT), NCT00989131 (ClinicalTrials.gov).
Collapse
Affiliation(s)
- I Vergote
- Division of Gynecologic Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium.
| | - K Bergfeldt
- Joint Commission of County Councils for Advanced Radiotherapy, Uppsala, Sweden
| | - A Franquet
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | | | - H Bjermo
- Oasmia Pharmaceutical AB, Vallongatan 1, SE-752 28 Uppsala, Sweden
| | - N Heldring
- Oasmia Pharmaceutical AB, Vallongatan 1, SE-752 28 Uppsala, Sweden
| | - M Buyse
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | - A Brize
- Latvian Oncology Center, Riga Eastern Clinical University Hospital, Riga, Latvia
| |
Collapse
|
11
|
Lazzaro C, Mazzanti NA, Parazzini F. Severe haematological toxicities in relapsed ovarian cancer treated with olaparib or niraparib: an Italian cost-minimization analysis. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2019. [DOI: 10.1177/2284240319843941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Nicola Amedeo Mazzanti
- Pricing & Value Access Specialist Oncology, Market Access, AstraZeneca S.p.A., Basiglio, Italy
| | - Fabio Parazzini
- Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milan, Italy
| |
Collapse
|
12
|
Huang J, Liao W, Zhou J, Zhang P, Wen F, Wang X, Zhang M, Zhou K, Wu Q, Li Q. Cost-effectiveness analysis of adjuvant treatment for resected pancreatic cancer in China based on the ESPAC-4 trial. Cancer Manag Res 2018; 10:4065-4072. [PMID: 30323662 PMCID: PMC6173491 DOI: 10.2147/cmar.s172704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The effectiveness of gemcitabine plus capecitabine compared with gemcitabine monotherapy for resected pancreatic cancer has been evaluated in the ESPAC-4 trial. We aimed to assess the cost-effectiveness of these adjuvant regimens on resected pancreatic cancer. METHODS A Markov model was established to simulate the disease process of resected pancreatic cancer (relapse-free survival, progressive disease, and death). The efficacy and toxicity profiles were collected from the ESPAC-4 trial. Transition probabilities were calculated based on survival in each group. Cost data were calculated from the perspective of the Chinese health-care payer. The primary endpoint in the analysis was the incremental cost-effectiveness ratio (ICER), and model uncertainties were explored by one-way sensitivity analysis and probabilistic sensitivity analysis. RESULTS Our results demonstrated that gemcitabine monotherapy cost $36,028.45 and yielded a survival of 1.02 quality-adjusted life year (QALY), while gemcitabine plus capecitabine cost $46,095.05 and yielded a survival of 1.23 QALY. Therefore, the incremental cost-effectiveness ratio of gemcitabine plus capecitabine vs gemcitabine monotherapy was $45,191.23 which surpassed the willingness-to-pay threshold of $29,291.42 per QALY in China. CONCLUSION The gemcitabine monotherapy regimen is more cost-effective compared with gemcitabine plus capecitabine regimen for the patients with postoperative pancreatic cancer from the Chinese societal perspective.
Collapse
Affiliation(s)
- Jiaxing Huang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China,
- West China Biomedical Big Data Center, Sichuan University, Chengdu 610041, China,
| | - Weiting Liao
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China,
- West China Biomedical Big Data Center, Sichuan University, Chengdu 610041, China,
| | - Jing Zhou
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China,
- West China Biomedical Big Data Center, Sichuan University, Chengdu 610041, China,
| | - Pengfei Zhang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China,
- West China Biomedical Big Data Center, Sichuan University, Chengdu 610041, China,
| | - Feng Wen
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China,
- West China Biomedical Big Data Center, Sichuan University, Chengdu 610041, China,
| | - Xinyuan Wang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China,
- West China Biomedical Big Data Center, Sichuan University, Chengdu 610041, China,
| | - Mengxi Zhang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China,
- West China Biomedical Big Data Center, Sichuan University, Chengdu 610041, China,
| | - Kexun Zhou
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China,
- West China Biomedical Big Data Center, Sichuan University, Chengdu 610041, China,
| | - Qiuji Wu
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China,
- West China Biomedical Big Data Center, Sichuan University, Chengdu 610041, China,
| | - Qiu Li
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China,
- West China Biomedical Big Data Center, Sichuan University, Chengdu 610041, China,
| |
Collapse
|