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Meertens A, Van Coile L, Van Iseghem T, Brochez L, Verhaeghe N, Hoorens I. Cost-of-Illness of Skin Cancer: A Systematic Review. PHARMACOECONOMICS 2024; 42:751-765. [PMID: 38755518 DOI: 10.1007/s40273-024-01389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Skin cancer's rising incidence demands understanding of its economic impact. The current understanding is fragmented because of the various methodological approaches applied in skin cancer cost-of-illness studies. OBJECTIVE This study systematically reviews melanoma and keratinocyte carcinoma cost-of-illness studies to provide an overview of the applied methodological approaches and to identify the main cost drivers. METHODS This systematic review was conducted adhering to the 2020 PRISMA guidelines. PubMed, Embase, and Web of Science were searched from December 2022 until December 2023 using a search strategy with entry terms related to the concepts of skin cancer and cost of illness. The records were screened on the basis of the title and abstract and subsequently on full text against predetermined eligibility criteria. Articles published before 2012 were excluded. A nine-item checklist adapted for cost-of-illness studies was used to assess the methodological quality of the articles. RESULTS This review included a total of 45 studies, together evaluating more than half a million patients. The majority of the studies (n = 36) focused on melanoma skin cancer, a few (n = 3) focused on keratinocyte carcinomas, and 6 studies examined both. Direct costs were estimated in all studies, while indirect costs were only estimated in nine studies. Considerable heterogeneity was observed across studies, mainly owing to disparities in study population, methodological approaches, included cost categories, and differences in healthcare systems. In melanoma skin cancer, both direct and indirect costs increased with progressing tumor stage. In advanced stage melanoma, systemic therapy emerged as the main cost driver. In contrast, for keratinocyte carcinoma no obvious cost drivers were identified. CONCLUSIONS A homogeneous skin cancer cost-of-illness study design would be beneficial to enhance between-studies comparability, identification of cost drivers, and support evidence-based decision-making for skin cancer.
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Affiliation(s)
- Annick Meertens
- Department of Dermatology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | - Laura Van Coile
- Department of Dermatology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Tijs Van Iseghem
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
| | - Lieve Brochez
- Department of Dermatology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Interuniversity Centre for Health Economics Research (I-CHER), Ghent University, Ghent, Belgium
- Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium
| | - Isabelle Hoorens
- Department of Dermatology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
- Cancer Research Institute Ghent (CRIG), Ghent, Belgium.
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Bateni SB, Nguyen P, Eskander A, Seung SJ, Mittmann N, Jalink M, Gupta A, Chan KKW, Look Hong NJ, Hanna TP. Changes in Health Care Costs, Survival, and Time Toxicity in the Era of Immunotherapy and Targeted Systemic Therapy for Melanoma. JAMA Dermatol 2023; 159:1195-1204. [PMID: 37672282 PMCID: PMC10483386 DOI: 10.1001/jamadermatol.2023.3179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/27/2023] [Indexed: 09/07/2023]
Abstract
Importance Melanoma treatment has evolved during the past decade with the adoption of adjuvant and palliative immunotherapy and targeted therapies, with an unclear impact on health care costs and outcomes in routine practice. Objective To examine changes in health care costs, overall survival (OS), and time toxicity associated with primary treatment of melanoma. Design, Setting, and Participants This cohort study assessed a longitudinal, propensity score (PS)-matched, retrospective cohort of residents of Ontario, Canada, aged 20 years or older with stages II to IV cutaneous melanoma identified from the Ontario Cancer Registry from January 1, 2018, to March 31, 2019. A historical comparison cohort was identified from a population-based sample of invasive melanoma cases diagnosed from the Ontario Cancer Registry from January 1, 2007, to December 31, 2012. Data analysis was performed from October 17, 2022, to March 13, 2023. Exposures Era of melanoma diagnosis (2007-2012 vs 2018-2019). Main Outcomes and Measures The primary outcomes were mean per-capita health care and systemic therapy costs (Canadian dollars) during the first year after melanoma diagnosis, time toxicity (days with physical health care contact) within 1 year of initial treatment, and OS. Standardized differences were used to compare costs and time toxicity. Kaplan-Meier methods and Cox proportional hazards regression were used to compare OS among PS-matched cohorts. Results A PS-matched cohort of 731 patients (mean [SD] age, 67.9 [14.8] years; 437 [59.8%] male) with melanoma from 2018 to 2019 and 731 patients (mean [SD] age, 67.9 [14.4] years; 440 [60.2%] male) from 2007 to 2012 were evaluated. The 2018 to 2019 patients had greater mean (SD) health care (including systemic therapy) costs compared with the 2007 to 2012 patients ($47 886 [$55 176] vs $33 347 [$31 576]), specifically for stage III ($67 108 [$57 226] vs $46 511 [$30 622]) and stage IV disease ($117 450 [$79 272] vs $47 739 [$37 652]). Mean (SD) systemic therapy costs were greater among 2018 to 2019 patients: stage II ($40 823 [$40 621] vs $10 309 [$12 176]), III ($55 699 [$41 181] vs $9764 [$12 771]), and IV disease ($79 358 [$50 442] vs $9318 [$14 986]). Overall survival was greater for the 2018 to 2019 cohort compared with the 2007 to 2012 cohort (3-year OS: 74.2% [95% CI, 70.8%-77.2%] vs 65.8% [95% CI, 62.2%-69.1%], hazard ratio, 0.72 [95% CI, 0.61-0.85]; P < .001). Time toxicity was similar between eras. Patients with stage IV disease spent more than 1 day per week (>52 days) with physical contact with the health care system by 2018 to 2019 (mean [SD], 58.7 [43.8] vs 44.2 [26.5] days; standardized difference, 0.40; P = .20). Conclusions and Relevance This cohort study found greater health care costs in the treatment of stages II to IV melanoma and substantial time toxicity for patients with stage IV disease, with improvements in OS associated with the adoption of immunotherapy and targeted therapies. These health system-wide data highlight the trade-off with adoption of new therapies, for which there is a greater economic burden to the health care system and time burden to patients but an associated improvement in survival.
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Affiliation(s)
- Sarah B. Bateni
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham
| | - Paul Nguyen
- ICES at Queen’s University, Kingston, Ontario, Canada
| | - Antoine Eskander
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Soo Jin Seung
- Health Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Nicole Mittmann
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew Jalink
- Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Kingston, Ontario, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Arjun Gupta
- Division of Hematology, Oncology, & Transplantation, University of Minnesota, Minneapolis
| | - Kelvin K. W. Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nicole J. Look Hong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Timothy P. Hanna
- ICES at Queen’s University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Kingston, Ontario, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
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3
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Wu YP, Stump TK, Hay JL, Aspinwall LG, Boucher KM, Deboeck PR, Grossman D, Mooney K, Leachman SA, Smith KR, Wankier AP, Brady HL, Hancock SE, Parsons BG, Tercyak KP. The Family Lifestyles, Actions and Risk Education (FLARE) study: Protocol for a randomized controlled trial of a sun protection intervention for children of melanoma survivors. Contemp Clin Trials 2023; 131:107276. [PMID: 37393004 PMCID: PMC10529923 DOI: 10.1016/j.cct.2023.107276] [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] [Received: 03/14/2023] [Revised: 06/08/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Children of parents who had melanoma are more likely to develop skin cancer themselves owing to shared familial risks. The prevention of sunburns and promotion of sun-protective behaviors are essential to control cancer among these children. The Family Lifestyles, Actions and Risk Education (FLARE) intervention will be delivered as part of a randomized controlled trial to support parent-child collaboration to improve sun safety outcomes among children of melanoma survivors. METHODS FLARE is a two-arm randomized controlled trial design that will recruit dyads comprised of a parent who is a melanoma survivor and their child (aged 8-17 years). Dyads will be randomized to receive FLARE or standard skin cancer prevention education, which both entail 3 telehealth sessions with an interventionist. FLARE is guided by Social-Cognitive and Protection Motivation theories to target child sun protection behaviors through parent and child perceived risk for melanoma, problem-solving skills, and development of a family skin protection action plan to promote positive modeling of sun protection behaviors. At multiple assessments through one-year post-baseline, parents and children complete surveys to assess frequency of reported child sunburns, child sun protection behaviors and melanin-induced surface skin color change, and potential mediators of intervention effects (e.g., parent-child modeling). CONCLUSION The FLARE trial addresses the need for melanoma preventive interventions for children with familial risk for the disease. If efficacious, FLARE could help to mitigate familial risk for melanoma among these children by teaching practices which, if enacted, decrease sunburn occurrence and improve children's use of well-established sun protection strategies.
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Affiliation(s)
- Yelena P Wu
- Department of Dermatology, University of Utah, 30 North 1900 East, 4A330, Salt Lake City, UT 84132, USA; Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Tammy K Stump
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, NY, New York 10021, USA.
| | - Lisa G Aspinwall
- Department of Psychology, University of Utah, 380 North 1530 East, Salt Lake City, UT 84112, USA.
| | - Kenneth M Boucher
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA; Department of Internal Medicine, University of Utah, 30 North 1900 East, Salt Lake City, UT, USA.
| | - Pascal R Deboeck
- Department of Psychology, University of Utah, 380 North 1530 East, Salt Lake City, UT 84112, USA.
| | - Douglas Grossman
- Department of Dermatology, University of Utah, 30 North 1900 East, 4A330, Salt Lake City, UT 84132, USA; Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Kathi Mooney
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA; College of Nursing, University of Utah, 10 North, 2000 E, Salt Lake City, UT 84112, USA.
| | - Sancy A Leachman
- Department of Dermatology & Knight Cancer Institute, Oregon Health & Science University, 3303 SW Bond Ave; Suite 16D, Portland, OR 97239, USA.
| | - Ken R Smith
- Utah Population Database Pedigree and Population Resource, Department of Population Sciences, Huntsman Cancer Institute, University of Utah, 675 Arapeen Drive; Suite 200, Salt Lake City, UT 84112, USA.
| | - Ali P Wankier
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Hannah L Brady
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Samuel E Hancock
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA.
| | - Bridget G Parsons
- Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Ave, NW, Washington, DC 20007, USA.
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Tukiendorf A, Kamińska-Winciorek G, Lancé MD, Olszak-Wąsik K, Szczepanowski Z, Kulik-Parobczy I, Wolny-Rokicka EI. Recent Malignant Melanoma Epidemiology in Upper Silesia, Poland. A Decade-Long Study Focusing on the Agricultural Sector. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010863. [PMID: 34682617 PMCID: PMC8535977 DOI: 10.3390/ijerph182010863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/03/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022]
Abstract
The aim of the present study was to create spatial and spatio-temporal patterns of cutaneous malignant melanoma (MM) incidence in Upper Silesia, Poland, using the largest MM database (<4K cases) in Central Europe, focusing on the agricultural sector. The data comprised all the registered cancer cases (C43, according to the International Classification of Diseases after the 10th Revision) between the years 2004-2013 by the Regional Cancer Registries (RCRs) in Opole and Gliwice. The standardized incidence ratios (SIRs), spatio-temporal growth rates (GRs), and disease cluster relative risks (RRs) were estimated. Based on the regression coefficients, we have indicated irregularities of spatial variance in cutaneous malignant melanoma, especially in older women (≥60), and a possible age-migrating effect of agricultural population density on the risk of malignant melanoma in Upper Silesia. All the estimates were illustrated in choropleth thematic maps.
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Affiliation(s)
- Andrzej Tukiendorf
- Department of Population Health, Wrocław Medical University, ul. Bartla 5, 51-618 Wrocław, Poland
- Correspondence: ; Tel.: +48-601-409-079
| | - Grażyna Kamińska-Winciorek
- Department of Bone Marrow Transplantation and Onco-Hematology, National Institute of Oncology, Gliwice, ul. Armii Krajowej 15, 44-101 Gliwice, Poland;
| | - Marcus Daniel Lancé
- Department of Anesthesiology, Hamad Medical Corporation, Al Rayyan Street, Doha P.O. Box 3050, Qatar;
| | - Katarzyna Olszak-Wąsik
- Department of Gynecology, Obstetrics and Oncological Gynecology, School of Medicine and Division of Dentistry in Zabrze, Medical University of Silesia, ul. Batorego 15, 41-902 Bytom, Poland;
| | | | - Iwona Kulik-Parobczy
- Department of Physical Education and Physiotherapy, Opole University of Technology, ul. Prószkowska 76, 45-758 Opole, Poland;
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van Boemmel-Wegmann S, Brown JD, Diaby V, Huo J, Silver N, Park H. Health Care Utilization and Costs Associated With Systemic First-Line Metastatic Melanoma Therapies in the United States. JCO Oncol Pract 2021; 18:e163-e174. [PMID: 34228489 DOI: 10.1200/op.21.00140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE US Food and Drug Administration approvals of immune checkpoint inhibitors and targeted therapies revolutionized the treatment of metastatic melanoma. Our aim was to assess health care resource utilization and costs for patients with metastatic melanoma treated with systemic therapies in first line between January 2012 and December 2017. METHODS We conducted a retrospective cohort study of patients with metastatic melanoma using MarketScan data. We included patients diagnosed with melanoma and secondary malignant neoplasm who used pembrolizumab, nivolumab, ipilimumab, ipilimumab plus nivolumab, BRAF-inhibitor (BRAF-i) plus MEK inhibitor (MEK-i), BRAF-i or MEK-i monotherapy, or chemotherapy in first line. We compared health care utilization and costs per patient per month (PPPM) using two-part and generalized linear models. RESULTS We identified 1,870 patients, including 185 pembrolizumab, 103 nivolumab, 689 ipilimumab, 185 nivolumab plus ipilimumab, 214 BRAF-i plus MEK-i, 240 BRAF-i or MEK-i monotherapy, and 254 chemotherapy users. Highest PPPM rates of hospitalizations, emergency room visits, and outpatient visits were observed in patients with ipilimumab plus nivolumab therapy (adjusted difference v pembrolizumab [aDiff], 0.18, 0.12, and 0.88, respectively; all P < .001). Ipilimumab monotherapy users (aDiff, 0.07 and 0.93; all P < .001) and chemotherapy users (aDiff, 0.10 and 2.63; all P < .001) showed higher PPPM rates of hospitalizations and outpatient visits compared with pembrolizumab users, respectively. Utilization rates in nivolumab, BRAF-i plus MEK-i, and BRAF-i or MEK-i groups were similar to the pembrolizumab group. Highest PPPM total costs and drug-related costs were observed in the ipilimumab group ($80,139 US dollars [USD] and $70,051 USD; all P < .001), followed by the ipilimumab plus nivolumab ($71,689 USD and $56,217 USD; all P < .001) and the BRAF-i plus MEK-i group ($31,184 USD and $19,648 USD; all P < .001). PPPM costs in the nivolumab group were similar to the pembrolizumab group. CONCLUSION Significant differences in health care resource utilization and costs were found across first-line metastatic melanoma regimens. Utilization rates were highest in patients using ipilimumab-containing therapies. High drug costs constituted a major fraction of total PPPM health care costs.
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Affiliation(s)
- Sascha van Boemmel-Wegmann
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Joshua D Brown
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Jinhai Huo
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Natalie Silver
- Department of Otolaryngology, College of Medicine, University of Florida, Gainesville, FL
| | - Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
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Sezen D, Verma V, He K, Abana CO, Barsoumian H, Ning MS, Tang C, Hurmuz P, Puebla-Osorio N, Chen D, Tendler I, Comeaux N, Nguyen QN, Chang JY, Welsh JW. Considerations for Clinical Trials Testing Radiotherapy Combined With Immunotherapy for Metastatic Disease. Semin Radiat Oncol 2021; 31:217-226. [PMID: 34090648 DOI: 10.1016/j.semradonc.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Metastatic cancer is inherently heterogeneous, and patients with metastatic disease can experience vastly different oncologic outcomes depending on several patient- and disease-specific characteristics. Designing trials for such a diverse population is challenging yet necessary to improve treatment outcomes for metastatic-previously thought to be incurable-disease. Here we review core considerations for designing and conducting clinical trials involving radiation therapy and immunotherapy for patients with metastatic cancer.
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Affiliation(s)
- Duygu Sezen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, Koc University School of Medicine, Istanbul, Turkey
| | - Vivek Verma
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kewen He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Chike O Abana
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hampartsaum Barsoumian
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew S Ning
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Nahum Puebla-Osorio
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dawei Chen
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Irwin Tendler
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nathan Comeaux
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Patel RR, Verma V, Barsoumian HB, Ning MS, Chun SG, Tang C, Chang JY, Lee PP, Gandhi S, Balter P, Dunn JD, Chen D, Puebla-Osorio N, Cortez MA, Welsh JW. Use of Multi-Site Radiation Therapy for Systemic Disease Control. Int J Radiat Oncol Biol Phys 2021; 109:352-364. [PMID: 32798606 PMCID: PMC10644952 DOI: 10.1016/j.ijrobp.2020.08.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 02/08/2023]
Abstract
Metastatic cancer is a heterogeneous entity, some of which could benefit from local consolidative radiation therapy (RT). Although randomized evidence is growing in support of using RT for oligometastatic disease, a highly active area of investigation relates to whether RT could benefit patients with polymetastatic disease. This article highlights the preclinical and clinical rationale for using RT for polymetastatic disease, proposes an exploratory framework for selecting patients best suited for these types of treatments, and briefly reviews potential challenges. The goal of this hypothesis-generating review is to address personalized multimodality systemic treatment for patients with metastatic cancer. The rationale for using high-dose RT is primarily for local control and immune activation in either oligometastatic or polymetastatic disease. However, the primary application of low-dose RT is to activate distinct antitumor immune pathways and modulate the tumor stroma in efforts to better facilitate T cell infiltration. We explore clinical cases involving high- and low-dose RT to demonstrate the potential efficacy of such treatment. We then group patients by extent of disease burden to implement high- and/or low-dose RT. Patients with low-volume disease may receive high-dose RT to all sites as part of an oligometastatic paradigm. Subjects with high-volume disease (for whom standard of care remains palliative RT only) could be treated with a combination of high-dose RT to a few sites for immune activation, while receiving low-dose RT to several remaining lesions to enhance systemic responses from high-dose RT and immunotherapy. We further discuss how emerging but speculative concepts such as immune function may be integrated into this approach and examine therapies currently under investigation that may help address immune deficiencies. The review concludes by addressing challenges in using RT for polymetastatic disease, such as concerns about treatment planning workflows, treatment times, dose constraints for multiple-isocenter treatments, and economic considerations.
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Affiliation(s)
- Roshal R Patel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Albany Medical College, Albany, New York
| | - Vivek Verma
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hampartsoum B Barsoumian
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew S Ning
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Chun
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Percy P Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Saumil Gandhi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter Balter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joe Dan Dunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dawei Chen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nahum Puebla-Osorio
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria Angelica Cortez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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8
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Rai P, Shen C, Kolodney J, Kelly KM, Scott VG, Sambamoorthi U. Immune checkpoint inhibitor use, multimorbidity and healthcare expenditures among older adults with late-stage melanoma. Immunotherapy 2021; 13:103-112. [PMID: 33148082 PMCID: PMC8008205 DOI: 10.2217/imt-2020-0152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022] Open
Abstract
Background: The objective of this study is to assess the impact of immune checkpoint inhibitors (ICIs) and multimorbidity on healthcare expenditures among older patients with late-stage melanoma. Materials & methods: A retrospective longitudinal cohort study using Surveillance, Epidemiology and End Results linked with Medicare claims was conducted. Generalized linear mixed models were used to analyze adjusted relationships of ICI, multimorbidity and ICI-multimorbidity interaction on average healthcare expenditures. Results: Patients who received ICI and those who had multimorbidity had significantly higher average total healthcare expenditures compared with ICI nonusers and no multimorbidity. In the fully adjusted model using ICI-multimorbidity interaction, no excess cost was added by multimorbidity. Conclusion: Use of ICIs, regardless of multimorbidity, is associated with increased healthcare expenditures.
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Affiliation(s)
- Pragya Rai
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
| | - Chan Shen
- Department of Surgery Chief, Division of Outcomes, Research & Quality Cancer Institute, Cancer Control Penn State Cancer Institute, Hershey 17033, PA
| | - Joanna Kolodney
- Department of Medicine, West Virginia University School of Medicine, Morgantown 26506, WV
| | - Kimberly M Kelly
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
| | - Virginia G Scott
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems & Policy, West Virginia University School of Pharmacy, Morgantown 26506, WV
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Couchoud C, Fagnoni P, Aubin F, Westeel V, Maurina T, Thiery-Vuillemin A, Gerard C, Kroemer M, Borg C, Limat S, Nerich V. Economic evaluations of cancer immunotherapy: a systematic review and quality evaluation. Cancer Immunol Immunother 2020; 69:1947-1958. [PMID: 32676716 DOI: 10.1007/s00262-020-02646-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 06/17/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Scientific advances in the last decade have highlighted the use of immunotherapy, especially immune checkpoint inhibitors, to be an effective strategy in cancer therapy. However, these immunotherapeutic agents are expensive, and their use must take into account economic criteria. Thus, the objective of the present study was to systematically identify and review published EE related to the use of ipilimumab, nivolumab or pembrolizumab in melanoma, lung cancer, head and neck cancer or renal cell carcinoma, and to assess their quality. METHODS The systematic literature research was conducted on Medline via PubMed and the Cochrane Central Register of Controlled Trials to identify economic evaluations published before July 2018. The quality of each selected economic evaluation was assessed by two independent reviewers using the Drummond checklist. RESULTS Our systematic review was based on 32 economic evaluations using different methodological approaches, different perspectives and different time horizons. Three-quarters of the economic evaluations are full (n = 24) with a Drummond score ≥ 7, synonymous of "high quality". Among them, 66% reported a strategy that was cost-effective. The most assessed immunotherapeutic agent was nivolumab. In patients with renal cell carcinoma or head and neck cancer, it was less likely to be cost-effective than in patients with melanoma or lung cancer. CONCLUSIONS Whether or not these findings will be confirmed remains to be seen when market approval to cover more indications is extended and new effective immunotherapeutic agents become available.
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Affiliation(s)
- Charlotte Couchoud
- Department of Pharmacy, University Hospital of Besançon, 3 Boulevard Alexandre Fleming, 25030, Besancon Cedex, France
| | - Philippe Fagnoni
- Department of Pharmacy, University Hospital, Dijon, France
- INSERM UMR 866, University of Bourgogne-Franche-Comté, Dijon, France
- EPICAD LNC UMR 1231, University of Bourgogne-Franche-Comté, Dijon, France
| | - François Aubin
- Department of Dermatology, University Hospital, Besançon, France
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire Et Génique, Besançon, France
| | - Virginie Westeel
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire Et Génique, Besançon, France
- Pulmonary Medicine Department, University Hospital Jean Minjoz, Besançon, France
| | - Tristan Maurina
- Department of Medical Oncology, University Hospital, Besançon, France
| | - Antoine Thiery-Vuillemin
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire Et Génique, Besançon, France
- Department of Medical Oncology, University Hospital, Besançon, France
| | - Claire Gerard
- Department of Pharmacy, University Hospital of Besançon, 3 Boulevard Alexandre Fleming, 25030, Besancon Cedex, France
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire Et Génique, Besançon, France
| | - Marie Kroemer
- Department of Pharmacy, University Hospital of Besançon, 3 Boulevard Alexandre Fleming, 25030, Besancon Cedex, France
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire Et Génique, Besançon, France
| | - Christophe Borg
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire Et Génique, Besançon, France
- Department of Medical Oncology, University Hospital, Besançon, France
| | - Samuel Limat
- Department of Pharmacy, University Hospital of Besançon, 3 Boulevard Alexandre Fleming, 25030, Besancon Cedex, France
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire Et Génique, Besançon, France
| | - Virginie Nerich
- Department of Pharmacy, University Hospital of Besançon, 3 Boulevard Alexandre Fleming, 25030, Besancon Cedex, France.
- INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire Et Génique, Besançon, France.
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Healthcare Costs of Metastatic Cutaneous Melanoma in the Era of Immunotherapeutic and Targeted Drugs. Cancers (Basel) 2020; 12:cancers12041003. [PMID: 32325748 PMCID: PMC7225943 DOI: 10.3390/cancers12041003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022] Open
Abstract
Immunotherapeutic and targeted drugs improved survival of patients with metastatic melanoma. There is, however, a lack of evidence regarding their healthcare costs in clinical practice. The aim of our study was to provide insight into real-world healthcare costs of patients with metastatic cutaneous melanoma. Data were obtained from the Dutch Melanoma Treatment Registry for patients who were registered between July 2012 and December 2018. Mean total/monthly costs per patient were reported for all patients, patients who did not receive systemic therapy, and patients who received systemic therapy. Furthermore, mean episode/monthly costs per line of therapy and drug were reported for patients who received systemic therapy. Mean total/monthly costs were € 89,240/€ 6809: € 7988/€ 2483 for patients who did not receive systemic therapy (n = 784) and € 105,078/€ 7652 for patients who received systemic therapy (n = 4022). Mean episode/monthly costs were the highest for nivolumab plus ipilimumab (€ 79,675/€ 16,976), ipilimumab monotherapy (€ 79,110/€ 17,252), and dabrafenib plus trametinib (€ 77,053/€ 12,015). Dacarbazine yielded the lowest mean episode/monthly costs (€ 6564/€ 2027). Our study showed that immunotherapeutic and targeted drugs had a large impact on real-world healthcare costs. As new drugs continue entering the treatment landscape for (metastatic) melanoma, it remains crucial to monitor whether the benefits of these drugs outweigh their costs.
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Klink AJ, Chmielowski B, Feinberg B, Ahsan S, Nero D, Liu FX. Health Care Resource Utilization and Costs in First-Line Treatments for Patients with Metastatic Melanoma in the United States. J Manag Care Spec Pharm 2019; 25:869-877. [PMID: 30945965 PMCID: PMC10397699 DOI: 10.18553/jmcp.2019.18442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The treatment landscape for patients with metastatic melanoma has changed dramatically with the introduction of novel therapies, such as targeted therapies and immunotherapies, in recent years. Health care resource utilization (HCRU) and cost data are needed to further evaluate these treatments in a value-based health care system. OBJECTIVE To examine HCRU and total cost of care among U.S. metastatic melanoma patients treated with first-line systemic therapies, including immunotherapies, targeted therapies, and chemotherapy. METHODS A retrospective observational study was conducted using a U.S. claims database. Adults with ≥ 2 claims for melanoma and ≥ 1 claim for metastasis between January 1, 2012, and June 30, 2017, were identified. Patients had pharmacy and medical enrollment ≥ 6 months before and ≥ 3 months following first-line treatment start. Per patient per month (PPPM) HCRU and costs were calculated by first-line treatment drug class: PD-1 inhibitors, CTLA-4 inhibitors, CTLA-4 + PD-1 combination, BRAF monotherapy, BRAF + MEK combination, and chemotherapy. Adjusted odds ratios (ORs) for HCRU were estimated by logistic regressions and adjusted costs were estimated by generalized linear models using log-link with gamma distribution to control for differences in patient characteristics across groups. RESULTS Among 1,599 metastatic melanoma patients (PD-1, n = 255; CTLA-4, n = 555; CTLA-4 + PD-1, n = 88; BRAF, n = 210; BRAF + MEK, n=102; chemotherapy=389), mean age ranged from 59-68 years, and the majority were male (62%). Any hospitalization during first-line treatment was less frequent among PD-1-treated patients (25.9%) compared with 34.7%-45.5% of all other groups (all P < 0.05). PPPM hospitalizations were lowest in PD-1 (0.06) compared with 0.09-0.16 across all other groups (all P < 0.05), and PPPM emergency department (ED) visits were lowest in PD-1 (0.09) compared with 0.13-0.18 across all other groups (all P < 0.05), except for BRAF + MEK (0.14, P = 0.08). CTLA-4, CTLA-4 + PD-1, and BRAF + MEK had increased odds of hospitalization compared to PD-1 (adjusted ORs = 2.10, 2.35, 2.15, respectively; all P < 0.05). Total adjusted PPPM costs were significantly lower for PD-1 ($13,059) compared with CTLA-4 ($25,583), CTLA-4 + PD-1 ($31,310), and BRAF + MEK ($21,517) and higher compared to BRAF ($8,158) and chemotherapy ($6,361). CONCLUSIONS Hospitalizations and ED visits represent important HCRU for metastatic melanoma patients and were lowest among PD-1-treated patients compared with any other systemic therapies (except for ED visits when compared with BRAF + MEK). Total monthly costs varied substantially across first-line regimens and were significantly lower in PD-1-treated patients compared with patients treated with CTLA-4, CTLA-4 + PD-1, and BRAF + MEK. DISCLOSURES This study was funded by Merck Sharp & Dohme, a subsidiary of Merck & Co. Klink, Feinberg, and Nero are employees of Cardinal Health Specialty Solutions, which received funding from Merck to conduct this study. Chmielsowki is a consultant to Merck but received no funding for the development of this manuscript. Ahsan and Liu are employees of Merck. Chmielowski reports advisory board/speaker fees from Bristol-Myers Squibb, Merck, Genentech/Roche, Iovance Biotherapeutics, HUYA Bioscience International, Compugen, Array BioPharma, Regeneron, Biothera, Janssen, and Novartis. Ahsan has a patent (US20160008380A1) pending.
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Affiliation(s)
| | - Bartosz Chmielowski
- Division of Hematology-Medical Oncology, University of California, Los Angeles
| | | | | | - Damion Nero
- Cardinal Health Specialty Solutions, Columbus, Ohio
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Postsurgical treatment landscape and economic burden of locoregional and distant recurrence in patients with operable nonmetastatic melanoma. Melanoma Res 2019; 28:618-628. [PMID: 30216199 PMCID: PMC6221390 DOI: 10.1097/cmr.0000000000000507] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Surgery is the mainstay treatment for operable nonmetastatic melanoma, but recurrences are common and limit patients’ survival. This study aimed to describe real-world patterns of treatment and recurrence in patients with melanoma and to quantify healthcare resource utilization (HRU) and costs associated with episodes of locoregional/distant recurrences. Adults with nonmetastatic melanoma who underwent melanoma lymph node surgery were identified from the Truven Health MarketScan database (1 January 2008 to 31 July 2017). Locoregional and distant recurrence(s) were identified on the basis of postsurgery recurrence indicators (i.e. initiation of new melanoma pharmacotherapy, new radiotherapy, or new surgery; secondary malignancy diagnoses). Of 6400 eligible patients, 219 (3.4%) initiated adjuvant therapy within 3 months of surgery, mostly with interferon α-2b (n=206/219, 94.1%). A total of 1191/6400 (18.6%) patients developed recurrence(s) over a median follow-up of 23.1 months (102/6400, 1.6% distant recurrences). Among the 219 patients initiated on adjuvant therapy, 73 (33.3%) experienced recurrences (distant recurrences: 13/219, 5.9%). The mean total all-cause healthcare cost was $2645 per patient per month (PPPM) during locoregional recurrence episodes and $12 940 PPPM during distant recurrence episodes. In the year after recurrence, HRU was particularly higher in patients with distant recurrence versus recurrence-free matched controls: by 9.2 inpatient admissions, 54.4 inpatient days, 8.8 emergency department admissions, and 185.9 outpatient visits (per 100 person-months), whereas all-cause healthcare costs were higher by $14 953 PPPM. It remains to be determined whether the new generation of adjuvant therapies, such as immune checkpoint inhibitors and targeted agents, will increase the use of adjuvant therapies, and reduce the risk of recurrences and associated HRU/cost.
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13
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Fu AZ, Li Z, Tang J, Mahmood S, Whisman T, Qiu Y. Costs associated with adverse events for systemic therapies in metastatic melanoma. J Comp Eff Res 2018; 7:867-879. [PMID: 30192155 DOI: 10.2217/cer-2018-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To determine the costs of adverse events (AEs) associated with current metastatic melanoma (MM) therapies. MATERIALS & METHODS Two retrospective cohort studies were independently conducted using the PharMetrics and MarketScan databases. Included patients were aged ≥18 years, and had ≥1 MM diagnosis and ≥1 claim for systemic therapy from 2004 to 2015. RESULTS A total of 1654 and 1329 patients were identified in PharMetrics and MarketScan, respectively. The corresponding adjusted 30-day incremental costs of AEs by category were highest for CNS/psychiatric (US$21,277 and $18,739), gastrointestinal ($18,534 and $15,648), respiratory ($17,338 and $17,064), cardiovascular ($16,083 and $15,430), hematological/lymphatic ($14,997 and $15,538) and metabolic/nutritional AEs ($12,340 and $17,251). CONCLUSION The costs of AEs associated with systemic therapies for MM are substantial.
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Affiliation(s)
- Alex Z Fu
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA
| | - Zhiyi Li
- Asclepius Analytics LLC, New York, NY 10004, USA
| | - Jackson Tang
- Asclepius Analytics LLC, New York, NY 10004, USA
| | - Syed Mahmood
- Jacobi Medical Center & North Central Bronx Hospital, Bronx, NY 10461, USA
| | - Tyler Whisman
- Novartis Oncology, Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936-1080, USA
| | - Ying Qiu
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Corporation, Princeton Pike, NJ 08648, USA
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Copley-Merriman C, Stevinson K, Liu FX, Wang J, Mauskopf J, Zimovetz EA, Chmielowski B. Direct costs associated with adverse events of systemic therapies for advanced melanoma: Systematic literature review. Medicine (Baltimore) 2018; 97:e11736. [PMID: 30075584 PMCID: PMC6081130 DOI: 10.1097/md.0000000000011736] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Treatments for advanced melanoma are associated with different adverse events (AEs), which may be costly to manage. This study aimed to evaluate direct costs associated with managing treatment-related AEs for advanced melanoma through a systematic literature review. METHODS Systematic searches were conducted of the PubMed, Embase, Cochrane, BIOSIS, and EconLit medical literature databases to identify studies providing estimates of direct costs and health care resource utilization for the management of AEs of melanoma treatments, published between January 1, 2007, and February 23, 2017. Gray literature searches also were conducted. Studies reporting direct costs for patients with advanced melanoma that were published in English between 2007 and 2017 were eligible. Studies were systematically screened in 2 phases by 2 independent reviewers. Study design details and data on direct costs by country were extracted. RESULTS Seven studies evaluating the cost of AEs in patients with advanced melanoma were included; most estimated the costs for grade 3 or 4 events. In a United States study, monthly AE costs constituted 36.9% of overall health care costs for dacarbazine, 30.3% for paclitaxel, 9.2% for temozolomide, 6.4% for vemurafenib, and 4.0% for ipilimumab. A multicountry study found the greatest cost per event to be for grade 3 or 4 AEs associated with ipilimumab, including colitis (A$1471 [Australia]-&OV0556;3313 [France]) and diarrhea (£2836 [United Kingdom]), and chemotherapy (neutropenia/leukopenia in Germany [&OV0556;1744] and Italy [&OV0556;804]). Across studies, cost drivers for the most expensive AEs to manage were requiring hospitalization or use of expensive outpatient medications and/or procedures (eg, erythropoietin and blood transfusions for anemia). Some currently available therapies were not available during the research period, and their associated AEs are not reflected. Results may not be comparable across countries. For some studies, resource-use estimates reflect practice patterns from a limited number of centers, limiting generalizability. CONCLUSION Costs for managing each type of AE associated with the treatment of advanced melanoma are substantial. Effective treatments with improved safety profiles may help reduce total AE management costs.
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Affiliation(s)
| | | | | | | | | | | | - Bartosz Chmielowski
- Division of Hematology - Medical Oncology, Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA
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15
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Morgan FC, Duran J, Fraile B, Karia PS, Lin JY, Ott PA, Ruiz ES, Wang DM, Zhang Y, Schmults CD. A comparison of skin cancer screening and treatment costs at a Massachusetts cancer center, 2008 versus 2013. J Am Acad Dermatol 2018; 79:921-928. [PMID: 30322559 DOI: 10.1016/j.jaad.2018.06.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 03/19/2018] [Accepted: 06/22/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Temporal analyses of skin cancer costs are needed to examine how expenditure differences between diagnoses are changing. OBJECTIVE To tabulate the costs of skin cancer-related care (SCRC), including both screening and treatment, at an academic cancer center at 2 time points. METHODS Cost data (insurance and patient payments) at an academic cancer center from 2008 and 2013 were queried for International Classification of Diseases, Ninth Revision, codes pertaining to skin cancer. Screening costs were separated from treatment costs through associated Current Procedural Terminology codes. RESULTS The total annual cost of SCRC increased by 64%, the number of patients receiving SCRC increased by 45%, and the mean cost per patient treated increased by 13%. Screening accounted for 17% and 16% of total annual costs in 2008 and 2013, respectively. The mean cost per patient with melanoma increased by 84%, which was the largest increase among skin cancer diagnoses. In 2013, the few patients with melanoma who were treated with ipilimumab (n = 48 [4% of patients with melanoma]) accounted for 42% of melanoma treatment costs and 20% of SCRC costs. LIMITATIONS Prescription costs were unavailable. CONCLUSIONS Melanoma costs have increased as a result of the introduction of ipilimumab. Ongoing studies are needed to monitor the cost-effectiveness of SCRC at a national level.
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Affiliation(s)
- Frederick C Morgan
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Juanita Duran
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Belen Fraile
- Value and Population Health Management, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Pritesh S Karia
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Y Lin
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Melanoma Disease Center, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Patrick A Ott
- Melanoma Disease Center, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Stamell Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David M Wang
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yichen Zhang
- Value and Population Health Management, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Turner J, Couts K, Sheren J, Saichaemchan S, Ariyawutyakorn W, Avolio I, Cabral E, Glogowska M, Amato C, Robinson S, Hintzsche J, Applegate A, Seelenfreund E, Gonzalez R, Wells K, Bagby S, Tentler J, Tan AC, Wisell J, Varella-Garcia M, Robinson W. Kinase gene fusions in defined subsets of melanoma. Pigment Cell Melanoma Res 2017; 30:53-62. [PMID: 27864876 DOI: 10.1111/pcmr.12560] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/31/2016] [Indexed: 12/14/2022]
Abstract
Genomic rearrangements resulting in activating kinase fusions have been increasingly described in a number of cancers including malignant melanoma, but their frequency in specific melanoma subtypes has not been reported. We used break-apart fluorescence in situ hybridization (FISH) to identify genomic rearrangements in tissues from 59 patients with various types of malignant melanoma including acral lentiginous, mucosal, superficial spreading, and nodular. We identified four genomic rearrangements involving the genes BRAF, RET, and ROS1. Of these, three were confirmed by Immunohistochemistry (IHC) or sequencing and one was found to be an ARMC10-BRAF fusion that has not been previously reported in melanoma. These fusions occurred in different subtypes of melanoma but all in tumors lacking known driver mutations. Our data suggest gene fusions are more common than previously thought and should be further explored particularly in melanomas lacking known driver mutations.
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Affiliation(s)
- Jacqueline Turner
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Kasey Couts
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Jamie Sheren
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Siriwimon Saichaemchan
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Witthawat Ariyawutyakorn
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Izabela Avolio
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Ethan Cabral
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Magdelena Glogowska
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Carol Amato
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Steven Robinson
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Jennifer Hintzsche
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Allison Applegate
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Eric Seelenfreund
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Rita Gonzalez
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Keith Wells
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Stacey Bagby
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - John Tentler
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Aik-Choon Tan
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Joshua Wisell
- Department of Pathology, University of Colorado Denver, Aurora, CO, USA
| | - Marileila Varella-Garcia
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - William Robinson
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA
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Gwadry-Sridhar F, Nikan S, Hamou A, Seung SJ, Petrella T, Joshua AM, Ernst S, Mittmann N. Resource utilization and costs of managing patients with advanced melanoma: a Canadian population-based study. ACTA ACUST UNITED AC 2017; 24:168-175. [PMID: 28680276 DOI: 10.3747/co.24.3432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The use and detailed costs of services provided for people with advanced melanoma (amel) are not well known. We conducted an analysis to determine the use of health care services and the associated costs delineated by relevant attributable costs, which we defined for subjects in the province of Ontario. METHODS Through the Ontario Cancer Data Linkage Project, a cohort of amel patients with diagnoses between 31 August 2005 and 2012 (follow-up to 2013) and with valid International Classification of Diseases (9th revision, Clinical Modification) 172 codes and histology codes was identified. A cohort of individuals with amel having a combination of at least 1 palliative, 1 medical oncology, and 1 hospitalization code was generated. The health system services used by this population were clustered into hospitalization, palliation, physician medical visits, medication, homecare, laboratory, diagnostics, and other resources. Overall rates of use and disaggregated costs were determined by phase of care for the entire cohort. RESULTS The mean age for the 2748 individuals in the cohort was 67 years. The greater proportion of the patients were men (65.6%) and were more than 65 years of age (>50%). In this advanced cohort, fewer than 45% of patients were alive 3 years after the malignant melanoma diagnosis. The average annual cost per patient over the time horizon was $6,551. At $15,830, year 1 after diagnosis was the most expensive, followed by year 2, at $8,166. CONCLUSIONS Our data provide a baseline for the costs associated with amel treatment. Future studies will include newer agents and comparative effectiveness research for personalized therapies.
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Affiliation(s)
| | | | | | - S J Seung
- Health Outcomes and PharmacoEconomics (hope) Research Centre, Sunnybrook Research Institute, Toronto
| | - T Petrella
- Sunnybrook Health Sciences Centre, Toronto
| | - A M Joshua
- Princess Margaret Hospital, Toronto; and
| | - S Ernst
- London Regional Cancer Program, London, ON
| | - N Mittmann
- Sunnybrook Health Sciences Centre, Toronto
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18
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Kohn CG, Zeichner SB, Chen Q, Montero AJ, Goldstein DA, Flowers CR. Cost-Effectiveness of Immune Checkpoint Inhibition in BRAF Wild-Type Advanced Melanoma. J Clin Oncol 2017; 35:1194-1202. [PMID: 28221865 PMCID: PMC5791832 DOI: 10.1200/jco.2016.69.6336] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Patients who are diagnosed with stage IV metastatic melanoma have an estimated 5-year relative survival rate of only 17%. Randomized controlled trials of recent US Food and Drug Administration-approved immune checkpoint inhibitors-pembrolizumab (PEM), nivolumab (NIVO), and ipilumumab (IPI)-demonstrate improved patient outcomes, but the optimal treatment sequence in patients with BRAF wild-type metastatic melanoma remains unclear. To inform policy makers about the value of these treatments, we developed a Markov model to compare the cost-effectiveness of different strategies for sequencing novel agents for the treatment of advanced melanoma. Materials and Methods We developed Markov models by using a US-payer perspective and lifetime horizon to estimate costs (2016 US$) and quality-adjusted life years (QALYs) for treatment sequences with first-line NIVO, IPI, NIVO + IPI, PEM every 2 weeks, and PEM every 3 weeks. Health states were defined for initial treatment, first and second progression, and death. Rates for drug discontinuation, frequency of adverse events, disease progression, and death obtained from randomized phase III trials were used to determine the likelihood of transition between states. Deterministic and probabilistic sensitivity analyses were conducted to evaluate model uncertainty. Results PEM every 3 weeks followed by second-line IPI was both more effective and less costly than dacarbazine followed by IPI then NIVO, or IPI followed by NIVO. Compared with the first-line dacarbazine treatment strategy, NIVO followed by IPI produced an incremental cost effectiveness ratio of $90,871/QALY, and first-line NIVO + IPI followed by carboplatin plus paclitaxel chemotherapy produced an incremental cost effectiveness ratio of $198,867/QALY. Conclusion For patients with treatment-naive BRAF wild-type advanced melanoma, first-line PEM every 3 weeks followed by second-line IPI or first-line NIVO followed by second-line IPI are the most cost-effective, immune-based treatment strategies for metastatic melanoma.
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Affiliation(s)
- Christine G. Kohn
- Christine G. Kohn, University of Saint Joseph School of Pharmacy; Christine G. Kohn, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT; Simon B. Zeichner, Daniel A. Goldstein, and Christopher R. Flowers, Winship Cancer Institute at Emory University; Qiushi Chen, Georgia Institute of Technology, Atlanta, GA; Alberto J. Montero, Cleveland Clinic, Cleveland, OH; and Daniel A. Goldstein, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Simon B. Zeichner
- Christine G. Kohn, University of Saint Joseph School of Pharmacy; Christine G. Kohn, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT; Simon B. Zeichner, Daniel A. Goldstein, and Christopher R. Flowers, Winship Cancer Institute at Emory University; Qiushi Chen, Georgia Institute of Technology, Atlanta, GA; Alberto J. Montero, Cleveland Clinic, Cleveland, OH; and Daniel A. Goldstein, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Qiushi Chen
- Christine G. Kohn, University of Saint Joseph School of Pharmacy; Christine G. Kohn, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT; Simon B. Zeichner, Daniel A. Goldstein, and Christopher R. Flowers, Winship Cancer Institute at Emory University; Qiushi Chen, Georgia Institute of Technology, Atlanta, GA; Alberto J. Montero, Cleveland Clinic, Cleveland, OH; and Daniel A. Goldstein, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Alberto J. Montero
- Christine G. Kohn, University of Saint Joseph School of Pharmacy; Christine G. Kohn, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT; Simon B. Zeichner, Daniel A. Goldstein, and Christopher R. Flowers, Winship Cancer Institute at Emory University; Qiushi Chen, Georgia Institute of Technology, Atlanta, GA; Alberto J. Montero, Cleveland Clinic, Cleveland, OH; and Daniel A. Goldstein, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Daniel A. Goldstein
- Christine G. Kohn, University of Saint Joseph School of Pharmacy; Christine G. Kohn, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT; Simon B. Zeichner, Daniel A. Goldstein, and Christopher R. Flowers, Winship Cancer Institute at Emory University; Qiushi Chen, Georgia Institute of Technology, Atlanta, GA; Alberto J. Montero, Cleveland Clinic, Cleveland, OH; and Daniel A. Goldstein, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Christopher R. Flowers
- Christine G. Kohn, University of Saint Joseph School of Pharmacy; Christine G. Kohn, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Hartford, CT; Simon B. Zeichner, Daniel A. Goldstein, and Christopher R. Flowers, Winship Cancer Institute at Emory University; Qiushi Chen, Georgia Institute of Technology, Atlanta, GA; Alberto J. Montero, Cleveland Clinic, Cleveland, OH; and Daniel A. Goldstein, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
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19
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Wehler E, Zhao Z, Pinar Bilir S, Munakata J, Barber B. Economic burden of toxicities associated with treating metastatic melanoma in eight countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:49-58. [PMID: 26721505 PMCID: PMC5209401 DOI: 10.1007/s10198-015-0757-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 12/09/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND Information on costs of managing adverse events (AEs) associated with current treatments in metastatic melanoma is limited. This study estimates costs of AEs in eight countries: Australia (AU), Canada (CA), France (FR), Germany (GE), Italy (IT), the Netherlands (NL), Spain (ES), and the UK. METHODS A literature search was conducted to identify grade 3/4 AEs from product label, published trials, conference abstracts, and treatment guidelines. Resource utilization for the management of each type of AE was determined via interviews with 5 melanoma clinicians in each country. Outpatient and inpatient costs were estimated for each type of AE using country-specific tariffs or government/published sources. RESULTS In outpatient settings, the most costly AEs per incident included cutaneous squamous cell carcinoma (CSCC) (€1063, £720; NL/UK), anemia (€1443, €1329, €1285; ES/IT/FR), peripheral neuropathy (€1289; ES), and immune-related diarrhea (AUS$1,121; AU). In inpatient settings, the most costly AEs per hospitalization included hypophysitis (€10,265; €5316; CAN$9735; AUS$7231: ES/FR/CA/AU), dyspnea (€9077; GE), elevated liver enzymes (€6913, CAN$8030, AUS$6594; FR/CA/AU), CSCC (CAN$8934; CA), peripheral neuropathy (€6977, €4144, CAN$9472; NL/ES/CA), and diarrhea (£4284, €4113; UK/ES). CONCLUSIONS Costs of managing AEs can be significant, and thus effective treatments with lower rates of severe AEs would be valuable.
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Affiliation(s)
| | - Zhongyun Zhao
- Amgen, 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - S Pinar Bilir
- IMS Health, 425 Market Street, 7th Floor, San Francisco, CA, 94105, USA
| | - Julie Munakata
- IMS Health, 425 Market Street, 7th Floor, San Francisco, CA, 94105, USA
| | - Beth Barber
- Amgen, 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
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Lester-Coll NH, Rutter CE, Bledsoe TJ, Goldberg SB, Decker RH, Yu JB. Cost-Effectiveness of Surgery, Stereotactic Body Radiation Therapy, and Systemic Therapy for Pulmonary Oligometastases. Int J Radiat Oncol Biol Phys 2016; 95:663-72. [PMID: 27055395 DOI: 10.1016/j.ijrobp.2016.01.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/06/2016] [Accepted: 01/12/2016] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Pulmonary oligometastases have conventionally been managed with surgery and/or systemic therapy. However, given concerns about the high cost of systemic therapy and improvements in local treatment of metastatic cancer, the optimal cost-effective management of these patients is unclear. Therefore, we sought to assess the cost-effectiveness of initial management strategies for pulmonary oligometastases. METHODS AND MATERIALS A cost-effectiveness analysis using a Markov modeling approach was used to compare average cumulative costs, quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) among 3 initial disease management strategies: video-assisted thoracic surgery (VATS) wedge resection, stereotactic body radiation therapy (SBRT), and systemic therapy among 5 different cohorts of patient disease: (1) melanoma; (2) non-small cell lung cancer adenocarcinoma without an EGFR mutation (NSCLC AC); (3) NSCLC with an EGFR mutation (NSCLC EGFRm AC); (4) NSCLC squamous cell carcinoma (NSCLC SCC); and (5) colon cancer. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to analyze uncertainty with regard to model parameters. RESULTS In the base case, SBRT was cost effective for melanoma, with costs/net QALYs of $467,787/0.85. In patients with NSCLC, the most cost-effective strategies were SBRT for AC ($156,725/0.80), paclitaxel/carboplatin for SCC ($123,799/0.48), and erlotinib for EGFRm AC ($147,091/1.90). Stereotactic body radiation therapy was marginally cost-effective for EGFRm AC compared to erlotinib with an incremental cost-effectiveness ratio of $126,303/QALY. For colon cancer, VATS wedge resection ($147,730/2.14) was the most cost-effective strategy. Variables with the greatest influence in the model were erlotinib-associated progression-free survival (EGFRm AC), toxicity (EGFRm AC), cost of SBRT (NSCLC SCC), and patient utilities (all histologies). CONCLUSIONS Video-assisted thoracic surgery wedge resection or SBRT can be cost-effective in select patients with pulmonary oligometastases, depending on histology, efficacy, and tolerability of treatment and patient preferences.
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Affiliation(s)
- Nataniel H Lester-Coll
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
| | - Charles E Rutter
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Trevor J Bledsoe
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Sarah B Goldberg
- Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, Connecticut
| | - Roy H Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - James B Yu
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
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