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Alrawashdh N, McBride A, Erstad B, Sweasy J, Persky DO, Abraham I. Cost-Effectiveness and Economic Burden Analyses on All First-Line Treatments of Chronic Lymphocytic Leukemia. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1685-1695. [PMID: 35537984 DOI: 10.1016/j.jval.2022.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/10/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Several chemoimmunotherapy and targeted treatment regimens are approved as front-line therapies in chronic lymphocytic leukemia. We estimated for the 10-year cost-effectiveness of these treatment regimens and the economic burden of following the estimated risk-stratified 21 040 patients with chronic lymphocytic leukemia diagnosed in 2020 for 10 years. METHODS A Markov model with 7 exclusive health states was specified over a 10-year time horizon. Treatment effectiveness inputs were obtained from a novel network meta-analysis on the progression-free survival, overall survival curves, and time to next treatment. Costs and utilities inputs were included for each health state for each treatment and discounted at 3.0%/year. Life-years (LYs) and quality-adjusted LYs (QALYs) for each treatment were determined. Using the lowest cost regimen as reference, the incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were estimated. The 10-year per-patient cost was determined by risk status and by initial treatment. RESULTS Venetoclax-plus-obinutuzumab was the lowest cost regimen, hence the reference. Superior in effectiveness to all chemoimmunotherapies, it was cost saving. With the highest effectiveness gains at 6.26 LYs and 5.01 QALYs and despite being the most expensive regimen ($1 298 638 per patient), acalabrutinib-plus-obinutuzumab yielded the best ICER ($409 343/LY gained) and ICUR ($501 236/QALY gained). The remaining ICERs of targeted therapies ranged from $512 101/LY gained to $793 236/LY gained and the ICURs from $579 737/QALY gained to $869 300/QALY gained. The 10-year postdiagnosis low/high (venetoclax-plus-obinutuzumab/acalabrutinib-plus-obinutuzumab) economic burden ranges were $42 690 to $98 665 for low-risk, $141 339 to $326 660 for intermediate-risk, and $273 650 to $632 453 for high-risk patients. CONCLUSIONS Compared with venetoclax-plus-obinutuzumab, chemoimmunotherapies are associated with less health benefits at higher cost. The targeted therapies achieve greater benefits at higher cost.
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Affiliation(s)
- Neda Alrawashdh
- Center for Health Outcomes and PharmacoEconomic Research, Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA; Department of Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Ali McBride
- Center for Health Outcomes and PharmacoEconomic Research, Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA; Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Brian Erstad
- Center for Health Outcomes and PharmacoEconomic Research, Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA; Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Joann Sweasy
- University of Arizona Cancer Center, Tucson, AZ, USA
| | - Daniel O Persky
- University of Arizona Cancer Center, Tucson, AZ, USA; Banner University Medical Center, Tucson, AZ, USA
| | - Ivo Abraham
- Center for Health Outcomes and PharmacoEconomic Research, Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA; Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, Tucson, AZ, USA.
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Application of High-Quality Nursing Intervention Based on Humanistic Care Combined with the Project Teaching Method in Patients with Acute Leukemia Undergoing Chemotherapy. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2972037. [PMID: 35186225 PMCID: PMC8849799 DOI: 10.1155/2022/2972037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022]
Abstract
Chemotherapy, the main treatment method of AL, can produce varying degrees of toxic and side effects on patients while killing tumor cells, resulting in decreased immune function of patients. We aim to explore the application effect of high-quality nursing intervention based on humanistic care combined with the project teaching method on patients with acute leukemia (AL) undergoing chemotherapy and its effect on their psychological state and satisfaction. 114 AL patients undergoing chemotherapy in the Department of Hematology of our hospital from July 2018 to July 2020 were chosen as the research objects and equally randomized into the experimental group (EG) and control group (CG). CG received routine nursing during chemotherapy, while EG received high-quality nursing intervention based on humanistic care combined with the project teaching method. Hospital Anxiety and Depression Scale (HAD) was adopted to evaluate the psychological state of patients in both groups after intervention, and the self-made nursing satisfaction questionnaire in our hospital was applied to evaluate the clinical nursing satisfaction. The HAD-A and HAD-D scores in the CG (P < 0.001) were significantly higher than the HAD-A and HAD-D scores in the EG after intervention. The scores of various coping styles in the EG after intervention were better than those in the CG (P < 0.05). Compared with the CG, the total nursing satisfaction after intervention was remarkably higher in the EG (P < 0.001), while the total incidence of adverse reactions during intervention was notably lower (P < 0.05). High-quality nursing intervention based on humanistic care combined with the project teaching method for AL patients undergoing chemotherapy can effectively relieve negative emotions, improve clinical nursing satisfaction, and reduce adverse reactions during chemotherapy.
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Ranti J, Perkonoja K, Kauko T, Loponen H, Joensuu EI, Järvinen TM. Characterization of real-world treatment practices and outcomes among patients with chronic lymphocytic leukemia treated in a Finnish tertiary center. EJHAEM 2022; 3:291-300. [PMID: 35846189 PMCID: PMC9176063 DOI: 10.1002/jha2.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/09/2022]
Abstract
Objectives We conducted this retrospective study to characterize the change in chronic lymphocytic leukemia (CLL) treatment patterns between 2005 and 2019, to understand the treatment sequencing across the course of the disease, and to investigate how targeted agents and prognostic testing were implemented into the patient care. Methods This study included adult patients with CLL treated at the Hospital District of Southwest Finland during the study period. Data were collected from the Turku University Hospital data lake. Results In total, 122 and 60 patients received first- and second-line treatments for CLL, respectively. The shift from conventional chemoimmunotherapy to targeted treatments in recent years (2014-2019) was observed. The median overall survival times were not reached in patients treated with targeted agents compared to conventional standard treatments in first- and second-line settings and improved toward the end of the study period. Prognostic testing increased during the study follow-up and patients with unmutated immunoglobulin heavy-chain variable showed significantly poorer overall survival and time-to-next-treatment outcomes than patients with mutated immunoglobulin heavy-chain variable. Conclusions This real-world study implicated added value of targeted chemo-free therapies as reported in randomized clinical trials, and highlighted the necessity of prognostic testing in order to improve treatment selection and patient outcomes.
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Affiliation(s)
- Juha Ranti
- Department of Hematology and Stem Cell Transplantation UnitDivision of MedicineTurku University HospitalTurkuFinland
| | - Katariina Perkonoja
- Auria Clinical InformaticsTurku University Hospital, Hospital District of Southwest FinlandTurkuFinland
| | - Tommi Kauko
- Auria Clinical InformaticsTurku University Hospital, Hospital District of Southwest FinlandTurkuFinland
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Cherng HJJ, Jain N. First-Line Therapy for Chronic Lymphocytic Leukemia: Bruton Tyrosine Kinase or BCL2 or Both? Hematol Oncol Clin North Am 2021; 35:725-738. [PMID: 34174983 PMCID: PMC9185694 DOI: 10.1016/j.hoc.2021.03.005] [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] [Indexed: 11/30/2022]
Abstract
Novel therapies largely have replaced chemoimmunotherapy as optimal first-line treatment of chronic lymphocytic leukemia (CLL). Approved novel therapies for CLL in the first-line setting include Bruton tyrosine kinase inhibitors, ibrutinib and acalabrutinib, and the BCL2 inhibitor venetoclax. Each of these novel agents has its own unique attributes and they have not been compared head to head in randomized trials. This review summarizes the pivotal trials that led to the approval of novel agents and compares the features of each agent to guide treatment decisions in treatment-naïve CLL. Ongoing studies investigating combinations of novel agents in the first-line setting also are discussed.
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Affiliation(s)
- Hua-Jay J Cherng
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0463, Houston, TX 77030, USA
| | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0428, Houston, TX 77030, USA.
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Frei M, Aitken SL, Jain N, Thompson P, Wierda W, Kontoyiannis DP, DiPippo AJ. Incidence and characterization of fungal infections in chronic lymphocytic leukemia patients receiving ibrutinib. Leuk Lymphoma 2020; 61:2488-2491. [PMID: 32530347 DOI: 10.1080/10428194.2020.1775215] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/01/2020] [Accepted: 05/17/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Michael Frei
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samuel L Aitken
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Center for Antimicrobial Resistance and Microbial Genomics (CARMiG); UTHealth McGovern Medical School, Houston, TX, USA
| | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Philip Thompson
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam J DiPippo
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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