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Marin S, Pérez-Cordón L, Salvà F, Camps ML, Campins L, Lianes P. Cost-minimisation analysis of rectal cancer neoadjuvant chemoradiotherapy based on fluoropyrimidines (capecitabine versus 5-fluorouracil). Eur J Hosp Pharm 2021; 28:e13-e17. [PMID: 34728541 DOI: 10.1136/ejhpharm-2019-002156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/08/2020] [Accepted: 03/03/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The current standard treatment for patients with rectal cancer stage II-III is neoadjuvant chemoradiotherapy followed by surgery. Neoadjuvant chemoradiotherapy can be performed with 5-fluorouracil (5-FU) or capecitabine (CPC) considered to be equivalent therapies. Medication cost is higher for CPC than for 5-FU, however, the administration of continuous 5-FU intravenous infusion is related to other costs such as those associated with outpatient facilities or central venous catheter insertion. METHODS This retrospective study analysed the direct sanitary costs associated with the treatments and their complications from a hospital perspective. Costs in patients treated with 5-FU or CPC were measured between January 2010 and July 2018 at Mataró Hospital. The aim of this study was to perform a cost-minimisation analysis between the two treatments. We aimed to assess the cost associated with the complications related to each drug and the economic impact of applying the most efficient option. RESULTS Ninety-eight patients were analysed: 32 were treated with CPC and 66 with 5-FU. Treatment cost was significantly higher for 5-FU than for CPC (2560.86±99.17 and 563.10±9.52 respectively, P=0.0001). No significant differences were found in the costs associated with treatment complications between groups (148.21±934.91 and 41.41±102.50 euros respectively, P=0.322). CONCLUSIONS Considering the clinical equivalence shown in the available trials and previous reviews, the most efficient treatment is neoadjuvant chemoradiotherapy with CPC. Complications associated with the treatments did not significantly modify these results. Other studies gave similar results both in the neoadjuvant and adjuvant context, reaffirmed in this study.
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Affiliation(s)
- Sergio Marin
- Pharmacy Department, Hospital de Mataró, Mataró, Spain .,Pharmacy Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Marcel la Camps
- Pharmacy Department, Consorci Sanitari de l'Anoia, Igualada, Spain
| | - Lluís Campins
- Pharmacy Department, Hospital de Mataró, Mataró, Spain
| | - Pilar Lianes
- Oncology Department, Hospital de Mataró, Mataró, Spain
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Survival outcomes in patients with non-small-cell lung cancer treated with erlotinib. Anticancer Drugs 2018; 29:786-790. [PMID: 30110016 DOI: 10.1097/cad.0000000000000640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Erlotinib is used to treat non-small-cell lung cancer (NSCLC). Erlotinib was subsidized on the Pharmaceutical Benefits Schedule in Australia for the treatment of advanced stage (IIIB or IV) NSCLC (August 2008). In the pivotal trial supporting initial subsidy, erlotinib increased overall survival (OS) by 2 months compared with placebo (adjusted hazard ratio, 0.70; 95% confidence interval: 0.58-0.85). We examined the effectiveness of erlotinib in a 'real-world' setting by measuring survival outcomes in NSCLC patients treated in two tertiary metropolitan public hospitals in Queensland. We extracted data from the electronic oncology prescribing system (CHARM) for NSCLC patients prescribed erlotinib (1 September 2009 to 1 February 2015). Survival estimates and analyses were generated using Kaplan-Meier curves. 134 patients received at least one dose of erlotinib during the study period. At the date of data extraction 113 patients had died. The median patient age was 64 years and 55% were men. The median duration of treatment was 2.0 months. The median OS was 5.8 months. The median progression-free survival (time from start of erlotinib to disease progression or death from any cause) was 3.6 months. The use of erlotinib in the two Queensland sites was consistent with the pivotal trial used to support subsidy. The median OS was somewhat less than the trial (5.8 vs. 6.7 months), which could be because of the hospital cohort including frailer patients who were unsuitable for parenteral chemotherapy, and the mixed epidermal growth factor receptor mutation status of the hospital cohort.
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Karakoç MD. A Cost Saving and Waste Minimization Study About Handling of the Antineoplastic Agents. Turk J Pharm Sci 2017; 14:304-310. [PMID: 32454629 DOI: 10.4274/tjps.25238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/09/2017] [Indexed: 12/01/2022]
Abstract
Objectives As a cancer treatment option, chemotherapy costs make up a large part of the budgets of social insurance foundations and related expenditures are increasing continuously annually. Cost saving and waste minimizing strategies are required to reduce the expenditures in the field of oncology. The study aimed to reduce the amount of wasted antineoplastic drugs and medical supply consumption. Materials and Methods The study explains why vials with a larger size and drugs in liquid form should be preferred over various smaller sizes and powder forms of antineoplastic preparations. Results Amounts of drug wastage, vial adaptor, and transfer set consumption data were recorded regularly for a period of seven months. The average vial adaptor consumption per patient in the last three months decreased from 5 to 3.3. The preference of liquid forms as much as possible instead of powder forms, which has a shorter stability time after dilution, and the choice of larger package sizes of frequently used drugs decreased vial adaptor consumption. Potential savings were calculated as around 31.660 USD annually. Costs of total wasted doses were 8.699.87 USD, and the whole antineoplastic drug consumption was 515.500 USD during the study. A decrease of 0.58 USD was observed per capita when the first and last three-month periods were compared in terms of waste costs. Conclusion These values indicate that the reduction of wasted drugs have potential annual savings of 3.375 USD. It is shown that total potential savings of 35.000 USD could be made per year. By implementing the same principles in all hospitals in Turkey, approximately 2.8 million USD could be made annually. The pharmaceutical industry and hospital pharmacists have important responsibilities in this issue.
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Jeong K, Cairns J. Systematic review of health state utility values for economic evaluation of colorectal cancer. HEALTH ECONOMICS REVIEW 2016; 6:36. [PMID: 27541298 PMCID: PMC4991979 DOI: 10.1186/s13561-016-0115-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 08/12/2016] [Indexed: 05/30/2023]
Abstract
Cost-utility analyses undertaken to inform decision making regarding colorectal cancer (CRC) require a set of health state utility values (HSUVs) so that the time CRC patients spend in different health states can be aggregated into quality-adjusted life-years (QALY). This study reviews CRC-related HSUVs that could be used in economic evaluation and assesses their advantages and disadvantages with respect to valuation methods used and CRC clinical pathways. Fifty-seven potentially relevant studies were identified which collectively report 321 CRC-related HSUVs. HSUVs (even for similar health states) vary markedly and this adds to the uncertainty regarding estimates of cost-effectiveness. There are relatively few methodologically robust HSUVs that can be directly used in economic evaluations concerned with CRC. There is considerable scope to develop new HSUVs which improve on those currently available either by expanded collection of generic measures or by making greater use of condition-specific data, for example, using mapping algorithms.
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Affiliation(s)
- Kim Jeong
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Marín-Pozo JF, Duarte-Pérez JM, Sánchez-Rovira P. Safety, Effectiveness, and Costs of Bevacizumab-Based Therapy in Southern Spain: A Real World Experience. Medicine (Baltimore) 2016; 95:e3623. [PMID: 27175672 PMCID: PMC4902514 DOI: 10.1097/md.0000000000003623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
To evaluate the safety and efficacy of bevacizumab in a broader patient population with solid tumors in the context of general clinical practice. Moreover, we quantified the economic impact and characterized the off-label use (OLU) of this agent in real-life prescribing practices.This is an open, retrospective, observational, real world study carried out at a regional Spanish hospital attending a population of 665,000 inhabitants. All of the patients receiving bevacizumab-containing therapy between January 2006 and February 2012 at the study hospital were included: no exclusion criteria were specified. All study variables were collected from available hospital records.The analysis comprised 240 episodes from 226 patients (male 41%; median age 57 years, 25% ≥65 years). Eighty cases (33%) of bevacizumab treatment were administered as first-line therapy. The median duration of bevacizumab treatment was 5.8 months (95% CI 5.1-6.6), without difference by age, line of treatment, or type of tumor. Typically bevacizumab-related toxicities included bleeding (25%), hypertension (5%), wound-healing complications (4%), gastrointestinal perforation (2%), and arterial thromboembolism (1%). Median progression-free survival was 7.5 months (95% CI 6.3-8.7) and median OS reached 13.1 months (95% CI 11.4-14.9). Bevacizumab increased the chemotherapy cost to 207% (from &OV0556;3,115,615 to &OV0556;9,552,405). Bevacizumab was prescribed off-label in 43% of episodes, amounting to &OV0556;3,586,420 (56% of bevacizumab total cost).The efficacy and safety profile of bevacizumab in routine clinical practice is consistent with results observed in prospective randomized clinical trials. OLU of this drug should be closely monitored.
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Affiliation(s)
- Juan F Marín-Pozo
- From the Complejo Hospitalario de Jaén, Jaén (JFM-P, PS-R), Spain; and University of Granada (JMD-P), Granada, Spain
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Djalalov S, Rabeneck L, Tomlinson G, Bremner KE, Hilsden R, Hoch JS. A Review and Meta-analysis of Colorectal Cancer Utilities. Med Decis Making 2014; 34:809-18. [PMID: 24903121 DOI: 10.1177/0272989x14536779] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 04/29/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To perform a systematic review of utility weights for colorectal cancer (CRC) health states reported in the scientific literature and to determine the effects of disease factors, patient characteristics, and utility methods on utility values. METHODS We identified 26 articles written in English and published from January 1980 to January 2013, providing 351 unique utilities for CRC health states elicited from 6546 unique respondents. The CRC utility data were analyzed using linear mixed-effects models with CRC type, stage, time to or from initial care, utility measurement instrument, and administration method as independent variables. RESULTS In the base case model, the estimated utility for a patient with stage I to III CRC more than 1 year after surgery, rated using a self-administered time tradeoff instrument, was 0.90. Stage, time to or from initial care, and utility measurement instrument were associated with statistically significant utility differences ranging from -0.19 to 0.02. Utilities for patients with stage IV cancer were 0.19 lower (P < 0.001) than for those with stage I to III cancer. Utilities elicited at more than 1 year after surgery were 0.05 higher than those elicited at 3 months after surgery (P = 0.008). Estimates of differences between utility measurement instruments were sensitive to how repeated scores in the same patient group were treated, and other findings were sensitive to how the disease stage was modeled and method of administration. CONCLUSIONS Variations in reported utilities are associated with factors such as cancer stage, time to or from initial care, and utility measurement instrument. More research is needed to study why apparently similar patients report different quality of life.
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Affiliation(s)
- Sandjar Djalalov
- Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada (SD, JSH),Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada (SD, LR, JSH),Canadian Centre for Applied Research in Cancer Control (ARCC), Toronto, ON, Canada (SD, JSH)
| | - Linda Rabeneck
- Institute of Health Policy, Management and Evaluation and Department of Medicine, University of Toronto, Toronto, ON, Canada (LR, GT, JSH),Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada (SD, LR, JSH)
| | - George Tomlinson
- Institute of Health Policy, Management and Evaluation and Department of Medicine, University of Toronto, Toronto, ON, Canada (LR, GT, JSH),Department of Medicine, University Health Network/Mt. Sinai Hospital, Toronto, ON, Canada (GT)
| | | | | | - Jeffrey S Hoch
- Centre for Excellence in Economic Analysis Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada (SD, JSH),Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada (SD, LR, JSH),Canadian Centre for Applied Research in Cancer Control (ARCC), Toronto, ON, Canada (SD, JSH)
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Karikios DJ, Schofield D, Salkeld G, Mann KP, Trotman J, Stockler MR. Rising cost of anticancer drugs in Australia. Intern Med J 2014; 44:458-63. [DOI: 10.1111/imj.12399] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/19/2014] [Indexed: 11/26/2022]
Affiliation(s)
- D. J. Karikios
- NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | - D. Schofield
- NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | - G. Salkeld
- Sydney School of Public Health; Sydney Medical School; University of Sydney; Sydney New South Wales Australia
| | - K. P. Mann
- NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | - J. Trotman
- Concord Repatriation General Hospital; University of Sydney; Sydney New South Wales Australia
| | - M. R. Stockler
- NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
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Lopert R, Ruiz F, Chalkidou K. Applying rapid 'de-facto' HTA in resource-limited settings: experience from Romania. Health Policy 2013; 112:202-8. [PMID: 23953877 DOI: 10.1016/j.healthpol.2013.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 07/18/2013] [Accepted: 07/23/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND In attempting to constrain healthcare expenditure growth, health technology assessment (HTA) can enable policy-makers to look beyond budget impact and facilitate more rational decision-making. However lack of technical capacity and poor governance can limit use in some countries. Undertaking de facto HTA by adapting decisions taken in countries with established processes is a method that may be applied while building domestic HTA capacity. We explored the potential for applying this approach in Romania. METHODS As part of a review of the basic health benefits available to insured Romanians we examined the listing process and content of the Romanian drug reimbursement formulary. We assessed value for money indirectly by drawing on appraisals by UK's NICE, and for products considered cost effective in the UK, adjusting prices by the ratio of Romanian per capita GDP to UK per capita GDP. FINDINGS We found more than 30 of the top 50 medicines on the Romanian formulary unlikely to be cost-effective, suggesting that existing external reference pricing mechanisms may not be delivering good value for money. CONCLUSIONS While not taking into account local costs or treatment patterns, absent local considerations of value for money, this method offers a guide for both drug selection and pricing. Until robust local HTA processes are established this approach could support further analysis of existing prices and pricing mechanisms. Applied more generally, it is arguably preferable to external reference pricing, product delisting or arbitrary price cuts, and may support the future development of more rigorous, evidence-based decision-making.
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Affiliation(s)
- Ruth Lopert
- Department of Health Policy, George Washington University, 2021 K St NW, Washington DC.
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WOODWARD R, MENZIN J, NEUMANN P. Quality-adjusted life years in cancer: pros, cons, and alternatives. Eur J Cancer Care (Engl) 2012; 22:12-9. [DOI: 10.1111/ecc.12006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dasanu CA. Bevacizumab in lung cancer: lackluster performance and unjustified expense? J Oncol Pharm Pract 2012; 18:381-2. [PMID: 22777997 DOI: 10.1177/1078155212453607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A recent retrospective analysis of a large cohort of patients aged 65 and older with advanced non-small cell lung cancer failed to demonstrate any improvement in survival with the addition of bevacizumab to the platinum doublet in the first-line therapy. A few points have to be made: 1) a vast majority of patients with lung cancer are 65 and older; 2) important including fatal toxicity can occur with the use of bevacizumab; and 3) costs of bevacizumab are significant. Integrating the conclusions of this study into clinical practice and further analysis of underlying physical, psychosocial, and economic hurdles of bevacizumab use in lung cancer patients are certainly justified.
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Affiliation(s)
- Constantin A Dasanu
- Department of Hematology-Oncology, St. Francis Hospital and Medical Center, USA.
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