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Pala L, Pagan E, Sala I, Oriecuia C, Oliari M, De Pas T, Specchia C, Cocorocchio E, Zattarin E, Rossi G, Catania C, Ceresoli GL, Laszlo D, Canzian J, Valenzi E, Viale G, Gelber RD, Mantovani A, Bagnardi V, Conforti F. Outcomes of patients with advanced solid tumors who discontinued immune-checkpoint inhibitors: a systematic review and meta-analysis. EClinicalMedicine 2024; 73:102681. [PMID: 39007061 PMCID: PMC11245998 DOI: 10.1016/j.eclinm.2024.102681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 05/12/2024] [Accepted: 05/28/2024] [Indexed: 07/16/2024] Open
Abstract
Background The outcome of patients with metastatic tumors who discontinued immune checkpoint inhibitors (ICIs) not for progressive disease (PD) has been poorly explored. We performed a meta-analysis of all studies reporting the clinical outcome of patients who discontinued ICIs for reasons other than PD. Methods We searched PubMed, Embase and Scopus databases, from the inception of each database to December 2023, for clinical trials (randomized or not) and observational studies assessing PD-(L)1 and CTLA-4 inhibitors in patients with metastatic solid tumors who discontinued treatment for reasons other than PD. Each study had to provide swimmer plots or Kaplan-Meier survival curves enabling the reconstruction of individual patient-level data on progression-free survival (PFS) following the discontinuation of immunotherapy. The primary endpoint was PFS from the date of treatment discontinuation overall and according to tumor histotype, type of treatment and reason of discontinuation. The Combersure's method was used to estimate meta-analytical non-parametric summary survival curves assuming random effects at study level. Findings Thirty-six studies (2180 patients) were included. The pooled median PFS (mPFS) was 24.7 months (95% CI, 18.8-30.6) and the PFS-rate at 12, 24, and 36 months was respectively 69.8% (95% CI, 63.1-77.3), 51.0% (95% CI, 43.4-59.8) and 34.0% (95% CI, 27.0-42.9). Univariable analysis showed that the mPFS was significantly longer for patients with melanoma (43.0 months), as compared with non-small cell lung cancer (NSCLC, 13.5 months) and renal cell carcinoma (RCC, 10.0 months; between-strata comparison test p-value < 0.001); for patients treated with anti-PD-(L)1 + anti-CTLA-4 as compared with anti-PD-(L)1 monotherapy (44.6 versus 19.9 months; p-value < 0.001), and in NSCLC when the reason of treatment discontinuation was elective as compared with toxicity onset (19.6 versus 4.8 months; p-value = 0.003). The multivariable analysis confirmed these differences. Interpretation The long-term outcome of patients who stopped ICIs for reasons other than PD was substantially affected by clinicopathological features: PFS after treatment discontinuation was longer in patients with melanoma, and/or treated with anti-PD-(L)1 + anti-CTLA-4, and shorter in patients with RCC or in those patients with NSCLC who stopped treatment for toxicity onset. Funding The Italian Ministry of University and Research (PRIN 2022Y7HHNW).
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Affiliation(s)
- Laura Pala
- Division of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | - Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Isabella Sala
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Chiara Oriecuia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Oliari
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Tommaso De Pas
- Division of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | | | - Emma Zattarin
- Division of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | - Giovanna Rossi
- Division of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | - Chiara Catania
- Division of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | | | - Daniele Laszlo
- Division of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
| | - Jacopo Canzian
- Division of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
- Department of Biomedical Sciences, Humanitas University, Italy
| | - Elena Valenzi
- Division of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
- Department of Biomedical Sciences, Humanitas University, Italy
| | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology, IRCCS Milan, Italy
- University of Milan, Milan, Italy
| | - Richard D. Gelber
- Department of Data Science, Dana-Farber Cancer Institute, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Frontier Science & Technology Research Foundation, Boston, USA
| | - Alberto Mantovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- William Harvey Research Institute, Queen Mary University, London, UK
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Fabio Conforti
- Division of Medical Oncology, Humanitas Gavazzeni, Bergamo, Italy
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Nogueira-Rodrigues A, Giannecchini GV, Secord AA. Real world challenges and disparities in the systemic treatment of ovarian cancer. Gynecol Oncol 2024; 185:180-185. [PMID: 38442493 DOI: 10.1016/j.ygyno.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024]
Abstract
Ovarian cancer (OC) is a global health problem, and the mortality-to-incidence ratio is expected to increase, especially in low- and middle-income countries. These regions face disparities in access to OC care, including lack of awareness, limited access to genetic and tumor testing, paucity of surgical expertise, time to approval of novel therapeutics, and treatment costs. By addressing these inequities, the core aim of this paper is to promote action through collaboration in order to overcome these barriers and promote health equity in OC management and treatment.
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Affiliation(s)
- Angélica Nogueira-Rodrigues
- Federal University MG, Brazilian Group of Gynecologic Oncology (EVA), Latin American Cooperative Oncology Group (LACOG), Oncoclínicas, DOM Oncologia, Brazil.
| | | | - Angeles Alvarez Secord
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, Duke Cancer Institute, Duke University Health System, Durham, North Carolina, USA
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Trojan A, Roth S, Atassi Z, Kiessling M, Zenhaeusern R, Kadvany Y, Schumacher J, Kullak-Ublick GA, Aapro M, Eniu A. Comparison of the Real-World Reporting of Symptoms and Well-Being for the HER2-Directed Trastuzumab Biosimilar Ogivri With Registry Data for Herceptin in the Treatment of Breast Cancer: Prospective Observational Study (OGIPRO) of Electronic Patient-Reported Outcomes. JMIR Cancer 2024; 10:e54178. [PMID: 38573759 PMCID: PMC11027054 DOI: 10.2196/54178] [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: 11/01/2023] [Revised: 12/22/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Trastuzumab has had a major impact on the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). Anti-HER2 biosimilars such as Ogivri have demonstrated safety and clinical equivalence to trastuzumab (using Herceptin as the reference product) in clinical trials. To our knowledge, there has been no real-world report of the side effects and quality of life (QoL) in patients treated with biosimilars using electronic patient-reported outcomes (ePROs). OBJECTIVE The primary objective of this prospective observational study (OGIPRO study) was to compare the ePRO data related to treatment side effects collected with the medidux app in patients with HER2-positive BC treated with the trastuzumab biosimilar Ogivri (prospective cohort) to those obtained from historical cohorts treated with Herceptin alone or combined with pertuzumab and/or chemotherapy (ClinicalTrials.gov NCT02004496 and NCT03578731). METHODS Patients were treated with Ogivri alone or combined with pertuzumab and/or chemotherapy and hormone therapy in (neo)adjuvant and palliative settings. Patients used the medidux app to dynamically record symptoms (according to the Common Terminology Criteria for Adverse Events [CTCAE]), well-being (according to the Eastern Cooperative Oncology Group Performance Status scale), QoL (using the EQ-5D-5L questionnaire), cognitive capabilities, and vital parameters over 6 weeks. The primary endpoint was the mean CTCAE score. Key secondary endpoints included the mean well-being score. Data of this prospective cohort were compared with those of the historical cohorts (n=38 patients; median age 51, range 31-78 years). RESULTS Overall, 53 female patients with a median age of 54 years (range 31-87 years) were enrolled in the OGIPRO study. The mean CTCAE score was analyzed in 50 patients with available data on symptoms, while the mean well-being score was evaluated in 52 patients with available data. The most common symptoms reported in both cohorts included fatigue, taste disorder, nausea, diarrhea, dry mucosa, joint discomfort, tingling, sleep disorder, headache, and appetite loss. Most patients experienced minimal (grade 0) or mild (grade 1) toxicities in both cohorts. The mean CTCAE score was comparable between the prospective and historical cohorts (29.0 and 30.3, respectively; mean difference -1.27, 95% CI -7.24 to 4.70; P=.68). Similarly, no significant difference was found for the mean well-being score between the groups treated with the trastuzumab biosimilar Ogivri and Herceptin (74.3 and 69.8, respectively; mean difference 4.45, 95% CI -3.53 to 12.44; P=.28). CONCLUSIONS Treatment of patients with HER2-positive BC with the trastuzumab biosimilar Ogivri resulted in equivalent symptoms, adverse events, and well-being as found for patients treated with Herceptin as determined by ePRO data. Hence, integration of an ePRO system into research and clinical practice can provide reliable information when investigating the real-world tolerability and outcomes of similar therapeutic compounds. TRIAL REGISTRATION ClinicalTrials.gov NCT05234021; https://clinicaltrials.gov/study/NCT05234021.
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Affiliation(s)
- Andreas Trojan
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- BrustZentrum Zürichsee, Horgen, Switzerland
| | - Sven Roth
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | | | | | | | | | - Gerd A Kullak-Ublick
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matti Aapro
- Cancer Center, Clinique de Genolier, Genolier, Switzerland
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Conic J, Reske T. Trends in Medicare utilization and reimbursement for hematology/oncology procedures from 2012 to 2023: A geriatric oncology perspective. Aging Med (Milton) 2024; 7:171-178. [PMID: 38725700 PMCID: PMC11077331 DOI: 10.1002/agm2.12298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/05/2024] [Accepted: 03/28/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives Given the scarcity of data exploring reimbursement trends in the field of hematology/oncology, we sought to characterize these trends for common procedures in this field from 2012 to 2023. Methods Using the Centers for Medicare and Medicaid Services' Physician Fee Schedule Look-Up Tool we collected reimbursement data for 40 hematology/oncology procedure codes from 2012 to 2023. Data was adjusted to 2023 United States (US) dollars using the Consumer Price Index (CPI). Results From 2012 to 2023 gross reimbursement for the facility price decreased 4.4% and increased 9.2% for the non-facility price. When adjusted for inflation, compensation decreased 96.1% and 96.6%, respectively. None of the 40 examined Current Procedural Terminology (CPT) codes increased in net reimbursement over the study period. Conclusions Medicare reimbursement for common hematology/oncology procedures decreased from 2012 to 2023. Further research is necessary to explore the implications of these trends on the delivery of patient care.
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Affiliation(s)
- J. Conic
- Department of Internal Medicine, Section of Geriatric MedicineLouisiana State University Health Sciences CenterNew OrleansLouisianaUSA
| | - T. Reske
- Department of Internal Medicine, Section of Geriatric Medicine and Section of Hematology/OncologyLouisiana State University Health Sciences CenterNew OrleansLouisianaUSA
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Dioun S, Chen L, De Meritens AB, St Clair CM, Hou JY, Khoury-Collado F, Pua T, Hershman DL, Wright JD. Cost-effectiveness of lenvatinib plus pembrolizumab versus chemotherapy for recurrent mismatch repair-proficient endometrial cancer after platinum-based therapy. Gynecol Oncol 2024; 182:70-74. [PMID: 38262241 DOI: 10.1016/j.ygyno.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE The recent Study 309-KEYNOTE-775 showed improved survival for lenvatinib plus pembrolizumab compared to chemotherapy in patients with recurrent endometrial cancer. We created a decision model to compare the cost-effectiveness of lenvatinib plus pembrolizumab in patients with recurrent mismatch repair-proficient (pMMR) endometrial cancer who had progressed after first-line chemotherapy. METHODS A Markov model was created to simulate the clinical trajectory of 10,000 patients with recurrent pMMR endometrial cancer. The initial decision point in the model was treatment with ether lenvatinib plus pembrolizumab or chemotherapy (doxorubicin or dose-dense paclitaxel). Model probabilities, utility values and costs were derived with assumptions drawn from published literature. A cycle length of 3 months and a time horizon of 2 years was used. The effectiveness was calculated in terms of average quality adjusted life years (QALYs) gained. The primary outcome was incremental cost-effectiveness ratios (ICERs), expressed in 2020 US dollars/QALYs. One-way, two-way and probabilistic sensitivity analyses were performed. RESULTS Chemotherapy was the least costly strategy at $66,693 followed by lenvatinib plus pembrolizumab ($193,590). Lenvatinib plus pembrolizumab resulted in more patients being alive at 2 years (lenvatinib plus pembrolizumab: 367, chemotherapy: 109). Chemotherapy was cost-effective compared with lenvatinib plus pembrolizumab (ICER: $164,493/QALYs). Lenvatinib plus pembrolizumab became cost-effective when its cost was reduced by $1553 per month (7.8% reduction). CONCLUSION For patients with recurrent pMMR endometrial cancer Lenvatinib plus pembrolizumab is associated with greater survival but is more costly than chemotherapy. The cost of lenvatinib and pembrolizumab would have to be reduced by approximately 7% to be considered cost-effective.
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Affiliation(s)
- Shayan Dioun
- Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center; New York Presbyterian Hospital
| | - Ling Chen
- Columbia University College of Physicians and Surgeons
| | - Alexandre Buckley De Meritens
- Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center; New York Presbyterian Hospital
| | - Caryn M St Clair
- Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center; New York Presbyterian Hospital
| | - June Y Hou
- Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center; New York Presbyterian Hospital
| | - Fady Khoury-Collado
- Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center; New York Presbyterian Hospital
| | - Tarah Pua
- Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center; New York Presbyterian Hospital
| | - Dawn L Hershman
- Columbia University College of Physicians and Surgeons; Joseph L. Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center; New York Presbyterian Hospital
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center; New York Presbyterian Hospital.
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Dee EC. Family and Caregiver Financial Toxicity Associated With Cancer-A Global, Inequitable, and Urgent Consideration. JAMA Netw Open 2023; 6:e2319317. [PMID: 37347488 DOI: 10.1001/jamanetworkopen.2023.19317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Trovato A, Tyler LS, Nickman NA, Findlay R. Interventions to reduce waste and improve billing compliance with medications in single-dose vials. Am J Health Syst Pharm 2023; 80:222-226. [PMID: 36322482 DOI: 10.1093/ajhp/zxac330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this process improvement project was to implement features in the electronic health record to help reduce inappropriate drug waste and Medicare billing noncompliance for injectable drugs in single-dose vials in outpatient settings. METHODS The pharmacy department mapped processes from order entry to dose administration and claims processing. They used the process map to identify gaps that could lead to inappropriate drug waste. The organization then chose 3 drugs they believed to be at high risk of excess waste and possible billing noncompliance after cross-referencing drug cost, volume of use, and previous Medicare audits in outpatient settings. They tested a grouper and dose rounding on these drugs and compared 3 months of claims before and after implementation to assess the impact on waste and billing compliance. RESULTS This study evaluated 826 claims before implementation and 1,075 claims after implementation. A total of 455 of 826 (55.1%) preimplementation claims included drug waste compared to 224 of 1,075 (20.8%) postimplementation claims. Twenty-three claims before implementation included an amount of waste exceeding the smallest vial size, putting the institution at risk of billing noncompliance. No claims had excess waste in the postimplementation period. The approximate cost of total drug waste before implementation was $1,397,437, with approximately $23,730 from inappropriate carfilzomib claims. The approximate cost of waste after implementation was $569,041. This equated to a reduction in drug waste of approximately $828,396 for bevacizumab-bvzr, carfilzomib, and ipilimumab. CONCLUSION Using a grouper and implementing dose rounding, the institution reduced drug waste, saved money, and reduced the incidence of claims noncompliant with Medicare Part B billing requirements.
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Affiliation(s)
| | - Linda S Tyler
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Nancy A Nickman
- University of Utah Health, Salt Lake City, UT, and University of Utah College of Pharmacy, Salt Lake City, UT, USA
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Mazmudar RS, Tripathi R, Bordeaux JS, Scott JF. Trends in brand and generic drug utilization for dermatology providers from 2013–2019. Arch Dermatol Res 2022; 315:1041-1044. [PMID: 36309878 DOI: 10.1007/s00403-022-02431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prescription drug costs have risen considerably in the United States and are projected to reach $560 billion by 2028. OBJECTIVE To evaluate brand and generic drug utilization and cost proportions within Medicare Part D. METHODS Prescription data for dermatology providers were obtained from the Centers for Medicare and Medicaid Services 2013-2019 Medicare Part D Prescribers by Provider datasets. Percentage of brand vs. generic drug claims and costs and cumulative annual growth rates (CAGRs) were calculated. For the most recent year of data (2019), we conducted additional sub-analyses for calculated percentages by prescriber variables. RESULTS The proportion of brand drug claims increased from 7.4% (in 2013) to 10.5% (2019) with a CAGR of 8.66%. In comparison, generic drug claims increased at a lower rate (CAGR 4.47%). The percentage of brand drug costs increased from 27.5% (in 2013) to 75.1% (2019). LIMITATIONS Inability to assess and generalize data for prescription patterns under non-Medicare plans. CONCLUSIONS Our study demonstrates a disproportionate rise in dermatologic brand drug claims and a substantial increase in costs associated with brand drugs. Brand-name drugs are associated with higher out-of-pocket expenses for patients, which can lead to decreased access and adherence to treatment.
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Affiliation(s)
- Rishabh S Mazmudar
- MetroHealth System/Case Western Reserve University School of Medicine, 2500 Metrohealth Dr, Cleveland, OH, 44109, U.S.A..
| | - Raghav Tripathi
- Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, U.S.A
| | - Jeffrey F Scott
- Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
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Marsh LA, Aviki EM, Wright JD, Chen L, Abu-Rustum N, Salani R. Sentinel lymph node mapping for endometrial cancer: Opportunity for medical waste reform. Gynecol Oncol 2022; 166:162-164. [PMID: 35597685 PMCID: PMC9772901 DOI: 10.1016/j.ygyno.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/29/2022] [Accepted: 05/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE As healthcare expenditures continue to rise, identifying mechanisms to reduce unnecessary costs is critical. The objective of this study is to estimate the annual cost of wasted indocyanine green (ICG) used for sentinel lymph node mapping in patients with endometrial cancer. METHODS Using the Surveillance, Epidemiology, and End Results program database and Premier database, we determined the annual number of cases in which sentinel lymph node mapping with ICG would be used and the median cost of ICG to institutions and patients, respectively. We assumed that gynecologic oncologists use 2-4 mL (20-40%) of the currently available ICG vial kit (25 mg per 10 mL) per case. Estimated waste was then calculated using cost as a measure of institutional waste and charge as excess cost transferred to patients or payers. RESULTS An estimated 45,864 cases of localized endometrial cancer were identified and eligible for sentinel lymph node (SLN) mapping. The mean total cost associated with ICG was 99.20 and the mean charge was $483.64. The estimated excess annual cost to hospitals was $2,729,825 to $3,639,767. Similarly, using mean charge data, the annual cost of wasted drug for patients and payers was $13,308,999 to $17,745,332. CONCLUSIONS The annual cost of wasted ICG due to its current manufactured vial size exceeds $2 million for hospitals and $13.3-$17.7 million for patients. We suggest ICG vials should be packaged in a 10 mg vial kit (2-4 mL sterile solution) to avoid drug waste and the financial impact to institutions and patients.
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Affiliation(s)
- Leah A Marsh
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California Los Angeles, Los Angeles, CA, United States of America.
| | - Emeline M Aviki
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Jason D Wright
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Ling Chen
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Nadeem Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, United States of America
| | - Ritu Salani
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California Los Angeles, Los Angeles, CA, United States of America
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The Cost of Enfortumab Vedotin Wastage Due to Vial Size-A Real-World Analysis. Cancers (Basel) 2021; 13:cancers13235977. [PMID: 34885086 PMCID: PMC8657095 DOI: 10.3390/cancers13235977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Enfortumab Vedotin (EV) is FDA-approved for advanced urothelial cancer in patients previously treated with chemotherapy and immunotherapy. In this report, we looked at the extent of EV wastage (i.e., discarding of leftover drug not administered to the patient) in a single institute and estimated the financial impact of EV wastage annually in the United States. We found that wastage occurred in 46% of administered doses, with an average waste per dose of 2.9% (range 0–18%). The average drug wastage cost per patient was $3127 ($252 per dose). The annual cost of EV wastage in the US is estimated to be $15 million. Abstract Enfortumab Vedotin (EV) is FDA-approved for advanced urothelial cancer in patients previously treated with platinum-based chemotherapy and a checkpoint inhibitor. We conducted a real-world study to determine the extent of EV wastage in a single institution and assessed the financial impact of EV wastage annually in the United States. Systematic examination of the usage and wastage of all standard-of-care EV treatments administered to urothelial cancer patients at Memorial Sloan Kettering Cancer Center (MSKCC) between 1 January 2020 and 31 December 2020 was performed. Drug wastage was calculated by subtracting the actual administered dose from the total dose in an optimal set of vials. We built a pharmacoeconomic model to assess the financial impact of EV wastage annually in the US using the January 2021 Average Sales Prices from the Centers for Medicare and Medicaid Services. Sixty-four patients were treated with standard-of-care EV, with a median of 11 doses per patient (range 1–28). Wastage occurred in 46% of administered doses (367/793), with a mean waste per dose of 2.9% (0–18%). The average drug wastage cost per patient was $3127 ($252/dose). The annual cost of EV wastage in the US is estimated to be $15 million based on wastage data from a single center in the US. In summary, EV wastage due to available vial sizes was 2.9%, which falls under acceptable thresholds. While the percentage of EV wastage is relatively low, waste-minimizing practices may reduce the financial toxicity for the individual patient and for society.
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Henderson R, Keeling P, French D, Smart D, Sullivan R, Lawler M. Cost-effectiveness of precision diagnostic testing for precision medicine approaches against non-small-cell lung cancer: A systematic review. Mol Oncol 2021; 15:2672-2687. [PMID: 34110679 PMCID: PMC8486593 DOI: 10.1002/1878-0261.13038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/10/2021] [Accepted: 06/09/2021] [Indexed: 11/11/2022] Open
Abstract
Precision diagnostic testing (PDT) employs appropriate biomarkers to identify cancer patients that may optimally respond to precision medicine (PM) approaches, such as treatments with targeted agents and immuno-oncology drugs. To date, there are no published systematic appraisals evaluating the cost-effectiveness of PDT in non-small-cell lung cancer (NSCLC). To address this gap, we conducted Preferred Reporting Items for Systematic Reviews and Meta-Analyses searches for the years 2009-2019. Consolidated Health Economic Evaluation Reporting Standards were employed to screen, assess and extract data. Employing base costs, life years gained or quality-adjusted life years, as well as willingness-to-pay (WTP) threshold for each country, net monetary benefit was calculated to determine cost-effectiveness of each intervention. Thirty-seven studies (50%) were included for analysis; a further 37 (50%) were excluded, having failed population-, intervention-, comparator-, outcomes- and study-design criteria. Within the 37 studies included, we defined 64 scenarios. Eleven scenarios compared PDT-guided PM with non-guided therapy [epidermal growth factor receptor (EGFR), n = 5; programmed death-ligand 1 (PD-L1), n = 6]. Twenty-eight scenarios compared PDT-guided PM with chemotherapy alone (anaplastic lymphoma kinase, n = 3; EGFR, n = 17; PD-L1, n = 8). Twenty-five scenarios compared PDT-guided PM with chemotherapy alone, while varying the PDT approach. Thirty-four scenarios (53%) were cost-effective, 28 (44%) were not cost-effective, and two were marginal, dependent on their country's WTP threshold. When PDT-guided therapy was compared with a therapy-for-all patients approach, all scenarios (100%) proved cost-effective. Seven of 37 studies had been structured appropriately to assess PDT-PM cost-effectiveness. Within these seven studies, all evaluated scenarios were cost-effective. However, 81% of studies had been poorly designed. Our systematic analysis implies that more robust health economic evaluation could help identify additional approaches towards PDT cost-effectiveness, underpinning value-based care and enhanced outcomes for patients with NSCLC.
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Affiliation(s)
| | | | - Declan French
- Queen’s Management SchoolQueen’s University BelfastUK
| | | | - Richard Sullivan
- Institute of Cancer PolicyKing’s College London & King’s Health Partners Comprehensive Cancer CentreUK
| | - Mark Lawler
- Patrick G. Johnston Centre for Cancer ResearchQueen’s University BelfastUK
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12
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Green AK, Makker V. Novel therapy in endometrial cancer: How much will we pay? Gynecol Oncol 2021; 162:243-244. [PMID: 34311843 DOI: 10.1016/j.ygyno.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Angela K Green
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.
| | - Vicky Makker
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
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Harrison RF, Fu S, Sun CC, Zhao H, Lu KH, Giordano SH, Meyer LA. Patient cost sharing during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment in ovarian cancer. Am J Obstet Gynecol 2021; 225:68.e1-68.e11. [PMID: 33549538 DOI: 10.1016/j.ajog.2021.01.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/26/2021] [Accepted: 01/30/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND More patients with ovarian cancer are being treated with poly(adenosine diphosphate-ribose) polymerase inhibitors because regulatory agencies have granted these drugs new approvals for a variety of treatment indications. However, poly(adenosine diphosphate-ribose) polymerase inhibitors are expensive. When administered as a maintenance therapy, these drugs may be administered for months or years. How much of this cost patients experience as out-of-pocket spending is unknown. OBJECTIVE This study aimed to estimate the out-of-pocket spending that patients experience during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment and to characterize which healthcare services account for that spending. STUDY DESIGN A retrospective cohort study was performed with a sample of patients with ovarian cancer treated between 2014 and 2017 with olaparib, niraparib, or rucaparib. Patients were identified using MarketScan, a health insurance claims database. All insurance claims during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment were collected. The primary outcome variable was the patients' out-of-pocket spending (copayment, coinsurance, and deductibles) during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment for the medication itself. Other outcomes of interest included out-of-pocket spending for other healthcare services, the types and frequency of other healthcare services used, health plan spending, the estimated proportion of patients' household income used each month for healthcare, and patients' out-of-pocket spending immediately before poly(adenosine diphosphate-ribose) polymerase inhibitor treatment. RESULTS We identified 503 patients with ovarian cancer with a median age of 55 years (interquartile range, 50-62 years); 83% of those had out-of-pocket spendings during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment. The median treatment duration was 124 days (interquartile range, 66-240 days). The mean out-of-pocket spending for poly(adenosine diphosphate-ribose) polymerase inhibitors was $305 (standard deviation, $2275) per month. On average, this accounted for 44.8% (standard deviation, 34.8%) of the patients' overall monthly out-of-pocket spending. The mean out-of-pocket spending for other healthcare services was $165 (standard deviation, $769) per month. Health plans spent, on average, $12,661 (standard deviation, $15,668) per month for poly(adenosine diphosphate-ribose) polymerase inhibitors and $7108 (standard deviation, $15,254) per month for all other healthcare services. The cost sharing for office visits, laboratory tests, and imaging studies represented the majority of non-poly(adenosine diphosphate-ribose) polymerase inhibitor treatment out-of-pocket spending. The average amount patients paid for all healthcare services per month during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment was $470 (standard deviation, $2407), which was estimated to be 8.7% of the patients' monthly household income. The mean out-of-pocket spending in the 12 months before poly(adenosine diphosphate-ribose) polymerase inhibitor treatment was $3110 (standard deviation, $6987). CONCLUSION Patients can face high out-of-pocket costs for poly(adenosine diphosphate-ribose) polymerase inhibitors, although the sum of cost sharing for other healthcare services used during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment is often higher. The spending on healthcare costs consumes a large proportion of these patients' household income. Patients with ovarian cancer experience high out-of-pocket costs for healthcare, both before and during poly(adenosine diphosphate-ribose) polymerase inhibitor treatment.
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Affiliation(s)
- Ross F Harrison
- Division of Surgery, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shuangshuang Fu
- Cancer Prevention and Population Sciences Division, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charlotte C Sun
- Division of Surgery, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hui Zhao
- Cancer Prevention and Population Sciences Division, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen H Lu
- Division of Surgery, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sharon H Giordano
- Cancer Prevention and Population Sciences Division, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Larissa A Meyer
- Division of Surgery, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Cancer Prevention and Population Sciences Division, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Abstract
Introduction: Esophageal cancer (EC) is the seventh most common cancer and the sixth leading cause of cancer death worldwide. The prognosis for advanced EC patients remains poor and there are few effective therapeutic agents available. Nivolumab is a fully human IgG4 monoclonal antibody that exerts antitumor activity by inhibiting the interaction of programmed cell death protein 1 on activated lymphocytes with its ligands. Nivolumab monotherapy showed significant benefit for overall survival of patients with advanced esophageal squamous cell carcinoma (ESCC) relative to taxane as a second-line treatment. Additionally, adjuvant nivolumab monotherapy showed significant disease-free survival benefit relative to placebo for resectable EC patients with residual pathologic disease who had received neoadjuvant chemoradiotherapy followed by surgery.Areas covered: Here, we provide an overview of checkpoint blockade with nivolumab and present the available clinical data related to its use in EC.Expert opinion: Nivolumab should be the standard second-line treatment for advanced ESCC patients and possibly adjuvant treatment of choice after neoadjuvant chemoradiotherapy followed by surgery. Trials assessing efficacy of a combination of cytotoxic agents and nivolumab as first-line treatment, nivolumab-containing chemoradiotherapy, and neoadjuvant chemotherapy are ongoing. These trials should result in improved protocols for better clinical outcomes in EC.
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Affiliation(s)
- Hayato Mikuni
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shun Yamamoto
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ken Kato
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
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Sureda M, Calvo E, Mata JJ, Escudero-Ortiz V, Martinez-Navarro E, Catalán A, Rebollo J. Dosage of anti-PD-1 monoclonal antibodies: a cardinal open question. Clin Transl Oncol 2021; 23:1511-1519. [PMID: 33583005 DOI: 10.1007/s12094-021-02563-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/28/2021] [Indexed: 12/11/2022]
Abstract
Discovery and clinical development of monoclonal antibodies with the ability to interfere in the regulation of the immune response have significantly changed the landscape of oncology in recent years. Among the active agents licensed by the regulatory agencies, nivolumab and pembrolizumab are paradigmatic as the most relevant ones according to the magnitude of available data derived from the extensive preclinical and clinical experience. Although in both cases the respective data sheets indicate well-defined dosage regimens, a review of the literature permits to verify the existence of many issues still unresolved about dosing the two agents, so it must be considered an open question of potentially important consequences, in which to work to improve the effectiveness and efficiency of use.
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Affiliation(s)
- M Sureda
- Plataforma de Oncología, Hospital Quironsalud Torrevieja, C/Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain.
| | - E Calvo
- START Madrid-Centro Integral Oncológico Clara Campal, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - J J Mata
- Plataforma de Oncología, Hospital Quironsalud Torrevieja, C/Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain
| | - V Escudero-Ortiz
- Plataforma de Oncología, Hospital Quironsalud Torrevieja, C/Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain
| | - E Martinez-Navarro
- Plataforma de Oncología, Hospital Quironsalud Torrevieja, C/Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain
| | - A Catalán
- Plataforma de Oncología, Hospital Quironsalud Torrevieja, C/Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain
| | - J Rebollo
- Plataforma de Oncología, Hospital Quironsalud Torrevieja, C/Partida de la Loma s/n, 03184, Torrevieja, Alicante, Spain
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Affiliation(s)
- Angela K Green
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
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Matsuo K, Nomura H, Uchiyama M, Miyazaki M, Imakyure O. Estimating the effect of optimizing anticancer drug vials on medical costs in Japan based on the data from a cancer hospital. BMC Health Serv Res 2020; 20:1017. [PMID: 33167996 PMCID: PMC7650189 DOI: 10.1186/s12913-020-05822-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The substantial increase in the use of expensive anticancer drugs has been accompanied by an increase in the amount of disposing residual liquid from drug preparations. Many Western countries, including the United States, have implemented drug vial optimization (DVO) to prevent the waste of anticancer drugs and have reported the reductions in the total drug costs. This study was designed to estimate the expected reduction in spending on anticancer drugs by Japanese cancer hospitals when DVO was implemented instead of individual preparations and to test the effectiveness of this approach. METHODS We investigated the doses of drugs used and quantity specifications for individually prepared vials for patients who received anticancer drug treatment in December 2017 at the Outpatient Treatment Center of the National Cancer Center Hospital East. Based on these findings, we calculated the total quantity of each drug used on a given day, and the minimum cost for preparation of the number of specified combinations corresponding to the total cost (DVO preparation). Based on the differences in these two costs, we estimated the economic impact of implementing DVO. RESULTS While the cost for anticancer drugs for the 1-month study period was US$3,305,595 (US$1 = \110) for individual preparations, the estimated cost for DVO preparations was US$3,092,955, equivalent to a reduction of US$212,640. CONCLUSIONS Based on these study results, implementation of DVO-based preparation of injectable anticancer drugs in Japan in 2017 would have resulted in saving approximately US$460 million. This calculation revealed the need for the Japanese government to modify the methods employed to calculate drug costs in the insurance system and develop policies for the proper and optimal use of medical resources.
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Affiliation(s)
- Koichi Matsuo
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, 818-8502, Japan.
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan.
| | - Hisanaga Nomura
- Department of Pharmacy, National Cancer Center Hospital East, Chiba, Japan
| | - Masanobu Uchiyama
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, 818-8502, Japan
| | - Motoyasu Miyazaki
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, 818-8502, Japan
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
| | - Osamu Imakyure
- Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka, 818-8502, Japan
- Department of Pharmaceutical and Health Care Management, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka, Japan
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Ramsey SD, Dusetzina SB. Weighing Costs and Benefits in the Economics of Cancer Care. J Clin Oncol 2020; 38:289-291. [PMID: 31804863 DOI: 10.1200/jco.19.02316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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