1
|
Li W, Wan L. Cost-utility of sintilimab plus chemotherapy vs chemotherapy as first-line treatment of advanced gastric or gastroesophageal junction cancer in China. Expert Rev Pharmacoecon Outcomes Res 2024; 24:671-678. [PMID: 38594905 DOI: 10.1080/14737167.2024.2341859] [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: 01/22/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES ORIENT-16, a phase III clinical trial conducted at 62 hospitals in China, reported that add-on sintilimab (Sin) to chemotherapy (Chemo) had favorable efficacy (p < 0.05) for patients with advanced HER2-negative gastric or gastroesophageal junction cancer (GC/GEJC). This study aimed to evaluate the cost-utility of the Sin+Chemo based on results of ORIENT-16 from the perspective of Chinese healthcare payers. METHODS A three-state partitioned survival model was developed to simulate the 10-year life expectancy and total healthcare costs for patients with advanced HER2-negative GC/GEJC. Primary measure outcomes were: cost, quality-adjusted life-years (QALYs), and incremental cost-utility ratios (ICURs). Sensitivity/scenario analyses were conducted to assess the model robustness. RESULTS In all patients, Sin+Chemo vs Chemo increased costs by $6,472, additionally providing 0.61 QALYs, resulting in an ICUR of $10,610/QALY. While, in PD-L1 combined positive score ≥ 5 cohort, the ICUR was $9,738/QALYs. The ICUR was most sensitive to the utility of progression-free survival. The probabilistic sensitivity analysis showed that add-on Sin had a 100% probability of being cost-effective at a willingness-to-pay threshold of $18,625/QALY gained. CONCLUSIONS Sin+Chemo is a cost-effective first-line treatment option for advanced HER2-negative GC/GEJC in China. CLINICAL TRIAL REGISTRATION ORIENT-16, www.clinicaltrials.gov, identifier is NCT03745170.
Collapse
Affiliation(s)
- Wei Li
- Department of Pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Wan
- Department of Pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
2
|
Closset M, Onorati S, Colsoul ML, Goderniaux N, Bihin B, Jamart J, Soumoy L, Hecq JD, Odou P, Galanti L. Long-term physicochemical stability of 5-fluorouracil at selected standardised rounded doses in polyolefin bags. J Oncol Pharm Pract 2023; 29:1878-1883. [PMID: 36718964 DOI: 10.1177/10781552231152618] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chemotherapy doses are usually prescribed on the basis of body surface area but dose banding is emerging as an efficient alternative. Dose banding presents the possibility of in-advance preparation in a Centralized Intravenous Admixture Service. AIM OF THE STUDY To evaluate the long-term stability of 5-fluorouracil at banded doses (700 mg and 800 mg) in polyolefin bags. MATERIALS AND METHODS Ten polyolefin bags were prepared under aseptic conditions and stored at 23 ± 2°C for 24 days. Five of them were composed of 14 mL 5-fluorocuracil (700 g) in 100 mL 0.9% sodium chloride solution and the five other of 16 mL 5-fluorouracil (800 mg) in 100 mL 0.9% sodium chloride solution. At defined times, physical stability parameters were assessed: optical densities, pH measurements, visual and microscopical inspections. Solutions concentrations were measured using high-performance liquid chromatography coupled with a photodiode array detector. RESULTS No change was observed on pH and optical density measurements during the study period. Visual and microscopical inspections remained free of colour change, precipitate, microagregate or crystal. The concentrations of 5-Fluorouracil in 800 mg bags remained stable for 24 days while the concentration in 700 mg bags showed a stability of at least 17 days. CONCLUSION Five-fluorouracil at banded doses of 700 and 800 mg in polyolefin bags is physicochemically stable for at least 17 days at 23 ± 2°C. These results support the possibility of in advance centralised preparation.
Collapse
Affiliation(s)
- Mélanie Closset
- Medical Laboratory, CHU UCL Namur, Yvoir, Belgium
- Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | | | - Marie-Lise Colsoul
- Medical Laboratory, CHU UCL Namur, Yvoir, Belgium
- Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | - Nicolas Goderniaux
- Medical Laboratory, CHU UCL Namur, Yvoir, Belgium
- Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | - Benoît Bihin
- Scientific Support Unit, CHU UCL Namur, Yvoir, Belgium
- Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | - Jacques Jamart
- Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | - Laura Soumoy
- Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium
- Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | - Jean-Daniel Hecq
- Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium
- Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | - Pascal Odou
- Université de Lille, CHU Lille, ULR7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Laurence Galanti
- Medical Laboratory, CHU UCL Namur, Yvoir, Belgium
- Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| |
Collapse
|
3
|
Vijenthira A, Kuruvilla J, Crump M, Jain M, Prica A. Cost-Effectiveness Analysis of Frontline Polatuzumab-Rituximab, Cyclophosphamide, Doxorubicin, and Prednisone and/or Second-Line Chimeric Antigen Receptor T-Cell Therapy Versus Standard of Care for Treatment of Patients With Intermediate- to High-Risk Diffuse Large B-Cell Lymphoma. J Clin Oncol 2023; 41:1577-1589. [PMID: 36315922 DOI: 10.1200/jco.22.00478] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Recent studies of polatuzumab vedotin and CD19 chimeric antigen receptor T-cell therapy (CAR-T) have shown significant improvements in progression-free survival over standard of care (SOC) for patients with diffuse large B-cell lymphoma. However, they are costly, and it is unclear whether these strategies, alone or combined, are cost-effective over SOC. METHODS A Markov model was constructed to compare four strategies for patients with newly diagnosed intermediate- to high-risk diffuse large B-cell lymphoma: strategy 1: polatuzumab-rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHP) plus second-line CAR-T for early relapse (< 12 months); strategy 2: polatuzumab-R-CHP plus second-line salvage therapy ± autologous stem-cell transplant; strategy 3: rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone plus second-line CAR-T for early relapse; strategy 4: SOC (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone plus second-line salvage therapy ± autologous stem-cell transplant). Transition probabilities were estimated from trial data. Lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated from US and Canadian payer perspectives. Willingness-to-pay (WTP) thresholds of $150,000 US dollars (USD) or Canadian dollars (CAD)/QALY were used. RESULTS In probabilistic analyses (10,000 simulations), each strategy was incrementally more effective than the previous strategy, but also more costly. Adding polatuzumab-R-CHP to the SOC had an ICER of $546,956 (338,797-1,199,923) USD/QALY and $245,381 (151,671-573,250) CAD/QALY. Adding second-line CAR-T to the SOC had an ICER of $309,813 (190,197-694,200) USD/QALY and $303,163 (221,300-1,063,864) CAD/QALY. Simultaneously adding both polatuzumab-R-CHP and second-line CAR-T to the SOC had an ICER of $488,284 (326,765-840,157) USD/QALY and $267,050 (182,832-520,922) CAD/QALY. CONCLUSION Given uncertain incremental benefits in long-term survival and high costs, neither polatuzumab-R-CHP frontline, CAR-T second-line, nor a combination are likely to be cost-effective in the United States or Canada at current pricing compared with the SOC.
Collapse
Affiliation(s)
- Abi Vijenthira
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - John Kuruvilla
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael Crump
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael Jain
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL
| | - Anca Prica
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| |
Collapse
|
4
|
Yamada H, Yamada Y, Iihara H, Kobayashi R, Tanaka H, Suzuki A. A pharmacist check of patients' infection-related condition prior to drug preparation reduces anticancer drug wastage after mixing: a retrospective study. J Pharm Policy Pract 2023; 16:5. [PMID: 36650580 PMCID: PMC9847088 DOI: 10.1186/s40545-023-00518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/07/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We previously reported that a standardized pharmacist check of medical orders related to the administration criteria of anticancer drugs prior to preparation of injectable anticancer drugs was useful for reducing drug wastage after mixing. To further reduce anticancer drug wastage after preparation, we added a pharmacist check of patients' infection-related condition to the previous protocol and assessed the effectiveness of the modified protocol for reducing injectable anticancer drug wastage. METHODS In addition to the administration criteria of anticancer drugs, patients' infection-related condition, which was based on a body temperature ≥ 37.5 °C or elevated C-reactive protein (CRP) or white blood cell (WBC) count from baseline, was added to pharmacists' checklist of items used previously to prepare injectable anticancer drugs. We retrospectively compared the number, type and cost of anticancer drugs discarded after preparation and the reasons for discarding these drugs between pre- and post-protocol modification. RESULTS The rate at which anticancer drugs were discarded after preparation was significantly reduced after introducing the modified protocol compared to the original protocol (0.288% [18/6253] vs. 0.095% [6/6331], P = 0.013). Furthermore, the number of cases for which mixed anticancer agents were discarded because of infection decreased from 11 (fever: n = 8; elevated CRP or WBC: n = 3) to one (elevated CRP: n = 1) a year. CONCLUSIONS In addition to the standard administration criteria of anticancer drugs, checking patients' infection-related condition, defined by a body temperature ≥ 37.5 °C or elevated CRP or WBC from baseline, before mixing by the pharmacist is useful for reducing anticancer drug wastage after preparation.
Collapse
Affiliation(s)
- Hirotsugu Yamada
- grid.411704.7Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan ,grid.256342.40000 0004 0370 4927United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu, Japan
| | - Yuto Yamada
- grid.411704.7Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Hirotoshi Iihara
- grid.411704.7Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Ryo Kobayashi
- grid.411704.7Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan ,grid.411697.c0000 0000 9242 8418Laboratory of Advanced Medical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Hiroyuki Tanaka
- grid.256342.40000 0004 0370 4927United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu, Japan ,grid.411697.c0000 0000 9242 8418Laboratory of Immunobiology, Department of Biofunctional Analysis, Gifu Pharmaceutical University, Gifu, Japan
| | - Akio Suzuki
- grid.411704.7Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan ,grid.411697.c0000 0000 9242 8418Laboratory of Advanced Medical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| |
Collapse
|
5
|
Davidoff AJ, Akif K, Halpern MT. Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature. J Natl Cancer Inst Monogr 2022; 2022:12-20. [PMID: 35788372 DOI: 10.1093/jncimonographs/lgac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/21/2022] [Indexed: 01/16/2023] Open
Abstract
We reviewed current literature reviews regarding economics of cancer-related health care to identify focus areas and gaps. We searched PubMed for systematic and other reviews with the Medical Subject Headings "neoplasms" and "economics" published between January 1, 2010, and April 1, 2020, identifying 164 reviews. Review characteristics were abstracted and described. The majority (70.7%) of reviews focused on cost-effectiveness or cost-utility analyses. Few reviews addressed other types of cancer health economic studies. More than two-thirds of the reviews examined cancer treatments, followed by screening (15.9%) and survivorship or end-of-life (13.4%). The plurality of reviews (28.7%) cut across cancer site, followed by breast (20.7%), colorectal (11.6%), and gynecologic (8.5%) cancers. Specific topics addressed cancer screening modalities, novel therapies, pain management, or exercise interventions during survivorship. The results indicate that reviews do not regularly cover other phases of care or topics including financial hardship, policy, and measurement and methods.
Collapse
Affiliation(s)
- Amy J Davidoff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kaitlin Akif
- Office of the Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michael T Halpern
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| |
Collapse
|
6
|
Liu Q, Zhou Z, Luo X, Yi L, Peng L, Wan X, Tan C, Zeng X. Cost-Effectiveness of Pembrolizumab Plus Chemotherapy Versus Pembrolizumab Monotherapy in Metastatic Non-Squamous and Squamous NSCLC Patients With PD-L1 Expression ≥ 50. Front Pharmacol 2022; 12:803626. [PMID: 35082679 PMCID: PMC8784520 DOI: 10.3389/fphar.2021.803626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To compare the cost-effectiveness of the combination of pembrolizumab and chemotherapy (Pembro+Chemo) versus pembrolizumab monotherapy (Pembro) as the first-line treatment for metastatic non-squamous and squamous non-small-cell lung cancer (NSCLC) with PD-L1expression ≥50%, respectively, from a US health care perspective. Material and Methods A comprehensive Makrov model were designed to compare the health costs and outcomes associated with first-line Pembro+Chemo and first-line Pembro over a 20-years time horizon. Health states consisted of three main states: progression-free survival (PFS), progressive disease (PD) and death, among which the PFS health state was divided into two substates: PFS while receiving first-line therapy and PFS with discontinued first-line therapy. Two scenario analyses were performed to explore satisfactory long-term survival modeling. Results In base case analysis, for non-squamous NSCLC patients, Pembro+Chemo was associated with a significantly longer life expectancy [3.24 vs 2.16 quality-adjusted life-years (QALYs)] and a substantially greater healthcare cost ($341,237 vs $159,055) compared with Pembro, resulting in an ICER of $169,335/QALY; for squamous NSCLC patients, Pembro+Chemo was associated with a slightly extended life expectancy of 0.22 QALYs and a marginal incremental cost of $3,449 compared with Pembro, resulting in an ICER of $15,613/QALY. Our results were particularly sensitive to parameters that determine QALYs. The first scenario analysis yielded lower ICERs than our base case results. The second scenario analysis founded Pembro+Chemo was dominated by Pembro. Conclusion For metastatic non-squamous NSCLC patients with PD-L1 expression ≥50%, first-line Pembro+Chemo was not cost-effective when compared with first-line Pembro. In contrast, for the squamous NSCLC patient population, our results supported the first-line Pembro+Chemo as a cost-effective treatment. Although there are multiple approaches that are used for extrapolating long-term survival, the optimal method has yet to be determined.
Collapse
Affiliation(s)
- Qiao Liu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Xia Luo
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lidan Yi
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Liubao Peng
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaomin Wan
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chongqing Tan
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaohui Zeng
- Department of Nuclear Medicine/PET Image Center, The Second Xiangya Hospital of Central South University, Changsha, China
| |
Collapse
|
7
|
Monteith BE, Venner CP, Cheung MC, Pater J, Shepherd L, Richardson H, Reece D, Gul E, Lalancette M, Castonguay V, Kukreti V, Tiedemann R, Phua C, Bhella S, Dudebout J, Sherry M, Yen H, Chen BE, Hay AE. A descriptive cost-analysis of MYX.1/MCRN003, a phase 2 clinical trial evaluating high-dose weekly carfilzomib, cyclophosphamide, and dexamethasone in relapsed and refractory multiple myeloma. Eur J Haematol 2021; 107:333-342. [PMID: 34053112 DOI: 10.1111/ejh.13671] [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: 03/23/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The prevalence of multiple myeloma is increasing and there is a need to evaluate escalating therapy costs (Canadian Cancer Statistics A, 2020). The MYX.1 phase II trial showed that high-dose weekly carfilzomib, cyclophosphamide, and dexamethasone (wKCD) is efficacious in relapsed and refractory disease. We conducted a descriptive cost analysis, from the perspective of the Canadian public healthcare system, using trial data. METHODS The primary outcome was the mean total cost per patient. Resource utilization data were collected from all 75 trial patients over a trial time horizon. Costs are presented in Canadian dollars (2020). RESULTS The cost of treatment was calculated from the time of patient (pt) enrollment until the second data lock. The mean total cost was $203 336.08/pt (range $17 891.27-$505 583.55) Canadian dollars (CAD, where 1 CAD = 0.67 Euro (EUR)) and $14 081.45/pt per cycle. The median number of cycles was 15. The predominant cost driver was the cost of chemotherapy accounting for an average of $179 332.78/pt or $12 419.17/pt per cycle. Carfilzomib acquisition accounted for the majority of chemotherapy costs - $162 471.65/pt or $11 251.50/pt per cycle. Fifty-six percent (56%) of patients had at least one hospitalization during the trial period with an average cost of $12 657.86 per hospitalization. Three patients developed thrombotic microangiopathy (TMA) with an average cost of $18 863.32/pt including the cost of hospitalizations and therapeutic plasma exchange. CONCLUSIONS High-dose wKCD is an active triplet regimen for relapsed and refractory multiple myeloma (RRMM) associated with reduced total cost compared with twice-weekly carfilzomib-based regimens.
Collapse
Affiliation(s)
- Bethany E Monteith
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada.,Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | | | - Matthew C Cheung
- Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Joe Pater
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Lois Shepherd
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | | | - Donna Reece
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Engin Gul
- Canadian Myeloma Research Group (formerly the Myeloma Canada Research Network), Vaughan, ON, Canada
| | - Marc Lalancette
- CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Quebec City, QC, Canada
| | - Vincent Castonguay
- CHU de Québec, Hôtel-Dieu de Québec, Université Laval, Quebec City, QC, Canada
| | - Vishal Kukreti
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Rodger Tiedemann
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Chai Phua
- Victoria Hospital, Western University, London, ON, Canada
| | - Sita Bhella
- Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | - Jill Dudebout
- Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| | - Max Sherry
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Hope Yen
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Bingshu E Chen
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Annette E Hay
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada.,Cancer Center of Southeastern Ontario, Queen's University, Kingston, ON, Canada
| |
Collapse
|
8
|
Patel KK, Parker T, Di M, Bar N, Huntington SF, Giri S. Cost-effectiveness of once-weekly selinexor, bortezomib, and dexamethasone in relapsed or refractory multiple myeloma. Leuk Lymphoma 2021; 62:2777-2784. [PMID: 34151696 DOI: 10.1080/10428194.2021.1933477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The BOSTON trial showed that use of once-weekly selinexor, bortezomib, and dexamethasone (SVd) prolonged progression-free survival compared to twice-weekly bortezomib and dexamethasone (Vd) in patients with relapsed or refractory (R/R) multiple myeloma (MM). In this study, we constructed a Markov model to assess the cost-effectiveness of SVd versus Vd in R/R MM. We calculated the incremental cost-effectiveness ratio (ICER) of each treatment strategy from a US payer perspective, using a lifetime horizon and a willingness-to-pay threshold of $150,000 per quality-adjusted life-year (QALY). Use of SVd was associated with an incremental cost of $170,002 compared to Vd alone ($1,015,120 vs. $845,118, respectively), an incremental effectiveness of 0.35 QALYs (3.43 vs. 3.08 QALYs, respectively), and an ICER of $487,361/QALY. These data suggest that use of once-weekly SVd for R/R M/M is unlikely to be cost-effective compared to twice-weekly Vd.
Collapse
Affiliation(s)
- Kishan K Patel
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Terri Parker
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Mengyang Di
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Noffar Bar
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Scott F Huntington
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, USA
| | - Smith Giri
- Department of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
9
|
Cost-effectiveness of azacitidine and venetoclax in unfit patients with previously untreated acute myeloid leukemia. Blood Adv 2021; 5:994-1002. [PMID: 33591323 DOI: 10.1182/bloodadvances.2020003902] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/08/2021] [Indexed: 01/03/2023] Open
Abstract
The phase 3 VIALE-A trial reported that venetoclax in combination with azacitidine significantly improved response rates and overall survival compared with azacitidine alone in older, unfit patients with previously untreated acute myeloid leukemia (AML). However, the cost-effectiveness of azacitidine-venetoclax in this clinical setting is unknown. In this study, we constructed a partitioned survival model to compare the cost and effectiveness of azacitidine-venetoclax with azacitidine alone in previously untreated AML. Event-free and overall survival curves for each treatment strategy were derived from the VIALE-A trial using parametric survival modeling. We calculated the incremental cost-effectiveness ratio (ICER) of azacitidine-venetoclax from a US-payer perspective. Azacitidine-venetoclax was associated with an improvement of 0.61 quality-adjusted life-years (QALYs) compared with azacitidine alone. However, the combination led to significantly higher lifetime health care costs (incremental cost, $159 595), resulting in an ICER of $260 343 per QALY gained. The price of venetoclax would need to decrease by 60% for azacitidine-venetoclax to be cost-effective at a willingness-to-pay threshold of $150 000 per QALY. These data suggest that use of azacitidine-venetoclax for previously untreated AML patients who are ineligible for intensive chemotherapy is unlikely to be cost-effective under current pricing. Significant price reduction of venetoclax would be required to reduce the ICER to a more widely acceptable value.
Collapse
|
10
|
Chen Z, Cheng Y, DeRemer D, Diaby V. Cost-effectiveness and drug wastage of immunotherapeutic agents for hematologic malignancies: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2021; 21:923-941. [PMID: 33934691 DOI: 10.1080/14737167.2021.1913056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Novel immunotherapeutic agents (e.g. monoclonal antibodies, antibody-drug conjugates, bispecific T-cell engagers) as treatment options for hematologic malignancies continue to emerge. These agents have been used as the standard of care in specific disease states and are associated with high costs. Value assessment of these therapies is of critical importance for coverage and reimbursement decision-making.Areas covered: We identified 15 immunotherapeutic agents through the U.S. FDA approvals for hematologic malignancies until 2018 and systematically reviewed related cost-effectiveness studies. Additionally, we examined whether drug wastage was accounted for in these studies.Expert opinion: We reviewed 51 studies for 14 identified immunotherapeutic agents that met the inclusion criteria for this systematic review. Three studies were observational-based, one study was model-based and incorporated observational data. The remaining studies were model-based with the majority of the model parameters extracted from randomized control trials (RCTs). Among 43 model-based economic evaluations, 13 studies accounted for drug wastage. Most of the studies showed favorable incremental cost-effectiveness ratios of immunotherapeutic agents-containing regimens when compared with no immunotherapeutic agents-containing regimens. Alemtuzumab, brentuximab vedotin, and daratumumab were not considered cost-effective across all the studies. Further investigations are warranted to establish the value of recent immunotherapeutic agents for hematologic malignancies.
Collapse
Affiliation(s)
- Ziyan Chen
- Department of Pharmaceutical Outcomes & Policy (POP), College of Pharmacy, University of Florida, Gainesville, Florida, United States
| | - Yue Cheng
- Institute for Pharmaceutical Outcomes & Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky, United States
| | - David DeRemer
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, United States
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes & Policy (POP), College of Pharmacy, University of Florida, Gainesville, Florida, United States
| |
Collapse
|
11
|
Closset M, Onorati S, Colsoul ML, Goderniaux N, Bihin B, Jamart J, Soumoy L, Hecq JD, Odou P, Galanti L. Long-term physico-chemical stability of 5-fluorouracile at standardised rounded doses (SRD) in MyFuser® portable infusion pump. J Chemother 2021; 33:486-491. [PMID: 33835887 DOI: 10.1080/1120009x.2021.1906037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Management of chemotherapies is a strategic issue for european healthcare. Dose-banding enables to reduce waiting time of patients in day care units and drug wastage. The aim of this study was to assess the stability of 5-Fluorouracile (5-FU) at standardised rounded doses of 4 and 5 g in MyFuser® portable infusion pump for in-advance preparation. Ten MyFuser® (4 and 5 gr 5-FU added to NaCl 0.9%) were prepared under aseptic conditions and stored at room temperature (23 ± 2 °C) for 28 days then at 30 °C for three days. Physical stability tests were periodically performed: visual and microscopic inspection, pH measurements and optical densities. The concentration of solutions was measured by High Performance Liquid Chromatography/UV detector. Results confirm the stability of 5-FU at selected SRD of 4 g and 5 g with NaCl 0.9% in MyFuser® for at least 28 days at room temperature and three days at 30 °C, allowing in-advance preparation.
Collapse
Affiliation(s)
- Mélanie Closset
- Medical Laboratory, CHU UCL Namur, Yvoir, Belgium.,Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | | | - Marie-Lise Colsoul
- Medical Laboratory, CHU UCL Namur, Yvoir, Belgium.,Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | - Nicolas Goderniaux
- Medical Laboratory, CHU UCL Namur, Yvoir, Belgium.,Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | - Benoît Bihin
- Scientific Support Unit, CHU UCL Namur, Yvoir, Belgium.,Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | - Jacques Jamart
- Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | - Laura Soumoy
- Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium.,Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | - Jean-Daniel Hecq
- Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium.,Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| | - Pascal Odou
- CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Université de Lille, Lille, France
| | - Laurence Galanti
- Medical Laboratory, CHU UCL Namur, Yvoir, Belgium.,Drug Stability Research Group, CHU UCL Namur, Yvoir, Belgium
| |
Collapse
|
12
|
Cost-effectiveness of first-line vs third-line ibrutinib in patients with untreated chronic lymphocytic leukemia. Blood 2021; 136:1946-1955. [PMID: 32518952 DOI: 10.1182/blood.2020004922] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/03/2020] [Indexed: 01/18/2023] Open
Abstract
The ALLIANCE A041202 trial found that continuously administered ibrutinib in the first-line setting significantly prolonged progression-free survival compared with a fixed-duration treatment of rituximab and bendamustine in older adults with chronic lymphocytic leukemia (CLL). In this study, we created a Markov model to assess the cost-effectiveness of ibrutinib in the first-line setting, compared with a strategy of using ibrutinib in the third-line after failure of time-limited bendamustine and venetoclax-based regimens. We estimated transition probabilities from randomized trials using parametric survival modeling. Lifetime direct health care costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated from a US payer perspective. First-line ibrutinib was associated with an improvement of 0.26 QALYs and 0.40 life-years compared with using ibrutinib in the third-line setting. However, using ibrutinib in the first-line led to significantly higher health care costs (incremental cost of $612 700), resulting in an ICER of $2 350 041 per QALY. The monthly cost of ibrutinib would need to be decreased by 72% for first-line ibrutinib therapy to be cost-effective at a willingness-to-pay threshold of $150 000 per QALY. In a scenario analysis where ibrutinib was used in the second-line in the delayed ibrutinib arm, first-line ibrutinib had an incremental cost of $478 823, an incremental effectiveness of 0.05 QALYs, and an ICER of $9 810 360 per QALY when compared with second-line use. These data suggest that first-line ibrutinib for unselected older adults with CLL is unlikely to be cost-effective under current pricing. Delaying ibrutinib for most patients with CLL until later lines of therapy may be a reasonable strategy to limit health care costs without compromising clinical outcomes.
Collapse
|
13
|
Patel KK, Giri S, Parker TL, Bar N, Neparidze N, Huntington SF. Cost-Effectiveness of First-Line Versus Second-Line Use of Daratumumab in Older, Transplant-Ineligible Patients With Multiple Myeloma. J Clin Oncol 2021; 39:1119-1128. [PMID: 33411586 DOI: 10.1200/jco.20.01849] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The MAIA trial found that addition of daratumumab to lenalidomide and dexamethasone (DRd) significantly prolonged progression-free survival in transplant-ineligible patients with newly diagnosed multiple myeloma, compared with lenalidomide and dexamethasone alone (Rd). However, daratumumab is a costly treatment and is administered indefinitely until disease progression. Therefore, it is unclear whether it is cost-effective to use daratumumab in the first-line setting compared with reserving its use until later lines of therapy. METHODS We created a Markov model to compare healthcare costs and clinical outcomes of transplant-ineligible patients treated with daratumumab in the first-line setting compared with a strategy of reserving daratumumab until the second-line. We estimated transition probabilities from randomized trials using parametric survival modeling. Lifetime direct healthcare costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for first-line daratumumab versus second-line daratumumab from a US payer perspective. RESULTS First-line daratumumab was associated with an improvement of 0.52 QALYs and 0.66 discounted life-years compared with second-line daratumumab. While both treatment strategies were associated with considerable lifetime expenditures ($1,434,937 v $1,112,101 in US dollars), an incremental cost of $322,836 for first-line daratumumab led to an ICER of $618,018 per QALY. The cost of daratumumab would need to be decreased by 67% for first-line daratumumab to be cost-effective at a willingness-to-pay threshold of $150,000 per QALY. CONCLUSION Using daratumumab in the first-line setting for transplant-ineligible patients may not be cost-effective under current pricing. Delaying daratumumab until subsequent lines of therapy may be a reasonable strategy to limit healthcare costs without significantly compromising clinical outcomes. Mature overall survival data are necessary to more fully evaluate cost-effectiveness in this setting.
Collapse
Affiliation(s)
- Kishan K Patel
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT
| | - Smith Giri
- Department of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Terri L Parker
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT
| | - Noffar Bar
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT
| | - Natalia Neparidze
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT
| | - Scott F Huntington
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT.,Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT
| |
Collapse
|
14
|
Patel KK, Stein S, Lacy J, O’Hara M, Huntington SF. Evaluation of the Cost-effectiveness of Doublet Therapy in Metastatic BRAF Variant Colorectal Cancer. JAMA Netw Open 2021; 4:e2033441. [PMID: 33433598 PMCID: PMC7804917 DOI: 10.1001/jamanetworkopen.2020.33441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE The BEACON trial showed that combination therapy with encorafenib (BRAF inhibitor) and cetuximab (EGFR inhibitor) was associated with prolonged overall survival compared with standard chemotherapy in patients with metastatic BRAF variant colorectal cancer. However, the cost-effectiveness of using these agents in this clinical setting is unknown. OBJECTIVE To create a cost-effectiveness model to compare doublet therapy (encorafenib plus cetuximab) with standard chemotherapy (cetuximab plus irinotecan or cetuximab plus folinic acid, fluorouracil, and irinotecan) in treating patients with metastatic BRAF variant colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation constructed a Markov model to compare the lifetime cost and utility of doublet therapy and standard chemotherapy. Parametric survival modeling was used to extrapolate the effectiveness of each line of therapy from large clinical trials. One-way and probabilistic sensitivity analyses assessed the uncertainty in the model. Patients mirrored the cohorts in the BEACON trial: they had metastatic BRAF variant colorectal cancer and were followed up as they progressed through multiple lines of therapy, best supportive care, and death. Data collection and data analysis were performed from November 15, 2019, to July 14, 2020. MAIN OUTCOMES AND MEASURES The main outcome was the incremental cost-effectiveness ratio, which was calculated using the cumulative cost and effectiveness in quality-adjusted life years (QALYs), of doublet therapy compared with standard chemotherapy. RESULTS The model patient cohort had a mean age of 61 years, and 53% of the patients were women, 66% had 1 previous line of therapy, and 8% had high microsatellite instability. Doublet therapy was associated with an improvement of 0.15 QALYs compared with standard chemotherapy. However, the incremental cost of doublet therapy was $78 233, leading to an incremental cost-effectiveness ratio of $523 374 per QALY gained. Concomitant decreases in the price of encorafenib and cetuximab are needed to achieve cost-effectiveness at a willingness-to-pay threshold of $150 000 per QALY gained. CONCLUSIONS AND RELEVANCE This study found that doublet therapy for metastatic BRAF variant colorectal cancer was unlikely to be cost-effective under current pricing. Cost-effectiveness needs to be considered in clinical trial design, particularly when combining new therapies with non-cost-effective treatments that are coadministered without a fixed duration.
Collapse
Affiliation(s)
- Kishan K. Patel
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - Stacey Stein
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - Jill Lacy
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - Mark O’Hara
- Department of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Scott F. Huntington
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, Connecticut
- Yale Cancer Outcomes, Public Policy and Effectiveness Research Center, New Haven, Connecticut
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Patel KK, Isufi I, Kothari S, Foss F, Huntington S. Cost-effectiveness of polatuzumab vedotin in relapsed or refractory diffuse large B-cell lymphoma. Leuk Lymphoma 2020; 61:3387-3394. [PMID: 32835553 DOI: 10.1080/10428194.2020.1808208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A recent phase II trial showed that use of polatuzumab vedotin in combination with bendamustine plus rituximab (Pola-BR) in transplant-ineligible patients with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL) resulted in longer progression-free survival and overall survival compared to bendamustine plus rituximab (BR) alone. In this study, we constructed a Markov model to assess the cost-effectiveness of Pola-BR versus BR in transplant-ineligible R/R DLBCL. We calculated the incremental cost-effectiveness ratio (ICER) of each treatment strategy from a US payer perspective, using a lifetime horizon and a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY). Use of Pola-BR was associated with an incremental cost of $92,641 compared to BR alone ($200,905 vs $108,265, respectively), an incremental effectiveness of 1.76 QALYs (2.35 vs 0.59 QALYs, respectively), and an ICER of $52,519/QALY. These data suggest that use of Pola-BR for R/R DLBCL is likely to be cost-effective compared to BR alone.
Collapse
Affiliation(s)
- Kishan K Patel
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Iris Isufi
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Shalin Kothari
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Francine Foss
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Scott Huntington
- Department of Hematology/Oncology, Yale University School of Medicine, New Haven, CT, USA.,Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT, USA
| |
Collapse
|
17
|
Jyoti K, Manjula G, Ganachari MS. Application of KW-ANOVA statistics to generate evidence for cytotoxic drug wastage induced financial burden among cancer patients: A clinical pharmacist observation. J Oncol Pharm Pract 2020; 26:1559-1565. [PMID: 31948346 DOI: 10.1177/1078155219898710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Very little is known about the effects of drug wastage costs among cancer patients in terms of "financial toxicity" leading to poor health and nonhealth outcomes. But reducing this drug waste is an attractive strategy for cost-cutting with regard to improving the health-related quality of life of the cancer patients. Thus, the objective of the study was to determine drug wastage and to generate evidence for cytotoxic drug waste and financial burden among cancer patients.Methodology: On Ethics Committee approval, a prospective-observational study was conducted in cancer patients. The data were collected in data collection form. Daily monitoring was done to analyze the quantity of drug wastage which was interpreted using KW-ANOVA and further evidence was developed for corrective mitigation strategies applicable to intent drugs. RESULTS Among 90 patients, 52 patients experienced drug wastage that includes 9 intent drugs which figured out unnecessary monetary units and quantity wastage that range from 80 to 50,000 INR and 10 to 500 mg, respectively. The median price value for cost of drug wastage was 237.30 INR. CONCLUSION The study generates evidence that concludes the mandatory requirement of implementation of drug wastage mitigation strategies for the drugs expected to cause wastage. Clinical pharmacist extensively contributes in oncology pharmacy practice setting to identify the intent drugs and to abate the drug wastage among medications intending to cause potential increment in drug expenditure among cancer patients on chemotherapy clinical pharmacist.
Collapse
Affiliation(s)
- K Jyoti
- Department of Pharmacy Practice, KLE College of Pharmacy, KAHER, Belagavi, Karnataka, India
| | - G Manjula
- Department of Pharmacy Practice, KLE College of Pharmacy, KAHER, Belagavi, Karnataka, India
| | - M S Ganachari
- Department of Pharmacy Practice, KLE College of Pharmacy, KAHER, Belagavi, Karnataka, India
| |
Collapse
|
18
|
Siderov J. Utility of PhaSeal, a closed‐system drug transfer device, in facilitating vial sharing to reduce waste and assist in medication cost savings. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Jim Siderov
- Pharmacy Department Austin Health Melbourne Australia
| |
Collapse
|
19
|
Seixas BV, Dionne F, Conte T, Mitton C. Assessing value in health care: using an interpretive classification system to understand existing practices based on a systematic review. BMC Health Serv Res 2019; 19:560. [PMID: 31409369 PMCID: PMC6693163 DOI: 10.1186/s12913-019-4405-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 08/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementing adequate strategies to assess the value of health services plays a central role in the effort to deal with the financial pressures faced by health care systems worldwide. This study aimed to understand which approaches to value assessment have been used in developed countries. METHODS We conducted a rapid review and a gray literature search to identify value assessment frameworks. A two-stage screening process was utilized to identify existing approaches and cluster similar frameworks. In addition, we developed an interpretive classification system to make sense of existing approaches. RESULTS One thousand one hundred seventy-six references were identified and 38 papers were selected for full-review. Among these 38 articles, 22 distinct approaches to assess value of health care interventions were identified and classified according to four points: 1) use of single or multiple considerations to base value estimates; 2) use of disease-specific or generic criteria; 3) reliance on process-based or outcomes-based consideration; and 4) type of input and evidence considered. CONCLUSIONS The contextual nature of value assessment in health care becomes evident with the diversity of existing approaches. Despite the predominance of cases relying on the Incremental cost-effectiveness ratio as the measure of value, this approach has not been sufficient to meet the needs of decision-makers. The use of multiple criteria has become more and more important, as well as the consideration of patient-reported measures. Considerations of costs are not always explicit and consistent.
Collapse
Affiliation(s)
- Brayan V Seixas
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, USA.
| | | | - Tania Conte
- Center for Clinical Epidemiology and Evaluation, Vancouver, Canada
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia (UBC), Vancouver, Canada
| |
Collapse
|
20
|
Biskupiak J, Oderda G, Brixner D, Tang D, Zacker C, Dalal AA. Quantification of Economic Impact of Drug Wastage in Oral Oncology Medications: Comparison of 3 Methods Using Palbociclib and Ribociclib in Advanced or Metastatic Breast Cancer. J Manag Care Spec Pharm 2019; 25:859-866. [PMID: 31347980 PMCID: PMC10397918 DOI: 10.18553/jmcp.2019.25.8.859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Discarding unused drugs after dose changes or discontinuation can significantly affect pharmacy budgets. This is especially concerning for expensive oncology agents. However, few economic studies account for drug wastage, providing an inaccurate estimate of a drug's actual economic cost, cost-effectiveness, and value. OBJECTIVES To (a) compare the economic impact of drug wastage between ribociclib and palbociclib-clinically similar oral medications for metastatic breast cancer-using 3 approaches (Markov model, pharmacy acquisition cost model, and a retrospective claims analysis) and (b) compare the modeling results with a published estimate of drug wastage for palbociclib from a claims analysis. METHODS A Markov model and a pharmacy acquisitions cost model were developed to evaluate the economic impact of dose reductions for ribociclib and palbociclib over a 1-year time period. Data inputs were pharmacy costs (RED BOOK wholesale acquisition cost) and proportion of patients experiencing dose reductions from either ribociclib randomized clinical trials (MONALEESA-2, -3, or -7) or real-world observational data (Symphony Health retrospective claims analysis). The latter constituted the third approach for quantifying drug wastage. The economic impact of dose reductions for ribociclib and palbociclib in postmenopausal women with previously untreated HR-positive/HER2-negative advanced breast cancer was assessed. Drug wastage was defined as drug doses that could not be used by a patient following a dose reduction. The cost of drug wastage was defined as the cost associated with an unused drug resulting from a dose reduction. The predicted results from the 2 models were compared with a previously published claims analysis that estimated the effect of treatment costs and drug wastage for palbociclib based on the observed dosing patterns from the Symphony Health Solutions database. RESULTS In the Markov model, relative to ribociclib, palbociclib users experienced drug wastage of $112,382 total, or $1,124 per treated patient, per year due to dose changes. In the pharmacy acquisition cost model, relative to ribociclib, palbociclib usage was associated with an increased cost of $7,196 per patient per year (based on a mid-cycle dose reduction) comprising dosing-based cost differences and drug wastage cost for palbociclib of $3,727. The previously published claims analysis found that palbociclib users experiencing a dose reduction had drug wastage costs of $5,471 per patient. CONCLUSIONS In both models, dose reductions for ribociclib patients resulted in no wastage, since unused tablets could be administered in subsequent cycles, while dose reductions for palbociclib resulted in drug wastage and increased costs. The results from both models were consistent with previously published results from the claims analysis, demonstrating drug wastage costs for palbociclib. DISCLOSURES This study received financial support from Novartis Pharmaceuticals, which has products approved for treatment of breast cancer. Tang was employed by Novartis during this study; Zacker and Dalal are employed by Novartis and own company stock. Biskupiak, Brixner, and Oderda received payment from Novartis for this study. Brixner serves as a consultant for Millcreek Outcomes Group and also declares consulting fees from Abbvie, AstraZeneca, Abbott, Becton Dickinson, and Xcenda, unrelated to this study.
Collapse
Affiliation(s)
| | - Gary Oderda
- 1University of Utah College of Pharmacy, Salt Lake City
| | - Diana Brixner
- 1University of Utah College of Pharmacy, Salt Lake City
| | - Derek Tang
- 2Novartis Pharmaceuticals, East Hanover, New Jersey
| | | | | |
Collapse
|
21
|
Gopisankar MG, Wahlang J, Jagtap V, Sarkar C, Purnima Devi L, Harris C. Cancer chemotherapy drug wastage in a tertiary care hospital in India-A 3-month prospective and 1-year retrospective study. Br J Clin Pharmacol 2019; 85:2428-2435. [PMID: 31323137 DOI: 10.1111/bcp.14064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/26/2019] [Accepted: 07/10/2019] [Indexed: 11/30/2022] Open
Abstract
This study prospectively quantified wastage of cancer chemotherapeutic drugs in an oncology unit to find the associated cost in 3 months. Retrospective analysis of drug usage for 12 months was also conducted to determine the expected drug loss in 1 year. The effect of vial sharing was evaluated under the assumption of sharing. A significant drug wastage of 19.72% (95% confidence interval [CI], 14.52-24.93%) in 3 months and 17.14% (95% CI 14.69-19.59%) in 1 year occurred in our oncology unit. Number of vials purchased (r = 0.362, p < 0.01), weight (r = -0.146, P < .01) and body surface area (r = -0.26, P < .01) correlated with the drug wasted. Vial sharing assumption showed a 9% (95% CI, 2.5-15.5%) reduction in cost in 1 year.
Collapse
Affiliation(s)
| | | | - Vikas Jagtap
- Department of Radiation Oncology, NEIGRIHMS, India
| | | | | | - Caleb Harris
- Department of Surgical Oncology, NEIGRIHMS, India
| |
Collapse
|
22
|
Huntington SF, von Keudell G, Davidoff AJ, Gross CP, Prasad SA. Cost-Effectiveness Analysis of Brentuximab Vedotin With Chemotherapy in Newly Diagnosed Stage III and IV Hodgkin Lymphoma. J Clin Oncol 2018; 36:JCO1800122. [PMID: 30285558 PMCID: PMC6241679 DOI: 10.1200/jco.18.00122] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE In a recent randomized, open-label trial (ECHELON-1), brentuximab vedotin (BV) combined with doxorubicin, vinblastine, and dacarbazine (AVD+BV) decreased the risk of progression in adults diagnosed with stage III or IV Hodgkin lymphoma (HL) compared with standard bleomycin-containing chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD]). However, the cost effectiveness of incorporating BV (US$6,970 per 50-mg vial) into the first-line setting is unknown. PATIENTS AND METHODS We constructed a Markov decision-analytic model to measure the costs and clinical outcomes for AVD+BV compared with ABVD as first-line therapy in a cohort of patients with stage III or IV HL. Transition probabilities were estimated from ECHELON-1 by fitting parametric survival distributions. Lifetime direct health care costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for AVD+BV compared with ABVD from a US payer perspective. Our model was also used to estimate BV price reductions that would achieve more favorable cost effectiveness under indication-specific pricing. RESULTS AVD+BV was associated with an improvement of 0.56 QALYs compared with treatment with standard ABVD. However, incorporating BV into first-line therapy led to significantly higher lifetime health care costs ($361,137 v $184,291), causing the ICER for AVD+BV to be $317,254 per QALY. If indication-specific pricing were implemented, acquisition costs for BV used in the first-line setting would need to be reduced by 56% to 73% for ICERs of $150,000 to $100,000 per QALY, respectively. CONCLUSION Substituting BV for bleomycin during first-line therapy for stage III or IV HL is unlikely to be cost effective under current drug pricing. Should indication-specific pricing be implemented, significant price reductions for BV used in the first-line setting would be needed to reduce ICERs to more widely acceptable values.
Collapse
Affiliation(s)
- Scott F. Huntington
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Gottfried von Keudell
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Amy J. Davidoff
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Cary P. Gross
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | - Sapna A. Prasad
- Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale School of Medicine; Scott F. Huntington, Amy J. Davidoff, and Cary P. Gross, Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center; Amy J. Davidoff, Yale School of Public Health; Sapna A. Prasad, Smilow Cancer Hospital at Yale-New Haven Health, New Haven, CT; and Gottfried von Keudell, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| |
Collapse
|
23
|
Suzuki S, Gilbar P, Yu B, Matsuyama C, Yamaguchi M. Current status of drug vial optimization use to prevent waste associated with injectable anticancer agents. J Oncol Pharm Pract 2018; 25:244-246. [DOI: 10.1177/1078155218758501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Shinya Suzuki
- Department of Pharmacy, National Cancer Center Hospital East, National Research and Development Agency, Kashiwa, Japan
| | - Peter Gilbar
- Cancer and Palliative Care Services, Toowoomba Hospital, Toowoomba, Australia
| | - Bo Yu
- Department of Pharmacy, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chihiro Matsuyama
- Department of Pharmacy, National Cancer Center Hospital East, National Research and Development Agency, Kashiwa, Japan
| | - Masakazu Yamaguchi
- Department of Pharmacy, National Cancer Center Hospital East, National Research and Development Agency, Kashiwa, Japan
| |
Collapse
|
24
|
Gilbar PJ, Chambers CR, Vandenbrouche J, Sessink PJM, Tyler TG. How can the use of closed system transfer devices to facilitate sharing of drug vials be optimised to achieve maximum cost savings? J Oncol Pharm Pract 2018; 25:205-209. [DOI: 10.1177/1078155217753890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Peter J Gilbar
- Cancer and Palliative Care Services, Toowoomba Hospital, Toowoomba, Australia
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
| | - Carole R Chambers
- Department of Cancer Services Pharmacy, Alberta Health Services, Calgary, Canada
| | | | | | - Timothy G Tyler
- Comprehensive Cancer Center, Desert Regional Medical Center, Palm Springs, CA, USA
| |
Collapse
|
25
|
Hui L, von Keudell G, Wang R, Zeidan AM, Gore SD, Ma X, Davidoff AJ, Huntington SF. Cost-effectiveness analysis of consolidation with brentuximab vedotin for high-risk Hodgkin lymphoma after autologous stem cell transplantation. Cancer 2017; 123:3763-3771. [PMID: 28640385 PMCID: PMC5610636 DOI: 10.1002/cncr.30818] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND In a recent randomized, placebo-controlled trial, consolidation treatment with brentuximab vedotin (BV) decreased the risk of Hodgkin lymphoma (HL) progression after autologous stem cell transplantation (ASCT). However, the impact of BV consolidation on overall survival, quality of life, and health care costs remain unclear. METHODS A Markov decision-analytic model was constructed to measure the costs and clinical outcomes for BV consolidation therapy compared with active surveillance in a cohort of patients aged 33 years who were at risk for HL relapse after ASCT. Life-time costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each post-ASCT strategy. RESULTS After quality-of-life adjustments and standard discounting, upfront BV consolidation was associated with an improvement of 1.07 QALYs compared with active surveillance plus BV as salvage. However, the strategy of BV consolidation led to significantly higher health care costs ($378,832 vs $219,761), resulting in an ICER for BV consolidation compared with active surveillance of $148,664/QALY. If indication-specific pricing was implemented, then the model-estimated BV price reductions of 18% to 38% for the consolidative setting would translate into ICERs of $100,000 and $50,000 per QALY, respectively. These findings were consistent on 1-way and probabilistic sensitivity analyses. CONCLUSIONS BV as consolidation therapy under current US pricing is unlikely to be cost effective at a willingness-to-pay threshold of $100,000 per QALY. However, indication-specific price reductions for the consolidative setting could reduce ICERs to widely acceptable values. Cancer 2017. © 2017 American Cancer Society. Cancer 2017;123:3763-3771. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Lucy Hui
- Yale School of Medicine, New Haven, CT
| | - Gottfried von Keudell
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Rong Wang
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Amer M. Zeidan
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - Steven D. Gore
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Amy J. Davidoff
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - Scott F Huntington
- Department of Internal Medicine, Section of Hematology, Yale School of Medicine, New Haven, CT
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| |
Collapse
|
26
|
Truong J, Cheung MC, Mai H, Letargo J, Chambers A, Sabharwal M, Trudeau ME, Chan KKW. The impact of cancer drug wastage on economic evaluations. Cancer 2017. [DOI: 10.1002/cncr.30807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Judy Truong
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Division of Hematology and Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Toronto Ontario Canada
| | - Matthew C. Cheung
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Division of Hematology and Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Toronto Ontario Canada
- Pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health; Ottawa Ontario Canada
| | - Helen Mai
- Pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health; Ottawa Ontario Canada
| | - Jessa Letargo
- Pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health; Ottawa Ontario Canada
| | - Alexandra Chambers
- Pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health; Ottawa Ontario Canada
| | - Mona Sabharwal
- Pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health; Ottawa Ontario Canada
| | - Maureen E. Trudeau
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Division of Hematology and Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Toronto Ontario Canada
| | - Kelvin K. W. Chan
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Division of Hematology and Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre; Toronto Ontario Canada
- Pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health; Ottawa Ontario Canada
- Division of Biostatistics; Dalla Lana School of Public Health, University of Toronto; Toronto Ontario Canada
- Canadian Centre for Applied Research in Cancer Control; Toronto Ontario Canada
| |
Collapse
|
27
|
Goldstein DA, Chen Q, Ayer T, Chan KKW, Virik K, Hammerman A, Brenner B, Flowers CR, Hall PS. Bevacizumab for Metastatic Colorectal Cancer: A Global Cost-Effectiveness Analysis. Oncologist 2017; 22:694-699. [PMID: 28592621 DOI: 10.1634/theoncologist.2016-0455] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/21/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the U.S., the addition of bevacizumab to first-line chemotherapy in metastatic colorectal cancer (mCRC) has been demonstrated to provide 0.10 quality-adjusted life years (QALYs) at an incremental cost-effectiveness ratio (ICER) of $571,000/QALY. Due to variability in pricing, value for money may be different in other countries. Our objective was to establish the cost-effectiveness of bevacizumab in mCRC in the U.S., U.K., Canada, Australia, and Israel. METHODS We performed the analysis using a previously established Markov model for mCRC. Input data for efficacy, adverse events, and quality of life were considered to be generalizable and therefore identical for all countries. We used country-specific prices for medications, administration, and other health service costs. All costs were converted from local currency to U.S. dollars at the exchange rates in March 2016. We conducted one-way and probabilistic sensitivity analyses (PSA) to assess the model robustness across parameter uncertainties. RESULTS Base case results demonstrated that the highest ICER was in the U.S. ($571,000/QALY) and the lowest was in Australia ($277,000/QALY). In Canada, the U.K., and Israel, ICERs ranged between $351,000 and $358,000 per QALY. PSA demonstrated 0% likelihood of bevacizumab being cost-effective in any country at a willingness to pay threshold of $150,000 per QALY. CONCLUSION The addition of bevacizumab to first-line chemotherapy for mCRC consistently fails to be cost-effective in all five countries. There are large differences in cost-effectiveness between countries. This study provides a framework for analyzing the value of a cancer drug from the perspectives of multiple international payers. IMPLICATIONS FOR PRACTICE The cost-effectiveness of bevacizumab varies significantly between multiple countries. By conventional thresholds, bevacizumab is not cost-effective in metastatic colon cancer in the U.S., the U.K., Australia, Canada, and Israel.
Collapse
Affiliation(s)
- Daniel A Goldstein
- Davidoff Center, Rabin Medical Center, Petach, Tikvah, Israel
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Qiushi Chen
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Turgay Ayer
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Kelvin K W Chan
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Kiran Virik
- Department of Medicine, University of Tasmania, Tasmania, Australia
| | | | - Baruch Brenner
- Davidoff Center, Rabin Medical Center, Petach, Tikvah, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | | | - Peter S Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, United Kingdom
| |
Collapse
|
28
|
Gilbar PJ, Chambers CR, Gilbar EC. Opportunities to significantly reduce expenditure associated with cancer drugs. Future Oncol 2017; 13:1311-1322. [DOI: 10.2217/fon-2017-0033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Aim: To identify cancer drugs amenable to strategies for reducing expenditure and avoiding drug wastage. Methods: Information was sourced from product information in 20 countries on parenteral cytotoxic agents, and cancer and noncancer monoclonal antibodies. Data were collected on vial sizes, overage, stability and presentation forms. Results: Vial size availability varied significantly between countries, with often only single vial sizes for numerous medications. Overage was poorly reported. Stability data were inconsistent and variable between countries, with most drugs only having a 24 h expiry. Three cancer-indicated monoclonal antibodies, thought suitable for prefilled syringe administration, were only available as vials. Conclusion: Many expensive cancer drugs are suitable for global cost-reduction strategies. Collaboration is vital to affecting change and reducing expenditure.
Collapse
Affiliation(s)
- Peter J Gilbar
- Cancer & Palliative Care Services, Toowoomba Hospital, Toowoomba, Australia
- School of Medicine, University of Queensland, Toowoomba Hospital, Toowoomba, Australia
| | - Carole R Chambers
- Department of Cancer Services Pharmacy, Alberta Health Services, Calgary, Canada
| | - Erin C Gilbar
- School of Medicine, University of Queensland, Toowoomba Hospital, Toowoomba, Australia
| |
Collapse
|
29
|
Gilbar PJ, Chambers CR. How can we ensure value for money from expenditure on injectable cancer drugs? J Oncol Pharm Pract 2017; 24:473-476. [DOI: 10.1177/1078155217706195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter J Gilbar
- Cancer and Palliative Care Services, Toowoomba Hospital, Toowoomba, Australia
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
| | - Carole R Chambers
- Department of Cancer Services Pharmacy, Alberta Health Services, Alberta, Canada
| |
Collapse
|
30
|
Bach PB, Conti RM, Muller RJ, Schnorr GC, Saltz LB. Overspending driven by oversized single dose vials of cancer drugs. BMJ 2016; 352:i788. [PMID: 26932932 PMCID: PMC6894487 DOI: 10.1136/bmj.i788] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 11/03/2022]
Abstract
Peter B Bach and colleagues call for an end to contradictory regulatory standards in the US that allow drug manufacturers to boost profits by producing single dose vials containing quantities that increase leftover drug
Collapse
Affiliation(s)
- Peter B Bach
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA
| | - Rena M Conti
- Departments of Pediatrics Hematology/Oncology and Health Studies, University of Chicago, Chicago, IL, USA
| | - Raymond J Muller
- Research Pharmacy, Memorial Sloan Kettering Cancer Center, New York
| | - Geoffrey C Schnorr
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA
| | - Leonard B Saltz
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
| |
Collapse
|