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Phisalprapa P, Kositamongkol C, Korphaisarn K, Akewanlop C, Srimuninnimit V, Supakankunti S, Apiraksattayakul N, Chaiyakunapruk N. Cost-Utility and Budget Impact Analyses of Oral Chemotherapy for Stage III Colorectal Cancer: Real-World Evidence after Policy Implementation in Thailand. Cancers (Basel) 2023; 15:4930. [PMID: 37894297 PMCID: PMC10605760 DOI: 10.3390/cancers15204930] [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: 09/01/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
This study conducted a cost-utility analysis and a budget impact analysis (BIA) of outpatient oral chemotherapy versus inpatient intravenous chemotherapy for stage III colorectal cancer (CRC) in Thailand. A Markov model was constructed to estimate the lifetime cost and health outcomes based on a societal perspective. Eight chemotherapy strategies were compared. Clinical and cost data on adjuvant chemotherapy were collected from the medical records of 1747 patients at Siriraj Hospital, Thailand. The cost-effectiveness results were interpreted against a Thai willingness-to-pay threshold of USD 5003/quality-adjusted life year (QALY) gained. A 5-year BIA was performed. Of the eight strategies, CAPOX then FOLFIRI yielded the highest life-year and QALY gains. Its total lifetime cost was also the highest. An incremental cost-effectiveness ratio of CAPOX then FOLFIRI compared to 5FU/LV then FOLFOX, a commonly used regimen USD was 4258 per QALY gained.The BIA showed that when generic drug prices were applied, 5-FU/LV then FOLFOX had the smallest budgetary impact (USD 9.1 million). CAPOX then FOLFIRI required an approximately three times higher budgetary level (USD 25.1 million). CAPOX then FOLFIRI is the best option. It is cost-effective compared with 5-FU/LV then FOLFOX. However, policymakers should consider the relatively high budgetary burden of the CAPOX then FOLFIRI regimen.
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Affiliation(s)
- Pochamana Phisalprapa
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Chayanis Kositamongkol
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Krittiya Korphaisarn
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Charuwan Akewanlop
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Vichien Srimuninnimit
- Division of Medical Oncology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Siripen Supakankunti
- Centre of Excellence for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok 10330, Thailand
| | | | - Nathorn Chaiyakunapruk
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT 84108, USA
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2
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Ding PQ, Au F, Cheung WY, Heitman SJ, Lee-Ying R. Cost-Effectiveness of Surveillance after Metastasectomy of Stage IV Colorectal Cancer. Cancers (Basel) 2023; 15:4121. [PMID: 37627149 PMCID: PMC10452589 DOI: 10.3390/cancers15164121] [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: 07/25/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
Surveillance of stage IV colorectal cancer (CRC) after curative-intent metastasectomy can be effective for detecting asymptomatic recurrence. Guidelines for various forms of surveillance exist but are supported by limited evidence. We aimed to determine the most cost-effective strategy for surveillance following curative-intent metastasectomy of stage IV CRC. We performed a decision analysis to compare four active surveillance strategies involving clinic visits and investigations elicited from National Comprehensive Cancer Network (NCCN) recommendations. Markov model inputs included data from a population-based cohort and literature-derived costs, utilities, and probabilities. The primary outcomes were costs (2021 Canadian dollars) and quality-adjusted life years (QALYs) gained. Over a 10-year base-case time horizon, surveillance with follow-ups every 12 months for 5 years was most economically favourable at a willingness-to-pay threshold of CAD 50,000 per QALY. These patterns were generally robust in the sensitivity analysis. A more intensive surveillance strategy was only favourable with a much higher willingness-to-pay threshold of approximately CAD 425,000 per QALY, with follow-ups every 3 months for 2 years then every 12 months for 3 additional years. Our findings are consistent with NCCN guidelines and justify the need for additional research to determine the impact of surveillance on CRC outcomes.
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Affiliation(s)
- Philip Q. Ding
- Oncology Outcomes Program, Department of Oncology, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Flora Au
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Winson Y. Cheung
- Oncology Outcomes Program, Department of Oncology, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Steven J. Heitman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Richard Lee-Ying
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada
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To YH, Gibbs P, Tie J, IJzerman M, Degeling K. Health economic evidence for adjuvant chemotherapy in stage II and III colon cancer: a systematic review. Cost Eff Resour Alloc 2023; 21:11. [PMID: 36721219 PMCID: PMC9887815 DOI: 10.1186/s12962-023-00422-2] [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: 07/20/2022] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The aims of this study was to appraise the health economic evidence for adjuvant chemotherapy (AC) strategies in stage II and III colon cancer (CC) and identify gaps in the available evidence that might inform further research. METHOD A systematic review of published economic evaluations was undertaken. Four databases were searched and full-text publications in English were screened for inclusion. A narrative synthesis was performed to summarise the evidence. RESULTS Thirty-eight studies were identified and stratified by cancer stage and AC strategy. The majority (89%) were full economic evaluations considering both health outcomes, usually measured as quality-adjusted life years (QALYs), and costs. AC was found to be cost-effective compared to no AC for both stage II and III CC. Oral and oxaliplatin-based AC was cost-effective for stage III. Three months of CAPOX was cost-effective compared to 6-month in high-risk stage II and stage III CC. Preliminary evidence suggests that biomarker approaches to AC selection in stage II can reduce costs and improve health outcomes. Notably, assessment of QALYs were predominantly reliant on a small number of non-contemporary health-utility studies. Only 32% of studies considered societal costs such as travel and time off work. CONCLUSIONS Published economic evaluations consistently supported the use of AC in stage II and III colon cancer. Biomarker-driven approaches to patient selection have great potential to be cost-effective, but more robust clinical and economic evidence is warranted. Patient surveys embedded into clinical trials may address critical knowledge gaps regarding accurate assessment of QALYs and societal costs in the modern era.
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Affiliation(s)
- Yat Hang To
- grid.1042.70000 0004 0432 4889Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia ,grid.1055.10000000403978434Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Gibbs
- grid.1042.70000 0004 0432 4889Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia ,grid.417072.70000 0004 0645 2884Department of Medical Oncology, Western Health, Melbourne, Australia ,grid.1008.90000 0001 2179 088XFaculty of Medicine and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Jeanne Tie
- grid.1042.70000 0004 0432 4889Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia ,grid.1055.10000000403978434Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia ,grid.1008.90000 0001 2179 088XFaculty of Medicine and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Maarten IJzerman
- grid.1008.90000 0001 2179 088XCancer Health Services Research, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia ,grid.1008.90000 0001 2179 088XCancer Health Services Research, Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia ,grid.1055.10000000403978434Department of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Koen Degeling
- grid.1008.90000 0001 2179 088XCancer Health Services Research, Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia ,grid.1008.90000 0001 2179 088XCancer Health Services Research, Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Jones E, Duan Z, Nguyen TT, Giordano SH, Zhao H. Adjuvant 5-Fluorouracil/leucovorin, capecitabine, and oxaliplatin-related regimens for stage II/III colon cancer patients 66 years or older. Cancer Med 2022; 12:2389-2406. [PMID: 36229957 PMCID: PMC9939133 DOI: 10.1002/cam4.5078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 11/11/2022] Open
Abstract
Adjuvant chemotherapy of leucovorin-modulated 5-fluorouracil (5-FU/LV), capecitabine, and adding oxaliplatin to 5-FU/LV or capecitabine (FLOX/OX) have been standard regimens for high-risk stage II or III colon cancer (CC). We aimed to evaluate their patterns of use, association with survival, and rate of emergency room visit (ER) or hospitalization during the treatment period. High-risk stage II or III patients aged >65 years diagnosed between 2007 and 2015, underwent colectomy, and received any of these three regimens were selected from SEER and Texas Cancer Registry (TC) linked with Medicare data. Chi-square test, Kaplan-Meier survival curves, Cox regression, and logistic regression were used in data analysis. A total of 5621 (1080 stage II and 4541 stage III) patients with median age of 72 years were included in this study. For stage II, 24.4% used 5-FU/LV, 31.2% used capecitabine, and 44.4% used FLOX/OX; the respective numbers for stage III were 13.8%, 17.9%, and 68.3%. Patients aged <70 years, not in the West region, not in Medicare state-buy-in program, and with no comorbidity were more likely to use FLOX/OX. FLOX/OX was associated with improved overall survival (OS) in stage II and III patients and improved cancer-specific survival in stage III patients compared with 5-FU/LV. The survival benefit of FLOX/OX was sustained in stage III patients aged ≥70 years. Capecitabine had the lowest ER/hospitalization rate with 19.2% in stage II and 28.9% in III. The use of FLOX/OX was associated with improved survival compared with 5-FU/LV among CC patients. Capecitabine was associated with the lowest ER/hospitalization rate.
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Affiliation(s)
- Emily Jones
- Department of BiostatisticsThe University of Texas School of Public Health at HoustonHoustonTexasUSA
| | - Zhigang Duan
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Thinh T. Nguyen
- Institute for Clinical and Translational Research, Baylor College of MedicineHoustonTexasUSA
| | - Sharon H. Giordano
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA,Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Hui Zhao
- Department of Health Services ResearchThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Jongeneel G, Greuter MJE, Kunst N, van Erning FN, Koopman M, Medema JP, Vermeulen L, Ijzermans JNM, Vink GR, Punt CJA, Coupé VMH. Early Cost-effectiveness Analysis of Risk-Based Selection Strategies for Adjuvant Treatment in Stage II Colon Cancer: The Potential Value of Prognostic Molecular Markers. Cancer Epidemiol Biomarkers Prev 2021; 30:1726-1734. [PMID: 34162659 DOI: 10.1158/1055-9965.epi-21-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/28/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To explore the potential value of consensus molecular subtypes (CMS) in stage II colon cancer treatment selection, we carried out an early cost-effectiveness assessment of a CMS-based strategy for adjuvant chemotherapy. METHODS We used a Markov cohort model to evaluate three selection strategies: (i) the Dutch guideline strategy (MSS+pT4), (ii) the mutation-based strategy (MSS plus a BRAF and/or KRAS mutation or MSS plus pT4), and (iii) the CMS-based strategy (CMS4 or pT4). Outcomes were number of colon cancer deaths per 1,000 patients, total discounted costs per patient (pp), and quality-adjusted life-years (QALY) pp. The analyses were conducted from a Dutch societal perspective. The robustness of model predictions was assessed in sensitivity analyses. To evaluate the value of future research, we performed a value of information (VOI) analysis. RESULTS The Dutch guideline strategy resulted in 8.10 QALYs pp and total costs of €23,660 pp. The CMS-based and mutation-based strategies were more effective and more costly, with 8.12 and 8.13 QALYs pp and €24,643 and €24,542 pp, respectively. Assuming a threshold of €50,000/QALY, the mutation-based strategy was considered as the optimal strategy in an incremental analysis. However, the VOI analysis showed substantial decision uncertainty driven by the molecular markers (expected value of partial perfect information: €18M). CONCLUSIONS On the basis of current evidence, our analyses suggest that the mutation-based selection strategy would be the best use of resources. However, the extensive decision uncertainty for the molecular markers does not allow selection of an optimal strategy at present. IMPACT Future research is needed to eliminate decision uncertainty driven by molecular markers.
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Affiliation(s)
- Gabrielle Jongeneel
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, the Netherlands.
| | - Marjolein J E Greuter
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Natalia Kunst
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, the Netherlands.,Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, Connecticut.,Public Health Modeling Unit, Yale University School of Public Health, New Haven, Connecticut
| | - Felice N van Erning
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Miriam Koopman
- University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jan P Medema
- Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Center for Experimental Molecular Medicine (CEMM), Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, the Netherlands
| | - Louis Vermeulen
- Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Center for Experimental Molecular Medicine (CEMM), Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, the Netherlands
| | - Jan N M Ijzermans
- Department of General Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Geraldine R Vink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.,University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cornelis J A Punt
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, the Netherlands
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Jongeneel G, Greuter MJE, van Erning FN, Koopman M, Vink GR, Punt CJA, Coupé VMH. Model-based effectiveness and cost-effectiveness of risk-based selection strategies for adjuvant chemotherapy in Dutch stage II colon cancer patients. Therap Adv Gastroenterol 2021; 14:1756284821995715. [PMID: 33786064 PMCID: PMC7958170 DOI: 10.1177/1756284821995715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/28/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We aimed to evaluate the cost-effectiveness of risk-based strategies to improve the selection of surgically treated stage II colon cancer (CC) patients for adjuvant chemotherapy. METHODS Using the 'Personalized Adjuvant TreaTment in EaRly stage coloN cancer' (PATTERN) model, we evaluated five selection strategies: (1) no chemotherapy, (2) Dutch guideline recommendations assuming observed adherence, (3) Dutch guideline recommendations assuming perfect adherence, (4) biomarker mutation OR pT4 stage strategy in which patients with MSS status combined with a pT4 stage or a mutation in BRAF and/or KRAS receive chemotherapy assuming perfect adherence and (5) biomarker mutation AND pT4 stage strategy in which patients with MSS status combined with a pT4 stage tumor and a BRAF and/or KRAS mutation receive chemotherapy assuming perfect adherence. Outcomes were number of CC deaths per 1000 patients and total discounted costs and quality-adjusted life-years (QALYs) per patient (pp). Analyses were conducted from a societal perspective. The robustness of model predictions was assessed in sensitivity analyses. RESULTS The reference strategy, that is, no adjuvant chemotherapy, resulted in 139 CC deaths in a cohort of 1000 patients, 8.077 QALYs pp and total costs of €22,032 pp. Strategies 2-5 were more effective (range 8.094-8.217 QALYs pp and range 118-136 CC deaths per 1000 patients) and more costly (range €22,404-€25,102 pp). Given a threshold of €50,000/QALY, the optimal use of resources would be to treat patients with either the full adherence strategy and biomarker mutation OR pT4 stage strategy. CONCLUSION Selection of stage II CC patients for chemotherapy can be improved by either including biomarker status in the selection strategy or by improving adherence to the Dutch guideline recommendations.
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Affiliation(s)
- Gabrielle Jongeneel
- Department of Epidemiology and Data Science,
Amsterdam UMC, VU University, PO Box 7057, MF F-wing, Amsterdam, 1007 MB,
the Netherlands
| | - Marjolein J. E. Greuter
- Department of Epidemiology and Data Science,
Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Felice N. van Erning
- Department of Research and Development,
Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The
Netherlands
| | - Miriam Koopman
- Department of medical oncology, University
Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geraldine R. Vink
- Department of Research and Development,
Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The
Netherlands
- Department of medical oncology, University
Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelis J. A. Punt
- Department of Epidemiology, University Medical
Center Utrecht, Julius Center for Health Sciences, Utrecht, The
Netherlands
| | - Veerle M. H. Coupé
- Department of Epidemiology and Data Science,
Amsterdam UMC, VU University, Amsterdam, The Netherlands
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Kulthanachairojana N, Chansriwong P, Thokanit NS, Sirilerttrakul S, Wannakansophon N, Taychakhoonavudh S. Home-based chemotherapy for stage III colon cancer patients in Thailand: Cost-utility and budget impact analyses. Cancer Med 2020; 10:1027-1033. [PMID: 33377629 PMCID: PMC7897966 DOI: 10.1002/cam4.3690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 11/16/2020] [Accepted: 12/06/2020] [Indexed: 12/27/2022] Open
Abstract
Home‐based chemotherapy (HC) is a new treatment alternative to hospital‐based chemotherapy treatment (IP) and is administered via portable intravenous pumps at the patient's home. HC reduces the demand for inpatient bed capacity in hospitals and reduces the cost of an infusion. This study takes a societal perspective while conducting the cost‐utility and budget impact analyses (BIA) of HC and IP with an mFOLFOX6 regimen on patients with stage III colon cancer. We conducted a cost‐utility analysis with a 6‐month time horizon. The parameter inputs for the model were gathered from a retrospective cohort study on patients diagnosed with stage III colon cancer at Ramathibodi Hospital, Bangkok. The resource usage of HC and IP was determined based on medical records. The per‐unit direct medical, home health service, and adverse events (AE) management costs were gathered from the standard cost list. The health outcome of treatment was measured in terms of quality‐adjusted life years. Disutility related to AE was calculated. We conducted a sensitivity analysis for the uncertainty results and performed BIA based on the societal perspective on a 1‐year time horizon. HC provided a cost‐saving of $1,513.37 per patient for the period of treatment. Thus, assuming 526 patients per year, the use of HC could achieve a cumulative annual cost‐saving of $828,436. HC is a cost‐saving strategy compared to IP for stage III colon cancer treatment. We recommend that the service reimbursement should include national standardization in chemotherapy regimens as well as practice guidelines and protocols to prevent serious AEs.
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Affiliation(s)
- Nattanichcha Kulthanachairojana
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Phichai Chansriwong
- Medical Oncology Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | - Suthira Taychakhoonavudh
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
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Jongeneel G, Greuter MJE, van Erning FN, Koopman M, Vink GR, Punt CJA, Coupé VMH. Model-based evaluation of the cost effectiveness of 3 versus 6 months' adjuvant chemotherapy in high-risk stage II colon cancer patients. Therap Adv Gastroenterol 2020; 13:1756284820954114. [PMID: 32994804 PMCID: PMC7502861 DOI: 10.1177/1756284820954114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/11/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Our aim was to evaluate the cost effectiveness of 3 months' adjuvant chemotherapy versus 6 months in high-risk (T4 stage + microsatellite stable) stage II colon cancer (CC) patients. METHODS Using the validated PATTERN Markov cohort model, which simulates the disease progression of stage II CC patients from diagnosis to death, we first evaluated a reference strategy in which high-risk patients were treated with chemotherapy for 6 months. In the second strategy, treatment duration was shortened to 3 months. Both strategies were evaluated for CAPOX (capecitabine plus oxaliplatin) and FOLFOX (fluorouracil, leucovorin and oxaliplatin). Based on trial data, we assumed that shortened treatment duration compared with a 6-month regimen was equally effective for CAPOX and less effective for FOLFOX. Adverse events were highest in the 6-month strategy. Analyses were conducted from a societal perspective using a lifelong time horizon. Outcomes were number of CC deaths per 1000 patients and total discounted costs and quality-adjusted life-years (QALYs) per patient (pp). Incremental net monetary benefit (iNMB) was calculated using a willingness-to-pay value of €50,000/QALY. RESULTS For CAPOX, the 6-month strategy resulted in 316 CC deaths per 1000 patients, 6.71 QALYs pp and total costs of €41,257 pp. The 3-month strategy resulted in an equal number of CC deaths, but higher QALYs (6.80 pp) and lower costs (€37,645 pp), leading to a iNMB of €8454 per person for 3 months versus 6 months. For FOLFOX, the 6-month strategy resulted in 316 CC deaths per 1000 patients, 6.71 QALYs pp and total costs of €47,135 pp. The 3-month strategy resulted in more CC deaths (393), lower QALYs (6.19 pp) and lower costs (€44,389 pp). An iNMB of -€23,189 was found for 3 months versus 6 months. CONCLUSION Our findings indicate that 3 months' adjuvant chemotherapy should be considered as standard of care in high-risk stage II CC patients for CAPOX, but not for FOLFOX.
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Affiliation(s)
| | | | - Felice N. van Erning
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Miriam Koopman
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geraldine R. Vink
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands,University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelis J. A. Punt
- Department of Medical Oncology, University of Amsterdam, Amsterdam, The Netherlands
| | - Veerle M. H. Coupé
- Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands
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9
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Ball G, Xie F, Tarride JE. Economic Evaluation of Bevacizumab for Treatment of Platinum-Resistant Recurrent Ovarian Cancer in Canada. PHARMACOECONOMICS - OPEN 2018; 2:19-29. [PMID: 29464667 PMCID: PMC5820234 DOI: 10.1007/s41669-017-0030-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Ovarian cancer is a leading cause of cancer-related mortality. Although the disease is relatively rare, it carries a disproportionately large morbidity burden. OBJECTIVE We conducted a cost-utility analysis from a Canadian public payer perspective to determine the cost effectiveness of bevacizumab, a newly available treatment option for recurrent ovarian cancer. METHODS Using a 7-year time horizon, a three health-state cohort-based partitioned survival model was developed to assess the cost utility of bevacizumab plus chemotherapy (BEV) versus chemotherapy alone. We reconstructed individual patient data from published Kaplan-Meier curves. Clinical parameters, including progression-free survival and overall survival, were derived from the AURELIA phase III randomized controlled trial. Costs, resource utilization and utility values from recent Canadian sources were used to populate the model. Results were presented using incremental cost-utility ratios (ICURs). Uncertainty was examined through univariate and probabilistic sensitivity analyses. RESULTS The reconstructed individual patient data matched the AURELIA trial results. Total costs for the BEV and chemotherapy treatment arms were $Can79,086 and $Can54,982, respectively. Total estimated quality-adjusted life-years (QALYs) were 1.1055 and 0.9926 for the BEV and chemotherapy arms, respectively. The ICUR was estimated to be $Can213,424 per QALY gained. At a willingness-to-pay threshold of $Can100,000 per QALY gained, the probability of BEV being cost effective was 0. CONCLUSIONS The results of our analysis suggest that the addition of bevacizumab to single-agent chemotherapy treatment, while improving patient outcomes, is unlikely to be cost effective in this Canadian patient population. The results also provide some preliminary validation for use of individual patient data-reconstruction techniques in pharmacoeconomic evaluation.
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Affiliation(s)
- Graeme Ball
- McMaster University Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Hamilton, ON, Canada.
| | - Feng Xie
- McMaster University Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Hamilton, ON, Canada
- Program for Health Economics and Outcome Measures, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Jean-Eric Tarride
- Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare, Hamilton, ON, Canada
- McMaster University Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Hamilton, ON, Canada
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Zhou J, Niu G, Pei Y, Cao C, Ding C, Sun G, Guo J, Liu Y, Yu Y. The effect and clinical efficacy of lienal polypeptide injection combined with FOLFOX chemotherapy regimen in colon cancer patients. Oncol Lett 2016; 12:3191-3194. [PMID: 27899981 PMCID: PMC5103917 DOI: 10.3892/ol.2016.5055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/19/2016] [Indexed: 01/09/2023] Open
Abstract
The aim was to investigate the clinical efficacy and immunomodulatory effect of lienal polypeptide injection combined with postoperative FOLFOX chemotherapy regimen in colon cancer patients. A total of 84 colon cancer patients were selected between January, 2014 and December, 2015. The selected patients were randomly divided into the observation (42 patients) and control (42 patients) groups. The observation group patients were treated with FOLFOX chemotherapy regimen combined with lienal polypeptide, whereas, the control group patients were treated with FOLFOX chemotherapeutic regimen only. After two cycles of treatment, Karnofsky performance scale (KPS) index, side effects or toxicity and the peripheral blood T-cell subset analyses in the two groups of patients were evaluated. The patients who received FOLFOX chemotherapeutic regimen combined with lienal polypeptide in the observation group showed significantly higher score of KPS than patients of the control group (P<0.05). No significant difference in the spectrum of side effects such as nausea, vomiting, neurotoxicity, liver and kidney dysfunction, oral mucosal inflammation were observed in the treatment groups. However, the incidence of bone marrow suppression was significantly lower in the observation group in comparison with the control group (P<0.05). Additionally, the CD8+ T cells were decreased in the observation group patients compared to the control group, while the ratio of CD4+ T/CD8+ T (TH/TC) cells and the number of natural killer cells were higher in the observation group patients than the control group (P<0.05). In conclusion, the results suggest that, when the standard FOLFOX chemotheraputic regimen is combined with lienal polypeptide to treat colon cancer, it enhances the general well being of patients and strengthens the immune system in the combat against cancer.
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Affiliation(s)
- Juan Zhou
- Clinical Laboratory, Xuzhou Central Hospital, Xuzhou, Jiangsu 221000, P.R. China
| | - Guoping Niu
- Clinical Laboratory, Xuzhou Central Hospital, Xuzhou, Jiangsu 221000, P.R. China
| | - Yunfeng Pei
- Clinical Laboratory, Xuzhou Central Hospital, Xuzhou, Jiangsu 221000, P.R. China
| | - Chunping Cao
- Clinical Laboratory, Xuzhou Central Hospital, Xuzhou, Jiangsu 221000, P.R. China
| | - Chen Ding
- Clinical Laboratory, Xuzhou Central Hospital, Xuzhou, Jiangsu 221000, P.R. China
| | - Guangming Sun
- Clinical Laboratory, Xuzhou Central Hospital, Xuzhou, Jiangsu 221000, P.R. China
| | - Jing Guo
- Clinical Laboratory, Xuzhou Central Hospital, Xuzhou, Jiangsu 221000, P.R. China
| | - Yong Liu
- Department of Medical Oncology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221000, P.R. China
| | - Yang Yu
- Department of Medical Oncology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221000, P.R. China
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Beauchemin C, Letarte N, Mathurin K, Yelle L, Lachaine J. A global economic model to assess the cost-effectiveness of new treatments for advanced breast cancer in Canada. J Med Econ 2016; 19:619-29. [PMID: 26850287 DOI: 10.3111/13696998.2016.1151431] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective Considering the increasing number of treatment options for metastatic breast cancer (MBC), it is important to develop high-quality methods to assess the cost-effectiveness of new anti-cancer drugs. This study aims to develop a global economic model that could be used as a benchmark for the economic evaluation of new therapies for MBC. Methods The Global Pharmacoeconomics of Metastatic Breast Cancer (GPMBC) model is a Markov model that was constructed to estimate the incremental cost per quality-adjusted life years (QALY) of new treatments for MBC from a Canadian healthcare system perspective over a lifetime horizon. Specific parameters included in the model are cost of drug treatment, survival outcomes, and incidence of treatment-related adverse events (AEs). Global parameters are patient characteristics, health states utilities, disutilities, and costs associated with treatment-related AEs, as well as costs associated with drug administration, medical follow-up, and end-of-life care. The GPMBC model was tested and validated in a specific context, by assessing the cost-effectiveness of lapatinib plus letrozole compared with other widely used first-line therapies for post-menopausal women with hormone receptor-positive (HR+) and epidermal growth factor receptor 2-positive (HER2+) MBC. Results When tested, the GPMBC model led to incremental cost-utility ratios of CA$131 811 per QALY, CA$56 211 per QALY, and CA$102 477 per QALY for the comparison of lapatinib plus letrozole vs letrozole alone, trastuzumab plus anastrozole, and anastrozole alone, respectively. Results of the model testing were quite similar to those obtained by Delea et al., who also assessed the cost-effectiveness of lapatinib in combination with letrozole in HR+/HER2 + MBC in Canada, thus suggesting that the GPMBC model can replicate results of well-conducted economic evaluations. Conclusions The GPMBC model can be very valuable as it allows a quick and valid assessment of the cost-effectiveness of any new treatments for MBC in a Canadian context.
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Affiliation(s)
- C Beauchemin
- a Faculté de pharmacie , Université de Montréal , Montreal , Quebec , Canada
| | - N Letarte
- a Faculté de pharmacie , Université de Montréal , Montreal , Quebec , Canada
- b Département de pharmacie , Centre hospitalier de l'Université de Montréal - Hôpital Notre-Dame , Montreal , Quebec , Canada
| | - K Mathurin
- a Faculté de pharmacie , Université de Montréal , Montreal , Quebec , Canada
| | - L Yelle
- c Département de médecine , Centre hospitalier de l'Université de Montréal - Hôpital Notre-Dame , Montreal , Quebec , Canada
| | - J Lachaine
- a Faculté de pharmacie , Université de Montréal , Montreal , Quebec , Canada
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12
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Soni A, Chu E. Cost-Effectiveness of Adjuvant Chemotherapy in the Treatment of Early-Stage Colon Cancer. Clin Colorectal Cancer 2015; 14:219-26. [DOI: 10.1016/j.clcc.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/10/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
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Klahan S, Huang CC, Chien SC, Wu MS, Wong HSC, Huang CY, Chang WC, Wei PL. Bioinformatic analyses revealed underlying biological functions correlated with oxaliplatin responsiveness. Tumour Biol 2015; 37:583-90. [PMID: 26232912 DOI: 10.1007/s13277-015-3807-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/20/2015] [Indexed: 11/27/2022] Open
Abstract
Colorectal cancer is one of the most common cancers worldwide. Surgery is usually the primary treatment for colon cancers that have not spread to distant sites. However, chemotherapy may be considered after surgery to eliminate remaining cancer cells or in case the cancer has a high risk of recurrence. Oxaliplatin is often used in combination regimens such as FOLFOX, CapeOX, and FOLFOXIRI because of the cost-effectiveness of adjuvant treatment for patients and also the good tolerability profile. However, some patients show resistance to oxaliplatin which causes poor treatment outcomes. Most colon cancer studies focused on treatments and patient survival. Some studies focused on genetic associations of specific genes. However, pathway and network analyses of oxaliplatin resistance in colon cancer cells using gene expression patterns are still lacking. We performed a microarray analysis and found that endothelin-1 (EDN1), dishevelled segment polarity protein (DV1), toll-like receptor 5(TLR5), mitogen-activated protein kinase 3 (MAP2K3), phosphatidylinositol-4,5-bisphosphate 3-kinase, and catalytic subunit beta (PIK3CB) were closely related to responsiveness to oxaliplatin treatment. Furthermore, we found that the signal transduction, melanogenesis, and toll-like receptor signaling pathways might be involved in oxaliplatin-resistant colon cancer. These genes and pathways might be potential targets for improving oxaliplatin treatment in colon cancer patients.
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Affiliation(s)
- Sukhontip Klahan
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chi-Cheng Huang
- Department of Surgery, Cathay General Hospital, SiJhih, New Taipei City, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- School of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Shu-Chen Chien
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Mei-Shin Wu
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Henry Sung-Ching Wong
- Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yu Huang
- Division of General Surgery, Department of Surgery, Department of Neurosurgery Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wei-Chiao Chang
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan.
- Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan.
| | - Po-Li Wei
- Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, Taipei, Taiwan.
- Division of General Surgery, Department of Surgery, Department of Neurosurgery Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Surgery, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
- Cancer Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
- Graduate Institute of Cancer Biology and Drug Discovery, Taipei Medical University, Taipei, Taiwan.
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Lairson DR, Parikh RC, Cormier JN, Chan W, Du XL. Cost-utility analysis of chemotherapy regimens in elderly patients with stage III colon cancer. PHARMACOECONOMICS 2014; 32:1005-1013. [PMID: 24920195 DOI: 10.1007/s40273-014-0180-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Chemotherapy prolongs survival for stage III colon cancer patients but community-level evidence on the effectiveness and cost effectiveness of treatment for elderly patients is limited. Comparisons were between patients receiving no chemotherapy, 5-fluorouracil (5-FU), and FOLFOX (5-FU + oxaliplatin). METHODS A retrospective cohort study was conducted using the Surveillance Epidemiology, and End Results (SEER)-Medicare linked database. Patients (≥65 years) with American Joint Committee on Cancer stage III colon cancer at diagnosis in 2004-2009 were identified. The 3-way propensity score matched sample included 3,534 patients. Effectiveness was measured in life-years and quality-adjusted life-years (QALYs). Medicare costs (2010 US dollars) were estimated from diagnosis until death or end of study. RESULTS FOLFOX patients experienced 6.06 median life-years and 4.73 QALYs. Patients on 5-FU had 5.75 median life-years and 4.50 median QALYs, compared to 3.42 and 2.51, respectively, for the no chemotherapy patients. Average total healthcare costs ranged from US$85,422 for no chemotherapy to US$168,628 for FOLFOX. Incremental cost-effectiveness ratios (ICER) for 5-FU versus no chemotherapy were US$17,131 per life-year gained and US$20,058 per QALY gained. ICERs for FOLFOX versus 5-FU were US$139,646 per life-year gained and US$188,218 per QALY gained. Results appear to be sensitive to age, suggesting that FOLFOX performs better for patients 65-69 and 80+ years old while 5-FU appears most effective and cost effective for the age groups 70-74 and 75-79 years. CONCLUSION FOLFOX appears more effective and cost effective than other strategies for colon cancer treatment of older patients. Results were sensitive to age, with ICERs exhibiting a U-shaped pattern.
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Affiliation(s)
- David R Lairson
- Division of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, 1200 Herman Pressler Drive, Houston, TX, 77030, USA,
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Soni A, Aspinall SL, Zhao X, Good CB, Cunningham FE, Chatta G, Passero V, Smith KJ. Cost-Effectiveness Analysis of Adjuvant Stage III Colon Cancer Treatment at Veterans Affairs Medical Centers. Oncol Res 2014; 22:311-9. [PMID: 26629943 PMCID: PMC7842555 DOI: 10.3727/096504015x14424348426152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The objective of this study was to evaluate the real-world cost effectiveness of adjuvant stage III colon cancer chemotherapy regimens, given that previous analyses have been based on data from clinical trials. The study was designed using integrated decision tree and Markov model, which was developed to evaluate the cost effectiveness of 5-fluorouracil/leucovorin (5-FU/LV), capecitabine, and the combination of each with oxaliplatin. The analysis was performed from a US Veterans Affairs perspective via retrospectively collected data, over a 5-year model time horizon. Outcome and cost data were used to calculate cost per quality adjusted life year (QALY), and one-way and probabilistic sensitivity analyses were performed. In the base case analysis, capecitabine and capecitabine plus oxaliplatin both cost more and were less effective than other regimens, and 5-FU/LV plus oxaliplatin, compared to 5-FU/LV alone, resulted in a cost of $25,997 per QALY gained. Model results were generally robust to parameter variation. Capecitabine plus oxaliplatin could be economically reasonable if full dosing occurred ≥76% of the time (base case 42%). In a real-world setting, the addition of oxaliplatin to 5-FU/LV is more effective but also more costly than 5-FU/LV alone. If full dosing of capecitabine-containing regimens can be assured, they may also be cost-effective strategies.
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Affiliation(s)
- Amy Soni
- *University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Sherrie L. Aspinall
- †VA Pharmacy Benefits Management Services, Hines, IL, USA
- ‡VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- §University of Pittsburgh, School of Pharmacy, Pittsburgh, PA, USA
| | - Xinhua Zhao
- ‡VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Chester B. Good
- †VA Pharmacy Benefits Management Services, Hines, IL, USA
- ‡VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- §University of Pittsburgh, School of Pharmacy, Pittsburgh, PA, USA
- ¶University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | | | | | - Vida Passero
- **VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Kenneth J. Smith
- ††University of Pittsburgh, Division of Clinical Modeling and Decision Sciences, Pittsburgh, PA, USA
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van Gils C, de Groot S, Tan S, Redekop W, Koopman M, Punt C, Uyl-de Groot C. Real-world resource use and costs of adjuvant treatment for stage III colon cancer. Eur J Cancer Care (Engl) 2013; 24:321-32. [DOI: 10.1111/ecc.12154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2013] [Indexed: 11/29/2022]
Affiliation(s)
- C.W.M. van Gils
- Institute for Medical Technology Assessment; Erasmus University Rotterdam; Rotterdam
| | - S. de Groot
- Institute for Medical Technology Assessment; Erasmus University Rotterdam; Rotterdam
| | - S.S. Tan
- Institute for Medical Technology Assessment; Erasmus University Rotterdam; Rotterdam
| | - W.K. Redekop
- Institute for Medical Technology Assessment; Erasmus University Rotterdam; Rotterdam
| | - M. Koopman
- Department of Medical Oncology; University Medical Center Utrecht; Utrecht
| | - C.J.A. Punt
- Department of Medical Oncology; Academic Medical Center; University of Amsterdam; Amsterdam
| | - C.A. Uyl-de Groot
- Institute for Medical Technology Assessment; Erasmus University Rotterdam; Rotterdam
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van Gils CWM, de Groot S, Redekop WK, Koopman M, Punt CJA, Uyl-de Groot CA. Real-world cost-effectiveness of oxaliplatin in stage III colon cancer: a synthesis of clinical trial and daily practice evidence. PHARMACOECONOMICS 2013; 31:703-718. [PMID: 23657918 DOI: 10.1007/s40273-013-0061-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Previous cost-effectiveness analyses of oxaliplatin have been based on randomised trials whereas current Dutch policy requires evidence from daily practice. The objective of this study was to examine the real-world cost-effectiveness of oxaliplatin plus fluoropyrimidines (FL) versus FL-only as adjuvant treatment of stage III colon cancer. METHODS A Markov model was developed to estimate lifetime cost and quality-adjusted life-years from a hospital perspective. The effectiveness of the oxaliplatin arm was modelled by combining published efficacy data from the pivotal clinical registration trial (MOSAIC trial) with real-world (RW) data from a Dutch population-based observational study. RW patients were categorised into "eligible" or "ineligible", depending on whether the patients fulfilled the MOSAIC trial eligibility criteria. Ineligible RW patients (18 %) had a poorer prognosis than eligible RW patients (82 %) and MOSAIC trial patients. The effectiveness of the comparator was modelled using MOSAIC trial results. All cost inputs were based on RW patients and reported in Euro 2012. Cost-effectiveness analyses were performed for four different scenarios: (1) cost-effectiveness analyses based on MOSAIC trial patients; (2) cost-effectiveness analyses using MOSAIC and eligible RW patients; (3) cost-effectiveness analyses using MOSAIC and both eligible and ineligible RW patients, assuming oxaliplatin had an equal effect in ineligible and eligible patients; (4) cost-effectiveness analyses using MOSAIC and both eligible and ineligible RW patients, assuming oxaliplatin had no effect amongst ineligibles. For each scenario, univariate and probabilistic sensitivity analyses were undertaken. RESULTS MOSAIC trial patients and eligible RW patients treated with oxaliplatin had comparable 2-year disease-free survivals (79.5 vs. 78.4 %). Oxaliplatin showed an incremental QALY gain of 1.02, 1.13, 1.17 and 0.93 and incremental cost of <euro>9,961, <euro>11,055, <euro>9,814 and <euro>11,854 in scenarios 1-4, respectively. The corresponding incremental cost-effectiveness ratios (ICERs) were <euro>9,766, <euro>9,783, <euro>8,388 and <euro>12,746 in scenarios 1-4, respectively. In all scenarios, univariate and probabilistic sensitivity analyses indicated that the ICERs are acceptable and robust under a wide range of model assumptions. CONCLUSIONS The ICERs of the different scenarios that resulted from combining MOSAIC trial data with data from Dutch daily practice all suggest that FL + oxaliplatin is cost-effective versus FL alone in the adjuvant treatment of colon cancer. This article illustrates how one could design and implement a real-world cost-effectiveness study to yield internally valid results that could also be generalisable.
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Affiliation(s)
- Chantal W M van Gils
- Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University, Burgemeester Oudlaan 50, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
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Uwah AN, Ackler J, Leighton JC, Pomerantz S, Tester W. The Effect of Diabetes on Oxaliplatin-Induced Peripheral Neuropathy. Clin Colorectal Cancer 2012; 11:275-9. [DOI: 10.1016/j.clcc.2012.05.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 03/27/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
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Shiroiwa T, Takeuchi T, Fukuda T, Shimozuma K, Ohashi Y. Cost-effectiveness of adjuvant FOLFOX therapy for stage III colon cancer in Japan based on the MOSAIC trial. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:255-260. [PMID: 22433756 DOI: 10.1016/j.jval.2011.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 09/23/2011] [Accepted: 10/13/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of adjuvant FOLFOX therapy versus 5-fluorouracil/leucovorin (FU/LV) for patients with stage III colorectal cancer. METHODS We performed the cost-effectiveness of FOLFOX compared with standard FU/LV treatment by the retrospective analysis of patient-level data from the randomized controlled Multicenter International Study of Oxaliplatin, 5-Fluorouracil, and Leucovorin in the Adjuvant Treatment of Colon Cancer (MOSAIC) trial. Predicted mean time spent in each disease state was calculated by our statistical model, which takes into account the cure rate and treats death from causes other than colon cancer as a competing risk. We performed this analysis from the perspective of the health-care payer. Using a time horizon of 30 years, both cost and effectiveness were discounted by 3% per year. RESULTS Estimated cure rates for colon cancer were 0.715 (FOLFOX) and 0.622 (FU/LV). Estimated medical costs of FOLFOX were JPY 3.1 million (USD 34,000) compared with JPY 1.9 million (USD 22,000) of FU/LV. The mean estimated quality-adjusted life-year was 9.83 with FOLFOX and 9.07 with that of FU/LV. The incremental cost-effectiveness ratio of FOLFOX was JPY 1.5 million (USD 17,000) per quality-adjusted life-year compared with FU/LV, which was supported by sensitivity analysis. Even if we assume that Japanese outcomes were better than those reported by the MOSAIC trial, which would reduce the difference between cure rates for each treatment to 5%, the incremental cost-effectiveness ratio remained below 5.0 million (USD 56,000) per quality-adjusted life-year. CONCLUSIONS Adjuvant FOLFOX is a cost-effective treatment for stage III colon cancer in Japan compared with FU/LV therapy. Even when parameters were changed to reflect smaller improvements with FOLFOX, the conclusion is the same.
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Affiliation(s)
- Takeru Shiroiwa
- Department of Biomedical Sciences, College of Life Sciences, Ritsumeikan University, Shiga, Japan.
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