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Tchétché D, de Gennes CD, Cormerais Q, Geisler BP, Dutot C, Wilquin-Bequet F, Breau-Brunel M, Lueza B, Pietzsch JB. Cost-effectiveness of transcatheter aortic valve implantation in patients at low surgical risk in France: a model-based analysis of the Evolut LR trial. Eur J Health Econ 2024; 25:447-457. [PMID: 37254006 PMCID: PMC10972970 DOI: 10.1007/s10198-023-01590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/17/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND In the recent Evolut Low Risk randomized trial, transcatheter aortic valve implantation (TAVI) was shown to be non-inferior to surgery (SAVR) regarding the composite end point of all-cause mortality or disabling stroke at 24 months. AIMS To evaluate the cost-effectiveness of self-expandable TAVI in low-risk patients, using the French healthcare system as the basis for analysis. METHODS Mortality, health-related quality of life, and clinical event rates through two-year follow-up were derived from trial data (N = 725 TAVI and N = 678 SAVR; mean age: 73.9 years; mean STS-PROM: 1.9%). Cost inputs were based on real-world data for TAVI and SAVR procedures in the French healthcare system. Costs and effectiveness as quality-adjusted life years (QALYs) were projected to lifetime via a decision-analytic model under assumption of no mortality difference beyond two years. The discounted incremental cost-effectiveness ratio (ICER) was evaluated against a willingness-to-pay threshold of €50,000 per QALY gained. Deterministic and probabilistic sensitivity analyses were conducted, including assumptions about differential long-term survival. RESULTS For the base case, mean survival was 13.69 vs 13.56 (+ 0.13) years for TAVI and SAVR, respectively. Discounted QALYs were 9.34 vs. 9.21 (+ 0.13) and discounted lifetime costs €52,267 vs. €51,433 (+ €833), resulting in a lifetime ICER of €6368 per QALY gained. In probabilistic sensitivity analysis, TAVI was found dominant or cost-effective in 74.4% of samples. CONCLUSION TAVI in patients at low surgical risk is a cost-effective alternative to SAVR in the French healthcare system. Longer follow-up data will help increase the accuracy of lifetime survival projections.
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Affiliation(s)
- Didier Tchétché
- Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France.
| | | | | | - Benjamin P Geisler
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Wing Tech Inc., Menlo Park, CA, USA
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Lueza B, Aupérin A, Rigaud C, Gross TG, Pillon M, Delgado RF, Uyttebroeck A, Amos Burke GA, Zsíros J, Csóka M, Simonin M, Patte C, Minard-Colin V, Bonastre J. Cost-effectiveness analysis alongside the inter-B-NHL ritux 2010 trial: rituximab in children and adolescents with B cell non-Hodgkin's lymphoma. Eur J Health Econ 2024; 25:307-317. [PMID: 37058173 PMCID: PMC10858928 DOI: 10.1007/s10198-023-01581-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES The randomized controlled trial Inter-B-NHL ritux 2010 showed overall survival (OS) benefit and event-free survival (EFS) benefit with the addition of rituximab to standard Lymphomes Malins B (LMB) chemotherapy in children and adolescents with high-risk, mature B cell non-Hodgkin's lymphoma. Our aim was to assess the cost-effectiveness of rituximab-chemotherapy versus chemotherapy alone in the French setting. METHODS We used a decision-analytic semi-Markov model with four health states and 1-month cycles. Resource use was prospectively collected in the Inter-B-NHL ritux 2010 trial (NCT01516580). Transition probabilities were assessed from patient-level data from the trial (n = 328). In the base case analysis, direct medical costs from the French National Insurance Scheme and life-years (LYs) were computed in both arms over a 3-year time horizon. Incremental net monetary benefit and cost-effectiveness acceptability curve were computed through a probabilistic sensitivity analysis. Deterministic sensitivity analysis and several sensitivity analyses on key assumptions were also conducted, including one exploratory analysis with quality-adjusted life years as the health outcome. RESULTS OS and EFS benefits shown in the Inter-B-NHL ritux 2010 trial translated into the model by rituximab-chemotherapy being the most effective and also the least expensive strategy over the chemotherapy strategy. The mean difference in LYs between arms was 0.13 [95% CI 0.02; 0.25], and the mean cost difference € - 3 710 [95% CI € - 17,877; € 10,525] in favor of rituximab-chemotherapy group. For a € 50,000 per LY willingness-to-pay threshold, the probability of the rituximab-chemotherapy strategy being cost-effective was 91.1%. All sensitivity analyses confirmed these findings. CONCLUSION Adding rituximab to LMB chemotherapy in children and adolescents with high-risk mature B-cell non-Hodgkin's lymphoma is highly cost-effective in France. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01516580.
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Affiliation(s)
- Béranger Lueza
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif Cedex, France
- Oncostat CESP - Labeled Ligue Contre le Cancer, INSERM 1018, Université Paris-Saclay, UVSQ, Villejuif, France
| | - Anne Aupérin
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif Cedex, France
- Oncostat CESP - Labeled Ligue Contre le Cancer, INSERM 1018, Université Paris-Saclay, UVSQ, Villejuif, France
| | - Charlotte Rigaud
- Département de Cancérologie de l'Enfant et l'adolescent, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Thomas G Gross
- Department of Pediatrics, Center for Cancer and Blood Diseases, Children's Hospital Colorado, Aurora, CO, USA
| | - Marta Pillon
- Pediatric Hematology and Oncology, University of Padova, Padua, Italy
| | - Rafael F Delgado
- Pediatric Hematology and Oncology, University of Valencia, Valencia, Spain
| | - Anne Uyttebroeck
- Department of Pediatric Hematology and Oncology, University Hospitals Leuven, Louvain, Belgium
| | - G A Amos Burke
- Department of Paediatric Haematology, Oncology and Palliative Care, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - József Zsíros
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Monika Csóka
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Mathieu Simonin
- Department of Pediatric Oncology and Hematology, Armand Trousseau Hospital-APHP, Sorbonne University, Paris, France
| | - Catherine Patte
- Département de Cancérologie de l'Enfant et l'adolescent, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Véronique Minard-Colin
- Département de Cancérologie de l'Enfant et l'adolescent, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
- INSERM 1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Julia Bonastre
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif Cedex, France.
- Oncostat CESP - Labeled Ligue Contre le Cancer, INSERM 1018, Université Paris-Saclay, UVSQ, Villejuif, France.
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Petit C, Blanchard P, Pignon JP, Lueza B. Individual patient data network meta-analysis using either restricted mean survival time difference or hazard ratios: is there a difference? A case study on locoregionally advanced nasopharyngeal carcinomas. Syst Rev 2019; 8:96. [PMID: 30987679 PMCID: PMC6463649 DOI: 10.1186/s13643-019-0984-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/11/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This study aimed at applying the restricted mean survival time difference (rmstD) as an absolute outcome measure in a network meta-analysis and comparing the results with those obtained using hazard ratios (HR) from the individual patient data (IPD) network meta-analysis (NMA) on the role of chemotherapy for nasopharyngeal carcinoma (NPC) recently published by the MAC-NPC collaborative group (Meta-Analysis of Chemotherapy [CT] in NPC). PATIENTS AND METHODS Twenty trials (5144 patients) comparing radiotherapy (RT) with or without CT in non-metastatic NPC were included. Treatments were grouped in seven categories: RT alone (RT), induction CT followed by RT (IC-RT), RT followed by adjuvant CT (RT-AC), IC followed by RT followed by AC (IC-RT-AC), concomitant chemoradiotherapy (CRT), IC followed by CRT (IC-CRT), and CRT followed by AC (CRT-AC). The primary endpoint was overall survival (OS); secondary endpoints were progression-free survival and locoregional control. The rmstD was estimated at t* = 10 years in each trial. Random-effect frequentist NMA models were applied. P score was used to rank treatments. Heterogeneity and inconsistency were evaluated. RESULTS The three treatments that had the highest effect on OS with rmstD were CRT-AC, IC-CRT, and CRT (respective P scores of 92%, 72%, and 64%) compared to CRT-AC, CRT, and IC-CRT when using HR (respective P scores of 96%, 71%, and 63%). Of the 32 HR and rmstD analyzed, 5 had a different interpretation, 3 with a direction change (different direction of treatment effect) and 2 with a change in significance (same direction but a change in statistical significance). Results for secondary endpoints were overall in agreement. CONCLUSION The use of either HR or rmstD impacts the results of NMA. Given the sensitivity of HR to non-proportional hazards, this finding could have implications in terms of meta-analysis methodology.
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Affiliation(s)
- C Petit
- Gustave Roussy, Service de Biostatistiques et d'Épidémiologie and Ligue Nationale Contre le Cancer Meta-Analysis Platform, Université Paris-Saclay, F-94805, Villejuif, France. .,Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France. .,Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France.
| | - P Blanchard
- Gustave Roussy, Service de Biostatistiques et d'Épidémiologie and Ligue Nationale Contre le Cancer Meta-Analysis Platform, Université Paris-Saclay, F-94805, Villejuif, France.,Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France.,Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - J P Pignon
- Gustave Roussy, Service de Biostatistiques et d'Épidémiologie and Ligue Nationale Contre le Cancer Meta-Analysis Platform, Université Paris-Saclay, F-94805, Villejuif, France.,Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France
| | - B Lueza
- Gustave Roussy, Service de Biostatistiques et d'Épidémiologie and Ligue Nationale Contre le Cancer Meta-Analysis Platform, Université Paris-Saclay, F-94805, Villejuif, France.,Centre for Research in Epidemiology and Population Health, INSERM U1018, Paris-Saclay University, Villejuif, France
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Charrier M, Mezquita L, Lueza B, Dupraz L, Planchard D, Remon J, Caramella C, Cassard L, Boselli L, Reiners KS, Pogge von Strandmann E, Rusakiewicz S, Ferrara R, Duchemann B, Naigeon M, Pignon JP, Besse B, Chaput N. Circulating innate immune markers and outcomes in treatment-naïve advanced non-small cell lung cancer patients. Eur J Cancer 2019; 108:88-96. [PMID: 30648633 DOI: 10.1016/j.ejca.2018.12.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Innate immunity represents the first step of activation of the immune system and dictates the quality of adaptive immune responses. Studies have reported links between systemic inflammatory or innate immune markers and prognosis in patients with lung cancer. To our knowledge, the prospective and concomitant study of these systemic markers has never been performed. METHODS Advanced treatment-naive non-small cell lung cancer (NSCLC) patients eligible for first-line platinum-based chemotherapy were prospectively included from December 2012 to July 2015 (N = 148). Blood samples of patients were collected before the first cycle for fresh NK cell phenotyping. Peripheral blood mononuclear cells were cryopreserved for natural cytotoxicity receptor (NCR) genotyping as well as sera for NCR's ligand quantification. Data on leukocytes, neutrophils and monocyte counts and lactate dehydrogenase (LDH) levels were extracted from electronic medical records. RESULTS Among all studied markers, monocytosis, neutrophilia, leucocytosis, high LDH and sBAG6 levels and reduced levels of NCR3 transcripts were associated with poor overall survival (OS) in univariate analysis. The levels of NCR3 transcripts was linked to age, number of metastatic sites, monocyte counts, LDH and sBAG6 levels. Neutrophilia was associated to high sBAG6 levels. NCR3 was the unique innate immune parameter that remained as an independent factor associated with both OS (P = 0.003) and progression-free survival (P = 0.009) in the multivariate analysis. CONCLUSION This study brought evidence that these biomarkers are entangled; parameters associated with an inflammatory process were related to reduced levels of NCR3 transcripts. Finally, the level of NCR3 transcripts was independently associated with outcomes in treatment-naive patients with advanced NSCLC.
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Affiliation(s)
- M Charrier
- Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Laboratory of Immunomonitoring in Oncology, UMS 3655 CNRS/US 23 INSERM, Gustave Roussy Cancer Campus, F-94805, Villejuif, France; University Paris-Saclay, Faculty of Medicine, F-94270, Le Kremlin-Bicêtre, France
| | - L Mezquita
- Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Laboratory of Immunomonitoring in Oncology, UMS 3655 CNRS/US 23 INSERM, Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Department of Cancer Medicine, Gustave Roussy Cancer Campus, F-94805, Villejuif, France
| | - B Lueza
- Biostatistics and Epidemiology Department, University Paris Saclay, Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Oncostat CESP, INSERM, University Paris-Saclay, France; UVSQ, University Paris-Sud, F-94085, Villejuif, France
| | - L Dupraz
- Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Laboratory of Immunomonitoring in Oncology, UMS 3655 CNRS/US 23 INSERM, Gustave Roussy Cancer Campus, F-94805, Villejuif, France
| | - D Planchard
- Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Department of Cancer Medicine, Gustave Roussy Cancer Campus, F-94805, Villejuif, France
| | - J Remon
- Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Department of Cancer Medicine, Gustave Roussy Cancer Campus, F-94805, Villejuif, France
| | - C Caramella
- Radiology Department, Gustave Roussy, Cancer Campus, F-94085, Villejuif, France
| | - L Cassard
- Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Laboratory of Immunomonitoring in Oncology, UMS 3655 CNRS/US 23 INSERM, Gustave Roussy Cancer Campus, F-94805, Villejuif, France
| | - L Boselli
- Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Laboratory of Immunomonitoring in Oncology, UMS 3655 CNRS/US 23 INSERM, Gustave Roussy Cancer Campus, F-94805, Villejuif, France
| | - K S Reiners
- Institute for Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, 53127 Bonn, Germany
| | - E Pogge von Strandmann
- Experimental Tumor Research, Center for Tumor Biology and Immunology, Clinic for Hematology, Oncology and Immunology, Philipps University, 35043 Marburg, Germany
| | - S Rusakiewicz
- Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Center of Clinical Investigations in Biotherapies of Cancer (CICBT) 1428, Villejuif, France
| | - R Ferrara
- Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Laboratory of Immunomonitoring in Oncology, UMS 3655 CNRS/US 23 INSERM, Gustave Roussy Cancer Campus, F-94805, Villejuif, France
| | - B Duchemann
- Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Laboratory of Immunomonitoring in Oncology, UMS 3655 CNRS/US 23 INSERM, Gustave Roussy Cancer Campus, F-94805, Villejuif, France; University Paris-Saclay, Faculty of Medicine, F-94270, Le Kremlin-Bicêtre, France
| | - M Naigeon
- Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Laboratory of Immunomonitoring in Oncology, UMS 3655 CNRS/US 23 INSERM, Gustave Roussy Cancer Campus, F-94805, Villejuif, France; University Paris-Saclay, Faculty of Medicine, F-94270, Le Kremlin-Bicêtre, France
| | - J P Pignon
- Biostatistics and Epidemiology Department, University Paris Saclay, Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Oncostat CESP, INSERM, University Paris-Saclay, France; UVSQ, University Paris-Sud, F-94085, Villejuif, France
| | - B Besse
- Gustave Roussy Cancer Campus, F-94805, Villejuif, France; University Paris-Saclay, Faculty of Medicine, F-94270, Le Kremlin-Bicêtre, France; Department of Cancer Medicine, Gustave Roussy Cancer Campus, F-94805, Villejuif, France
| | - N Chaput
- Gustave Roussy Cancer Campus, F-94805, Villejuif, France; Laboratory of Immunomonitoring in Oncology, UMS 3655 CNRS/US 23 INSERM, Gustave Roussy Cancer Campus, F-94805, Villejuif, France; University Paris-Saclay, Faculty of Pharmacy, Chatenay-Malabry, F-92296, France.
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Arnold D, Lueza B, Douillard JY, Peeters M, Lenz HJ, Venook A, Heinemann V, Van Cutsem E, Pignon JP, Tabernero J, Cervantes A, Ciardiello F. Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials. Ann Oncol 2018; 28:1713-1729. [PMID: 28407110 DOI: 10.1093/annonc/mdx175] [Citation(s) in RCA: 562] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background There is increasing evidence that metastatic colorectal cancer (mCRC) is a genetically heterogeneous disease and that tumours arising from different sides of the colon (left versus right) have different clinical outcomes. Furthermore, previous analyses comparing the activity of different classes of targeted agents in patients with KRAS wild-type (wt) or RAS wt mCRC suggest that primary tumour location (side), might be both prognostic and predictive for clinical outcome. Methods This retrospective analysis investigated the prognostic and predictive influence of the localization of the primary tumour in patients with unresectable RAS wt mCRC included in six randomized trials (CRYSTAL, FIRE-3, CALGB 80405, PRIME, PEAK and 20050181), comparing chemotherapy plus EGFR antibody therapy (experimental arm) with chemotherapy or chemotherapy and bevacizumab (control arms). Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and progression-free survival (PFS) for patients with left-sided versus right-sided tumours, and odds ratios (ORs) for objective response rate (ORR) were estimated by pooling individual study HRs/ORs. The predictive value was evaluated by pooling study interaction between treatment effect and tumour side. Results Primary tumour location and RAS mutation status were available for 2159 of the 5760 patients (37.5%) randomized across the 6 trials, 515 right-sided and 1644 left-sided. A significantly worse prognosis was observed for patients with right-sided tumours compared with those with left-sided tumours in both the pooled control and experimental arms for OS [HRs = 2.03 (95% CI: 1.69-2.42) and 1.38 (1.17-1.63), respectively], PFS [HRs = 1.59 (1.34-1.88) and 1.25 (1.06-1.47)], and ORR [ORs = 0.38 (0.28-0.50) and 0.56 (0.43-0.73)]. In terms of a predictive effect, a significant benefit for chemotherapy plus EGFR antibody therapy was observed in patients with left-sided tumours [HRs = 0.75 (0.67-0.84) and 0.78 (0.70-0.87) for OS and PFS, respectively] compared with no significant benefit for those with right-sided tumours [HRs = 1.12 (0.87-1.45) and 1.12 (0.87-1.44) for OS and PFS, respectively; P value for interaction <0.001 and 0.002, respectively]. For ORR, there was a trend (P value for interaction = 0.07) towards a greater benefit for chemotherapy plus EGFR antibody therapy in the patients with left-sided tumours [OR = 2.12 (1.77-2.55)] compared with those with right-sided tumours [OR = 1.47 (0.94-2.29)]. Exclusion of the unique phase II trial or the unique second-line trial had no impact on the results. The predictive effect on PFS may depend of the type of EGFR antibody therapy and on the presence or absence of bevacizumab in the control arm. Conclusion This pooled analysis showed a worse prognosis for OS, PFS and ORR for patients with right-sided tumours compared with those with left-sided tumours in patients with RAS wt mCRC and a predictive effect of tumour side, with a greater effect of chemotherapy plus EGFR antibody therapy compared with chemotherapy or chemotherapy and bevacizumab, the effect being greatest in patients with left-sided tumours. These predictive results should be interpreted with caution due to the retrospective nature of the analysis, which was carried out on subpopulations of patients included in these trials, and because none of these studies contemplated a full treatment sequence strategy.
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Affiliation(s)
- D Arnold
- Institute of Oncology, CUF Hospitals, Lisbon, Portugal
| | - B Lueza
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | | | - M Peeters
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
| | - H-J Lenz
- Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Los Angeles
| | - A Venook
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
| | - V Heinemann
- Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximillans-Universität, Munich, Germany
| | - E Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - J-P Pignon
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | - J Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain and CIBERONC, Institute of Health Carlos III, Madrid
| | - A Cervantes
- Department of Medical Oncology, Biomedical Health Research Institute INCLIVA, University of Valencia, Valencia.,CIBERONC, Institute of Health Carlos III, Madrid, Spain
| | - F Ciardiello
- Division of Medical Oncology, Department of Experimental and Clinical Medicine and Surgery "F. Magrassi and A. Lanzara", Second University of Naples, Naples, Italy
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Lejeune C, Lueza B, Bonastre J. [Economic analysis of multinational clinical trials in oncology]. Bull Cancer 2018; 105:204-211. [PMID: 29397917 DOI: 10.1016/j.bulcan.2017.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
In oncology, as in other fields of medicine, international multicentre clinical trials came into being so as to include a sufficient number of subjects to investigate a clinical situation. The existence of tight budgetary constraints and the desire to make the best use of the resources available have resulted in the development of economic evaluations associated with these trials, which, thanks to their level of evidence and their size, provide particularly relevant material. Nonetheless, economic evaluations alongside international clinical trials raise specific questions of methodology with regard to both the design and the analysis of the results. Indeed, the costs of goods and services consumed, the types and quantities of resources, and medical practices vary from one country to another and within an individual country. Economic data from the different countries involved must be available so as to study and to take into account this variability, and appropriate techniques for cost estimations and analysis must be implemented to aggregate the results from several countries. From a review of the literature, the aim of this work was to provide an overview of the specific methodological features of economic evaluations alongside international clinical trials: analysis of efficacy data from several countries, collection of resources and real costs, methods to establish the monetary value of resources, methods to aggregate results accounting for the trial effect.
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Affiliation(s)
- Catherine Lejeune
- Université Bourgogne Franche-Comté-Inserm CIC1432, module épidémiologie clinique, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France; Centre hospitalier universitaire, centre d'investigation clinique, module épidémiologie clinique/essais cliniques, 7, boulevard Jeanne-d'Arc, BP 87900, 21000 Dijon, France; Université de Bourgogne et Franche-Comté, EPICAD LNC-UMR1231, 7, boulevard Jeanne-d'Arc, BP 87900, 21000 Dijon, France.
| | - Béranger Lueza
- Université Paris-Saclay, Gustave-Roussy, service de biostatistique et d'épidémiologie, 94805 Villejuif, France; Université Paris-Sud, UVSQ, université Paris-Saclay, Oncostat CESP, Inserm, 94085 Villejuif, France
| | - Julia Bonastre
- Université Paris-Saclay, Gustave-Roussy, service de biostatistique et d'épidémiologie, 94805 Villejuif, France; Université Paris-Sud, UVSQ, université Paris-Saclay, Oncostat CESP, Inserm, 94085 Villejuif, France
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Arnold D, Lueza B, Douillard JY, Peeters M, Lenz HJ, Venook A, Heinemann V, Van Cutsem E, Pignon JP, Tabernero J, Cervantes A, Ciardiello F. Prognostic and predictive value of primary tumour side in patients with RAS wild-type metastatic colorectal cancer treated with chemotherapy and EGFR directed antibodies in six randomized trials. Ann Oncol 2017. [PMID: 28407110 DOI: 10.1093/annonc/mdx175.pmid:28407110;pmcid:pmc6246616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND There is increasing evidence that metastatic colorectal cancer (mCRC) is a genetically heterogeneous disease and that tumours arising from different sides of the colon (left versus right) have different clinical outcomes. Furthermore, previous analyses comparing the activity of different classes of targeted agents in patients with KRAS wild-type (wt) or RAS wt mCRC suggest that primary tumour location (side), might be both prognostic and predictive for clinical outcome. METHODS This retrospective analysis investigated the prognostic and predictive influence of the localization of the primary tumour in patients with unresectable RAS wt mCRC included in six randomized trials (CRYSTAL, FIRE-3, CALGB 80405, PRIME, PEAK and 20050181), comparing chemotherapy plus EGFR antibody therapy (experimental arm) with chemotherapy or chemotherapy and bevacizumab (control arms). Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and progression-free survival (PFS) for patients with left-sided versus right-sided tumours, and odds ratios (ORs) for objective response rate (ORR) were estimated by pooling individual study HRs/ORs. The predictive value was evaluated by pooling study interaction between treatment effect and tumour side. RESULTS Primary tumour location and RAS mutation status were available for 2159 of the 5760 patients (37.5%) randomized across the 6 trials, 515 right-sided and 1644 left-sided. A significantly worse prognosis was observed for patients with right-sided tumours compared with those with left-sided tumours in both the pooled control and experimental arms for OS [HRs = 2.03 (95% CI: 1.69-2.42) and 1.38 (1.17-1.63), respectively], PFS [HRs = 1.59 (1.34-1.88) and 1.25 (1.06-1.47)], and ORR [ORs = 0.38 (0.28-0.50) and 0.56 (0.43-0.73)]. In terms of a predictive effect, a significant benefit for chemotherapy plus EGFR antibody therapy was observed in patients with left-sided tumours [HRs = 0.75 (0.67-0.84) and 0.78 (0.70-0.87) for OS and PFS, respectively] compared with no significant benefit for those with right-sided tumours [HRs = 1.12 (0.87-1.45) and 1.12 (0.87-1.44) for OS and PFS, respectively; P value for interaction <0.001 and 0.002, respectively]. For ORR, there was a trend (P value for interaction = 0.07) towards a greater benefit for chemotherapy plus EGFR antibody therapy in the patients with left-sided tumours [OR = 2.12 (1.77-2.55)] compared with those with right-sided tumours [OR = 1.47 (0.94-2.29)]. Exclusion of the unique phase II trial or the unique second-line trial had no impact on the results. The predictive effect on PFS may depend of the type of EGFR antibody therapy and on the presence or absence of bevacizumab in the control arm. CONCLUSION This pooled analysis showed a worse prognosis for OS, PFS and ORR for patients with right-sided tumours compared with those with left-sided tumours in patients with RAS wt mCRC and a predictive effect of tumour side, with a greater effect of chemotherapy plus EGFR antibody therapy compared with chemotherapy or chemotherapy and bevacizumab, the effect being greatest in patients with left-sided tumours. These predictive results should be interpreted with caution due to the retrospective nature of the analysis, which was carried out on subpopulations of patients included in these trials, and because none of these studies contemplated a full treatment sequence strategy.
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Affiliation(s)
- D Arnold
- Institute of Oncology, CUF Hospitals, Lisbon, Portugal
| | - B Lueza
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | | | - M Peeters
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
| | - H-J Lenz
- Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Los Angeles
| | - A Venook
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
| | - V Heinemann
- Comprehensive Cancer Center, University Hospital Grosshadern, Ludwig-Maximillans-Universität, Munich, Germany
| | - E Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - J-P Pignon
- Ligue Nationale Contre Le Cancer Meta-Analysis Platform, Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, CESP, University of Paris-Sud, University of Paris-Saclay, Villejuif, France
| | - J Tabernero
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain and CIBERONC, Institute of Health Carlos III, Madrid
| | - A Cervantes
- Department of Medical Oncology, Biomedical Health Research Institute INCLIVA, University of Valencia, Valencia.,CIBERONC, Institute of Health Carlos III, Madrid, Spain
| | - F Ciardiello
- Division of Medical Oncology, Department of Experimental and Clinical Medicine and Surgery "F. Magrassi and A. Lanzara", Second University of Naples, Naples, Italy
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Mezquita L, Charrier M, Faivre L, Dupraz L, Lueza B, Remon J, Planchard D, Bluthgen MV, Facchinetti F, Rahal A, Polo V, Gazzah A, Caramella C, Adam J, Pignon JP, Soria JC, Chaput N, Besse B. Prognostic value of HLA-A2 status in advanced non-small cell lung cancer patients. Lung Cancer 2017; 112:10-15. [PMID: 29191581 DOI: 10.1016/j.lungcan.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/14/2017] [Accepted: 07/05/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The class I human leucocyte antigen (HLA) molecules play a critical role as an escape mechanism of antitumoral immunity. HLA-A2 status has been evaluated as a prognostic factor in lung cancer, mostly in localized disease and with inconsistent findings. We evaluated the role of HLA-A2 status as a prognostic factor in a large and homogeneus cohort of advanced NSCLC patients. METHODS Advanced NSCLC patients eligible for platinum-based chemotherapy were consecutively included in a single center between October 2009 and July 2015 in the prospective MSN study (NCT02105168). HLA-A2 status was analysed by flow cytometry. Clinical, pathological and molecular data were collected. A Cox model was used for prognostic analyses. RESULTS Of 545 stage IIIB/IV NSCLC patients included, 344 (63%) were male, 466 (85%) were smokers, 447 (83%) had PS 0-1, 508 (93%) had stage IV, 407 (75%) had an adenocarcinoma and median age was 61 years (range, 21-84). Incidence of patients with EGFRmut, ALK-positive and KRASmut was 14% (49/361), 9% (29/333) and 31% (107/350), respectively. The overall rate of HLA-A2 positivity was 48%. No association was observed between HLA-A2 status and any patient or tumor characteristics analyzed. With a median follow-up of 27.1 months, median OS was 12.8 months [95%CI 11.0-14.6] in HLA-A2+ vs. 12.5 months [95%CI 10.4-15.3] in HLA-A2- patients (HR 1.05 [95%CI 0.86-1.29], p=0.61). Median progression-free survival was similar in the two cohorts. CONCLUSION HLA-A2 status was not identified as prognostic for benefit in a large advanced NSCLC population treated with platinum-based chemotherapy.
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Affiliation(s)
- Laura Mezquita
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Melinda Charrier
- Laboratory of Immunomonitoring in Oncology, CNRS-UMS 3655, INSERM-US23, Gustave Roussy, Villejuif, France
| | - Laura Faivre
- Biostatistics and Epidemiology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Louise Dupraz
- Laboratory of Immunomonitoring in Oncology, CNRS-UMS 3655, INSERM-US23, Gustave Roussy, Villejuif, France
| | - Béranger Lueza
- Biostatistics and Epidemiology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Oncostat CESP, INSERM, Université Paris-Saclay, University Paris-Sud, UVSQ, Villejuif, France
| | - Jordi Remon
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - David Planchard
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | | | | | - Arslane Rahal
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Valentina Polo
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Anas Gazzah
- Drug Development Department, Gustave Roussy, Villejuif, France
| | | | - Julien Adam
- Pathology Department, Gustave Roussy, Villejuif, France
| | - Jean Pierre Pignon
- Biostatistics and Epidemiology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Oncostat CESP, INSERM, Université Paris-Saclay, University Paris-Sud, UVSQ, Villejuif, France
| | - Jean-Charles Soria
- Drug Development Department, Gustave Roussy, Villejuif, France; University Paris-Saclay, Faculté de Médecine, Le Kremlin Bicêtre, France
| | - Nathalie Chaput
- Laboratory of Immunomonitoring in Oncology, CNRS-UMS 3655, INSERM-US23, Gustave Roussy, Villejuif, France; University Paris-Saclay, Faculté de Pharmacie, Chatenay-Malabry, France
| | - Benjamin Besse
- Medical Oncology Department, Gustave Roussy, Villejuif, France; University Paris-Saclay, Faculté de Médecine, Le Kremlin Bicêtre, France.
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Guyot P, Ades AE, Beasley M, Lueza B, Pignon JP, Welton NJ. Extrapolation of Survival Curves from Cancer Trials Using External Information. Med Decis Making 2017; 37:353-366. [PMID: 27681990 PMCID: PMC6190619 DOI: 10.1177/0272989x16670604] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 06/09/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Estimates of life expectancy are a key input to cost-effectiveness analysis (CEA) models for cancer treatments. Due to the limited follow-up in Randomized Controlled Trials (RCTs), parametric models are frequently used to extrapolate survival outcomes beyond the RCT period. However, different parametric models that fit the RCT data equally well may generate highly divergent predictions of treatment-related gain in life expectancy. Here, we investigate the use of information external to the RCT data to inform model choice and estimation of life expectancy. METHODS We used Bayesian multi-parameter evidence synthesis to combine the RCT data with external information on general population survival, conditional survival from cancer registry databases, and expert opinion. We illustrate with a 5-year follow-up RCT of cetuximab plus radiotherapy v. radiotherapy alone for head and neck cancer. RESULTS Standard survival time distributions were insufficiently flexible to simultaneously fit both the RCT data and external data on general population survival. Using spline models, we were able to estimate a model that was consistent with the trial data and all external data. A model integrating all sources achieved an adequate fit and predicted a 4.7-month (95% CrL: 0.4; 9.1) gain in life expectancy due to cetuximab. CONCLUSIONS Long-term extrapolation using parametric models based on RCT data alone is highly unreliable and these models are unlikely to be consistent with external data. External data can be integrated with RCT data using spline models to enable long-term extrapolation. Conditional survival data could be used for many cancers and general population survival may have a role in other conditions. The use of external data should be guided by knowledge of natural history and treatment mechanisms.
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Affiliation(s)
- Patricia Guyot
- Patricia Guyot, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS UK; telephone: +33 (0)4 72 13 51 46; fax: +33 (0)4 72 13 51 40; e-mail:
| | - Anthony E. Ades
- />School of Social and Community Medicine, University of Bristol, Bristol, UK (PG, AED, NJW)
- />Mapi, Houten, the Netherlands (PG)
- />Bristol Haematology and Oncology Centre, Bristol, UK (MB)
- />Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d’épidémiologie / Ligue Nationale Contre le Cancer meta-analysis plateform, F-94805 Villejuif, France (BL, JP)
- />Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085 Villejuif, France (BL, JP)
| | - Matthew Beasley
- />School of Social and Community Medicine, University of Bristol, Bristol, UK (PG, AED, NJW)
- />Mapi, Houten, the Netherlands (PG)
- />Bristol Haematology and Oncology Centre, Bristol, UK (MB)
- />Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d’épidémiologie / Ligue Nationale Contre le Cancer meta-analysis plateform, F-94805 Villejuif, France (BL, JP)
- />Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085 Villejuif, France (BL, JP)
| | - Béranger Lueza
- />School of Social and Community Medicine, University of Bristol, Bristol, UK (PG, AED, NJW)
- />Mapi, Houten, the Netherlands (PG)
- />Bristol Haematology and Oncology Centre, Bristol, UK (MB)
- />Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d’épidémiologie / Ligue Nationale Contre le Cancer meta-analysis plateform, F-94805 Villejuif, France (BL, JP)
- />Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085 Villejuif, France (BL, JP)
| | - Jean-Pierre Pignon
- />School of Social and Community Medicine, University of Bristol, Bristol, UK (PG, AED, NJW)
- />Mapi, Houten, the Netherlands (PG)
- />Bristol Haematology and Oncology Centre, Bristol, UK (MB)
- />Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d’épidémiologie / Ligue Nationale Contre le Cancer meta-analysis plateform, F-94805 Villejuif, France (BL, JP)
- />Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085 Villejuif, France (BL, JP)
| | - Nicky J. Welton
- />School of Social and Community Medicine, University of Bristol, Bristol, UK (PG, AED, NJW)
- />Mapi, Houten, the Netherlands (PG)
- />Bristol Haematology and Oncology Centre, Bristol, UK (MB)
- />Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d’épidémiologie / Ligue Nationale Contre le Cancer meta-analysis plateform, F-94805 Villejuif, France (BL, JP)
- />Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085 Villejuif, France (BL, JP)
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Lueza B, Lacas B, Pignon JP, Paoletti X. [New applications for individual participant data meta-analyses of randomized trials]. Bull Cancer 2016; 104:139-146. [PMID: 27908441 DOI: 10.1016/j.bulcan.2016.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
Meta-analyses of randomized trials using individual-participant data, which represent the highest level of evidence for the evaluation of a treatment effect, are now used in different contexts in clinical research. This article aims at reviewing some of these new applications. Meta-analyses are increasingly used in economic evaluation, which implies new measure outcomes of the treatment effect, as well as in biomarkers evaluations thanks to their higher statistical power and the possibility to validate findings on independent data. This article also considers the perspectives opened up by new data sources, such as randomized trials registers, and data sharing policies.
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Affiliation(s)
- Béranger Lueza
- Gustave-Roussy, université Paris-Saclay, service de biostatistique et d'épidémiologie, 94805 Villejuif, France; Oncostat CESP, INSERM, université Paris-Saclay, university Paris-Sud, UVSQ, 94085 Villejuif, France; Gustave-Roussy, plateforme Ligue nationale contre le cancer de méta-analyse en oncologie, 94085 Villejuif, France
| | - Benjamin Lacas
- Gustave-Roussy, université Paris-Saclay, service de biostatistique et d'épidémiologie, 94805 Villejuif, France; Oncostat CESP, INSERM, université Paris-Saclay, university Paris-Sud, UVSQ, 94085 Villejuif, France; Gustave-Roussy, plateforme Ligue nationale contre le cancer de méta-analyse en oncologie, 94085 Villejuif, France
| | - Jean-Pierre Pignon
- Gustave-Roussy, université Paris-Saclay, service de biostatistique et d'épidémiologie, 94805 Villejuif, France; Oncostat CESP, INSERM, université Paris-Saclay, university Paris-Sud, UVSQ, 94085 Villejuif, France; Gustave-Roussy, plateforme Ligue nationale contre le cancer de méta-analyse en oncologie, 94085 Villejuif, France
| | - Xavier Paoletti
- Gustave-Roussy, université Paris-Saclay, service de biostatistique et d'épidémiologie, 94805 Villejuif, France; Oncostat CESP, INSERM, université Paris-Saclay, university Paris-Sud, UVSQ, 94085 Villejuif, France; Gustave-Roussy, plateforme Ligue nationale contre le cancer de méta-analyse en oncologie, 94085 Villejuif, France.
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Lueza B, Rotolo F, Bonastre J, Pignon JP, Michiels S. Erratum to: Bias and precision of methods for estimating the difference in restricted mean survival time from an individual patient data meta-analysis. BMC Med Res Methodol 2016; 16:71. [PMID: 27306030 PMCID: PMC4910251 DOI: 10.1186/s12874-016-0154-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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De Ruysscher D, Lueza B, Le Péchoux C, Johnson DH, O'Brien M, Murray N, Spiro S, Wang X, Takada M, Lebeau B, Blackstock W, Skarlos D, Baas P, Choy H, Price A, Seymour L, Arriagada R, Pignon JP. Impact of thoracic radiotherapy timing in limited-stage small-cell lung cancer: usefulness of the individual patient data meta-analysis. Ann Oncol 2016; 27:1818-28. [PMID: 27436850 PMCID: PMC5035783 DOI: 10.1093/annonc/mdw263] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/24/2016] [Accepted: 06/28/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chemotherapy (CT) combined with radiotherapy is the standard treatment of 'limited-stage' small-cell lung cancer. However, controversy persists over the optimal timing of thoracic radiotherapy and CT. MATERIALS AND METHODS We carried out a meta-analysis of individual patient data in randomized trials comparing earlier versus later radiotherapy, or shorter versus longer radiotherapy duration, as defined in each trial. We combined the results from trials using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival. RESULTS Twelve trials with 2668 patients were eligible. Data from nine trials comprising 2305 patients were available for analysis. The median follow-up was 10 years. When all trials were analysed together, 'earlier or shorter' versus 'later or longer' thoracic radiotherapy did not affect overall survival. However, the HR for overall survival was significantly in favour of 'earlier or shorter' radiotherapy among trials with a similar proportion of patients who were compliant with CT (defined as having received 100% or more of the planned CT cycles) in both arms (HR 0.79, 95% CI 0.69-0.91), and in favour of 'later or longer' radiotherapy among trials with different rates of CT compliance (HR 1.19, 1.05-1.34, interaction test, P < 0.0001). The absolute gain between 'earlier or shorter' versus 'later or longer' thoracic radiotherapy in 5-year overall survival for similar and for different CT compliance trials was 7.7% (95% CI 2.6-12.8%) and -2.2% (-5.8% to 1.4%), respectively. However, 'earlier or shorter' thoracic radiotherapy was associated with a higher incidence of severe acute oesophagitis than 'later or longer' radiotherapy. CONCLUSION 'Earlier or shorter' delivery of thoracic radiotherapy with planned CT significantly improves 5-year overall survival at the expense of more acute toxicity, especially oesophagitis.
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Affiliation(s)
- D De Ruysscher
- Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands Department of Oncology, Experimental Radiation Oncology, KU Leuven, Leuven, Belgium
| | - B Lueza
- Department of Biostatistics and Epidemiology and "Ligue Nationale Contre le Cancer" meta-analysis platform, Gustave Roussy, Villejuif, France CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif
| | - C Le Péchoux
- Department of Oncology and radiation therapy, Gustave Roussy, Villejuif Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - D H Johnson
- UT Southwestern University School of Medicine, Dallas, USA
| | - M O'Brien
- EORTC Data Center, Brussels, Belgium
| | - N Murray
- British Columbia Cancer Agency, Vancouver, Canada
| | - S Spiro
- University College London Hospitals, London, UK
| | - X Wang
- Alliance Data and Statistical Center, Duke University, Durham, USA
| | - M Takada
- Osaka Prefectural Habikino Hospital, Osaka, Japan
| | - B Lebeau
- Hôpital St Antoine, Paris, France
| | - W Blackstock
- Wake Forest University School of Medicine, Winston-Salem, USA
| | - D Skarlos
- Second Department of Medical Oncology, Metropolitan Hospital N. Faliro, Athens, Greece
| | - P Baas
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Choy
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, USA
| | - A Price
- NHS Lothian and University of Edinburgh, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - L Seymour
- NCIC Clinical Trials Group and Queen's University, Kingston, Canada
| | - R Arriagada
- Gustave Roussy, Villejuif, France Karolinska Institutet, Stockholm, Sweden
| | - J-P Pignon
- Department of Biostatistics and Epidemiology and "Ligue Nationale Contre le Cancer" meta-analysis platform, Gustave Roussy, Villejuif, France CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif
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Lueza B, Rotolo F, Bonastre J, Pignon JP, Michiels S. Bias and precision of methods for estimating the difference in restricted mean survival time from an individual patient data meta-analysis. BMC Med Res Methodol 2016; 16:37. [PMID: 27025706 PMCID: PMC4812643 DOI: 10.1186/s12874-016-0137-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/15/2016] [Indexed: 11/13/2022] Open
Abstract
Background The difference in restricted mean survival time (\documentclass[12pt]{minimal}
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\begin{document}$$ rmstD\left({t}^{\ast}\right) $$\end{document}rmstDt∗), the area between two survival curves up to time horizon \documentclass[12pt]{minimal}
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\begin{document}$$ {t}^{\ast } $$\end{document}t∗, is often used in cost-effectiveness analyses to estimate the treatment effect in randomized controlled trials. A challenge in individual patient data (IPD) meta-analyses is to account for the trial effect. We aimed at comparing different methods to estimate the \documentclass[12pt]{minimal}
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\begin{document}$$ rmstD\left({t}^{\ast}\right) $$\end{document}rmstDt∗ from an IPD meta-analysis. Methods We compared four methods: the area between Kaplan-Meier curves (experimental vs. control arm) ignoring the trial effect (Naïve Kaplan-Meier); the area between Peto curves computed at quintiles of event times (Peto-quintile); the weighted average of the areas between either trial-specific Kaplan-Meier curves (Pooled Kaplan-Meier) or trial-specific exponential curves (Pooled Exponential). In a simulation study, we varied the between-trial heterogeneity for the baseline hazard and for the treatment effect (possibly correlated), the overall treatment effect, the time horizon \documentclass[12pt]{minimal}
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\begin{document}$$ {t}^{\ast } $$\end{document}t∗, the number of trials and of patients, the use of fixed or DerSimonian-Laird random effects model, and the proportionality of hazards. We compared the methods in terms of bias, empirical and average standard errors. We used IPD from the Meta-Analysis of Chemotherapy in Nasopharynx Carcinoma (MAC-NPC) and its updated version MAC-NPC2 for illustration that included respectively 1,975 and 5,028 patients in 11 and 23 comparisons. Results The Naïve Kaplan-Meier method was unbiased, whereas the Pooled Exponential and, to a much lesser extent, the Pooled Kaplan-Meier methods showed a bias with non-proportional hazards. The Peto-quintile method underestimated the \documentclass[12pt]{minimal}
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\begin{document}$$ rmstD\left({t}^{\ast}\right) $$\end{document}rmstDt∗, except with non-proportional hazards at \documentclass[12pt]{minimal}
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\begin{document}$$ {t}^{\ast } $$\end{document}t∗= 5 years. In the presence of treatment effect heterogeneity, all methods except the Pooled Kaplan-Meier and the Pooled Exponential with DerSimonian-Laird random effects underestimated the standard error of the \documentclass[12pt]{minimal}
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\begin{document}$$ rmstD\left({t}^{\ast}\right) $$\end{document}rmstDt∗. Overall, the Pooled Kaplan-Meier method with DerSimonian-Laird random effects formed the best compromise in terms of bias and variance. The \documentclass[12pt]{minimal}
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\begin{document}$$ rmstD\left({t}^{\ast },=,10,\kern0.5em ,\mathrm{years}\right) $$\end{document}rmstDt∗=10years estimated with the Pooled Kaplan-Meier method was 0.49 years (95 % CI: [−0.06;1.03], p = 0.08) when comparing radiotherapy plus chemotherapy vs. radiotherapy alone in the MAC-NPC and 0.59 years (95 % CI: [0.34;0.84], p < 0.0001) in the MAC-NPC2. Conclusions We recommend the Pooled Kaplan-Meier method with DerSimonian-Laird random effects to estimate the difference in restricted mean survival time from an individual-patient data meta-analysis. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0137-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Béranger Lueza
- Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d'épidémiologie, F-94805, Villejuif, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085, Villejuif, France.,Ligue Nationale Contre le Cancer meta-analysis platform, Gustave Roussy, F-94085, Villejuif, France
| | - Federico Rotolo
- Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d'épidémiologie, F-94805, Villejuif, France. .,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085, Villejuif, France. .,Ligue Nationale Contre le Cancer meta-analysis platform, Gustave Roussy, F-94085, Villejuif, France.
| | - Julia Bonastre
- Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d'épidémiologie, F-94805, Villejuif, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085, Villejuif, France
| | - Jean-Pierre Pignon
- Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d'épidémiologie, F-94805, Villejuif, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085, Villejuif, France.,Ligue Nationale Contre le Cancer meta-analysis platform, Gustave Roussy, F-94085, Villejuif, France
| | - Stefan Michiels
- Gustave Roussy, Université Paris-Saclay, Service de biostatistique et d'épidémiologie, F-94805, Villejuif, France.,Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, F-94085, Villejuif, France.,Ligue Nationale Contre le Cancer meta-analysis platform, Gustave Roussy, F-94085, Villejuif, France
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Lueza B, Mauguen A, Pignon JP, Rivero-Arias O, Bonastre J. Difference in Restricted Mean Survival Time for Cost-Effectiveness Analysis Using Individual Patient Data Meta-Analysis: Evidence from a Case Study. PLoS One 2016; 11:e0150032. [PMID: 26960150 PMCID: PMC4784740 DOI: 10.1371/journal.pone.0150032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/08/2016] [Indexed: 12/25/2022] Open
Abstract
Objective In economic evaluation, a commonly used outcome measure for the treatment effect is the between-arm difference in restricted mean survival time (rmstD). This study illustrates how different survival analysis methods can be used to estimate the rmstD for economic evaluation using individual patient data (IPD) meta-analysis. Our aim was to study if/how the choice of a method impacts on cost-effectiveness results. Methods We used IPD from the Meta-Analysis of Radiotherapy in Lung Cancer concerning 2,000 patients with locally advanced non-small cell lung cancer, included in ten trials. We considered methods either used in the field of meta-analysis or in economic evaluation but never applied to assess the rmstD for economic evaluation using IPD meta-analysis. Methods were classified into two approaches. With the first approach, the rmstD is estimated directly as the area between the two pooled survival curves. With the second approach, the rmstD is based on the aggregation of the rmstDs estimated in each trial. Results The average incremental cost-effectiveness ratio (ICER) and acceptability curves were sensitive to the method used to estimate the rmstD. The estimated rmstDs ranged from 1.7 month to 2.5 months, and mean ICERs ranged from € 24,299 to € 34,934 per life-year gained depending on the chosen method. At a ceiling ratio of € 25,000 per life year-gained, the probability of the experimental treatment being cost-effective ranged from 31% to 68%. Conclusions This case study suggests that the method chosen to estimate the rmstD from IPD meta-analysis is likely to influence the results of cost-effectiveness analyses.
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Affiliation(s)
- Béranger Lueza
- Gustave Roussy, Service de biostatistique et d’épidémiologie, Villejuif, France
- CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Ligue Nationale Contre le Cancer meta-analysis plateform, Villejuif, France
- * E-mail:
| | - Audrey Mauguen
- Gustave Roussy, Service de biostatistique et d’épidémiologie, Villejuif, France
- Gustave Roussy, Ligue Nationale Contre le Cancer meta-analysis plateform, Villejuif, France
| | - Jean-Pierre Pignon
- Gustave Roussy, Service de biostatistique et d’épidémiologie, Villejuif, France
- CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Ligue Nationale Contre le Cancer meta-analysis plateform, Villejuif, France
| | - Oliver Rivero-Arias
- University of Oxford, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford, United Kingdom
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Julia Bonastre
- Gustave Roussy, Service de biostatistique et d’épidémiologie, Villejuif, France
- CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
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Facchinetti F, Kalai K, Lueza B, Lacroix L, Pignon J, Valent A, Adam J, Auger N, Besse B. 3130 Prognostic value of ALK gene copy number in advanced Non Small Cell Lung Cancer (NSCLC) patients. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lueza B, Le Péchoux C, Pignon JP. Phase III trial of concurrent thoracic radiotherapy with either first- or third-cycle chemotherapy for limited-disease small-cell lung cancer. Ann Oncol 2014; 25:1865-1866. [PMID: 24920790 DOI: 10.1093/annonc/mdu221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B Lueza
- Service Biostatistique et épidémiologie
| | - C Le Péchoux
- Département D'oncologie et de Radiothérapie, Gustave Roussy, Villejuif, France
| | - J-P Pignon
- Service Biostatistique et épidémiologie.
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Ramaekers BL, Joore MA, Lueza B, Bonastre J, Mauguen A, Pignon JP, Le Pechoux C, De Ruysscher DK, Grutters JP. Cost Effectiveness of Modified Fractionation Radiotherapy versus Conventional Radiotherapy for Unresected Non–Small-Cell Lung Cancer Patients. J Thorac Oncol 2013; 8:1295-307. [DOI: 10.1097/jto.0b013e31829f6c55] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Einert TR, Schmidt G, Binnig G, Balacescu O, Balacescu L, Rus M, Buiga R, Tudoran O, Todor N, Nagy V, Irimie A, Neagoe I, Yacobi R, Ustaev E, Berger RR, Barshack I, Kaur K, Henderson S, Cutts A, Domingo E, Woods J, Motley C, Dougherty B, Middleton M, Hassan B, Wang Y, Beasley E, Naley M, Schuh A, Tomlinson I, Taylor J, Planchard D, Lueza B, Rahal A, Lacroix L, Ngocamus M, Auger N, Saulnier P, Dorfmuller P, Le Chevalier T, Celebic A, Pignon JP, Soria JC, Besse B, Sun YH, Wang R, Li CG, Pan YJ, Chen HQ, Chouchane L, Shan J, Kizhakayil D, Aigha I, Dsouza S, Noureddine B, Gabbouj S, Mathew R, Hassen E, Chouchane L, Shan S, al-Rumaihi K, al-Bozom I, al-Said S, Rabah D, Farhat K, Kizhakayil D, Aigha I, Jakobsen Falk IA, Green KHZ, Lotfi K, Fyrberg A, Pejovic T, Li H, Mhawech-Fauceglia P, Hoatlin M, Guo MG, Huang M, Ge Y, Hess K, Wei C, Zhang W, Bogush TA, Dudko EA, Nureev MV, Kamensky AA, Polotsky BE, Tjulandin SA, Davydov MI, Caballero M, Hasmats J, Green H, Quanz M, Buhler C, Sun JS, Dutreix M, Cebotaru CL, Buiga R, Placintar AN, Ghilezan N, Balogh ZB, Reiniger L, Rajnai H, Csomor J, Szepesi A, Balogh A, Deak L, Gagyi E, Bodor C, Matolcsy A, Bozhenko VK, Rozhkova NI, Kudinova EA, Bliznyukov OP, Vaskevich EN, Trotsenko ID, Bozhenko VK, Rozhkova NI, Kharchenko NV, Kudinova EA, Bliznyukov OP, Kiandarian IV, Trotsenko ID, Pulito C, Terrenato I, Sacconi A, Biagioni F, Mottolese M, Blandino G, Muti P, Falvo E, Strano S, Mori F, Sacconi A, Ganci F, Covello R, Zoccali C, Biagini R, Blandino G, Strano S, Palmer GA, Wegdam W, Meijer D, Kramer G, Langridge J, Moerland PD, de Jong SM, Vissers JP, Kenter GG, Buist MR, Aerts JMFG, Milione M, de Braud F, Buzzoni R, Pusceddu S, Mazzaferro V, Damato A, Pelosi G, Garassino M, de Braud F, Broggini M, Marabese M, Veronese S, Ganzinelli M, Martelli O, Ganci F, Bossel N, Sacconi A, Fontemaggi G, Manciocco V, Sperduti I, Falvo E, Strigari L, Covello R, Muti P, Strano S, Spriano G, Domany E, Blandino G, Donzelli S, Sacconi A, Bellissimo T, Alessandrini G, Strano S, Carosi MA, Pescarmona E, Facciolo F, Telera S, Pompili A, Blandino G, de Vriendt V, de Roock W, di Narzo AF, Tian S, Biesmans B, Jacobs B, de Schutter J, Budzinska E, Sagaert X, Delorenzi M, Simon I, Tejpar S, Zhu Y, Wang HK, Ye DW, Denisov E, Tsyganov M, Tashireva L, Zavyalova M, Perelmuter V, Cherdyntseva N, Kim YC, Jang T, Oh IJ, Kim KS, Ban H, Na KJ, Ahn SJ, Kang H, Kim WJ, Park C, Abousamra NK, El-Din MS, Azmy EA. Diagnostics. Ann Oncol 2012. [DOI: 10.1093/annonc/mds161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Planchard D, Lueza B, Rahal A, Lacroix L, Ngocamus M, Auger N, Saulnier P, Dorfmuller P, Le Chevalier T, Celebic A, Pignon J, Soria J, Besse B. P1.05 Upfront Genomic Testing for Patients With Non-Small Cell Lung Cancer Receiving First-Line Platinum-Based Regimen: Preliminary Result of the Msn Study. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)31296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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