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Houda I, Dickhoff C, Uyl-de Groot CA, Reguart N, Provencio M, Levy A, Dziadziuszko R, Pompili C, Di Maio M, Thomas M, Brunelli A, Popat S, Senan S, Bahce I. New systemic treatment paradigms in resectable non-small cell lung cancer and variations in patient access across Europe. Lancet Reg Health Eur 2024; 38:100840. [PMID: 38476748 PMCID: PMC10928304 DOI: 10.1016/j.lanepe.2024.100840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 03/14/2024]
Abstract
The treatment landscape of resectable early-stage non-small cell lung cancer (NSCLC) is set to change significantly due to encouraging results from randomized trials evaluating neoadjuvant and adjuvant immunotherapy, as well as adjuvant targeted therapy. As of January 2024, marketing authorization has been granted for four new indications in Europe, and regulatory approvals for other study regimens are expected. Because cost-effectiveness and reimbursement criteria for novel treatments often differ between European countries, access to emerging developments may lead to inequalities due to variations in recommended and available lung cancer care throughout Europe. This Series paper (i) highlights the clinical studies reshaping the treatment landscape in resectable early-stage NSCLC, (ii) compares and contrasts approaches taken by the European Medicines Agency (EMA) for drug approval to that taken by the United States Food and Drug Administration (FDA), and (iii) evaluates the differences in access to emerging treatments from an availability perspective across European countries.
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Affiliation(s)
- Ilias Houda
- Department of Pulmonary Medicine, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
| | - Noemi Reguart
- Department of Medical Oncology, Hospital Clínic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Mariano Provencio
- Department of Medical Oncology, Hospital Universitario Puerta De Hierro, C. Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain
| | - Antonin Levy
- Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Université Paris Saclay, Gustave Roussy, 114 Rue Edouard Vaillant, 94805, Villejuif, France
| | - Rafal Dziadziuszko
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210, Gdańsk, Poland
| | - Cecilia Pompili
- Department of Thoracic Surgery, University and Hospital Trust – Ospedale Borgo Trento, P.Le A. Stefani, 1, 37126, Verona, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Medical Oncology 1U, AOU Città della Salute e della Scienza di Torino, 10126, Turin, Italy
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), NCT Heidelberg, a Partnership Between DKFZ and Heidelberg University Hospital, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Beckett Street, LS9 7TF, Leeds, United Kingdom
| | - Sanjay Popat
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
| | - Idris Bahce
- Department of Pulmonary Medicine, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV, Amsterdam, the Netherlands
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Houda I, Dickhoff C, Uyl-de Groot CA, Damhuis RA, Reguart N, Provencio M, Levy A, Dziadziuszko R, Pompili C, Di Maio M, Thomas M, Brunelli A, Popat S, Senan S, Bahce I. Challenges and controversies in resectable non-small cell lung cancer: a clinician's perspective. Lancet Reg Health Eur 2024; 38:100841. [PMID: 38476749 PMCID: PMC10928275 DOI: 10.1016/j.lanepe.2024.100841] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 03/14/2024]
Abstract
The treatment landscape of resectable early-stage non-small cell lung cancer (NSCLC) is transforming due to the approval of novel adjuvant and neoadjuvant systemic treatments. The European Medicines Agency (EMA) recently approved adjuvant osimertinib, adjuvant atezolizumab, adjuvant pembrolizumab, and neoadjuvant nivolumab combined with chemotherapy, and the approval of other agents or new indications may follow soon. Despite encouraging results, many unaddressed questions remain. Moreover, the transformed treatment paradigm in resectable NSCLC can pose major challenges to healthcare systems and magnify existing disparities in care as differences in reimbursement may vary across different European countries. This Viewpoint discusses the challenges and controversies in resectable early-stage NSCLC and how existing inequalities in access to these treatments could be addressed.
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Affiliation(s)
- Ilias Houda
- Department of Pulmonary Medicine, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV Amsterdam, the Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV Amsterdam, the Netherlands
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands
| | - Ronald A.M. Damhuis
- Department of Research, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands
| | - Noemi Reguart
- Department of Medical Oncology, Hospital Clínic de Barcelona, C. de Villarroel, 170, 08036 Barcelona, Spain
| | - Mariano Provencio
- Department of Medical Oncology, Hospital Universitario Puerta De Hierro, C. Joaquín Rodrigo, 1, Majadahonda, 28222 Madrid, Spain
| | - Antonin Levy
- Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Université Paris Saclay, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France
| | - Rafal Dziadziuszko
- Faculty of Medicine, Department of Oncology and Radiotherapy, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Cecilia Pompili
- Department of Thoracic Surgery, University and Hospital Trust – Ospedale Borgo Trento, P.Le A. Stefani, 1, 37126 Verona, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Medical Oncology 1U, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), NCT Heidelberg, A Partnership Between DKFZ and Heidelberg University Hospital, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St. James’s University Hospital, Beckett Street, LS9 7TF Leeds, UK
| | - Sanjay Popat
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, SW3 6JJ London, UK
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV Amsterdam, the Netherlands
| | - Idris Bahce
- Department of Pulmonary Medicine, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV Amsterdam, the Netherlands
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Bosch D, Kuppen MCP, Tascilar M, Smilde TJ, Mulders PFA, Uyl-de Groot CA, van Oort IM. Reliability and Efficiency of the CAPRI-3 Metastatic Prostate Cancer Registry Driven by Artificial Intelligence. Cancers (Basel) 2023; 15:3808. [PMID: 37568624 PMCID: PMC10417512 DOI: 10.3390/cancers15153808] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/19/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Manual data collection is still the gold standard for disease-specific patient registries. However, CAPRI-3 uses text mining (an artificial intelligence (AI) technology) for patient identification and data collection. The aim of this study is to demonstrate the reliability and efficiency of this AI-driven approach. METHODS CAPRI-3 is an observational retrospective multicenter cohort registry on metastatic prostate cancer. We tested the patient-identification algorithm and automated data extraction through manual validation of the same patients in two pilots in 2019 and 2022. RESULTS Pilot one identified 2030 patients and pilot two 9464 patients. The negative predictive value of the algorithm was maximized to prevent false exclusions and reached 94.8%. The completeness and accuracy of the automated data extraction were 92.3% or higher, except for date fields and inaccessible data (images/pdf) (10-88.9%). Additional manual quality control took over 3 h less time per patient than the original fully manual CAPRI registry (105 vs. 300 min). CONCLUSIONS The CAPRI-3 patient-identification algorithm is a sound replacement for excluding ineligible candidates. The AI-driven data extraction is largely accurate and complete, but manual quality control is needed for less reliable and inaccessible data. Overall, the AI-driven approach of the CAPRI-3 registry is reliable and timesaving.
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Affiliation(s)
- Dianne Bosch
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands (I.M.v.O.)
| | - Malou C. P. Kuppen
- Department of Radiotherapy, Maastro Clinic, 6229 ET Maastricht, The Netherlands
| | - Metin Tascilar
- Department of Medical Oncology, Isala Hospital, 8025 AB Zwolle, The Netherlands
| | - Tineke J. Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands;
| | - Peter F. A. Mulders
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands (I.M.v.O.)
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
| | - Inge M. van Oort
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands (I.M.v.O.)
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Xander NSH, Fiets WE, Uyl-de Groot CA. Cost-effectiveness and budget impact of pembrolizumab+axitinib versus sunitinib in patients with advanced clear-cell renal cell carcinoma in the Netherlands. Front Oncol 2023; 13:1205700. [PMID: 37448519 PMCID: PMC10336227 DOI: 10.3389/fonc.2023.1205700] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Background The phase 3 clinical trial KEYNOTE-426 suggested a higher efficacy regarding overall survival (OS) and progression-free survival (PFS) of pembrolizumab+axitinib compared to sunitinib as a first-line treatment for patients with advanced renal cell carcinoma. In this analysis, the potential cost-effectiveness of this combination treatment versus sunitinib for patients with advanced clear-cell renal cell carcinoma (accRCC) was examined from the societal perspective in the Netherlands. Methods For this analysis, a partitioned survival model was constructed. Clinical data were obtained from the published KEYNOTE-426 trial reports; data on costs and (dis-)utilities were derived from published literature. Costs outside of the healthcare sector included treatment-related travel, informal care and productivity loss. Next to a probabilistic scenario analysis, various scenario analyses were performed that aimed at survival extrapolation, different utility values, treatment duration and drug pricing, as well as restricting the cohort to patients with an intermediate or poor prognosis. Further, a budget impact analysis over three years was conducted, in which a sensitivity analysis concerning ranges in costs and the number of patients was applied. Moreover, a scenario concerning increasing market penetration of pembrolizumab+axitinib up to a market share of 80% in the third year was analyzed. Results The incremental cost-effectiveness ratio (ICER) of pembrolizumab+axitinib was estimated at €368,396/quality-adjusted life year (QALY) gained, with an incremental QALY gain of 0.55 over sunitinib. The probability of cost-effectiveness at a willingness-to-pay threshold of €80,000/QALY was estimated at 0%, a 50% probability was estimated at €340,000/QALY. Cost-effectiveness was not achieved in any of the applied scenarios. The budget impact over three years amounted to €417.3 million upon instantaneous and full replacement of sunitinib, and to €214.9 million with increasing market penetration. Conclusion Pembrolizumab+axitinib was not estimated to be cost-effective compared to sunitinib as a first-line treatment for patients with accRCC in the Netherlands from a societal perspective. In none of the analyzed scenarios, cost-effectiveness was achieved. However, price reductions and shorter treatment durations might lead to a more favorable ICER.
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Affiliation(s)
- Nicolas S. H. Xander
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - W. Edward Fiets
- Department of Medical Oncology, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Carin A. Uyl-de Groot
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, Netherlands
- Institute for Medical Technology Assessment, Rotterdam, Netherlands
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Zaim R, Redekop WK, Uyl-de Groot CA. Incorporating risk preferences of patients in the valuation of immune checkpoint inhibitors for non-small cell lung cancer. Front Oncol 2023; 13:1027659. [PMID: 36969040 PMCID: PMC10032401 DOI: 10.3389/fonc.2023.1027659] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/06/2023] [Indexed: 03/29/2023] Open
Abstract
Immunotherapy offers a distinctive mechanism of action compared to traditional treatments, arising from additional value dimensions that may not be captured in standard health technology assessments. Cancer patients may have the expectation that immunotherapy provides durable, long-term survival gains. Moreover, some patients may be willing to take a 'risk' to undergo immunotherapy to achieve better survival outcomes. We reviewed quantitative methods that explored patients' risk preferences in their non-small cell lung cancer (NSCLC) treatment choices, in PubMed (MEDLINE), from January 1, 2015, until July 1, 2022. The consideration of a value dimension ('hope') based on patients' risk-seeking preferences is specifically addressed for the valuation of immune checkpoint inhibitors in NSCLC. We reported that the quantitative methods that aim to measure patients' risk preferences or 'hope' empirically are emerging. Value assessments should not only comprise survival improvements for the mean or median patient but also consider methods that reflect durable, long-term overall survival gains for risk-seeking patients. However, the published evidence for incorporating 'hope' based on patients' stated preferences for uncertain treatment profiles is not strong, and future research could strengthen this evidence base. We encourage further research on the development and validation of quantification methods to incorporate 'hope' and risk preferences of patients treated with immunotherapy for NSCLC and beyond.
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Bremmers LGM, Hakkaart-van Roijen L, Gräler ES, Uyl-de Groot CA, Fabbricotti IN. How Do Shifts in Patients with Mental Health Problems' Formal and Informal Care Utilization Affect Informal Caregivers?: A COVID-19 Case Study. Int J Environ Res Public Health 2022; 19:16425. [PMID: 36554308 PMCID: PMC9778175 DOI: 10.3390/ijerph192416425] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: This study investigated how potential shifts in patients' formal and informal care utilization during the COVID-19 pandemic impacted their informal caregivers in terms of their subjective burden, psychological wellbeing, and happiness. (2) Methods: A retrospective cohort study design was employed for a panel of Dutch informal caregivers of persons with mental health problems (n = 219) in June 2020. Descriptive statistics and differences between means were determined for the patients' informal and care utilization and informal caregivers' subjective burden, happiness, and psychological wellbeing. Three mediation analyses were conducted using the PROCESS macro. (3) Results: Informal caregivers reported significantly worse happiness and subjective burden scores during the COVID-19 pandemic compared with before the lockdown. There were minimal shifts in patient's care utilization reported, with the exception of a decrease in significant emotional and practical support provided by the informal caregiver. In the mediation analyses, there was not a significant indirect effect of shifts in patients' formal care utilization on informal caregivers' subjective burden, psychological wellbeing, and happiness through shifts in patients' informal care utilization. (4) Discussion and conclusion: Whilst we found that shifts in patients' care utilization during the first wave of the pandemic did not affect the informal caregiver in the short term, it is unclear what the long-term impact of the pandemic might be on informal caregivers. More research should be conducted to understand the implications of short- and long-term impact of substitution on informal caregivers of persons with mental health problems, with special consideration of the COVID-19 context and uptake of e-health technology.
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Affiliation(s)
- Leonarda G. M. Bremmers
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Eleonora S. Gräler
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Isabelle N. Fabbricotti
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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Bremmers LGM, Fabbricotti IN, Gräler ES, Uyl-de Groot CA, Hakkaart-van Roijen L. Assessing the impact of caregiving on informal caregivers of adults with a mental disorder in OECD countries: A systematic literature review of concepts and their respective questionnaires. PLoS One 2022; 17:e0270278. [PMID: 35802584 PMCID: PMC9269485 DOI: 10.1371/journal.pone.0270278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/28/2021] [Accepted: 06/07/2022] [Indexed: 11/19/2022] Open
Abstract
We conducted a systematic literature review to identify and review the concepts and questionnaires used to assess the impact of caregiving on caregivers for adults with a mental disorder. With our study, we aimed to provide an overview and categorize the conceptualization and operationalization of the impact of caregiving, with special attention for the complexity and multi-conceptualization of concepts. Embase, Medline, PsycInfo, Web of Science Core Collection, Cochrane Central Register of Trials, Cinahl Plus, Econlit and Google Scholar were systematically searched for articles from 1 January 2004 to 31 December 2019. Eligible articles were peer-reviewed studies that assessed the impact of caregiving for informal caregivers of adults with a reported mental disorder by means of a questionnaire. The complete study protocol can be found on PROSPERO (CRD42020157300). A total of 144 questionnaires were identified that assessed the impact of caregiving. Based on similarities in meaning, concepts were classified into 15 concept clusters. The most frequently assessed concept clusters were mental health, caregiving burden, other caregiving consequences, family impact, and overall health-related outcomes. The use of concept clusters differed per diagnosis group, with diagnoses, such as schizophrenia, using a wide range of caregiving impact concepts and other diagnoses, such as personality disorders, only using a limited range of concepts. This is the first study that identified and reviewed the concepts and questionnaires that are used to assess the impact of caregiving. Caregiving is researched from a broad array of perspectives, with the identification of a variety of concepts and dimensions and use of non-specific questionnaires. Despite increasing interest in this field of research, a high degree of variability remains abundant with limited consensus. This can partially be accredited to differences in the naming of concepts. Ultimately, this review can serve as a reference to researchers who wish to assess the impact of caregiving and require further insight into concepts and their respective questionnaires.
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Affiliation(s)
- Leonarda G. M. Bremmers
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Isabelle N. Fabbricotti
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Eleonora S. Gräler
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Visser LA, Folcher M, Delgado Simao C, Gutierrez Arechederra B, Escudero E, Uyl-de Groot CA, Redekop WK. The Potential Cost-Effectiveness of a Cell-Based Bioelectronic Implantable Device Delivering Interferon-β1a Therapy Versus Injectable Interferon-β1a Treatment in Relapsing-Remitting Multiple Sclerosis. Pharmacoeconomics 2022; 40:91-108. [PMID: 34480325 PMCID: PMC8739553 DOI: 10.1007/s40273-021-01081-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 06/09/2023]
Abstract
BACKGROUND Current first-line disease-modifying therapies (DMT) for multiple sclerosis (MS) patients are injectable or oral treatments. The Optogenerapy consortium is developing a novel bioelectronic cell-based implant for controlled release of beta-interferon (IFNβ1a) protein into the body. The current study estimated the potential cost effectiveness of the Optogenerapy implant (hereafter: Optoferon) compared with injectable IFNβ1a (Avonex). METHODS A Markov model simulating the costs and effects of Optoferon compared with injectable 30 mg IFNβ1a over a 9-year time horizon from a Dutch societal perspective. Costs were reported in 2019 Euros and discounted at a 4% annual rate; health effects were discounted at a 1.5% annual rate. The cohort consisted of 35-year-old, relapsing-remitting MS patients with mild disability. The device is implanted in a daycare setting, and is replaced every 3 years. In the base-case analysis, we assumed equal input parameters for Optoferon and Avonex regarding disability progression, health effects, adverse event probabilities, and acquisition costs. We assumed reduced annual relapse rates and withdrawal rates for Optoferon compared with Avonex. Sensitivity, scenario, value of information, and headroom analysis were performed. RESULTS Optoferon was the dominant strategy with cost reductions (- €26,966) and health gains (0.45 quality-adjusted life-years gained). A main driver of cost differences are the acquisition costs of Optoferon being 2.5 times less than the costs of Avonex. The incremental cost-effectiveness ratio was most sensitive to variations in the annual acquisition costs of Avonex, the annual withdrawal rate of Avonex and Optoferon, and the disability progression of Avonex. CONCLUSION Innovative technology such as the Optoferon implant may be a cost-effective therapy for patients with MS. The novel implantable mode of therapeutic protein administration has the potential to become a new mode of treatment administration for MS patients and in other disease areas. However, trials are needed to establish safety and effectiveness.
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Affiliation(s)
- Laurenske A. Visser
- Erasmus School of Health Policy and Management, Department: Health Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marc Folcher
- Institute of Molecular and Clinical Opthalmology Basel, Basel, Switzerland
| | - Claudia Delgado Simao
- Functional Printing and Embedded Devices Unit, Eurecat, Centre Tecnològic de Catalunya, 08302 Mataró, Spain
| | | | - Encarna Escudero
- Plastic Materials Unit, Eurecat, Centre Tecnològic de Catalunya, Cerdanyola de Valles, Spain
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy and Management, Department of Health Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - William Ken Redekop
- Erasmus School of Health Policy and Management, Department: Health Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Bakker LJ, Goossens LM, O'Kane MJ, Uyl-de Groot CA, Redekop WK. Analysing electronic health records: The benefits of target trial emulation. Health Policy and Technology 2021. [DOI: 10.1016/j.hlpt.2021.100545] [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: 11/28/2022]
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10
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Clarijs ME, Thurell J, Kühn F, Uyl-de Groot CA, Hedayati E, Karsten MM, Jager A, Koppert LB. Measuring Quality of Life Using Patient-Reported Outcomes in Real-World Metastatic Breast Cancer Patients: The Need for a Standardized Approach. Cancers (Basel) 2021; 13:cancers13102308. [PMID: 34065805 PMCID: PMC8151772 DOI: 10.3390/cancers13102308] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/01/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Metastatic breast cancer (MBC) remains incurable despite treatment improvements. The health-related quality of life is a multidimensional entity which covers physical, psychological and social dimensions. It is an important outcome particularly in patients with metastatic disease, as the primary goal of therapy is no longer curation, but to provide the best possible quality of life weighted against treatment risks and adverse symptoms. Patient-reported outcomes reflecting the quality of life are usually measured with validated questionnaires to evaluate treatment strategies based on symptom burden and to improve care delivery. This review shares insights into the role of patient-reported outcome measurements in MBC patients and describes the heterogeneity of current questionnaires. We conclude that an up-to-date and standardized outcome set is needed, containing relevant domains referring to individual needs to improve the quality of life assessment among MBC patients. This is a prerequisite to learn about how they could impact the clinical care pathway. Abstract Metastatic breast cancer (MBC) patients are almost always treated to minimize the symptom burden, and to prolong life without a curative intent. Although the prognosis of MBC patients has improved in recent years, the median survival after diagnosis is still only 3 years. Therefore, the health-related quality of life (HRQoL) should play a leading role in making treatment decisions. Heterogeneity in questionnaires used to evaluate the HRQoL in MBC patients complicates the interpretability and comparability of patient-reported outcomes (PROs) globally. In this review, we aimed to provide an overview of PRO instruments used in real-world MBC patients and to discuss important issues in measuring HRQoL. Routinely collecting symptom information using PROs could enhance treatment evaluation and shared decision-making. Standardizing these measures might help to improve the implementation of PROs, and facilitates collecting and sharing data to establish valid comparisons in research. This is a prerequisite to learn about how they could impact the clinical care pathway. In addition, the prognostic value of intensified PRO collection throughout therapy on survival and disease progression is promising. Future perspectives in the field of PROs and MBC are described.
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Affiliation(s)
- Marloes E. Clarijs
- Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands;
| | - Jacob Thurell
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, 171 76 Stockholm, Sweden; (J.T.); (E.H.)
| | - Friedrich Kühn
- Department of Gynecology with Breast Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (F.K.); (M.M.K.)
| | - Carin A. Uyl-de Groot
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands;
| | - Elham Hedayati
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, 171 76 Stockholm, Sweden; (J.T.); (E.H.)
| | - Maria M. Karsten
- Department of Gynecology with Breast Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (F.K.); (M.M.K.)
| | - Agnes Jager
- Academic Breast Cancer Center, Department of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands;
| | - Linetta B. Koppert
- Academic Breast Cancer Center, Department of Surgical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands;
- Correspondence: ; Tel.: +31-107-041-161
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Visser LA, Louapre C, Uyl-de Groot CA, Redekop WK. Health-related quality of life of multiple sclerosis patients: a European multi-country study. Arch Public Health 2021; 79:39. [PMID: 33743785 PMCID: PMC7980344 DOI: 10.1186/s13690-021-00561-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inconsistent use of generic and disease-specific health-related quality of life (HRQOL) instruments in multiple sclerosis (MS) studies limits cross-country comparability. The objectives: 1) investigate real-world HRQOL of MS patients using both generic and disease-specific HRQOL instruments in the Netherlands, France, the United Kingdom, Spain, Germany and Italy; 2) compare HRQOL among these countries; 3) determine factors associated with HRQOL. METHODS A cross-sectional, observational online web-based survey amongst MS patients was conducted in June-October 2019. Patient demographics, clinical characteristics, and two HRQOL instruments: the generic EuroQOL (EQ-5D-5L) and disease-related Multiple Sclerosis Quality of Life (MSQOL)-54, an extension of the generic Short Form-36 (SF-36) was collected. Health utility scores were calculated using country-specific value sets. Mean differences in HRQOL were analysed and predictors of HRQOL were explored in regression analyses. RESULTS In total 182 patients were included (the Netherlands: n = 88; France: n = 58; the United Kingdom: n = 15; Spain: n = 10; living elsewhere: n = 11). Mean MSQOL-54 physical and mental composite scores (42.5, SD:17.2; 58.3, SD:21.5) were lower, whereas the SF-36 physical and mental composite scores (46.8, SD:22.6; 53.1, SD:22.5) were higher than reported in previous clinical trials. The mean EQ-5D utility was 0.65 (SD:0.26). Cross-country differences in HRQOL were found. A common predictor of HRQOL was disability status and primary progressive MS. CONCLUSIONS The effects of MS on HRQOL in real-world patients may be underestimated. Combined use of generic and disease-specific HRQOL instruments enhance the understanding of the health needs of MS patients. Consequent use of the same instruments in clinical trials and observational studies improves cross-country comparability of HRQOL.
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Affiliation(s)
- Laurenske A. Visser
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O.Box 1738/ 3000 DR, Rotterdam, The Netherlands
| | - Celine Louapre
- ICM Institut du cerveau et de la moelle epiniere, Sorbonne University, APHP, F-75013 Paris, France
- Department of Neurology, Sorbonne University, APHP, Paris, France
| | - Carin A. Uyl-de Groot
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O.Box 1738/ 3000 DR, Rotterdam, The Netherlands
- Bayle (J) Building, Burgemeester Oudlaan 50/ 3062, PA Rotterdam, The Netherlands
| | - William K. Redekop
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O.Box 1738/ 3000 DR, Rotterdam, The Netherlands
- Bayle (J) Building, Burgemeester Oudlaan 50/ 3062, PA Rotterdam, The Netherlands
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Blommestein HM, Franken MG, van Beurden-Tan CHY, Blijlevens NMA, Huijgens PC, Sonneveld P, Uyl-de Groot CA, Zweegman S. Cost-effectiveness of Novel Treatment Sequences for Transplant-Ineligible Patients With Multiple Myeloma. JAMA Netw Open 2021; 4:e213497. [PMID: 33779744 PMCID: PMC8008287 DOI: 10.1001/jamanetworkopen.2021.3497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although the number of treatments for elderly patients with non-transplant-eligible (NTE) multiple myeloma (MM) has increased substantially, evidence is lacking on the clinical effectiveness and cost-effectiveness of novel treatment sequences. OBJECTIVE To determine the optimal sequence of treatment for patients with NTE MM from the perspective of the patient, physician, and society. DESIGN, SETTING, AND PARTICIPANTS Using data from a Dutch observational registry, this economic evaluation combined evidence from network meta-analyses in a patient-level simulation model and modeled time-to-event and types of events from a hospital perspective with a lifetime horizon. Data analysis was performed from June 2019 to September 2020. INTERVENTIONS Thirty treatment sequences, including up to 3 lines of therapy, were compared with bortezomib-melphalan-prednisone (VMP)-lenalidomide-dexamethasone (LenDex)-pomalidomide-dexamethasone (PomDex). MAIN OUTCOMES AND MEASURES The primary outcomes of the model were overall survival (OS), quality-adjusted life-years (QALYs), costs, and cost-effectiveness. RESULTS Sequences starting with daratumumab-VMP (second line: carfilzomib-lenalidomide-dexamethasone or elotuzumab-lenalidomide-dexamethasone) or bortezomib-melphalan-prednisone-thalidomide-maintenance bortezomib-thalidomide (VMPT-VT) (second line: daratumumab-lenalidomide-dexamethasone) had the largest expected OS (7.5 years), which is 3.5 additional life-years compared with VMP-LenDex-PomDex. Total costs per patient for these sequences ranged between $786 024 and $1 085 794. The sequence VMPT-VT-carfilzomib-lenalidomide-dexamethasone-panobinostat-bortezomib-dexamethasone had the most favorable cost-effectiveness ratio ($98 585 per life-year gained and $132 707 per QALY gained vs VMP-LenDex-PomDex). CONCLUSIONS AND RELEVANCE These findings suggest that sequences including novel treatments were highly effective, but the cost-effectiveness ratios were above currently accepted willingness-to-pay thresholds. Treating MM with novel agents necessitates either a large increase in budget or a substantial reduction of drug costs by price negotiations, and these findings can support these reimbursement decisions and price negotiations.
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Affiliation(s)
- Hedwig M. Blommestein
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Margreet G. Franken
- Institute of Medical Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | | | | | - Peter C. Huijgens
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Pieter Sonneveld
- Department of Hematology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Institute of Medical Technology Assessment, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Sonja Zweegman
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Ansaripour A, Zendehdel K, Tadayon N, Sadeghi F, Uyl-de Groot CA, Redekop WK. Use of data-mining to support real-world cost analyses: An example using HER2-positive breast cancer in Iran. PLoS One 2018; 13:e0205079. [PMID: 30273393 PMCID: PMC6166984 DOI: 10.1371/journal.pone.0205079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/29/2016] [Accepted: 09/19/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patient registries play an important role in obtaining real-world evidence of the cost-effectiveness of treatments. However, their implementation is costly and sometimes infeasible in many middle-income countries (MICs). We explored the combination of data-mining and a large claims database to estimate the direct healthcare costs of HER2-positive breast cancer (BC) treatment in Iran and the fraction of total costs from trastuzumab use. METHOD We performed a retrospective analysis of claims data from the Iran Social Security Organization, a health insurer which covers approximately 50%(~40 million) of the Iranian population, in the period of 21/03/2011-20/03/2014. A data-mining algorithm using R software and validated using patient dossiers in the Cancer Research Center identified 1295 patients and divided them into the three main HER2-positive breast cancer stages (early, loco-regional and advanced). A payer perspective was used to calculate the absolute and relative direct costs of healthcare services associated with the treatment of HER2-positive breast cancer in the public and private healthcare systems. RESULTS The number of women totaled 802 (early), 125 (loco-regional) and 218 (advanced). The mean age[SD] was 45[10], 46[10] and 48[10] years, respectively, while mean follow-up in all stages was approximately one year. Average costs of direct healthcare care in early, loco-regional and advanced stages were €11,796 (95%CI: €9,356-€12,498), €8,253 (95%CI: €6,843-€10,002), and €17,742 (95%CI: €15,720-€19,505), respectively. Trastuzumab accounted for the largest share of total costs in all three stages (range: 53-76%). CONCLUSION Wherever comprehensive patient registries are infeasible or costly, real-world costs can be estimated through claims databases and data-mining strategies. Using this method, real-world costs have been estimated in Iran. The stage-specific cost estimates derived from this study can be used to perform real-world cost-effectiveness analyses of therapies for HER2-positive BC and support healthcare financing decisions.
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Affiliation(s)
- Amir Ansaripour
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Kazem Zendehdel
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Niki Tadayon
- Department of General and Vascular Surgery, Shohadaye Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sadeghi
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - W. Ken Redekop
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Westgeest HM, Uyl-de Groot CA, van Moorselaar RJ, de Wit R, van den Bergh AC, Coenen JL, Beerlage HP, Hendriks MP, Bos MM, van den Berg P, van de Wouw AJ, Spermon R, Boerma MO, Geenen MM, Tick LW, Polee MB, Bloemendal HJ, Cordia I, Peters FP, de Vos AI, van den Bosch J, van den Eertwegh AJ, Gerritsen WR. Differences in Trial and Real-world Populations in the Dutch Castration-resistant Prostate Cancer Registry. Eur Urol Focus 2018; 4:694-701. [DOI: 10.1016/j.euf.2016.09.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/11/2016] [Accepted: 09/28/2016] [Indexed: 11/29/2022]
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Uyl-de Groot CA, van Rooijen EM, Punt CJA, Pescott CP. Real-world cost-effectiveness of cetuximab in the third-line treatment of metastatic colorectal cancer based on patient chart review in the Netherlands. Health Econ Rev 2018; 8:13. [PMID: 30019286 PMCID: PMC6049844 DOI: 10.1186/s13561-018-0197-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 06/12/2018] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To assess the cost effectiveness of cetuximab in third-line treatment of patients with KRAS wild-type (wt) metastatic colorectal cancer (mCRC) in routine clinical practice compared with best supportive care (BSC). METHODS Patients (n = 287) with KRAS wt mCRC treated with cetuximab or BSC in eight hospitals in the Netherlands between 2009 and 2012 were included in our real-world study. Outcome measures were costs per life-year (LY) and costs per quality-adjusted LY (QALY) gained. A Markov model was developed, and a time horizon of four years was applied. Outcomes were calculated from Kaplan-Meier survival curves from patient-level data and literature. Direct medical costs were estimated in all centers (2013 values), and incremental cost-effectiveness ratios (ICERs) were calculated. Results were discounted, and a probabilistic sensitivity analysis was performed. RESULTS Administration of cetuximab in third-line treatment of mCRC resulted in a gain of 0.29 LYs and 0.25 QALYs compared with BSC. In the four-year study period, average discounted healthcare costs were €36,637 in the cetuximab group vs. €3648 in the BSC group. The discounted ICERs of cetuximab vs. BSC in the real-world setting were €114,907and €133,527 per LY and QALY gained, respectively. CONCLUSIONS Results of this cost-effectiveness analysis showed that third-line treatment with cetuximab for patients with KRAS (exon 2) wt mCRC offered clinical benefits at additional cost. The real-world ICERs were in line with those of previously published cetuximab and panitumumab cost-utility models.
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Affiliation(s)
- Carin A. Uyl-de Groot
- Erasmus School of Health Policy & Management/institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands
| | - Elisabeth M. van Rooijen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Cornelis J. A. Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Chris P. Pescott
- Global Evidence & Value Development, Merck KGaA, Darmstadt, Germany
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van Agthoven M, Fokkens WJ, Van de Merwe JP, Van Bolhuis EM, Uyl-de Groot CA, Busschbach JJ. Quality of Life of Patients with Refractory Chronic Rhinosinusitis: Effects of Filgrastim Treatment. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240101500403] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this double-blind placebo-controlled randomized clinical trial, we investigated the influence of filgrastim administration on the quality of life (QOL) of refractory chronic sinusitis patients who did not respond to regular treatments. QOL was considered to be an important outcome measurement because apart from classic sinusitis parameters, it measures the overall burden of the symptomatology of chronic sinusitis patients caused by general malaise, tiredness, and social impediments. The QOL of 56 patients was assessed five times during the 24-week trial with the EuroQol, the Short Form (SF)-36, and the McGill pain questionnaire (MPQ). The QOL scores were all well below population norm scores and scores in a group of patients with chronic sinusitis who had sinus surgery. QOL scores of the filgrastim group suggested a better QOL than the placebo group, although none of the differences were statistically significant. There were indications that it might be possible to determine a subpopulation in which the results are better. Although the QOL measurements were not able to show a significant treatment effect of filgrastim in this group of patients with refractory chronic sinusitis, these measurements are important in studying chronic sinusitis because they enable the comparison of the burden of illness of patients with chronic sinusitis with other patient groups.
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Affiliation(s)
- Michel van Agthoven
- Institute for Medical Technology Assessment, University Medical Centre, Utrecht, The Netherlands
| | - Wytske J. Fokkens
- Departments of Otorhinolaryngology, University Medical Centre, Utrecht, The Netherlands
| | - Joop P. Van de Merwe
- Immunology and Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Carin A. Uyl-de Groot
- Institute for Medical Technology Assessment, University Medical Centre, Utrecht, The Netherlands
| | - Jan J.V. Busschbach
- Institute for Medical Technology Assessment, University Medical Centre, Utrecht, The Netherlands
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van der Linden N, Bongers ML, Coupé VM, Smit EF, Groen HJ, Welling A, Schramel FM, Uyl-de Groot CA. Treatment Patterns and Differences in Survival of Non-Small Cell Lung Cancer Patients Between Academic and Non-Academic Hospitals in the Netherlands. Clin Lung Cancer 2017; 18:e341-e347. [DOI: 10.1016/j.cllc.2015.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 11/29/2022]
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van der Gronde T, Uyl-de Groot CA, Pieters T. Addressing the challenge of high-priced prescription drugs in the era of precision medicine: A systematic review of drug life cycles, therapeutic drug markets and regulatory frameworks. PLoS One 2017; 12:e0182613. [PMID: 28813502 PMCID: PMC5559086 DOI: 10.1371/journal.pone.0182613] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [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] [Indexed: 12/02/2022] Open
Abstract
CONTEXT Recent public outcry has highlighted the rising cost of prescription drugs worldwide, which in several disease areas outpaces other health care expenditures and results in a suboptimal global availability of essential medicines. METHOD A systematic review of Pubmed, the Financial Times, the New York Times, the Wall Street Journal and the Guardian was performed to identify articles related to the pricing of medicines. FINDINGS Changes in drug life cycles have dramatically affected patent medicine markets, which have long been considered a self-evident and self-sustainable source of income for highly profitable drug companies. Market failure in combination with high merger and acquisition activity in the sector have allowed price increases for even off-patent drugs. With market interventions and the introduction of QALY measures in health care, governments have tried to influence drug prices, but often encounter unintended consequences. Patent reform legislation, reference pricing, outcome-based pricing and incentivizing physicians and pharmacists to prescribe low-cost drugs are among the most promising short-term policy options. Due to the lack of systematic research on the effectiveness of policy measures, an increasing number of ad hoc decisions have been made with counterproductive effects on the availability of essential drugs. Future challenges demand new policies, for which recommendations are offered. CONCLUSION A fertile ground for high-priced drugs has been created by changes in drug life-cycle dynamics, the unintended effects of patent legislation, government policy measures and orphan drug programs. There is an urgent need for regulatory reform to curtail prices and safeguard equitable access to innovative medicines.
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Affiliation(s)
- Toon van der Gronde
- Department of Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Carin A. Uyl-de Groot
- Institute for Medical Technology Assessment, Department of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Toine Pieters
- Department of Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
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Blommestein HM, de Groot S, Aarts MJ, Vemer P, de Vries R, van Abeelen AF, Posthuma EW, Uyl-de Groot CA. Cost-effectiveness of obinutuzumab for chronic lymphocytic leukaemia in The Netherlands. Leuk Res 2016; 50:37-45. [DOI: 10.1016/j.leukres.2016.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/02/2016] [Accepted: 09/01/2016] [Indexed: 10/21/2022]
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Ansaripour A, Uyl-de Groot CA, Foroozanfar M, Rahimimoghadam S, Redekop WK. Which is more important for doctors in a middle-income country, a national guideline or the medical literature? An adherence survey of trastuzumab use for breast cancer in Iran. J Cancer Policy 2016. [DOI: 10.1016/j.jcpo.2016.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Blommestein HM, Franken MG, Uyl-de Groot CA. A practical guide for using registry data to inform decisions about the cost effectiveness of new cancer drugs: lessons learned from the PHAROS registry. Pharmacoeconomics 2015; 33:551-60. [PMID: 25644460 PMCID: PMC4445765 DOI: 10.1007/s40273-015-0260-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Decision makers increasingly request evidence on the real-world cost effectiveness of a new treatment. There is, however, a lack of practical guidance on how to conduct an economic evaluation based on registry data and how this evidence can be used in actual decision making. This paper explains the required steps on how to perform a sound economic evaluation using examples from an economic evaluation conducted with real-world data from the Dutch Population based HAematological Registry for Observational Studies. There are three main issues related to using registry data: confounding by indication, missing data, and insufficient numbers of (comparable) patients. If encountered, it is crucial to accurately deal with these issues to maximize the internal validity and generalizability of the outcomes and their value to decision makers. Multivariate regression modeling, propensity score matching, and data synthesis are well-established methods to deal with confounding. Multiple imputation methods should be used in cases where data are missing at random. Furthermore, it is important to base the incremental cost-effectiveness ratio of a new treatment compared with its alternative on comparable groups of (matched) patients, even if matching results in a small analytical population. Unmatched real-world data provide insights into the costs and effects of a treatment in a real-world setting. Decision makers should realize that real-world evidence provides extremely valuable and relevant policy information, but needs to be assessed differently compared with evidence derived from a randomized clinical trial.
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Affiliation(s)
- Hedwig M. Blommestein
- Department of Health Policy and Management, institute for Medical Technology Assessment, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Margreet G. Franken
- Department of Health Policy and Management, institute for Medical Technology Assessment, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Carin A. Uyl-de Groot
- Department of Health Policy and Management, institute for Medical Technology Assessment, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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Blommestein HM, Verelst SGR, de Groot S, Huijgens PC, Sonneveld P, Uyl-de Groot CA. A cost-effectiveness analysis of real-world treatment for elderly patients with multiple myeloma using a full disease model. Eur J Haematol 2015; 96:198-208. [DOI: 10.1111/ejh.12571] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Hedwig M. Blommestein
- Department of Health Policy & Management/institute for Medical Technology Assessment; Erasmus University; Rotterdam The Netherlands
- Comprehensive Cancer Organisation; Utrecht The Netherlands
| | | | - Saskia de Groot
- Department of Health Policy & Management/institute for Medical Technology Assessment; Erasmus University; Rotterdam The Netherlands
| | - Peter C. Huijgens
- Comprehensive Cancer Organisation; Utrecht The Netherlands
- VU Medical Center Amsterdam; Amsterdam The Netherlands
| | | | - Carin A. Uyl-de Groot
- Department of Health Policy & Management/institute for Medical Technology Assessment; Erasmus University; Rotterdam The Netherlands
- Comprehensive Cancer Organisation; Utrecht The Netherlands
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van der Linden N, Smit EF, Uyl-de Groot CA. Real-world costs of laboratory tests for non-small cell lung cancer. ACTA ACUST UNITED AC 2015; 53:e187-9. [DOI: 10.1515/cclm-2014-1262] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/10/2015] [Indexed: 11/15/2022]
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Franken MG, van Gils CW, Gaultney JG, Delwel GO, Goettsch W, Huijgens PC, Steenhoek A, Punt CJ, Koopman M, Redekop WK, Uyl-de Groot CA. Practical feasibility of outcomes research in oncology: Lessons learned in assessing drug use and cost-effectiveness in The Netherlands. Eur J Cancer 2013; 49:8-16. [DOI: 10.1016/j.ejca.2012.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 06/07/2012] [Accepted: 06/12/2012] [Indexed: 11/25/2022]
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Prick BW, Jansen AG, Steegers EA, Hop WC, Essink-Bot ML, Uyl-de Groot CA, Papatsonis DN, Akerboom BM, Metz GC, Bremer HA, van Loon AJ, Stigter RH, van der Post JA, van Alphen M, Porath M, Rijnders RJ, Spaanderman ME, Schippers DH, Bloemenkamp KW, Boers KE, Scheepers HC, Roumen FJ, Kwee A, Schuitemaker NW, Mol BWJ, van Rhenen DJ, Duvekot JJ. 64: RBC transfusion leads to an improvement of physical fatigue in women with acute postpartum anemia: the WOMB study (NCT00335023). Am J Obstet Gynecol 2012. [DOI: 10.1016/j.ajog.2011.10.090] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
Background Responses on condition-specific instruments can be mapped on the EQ-5D to estimate utility values for economic evaluation. Mapping functions differ in predictive quality, and not all condition-specific measures are suitable for estimating EQ-5D utilities. We mapped QLQ-C30, HAQ, and MSIS-29 on the EQ-5D and compared the quality of the mapping functions with statistical and clinical indicators. Methods We used 4 data sets that included both the EQ-5D and a condition-specific measure to develop ordinary least squares regression equations. For the QLQ-C30, we used a multiple myeloma data set and a non-Hodgkin lymphoma one. An early arthritis cohort was used for the HAQ, and a cohort of patients with relapsing remitting or secondary progressive multiple sclerosis was used for the MSIS-29. We assessed the predictive quality of the mapping functions with the root mean square error (RMSE) and mean absolute error (MAE) and the ability to discriminate among relevant clinical subgroups. Pearson correlations between the condition-specific measures and items of the EQ-5D were used to determine if there is a relationship between the quality of the mapping functions and the amount of correlated content between the used measures. Results The QLQ-C30 had the highest correlation with EQ-5D items. Average %RMSE was best for the QLQ-C30 with 10.9%, 12.2% for the HAQ, and 13.6% for the MSIS-29. The mappings predicted mean EQ-5D utilities without significant differences with observed utilities and discriminated between relevant clinical groups, except for the HAQ model. Conclusions The preferred mapping functions in this study seem suitable for estimating EQ-5D utilities for economic evaluation. However, this research shows that lower correlations between instruments lead to less predictive quality. Using additional validation tests besides reporting statistical measures of error improves the assessment of predictive quality.
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Affiliation(s)
- Matthijs M. Versteegh
- Erasmus University of Rotterdam, Rotterdam, the Netherlands (MMV, AL, CAU, EAS)
- University Medical Center Rotterdam, Rotterdam, the Netherlands (JJL)
- The Walton Centre, Liverpool, United Kingdom (MB)
| | - Annemieke Leunis
- Erasmus University of Rotterdam, Rotterdam, the Netherlands (MMV, AL, CAU, EAS)
- University Medical Center Rotterdam, Rotterdam, the Netherlands (JJL)
- The Walton Centre, Liverpool, United Kingdom (MB)
| | - Jolanda J. Luime
- Erasmus University of Rotterdam, Rotterdam, the Netherlands (MMV, AL, CAU, EAS)
- University Medical Center Rotterdam, Rotterdam, the Netherlands (JJL)
- The Walton Centre, Liverpool, United Kingdom (MB)
| | - Mike Boggild
- Erasmus University of Rotterdam, Rotterdam, the Netherlands (MMV, AL, CAU, EAS)
- University Medical Center Rotterdam, Rotterdam, the Netherlands (JJL)
- The Walton Centre, Liverpool, United Kingdom (MB)
| | - Carin A. Uyl-de Groot
- Erasmus University of Rotterdam, Rotterdam, the Netherlands (MMV, AL, CAU, EAS)
- University Medical Center Rotterdam, Rotterdam, the Netherlands (JJL)
- The Walton Centre, Liverpool, United Kingdom (MB)
| | - Elly A. Stolk
- Erasmus University of Rotterdam, Rotterdam, the Netherlands (MMV, AL, CAU, EAS)
- University Medical Center Rotterdam, Rotterdam, the Netherlands (JJL)
- The Walton Centre, Liverpool, United Kingdom (MB)
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Lamers LM, Stupp R, van den Bent MJ, Al MJ, Gorlia T, Wasserfallen JB, Mittmann N, Jin Seung S, Crott R, Uyl-de Groot CA. Cost-effectiveness of temozolomide for the treatment of newly diagnosed glioblastoma multiforme. Cancer 2008; 112:1337-44. [DOI: 10.1002/cncr.23297] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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van Tinteren H, Hoekstra OS, Uyl-de Groot CA, Boers M. Evaluating Positron Emission Tomography in Non-small cell Lung Cancer. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50029-8] [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: 11/24/2022] Open
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