1
|
Kelkar SS, Prabhu VS, Zhang J, Ogando YM, Roney K, Verma RP, Miles N, Marth C. Real-world prevalence of microsatellite instability testing and related status in women with advanced endometrial cancer in Europe. Arch Gynecol Obstet 2024:10.1007/s00404-024-07504-3. [PMID: 38634898 DOI: 10.1007/s00404-024-07504-3] [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: 12/01/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To assess the real-world prevalence of microsatellite instability (MSI)/mismatch repair (MMR) testing and related tumor status in recurrent/advanced endometrial cancer patients in Europe. METHODS Data were from two multi-center, retrospective patient chart review studies conducted in the United Kingdom, Germany, Italy, France and Spain: The Endometrial Cancer Health Outcomes-Europe-First-Line (ECHO-EU-1L) study and the ECHO-EU-Second-Line (ECHO-EU-2L) study. ECHO-EU-1L included recurrent/advanced endometrial cancer patients who received first-line systemic therapy between 1/JUN/2016 and 31/MAR/2020 after recurrent/advanced diagnosis. ECHO-EU-2L included patients with recurrent/advanced endometrial cancer who progressed between 1/JUN/2016 and 30/JUN/2019 following prior first-line systemic therapy. Data collected included patient demographics, MSI/MMR tumor testing and results, and clinical/treatment characteristics. RESULTS ECHO-EU-1L included 242 first-line patients and ECHO-EU-2L included 475 s-line patients. For all patients, median age at recurrent/advanced diagnosis was 69 years, roughly half had endometrioid carcinoma histology and over 75% had Stage IIIB-IV disease at initial diagnosis. The prevalence of MSI/MMR testing in the first-line and second-line cohorts was similar (36.4 and 34.9%, respectively). Among those tested, a majority had non-MSI-high/MMR proficient tumors (80.7 and 74.7% among first- and second-line patients, respectively). About 15% had MSI-high/MMR deficient tumors in both cohorts, and a few patients had discordant results (3.4 and 10.8% among first- and second-line patients, respectively). CONCLUSION Prior to the approvals of biomarker-directed therapies for recurrent/advanced endometrial cancer patients in Europe, there were low MSI/MMR testing rates for these patients of just over one-third. Given the availability of biomarker-directed therapies, increased MSI/MMR testing may help inform treatment decisions for recurrent/advanced endometrial cancer patients in Europe.
Collapse
Affiliation(s)
| | - Vimalanand S Prabhu
- Merck & Co., Inc., 126 East Lincoln Ave, P.O. Box 2000, Rahway, NJ, 07065, USA.
| | | | | | | | | | | | - Christian Marth
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
2
|
Zhang J, Kelkar SS, Prabhu VS, Qiao Y, Grall V, Miles N, Marth C. Real-world treatment patterns and clinical outcomes from a retrospective chart review study of patients with recurrent or advanced endometrial cancer who progressed following prior systemic therapy in Europe. BMJ Open 2024; 14:e079447. [PMID: 38569701 PMCID: PMC10989146 DOI: 10.1136/bmjopen-2023-079447] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To evaluate real-world treatment patterns and clinical outcomes in recurrent/advanced endometrial cancer patients who progressed following prior systemic therapy in clinical practice in Europe. DESIGN Endometrial Cancer Health Outcomes-Europe (ECHO-EU) is a retrospective patient chart review study. SETTING ECHO-EU is a multicentre study conducted in the UK, Germany, Italy, France and Spain. PARTICIPANTS Patients with recurrent/advanced endometrial cancer who progressed between 1 July 2016 and 30 June 2019 following prior first-line systemic therapy were eligible and data were collected until last available follow-up through November 2021. PRIMARY AND SECONDARY OUTCOME MEASURES Data collected included patient demographics, clinical and treatment characteristics, and clinical outcomes. Kaplan-Meier analyses were performed since initiation of second-line therapy to estimate time to treatment discontinuation, real-world progression-free survival (rwPFS) and overall survival (OS). RESULTS A total of 475 patients were included from EU5 countries. Median age was 69 years at advanced endometrial cancer diagnosis, 78.7% had stage IIIB-IV disease, 45.9% had Eastern Cooperative Oncology Group status ≥2 at second-line therapy initiation. In second line, a majority of patients initiated either non-platinum-based chemotherapy (55.6%) or endocrine therapy (16.2%). Physician-reported real-world overall response rate (classified as complete or partial response) to second-line therapy was 34.5%, median rwPFS was 7.4 months (95% CI 6.2 to 8.0) and median OS was 11.0 months (95% CI 9.9 to 12.3). CONCLUSIONS Patients had poor clinical outcomes with a median OS of <1 year and rwPFS of approximately 7 months, highlighting the significant unmet medical need in pretreated recurrent/advanced endometrial cancer patients. Novel therapies with potential to improve PFS and OS over conventional therapies could provide significant clinical benefit.
Collapse
Affiliation(s)
| | | | | | - Yao Qiao
- OPEN Health, Bethesda, Maryland, USA
| | | | | | - Christian Marth
- Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
3
|
Wada K, Zhang J, Lee I, Wang Y, Near A, Prabhu VS. Real-world utilization of lenvatinib and pembrolizumab combination therapy for the treatment of endometrial cancer in the USA. Future Oncol 2024; 20:257-267. [PMID: 37828843 DOI: 10.2217/fon-2023-0058] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Aim: Describe treatment and dosing patterns of lenvatinib and pembrolizumab combination therapy (lenva+pembro) among endometrial cancer (EC) patients in US clinical practice. Materials & methods: Retrospective cohort study among adults with EC initiating lenva+pembro in second line (2L) or third line and later (≥3L) between 17 September 2019 and 30 June 2021. Results: 110 patients initiated lenva+pembro in 2L and 135 patients in ≥3L. Majority of patients initiated lenva+pembro at label-recommended starting doses/interval. Less than half changed lenvatinib dose over time. At median follow-up of 7.3 and 8.7 months, median (95% CI) duration of therapy was 5.1 (4.7-6.1) and 5.8 (4.2-7.3) months for patients in 2L and ≥3L, respectively. Conclusion: Lenva+pembro was mostly initiated at label-recommended dose.
Collapse
Affiliation(s)
- Keiko Wada
- Real World Solutions, IQVIA Inc., Durham, NC 27703, USA
| | - Jingchuan Zhang
- Worldwide Real World Evidence (WW RWE), Eisai Inc., Nutley, NJ 07110, USA
| | - Inyoung Lee
- Real World Solutions, IQVIA Inc., Durham, NC 27703, USA
| | - Yi Wang
- Real World Solutions, IQVIA Inc., Durham, NC 27703, USA
| | - Aimee Near
- Real World Solutions, IQVIA Inc., Durham, NC 27703, USA
| | - Vimalanand S Prabhu
- Center for Observational and Real World Evidence(CORE), MRL, Merck & Co., Inc., Rahway, NJ 07065, USA
| |
Collapse
|
4
|
Lorusso D, Colombo N, Herraez AC, Santin AD, Colomba E, Miller DS, Fujiwara K, Pignata S, Baron-Hay SE, Ray-Coquard IL, Shapira-Frommer R, Kim YM, McCormack M, Massaad R, Nguyen AM, Zhao Q, McKenzie J, Prabhu VS, Makker V. Health-Related Quality of Life in Patients With Advanced Endometrial Cancer Treated With Lenvatinib Plus Pembrolizumab or Treatment of Physician's Choice. Eur J Cancer 2023; 186:172-184. [PMID: 37086595 PMCID: PMC11003310 DOI: 10.1016/j.ejca.2023.03.015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE Lenvatinib and pembrolizumab (LEN+PEMBRO) demonstrated clinically meaningful and statistically significant improvements in efficacy versus treatment of physician's choice (TPC) in patients with advanced endometrial cancer (aEC) in the phase 3 Study 309/KEYNOTE-775. Health-related quality-of-life (HRQoL) is reported. PATIENTS AND METHODS Patients were randomly assigned to receive LEN+PEMBRO (n = 411; LEN 20 mg/day; PEMBRO 200 mg Q3W) or TPC (n = 416; doxorubicin 60 mg/m2 Q3W or paclitaxel 80 mg/m2 [weekly, 3 weeks on/1 week off]). Impact of treatment on HRQoL assessed by the global health status/quality of life (GHS/QoL) score of the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30) was a secondary objective; other scales of the Quality-of-Life Questionnaire (QLQ-C30), EORTC QLQ-Endometrial, 24 questions (EORTC QLQ-EN24), and EuroQoL 5 dimensions, 5 levels (EQ-5D-5L) were exploratory objectives. HRQoL was assessed on day 1 of each cycle. Completion/compliance, change from baseline, time to first and definitive deterioration were assessed. No multiplicity adjustments were applied for HRQoL endpoints. RESULTS The latest timepoint at which the predefined rates of completion (≥60%) and compliance (≥80%) were met was week 12. HRQoL at week 12 between treatment groups was generally similar. Time to first deterioration symptom scales favoured LEN+PEMBRO for QLQ-C30 dyspnoea, and QLQ-EN24 for poor body image, tingling/numbness, and hair loss; and TPC was favoured for QLQ-C30 pain, appetite loss, and diarrhoea, and QLQ-EN24 muscular pain. While the QLQ-C30 physical functional scale favoured TPC, other functional scales were generally similar between arms. Time to definitive deterioration favoured LEN+PEMBRO on most scales. CONCLUSION HRQoL data from Study 309/KEYNOTE-775, with previously published efficacy and safety results, indicate that LEN+PEMBRO has an overall favourable benefit/risk profile versus TPC for the treatment of patients with aEC. CLINICALTRIALS GOV: NCT03517449.
Collapse
Affiliation(s)
- Domenica Lorusso
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, and Catholic University of Sacred Heart, Rome, Italy.
| | - Nicoletta Colombo
- University of Milan-Bicocca, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Emeline Colomba
- Gustave Roussy Cancerology Institute, Villejuif, GINECO Group, France
| | | | - Keiichi Fujiwara
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Sandro Pignata
- Istituto Nazionale Tumori IRCCS-Fondazione G. Pascale, Naples, Italy
| | | | | | | | - Yong Man Kim
- Asan Medical Center, University of Ulsan, Seoul, Korea, Republic of South Korea
| | - Mary McCormack
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | - Vicky Makker
- Weill Cornell Medical Center, New York, NY, USA; Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
5
|
Kelkar SS, Prabhu VS, Corman S, Odak S, Rusibamayila N, Macahilig C, Orlowski R, Duska L. Treatment patterns and real-world clinical outcomes in patients with advanced endometrial cancer who are microsatellite instability (MSI)-high or are mismatch repair deficient (dMMR) in the United States. Gynecol Oncol 2023; 169:154-163. [PMID: 36344294 DOI: 10.1016/j.ygyno.2022.10.016] [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: 06/10/2022] [Revised: 09/21/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Microsatellite instability-high (MSI-H) and deficient DNA mismatch repair (dMMR) status have emerged as actionable biomarkers for advanced endometrial cancer (aEC). The objective of this study was to assess clinical outcomes and treatment patterns among MSI-H/dMMR aEC patients who had disease progression following prior systemic therapy (FPST) in the US. METHODS Endometrial Cancer Health Outcomes (ECHO) was a retrospective, medical chart review study of patients with MSI-H/dMMR aEC who had disease progression between 07/01/2016 and 12/31/2018 FPST and were not candidates for curative surgery. Data on patient demographics, clinical and treatment characteristics, and clinical outcomes were collected. Kaplan-Meier analyses were performed to estimate real-world progression-free survival (rwPFS) and overall survival (OS), stratified by drug class. RESULTS A total of 124 eligible patients who initiated second-line chemotherapy ± bevacizumab or immunotherapy were included. Mean age was 61.4 years at aEC diagnosis and 86.3% of patients were stage IIIB-IV. Median rwPFS and OS were 4.0 months (95% CI: 2.0-9.0) and 7.0 months (95% CI: 5.0-18.0), respectively, among 21 patients who received chemotherapy ± bevacizumab, and 29.0 months (95% CI: 18.0-NE) and not reached (95% CI: 30.0-NA), respectively, among 103 patients who received immunotherapy. Most patients (n = 92) received pembrolizumab; among these patients, rwPFS and OS were 29.0 months (95% CI: 18.0-NE) and 30 months (95% CI: 30.0-NA), respectively. CONCLUSIONS Real-world evidence suggests that pembrolizumab monotherapy provides considerable clinical benefits and has become the standard of care for MSI-H/dMMR aEC patients FPST who are not candidates for curative surgery in real-world settings.
Collapse
Affiliation(s)
| | | | | | - Shardul Odak
- RTI-Health Solutions, Research Triangle Park, NC, USA
| | | | | | | | - Linda Duska
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA, USA
| |
Collapse
|
6
|
Knisely A, Huang Y, Li Y, Prabhu VS, Wright JD. Corrigendum to ‘Adjuvant and first line chemotherapy use for endometrial cancer’. Gynecol Oncol Rep 2022; 46:101112. [PMID: 37082519 PMCID: PMC10111931 DOI: 10.1016/j.gore.2022.101112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
[This corrects the article DOI: 10.1016/j.gore.2022.101002.].
Collapse
|
7
|
Kelkar SS, Prabhu VS, Zhang J, Corman S, Macahilig C, Rusibamayila N, Odak S, Duska LR. Treatment patterns and real-world clinical outcomes in patients with advanced endometrial cancer that are non-microsatellite instability high (non-MSI-high) or mismatch repair proficient (pMMR) in the United States. Gynecol Oncol Rep 2022; 42:101026. [PMID: 35800987 PMCID: PMC9253581 DOI: 10.1016/j.gore.2022.101026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/11/2022] [Indexed: 11/29/2022] Open
Abstract
First study to describe real-world outcomes in non-MSI-H/pMMR aEC patients who progressed following prior systemic therapy. MSI/MMR testing was near universal in aEC patients in the US, reflecting the increased awareness of biomarker status. Patients on second-line chemo or hormonal therapy had poor clinical outcomes: median OS of 10 months and rwPFS of 5 months. Data suggest an unmet medical need in this population between 2016 and 2019.
Objective Microsatellite instability (MSI) due to defective DNA mismatch repair has emerged as an actionable biomarker in advanced endometrial cancer (aEC). Currently, there are no treatment patterns and outcomes data in non-MSI-high (non-MSI-H) or mismatch repair proficient (pMMR) aEC patients following prior systemic therapy (FPST). Our goal was to describe real-world data in this population in the US in 2019 and prior years. Methods Endometrial Cancer Health Outcomes (ECHO) is a retrospective patient chart review study conducted in the US. Patients with non-MSI-H/pMMR aEC and progression between 06/01/2016–06/30/2019 FPST were eligible. Data collected included patient demographics, clinical and treatment characteristics, and clinical outcomes. Kaplan-Meier analyses were performed to estimate time to treatment discontinuation, real-world progression-free survival (rwPFS), and overall survival (OS), separately by treatment category. Results A total of 165 eligible patients initiated second-line therapy with chemotherapy ± bevacizumab (n = 140) or hormonal therapy (n = 25). Median age was 66.0 years at aEC diagnosis, 70.2% were Stage IIIB-IV, 40.0% had ECOG ≥ 2 at second-line therapy initiation. Median rwPFS was 5.0 months (95% CI: 4.0–6.0) for patients receiving chemotherapy ± bevacizumab and 5.5 months (95% CI: 3.0–29.0) for those receiving hormonal therapy. Median OS was 10.0 months (95% CI: 8.0–13.0) and 9.0 months (95% CI: 6.0-NA) in these groups, respectively. Conclusions Non-MSI-H/pMMR patients who initiated second-line therapy with chemotherapy ± bevacizumab or hormonal therapy had poor clinical outcomes with a median survival less than 1 year and rwPFS less than 6 months. This was the first study to define the clinical unmet need in patients with non-MSI-H/pMMR aEC with conventional therapy.
Collapse
Affiliation(s)
| | - Vimalanand S. Prabhu
- Merck & Co., Inc., Rahway, NJ, USA
- Corresponding author at: East Lincoln Ave., Rahway, NJ 07065, USA.
| | | | | | | | | | | | - Linda R. Duska
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA
| |
Collapse
|
8
|
Cherston C, Yoh K, Huang Y, Melamed A, Gamble CR, Prabhu VS, Li Y, Hershman DL, Wright JD. Relative importance of individual insurance status and hospital payer mix on survival for women with cervical cancer. Gynecol Oncol 2022; 166:552-560. [PMID: 35787803 DOI: 10.1016/j.ygyno.2022.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/27/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the relative contributions of individual insurance status and hospital payer mix (safety net status) to quality of care and survival for patients with cervical cancer. METHODS We used the National Cancer Database to identify patients with cervical cancer diagnosed from 2004 to 2017. Patients were classified by insurance (uninsured/Medicaid/private/Medicare/other) and hospitals were grouped into quartiles based on the proportion of uninsured/Medicaid patients (payer mix) (top quartile defined as safety-net hospital (SNHs) and lowest as Q1 hospitals). Quality-of-care was assessed by adherence to evidence-based metrics. Individual contributions of insurance status and payer mix to survival was assessed with a proportional hazards Cox model. RESULTS A total of 124,339 patients including 11,338 uninsured (9.1%) and 27,281 Medicaid (21.9%) recipients treated at 1156 hospitals were identified. Quality-of-care was not significantly different across hospital quartiles. Adjusting for patients' clinical/demographic characteristics, treatment at a SNH was associated with a 14% higher mortality (HR = 1.14; 95% CL, 1.08-1.20) than at Q1 hospitals. Testing for individual insurance, uninsured patients had 32% increased mortality (HR = 1.32; 95% CI,1.26-1.38) and Medicaid recipients 40% increased (HR = 1.40; 95%CI,1.35-1.44) compared to privately insured patients. Examining both payer mix and insurance, only individual insurance retained a significant impact on mortality. CONCLUSIONS Individual insurance may be a more important predictor of survival than site-of-care and hospital payer mix for women with cervical cancer. There is substantial variation in outcomes within hospitals based on individual insurance, regardless of hospital payer mix.
Collapse
Affiliation(s)
- Caroline Cherston
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Katherine Yoh
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Yongmei Huang
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Alexander Melamed
- Columbia University, College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Charlotte R Gamble
- Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | | | - Yeran Li
- Merck & Co., Inc., Kenilworth, NJ, USA
| | - Dawn L Hershman
- Columbia University, College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA
| | - Jason D Wright
- Columbia University, College of Physicians and Surgeons, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, USA; New York Presbyterian Hospital, USA.
| |
Collapse
|
9
|
Prabhu VS, Kelkar SS, Zhang J, Qiao Y, Verma RP, Schmier J, Miles N, King J, Marth C. Treatment patterns and outcomes among patients with recurrent or advanced endometrial cancer in Europe: Endometrial Cancer Health Outcomes Europe (ECHO EU) Study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e17627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17627 Background: Until recently, recurrent or advanced endometrial cancer (aEC) patients in Europe had limited treatment options, with no consensus on standard of care in such settings. Approval of novel targeted therapies in 2021 are changing the treatment landscape. However, there is little real-world evidence among aEC patients in Europe. The objective of our study was to evaluate real-world treatment patterns and clinical outcomes in aEC patients who progressed following prior systemic therapy (FPST) in clinical practice in Europe. Methods: The ECHO-EU is a multicenter, retrospective chart review study in United Kingdom (UK), Germany (GE), Italy (IT) and Spain (SP). Adult women diagnosed with aEC who received at least one prior systemic therapy and progressed between July 1, 2016 – June 30, 2019, were included. De-identified patient data extracted by treating oncologists from patients’ medical records included patient demographics, clinical and treatment characteristics, and clinical outcomes. Kaplan-Meier analyses were performed to estimate real-world overall survival (OS). Results: A total of 379 (UK=101, GE=88, IT=100, SP=90) eligible aEC patients were included in the analysis. At aEC diagnosis, patients’ median age was 69 years, 97% were White/Caucasian and most prevalent histology was endometrioid carcinoma (58%). Molecular characterization of tumors including microsatellite instability/mismatch repair (MSI/MMR) status was performed in only 37% of patients. Metastases were observed in 56% of the patients at diagnosis. Median duration of follow up from aEC diagnosis was 24 months. The majority (95%) of patients initiated 1st line with chemotherapy (most commonly with platinum chemotherapy and paclitaxel). As 2nd line therapy, 81% received mono or combination chemotherapy, and 19% received hormonal therapy. Doxorubicin was the most frequently used agent (45%) in 2nd line, and 16% of patients were re-treated with platinum therapy. At last follow-up, the majority (90%) of patients discontinued 2nd line treatment, mostly due to disease progression (54%). Median duration of 2nd line therapy was 5 months (95% Confidence Interval [CI]: 4-5). Median OS from initiation of 2nd line therapy was 11 months (95% CI: 10-13). Estimated probability of OS from initiation of 2nd line therapy at 6, 12, and 24 months were 70%, 45%, and 30%, respectively. Conclusions: Our study finds thatin Europe prior to mid-2019, available treatment options were sub-optimal for aEC patients FPST, leading to poor prognosis. The utilization of MSI/MMR testing for molecular characterization of tumors was low and needs to increase. There was a significant unmet need for novel therapies that improve clinical outcomes in this patient population. Future studies evaluating treatment patterns and clinical outcomes with more recently approved treatments are warranted.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Christian Marth
- AGO-Austria and Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
10
|
Knisely A, Huang Y, Li Y, Prabhu VS, Wright JD. Adjuvant and First Line Chemotherapy Use for Endometrial Cancer. Gynecol Oncol Rep 2022; 41:101002. [PMID: 35620299 PMCID: PMC9126968 DOI: 10.1016/j.gore.2022.101002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Among subjects who underwent hysterectomy for endometrial cancer, 19% received adjuvant chemotherapy. Platinum and taxane based chemotherapy is the most commonly used adjuvant chemotherapy. Platinum and taxane combination therapy was used in 48% of patients at first recurrence.
Objective The objective of this study was to describe patterns of utilization of cytotoxic, hormonal, and immunotherapy in patients with endometrial cancer in the adjuvant setting and at the time of first recurrence. Methods We identified patients in the IBM MarketScan database with endometrial cancer who underwent hysterectomy from 2011 to 2019. The use of clinically relevant therapeutic agents and combination regimens was determined in the adjuvant setting and at the time of first recurrence. Results A total of 22,632 patients were identified. Of these, 7,147 patients (31.6%) received adjuvant radiation and 4,381 (19.4%) received adjuvant chemotherapy following surgery. Of those who received adjuvant chemotherapy, the most commonly utilized agents were carboplatin (90.3%), paclitaxel (85.8%), cisplatin (9.4%), docetaxel (9.3%), gemcitabine (3.8%), and doxorubicin (2.0%), while bevacizumab was utilized in 1.5% of patients. A combination of platinum and a taxane were utilized as adjuvant therapy in 88.8% of women. Of the cohort, 1,825 patients (8.1%) recurred, of whom 1,017 patients had already received adjuvant chemotherapy. The median time from hysterectomy to initiation of chemotherapy for recurrence was 13.3 months (IQR: 7.6–23.1 months). Overall, platinum and taxane combination therapy was used in 788 (46.8%) of patients with recurrent disease, platinum alone or with other drugs in 194 (11.5%), taxanes alone or with other drugs in 145 (8.6%), and non-platinum and non-taxane based therapy in 31.3%. Conclusions Among patients with endometrial cancer who underwent hysterectomy, platinum-taxane combination chemotherapy was used in almost 90% of patients who received adjuvant chemotherapy while nearly 70% of patients who recurred were treated with platinum or taxane based therapy at first recurrence.
Collapse
|
11
|
Stephan AJ, Reuschenbach M, Saxena K, Prabhu VS, Jacob C, Schneider KM, Greiner W, Wölle R, Hampl M. Healthcare Costs and Resource Use Associated With Cervical Intraepithelial Neoplasia and Cervical Conization: A Retrospective Study of German Statutory Health Insurance Claims Data. J Health Econ Outcomes Res 2022; 9:128-139. [PMID: 36755814 PMCID: PMC9135472 DOI: 10.36469/001c.35329] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/19/2022] [Indexed: 05/14/2023]
Abstract
Background: Cervical intraepithelial neoplasia (CIN) can be a consequence of human papillomavirus (HPV) infection. High-grade CIN (CIN2/CIN3) may develop from persistent HPV infection and progress to cervical cancer if left untreated. Management of CIN includes conservative surveillance or ablation and excision by conization. Internationally, CIN and its treatment generate a considerable economic burden, but no current data regarding costs and resource use from the perspective of the German statutory health insurance exist. Objectives: The aim of this study was to explore the health economic burden in women with CIN diagnoses who either underwent cervical conization or were managed conservatively. Methods: We conducted a retrospective claims data analysis using the InGef Research Database from 2013 to 2018. Healthcare costs and resource utilization in a 24-month observation period (1:1:1 matching) were compared in 18- to 45-year-old women with CIN (1-3) who underwent a conization procedure (study cohort 1) and in women with CIN (1-3) who did not undergo conization (study cohort 2) to women with neither CIN nor conization (control group). Results: For each group, 2749 women were identified. Mean total healthcare costs after 24 months were higher in study cohort 1 (€4446, P<.01) and study cohort 2 (€3754, P=.09) compared with the control group (€3426). Comparing study cohort 1 and 2 to controls, mean differences were highest in age groups 41-45 years (cohort 1: €5115 vs €3354, P<.01; cohort 2: €4152 vs €3354, P=.14). Significantly more women were hospitalized at least once in study cohort 1 (57.46%, P<.01) and study cohort 2 (38.74%, P<.01) compared with the control group (31.14%). Frequency of outpatient physician visits was significantly higher in both study cohorts (43.23 visits, P<.01 and 38.60 visits, P<.01) compared with the control group (32.07 visits). Conclusion: Our results revealed 30% and 10% increased total healthcare costs in women with CIN undergoing invasive treatment (study cohort 1) and conservative management (study cohort 2), respectively, compared with a control group of women with no CIN in a 2-year follow-up period.
Collapse
Affiliation(s)
| | | | - Kunal Saxena
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc
| | | | | | | | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University
| | - Regine Wölle
- Department of Market Access, MSD Sharp & Dohme GmbH
| | - Monika Hampl
- Department of Gynecology, University of Duesseldorf
| |
Collapse
|
12
|
Prabhu VS, Roberts CS, Kothari S, Niccolai L. Median Age at HPV Infection Among Women in the United States: A Model-Based Analysis Informed by Real-world Data. Open Forum Infect Dis 2021; 8:ofab111. [PMID: 34888404 PMCID: PMC8653628 DOI: 10.1093/ofid/ofab111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/18/2020] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background The US Advisory Committee for Immunization Practices (ACIP) recommended
shared clinical decision-making for human papillomavirus (HPV) vaccination
of individuals aged 27 to 45 years (mid-adults) in June 2019. Determining
the median age at causal HPV infection and CIN2+ diagnosis based on the
natural history of HPV disease can help elucidate the incidence of HPV
infections and the potential benefits of vaccination in mid-adults. Methods Real-world data on CIN2+ diagnosis from the prevaccine era were sourced
from a statewide surveillance registry in Connecticut. Age distribution of
CIN2+ diagnosis in 2008 and 2009 was estimated. A discrete event
simulation model was developed to predict the age distribution of causal HPV
infection. The optimal age distribution of causal HPV infection provided the
best goodness-of-fit statistic to compare the predicted vs real-world age
distribution of CIN2+ diagnosis. Results The median age at CIN2+ diagnosis from 2008 through 2009 in Connecticut
was 28 years. The predicted median age at causal HPV infection was estimated
to be 23.9 years. There was a difference of 5.2 years in the median age at
acquisition of causal HPV infection and the median age at CIN2+
diagnosis. Conclusions Real-world data on CIN2+ diagnosis and model-based analysis indicate a
substantial burden of infection and disease among women aged 27 years or
older, which supports the ACIP recommendation to vaccinate some mid-adults.
When natural history is known, this novel approach can also help determine
the timing of causal infections for other commonly asymptomatic infectious
diseases.
Collapse
Affiliation(s)
| | | | | | - Linda Niccolai
- Yale School of Public Health and Connecticut Emerging Infections Program, New Haven, Connecticut, USA
| |
Collapse
|
13
|
Cheung TH, Cheng SSY, Hsu DC, Wong QWL, Pavelyev A, Walia A, Saxena K, Prabhu VS. The impact and cost-effectiveness of 9-valent human papillomavirus vaccine in adolescent females in Hong Kong. Cost Eff Resour Alloc 2021; 19:75. [PMID: 34801050 PMCID: PMC8606050 DOI: 10.1186/s12962-021-00328-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction In Hong Kong (HK), a single-cohort vaccination program for 10–12-year-old girls with the 9-valent human papillomavirus (HPV) vaccine (9vHPV; types 6/11/16/18/31/33/45/52/58) has been launched. This study assessed the public health impact and cost-effectiveness of implementing routine 9vHPV vaccination (12-year-olds) with or without catch-up 9vHPV vaccination (13–18-year-olds) in HK. Methods The health impact and costs of implementing routine 9vHPV vaccination with or without catch-up vaccination over a 100-year time horizon were evaluated using a validated HPV-type transmission dynamic model adapted to the HK population; analyses were performed from a healthcare payer perspective. Routine vaccination (12-year-old girls) and catch-up vaccination (13–18 years) assumed vaccine coverage rates of 70% (base case) and 30%, respectively. The model also assumed herd immunity, lifelong vaccine protection, a discount rate of 3%, and a cost per dose of HK dollars (HKD) 858 [United States dollars (USD) 110] and HKD 1390 (USD 179) for the 2-valent HPV (2vHPV) and 9vHPV vaccines, respectively. HPV disease-related incidence and the incremental cost-effectiveness ratio (ICER) per quality-adjusted-life-year (QALY) were estimated. Cost-effectiveness was determined at a ceiling threshold of HK dollars (HKD) 382,046 (USD 49,142) or 1.0 times the gross domestic product per capita of HK. Results Compared with routine 9vHPV alone, routine plus catch-up 9vHPV is projected to reduce cervical cancer incidence by 3.4%. Routine plus catch-up 9vHPV will also reduce genital warts incident cases for males/females by 2.6%/5.4%. The incremental cost-effectiveness ratios were HKD 29,911 (USD 3847)/quality-adjusted life-year (QALY) for routine plus catch-up 9vHPV versus routine 9vHPV alone and HKD 25,524 (USD 3283)/QALY for routine 9vHPV alone versus screening only. Sensitivity analyses indicated that routine plus catch-up 9vHPV compared with routine 9vHPV alone remained cost-effective at coverage rates of 30% and 90%. Conclusions This analysis predicts that the current HK vaccination strategy can be considered cost-effective and will provide maximum health benefit. These results support addition of the routine 9vHPV vaccine with or without catch-up 9vHPV vaccination to the regional vaccination program in HK. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-021-00328-x.
Collapse
Affiliation(s)
- Tak Hong Cheung
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Sally Shuk Yee Cheng
- Global Medical and Scientific Affairs, MSD Asia Ltd, 27/F Lee Gardens Two, 28 Yun Ping Road, Causeway Bay, Hong Kong, People's Republic of China
| | - Danny C Hsu
- Global Medical and Scientific Affairs, MSD Asia Ltd, 27/F Lee Gardens Two, 28 Yun Ping Road, Causeway Bay, Hong Kong, People's Republic of China
| | - Queenie Wing-Lei Wong
- Global Medical and Scientific Affairs, MSD Asia Ltd, 27/F Lee Gardens Two, 28 Yun Ping Road, Causeway Bay, Hong Kong, People's Republic of China
| | - Andrew Pavelyev
- MRL, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA.,HCL America, Inc., Sunnyvale, CA, USA
| | - Anuj Walia
- MRL, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Kunal Saxena
- MRL, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Vimalanand S Prabhu
- MRL, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA.
| |
Collapse
|
14
|
Prabhu VS, Bansal N, Liu Z, Finalle R, Sénécal M, Kothari S, Trowers K, Myers E. HPV vaccination uptake and administration from 2006 to 2016 in a commercially insured population of the United States. BMC Public Health 2021; 21:1629. [PMID: 34488705 PMCID: PMC8422649 DOI: 10.1186/s12889-021-11664-1] [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: 09/04/2020] [Accepted: 08/25/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection can cause various cancers and can be prevented through vaccination. The American Cancer Society (ACS) has set an HPV vaccination completion target in 13-year-old children to 80% by 2026. While HPV vaccine coverage (proportion ever vaccinated) estimates are available, annual uptakes (proportion initiating vaccine in a year) in the United States (U.S.) are not well-known. METHODS We analyzed MarketScan® claims database to assess HPV vaccination uptakes in the U.S. among the 9- to 26-year-olds in 2006-2016. The annual uptake was the ratio of the number of enrollees who had a first record of an HPV vaccine during the year, and the number of enrollees of similar age and sex that year. RESULTS Uptake was below 1% among children turning 9 and 10 years old during the year. Since 2009 among female and since 2013 among males, the annual uptake has been the highest in those turning 13 years old (19.7% among females and 17.6% among males in 2016). Catch-up vaccination among older adolescents and young adults increased after Advisory Committee for Immunization Practices (ACIP) recommendations, but eventually slowed down as more younger persons were vaccinated. Most young adolescents were vaccinated by pediatricians, whereas young adult women were predominantly vaccinated by obstetricians/gynecologists and young adult males by family physicians. While only about half of the adolescents had well-check visits, the majority of those who initiated HPV vaccination had one the same year. CONCLUSION Continued increase in uptake is needed to reach the ACS 2026 goals.
Collapse
Affiliation(s)
- Vimalanand S Prabhu
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc, 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA.
| | - Neha Bansal
- Complete HEOR Solutions (CHEORS), North Wales, PA, USA
| | - Zhiwen Liu
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc, 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
| | - Rodney Finalle
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc, 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
| | | | - Smita Kothari
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc, 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
| | - Kemar Trowers
- Center for Observational and Real-World Evidence, Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc, 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, USA
| | - Evan Myers
- Division of Women's Community and Population Health, Department of Obstetrics & Gynaecology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
15
|
Priyadarshini M, Prabhu VS, Snedecor SJ, Corman S, Kuter BJ, Nwankwo C, Chirovsky D, Myers E. Corrigendum: Economic Value of Lost Productivity Attributable to Human Papillomavirus Cancer Mortality in the United States. Front Public Health 2021; 9:691634. [PMID: 34381752 PMCID: PMC8350760 DOI: 10.3389/fpubh.2021.691634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Shelby Corman
- Pharmerit - an OPEN Health Company, Bethesda, MD, United States
| | | | | | | | - Evan Myers
- Division of Women's Community and Population Health, Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC, United States
| |
Collapse
|
16
|
Daniels V, Prabhu VS, Palmer C, Samant S, Kothari S, Roberts C, Elbasha E. Public health impact and cost-effectiveness of catch-up 9-valent HPV vaccination of individuals through age 45 years in the United States. Hum Vaccin Immunother 2021; 17:1943-1951. [PMID: 33427033 PMCID: PMC8189092 DOI: 10.1080/21645515.2020.1852870] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022] Open
Abstract
The Advisory Committee on Immunization Practices (ACIP) recommended catch-up 9-valent Human Papillomavirus (HPV) vaccination through age 26 years, and shared clinical decision-making for adults aged 27-45 years, compared with catch-up through age 26 years and 21 years for females and males, respectively (status quo; pre-June-2019 recommendations). This study assessed the public health impact and cost-effectiveness of expanded catch-up vaccination through age 45 years (expanded catch-up) compared with status quo. We used an HPV dynamic transmission infection and disease model to assess disease outcomes and incremental cost-effectiveness ratio (ICER) of expanded catch-up compared with status quo. Costs (2018 USD), calculated from a healthcare sector perspective, and quality-adjusted life years (QALY) were discounted at 3% annually. Historical vaccination coverage was estimated using NIS-TEEN survey data (NHANES data for sensitivity analysis). Alternative scenario analyses included restricting upper age of expanded catch-up through 26 years (June-2019 ACIP recommendation), 29 years, and further 5-year increments. Our results show expanded catch-up vaccination would prevent additional 37,856 cancers, 314,468 cervical intraepithelial neoplasia-2/3s, 1,743,461 genital warts, and 10,698 deaths compared with status quo over 100 years at cost of $141,000/QALY. With NHANES coverage, the ICER was $96,000/QALY. The June-2019 ACIP recommendation also provided public health benefits with an ICER of $117,000/QALY, compared with status quo. The ICER for expanded vaccination through age 34 years was $107,000/QALY. Expanding catch-up vaccination program through age 45 years-old in the US is expected to provide public health benefits, and cost-effectiveness improves with expanding catch-up through age 34.
Collapse
Affiliation(s)
- Vincent Daniels
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| | - Vimalanand S. Prabhu
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| | - Cody Palmer
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| | - Salome Samant
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| | - Smita Kothari
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| | - Craig Roberts
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| | - Elamin Elbasha
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| |
Collapse
|
17
|
Lorusso D, Colombo N, Casado Herraez A, Santin A, Colomba E, Miller DS, Fujiwara K, Pignata S, Baron-Hay SE, Ray-Coquard IL, Shapira-Frommer R, Kim YM, McCormack M, Bird S, Prabhu VS, Martin Nguyen A, Zhao Q, Dutta L, Makker V. Health-related quality of life (HRQoL) in advanced endometrial cancer (aEC) patients (pts) treated with lenvatinib plus pembrolizumab or treatment of physician’s choice (TPC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5570] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5570 Background: In Study 309/KEYNOTE-775, lenvatinib + pembrolizumab (L+P) demonstrated significant and clinically meaningful improvement in OS, PFS, and ORR compared with TPC in aEC pts following prior platinum-based systemic therapy. Given the medical complexity/age of EC pts, QoL analyses are critical, but often under-reported. We present results of pt-reported HRQoL for Study 309/KEYNOTE-775. Methods: Pts were randomized 1:1 to receive lenvatinib 20 mg QD PO + pembrolizumab 200 mg IV Q3W (n=411) or TPC (n=416; doxorubicin 60 mg/m2 IV Q3W or paclitaxel 80 mg/m2 IV QW, 3 wks on/1 wk off). Pt-reported HRQoL was assessed at cycle 1 day 1, day 1 of each subsequent cycle and at time of discontinuation using EORTC QLQ-C30, its EC module QLQ-EN24, and EQ-5D-5L in treated pts who had ≥1 HRQoL assessment available. Higher scores indicate better functioning/QoL (EORTC QLQ-C30, EQ-5D-5L) or worse symptom severity (QLQ-EN24). Changes in EORTC QLQ-C30 global health status (GHS)/QoL was a secondary endpoint. This was analyzed from baseline to the latest timepoint at which overall completion was ≥60% and overall compliance was ≥80%, using constrained longitudinal data analysis; other HRQoL analyses were exploratory. Results: Completion and compliance rates of EORTC QLQ-C30 were >95% in both groups at baseline. Primary analysis was conducted at wk 12 as completion rate was 80% for L+P and 62% for TPC; compliance rate was 93% for L+P and 87% for TPC. Baseline GHS/QoL scores were similar between the L+P group and TPC group: mean (SD) of 65.74 (21.87) vs 65.69 (22.71), respectively. Over 12 wks of follow-up, pts in both groups had slight decreases in GHS/QoL. Similar decreases were observed for pts receiving L+P vs TPC: -5.97 (95% CI: -8.36, -3.58) vs -6.98 (95% CI: -9.63, -4.33). The between-group difference in least-squares (LS) mean score change from baseline to wk 12 for L+P vs TPC was 1.01 points (95% CI: -2.28, 4.31). Over time, QoL scores were generally similar across treatments. Results were similar for other HRQoL endpoints (Table). Conclusions: No significant differences were observed in HRQoL scores between treatment groups. With no standard treatment approach following failure of platinum-based therapy, these data along with previously reported efficacy and safety findings from Study 309/KEYNOTE-775 further support that L+P has an overall favorable benefit/risk profile compared to chemotherapy. Clinical trial information: NCT03517449. [Table: see text]
Collapse
Affiliation(s)
- Domenica Lorusso
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS and Scientific Directorate, Rome, Italy
| | - Nicoletta Colombo
- University of Milan-Bicocca and European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | | | - Alessandro Santin
- Smilow Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT
| | - Emeline Colomba
- Gustave Roussy Cancerology Institute, Villejuif, Gineco Group, France
| | | | - Keiichi Fujiwara
- GOTIC and Saitama Medical University International Medical Center, Hidaka, Japan
| | - Sandro Pignata
- Istituto Nazionale Tumori IRCCS-Fondazione G. Pascale, Naples, Italy
| | | | | | | | - Yong Man Kim
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | - Mary McCormack
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Qi Zhao
- Eisai Inc., Woodcliff Lake, NJ
| | | | - Vicky Makker
- Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
18
|
Corman S, Kelkar S, Odak S, Zhang J, Prabhu VS, Rusibamayila N, Macahilig C, Duska LR. Treatment patterns and outcomes among patients with microsatellite stable (MSS) advanced endometrial cancer in the United States: Endometrial Cancer Health Outcomes (ECHO) retrospective chart review Study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.5581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5581 Background: Traditional platinum-based systemic chemotherapy continue to be the SOC for aEC in the first line. Phase 2 clinical trials of chemotherapy (GOG 129 series) and some targeted therapies (229 series) for second line advanced endometrial cancer (aEC) have proved disappointing. Recently the treatment landscape for aEC patients has significantly changed with newer targeted therapies focusing on the microsatellite instability (MSI) status of endometrial tumors. The objective of the ECHO study was to describe real-world treatment patterns and outcomes in non-MSI-high or DNA mismatch repair proficient (pMMR) aEC patients in clinical practice in the United States (US) prior to 2019. Methods: The ECHO study is a multicenter, retrospective chart review study in women diagnosed with aEC in the US. Data were obtained from medical records of adult women (≥18 years) diagnosed with advanced or inoperable aEC (stages III or IV) with known MSI status, who had received at least one prior systemic therapy and progressed between July 1, 2016 – June 30, 2019. De-identified patient data extracted by treating oncologists included patient demographics, clinical and treatment characteristics, and clinical outcomes. Kaplan-Meier analyses were performed to estimate real-world progression-free survival (rwPFS) and overall survival (OS). Results: A total of 124 non-MSI-high or pMMR aEC patients who had progression following first line therapy were included in this interim analysis. Average age was 63 years, 62.9% White/Caucasian, 16.9% Hispanic/Latino, and 86% had ECOG ≤1. Metastases were observed in 70% of patients at diagnosis, with the most common metastatic sites being lung (47.6%), liver (32.3%), and distant lymph nodes (29%). As 2nd line therapy, 69% of patients received mono or combination chemotherapy (primarily with doxorubicin), 13% hormonal therapy, and 18% targeted therapy ± chemotherapy. Median duration of 2nd line therapy was 4 months. The majority (86.3%) discontinued 2nd line therapy, with disease progression the most common reason (66.4%). A quarter (26.6%) of patients initiated an additional line of therapy. Median rwPFS from initiation of 2nd line therapy was 5 months (95% confidence interval [CI]: 4-9). Median OS from initiation of 2nd line therapy was 12 months (95%CI: 9-18). Estimated OS rates from initiation of 2nd line therapy at 6, 12, and 24 months were 66%, 47%, and 30%, respectively. Conclusions: In this retrospective, chart review study, patients with non-MSI-high/pMMR aEC in the US who failed at least one systemic therapy had poor prognosis on subsequent therapies. There continues to be a significant unmet need in this group of women. Novel therapies are needed that delay progression and/or improve overall survival and further research is indicated to explore this.
Collapse
|
19
|
Szamreta EA, Wayser GR, Prabhu VS, Mulvihill E, Stockstill K, Salani R. Drivers and barriers to information seeking: Qualitative research with advanced cervical cancer patients in the United States. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18705 Background: Patients diagnosed with persistent, recurrent, or metastatic cervical cancer (CC) may face uncertainty about treatment options, impact of treatment on health & quality of life (QoL), & available resources. This study provides insight into patient concerns & information seeking (IS) behaviors. Methods: In January 2021, semi-structured telephone interviews were conducted in the US with CC patients (diagnosed within 2 years) recruited through panels, social media & advocacy groups. The interview focused on rational & emotional drivers and barriers for IS. Transcripts were coded using NVivo qualitative analysis software to identify key themes. Results: 14 women of varied education status were interviewed (mean age 51 years (range: 37-70); 8 White, 4 Black, & 2 Latina). Patients emphasized trust in their oncologist to provide sufficient information. IS was driven by the desires to confirm their oncologist’s recommendation & find reassurance through the experience of other patients, and encouragement from family. Barriers to IS included: 1) hesitancy to undermine their oncologist’s recommendations, 2) pessimism about ability to find individualized answers about prognosis or QoL, 3) feeling overwhelmed & fearing mis-information, 4) personal urgency to decide on a treatment plan, 5) already having sufficient information, 6) potential exposure to “negative energy” from online patient communities, & 7) COVID-19 hindering opportunity for personal connections. Conclusions: While patients’ oncologist, family, & common patient experience provide comfort, reluctance towards IS exists. As trusted gatekeepers, oncologists should recognize patients’ desire for accessible, reliable, & personalized information. Better understanding this perspective and gaps in the availability of validated & relevant resources can enable clinicians/policy makers to develop strategies & tools for better communication. In turn, this will help CC patients feel more empowered & informed throughout their cancer care journey.[Table: see text]
Collapse
Affiliation(s)
| | | | | | | | | | - Ritu Salani
- The Ohio State University Wexner Medical Center, Columbus, OH
| |
Collapse
|
20
|
Priyadarshini M, Prabhu VS, Snedecor SJ, Corman S, Kuter BJ, Nwankwo C, Chirovsky D, Myers E. Economic Value of Lost Productivity Attributable to Human Papillomavirus Cancer Mortality in the United States. Front Public Health 2021; 8:624092. [PMID: 33665180 PMCID: PMC7921151 DOI: 10.3389/fpubh.2020.624092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/12/2020] [Accepted: 12/23/2020] [Indexed: 01/05/2023] Open
Abstract
Objectives: To estimate years of potential life lost (YPLL) and present value of future lost productivity (PVFLP) associated with premature mortality due to HPV-attributable cancers, specifically those targeted by nonavalent HPV (9vHPV) vaccination, in the United States (US) before vaccine use. Methods: YPLL was estimated from the reported number of deaths in 2017 due to HPV-related cancers, the proportion attributable to 9vHPV-targeted types, and age- and sex-specific US life expectancy. PVFLP was estimated as the product of YPLL by age- and sex-specific probability of labor force participation, annual wage, value of non-market labor, and fringe benefits markup factor. Results: An estimated 7,085 HPV-attributable cancer deaths occurred in 2017 accounting for 154,954 YPLL, with 5,450 deaths (77%) and 121,226 YPLL (78%) attributable to 9vHPV-targeted types. The estimated PVFLP was $3.3 billion for cancer deaths attributable to 9vHPV-targeted types (86% from women). The highest productivity burden was associated with cervical cancer in women and anal and oropharyngeal cancers in men. Conclusions: HPV-attributable cancer deaths are associated with a substantial economic burden in the US, much of which could be vaccine preventable.
Collapse
Affiliation(s)
| | | | | | - Shelby Corman
- Pharmerit - an OPEN Health Company, Bethesda, MD, United States
| | | | | | | | - Evan Myers
- Division of Women's Community and Population Health, Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC, United States
| |
Collapse
|
21
|
Zhang D, Prabhu VS, Marcella SW. Attributable Healthcare Resource Utilization and Costs for Patients With Primary and Recurrent Clostridium difficile Infection in the United States. Clin Infect Dis 2019; 66:1326-1332. [PMID: 29360950 PMCID: PMC5905590 DOI: 10.1093/cid/cix1021] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/12/2017] [Indexed: 12/28/2022] Open
Abstract
Background The economic burden of Clostridium difficile infection (CDI), the leading cause of nosocomial infectious diarrhea, is not well understood. The objective of this study was to estimate the healthcare resource utilization (HCRU) and costs attributable to primary CDI and recurrent CDI (rCDI). Methods This is a database (MarketScan) study. Patients without CDI were matched 1:1 by propensity score to those with primary CDI but no recurrences to obtain HCRU and costs attributable to primary CDI. Patients with primary CDI but no recurrences were matched 1:1 by propensity score to those with primary CDI plus 1 recurrence in order to obtain HCRU and costs attributable to rCDI. Adjusted estimates for incremental cumulative hospitalized days and healthcare costs over a 6-month follow-up period were obtained by generalized linear models with a Poisson or gamma distribution and a log link. Bootstrapping was used to obtain 95% confidence intervals (CIs). Results A total of 55504 eligible CDI patients were identified. Approximately 25% of these CDI patients had rCDI. The cumulative hospitalized days attributable to primary CDI and rCDI over the 6-month follow-up period were 5.20 days (95% CI, 5.01–5.39) and 1.95 days (95% CI, 1.48–2.43), respectively. The healthcare costs attributable to primary CDI and rCDI over the 6-month follow-up period were $24205 (95% CI, $23436–$25013) and $10580 (95% CI, $8849–$12446), respectively. Conclusions The HCRU and costs attributable to primary CDI and rCDI are quite substantial. It is necessary to reduce the burden of CDI, especially rCDI.
Collapse
Affiliation(s)
- Dongmu Zhang
- Center for Observational and Real-World Evidence, Merck & Co, Inc, Kenilworth, New Jersey
| | - Vimalanand S Prabhu
- Center for Observational and Real-World Evidence, Merck & Co, Inc, Kenilworth, New Jersey
| | - Stephen W Marcella
- Center for Observational and Real-World Evidence, Merck & Co, Inc, Kenilworth, New Jersey
| |
Collapse
|
22
|
Prabhu VS, Dubberke ER, Dorr MB, Elbasha E, Cossrow N, Jiang Y, Marcella S. Cost-effectiveness of Bezlotoxumab Compared With Placebo for the Prevention of Recurrent Clostridium difficile Infection. Clin Infect Dis 2019; 66:355-362. [PMID: 29106516 DOI: 10.1093/cid/cix809] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 05/22/2017] [Indexed: 02/06/2023] Open
Abstract
Background Clostridium difficile infection (CDI) is the most commonly recognized cause of recurrent diarrhea. Bezlotoxumab, administered concurrently with antibiotics directed against C. difficile (standard of care [SoC]), has been shown to reduce the recurrence of CDI, compared with SoC alone. This study aimed to assess the cost-effectiveness of bezlotoxumab administered concurrently with SoC, compared with SoC alone, in subgroups of patients at risk of recurrence of CDI. Methods A computer-based Markov health state transition model was designed to track the natural history of patients infected with CDI. A cohort of patients entered the model with either a mild/moderate or severe CDI episode, and were treated with SoC antibiotics together with either bezlotoxumab or placebo. The cohort was followed over a lifetime horizon, and costs and utilities for the various health states were used to estimate incremental cost-effectiveness ratios (ICERs). Both deterministic and probabilistic sensitivity analyses were used to test the robustness of the results. Results The cost-effectiveness model showed that, compared with placebo, bezlotoxumab was associated with 0.12 quality-adjusted life-years (QALYs) gained and was cost-effective in preventing CDI recurrences in the entire trial population, with an ICER of $19824/QALY gained. Compared with placebo, bezlotoxumab was also cost-effective in the subgroups of patients aged ≥65 years (ICER of $15298/QALY), immunocompromised patients (ICER of $12597/QALY), and patients with severe CDI (ICER of $21430/QALY). Conclusions Model-based results demonstrated that bezlotoxumab was cost-effective in the prevention of recurrent CDI compared with placebo, among patients receiving SoC antibiotics for treatment of CDI.
Collapse
Affiliation(s)
| | | | | | | | | | - Yiling Jiang
- Merck Sharp & Dohme Ltd, Hoddesdon, Hertfordshire, United Kingdom
| | | |
Collapse
|
23
|
Srivastava T, Prabhu VS, Li H, Xu R, Zarabi N, Zhong Y, Pellissier JM, Perini RF, de Wit R, Mamtani R. Cost-effectiveness of Pembrolizumab as Second-line Therapy for the Treatment of Locally Advanced or Metastatic Urothelial Carcinoma in Sweden. Eur Urol Oncol 2018; 3:663-670. [PMID: 31412001 DOI: 10.1016/j.euo.2018.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 07/13/2018] [Revised: 08/30/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Urothelial carcinoma (UC) is the most common subtype of bladder cancer. The randomized phase 3 KEYNOTE-045 trial showed that pembrolizumab, used as second-line therapy significantly prolonged overall survival with fewer treatment-related adverse events than chemotherapy for advanced UC. Pembrolizumab has been approved by the European Medicines Agency for the treatment of locally advanced or metastatic UC in adults who have received platinum-containing chemotherapy. Many European countries use cost-effectiveness analysis to inform reimbursement decisions. OBJECTIVE To assess the cost-effectiveness of pembrolizumab as second-line therapy for the treatment of advanced UC from a Swedish health care perspective. DESIGN, SETTING, AND PARTICIPANTS We developed a partitioned-survival model to assess the costs and effectiveness of pembrolizumab compared with vinflunine (base case), paclitaxel, or docetaxel monotherapy in patients with advanced UC over a 15-yr time horizon. We obtained Kaplan-Meier estimates for survival endpoints, adverse events, and utility data from KEYNOTE-045. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We performed parametric extrapolations to estimate overall and progression-free survival beyond the clinical trial period. Swedish costs and utility weights were used to estimate total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). We performed deterministic and probabilistic sensitivity analyses to assess the robustness of the model results. RESULTS AND LIMITATIONS In the base-case analysis, pembrolizumab resulted in a mean survival gain of 1.66 years (1.38 QALYs) at an incremental cost of €69852 and an ICER of €50529/QALY gained versus vinflunine monotherapy. ICERs for other chemotherapies were €81356/QALY for pembrolizumab versus paclitaxel or docetaxel monotherapy, and €71924/QALY for pembrolizumab versus paclitaxel, docetaxel, or vinflunine monotherapy. Long-term follow-up from KEYNOTE-045 and real-world data are needed to validate the extrapolations. CONCLUSIONS The results indicate that pembrolizumab improves survival, increases QALYs, and is cost-effective as second-line therapy at a willingness-to-pay threshold of €100000/QALY for the treatment of advanced UC. PATIENT SUMMARY To date, pembrolizumab is the only treatment associated with a significant overall survival benefit compared with chemotherapy in a randomized controlled trial as second-line therapy for advanced urothelial carcinoma. Our trial-based cost-effectiveness analysis suggests that pembrolizumab is a cost-effective option over chemotherapy in patients with advanced urothelial carcinoma after platinum-based therapy in Sweden.
Collapse
Affiliation(s)
| | | | - Haojie Li
- Merck & Co, Inc., Kenilworth, NJ, USA
| | | | | | | | | | | | - Ronald de Wit
- Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ronac Mamtani
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
24
|
Basu A, Prabhu VS, Dorr MB, Golan Y, Dubberke ER, Cornely OA, Heimann SM, Pedley A, Xu R, Hanson ME, Marcella S. Bezlotoxumab Is Associated With a Reduction in Cumulative Inpatient-Days: Analysis of the Hospitalization Data From the MODIFY I and II Clinical Trials. Open Forum Infect Dis 2018; 5:ofy218. [PMID: 30460321 PMCID: PMC6237242 DOI: 10.1093/ofid/ofy218] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/31/2018] [Indexed: 12/17/2022] Open
Abstract
Background Patients with recurrent Clostridium difficile infection (rCDI) are more likely to have a hospital readmission and spend increased time in inpatient settings compared with patients with primary CDI. MODIFY I and II demonstrated that bezlotoxumab significantly reduced rCDI vs placebo. A post hoc within-trial analysis assessed whether bezlotoxumab was associated with a reduction in cumulative inpatient-days. Methods Data were pooled from the MODIFY trials to estimate the cumulative hospitalized days summed over the 84-day follow-up period. We adjusted inpatient use data from pooled MODIFY I and II for survival and censoring to estimate 84-day cumulative inpatient-days, overall and for subgroups. Treatment effects were obtained using recycled predictions based on trial protocol and rCDI risk, and 95% confidence intervals were obtained using 1000 bootstrap replicates. Results Mean cumulative inpatient-days were greater in the placebo arm (14.1 days) vs the bezlotoxumab arm (12.1 days) in the overall population. The mean difference between treatment groups was 2.1 days (95% confidence interval, –0.4 to –3.7). This was consistent in participants with risk factors for rCDI: age ≥65 years, compromised immunity, severe CDI, prior CDI, and ribotype 027/078/244 infection. As the number of risk factors increased, bezlotoxumab resulted in greater reductions in the number of inpatient-days compared with placebo (difference: –1.2 days, –2.3 days, –2.5 days, and –3.0 days for 0, 1, 2, and ≥3 risk factors, respectively). Conclusions Bezlotoxumab was associated with a reduction in cumulative inpatient-days, suggesting that treatment with bezlotoxumab may substantially reduce rCDI-associated health care resource use. Trial registrations. MODIFY I (MK-3415A-001, NCT01241552) and II (MK-3415A-002, NCT01513239)
Collapse
Affiliation(s)
- Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington
| | | | | | - Yoav Golan
- New England Medical Center, Tufts University, Boston, Massachusetts
| | - Erik R Dubberke
- Department of Medicine, Washington University, St. Louis, Missouri
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Department I of Internal Medicine, ECMM Excellence Center of Medical Mycology, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Sebastian M Heimann
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | | | - Ruifeng Xu
- Merck & Co., Inc., Kenilworth, New Jersey
| | | | | |
Collapse
|
25
|
Prabhu VS, Solomkin JS, Medic G, Foo J, Borse RH, Kauf T, Miller B, Sen SS, Basu A. Cost-effectiveness of ceftolozane/tazobactam plus metronidazole versus piperacillin/tazobactam as initial empiric therapy for the treatment of complicated intra-abdominal infections based on pathogen distributions drawn from national surveillance data in the United States. Antimicrob Resist Infect Control 2017; 6:107. [PMID: 29090091 PMCID: PMC5658949 DOI: 10.1186/s13756-017-0264-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 01/03/2017] [Accepted: 10/03/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The prevalence of antimicrobial resistance among gram-negative pathogens in complicated intra-abdominal infections (cIAIs) has increased. In the absence of timely information on the infecting pathogens and their susceptibilities, local or regional epidemiology may guide initial empirical therapy and reduce treatment failure, length of stay and mortality. The objective of this study was to assess the cost-effectiveness of ceftolozane/tazobactam + metronidazole compared with piperacillin/tazobactam in the treatment of hospitalized US patients with cIAI at risk of infection with resistant pathogens. METHODS We used a decision-analytic Monte Carlo simulation model to compare the costs and quality-adjusted life years (QALYs) of persons infected with nosocomial gram-negative cIAI treated empirically with either ceftolozane/tazobactam + metronidazole or piperacillin/tazobactam. Pathogen isolates were randomly drawn from the Program to Assess Ceftolozane/Tazobactam Susceptibility (PACTS) database, a surveillance database of non-duplicate bacterial isolates collected from patients with cIAIs in medical centers in the USA from 2011 to 2013. Susceptibility to initial therapy was based on the measured susceptibilities reported in the PACTS database determined using standard broth micro-dilution methods as described by the Clinical and Laboratory Standards Institute (CLSI). RESULTS Our model results, with baseline resistance levels from the PACTS database, indicated that ceftolozane/tazobactam + metronidazole dominated piperacillin/tazobactam, with lower costs ($44,226/patient vs. $44,811/patient respectively) and higher QALYs (12.85/patient vs. 12.70/patient, respectively). Ceftolozane/tazobactam + metronidazole remained the dominant choice in one-way and probabilistic sensitivity analyses. CONCLUSIONS Based on surveillance data, ceftolozane/tazobactam is more likely to be an appropriate empiric therapy for cIAI in the US. Results from a decision-analytic simulation model indicate that use of ceftolozane/tazobactam + metronidazole would result in cost savings and improves QALYs, compared with piperacillin/tazobactam.
Collapse
Affiliation(s)
- Vimalanand S. Prabhu
- Merck & Co., Inc., Kenilworth, NJ USA
- Center for Observational and Real World Evidence (CORE), Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033 USA
| | | | | | | | | | | | | | | | - Anirban Basu
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA USA
| |
Collapse
|
26
|
Prabhu VS, Cornely OA, Golan Y, Dubberke ER, Heimann SM, Hanson ME, Liao J, Pedley A, Dorr MB, Marcella S. Thirty-Day Readmissions in Hospitalized Patients Who Received Bezlotoxumab With Antibacterial Drug Treatment for Clostridium difficile Infection. Clin Infect Dis 2017; 65:1218-1221. [PMID: 30060024 PMCID: PMC5848255 DOI: 10.1093/cid/cix523] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 06/21/2017] [Indexed: 12/26/2022] Open
Abstract
Clinical Trials Registration NCT01241552 (MODIFY I) and NCT01513239 (MODIFY II).
Collapse
Affiliation(s)
- Vimalanand S Prabhu
- Economic and Data Sciences, Center for Real World and Observational Studies, Merck & Co., Inc., Kenilworth, New Jersey
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Department of Internal Medicine, Clinical Trials Centre Cologne, University of Cologne, Germany
| | - Yoav Golan
- Department of Medicine, Geographic Medicine and Infectious Diseases, Tufts University School of Medicine, Boston, Massachusetts
| | - Erik R Dubberke
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | | | - Mary E Hanson
- Global Scientific and Medical Publications, Infectious Diseases & Vaccines
| | - Jane Liao
- Statistical Programming for Center for Outcomes Research Excellence
| | | | | | - Stephen Marcella
- Outcomes Research, Center for Outcomes Research Excellence, Acute Hospital & Specialty Care, Merck & Co., Inc., Kenilworth, New Jersey
| |
Collapse
|
27
|
Kauf TL, Prabhu VS, Medic G, Borse RH, Miller B, Gaultney J, Sen SS, Basu A. Cost-effectiveness of ceftolozane/tazobactam compared with piperacillin/tazobactam as empiric therapy based on the in-vitro surveillance of bacterial isolates in the United States for the treatment of complicated urinary tract infections. BMC Infect Dis 2017; 17:314. [PMID: 28454524 PMCID: PMC5410095 DOI: 10.1186/s12879-017-2408-7] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/18/2017] [Indexed: 11/27/2022] Open
Abstract
Background A challenge in the empiric treatment of complicated urinary tract infection (cUTI) is identifying the initial appropriate antibiotic therapy (IAAT), which is associated with reduced length of stay and mortality compared with initial inappropriate antibiotic therapy (IIAT). We evaluated the cost-effectiveness of ceftolozane/tazobactam compared with piperacillin/tazobactam (one of the standard of care antibiotics), for the treatment of hospitalized patients with cUTI. Methods A decision-analytic Monte Carlo simulation model was developed to compare the costs and effectiveness of empiric treatment with either ceftolozane/tazobactam or piperacillin/tazobactam in hospitalized adult patients with cUTI infected with Gram-negative pathogens in the US. The model applies the baseline prevalence of resistance as reported by national in-vitro surveillance data. Results In a cohort of 1000 patients, treatment with ceftolozane/tazobactam resulted in higher total costs compared with piperacillin/tazobactam ($36,413 /patient vs. $36,028/patient, respectively), greater quality-adjusted life years (QALYs) (9.19/patient vs. 9.13/patient, respectively) and an incremental cost-effectiveness ratio (ICER) of $6128/QALY. Ceftolozane/tazobactam remained cost-effective at a willingness to pay of $100,000 per QALY compared to piperacillin/tazobactam over a range of input parameter values during one-way and probabilistic sensitivity analysis. Conclusions Model results show that ceftolozane/tazobactam is likely to be cost-effective compared with piperacillin/tazobactam for the empiric treatment of hospitalized cUTI patients in the United States. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2408-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - Vimalanand S Prabhu
- Merck & Co., Inc., Kenilworth, NJ, USA. .,Merck & Co., Inc., 2000 Galloping Hill Rd., Kenilworth, NJ, 07033, USA.
| | | | | | | | | | | | | |
Collapse
|
28
|
Prabhu VS, Farnham PG, Hutchinson AB, Soorapanth S, Heffelfinger JD, Golden MR, Brooks JT, Rimland D, Sansom SL. Cost-effectiveness of HIV screening in STD clinics, emergency departments, and inpatient units: a model-based analysis. PLoS One 2011; 6:e19936. [PMID: 21625489 PMCID: PMC3098845 DOI: 10.1371/journal.pone.0019936] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [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: 12/10/2010] [Accepted: 04/19/2011] [Indexed: 02/04/2023] Open
Abstract
Background Identifying and treating persons with human immunodeficiency virus (HIV) infection early in their disease stage is considered an effective means of reducing the impact of the disease. We compared the cost-effectiveness of HIV screening in three settings, sexually transmitted disease (STD) clinics serving men who have sex with men, hospital emergency departments (EDs), settings where patients are likely to be diagnosed early, and inpatient diagnosis based on clinical manifestations. Methods and Findings We developed the Progression and Transmission of HIV/AIDS model, a health state transition model that tracks index patients and their infected partners from HIV infection to death. We used program characteristics for each setting to compare the incremental cost per quality-adjusted life year gained from early versus late diagnosis and treatment. We ran the model for 10,000 index patients for each setting, examining alternative scenarios, excluding and including transmission to partners, and assuming HAART was initiated at a CD4 count of either 350 or 500 cells/µL. Screening in STD clinics and EDs was cost-effective compared with diagnosing inpatients, even when including only the benefits to the index patients. Screening patients in STD clinics, who have less-advanced disease, was cost-effective compared with ED screening when treatment with HAART was initiated at a CD4 count of 500 cells/µL. When the benefits of reduced transmission to partners from early diagnosis were included, screening in settings with less-advanced disease stages was cost-saving compared with screening later in the course of infection. The study was limited by a small number of observations on CD4 count at diagnosis and by including transmission only to first generation partners of the index patients. Conclusions HIV prevention efforts can be advanced by screening in settings where patients present with less-advanced stages of HIV infection and by initiating treatment with HAART earlier in the course of infection.
Collapse
Affiliation(s)
- Vimalanand S. Prabhu
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Paul G. Farnham
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- * E-mail:
| | - Angela B. Hutchinson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Sada Soorapanth
- San Francisco State University, San Francisco, California, United States of America
| | - James D. Heffelfinger
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Matthew R. Golden
- Public Health-Seattle and King County STD Clinic and the Center for AIDS and STD, University of Washington, Seattle, Washington, United States of America
| | - John T. Brooks
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - David Rimland
- Medical Specialty Service Line (111-RIM), Veterans Affairs Medical Center, Decatur, Georgia, United States of America
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Stephanie L. Sansom
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| |
Collapse
|
29
|
Shrestha SS, Swerdlow DL, Borse RH, Prabhu VS, Finelli L, Atkins CY, Owusu-Edusei K, Bell B, Mead PS, Biggerstaff M, Brammer L, Davidson H, Jernigan D, Jhung MA, Kamimoto LA, Merlin TL, Nowell M, Redd SC, Reed C, Schuchat A, Meltzer MI. Estimating the burden of 2009 pandemic influenza A (H1N1) in the United States (April 2009-April 2010). Clin Infect Dis 2011; 52 Suppl 1:S75-82. [PMID: 21342903 DOI: 10.1093/cid/ciq012] [Citation(s) in RCA: 293] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To calculate the burden of 2009 pandemic influenza A (pH1N1) in the United States, we extrapolated from the Centers for Disease Control and Prevention's Emerging Infections Program laboratory-confirmed hospitalizations across the entire United States, and then corrected for underreporting. From 12 April 2009 to 10 April 2010, we estimate that approximately 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (195,086-402,719), and 12,469 deaths (8868-18,306) occurred in the United States due to pH1N1. Eighty-seven percent of deaths occurred in those under 65 years of age with children and working adults having risks of hospitalization and death 4 to 7 times and 8 to 12 times greater, respectively, than estimates of impact due to seasonal influenza covering the years 1976-2001. In our study, adults 65 years of age or older were found to have rates of hospitalization and death that were up to 75% and 81%, respectively, lower than seasonal influenza. These results confirm the necessity of a concerted public health response to pH1N1.
Collapse
Affiliation(s)
- Sundar S Shrestha
- Division of Diabetes Translation, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Sansom SL, Prabhu VS, Hutchinson AB, An Q, Hall HI, Shrestha RK, Lasry A, Taylor AW. Cost-effectiveness of newborn circumcision in reducing lifetime HIV risk among U.S. males. PLoS One 2010; 5:e8723. [PMID: 20090910 PMCID: PMC2807456 DOI: 10.1371/journal.pone.0008723] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [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: 05/29/2009] [Accepted: 12/15/2009] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND HIV incidence was substantially lower among circumcised versus uncircumcised heterosexual African men in three clinical trials. Based on those findings, we modeled the potential effect of newborn male circumcision on a U.S. male's lifetime risk of HIV, including associated costs and quality-adjusted life-years saved. METHODOLOGY/PRINCIPAL FINDINGS Given published estimates of U.S. males' lifetime HIV risk, we calculated the fraction of lifetime risk attributable to heterosexual behavior from 2005-2006 HIV surveillance data. We assumed 60% efficacy of circumcision in reducing heterosexually-acquired HIV over a lifetime, and varied efficacy in sensitivity analyses. We calculated differences in lifetime HIV risk, expected HIV treatment costs and quality-adjusted life years (QALYs) among circumcised versus uncircumcised males. The main outcome measure was cost per HIV-related QALY saved. Circumcision reduced the lifetime HIV risk among all males by 15.7% in the base case analysis, ranging from 7.9% for white males to 20.9% for black males. Newborn circumcision was a cost-saving HIV prevention intervention for all, black and Hispanic males. The net cost of newborn circumcision per QALY saved was $87,792 for white males. Results were most sensitive to the discount rate, and circumcision efficacy and cost. CONCLUSIONS/SIGNIFICANCE Newborn circumcision resulted in lower expected HIV-related treatment costs and a slight increase in QALYs. It reduced the 1.87% lifetime risk of HIV among all males by about 16%. The effect varied substantially by race and ethnicity. Racial and ethnic groups who could benefit the most from circumcision may have least access to it due to insurance coverage and state Medicaid policies, and these financial barriers should be addressed. More data on the long-term protective effect of circumcision on heterosexual males as well as on its efficacy in preventing HIV among MSM would be useful.
Collapse
Affiliation(s)
- Stephanie L. Sansom
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vimalanand S. Prabhu
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Angela B. Hutchinson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Qian An
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - H. Irene Hall
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ram K. Shrestha
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Arielle Lasry
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Allan W. Taylor
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
31
|
Abstract
The respiratory epithelium undergoes morphological and functional changes following exposure to single oxygen. However, mechanisms by which singlet oxygen causes cellular injury are unclear. The present experiments were designed to investigate the possibility that singlet oxygen, a highly reactive species, diffuses into respiratory epithelial cells. Of the various methods for detection of singlet oxygen, the electron spin resonance (ESR) spectrometric technique was judged to be most compatible and sensitive for use with cell suspensions. ESR spectrometry was used to monitor the singlet oxygen-mediated conversion of 2-(9,10-dimethoxyanthracenyl)-tert-butylhydroxylamine, (I), to 2-(9,10-dimethoxyanthracenyl)-tert-butylnitroxide, (II), and its corresponding endoperoxide, (III), in human bronchial epithelial cells treated with extracellularly generated singlet oxygen. In a second series of experiments, bronchial epithelial cells labeled with (I) were treated with singlet oxygen in the presence of 1,4-diazabicyclo[2.2.2]octane, a singlet oxygen quenching agent. The addition of this quenching agent eliminated the ESR spectrum corresponding with (II) and (III). This result is consistent with the quenching of singlet oxygen by 1.4-diazabicyclo[2.2.2]octane. Collectively, our results indicate that extracellularly generated singlet oxygen diffuses into human bronchial epithelial cells and that this process is a potentially important step in the cytotoxic action of singlet oxygen to the respiratory epithelium.
Collapse
|
32
|
Abstract
Vidian neurectomy is a useful procedure in relieving the symptoms of vasomotor rhinitis. However, the nerve is difficult to approach because of its deep location in the pterygopalatine fossa. A direct transnasal approach to the pterygopalatine fossa, passing through the sphenopalatine foramen in the lateral wall of the nose, is described and its merits are discussed. We have operated upon 247 cases by this approach over the past four years without any significant complications.
Collapse
|