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PCN1 |
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COST-EFFECTIVENESS OF
PEMETREXED PLUS CISPLATIN VERSUS CISPLATIN ALONE
IN THE TREATMENT OF MALIGNANT PLEURAL MESOTHELIOMA
Davey P1, Cordony A1, Rajan N2, Arora B2,
Pavlakis N3, 1M-TAG, A Unit of IMS Health,
Chatswood, NSW, Australia, 2Eli Lilly Australia
Pty Ltd, West Ryde, NSW, Australia, 3University of
Sydney, St Leonards, NSW, Australia OBJECTIVE:
To determine the
value-for-money offered by pemetrexed (Alimta)
plus cisplatin therapy for patients with malignant
pleural mesothelioma (MPM), relative to cisplatin
monotherapy, in Australia. MPM is an uncommon,
locally invasive and rapidly fatal malignancy.
There is currently no other drug reimbursed by the
Australian National Formulary specifically for the
treatment of mesothelioma. METHODS:
A
comprehensive literature search revealed one
randomised head-to-head trial of pemetrexed plus
cisplatin therapy versus cisplatin monotherapy (N
= 448) by Vogelzang et al. (2003). Median survival
for the intention-to-treat (ITT) population was
12.1 months for the pemetrexed plus cisplatin arm
versus 9.3 months for the cisplatin arm (hazard
ratio = 0.77, p = 0.020). Although there was
greater toxicity with the combination regimen,
quality of life was not negatively impacted. Mean
survival time for each treatment arm was estimated
from Kaplan-Meier survival curves. Resource use
was applied as per the trial and costed
accordingly. Study drug utilisation, concomitant
medications, supplementary medication (dexamethasone,
folic acid, and vitamin B12), post-study
chemotherapy, and care for serious and
treatmentemergent adverse events were costed.
RESULTS:
Patients received a mean of 4.7
treatment cycles in the pemetrexed plus cisplatin
arm, and 4.0 cycles in the cisplatin monotherapy
arm. The combination therapy required more
supportive care for toxicities. The additional
mean cost of pemetrexed plus cisplatin therapy,
over cisplatin monotherapy, was A$14,032.78 per
patient. The mean and median survival gain with
pemetrexed plus cisplatin therapy was found to be
0.191 and 0.233 years, respectively, relative to
cisplatin monotherapy, over the 27-month period of
observation. The cost per life-year saved was
A$73,470.04 for mean and A$60,226.52 for median
incremental survival. CONLUSIONS:
This
survival benefit is a highly patient-relevant
outcome. This economic evaluation found that
pemetrexed plus cisplatin therapy offers an
acceptable cost-effectiveness ratio for a small
population of MPM patients in Australia.
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PCN22 |
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A COST-EFFECTIVENESS ANALYSIS
OF ADJUVANT CHEMOTHERAPY FOR NODE POSITIVE EARLY
BREAST CANCER IN KOREA: DOCETAXEL, DOXORUBICIN AND
CYCLOPHOSPHAMIDE (TAC) VERSUS 5-FLUOROURACIL,
DOXORUBICIN AND CYCLOPHOSPHAMIDE (FAC)
Lee SG1, 2Jee YK, 3Chung HC, 4Kim SB, 5Ro
J, 6Im YH, 7Im SA, 8Seo JH, 9Lee SM, 1Dankook
University, College of Medicine, Cheonan,
Chungnam, South Korea, 2Pochon CHA University,
College of Medicine, Seongnam, Gyunggi, South
Korea, 3Yonsei University, College of Medicine,
Seoul, South Korea, 4University of Ulsan, College
of Medicine, Seoul, Seoul, South Korea, 5Korean
National Cancer Center Hospital, Goyang, Gyeonggi,
South Korea, 6Sungkyunkwan University, College of
Medicine, Seoul, South Korea, 7Seoul National
University, College of Medicine, Seoul, South
Korea, 8Korea University, College of Medicine,
Seoul, South Korea, 9Yonsei University, Graduate
School, Seoul, South Korea OBJECTIVE:
The
aim of this study was to determine the incremental
cost-effectiveness and cost-utility ratios of the
TAC treatment compared with the FAC treatment
following primary surgery for node positive breast
cancer patients in Korea. METHODS:
An
economic analysis was performed using a Markov
model. The model allowed assessments from the
start of adjuvant chemotherapy until death.
Clinical data introduced into the model were
mainly obtained from the long term (5years)
randomized controlled trial, BCIRG001 and some
Korea-specific clinical data were obtained from
the existing literature. The model allowed
projecting the lifetime costs and effectiveness of
both regimens beyond the time scope of the trial.
Costs were evaluated from the combined view of the
national health insurance and the patient; only
direct medical costs were included. The local
treatment patterns and their costs were estimated
from 3-hospital survey. Utility data were
extracted from existing foreign literature. A
discount rate of 5% was used for costs, and
alternatively 0%, 3%, and 5% for effectiveness.
All costs were expressed in Korean Won (KW).
RESULTS:
The base case and subsequent
sensitivity analyses showed that TAC was more
costly per patient but yielded higher health
benefits than FAC. According to the discount rate
of effectiveness, the ICER (cost per life year
saved) were 3,383,182 KW, 5,848,447 KW and
8,112,362 KW and the ICUR (cost per QALY gained)
were 3,849,233 KW, 6,560,432 KW and 8,981,543 KW,
respectively (1026 KW = 1 US$). CONLUSIONS:
The results indicate that additional life-years
with a modest increase in costs could be achieved
by the use of TAC compared with FAC as adjuvant
chemotherapy for node positive breast cancer
patients in Korea, thus TAC appears to be
cost-effective in the management of early breast
cancer in Korea.
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PCN3 |
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INCREMENTAL LIFETIME COST OF
LIVER CANCER- NCIDENCE-BASED APPROACH
Lang HC, University of California at
Berkeley, Moraga, CA, USA OBJECTIVE:
Liver
cancer is the third common cancer in Taiwan, only
after cervical and breast cancer (2000). For male
in Taiwan, it is the most dangerous cancer with
both highest incidence and mortality rate. This
study estimated the lifetime cost of care for
Taiwan patients with a diagnosis of liver cancer.
METHODS:
The estimation of the lifetime
cost based on incidence approach sourced from
1994-2002 cancer registry statistics of patients
with liver cancer and the claim data from Taipei
Veterans General Hospital (TVGH). Totally we have
2,873 liver cancer patients. Besides, the research
applied population claim data from The National
Health Research Institutes (NHRI) 1996-2002 as the
comparison group. The probabilities of survival,
dying of cancer and dying of other causes were
estimated through Cancer Registry statistics
offered by the Bureau of Health Promotion. We
divided the whole disease process into initial,
continue and terminal three phases. Therefore,
there is no need to follow up the whole progress
of the cases from diagnosis to death. The cost of
cancer is the sum of the average cost of each
phase. Lifetime costs of cancers were estimated
from the costs calculated above incorporate
survival rates of the cancers. RESULTS:
The
results showed 895 patients survived less than one
year and each patient spent NT$204,430 during this
period. For those survived more than one year,
terminal phase resulted in the highest costs which
was NT$353,910. The initial phase cost for each
patient is NT$181,923 and the monthly cost for
continuing phase is NT$9,239. For liver cancer
patient the 5 year lifetime cost is NT$409,813 and
10 year lifetime cost is NT$569,809.
CONCLUSIONS: Exploring the lifetime cost of
cancer will benefit not only the health policy
making but also the clinical decision-making. |
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PCN4 |
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ECONOMIC EVALUATION OF A NEW
DIAGNOSTIC METHOD FOR DETECTING THE METASTASIS OF
BREAST CANCER
Miyake K, Kamae I, Yanagisawa S, Kobe
University, Kobe, Hyogo, Japan
The metastasis to the sentinel lymph nodes (SLN)
is a key to determine whether or not a dissection
of axillaries lymph nodes should be performed at
the early stage of breast cancer, which
significantly affects the prognosis and HRQOL of a
patient. OBJECTIVE:
To evaluate the
cost-effectiveness of OSNA (One Step Nucleic Acid
Amplification)-based new diagnostic method for
navigation surgery of the SLNs developed by Sysmex
Corporation, Kobe, Japan. METHODS:
A decision
analytic model was constructed regarding
treatments of breast cancer at the early stage.
One arm of the decision tree was based upon the
conventional pathological examinations for SLNs.
The intra-operative pathological examinations show
relatively low sensitivity of diagnosis with less
than 80%. Hence, it was assumed that some patients
should have additional surgery to remove
metastasized axillaries lymph nodes preceded by
dissecting the primary tumors and the SLNs. The
other arm was for the OSNA-based testing, which is
expected to achieve high sensitivity and rapid
detection. We employed more than 95% sensitivity
and almost 100% specificity reported by the OSNA
clinical studies at Japanese institutions.
Utilities and costs in each arm were obtained from
English and Japanese literature. The cost of OSNA-based
testing were assumed to be equal to those of
conventional examinations since the OSNA is not
yet available in the market due to developing.
RESULTS:
The average cost per unit utility of a
patient for the OSNA-based test (US$17,405) was
slightly lower, with US$60, than that of the
conventional pathological examinations (US$17,465)
in five-year following-up duration with the
endpoint of recurrence. CONLUSIONS:
The newly
developed OSNA-based test for detecting the
metastasis of breast cancer showed an advantage of
lower average cost per utility of a patient
comparing to the conventional pathological
examinations. It is a promising technology for
efficiently detecting the early-stage metastases
of breast cancer.
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PCN5 |
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DOCUMENTATION OF PHARMACY
COST IN THE PREPARATION OF CHEMOTHERAPY INFUSIONS
IN ACADEMIC AND COMMUNITY-BASED ONCOLOGY PRACTICES
Brixner D, Oderda GM, Nickman N, University
of Utah College of Pharmacy, Salt Lake City, UT,
USA
OBJECTIVE:
Significant changes in Medicare
reimbursement for outpatient oncology services are
included as part of the Medicare Modernization Act
of 2003. The objective of this study was to
identify the “true cost” associated with the
drug-related handling for the preparation and
delivery of chemotherapy doses. METHODS:
Two academic medical outpatient infusion centers
(Universities of Utah and Wisconsin) and two
community cancer centers in the U.S. (Fairfax,
Virginia and Montgomery, Alabama) provided data
used to estimate all “fixed costs” associated with
the preparation of chemotherapy including drug
storage, space, insurance management, inventory
and waste management, pharmacy staff payroll,
equipment, supplies, information resources and
shipping. These costs were annualized and then
divided by the number of chemotherapy doses given
at each site per year. A Time-and-Motion study was
also performed to determine what tasks were
conducted by pharmacy staff and how much time was
spent in the preparation of the top fifteen
chemotherapeutic drugs and regimens used across
the four sites. Pharmacy staff were observed as to
the time spent in each task relative to the total
time in an average shift to determine the
proportion of total work hours dedicated to the
preparation of the selected chemotherapy drugs.
RESULTS:
The total average fixed costs for the
preparation of chemotherapy doses across all sites
was $36.03 (range $32.08 for Virginia and $67.19
for Utah). Data from the four centers was
projected to the 3,990,495 million estimated
chemotherapy infusions administered to a national
Medicare population in 2003 resulting in a total
annual cost to Medicare for chemotherapy
preparation of $143,777,535. Pharmacists were
observed to spend the majority of their day (90 %
or higher) on tasks directly related to the
preparation of these agents. CONLUSIONS:
Preparation costs for chemotherapy are significant
and need to be considered in determining
reimbursement rates for administration.
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PCN6 |
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IMPACT OF BREAST CANCER
TREATMENT ON HEALTH RELATED QUALITY OF LIFE
Raetai K, Pratheepawanit N, Weerapreeyakul
T, Khon Kaen University, Khon Kaen, Thailand OBJECTIVE:
Breast cancer is the second
most common cancer in Thai women. Current
treatments for breast cancer have shown increasing
survival rate as well as side effects. This study
presents HRQOL outcome of breast cancer treatment
using two designs. First, through a
cross-sectional study, 167 breast cancer patients
receiving care at Khon Kaen Hospital were
recruited into three groups: I) newly diagnosed
without treatment (n=57), II) undergoing
chemotherapy (n=80), and III) completed
chemotherapy (n=30). Patients mean age was 51
years (range 31-82) with the majority (76.5%) in
early stage. METHODS:
HRQOL was assessed
using Thai Functional Assessment of Cancer
Therapy-Breast (FACTB) version 4, consisting of
five domains: Physical (PWB), Social (SWB),
Emotional (EWB) and Functional (FWB) well-beings
plus a breast cancer subscale (BCS). Linear
regression analysis of QOL scores among the three
groups, adjusting for age, disease stage,
concomitant disease and hotflush showed patients
in group II had lower HRQOL scores than those in
group I in most domains, particularly in BCS (beta
= -1.6). RESULTS:
By contrast, patients
group III showed better HRQOL than those in group
I and II. HRQOL was greater than before treatment,
significant in PWB (beta = 2.2), EWB (beta = 3.4),
FACT-G (beta = 8.5) and FACT-B (beta = 9.0). The
results of side effects were further evaluated in
the second study, where HRQOL was evaluated at the
treatment initiation and after six months (N=24).
Significantly lower HRQOL scores during the
treatment were found. Adjusting for age, disease
and side effects, mucositis caused a significant
decline in PWB (beta = -12.9) and EWB (beta =
-10). CONLUSIONS:
The findings suggest
that breast cancer treatment improves patient’s
HRQOL, with a temporary reduction of HRQOL scores
in the breast cancer subscale while receiving
treatment. Side effect management, especially for
mucositis, could lead to improved HRQOL of these
patients.
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PCN7 |
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PATIENT PREFERENCE AND
WILLINGNESS-TO-PAY FOR PEMETREXED VERSUS DOCETAXEL
IN THE SECOND-LINE TREATMENT OF ADVANCED NON-SMALL
CELL LUNG CANCER: A DISCRETE CHOICE CONJOINT
ANALYSIS
Brown A1, Aristides M2, Fitzgerald P3,
Liepa A4, Boyer M4, Clarke S5, 1Medical Technology
Assessment Group: A Unit of IMS Health, Chatswood,
NSW, Australia, 2M-TAG, a division of IMS Health
Economics and Outcomes Research, London, United
Kingdom, 3M-TAG, A division of IMS Health
Economics and Outcomes Research, London, United
Kingdom, 4Eli Lilly and Company, Indianapolis,
Indiana, USA, 5Sydney Cancer Centre, Camperdown,
Australia OBJECTIVE:
The
value of health-related quality-of-life
assessments is established and inclusion in
clinical decision-making is increasing. A phase
III trial in second-line therapy for advanced
non-small cell lung cancer (NSCLC) showed similar
efficacy for pemetrexed, versus docetaxel, but key
safety benefits. A study in the United Kingdom
(UK) and France was conducted to determine patient
value associated with individual toxicity
profiles. METHODS:
A discrete choice
conjoint analysis was used to quantify patient
preference and willingness-to-pay (WTP) for
chemotherapy. Trial data plus expert opinion
identified clinically meaningful toxicities that
were statistically significantly different. Levels
of risk of: febrile neutropenia (requiring
hospitalisation) and nausea, neuropathy, alopecia,
were evaluated. A sample size of 70 pre-treated
NSCLC patients per country was calculated
following a pilot. Patients considered unique,
randomly generated sets of 10 pair-wise choice
scenarios representing levels for toxicity
attributes plus cost, designed to elicit
trade-offs. Logistic regression analysis was
applied to the stated scenario preferences against
the individual attribute levels. RESULTS:
Patients (N=140) were predominantly male; mean age
61 years and Stage III disease (60%). Pemetrexed
was preferred to docetaxel at zero cost, with a
probability of 0.81 in the UK and 0.90 in France.
Overall WTP was in favour of pemetrexed, driven
primarily by the risk of febrile neutropenia in
the UK, odds ratio (OR) 4.4. In France, preference
was driven by a reduced risk of febrile
neutropenia (OR 3.2) and neuropathy (OR 3.2). Cost
was not a significant determinant of choice in
France; however in the UK, cost was significant
determinant of choice. CONLUSIONS:
NSCLC
patients prefer the enhanced toxicity profile with
pemetrexed, which translates to valuable
quality-oflife gains in the second-line setting.
These data provide sensitive strength of
preference measures and may be useful for
decision-making purposes by patients, clinicians,
and formulary committees.
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PCN8 |
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METHODS OF COST DATA
COLLECTION FOR PHARMACOECONOMIC STUDY ALONG WITH A
CLINICAL TRIAL IN JAPAN
Fukuda T1, Mouri M2, Hirose N2, Ohsumi S3,
Mukai H4, Morita S5, Imai H6, Watanabe T7,
Shimozuma K8, Ohashi Y1, 1University of Tokyo,
Bunkyo, Tokyo, Japan, 2Japan Clinical Research
Support Unit, Bunkyo, Tokyo, Japan, 3Shikoku
Cancer Center, Matsuyama, Kagawa, Japan, 4National
Cancer Center, Kashiwa, Chiba, Japan, 5Kyoto
University, Kyoto, Japan, 6Asahikawa Medical
College, Asahikawa, Hokkaido, Japan, 7Hamamatsu
Oncology Center, Hamamatsu, Shizuoka, Japan,
8University of Marketing and Distribution
Sciences, Kobe, Japan OBJECTIVE:
Though cost data
is essential for pharmacoeconomic study, the
method of cost data collection is not standardized
in Japan. We started cost data collection along
with a clinical trial on breast cancer
treatment(National Surgical Adjuvant Study of
Breast Cancer: N-SAS BC02). The trial has been
supported by Comprehensive Support Project for
Oncological Research of Breast Cancer. The aim of
this study is to demonstrate our approach for both
direct and indirect cost data collection and
discuss some issues raised through the process.
METHODS:
N-SAS BC02 is a randomized controlled
trial of two regimens for breast cancer. From a
societal perspective, both direct and indirect
cost has been collected from a sample of 100
participants of the trial upon consent. For direct
medical cost, we collected health insurance claims
which were issued every month from each hospital
for one year. Even though unit price of each
medical procedure and drug is determined by the
government, total cost of treatment is unsure,
mainly because combination of procedures are
different among health care providers. Direct
non-medical cost includes cost for transportation
and supportive devices. Indirect cost was defined
as labor loss for participants. Direct non-medical
cost and labor loss days were asked through a
selfadministered questionnaire from each
participant. RESULTS:
Electric data which
were kept in a hospital for making health
insurance claims were not easy to use because data
format was not standardized. We propose to use
standardized health insurance claim format for
electronic submission. CONLUSIONS:
Though
electronic submission is not common yet, it will
be the best way to collect paper-based claims and
put the electronic code for each procedure and
drug for a while. Because it is difficult to
collect those data retrospectively,it will be
important to consider cost data collection
especially direct non-medical and indirect cost
along with a clinical trial.
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