Cost effectiveness of tyrosine kinase inhibitor therapy in metastatic gastrointestinal stromal tumors

Abstract

Background:

Tyrosine kinase inhibitors (TKIs) such as imatinib mesylate have revolutionized the treatment of primary unresectable and/or metastatic gastrointestinal stromal tumors (GISTs), providing durable disease control and extended survival. Although most patients eventually progress on therapy, dose escalation has been shown to benefit some patients. Sunitinib, a multitargeted kinase inhibitor is effective against imatinib-resistant or intolerant GIST patients. Although the cost of TKI therapy in GIST is high, no other effective systemic treatment options exist.

Objective:

Review pharmacoeconomic studies to determine the cost effectiveness (CE) of 1st- and 2nd-line TKI therapies in GIST.

Methods:

A literature review using Medline and PubMed databases was conducted to identify published economic analyses of TKI therapy in GIST. Key results from these studies were analyzed.

Results:

Six pharmacoeconomic studies were identified, including three analyses of 1st-line imatinib and three analyses of 2nd-line sunitinib. These studies employed various time horizons and discount rates and modeled CE from a number of different perspectives. Most of the pharmacoeconomic studies reviewed used survival as their efficacy endpoint, projecting outcomes beyond available data to model CE. Analyses of 2nd-line sunitinib using survival additionally faced the challenge of adjusting for the effect of placebo crossover to active treatment in the pivotal phase III study. Most studies used Markov techniques with a range of transition probabilities.

Conclusions:

Published pharmacoeconomic studies of 1st- and 2nd-line TKI therapy for advanced GIST employ various time horizons, discount rates, and different CE models. Consequently, these differences make comparisons between studies difficult. Studies of 1st-line imatinib concluded that imatinib was cost effective in advanced, metastatic GIST. Likewise, based on data reviewed here, 2nd-line sunitinib appears to be cost effective in patients with advanced GIST who are intolerant/resistant to imatinib. Key limitations of this review included inconsistency among the studies evaluated with regard to methodologies, countries of origination (currency and healthcare systems), and patient demographics.     

基于综合评价指标的火电厂风机选型方法研究

本文通过分析风机运行特性,建立了风机选型新模型。通过全寿命周期成本表示其经济性,ADC效能评估法表示其技术性。     

宏观利率政策的有效性研究

宏观利率政策对经济增长具有有效性。尽管我国几次调整利率的效果不如预期那么好 ,但否定货币政策在我国已失去作用的看法是错误的。从IS -LM分析可以看出货币政策的有效性 ,但其有效性受着一些因素的约束。为此 ,必须有适当的政策促进利率政策的有效性。     

质量体系运行机制研究

简要分析了质量体系运行机制的涵义及形成机理，讨论了质量体系运行中存在的问题，并提出了对策建议。     

Cost effectiveness of oral fludarabine in chronic lymphocytic leukaemia: the French case

Summary

The objective was to assess the medicoeconomic impact of initial and subsequent treatments based on oral fludarabine, intravenous chemotherapy (mini-CHOP) and chlorambucil in chronic lymphocytic leukaemia.

A Markov model has been defined to encompass the 18 strategies over a 3-year period after starting the first treatment. Costs of treatments, side effects and follow-up have been calculated by crossing data from published prospective trials, specific hospital databases and French resource-based relative value scales. When treatments were based on mini-CHOP, different possibilities offered for hospital care were taken into account.

Probalistic sensitivity analysis was performed.

Whatever the modality of hospital care for mini-CHOP, the strategies based on oral fludarabine as first-line treatment are not only more effective but are also cost effective and dominate other types of scenarios.

Fludarabine given orally should be preferred to mini-CHOP or chlorambucil as a first-line treatment for patients with chronic lymphocytic leukaemia.     

Cost effectiveness of asthma treatment with a breath-actuated inhaler: how has the story changed?

Abstract

Objectives: A database analysis evaluating the comparative costs and outcomes of asthma treatment with breath-actuated inhalers (BAIs) and metered-dose inhalers (MDIs) has previously been undertaken in 2001. This analysis found that, despite the higher acquisition cost associated with BAIs, economies elsewhere meant that the overall cost associated with BAIs was lower than MDIs. Between 2001 and 2007, the comparative price of MDIs was significantly reduced thus widening the gap between the comparative acquisition cost of MDIs and BAIs. Furthermore, the introduction of specific targets for asthma review included a requirement for regular checks on inhaler technique. Such initiatives may be expected to enhance the overall effectiveness of MDIs. Given the potential impact of such changes, it appeared to be timely to update the original database analysis to assess the extent to which the original findings have been altered by changes in the clinical and economic environment over the past 5 years.

Methods: As in all chronic diseases, it is important that economic analyses evaluate cost effectiveness over as long a period as possible, and so the 2006 analysis was conducted over a 12- and a 24-month time period.

Results: The results emphasised that the clinical benefits associated with BAIs for certain patients can still be translated into greater cost effectiveness, but that altered cost structures required a longer time period for the greater cost effectiveness of BAIs to become evident.

Conclusion: Since completing this study, the reimbursement costs for beclometasone MDIs have increased significantly (since October 2007) due to the discontinuation of Becotide and Becloforte. As a consequence of this higher acquisition cost for MDI inhalers, the current cost-effectiveness advantages of BAI compared to MDI can be expected to be even greater than that identified in the study.     

Innovative human resource practices and organizational commitment: an empirical investigation

In the contemporary business environment, human resource (HR) is an indispensable input for organizational effectiveness. Hence, an effective management of human resources has an important role to play in the performance and success of organizations. Competitive pressures have encouraged organizations to be proactive in diagnosing HR problems and to adopt more innovative HR practices since these were no longer a matter of trend, but rather of survival. The present study attempted to explore the relationship of three dimensions of innovative human resource practices (IHRPs): that is, the extent of introduction of IHRPs, their importance for organizational goal achievement and satisfaction with implementation of IHRPs, with organizational commitment (OC). Regression analyses showed that the perceived extent of introduction of innovative human resource practices by the organizations was the most significant predictor of organizational commitment.     

Pharmacoeconomic analysis of paricalcitol and calcitriol in the treatment of secondary hyperparathyroidism in haemodialysis: impact of hospitalisations and survival

Summary

The objective of this study was to evaluate the cost effectiveness of paricalcitol injection compared with calcitriol injection when used to reduce parathyroid hormone levels in patients undergoing haemodialysis. A decision tree was developed to model the 1-year costs and outcomes of therapy for secondary hyperparathyroidism from a US government payer's perspective (2005 US$). Probabilities of hospitalisations and survival with paricalcitol and calcitriol were obtained from published observational studies.

When only drug costs and survival were considered, the incremental cost effectiveness of paricalcitol over calcitriol was $9,900 per life saved. When utilities were included, the incremental cost-effectiveness ratio for paricalcitol compared with calcitriol was $13,200 per quality-adjusted life year. When both drug and hospitalisation costs were included in a cost analysis, paricalcitol treatment was cost saving compared with calcitriol, and when hospitalisation costs were included in both the cost-effectiveness analysis and cost-utility analysis paricalcitol demonstrated first-order dominance, cost savings and cost effectiveness.

This decision analysis demonstrated that paricalcitol injection is both cost effective and cost saving compared with calcitriol injection.     

Cost effectiveness of palivizumab for RSV prevention in high-risk children in the Netherlands

Abstract

Background: Respiratory syncytial virus (RSV) is a common pathogen that is the leading cause of lower respiratory tract infections in young children. High-risk children are at risk of severe infection, which may require hospitalisation. RSV is also associated with a high risk for respiratory morbidity and mortality, which may have long-term clinical and economic consequences.

Objective: To assess the cost effectiveness of palivizumab, a humanised monoclonal antibody, used as prevention against severe respiratory syncytial virus (RSV) infection requiring hospitalisation, in the indication of preterm infants and infants with preterm/bronchopulmonary dysplasia and in the second indication of children with congenital heart disease in the Dutch healthcare setting.

Methods: A decision-tree model was used to estimate the cost effectiveness of palivizumab, used as a preventative treatment against severe respiratory syncytial virus (RSV) infection, in high-risk groups of children in the Netherlands. The analysis was based on a lifetime follow-up period in order to capture the impact of palivizumab on long-term morbidity and mortality resulting from an RSV infection. Data sources included published literature, the palivizumab pivotal trials, official price/tariff lists and national population statistics. The study was conducted from the perspective of society in the Netherlands.

Results: The use of palivizumab results in undiscounted incremental cost-effectiveness ratios of €12,728/QALY and €4,256/QALY in the in preterm/bronchopulmonary dysplasia and congenital heart disease indications, respectively. Inclusion of indirect costs leads to even more favourable cost-effectiveness outcomes. The study is limited by a number of conservative assumptions. It was assumed that palivizumab only affects the occurrence of RSV hospitalisation and does not influence the severity of the RSV infection. Another assumption was that international clinical trial data and data on utilities could be applied to the Dutch healthcare setting.

Conclusion: Palivizumab provides cost-effective prophylaxis against RSV in high-risk infants. The use of palivizumab in these children results in positive short- and long-term health-economic benefits.     

Cost-per-remission analysis of infliximab compared to adalimumab among adults with moderate-to-severe ulcerative colitis

Abstract

Objective:

To compare cost per remission (CPR) of infliximab (IFX) versus adalimumab (ADA) for the treatment of moderately-to-severely active UC.

Methods:

This is CPR model comparing IFX and ADA in the treatment of UC using clinical trial data. Clinical outcome measures include clinical remission and sustained clinical remission (SCR). Economic endpoints were modeled as medication costs. CPR ratios and number needed to treat (NNT) costs were computed at 8, 52, and 54 weeks.

Results:

CPR for bio-naïve patients for IFX and ADA at weeks 8, 52, and 54 was $42,086 vs. $79,558: $147,379 vs. $320,097; $147,379 vs. $330,767, respectively. CPR for all patients for IFX and ADA at weeks 8, 52, and 54 was $42,086 vs. $113,812; $147,379 vs. $349,197; $147,379 vs. $360,836, respectively. Cost per SCR for bio-naïve patients and all patients for IFX and ADA was $203,205 vs. $682,873 and $203,205 vs. $698,393, respectively. NNT and NNT costs for clinical remission for bio-naïve patients at weeks 8, 52, and 54 were lower for IFX (4 vs.10, $40,235 vs. $81,945; 5 vs.10, $134,115 vs. $307,293; 5 vs. 10, $134,115 vs. $317,536, respectively) than for ADA. NNT and NNT costs for clinical remission for all patients at weeks 8, 52, and 54 were lower for IFX (4 vs.14, $40,235 vs. $114,723; 5 vs.11, $134,115 vs. $338,022; 5 vs. 11, $134,115 vs. $349,290, respectively) than for ADA. NNT and NNT costs for SCR for bio-naïve and all patients were lower for IFX (8 vs. 22, $214,584 vs. $676,045; 8 vs.23, $214,584 vs. $706,774) than for ADA. Study limitations include lack of head-to-head trial data, different primary endpoints between the two clinical trials, and indirect costs were not included.

Conclusion:

IFX had lower CPR and cost per SCR than ADA in the treatment of moderately to severely active UC.