Cost effectiveness of prophylactic HPV 16/18 vaccination in Finland: results from a modelling exercise

Objectives: the study aims to estimate the clinical-impact and cost-effectiveness value of adding human papillomavirus 16/18 vaccination against cervical cancer among women currently undergoing organised screening in Finland.

Methods: A Markov cohort model evaluating high-risk HPV infections and cervical cancer (CC) cases combined with screening has been customised to the Finnish setting. The model outcome for a cohort of 30,000 girls aged 10 years was calibrated to age-specific annual number of Pap smears, CC incidence and mortality.

Results: The observed age-specific incidence and mortality rates of CC closely match the data replicated by the model. The model predicts that with a 90% vaccine coverage rate, CC cases and mortality would be reduced by 70%. In the base-case analysis with a discount rate of 3% the incremental cost per quality-adjusted life-years (QALY) gained, from a healthcare perspective, was €17,294. Without discounting this value is €2,591/QALY gained.

Conclusions: The analysis suggests that implementing prophylactic CC vaccination within the current screening system would substantially reduce CC cases and deaths, as well as the overall disease burden expressed in pre-cancer lesions averted. Vaccination could be a cost-effective intervention in Finland despite the fact that the number of CC cases and deaths are currently relatively low. Conservative estimates of the cost effectiveness of the vaccination were provided since it was not possible to assess herd protection induced by vaccination using this Markov model.     

Cost of managing constipation among terminally ill cancer patients treated with transdermal fentanyl and 12 hour sustained-release morphine in Canada

Summary

This study examined the cost of treating constipation among terminally ill cancer patients receiving transdermal fentanyl and 12 hour sustained-release morphine in Ontario, Canada. A decision tree was constructed that modelled the treatment paths and associated resource use attributable to managing constipation among patients receiving both opioids using a randomised clinical trial and information on patient management obtained from a panel of eight physicians and two community nurses who specialise in palliative care in Ontario. The cost to the Ontario Ministry of Health of managing constipation in a patient receiving transdermal fentanyl and 12 hour sustained-release morphine was estimated to be $31.77 and $52.76 respectively during the first two weeks of treatment. When the opioids' acquisition costs were included, the two-weekly cost of managing a patient with transdermal fentanyl and 12 hour sustained-release morphine was $123.24 and $119.70 respectively. The results were sensitive to the incidence of constipation attributable to each opioid, the rate and length of hospital admission and the efficacy of various treatments for constipation. We conclude that opioid acquisition costs alone should not dictate treatment choice for palliative care, but attention should also be paid to the costs of managing opioid-related adverse events and care should always be tailored to the needs and preferences of individual patients.     

The economic advantages of response in the treatment of advanced breast cancer

Summary

The introduction of a new class of drugs, the taxoids, has dramatically improved the outlook for patients with advanced, metastatic breast cancer. Second-line monotherapy with the most effective taxoid, docetaxel, in patients with anthracycline-resistant metastatic breast cancer, shows an overall response rate up to 55% in this patient population. Increased response rate is associated with improved quality of life for these patients.

We carried out a cost analysis to determine the economic benefits of being in a response state compared with the other health states associated with advanced breast cancer: stable, progressive or terminal disease.

We found that the cost of care for responders is 40% of that for early progressive disease and just over a third of that for late progressive disease. The costs associated with stable disease are only a little less than those for progressive disease, and are more than double the costs for patients who have responded to chemotherapy. The costs during terminal disease are the highest, and are more than nine times those associated with caring for responders.

Our findings confirm other studies which demonstrate that the cost of chemotherapy can be offset against the reduction in costs incurred for patients who remain in healthier states for longer. The key parameter determining the economic efficiency of treatments for advanced breast cancer is response rate.     

An economic comparison of the net clinical benefit and treatment costs of raltitrexed and 5-fluorouracil + leucovorin (Mayo regimen) in advanced colorectal cancer

Summary

Background

This paper describes an economic evaluation in which raltitrexed (Tomudex®) was compared with 5-fluorouracil (5-FU) + leucovorin (LV), and where net clinical benefits were related to differential health service costs. Raltitrexed, a specific inhibitor of thymidylate synthetase, has shown anticancer activity against a range of solid tumours.

Tomudex® is a registered trademark ofZeneca Pharmaceuticals

Materials and Methods

In a large, open, randomised, multicentre study in patients with advanced colorectal cancer, raltitrexed (n = 223) and 5-FU plus LV (n = 216) showed similar efficacy in terms of patient survival and objective response (i.e. tumour shrinkage rates). Palliative benefits were seen in both groups of patients and suggest that patients with stable disease are as likely to show improvement as those with a tumour response. Reductions compared with 5-FU plus LV in the number of toxicity days (median 1.5 vs 8 treatment days) and administration days (6 vs 22 days) with raltitrexed were consistent with a net clinical benefit.

Results

A cost minimisation analysis that drew on data from a number of sources showed direct medical costs per month to be similar for the two treatments (£781 for raltitrexed vs £834 for 5-FU + LV).

Conclusions

Raltitrexed therefore represents a clinically effective alternative to 5-FU plus LV (Mayo regimen) and offers net clinical benefit to patients with advanced colorectal cancer at no apparent additional cost.     

Healthcare costs associated with skeletal-related events in breast cancer patients with bone metastases

Background:

Patients with bone metastases secondary to breast cancer are pre-disposed to skeletal-related events (SREs), including spinal cord compression (SCC), pathologic fracture (PF), surgery to bone (SB), and radiotherapy to bone (RT).

Objective:

To document current patterns of healthcare utilization and costs of SREs in patients with breast cancer and bone metastases.

Methods:

This was a retrospective, observational study using the Thomson MedStat MarketScan Commercial Claims and Encounters database from 9/2002 to 6/2011. Study subjects included all persons with claims for breast cancer and for bone metastases, and ≥1 claims for an SRE. Unique SRE episodes were identified based on a gap of at least 90 days without an SRE claim, and classified by treatment setting (inpatient or outpatient) and SRE type (SCC, PF, SB, or RT).

Results:

Of 17,266 patients with breast cancer and bone metastases, 9142 (53%) had one or more SRE episodes. Among 5809 patients who met all other criteria, there were 7617 SRE episodes over mean (SD) follow-up of 17.2 (15.2) months. The percentage of episodes that required inpatient treatment ranged from 11% (RT) to 76% (SB). On average, inpatient SCC episodes (n?=?83 episodes) were most costly; while outpatient PF episodes (n?=?552 episodes) were least costly. Of the total SRE costs (mean [SE] $21,072 [$36,462]/episode), 36% were attributable to outpatient RT (n?=?5265 episodes) and 31% to inpatient PF (n?=?838 episodes).

Limitations:

The administrative claims data used in this study may lack sensitivity and specificity for identification of clinical events and may not be generalizable to other populations. Also, for some SRE episode categories, the number of events was small and cost estimates may lack precision.

Conclusion:

In patients with breast cancer and bone metastases, SREs are associated with high costs and hospitalizations.     

Economic value of narrow band imaging versus white light endoscopy for the characterization of diminutive polyps in the colon: systematic literature review and cost-consequence model

Aims: To demonstrate the economic implication of adopting narrow-band imaging (NBI) for the characterization of diminutive polyps in the colon from an English payer perspective.

Materials and methods: A decision-tree model was undertaken to perform a cost-consequence and budget impact analysis from the NHS England perspective in the UK, over a 7-year time horizon. Clinical inputs came from the published literature (both randomized controlled trials and meta-analyses) identified through a systematic literature review, and cost inputs came from national list prices and unpublished internal market data. Deterministic sensitivity analysis (DSA) was conducted on the budget impact results to assess their robustness.

Results: Optical diagnosis with NBI offered cost savings vs white light endoscopy (WLE) over 7 years due to reductions in histological exams, resections, and associated adverse events, while having minimal impact on health outcomes. Budget impact analysis demonstrated annual cost savings of £141 192 057 over 7 years, with histological exams being the biggest cost driver. DSA showed these results to be robust, but most sensitive to the cost of tariff with and without biopsy, and the cost of histological exam. Break-even analysis to explore how changing the unit cost and number of biopsies per patient would change the budget impact found NBI consistently offered net savings, even if the cost of biopsy was £0.

Limitations: Although every effort was made to ensure robustness of results, as with any model, there were some limitations including a lack of published data for certain clinical inputs and potential variation between model inputs and real-life cost and market share values.

Conclusions: Optical diagnosis with NBI was found to be equally effective compared with the standard of care (WLE), while potentially enabling cost savings from the NHS England perspective.     

我院2000—2010年肺癌病325例资料统计分析

目的:肺癌是最常见的肺原发性恶性肿瘤。通过统计分析,了解我市肺癌的发病特点以及变化趋势,为我市肿瘤防治工作提供详细的参考数据。方法:收集本院2000～2010年10年间确诊的肺癌病例资料,录入到Access数据库中进行统计分析。结果10年间共检出肺癌病例325例,其中后5年肺癌病例224例,较前5年多101例;45岁以上278例,占全部病例的85.53%,高峰年龄段为50～65岁组。其中,男286例,占88%;女39例,占12%。入院进行手术的病例共126例,占全部病例的38.76%。结论:本市肺癌发病率呈上升状态,男性多于女性。     

Real-world incidence and burden of adverse events among non-metastatic prostate cancer patients treated with secondary hormonal therapies following androgen deprivation therapy

Abstract

Aims: To describe the incidence and identify prognostic factors of central nervous system (CNS) adverse events (AEs) and any AEs (CNS, skin rash, or fracture) and evaluate the healthcare resource utilization (HCRU), direct medical costs, and therapy discontinuation associated with these AEs among non-metastatic prostate cancer (nmPC) patients who received secondary hormone therapies.

Methods and results: nmPC patients who had initiated secondary hormonal therapy with enzalutamide, bicalutamide, or abiraterone ≥1?year after androgen deprivation therapy (ADT) were identified in the MarketScan database. Survival analyses were used to describe the incidence of CNS or any AEs. Annual HCRU and costs were compared across patient groups (CNS AE vs no CNS AE; any AE vs no AE) using propensity score weighted generalized linear models. Multivariate Cox proportional hazards models were used to identify AE predictors and compare risks of discontinuation.

Results: The analysis included 532 patients who initiated secondary hormonal therapies, among whom 201 (38%) and 244 (46%) experienced a CNS AE and any AE, respectively. Median times to CNS AE and any AE from therapy initiation were 17.90 and 11.00?months, respectively. Predictors of any AE were any AE in the baseline period (≤6?months before starting therapy), Charlson Comorbidity Index (CCI) score (1 vs 0), surgical castration, and older age. Predictors of CNS AEs were CNS AE in the baseline period and CCI score (1 vs 0). CNS and any AEs were associated with significantly higher HCRU. CNS AEs were associated with significantly higher incremental total medical costs ($18,522). CNS AEs and any AEs significantly increased therapy discontinuation risk by 48% and 38%, respectively.

Conclusions: AEs increase the economic burden and therapy discontinuation among nmPC patients receiving secondary hormonal therapies subsequent to ADTs. These patients should be carefully evaluated for AEs to reduce therapy discontinuation, HCRU, and direct medical costs.     

肿瘤坏死因子与胃癌的关系

肿瘤坏死因子(tumor necrosis factor,TNF)是一种蛋白因子.在胃癌患者血清中TNF水平明显高于正常人群,血清TNF-a可作为胃癌病人病情判断和疗效的观察指标之一.TNF对胃癌细胞具有明显细胞毒和抑制作用,但不良反应多.通过联合用药,尤其与细胞因子、化疗药物及某些中药的协同作用,能使其更好地发挥抗瘤作用.