Dutch Economic Value of Radium-223 in Metastatic Castration-Resistant Prostate Cancer (vol 16, pg 133, 2018)

The article Dutch Economic Value of Radium-223 in Metastatic Castration-Resistant Prostate Cancer, written by Michel L. Peters, Claudine de Meijer, Dirk Wyndaele, Walter Noordzij, Annemarie M. Leliveld-Kors, Joan van den Bosch, Pieter H. van den Berg, Agni Baka, Jennifer G. Gaultney was originally published electronically on the publisher's internet portal (currently SpringerLink) on 2nd September, 2017 without open access

Five-year cost-effectiveness analysis of the European Fans in Training (EuroFIT) physical activity intervention for men versus no intervention

OBJECTIVES: Increasing physical activity reduces the risk of chronic illness including Type 2 diabetes, cardiovascular disease and certain types of cancer. Lifestyle interventions can increase physical activity but few successfully engage men. This study aims to investigate the 5 year cost-effectiveness of EuroFIT, a program to improve physical activity tailored specifically for male football (soccer) fans compared to a no intervention comparison group. METHODS: We developed a Markov cohort model in which the impact of improving physical activity on five chronic health conditions (colorectal cancer, Type 2 diabetes, coronary heart disease, stroke and depression) and mortality was modelled. We estimated costs from a societal perspective and expressed benefits as quality adjusted life years (QALYs). We obtained data from a 4-country (England, Netherlands, Portugal and Norway) pragmatic randomised controlled trial evaluating EuroFIT, epidemiological and cohort studies, and meta-analyses. We performed deterministic and probabilistic sensitivity analyses to assess the impact of uncertainty in the model's parameter values on the cost-effectiveness results. We used Monte Carlo simulations to estimate uncertainty and presented this using cost-effectiveness acceptability curves (CEACs). We tested the robustness of the base case analysis using five scenario analyses. RESULTS: Average costs over 5 years per person receiving EuroFIT were €14,663 and per person receiving no intervention €14,598. Mean QALYs over 5 years were 4.05 per person for EuroFIT and 4.04 for no intervention. Thus, the average incremental cost per person receiving EuroFIT was €65 compared to no intervention, while the average QALY gain was 0.01. This resulted in an ICER of €5206 per QALY gained. CEACs show that the probability of EuroFIT being cost-effective compared to no intervention is 0.53, 0.56 and 0.58 at thresholds of €10,000, €22,000 and €34,000 per QALY gained, respectively. When using a time horizon of 10 years, the results suggest that EuroFIT is more effective and less expensive compared to (i.e. dominant over) no intervention with a probability of cost-effectiveness of 0.63 at a threshold of €22,000 per QALY gained. CONCLUSIONS: We conclude the EuroFIT intervention is not cost-effective compared to no intervention over a period of 5 years from a societal perspective, but is more effective and less expensive (i.e. dominant) after 10 years. We thus suggest that EuroFIT can potentially improve public health in a cost-effective manner in the long term

Cost-effectiveness of radium-223 compared to best standard of care, abiraterone acetate and enzalutamide in the treatment of castration resistant prostate cancer in the Netherlands

Background: The treatment landscape of metastatic castration resistant prostate cancer (mCRPC) has changed with the introduction of abiraterone acetate (AA), enzalutamide (EN) and radium-223 (Ra-223). Little is known about the cost-effectiveness of these novel agents. This study investigates the cost-effectiveness of Ra-223 in the Netherlands. First, the costeffectiveness of Ra-223 will be evaluated against best supportive care (BSoC) in the mCRPC population. Second, the cost-effectiveness of Ra-223 in the post-chemo setting will be evaluated against the active comparators AA and EN. Material and Methods: A Markov model with five health states is used to describe disease progression and evaluate the cost-effectiveness. The health states are: progression-free survival (PFS) without a symptomatic skeletal event (SSE), progressed disease without SSE, PFS after experiencing a SSE, progressed disease after experiencing a SSE, and death. Disease progression is measured by alkaline phosphatase (comparator=BSoC) or prostate specific antigen. Efficacy, safety and quality adjusted life year (QALY) data were extracted from Phase III RCT's. Efficacy and safety of Ra-223 versus AA and EN was obtained by indirect treatment comparisons. The model has been validated by specialists treating mCRPC. Analyses were performed from a societal perspective, including costs outside the health care budget. Results: Compared to BSoC, Ra-223 has higher quality adjusted survival (0.29 QALYs) and lifetime costs (€22.485) in mCRPC patients, resulting in an incremental cost-effectiveness ratio of €78.642 per QALY. This is below the proposed Dutch threshold of €80.000. Probabilistic sensitivity analyses reveal a 33% chance for Ra-223 to be cost-effective compared to BSoC at this threshold. Cost-effectiveness of Ra-223 in the postchemo setting compared to active comparators is as follows. While quality adjusted survival of Ra-223 is similar to AA, Ra-223 has lower lifetime costs (€5.905), which are mainly driven by lower drug and SSE treatment costs. Probabilistic sensitivity analyses show a 78% chance for Ra-223 to be cost-effective compared to AA at a threshold of €80.000. Compared to EN, Ra-223 has a slightly lower QALY gain (-0.06) and lower lifetime costs (-€7.255), resulting in only a 19% chance of EN to be cost-effective compared to Ra-223 at a €80.000 threshold. Conclusions: Our model suggests that Ra-223 may be cost-effective compared to BSoC and AA in the Netherlands, with Ra-223 even dominating AA (evaluated in post-chemo patients only). Although EN may lead to slightly more health in post-chemo patients, this health gain is accompanied by extra costs resulting in EN not being considered costeffective compared to Ra-223 according to the Dutch threshold. Ra-223's cost-effectiveness compared to AA and EN should be interpreted with caution due to indirect treatment comparisons

Cost-effectiveness of Guided Internet-Delivered Cognitive Behavioral Therapy in Comparison with Care-as-Usual for Patients with Insomnia in General Practice

Study objectives: Clinical guidelines recommend cognitive-behavioral therapy for insomnia (CBT-I) as first-line treatment. However, provision of CBT-I is limited due to insufficient time and expertise. Internet-delivered CBT-I might bridge this gap. This study aimed to estimate the cost-effectiveness of guided, internet-delivered CBT-I (i-Sleep) compared to care-as-usual for insomnia patients in general practice over 26 weeks from a societal perspective.Methods: Primary outcomes were the Insomnia Severity Index (ISI, continuous score and clinically relevant response), and Quality-Adjusted Life Years (QALYs). Societal costs were assessed at baseline, and at 8 and 26 weeks. Missing data were imputed using multiple imputation. Statistical uncertainty around cost and effect differences was estimated using bootstrapping, and presented in cost-effectiveness planes and acceptability curves.Results: The difference in societal costs between i-Sleep and care-as-usual was not statistically significant (-€318; 95% CI -1282 to 645). Cost-effectiveness analyses revealed a 95% probability of i-Sleep being cost-effective compared to care-as-usual at ceiling ratios of €450/extra point of improvement in ISI score and €7,000/additional response to treatment, respectively. Cost-utility analysis showed a 67% probability of cost-effectiveness for i-Sleep compared to care-as-usual at a ceiling ratio of 20,000 €/QALY gained.Conclusions: The internet-delivered intervention may be considered cost-effective for insomnia severity in comparison with care-as-usual from the societal perspective. However, the improvement in insomnia severity symptoms did not result in similar improvements in QALYs

Five-year cost-effectiveness analysis of the European Fans in Training (EuroFIT) physical activity intervention for men versus no intervention

Objectives: Increasing physical activity reduces the risk of chronic illness including Type 2 diabetes, cardiovascular disease and certain types of cancer. Lifestyle interventions can increase physical activity but few successfully engage men. This study aims to investigate the 5 year cost-effectiveness of EuroFIT, a program to improve physical activity tailored specifically for male football (soccer) fans compared to a no intervention comparison group. Methods: We developed a Markov cohort model in which the impact of improving physical activity on five chronic health conditions (colorectal cancer, Type 2 diabetes, coronary heart disease, stroke and depression) and mortality was modelled. We estimated costs from a societal perspective and expressed benefits as quality adjusted life years (QALYs). We obtained data from a 4-country (England, Netherlands, Portugal and Norway) pragmatic randomised controlled trial evaluating EuroFIT, epidemiological and cohort studies, and meta-analyses. We performed deterministic and probabilistic sensitivity analyses to assess the impact of uncertainty in the model's parameter values on the cost-effectiveness results. We used Monte Carlo simulations to estimate uncertainty and presented this using cost-effectiveness acceptability curves (CEACs). We tested the robustness of the base case analysis using five scenario analyses. Results: Average costs over 5 years per person receiving EuroFIT were €14,663 and per person receiving no intervention €14,598. Mean QALYs over 5 years were 4.05 per person for EuroFIT and 4.04 for no intervention. Thus, the average incremental cost per person receiving EuroFIT was €65 compared to no intervention, while the average QALY gain was 0.01. This resulted in an ICER of €5206 per QALY gained. CEACs show that the probability of EuroFIT being cost-effective compared to no intervention is 0.53, 0.56 and 0.58 at thresholds of €10,000, €22,000 and €34,000 per QALY gained, respectively. When using a time horizon of 10 years, the results suggest that EuroFIT is more effective and less expensive compared to (i.e. dominant over) no intervention with a probability of cost-effectiveness of 0.63 at a threshold of €22,000 per QALY gained. Conclusions: We conclude the EuroFIT intervention is not cost-effective compared to no intervention over a period of 5 years from a societal perspective, but is more effective and less expensive (i.e. dominant) after 10 years. We thus suggest that EuroFIT can potentially improve public health in a cost-effective manner in the long term