Custo-efetividade da adição de quimioterapia ao tratamento hormonal do câncer de próstata metastático sensível a hormônio ou localizado de alto risco

Objective: To assess the cost-effectiveness of chemohormonal therapy in patients with metastatic hormone-sensitive and non-metastatic high-risk prostate cancer. Methods: An analytical decision model was developed to determine the cost-effectiveness of chemohormonal therapy versus androgen deprivation therapy alone in patients with metastatic hormone-sensitive prostate cancer and patients with non-metastatic high-risk prostate cancer. The cost-effectiveness in metastatic patients with a high-volume disease was assessed separately. The model used data from randomized clinical trials and drug acquisition costs in Brazil. In addition, the costs of post-progression therapies have been included in this model. The benefits to health are expressed as the quality-adjusted life-years, and the incremental cost-effectiveness ratios were calculated. Results: Chemohormonal therapy may be associated with improved quality-adjusted life-years for all patient. The improvement was more than six times greater for patients with high-volume metastatic disease. In these patients, the incremental cost-effectiveness ratios were up to 74% lower than the incremental cost-effectiveness ratios of patients with non-metastatic disease. Conclusion: Chemohormonal therapy has been more cost-effective in patients with high-volume metastatic disease.Objetivo: Avaliar a relação custo-efetividade da adição de quimioterapia hormonal em pacientes com câncer de próstata metastático sensível a hormônio ou localizado de alto risco. Métodos: Um modelo de decisão analítico foi desenvolvido para determinar o custo-efetividade da adição de quimioterapia versus a monoterapia de privação de andrógeno para pacientes com câncer de próstata metastático hormônio-sensível e pacientes de alto risco com câncer de próstata não metastático. O custo-efetividade em pacientes metastáticos com um alto volume da doença foi verificado isoladamente. Os dados do modelo foram obtidos de ensaios clínicos randomizados utilizando custos de aquisição de medicamentos no Brasil. Os custos de terapias pós-progressão também foram incluídos no modelo. Os efeitos foram expressos em anos de vida ajustados por qualidade, e foram calculadas as razões de custo-efetividade incremental. Resultados: A adição de quimioterapia levou a um ganho de anos de vida ajustados por qualidade para todos os doentes. Este incremento foi seis vezes maior para os pacientes com doença metastática de alto volume. Nestes pacientes, as taxas do custo incremental por anos de vida ajustados por qualidade foram até 74% mais baixos do que o aumento das taxas dos pacientes com doença não metastática. Conclusão: A adição de quimioterapia foi mais custo-efetiva para pacientes com doença metastática de alto volume.Fac Med ABC, Santo Andre, SP, BrazilBeneficencia Portuguesa Sao Paulo, Sao Paulo, SP, BrazilUniv Paulista, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Sao Paulo, SP, BrazilMiami Univ, Sylvester Comprehens Canc Ctr, Oxford, OH 45056 USAUniv Fed Sao Paulo, Sao Paulo, SP, BrazilWeb of Scienc

In the Era of Cost-Effectiveness Analysis, Affordability Is a Limiting Factor for Patients' Access to Innovative Cancer Treatments

Over the past 5 years, 55 new anticancer drugs have been launched worldwide. Considering the increasing costs of innovative treatments, both the number and the relevance of cost-effectiveness analyses have increased, meaningfully supporting decision making by stakeholders and policy makers. Notably, cost-effective treatments remain unavailable to patients because they are still unaffordable for a multitude of payers. To discuss the differences between cost-effectiveness and affordability. We reviewed the most relevant data on the divergences between cost-effectiveness and affordability. In addition, we included our recommendations to improve patients' access to innovative cancer therapies. The increasing costs of recently launched antineoplastic drugs, as high as $150 000 per year, represent a major barrier to patients' access to treatments globally. In Brazil, for example, patients' access to innovative treatments depends greatly on whether the individual has private health insurance. In the public health sector, patients' access to cost-effective innovative treatments varies according to the financial capacity of the facility, leading to inequalities within the same healthcare system. We conclude that because of the socioeconomic inequality mostly seen in lower and middle-income countries, it is difficult to define a cost-effectiveness threshold by region or a willingness-to-pay threshold affordable to the entire population. We consider that benchmark interventions might help to find an affordable willingness-to-pay threshold, and league table interventions might help policy makers, physicians, and the society to share the decision making. •The cost of antineoplastic therapies is increasing for every new drug launched. The relevance of cost-effectiveness analysis studies is rising nowadays.•Nevertheless, a cost-effective treatment can be unaffordable for a multitude of payers, especially in lower and middle-income countries. The willingness to pay for a treatment can be heterogeneous within a country because of the socioeconomic inequality.•Novel strategies such as benchmark interventions and league table interventions might help to find an affordable willingness-to-pay threshold and establish a list of innovative drugs that the population needs most

Cost-effectiveness analysis of abiraterone, docetaxel or placebo plus androgen deprivation therapy for hormone-sensitive advanced prostate cancer

To evaluate the cost-effectiveness of the addition of chemotherapy or abiraterone to androgen deprivation. We developed an analytical model to determine the cost-effectiveness of the addition of docetaxel or abiraterone versus androgen deprivation therapy alone. Direct and indirect costs were included in the model. The effects were expressed in Quality-Adjusted Life Years adjusted for side effects. Compared to androgen deprivation therapy alone, the addition of chemotherapy and of abiraterone generated 0.492 and 0.999, respectively, in Quality-Adjusted Life Years. Abiraterone led to a Quality-Adjusted Life Years gain of 0.506 compared to docetaxel. The incremental costs per Quality-Adjusted Life Years were R$133.649,22 for docetaxel, R$ 330.828,70 for abiraterone and R$ 571.379,42 for abiraterone compared to docetaxel, respectively. The addition of chemotherapy to androgen deprivation therapy is more cost-effective than the addition of abiraterone to androgen deprivation therapy. However, discounts on abiraterone cost might improve cost-effectiveness

A paradigm shift for the treatment of hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-) advanced breast cancer: a review of CDK inhibitors

In the last 3 years, a novel class of targeted therapy has been approved for patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer. There are currently three approved agents, which are oral cyclin-dependent kinase 4/6 (CDK4/6) inhibitors. All of the approved drugs exhibit progression-free survival benefit when compared to standard of care and generally have less adverse events compared to traditional chemotherapeutic options. The treatment of HR+/HER2- advanced breast cancer is a continuously evolving landscape, and the addition of CDK4/6 inhibitors is the newest mechanism for treatment. In this review, we summarize all available data, highlight the unanswered questions, and discuss pharmacological differences between each CDK4/6 inhibitor

Definitive chemoradiotherapy for squamous head and neck cancer: cisplatin versus carboplatin? A meta-analysis

Aim: Concomitant chemoradiotherapy (with cisplatin or carboplatin) is an option of definitive treatment for squamous head and neck cancer. We aimed to perform a metaanalysis comparing those two platinum agents. Materials & methods: We carried out a systematic search on English literature between 1990 and 17 April 2015 according to the Cochrane review guidelines. Results: Five of 60 studies fulfilled inclusion criteria with 491 patients. There was no difference in response rate. Cisplatin tends to be more active systemically than carboplatin, without statistically significance5-year survival rate: 30 and 27%, respectively (p = 0.33). Conclusion: Despite the trend to improved outcomes in using cisplatin, carboplatin is also active and can be a reasonable option to treat patients.AmgenBristol-Meyers SquibRochePfizerMSDLillyAstra ZenecaSanofiPierre FabreUniv Fed Sao Paulo, Div Med Oncol, Sao Paulo, BrazilJohns Hopkins Singapore, Singapore, SingaporeHCor, Oncoclin Brazil, Sao Paulo, BrazilUniv Porto, Abel Salazar Biomed Inst, Dept Populat Studies, Oporto, PortugalUniv Porto, Dept Med, Fac Med, Oporto, PortugalUniv Algarve, Dept Biomed Sci & Med, Div Oncol, Campus Gambelas,Edificio 7,3 Andar, P-8005139 Faro, PortugalHosp Haroldo Juacaba, Clin Res Ctr, Fortaleza, Ceara, BrazilCeara Canc Inst, Ctr Oncol Sao Mateus, Dept Med Oncol, Fortaleza, Ceara, BrazilDivision of Medical Oncology, Universidade Federal de São Paulo (UNIFESP), São Paulo, BrazilWeb of Scienc