Burden of early, advanced and metastatic breast cancer in The Netherlands

BACKGROUND: The aim of this study was to estimate the total economic and health related burden of breast cancer in the Netherlands. METHODS: Data on incidence, prevalence, mortality and survival were extracted from the Dutch National Cancer Registry and were used to calculate the economic and health related burden of breast cancer for overall, DCIS (stage 0), early- (stage I), locally advanced- (stage II-III) and metastatic- (stage IV) breast cancer by age groups and by year (if applicable). RESULTS: The overall incidence of breast cancer increased from 103.4 up to 153.2 per 100,000 women between 1990 and 2014. The increase was driven by DCIS and early breast cancer as the incidence of locally advanced and metastatic breast cancer remained stable. Between 1990 and 2014, ten-year overall survival rates increased from 87% to 93% for early breast cancer, 41% to 62% for locally advanced- and from 6% to 9% for metastatic disease. Annually, breast cancer in the Netherlands is responsible for approximately 3100 deaths, 26,000 life years lost, 65,000 Disability Adjusted Life Years (DALYs) and an economic burden of €1.27 billion. CONCLUSIONS: This study provides a comprehensive assessment of the burden of breast cancer and subsequent trends over time in the Netherlands

Dabigatran for the Treatment and Secondary Prevention of Venous Thromboembolism; A Cost-Effectiveness Analysis for the Netherlands

Background Dabigatran was proven to have similar effect on the prevention of recurrence of venous thromboembolism (VTE) and a lower risk of bleeding compared to vitamin K antagonists (VKA). The aim of this study is to assess the cost-effectiveness (CE) of dabigatran for the treatment and secondary prevention in patients with VTE compared to VKAs in the Dutch setting. Methods Previously published Markov model was modified and updated to assess the CE of dabigatran and VKAs for the treatment and secondary prevention in patients with VTE from a societal perspective in the base-case analysis. The model was populated with efficacy and safety data from major dabigatran trials (i.e. RE-COVER, RECOVER II, RE-MEDY and RESONATE), Dutch specific costs, and utilities derived from dabigatran trials or other published literature. Univariate, probabilistic sensitivity and a number of scenario analyses evaluating various decision-analytic settings (e.g. the perspective of analysis, use of anticoagulants only for treatment or only for secondary prevention, or comparison to no treatment) were tested on the incremental cost-effectiveness ratio (ICER). Results In the base-case scenario, patients on dabigatran gained an additional 0.034 quality adjusted life year (QALY) while saving epsilon 1,598. Results of univariate sensitivity analysis were quite robust. The probability that dabigatran is cost-effective at a willingness-to-pay threshold of epsilon 20,000/ QALY was 98.1%. From the perspective of healthcare provider, extended anticoagulation with dabigatran compared to VKAs was estimated at epsilon 2,158 per QALY gained. The ICER for anticoagulation versus no treatment in patients with equipoise risk of recurrent VTE was estimated at epsilon 33,379 per QALY gained. Other scenarios showed dabigatran was cost-saving. Conclusion From a societal perspective, dabigatran is likely to be a cost-effective or even cost-saving strategy for treatment and secondary prevention of VTE compared to VKAs in the Netherlands

Costs of clinical events in diabetes type 2 patients in The Netherlands: A systematic review

Objectives: Diabetes mellitus type 2 (T2DM) is an established risk factor for vascular complications, cardiovascular events, and kidney failure. Prevalence of T2DM is expected to be as high as 8% in the year 2025. This will result in significant clinical impact and increases in healthcare expenditures, highlighting the need for well-informed reimbursement decisions. However, availability and consistent use of costs is limited. Here, we aim to systematically review available costing data for T2DM-related major cardiovascular and nephropathic events in the Netherlands, published in the last decade. Methods: A systematic literature review was conducted to identify all available publications for Dutch costs for clinical events commonly found in T2DM patients. The PubMed database was searched for studies covering T2DM-related events using inclusion criteria. Information extracted from publications included costs, source of costs, study population, and costing perspective. Results: Out of initially 214 papers, 29 were found to agree with the inclusion criteria. From these studies, 80 cost estimates for T2DM-related clinical events were identified, and arranged into tables. Twenty cost estimates were reported for MI. For stroke, 38 estimates for stroke were found. TIA and HF had two and eight estimates, respectively. Eleven cost estimates were found for renal failure-related events. Finally, eight cost estimates were reported for revascularisation. Conclusions: Many of studies covered MI and stroke, while only a limited number focussed on other T2DM-related events. The most expensive clinical events were found to be related to renal failure, most notably ESRD and dialysis. MI and TIA were found to be the least expensive in general. This systematic review showed that there is a substantial variation in reported cost estimates for the six major complications associated with T2DM. Costing of clinical events should be improved and preferably standardised, if accurate and consistent results in economic models are desired

Burden of early, advanced and metastatic breast cancer in The Netherlands

Background: The aim of this study was to estimate the total economic and health related burden of breast cancer in the Netherlands. Methods: Data on incidence, prevalence, mortality and survival were extracted from the Dutch National Cancer Registry and were used to calculate the economic and health related burden of breast cancer for overall, DCIS (stage 0), early- (stage I), locally advanced- (stage II-III) and metastatic- (stage IV) breast cancer by age groups and by year (if applicable). Results: The overall incidence of breast cancer increased from 103.4 up to 153.2 per 100,000 women between 1990 and 2014. The increase was driven by DCIS and early breast cancer as the incidence of locally advanced and metastatic breast cancer remained stable. Between 1990 and 2014, ten-year overall survival rates increased from 87% to 93% for early breast cancer, 41% to 62% for locally advanced- and from 6% to 9% for metastatic disease. Annually, breast cancer in the Netherlands is responsible for approximately 3100 deaths, 26,000 life years lost, 65,000 Disability Adjusted Life Years (DALYs) and an economic burden of €1.27 billion. Conclusions: This study provides a comprehensive assessment of the burden of breast cancer and subsequent trends over time in the Netherlands

Recurrent VTE, bleeding complications and other adverse events and related costs within a hypothetical patient population of 10,000 subjects receiving dabigatran and VKA over a lifetime horizon.

<p>VKA, vitamin K antagonists; VTE, venous thromboembolism; DVT, deep vein thrombosis; PE, pulmonary embolism; r, recurrent; LMWH, low molecular weight heparin; CRNMB = clinically relevant non-major bleed event; ICH = intracranial haemorrhage; MB = major bleed; MI = myocardial infarction; CTEPH = chronic thromboembolic pulmonary hypertension; PTS = post thrombotic syndrome; UA, unstable angina; INR, international normalised ratio.</p

Incremental cost-effectiveness plane.

<p>Incremental cost-effectiveness plane.</p

Distribution and parameter limits for the transition probabilities in the model as used in the probabilistic sensitivity analysis.

<p>CI, confidence interval; r VTE, recurrent venous thromboembolism; MCRB, major or clinically relevant bleeding; VKA, vitamin K antagonists; HR, hazard ratio; D, Dirichlet distribution applying to 2 or 3 linked probabilities with the parameter corresponding to the specific marginal Beta distribution in italics; DVT, deep vein thrombosis; PE, pulmonary embolism; CRNMB = clinically relevant non-major bleed event; ICH = intracranial haemorrhage; MB = major bleed; MI = myocardial infarction; UA, unstable angina; CTEPH = chronic thromboembolic pulmonary hypertension; PTS = post thrombotic syndrome.</p

Markov model.

<p>VTE, venous thromboembolism; DVT, deep vein thrombosis; PE, pulmonary embolism; r, recurrent; LMWH, low molecular weight heparin; CRNMB = clinically relevant non-major bleed event; ICH = intracranial haemorrhage; MB = major bleed; MI = myocardial infarction; CTEPH = chronic thromboembolic pulmonary hypertension; PTS = post thrombotic syndrome; UA, unstable angina; IHD, ischemic heart disease.</p