Economic Evaluations of Targeted Therapy and Risk-Stratified Treatment Approaches in Multiple Myeloma

__Abstract__ Multiple myeloma (MM) is a malignant plasma cell disorder accounting for 1% of all cancer diagnoses worldwide and 13% of all hematologic malignancies [1]. Worldwide, the incidence of MM is 0.4 to 5 per 100,000 people per year [2]. Incidence rates are higher among males than females, people of African descent, and increase rapidly until age 84 and then decline. In the Netherlands, the annual incidence rate is 5 per 100,000 with a median age of 70 at diagnosis [3]. The clinical characteristics of MM vary from asymptomatic patients to those with malignant disease. Nonetheless, the disease has a very characteristic presentation such as lytic bone disease, renal insufficiency, anemia, hypercalcemia, the presence of M-proteins found in the serum and/or urine and immunodeficiency [4]. Disorders of the central and peripheral nervous system are also common [5]. The development of hemorrhagic diathesis or thrombosis is also a risk for MM patients with bleeding present in 15-30% of patients and a 3% risk of thrombosis [6]. MM is considered a severe disease in terms of quality-of-life impact and life expectancy and remains incurable. The survival of multiple myeloma patients has improved substantially in the past decade and is attributable to the introduction of novel (‘targeted’) therapies bortezomib (Velcade®), thalidomide (Thalidomid®), and lenalidomide (Revlimid ®), as well as improvements in the use of autologous stem cell transplantation and supportive therapy [7, 8]. Newly diagnosed patients can now expect to live an average of 5-7 years, with some patients living longer than 10 years [9, 10]. In fact, many patients are dying with and not necessarily due to the underlying disease. Prognosis has sh

Efficient allocation of novel agents in Multiple Myeloma: A work in progress

__Abstract__ Payers of healthcare worldwide are concerned with the rising costs of healthcare. The costs of oncology care alone have increased, with the size of the oncology market having more than doubled since 1997, reaching $35 billion in 2006. Scientific advances, particularly the development of targeted agents, are a contributing factor to the rise in oncology costs. Patient outcomes have improved, but at significantly higher costs compared to conventional therapies. Over the past 40 years the median monthly costs of cancer drugs have risen from less than$100 in 1965–1969 to more than $5000 in 2005–2009 (2007 prices), with cancer drugs now accounting for10–20%of total expenditures for cancerand5%of total drug expenditures

Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands.

#### Objective Incontinence is an important health problem. Effectively treating incontinence could lead to important health gains in patients and caregivers. Management of incontinence is currently suboptimal, especially in elderly patients. To optimise the provision of incontinence care a global optimum continence service specification (OCSS) was developed. The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands. #### Method A decision analytic model was developed comparing the current care pathway for urinary incontinence in the Netherlands with the pathway as described in the OCSS. The new care strategy was operationalised as the appointment of a continence nurse specialist (NS) located with the general practitioner (GP). This was assumed to increase case detection and to include initial assessment and treatment by the NS. The analysis used a societal perspective, including medical costs, containment products (out-of-pocket and paid by insurer), home care, informal care, and implementation costs. #### Results With the new care strategy a QALY gain of 0.005 per patient is achieved while saving €402 per patient over a 3 year period from a societal perspective. In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%), or receive care for containment only. In both of these groups no health gains were achieved. #### Conclusion Implementing the OCSS in the Netherlands by locating a NS in the GP practice is likely to reduce incontinence, improve quality of life, and reduce costs. Furth

Concurrent chemotherapy with intensity-modulated radiation therapy for locally advanced squamous cell carcinoma of the larynx and oropharynx: A retrospective single-institution analysis

Background. We present outcome data from concurrent chemotherapy and intensity-modulated radiation therapy (IMRT) for squamous cell carcinoma (SCC) of the larynx and oropharyx. Methods. Eighty patients with laryngeal (n = 15) or oropharyngeal (n = 65) SCC underwent concurrent IMRT and chemotherapy (cisplatin or carboplatin/paclitaxel). Results. The 3-year overall survival (OS) and disease-free survival (DFS) were 81.2% and 78.3%, respectively, with a median follow-up of 31.2 months. There was a statistically significant correlation between OS and DFS with N classification (p = .0001), but not with disease site or T classification. Toxicities compared favorably with prior reports using conventional radiation therapy. Conclusions. This retrospective analysis reveals a very good outcome and an acceptable toxicity profile for patients with locally advanced SCC of the oropharynx and larynx treated with chemotherapy and IMRT concurrently