Economics of breast cancer preventive strategies in a Medicaid program

The primary objective of the study was to estimate the long-term benefits and costs of chemopreventive tamoxifen and mammography screening in women who are otherwise healthy but at high risk of developing breast cancer. Three hypothetical cohorts of high-risk women were initiated at age forty. The first cohort consumed chemopreventive tamoxifen and underwent routine mammography screening. The second cohort also consumed chemopreventive tamoxifen but underwent mammography screening at real-world rates. The third cohort (control cohort) did not consume chemopreventive tamoxifen and underwent mammography screening at real-world rates. The study also assessed the proportion of women in the West Virginia Medicaid Program (WVMP) who were healthy but at a high risk of developing breast cancer. Secondary objectives of the study involved determining breast cancer knowledge, utilization of breast cancer preventive strategies, and willingness to consume chemopreventive tamoxifen. Chemopreventive tamoxifen coupled with routine mammography screening resulted in an incremental life expectancy gain of 0.122 years at an incremental cost of {dollar}5,969.70 resulting in an incremental cost effectiveness ratio (ICER) of {dollar}48,931.80 per life year gained (3% discount rate) as compared to control cohort. Chemopreventive tamoxifen coupled with mammography screening at real-world rates resulted in an incremental life expectancy gain of 0.076 years at an incremental cost of {dollar}4,916.84 resulting in an incremental cost effectiveness ratio (ICER) of {dollar}64,695.20 per life year gained (3% discount rate) as compared to control cohort. Sensitivity analysis indicated robustness of results over a wide rage of assumptions. About half of the surveyed population was at a high risk of developing breast cancer and thus eligible to receive chemopreventive tamoxifen. However, only about 17% respondents indicated their inclination towards consuming chemopreventive tamoxifen. A low but significant correlation was observed between the respondent\u27s perceived risk and real risk indicating the need for increasing breast cancer awareness. Respondent\u27s actual risk of developing breast cancer did not appear to have any relationship with willingness to consume chemopreventive tamoxifen. In summary, chemopreventive tamoxifen plus mammography screening in high-risk women is a cost-effective strategy. However, at present, very few of these high-risk women may actually utilize chemoprevention

Cost-Effectiveness of Early versus Late Cinacalcet Treatment in Addition to Standard Care for Secondary Renal Hyperparathyroidism in the USA

AbstractObjectivesThe objective of this research was to estimate lifetime cost-effectiveness of treating patients with cinacalcet early (when parathyroid hormone [PTH] levels are in the range of 300–500 pg/ml) versus delaying treatment with cinacalcet (cinacalcet initiated when PTH levels are >800 pg/ml) in patients with secondary hyperparathyroidism (SHPT) in the US setting.MethodsA Markov model was developed to simulate the effects of early versus delayed use of cinacalcet (plus standard of care). Four different PTH ranges (≤300 pg/ml; 301–500 pg/ml; 501–800 pg/ml; >800 pg/ml) were used to represent four different health states within the Markov model. Associated with each Markov state (PTH range) were varying risks of major SHPT complications, including cardiovascular disease (CVD), fracture (Fx), and parathyroidectomy (PTx). Baseline cohort characteristics and risks of CVD, Fx, and PTx by PTH category were derived from a large US renal database and published sources. Costs were estimated from the US Renal Data System database and reported in 2006 US Dollars ($). Clinical and economic outcomes were discounted at 3.0$17,275 per QALY gained.ConclusionsEarly treatment with cinacalcet was associated with improvements in QALYs and would represent good value for money compared to delaying treatment with cinacalcet

Healthcare costs in patients with metastatic lung cancer receiving chemotherapy

<p>Abstract</p> <p>Background</p> <p>To characterize healthcare resource utilization and costs in patients with metastatic lung cancer receiving chemotherapy in the US.</p> <p>Methods</p> <p>Using data from a large private multi-payer health insurance claims database (2000-2006), we identified all patients beginning chemotherapy for metastatic lung cancer. Healthcare resource use (inpatient, outpatient, medications) and costs were tallied over time from date of therapy initiation ("index date") to date of disenrollment from the health plan (in most instances, presumably due to death) or the end of the study period, whichever occurred first. Healthcare utilization and costs were characterized using Kaplan-Meier sample average methods.</p> <p>Results</p> <p>The study population consisted of 4068 patients; mean (SD) age was 65 (11) years. Over a median follow-up of 334 days, study subjects averaged 1.5 hospital admissions, 8.9 total inpatient days, and 69 physician office and hospital outpatient visits. Mean (95% CI) cumulative total healthcare costs were $125,849 ($120,228, $131,231). Costs of outpatient medical services and inpatient care constituted 34% and 20% of total healthcare costs, respectively; corresponding estimates for outpatient chemotherapy and other medication were 22% and 24%.</p> <p>Conclusion</p> <p>Our study sheds additional light on the burden of metastatic lung cancer among patients receiving chemotherapy, in terms of total cost thru end of life as well as component costs by setting and type of service, and may be useful in informing medical resource allocation in this patient population.</p

Healthcare costs in women with metastatic breast cancer receiving chemotherapy as their principal treatment modality

<p>Abstract</p> <p>Background</p> <p>The economic costs of treating patients with metastatic breast cancer have been examined in several studies, but available estimates of economic burden are at least a decade old. In this study, we characterize healthcare utilization and costs in the US among women with metastatic breast cancer receiving chemotherapy as their principal treatment modality.</p> <p>Methods</p> <p>Using a large private health insurance claims database (2000-2006), we identified all women initiating chemotherapy for metastatic breast cancer with no evidence of receipt of concomitant or subsequent hormonal therapy, or receipt of trastuzumab at anytime. Healthcare utilization and costs (inpatient, outpatient, medication) were estimated on a cumulative basis from date of chemotherapy initiation ("index date") to date of disenrollment from the health plan or the end of the study period, whichever occurred first. Study measures were cumulated over time using the Kaplan-Meier Sample Average (KMSA) method; 95% CIs were generated using nonparametric bootstrapping. Findings also were examined among the subgroup of patients with uncensored data.</p> <p>Results</p> <p>The study population consisted of 1444 women; mean (SD) age was 59.1 (12.1) years. Over a mean follow-up of 532 days (range: 3 to 2412), study subjects averaged 1.7 hospital admissions, 10.7 inpatient days, and 83.6 physician office and hospital outpatient visits. Mean (95% CI) cumulative total healthcare costs were $128,556 ($118,409, $137,644) per patient. Outpatient services accounted for 29% of total costs, followed by medication other than chemotherapy (26%), chemotherapy (25%), and inpatient care (20%).</p> <p>Conclusions</p> <p>Healthcare costs-especially in the outpatient setting--are substantial among women with metastatic breast cancer for whom treatment options other than chemotherapy are limited.</p

A Cost-Effectiveness Analysis of First-Line Controller Therapies for Persistent Asthma

Background: Asthma is one of the most common chronic diseases in the US, and its prevalence continues to increase. Despite the availability of effective asthma controller medications, many patients with asthma are still not meeting therapeutic goals because of poor disease management. The high disease prevalence combined with the high costs associated with the poor management of asthma, make patients with asthma a costly group to treat for managed care organisations (MCOs) and this motivates decision makers in MCOs to consider both the clinical and economic value of asthma therapies. Objective: To compare the cost effectiveness of first-line controller asthma therapies in patients with mild-to-moderate persistent asthma from an MCO payer perspective. Methods: A decision-analysis model was developed to evaluate the cost effectiveness of fluticasone propionate and salmeterol administered in a single inhaler (salmeterol/fluticasone propionate 50/100mug), compared with fluticasone propionate inhaled corticosteroids (FPIC), non-fluticasone propionate inhaled corticosteroids (nFPIC) and leukotriene modifiers. The model estimated costs ($US, year 2005 values) and health outcomes over a 1-year period. Costs and outcomes data were obtained from published clinical trials and observational studies, and model assumptions on the relationship between adherence and effectiveness were evaluated by a panel of experts. Effectiveness measures included symptom-free days and rescue medication-free days. The cost effectiveness of first-line asthma therapies was compared using a step-wise approach, with FPIC as the reference case. Both one-way and probabilistic sensitivity analyses were performed to assess the robustness of results over a range of assumptions. Results: The step-wise comparison found that the additional costs for achieving an incremental effectiveness unit (incremental cost-effectiveness ratio) using single-inhaler salmeterol/fluticasone propionate compared with FPIC was$US9.55 per symptom-free day and $US8.93 per rescue medication-free day. Sensitivity analyses indicated that the model was robust to changes in base-case assumptions. A probabilistic sensitivity analysis showed that, corresponding to a benchmark value of$US14.8 per symptom-free day, the probabilities that single-inhaler salmeterol/fluticasone propionate, n-FPIC and leukotriene modifiers were more cost effective than FPIC were 98%, 30.7% and 2.1%, respectively. Conclusion: Based on our decision analysis, the additional costs for achieving incremental effectiveness with single-inhaler salmeterol/fluticasone propionate treatment compared with FPIC and nFPIC may be lower than the commonly accepted benchmark value for cost effectiveness, based on published estimates of the utility losses associated with asthma symptoms. Single-inhaler salmeterol/fluticasone propionate may also be more cost effective than leukotriene modifiers.Asthma, Corticosteroids, Cost-effectiveness, Fluticasone-propionate, Leukotriene-antagonists, Salmeterol/fluticasone-propionate

Cost-Effectiveness Comparison of Salmeterol/Fluticasone Propionate versus Montelukast in the Treatment of Adults with Persistent Asthma

Objective: To compare the relative cost effectiveness of salmeterol (50mug)/ fluticasone propionate (100mug) with that of oral montelukast (10mg) as initial maintenance therapy in patients with persistent asthma uncontrolled on short-acting beta2-agonist therapy alone. Study design: A cost-effectiveness analysis was performed based on effectiveness and resource utilisation data that was prospectively collected from a randomised, double-blind, double-dummy, 12-week trial. Patients and methods: Patients (>15 years of age) who had asthma for at least 6 months. Effectiveness measurements in this analysis included improvement in forced expiratory volume in 1 second (FEV1) and symptom-free days (SFDs). Cost of asthma drug treatment as well as costs related to an asthma exacerbation were used in the cost analysis. The study assumed a payer's perspective. All costs are in 2001 US dollars. Results: Of the 423 patients eligible for the study, 211 were randomised to salmeterol/fluticasone propionate and 212 to montelukast. Treatment with salmeterol/fluticasone propionate resulted in a significantly higher proportion of patients who achieved a 12% increase in FEV1 (successful treatment) [salmeterol/fluticasone propionate: 71% vs montelukast: 39%; pAsthma, Beta 2 adrenoceptor agonists, Cost effectiveness, Leukotriene D4 antagonists, Montelukast, Pharmacoeconomics, Salmeterol/fluticasone propionate

Cost Effectiveness of Fluticasone Propionate Plus Salmeterol Versus Fluticasone Propionate Plus Montelukast in the Treatment of Persistent Asthma

Background: Asthma is a chronic disease, the two main components of which are inflammation and bronchoconstriction. Fluticasone propionate (FP) and salmeterol, a strategy that treats both main components of asthma, has been recently compared with FP plus montelukast in a randomised clinical trial. The present study reports economic evaluation of these two strategies. Objective: To determine the relative cost effectiveness when persistent asthma is treated with FP/salmeterol 100/50mug twice daily administered via a single Diskus(R) inhaler device versus treatment with FP 100mug twice daily via a Diskus(R) inhaler plus oral montelukast 10mg once daily. Study design: A cost-effectiveness analysis was performed by applying cost unit data to resource utilisation data collected prospectively during a US randomised, double-blind, 12-week trial of FP/salmeterol Patients and methods: Efficacy measurements in this analysis included improvement in forced expiratory volume in 1 second (FEV1) and symptom-free days. Direct costs included those related to study drugs, emergency room department visits, unscheduled physician visits, treatment of drug-related adverse events (oral candidiasis), and rescue medication (salbutamol [albuterol]). The study assumed a US third-party payer Results: Treatment with FP/salmeterol resulted in a significantly higher proportion (p Conclusion: From a US third-party payerAntiasthmatics, Asthma, Cost-effectiveness, Fluticasone-propionate, Montelukast, Salmeterol/fluticasone-propionate