Annemans, Lieven

LOX, E

MALONNE, H

PETIT, C

STRENS, D

Ghent University Academic Bibliography

Cost-effectiveness analysis of aprepitant in the prevention of chemotherapy-induced nausea and vomiting in patients receiving either cisplatin-based chemotherapy regimens or moderately emetogenic chemotherapy

Annemans, L

Strens, D

Lox, E

Petit, C

Malonne, H

Elsevier - Publisher Connector 

A107Abstracts
cancer after failure of (neo) adjuvant anthracycline-based
therapy, relative to paclitaxel (T) monotherapy, in Australia.
Paclitaxel monotherapy is a treatment of choice in advanced,
anthracycline-resistant breast cancer in Australia. METHODS:
Economic evaluation was based on the global, randomised trial
of GT versus T (N = 529) (Albain et al, ASCO 2004). Median
survival for the intention-to-treat population was 18.5 months
(95% CI, 16.5 to 21.2 months) for the GT arm versus 15.8
months (95% CI, 14.4 to 17.4 months) for the T arm (hazard
ratio = 0.78 [95% CI, 0.63 to 0.96]. Higher toxicity in the com-
bination arm did not have a negative impact on quality of life
(Moinpour et al, ASCO 2004). Mean survival time for each
treatment arm was estimated from Kaplan-Meier survival curves.
Resource use (chemotherapy, administration, hospitalisation due
to adverse events [AEs], treatment emergent AEs) was applied as
per the trial and costed accordingly, using Australian dollars
(2004 value). Threshold of <$50,000 per life-year gained was
considered cost-effective. RESULTS: Mean cost per patient on
GT arm was $21,695 ($19,389 for chemotherapy, $1003 for
administration, and $1304 for AE management). Mean cost per
patient on T arm was $13,635 ($12,397 for chemotherapy, $567
for administration, and $670 for AE management). Mean sur-
vival gain for GT over T was 0.176 years. Cost per life-year
gained for GT was $45,799. CONCLUSION: This survival
beneﬁt is a highly patient-relevant outcome for advanced breast
cancer. This economic evaluation found that gemcitabine plus
paclitaxel offers an acceptable cost-effectiveness ratio and good
value-for-money for patients with advanced breast cancer in 
Australia.
PCN11
COST EFFECTIVENESS OF ADJUVANT, INTRAVESICAL
THERAPY FOR NON-INVASIVE TRANSITIONAL CELL
CARCINOMA OF THE BLADDER
Kerrigan M1, Ramsey SD2, Penson D3, Blough DK1, Garrison L1
1University of Washington, Seattle, WA, USA, 2Fred Hutchinson
Cancer Research Center, Seattle, WA, USA, 3University of Southern
California / Norris Cancer Center, Los Angeles, CA, USA
OBJECTIVES: Estimate the costs of care and outcomes associ-
ated with adjuvant, intravesical therapy (AIT)—either BCG or
chemotherapy—for non-invasive bladder cancer compared to no
AIT. METHODS: Subjects diagnosed with non-invasive transi-
tional cell carcinoma of the bladder between 1992 and 1999
were drawn from the SEER-Medicare dataset. We estimated the
effect of treatment on costs and outcomes within ﬁve risk groups
deﬁned by stage and grade of disease. We included subjects that
were at least 66 years old and who had fee-for-service coverage.
We estimated direct medical costs (for Medicare) using the
Kaplan-Meier sample average estimator. Using Cox models, we
estimated the effectiveness of AIT using three measures: survival
time, time to cystectomy (surgical removal of the bladder) and
time to repeat transurethral resection (TUR: surgical removal of
lesions in the bladder). The models adjusted for age, sex, race,
comorbidities and socioeconomic status. RESULTS: Subjects had
2 to 10 years of follow-up. A total of 13,658 subjects were
included: 2137 received AIT. Mean costs (2004 dollars) were
$53,834 for those that received AIT and $47,884 for those that
did not receive AIT. Difference in costs between treatment groups
was similar for the ﬁve risk groups. AIT reduced the risk of death
for subjects with stage 1, grade 3 or 4 tumors (hazard ratio: 0.82;
95% CI: 0.71 to 0.94). Survival was not statistically signiﬁcantly
different in other risk groups. AIT reduced the risk of repeat
TUR in each risk group. Conversely, AIT increased the risk of
cystectomy for subjects with low grade disease and carcinoma in
situ. CONCLUSIONS: AIT increased Medicare costs over 10
years by $5950. AIT reduced mortality for high risk subjects
only, reduced the risk of TUR for all risk groups and increased
the risk of cystectomy for low risk subjects. Residual confound-
ing may explain mixed ﬁndings.
PCN12
COST-EFFECTIVENESS ANALYSIS OF G-CSF IN ELDERLY
PATIENTS WITH AGGRESSIVE NON-HODGKIN’S LYMPHOMA
(NHL) RECEIVING CHOP
Lyman GH1, Cosler LE2
1University of Rochester School of Medicine and Dentistry, Rochester,
NY, USA, 2Albany College of Pharmacy, Albany, NY, USA
OBJECTIVES: A recent randomized trial compared granulocyte
colony-stimulating factor (G-CSF; ﬁlgrastim) to no G-CSF 
in elderly patients with aggressive NHL receiving CHOP
chemotherapy [Osby, 2003]. A cost-effectiveness analysis is pre-
sented comparing CHOP alone to CHOP + G-CSF. METHODS:
An economic model based on this trial compares the risk of neu-
tropenia, disease relapse, and 5-year survival among patients
receiving CHOP with or without G-CSF. Cost estimates were
derived from published literature and data from U.S. health
centers. Incremental cost-effectiveness ratios (ICERs) of $US/life
year saved (LYS) were estimated, and sensitivity analyses per-
formed. RESULTS: CHOP + G-CSF was associated with signif-
icantly fewer episodes of severe neutropenia (P < 0.001), FN (P
< 0.001), greater dose intensity (P < 0.05), fewer deaths (P =
0.04), and improved 5-year survival (P = 0.04). Based on ﬁve
years of followup, the life years averaged 2.93 years in the CHOP
alone group compared to 3.52 years in the CHOP + G-CSF arm.
Expected costs were $41,400 and $39,747 for the G-CSF and
control arms, respectively. Under baseline assumptions, the ICER
for G-CSF support was estimated at $2769/LYS. Sensitivity
analyses revealed G-CSF support to be cost saving across most
plausible values for baseline FN risk, relative risk reductions for
FN, infection-related mortality, and risks of disease relapse. G-
CSF support remained cost saving until the control risk for
disease relapse fell to <2%. Net cost savings were observed for
FN relative risk reductions >56%. CONCLUSIONS: A recent
clinical trial of G-CSF support demonstrated a reduction in neu-
tropenic complications and improved survival. Incorporation of
cost data into an economic model based on this trial demon-
strates that G-CSF support is within accepted limits for cost-
effectiveness across a broad range of assumptions.
PCN13
COST-EFFECTIVENESS ANALYSIS OF APREPITANT IN THE
PREVENTION OF CHEMOTHERAPY-INDUCED NAUSEA AND
VOMITING IN PATIENTS RECEIVING EITHER CISPLATIN-
BASED CHEMOTHERAPY REGIMENS OR MODERATELY
EMETOGENIC CHEMOTHERAPY
Annemans L1, Strens D1, Lox E2, Petit C2, Malonne H2
1HEDM-IMS Health, Brussels, Belgium, 2Merck Sharp & Dohme bv,
Brussels, Belgium
OBJECTIVES: Aprepitant is effective in preventing 
chemotherapy-induced nausea and vomiting (CINV), achieving
higher complete response (CR = no emesis and no rescue
therapy) compared to standard prevention, in patients receiving
either highly (HEC) or moderately emetogenic chemotherapy
(MEC) (absolute improvement = 11% and 13% respectively).
We assessed the cost-effectiveness of aprepitant based versus
standard prevention in these indications in Belgium.
METHODS: A decision analytical model was developed in MS
Excel. To estimate resource use, two approaches are used. The
ﬁrst is based on the preventive regimens applied in randomized
controlled trials comparing aprepitant based CINV prevention
A108 Abstracts
(for HEC: aprepitant days1–3, ondansetron 32mg IV day1; for
MEC: aprepitant days1–3, ondansetron 16mg PO day1), versus
a standard regimen (for HEC: ondansetron 32mg IV day1 and
16mg PO days2–4; for MEC: ondansetron 16mg PO days1–3).
The second analysis is based on current real-world resource use
in the prevention of CINV using the IMS Longitudinal Hospital
Database (with ondansetron PO only used in 53% (MEC) to
58% (HEC) of patients but at 132% (MEC) and 66% (HEC)
higher doses). CINV-speciﬁc utility values adapted from Sun et
al. (2002) were used to calculate QALYs. Drug costs were
obtained from ofﬁcial listings. Treatment costs for CINV were
obtained from a German study and adapted to Belgium.
RESULTS: The aprepitant-based regimen is associated with
0.003 and 0.014 more QALY’s in HEC and MEC respectively
and with savings of 66.84€ (trial based) and 74.62€ (real life
based) for HEC and 17.95€ (trial based) and 21.70€ (real life
based) for MEC. Hence, aprepitant is both more effective and
less expensive (= dominant). Sensitivity analyses were performed
on treatment cost of emesis and on the clinical beneﬁt of aprepi-
tant and showed that the results were very robust. CONCLU-
SIONS: In both approaches the aprepitant-based strategy is
dominant.
PCN14
COST-EFFECTIVENESS OF TAXANES AS SECOND LINE
AGENTS IN TREATMENT OF METASTATIC BREAST CANCER
Kawatkar AA, Hay JW
University of Southern California, Los Angeles, CA, USA
OBJECTIVES: To evaluate cost effectiveness (CE) of Paclitaxel
compared to Docetaxel for Anthracycline pretreated metastatic
breast cancer (MBC) patients from a societal perspective.
METHODS: A two year decision model was developed with
parameter inputs from published literature and the ﬁrst phase III
randomized clinical trial which compared the taxanes for treat-
ment of MBC. Direct cost (in 2005 $) included in the model were
drug and premedication cost, administration and personnel cost,
cost of hospitalization and adverse effects, laboratory cost, home
health aide cost along with follow up and terminal care cost.
Indirect cost consisted of informal caregiver time and patient
time cost. Effectiveness was measured in terms of quality
adjusted life years (QALYs), which was based on utilities elicited
from US oncology nurses and life expectancy calculated using
declining exponential approximation of life expectancy (DEALE)
method. All costs and QALYs were discounted at 3% and an
incremental cost effectiveness ratio (ICER) was calculated.
Uncertainty of point estimates was analyzed in Univariate sensi-
tivity analysis. Threshold sensitivity analysis was also conducted
to evaluate the values where the CE ratio changed. RESULTS:
Paclitaxel was more cost effective for treatment of MBC,
amongst the two taxanes. Docetaxel drug cost and adversity
proﬁle made the ICER $145,837/QALY gained. The model 
was robust to reasonable changes to the parameter estimates.
Response to treatment was one of the key parameters which
affected the CE ratio. Threshold analysis suggested, either Doc-
etaxel response rate should increase to 42% or Paclitaxel
response rate decrease by a third or the price of Docetaxel
decrease by one sixth, to bring the ICER close to the
$100,000/QALY. CONCLUSIONS: Docetaxel may be a better
choice from clinical stand point for treatment of MBC patients,
but its economic justiﬁcation is questionable in a cost conscious
society with limited resources.
PCN15
THE ANNUAL HEALTH INSURANCE COST OF COLORECTAL
CANCER TREATMENT IN HUNGARY:A COST OF ILLNESS
STUDY
Boncz I1, Sebestyén A1, Palásti J1, Betlehem J2
1National Health Insurance Fund Administration (OEP), Budapest,
Hungary, 2University of Pécs, Pécs, Hungary
OBJECTIVES: The purpose of the study is to calculate the
annual health insurance cost of treatment of colorectal cancer at
nationwide level in Hungary for the year 2001. METHODS:
Data derive from the nationwide database of the Hungarian
National Health Insurance Fund Administration (OEP), the only
health care ﬁnancing agency in Hungary. The cost of treatment
includes: out-patient care, acute and chronic inpatient care, sub-
sidies of medicines’ prices (ATC groups: “L”, antineoplastic and
immunomodulating agents, “N02”, Analgesics and “A04”
Antiemetics and antineuseants) and expenditure on disability to
work (including sickness-pay). According to standard cost cate-
gories direct medical and direct non-medical costs, indirect (pro-
ductivity) costs are included while informal care and intangible
costs are excluded. Disease was identiﬁed with the following
ICD-10 codes: C18, C19, C20, C21 (Malignant neoplasm of
colon, rectosigmoid junction, rectum and anus and anal canal),
D01.0, D01.1, D01.2, D01.3, D01.4 (carcinoma in situ), D12
(Benign neoplasm of colon, rectum, anus and anal canal).
RESULTS: The results showed the following cost structure. Out-
patient care: $1,889,315 or €2,109,102 (5.4% of total costs),
acute inpatient care: $25,994,160 or €29,018,103 (74.7% of
total costs), chronic inpatient care: $1,293,650 or €1,444,142
(3.7% of total costs), sickness-pay: $1,293,057 or €1,443,480
(3.7% of total costs), drugs from outpatient care’s budget:
$4,350,714 or €4,856,839 (12.5% of total costs). The National
Health Insurance Fund Administration (OEP) spent alltogether
$34,820,895 or €38,871,666 on colorectal cancer in 2001. Most
of the costs (82.8%) derived from malignant neoplasms, 17.0%
from benign neoplasms including polyps and 0.2% from in situ
cancers. CONCLUSIONS: Colorectal cancer represents a large
burden in Hungary. Benign neoplasms including polyps repre-
sents an important cost element. Most of the costs come from
acute in-patient care.
PCN16
ECONOMIC OUTCOMES IN HEPATOCELLULAR 
CARCINOMA AND METASTATIC LIVER DISEASE PATIENTS:
A MEDICARE PERSPECTIVE
Pelletier EM1, Dembek CJ1, Gazelle GS2
1Boston Scientiﬁc Corporation, Natick, MA, USA, 2Massachusetts
General Hospital, Boston, MA, USA
OBJECTIVES: Published data on costs associated with treating
Medicare patients with hepatocellular carcinoma (HCC) or
metastatic liver disease (MLD) are limited. This study evaluated
health resource use and medical costs in patients newly diag-
nosed with HCC or MLD. METHODS: Patients ≥ 65 years of
age with an HCC or MLD diagnosis were identiﬁed in the 2002
Medicare 5% sample Standard Analytic File and followed for 1
year after the ﬁrst diagnosis. Patients with HMO enrollment or
a prior HCC or MLD diagnosis were excluded. Total health
resource use and medical costs, including hospital inpatient, out-
patient, and physician and supplier services, were measured from
the Medicare payment perspective. RESULTS: The study
included 281 HCC and 1371 MLD patients (mean age 74.8
years; 45% male). Over 1 year, MLD patients had signiﬁcantly
higher outpatient services than HCC patients (10.3 vs. 13.3, p <
0.001), as well as signiﬁcantly more physician encounters,
including ofﬁce visits (p < 0.001). There was no difference in hos-


PCN13 COST-EFFECTIVENESS ANALYSIS OF APREPITANT IN THE PREVENTION OF CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING IN PATIENTS RECEIVING EITHER CISPLATIN-BASED CHEMOTHERAPY REGIMENS OR MODERATELY EMETOGENIC CHEMOTHERAPY 

file:///data/core-remote/dit/data/elsevier/pdf/c0a/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMTA5ODMwMTUxMDY0NjM4NA==.pdf

Cost-effectiveness analysis of aprepitant in the prevention of chemotherapy-induced nausea and vomiting in patients receiving either cisplatin-based chemotherapy regimens or moderately emetogenic chemotherapy

Abstract

Similar works

Full text

Available Versions

Ghent University Academic Bibliography

Elsevier - Publisher Connector