The objective of this study was to present evidence on the epidemiology, health outcomes and economic burden of cancer-related venous thromboembolism (VTE). Medline, Cochrane Central Register of Controlled Trials, Econlit, Science Direct, JSTOR, Oxford Journals and Cambridge Journals were searched. The systematic literature search was limited to manuscripts published from January 2000 to December 2012. On the basis of the literature, cancer patients experience between two-fold and 20-fold higher risk of developing VTE than noncancer patients. They are more likely to experience a VTE event during the first 3-6 months after cancer diagnosis. In addition, an increased risk of VTE in patients with distant metastases and certain types of cancer (i.e. pancreatic or lung) was revealed. VTE was found to be a leading cause of mortality in cancer patients. The annual average total cost for cancer patients with VTE was found to be almost 50% higher than that of cancer patients without VTE. Inpatient care costs accounted for more than 60% of total cost. The existing evidence assessed in the present review demonstrated the significant health and economic consequences of cancer-related VTE, which make a strong case for the importance of its proper and efficient prevention and management.

The resulting incremental cost-effectiveness ratio was € 56,667 per QALY. ConClusions: These economic analysis results demonstrate that although treatment with nivolumab is associated with higher costs of treatment, nivolumab provides significant survival benefits, improved quality-of-life, and a favorable toxicity profile versus everolimus. The ICER results above might be subject to change during negotiations with local authorities. This analysis aims to inform coverage and reimbursement decisions in Portugal.

<p class="NICEnormal"><strong>Background: </strong>Heart failure represents a major burden for health systems and societies. Cardiac contractility modulation (CCM) therapy was developed in recent years for patients with normal QRS in whom optimal pharmacological (OMT) treatment has failed to control symptoms adequately. This study presents an economic evaluation of CCM therapy for the UK.</p><p class="NICEnormal"><strong>Methods: </strong>A Markov model was built to simulate the management of patients under two therapy scenarios, on OMT alone and CCM+OMT respectively. The horizon is the patient’s life time and the cycle is 4 weeks. The model estimates life year (LYs), quality adjusted life years (QALYs) and overall treatment costs. Data to populate it came from relevant CCM trials, the literature and other sources.</p><p class="NICEnormal"><strong>Results: </strong>The total mean life-time cost was £37,467 in the CCM+OMT arm and £16,885 in the OMT arm. Patients in the OMT arm gained 7.00 LYs and 4.00 QALYs and those on CCM+OMT 7.96 and 5.26 respectively. The incremental cost per QALY was £16,405and the incremental cost per LY £21,415. Sensitivity analysis indicates that the results are pretty stable and stochastic analysis indicates that at a £30,000 per QALY threshold the likelihood of CCM+OMT being cost-effective is 99.8% and at £25,000 per QALY 97%.</p><p class="NICEnormal"><strong>Conclusion: </strong>The present analysis indicates that CCM may be cost-effective therapy. This early conclusion should be viewed in the light of the caveats of the modeling methods used, due to data availability.  Long-term studies directly collecting hospitalization and mortality data should be undertaken to provide more robust evidence.</p>

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Objectives: Metastatic melanoma has a poor prognosis with 10 year survival being < 5%. Standard therapy is the effective but costly Ipilimumab. An emerging 1st line treatment is Tumor Infiltrating Lymphocytes (TIL), with response rates > 50% and expected survival rates of 25%-42% versus 45% (1yr) and 23,5% (2yr) for Ipilimumab. TIL is highly personalized, however complex and requests substantial upfront investments from the hospital in expensive lab-equipment, staff expertise and training, as well as extremely tight hospital logistics. Therefore, an early health economic modelling study, supporting a Coverage with Evidence Development (CED) program, was performed. MethOds: We used a Markov decision model to estimate the expected costs and outcomes (quality adjusted life years; QALYs) for TIL versus Ipilimumab in metastatic melanoma patients from a societal perspective over a life long time horizon. Three mutually exclusive health states (stable disease, progressive disease and death) were modelled, divided in first and second line treatment. Technical failures and non-compliance were incorporated to reflect the dynamic nature of the technology. To inform further research prioritization, Value of Information (VOI) analysis was performed. Results: TIL is expected to yield more QALYs compared to Ipilimumab (0.99 vs 0.52 respectively) at lower total costs (€ 83,588 vs € 87,834 respectively). Based on current information TIL has a probability of 88% for being cost effective at a cost/QALY threshold of € 30,000. Expected Value of Perfect Information (EVPI) amounted to € 1,2 million. Partial EVPI (EVPPI) was highest for survival data (€ 550,000). Expected Value of Sample information was estimated € 355,000 for an optimal sample size of n= 50. cOnclusiOns: TIL is expected to improve QALYs compared to Ipilimumab at lower incremental cost and has the highest probability of being cost-effective. To reduce decision uncertainty, a future clinical trial to investigate survival seems most valuable, and should preferably be undertaken as part of a CED program.