BackgroundThe treatment of metastatic castration-resistant prostate cancer has changed with the introduction of radium-223, cabazitaxel, abiraterone and enzalutamide. To assess value for money, their cost effectiveness in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel from the Dutch societal perspective was investigated.MethodsA cost-effectiveness analysis was conducted using efficacy, symptomatic skeletal-related event and safety data obtained from indirect treatment comparisons. Missing skeletal-related event data for cabazitaxel were conservatively assumed to be identical to radium-223. A Markov model combined these clinical inputs with Dutch-specific resource use and costs for metastatic castration-resistant prostate cancer treatment from a societal perspective. Total quality-adjusted life-years and costs in 2017 euros were calculated over a 5-year (lifetime) time horizon.ResultsRadium-223 resulted in €6092 and €4465 lower costs and 0.02 and 0.01 higher quality-adjusted life-years compared with abiraterone and cabazitaxel, respectively, demonstrating dominance of radium-223. Sensitivity analyses reveal a 64% (54%) chance of radium-223 being cost effective compared with abiraterone (cabazitaxel) at the informal €80,000 willingness-to-pay threshold. Compared with enzalutamide, radium-223 resulted in slightly lower quality-adjusted life-years (−0.06) and €7390 lower costs, revealing a 61% chance of radium-223 being cost effective compared with enzalutamide. The lower costs of radium-223 compared with abiraterone and enzalutamide are driven by lower drug costs and prevention of expensive skeletal-related events. Compared with cabazitaxel, the lower costs of radium-223 are driven by lower costs of the drug, administration and adverse events.ConclusionRadium-223 may be a less costly treatment strategy offering similar gains in health benefits compared with abiraterone, cabazitaxel and enzalutamide in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel from the Dutch societal perspective.Electronic supplementary materialThe online version of this article (doi:10.1007/s40258-017-0350-x) contains supplementary material, which is available to authorized users.
A459first and second line therapy for advanced NSCLC patients with EGFR mutation by China guideline for treatment of primary lung cancer. This study aims to systematically evaluate cost-effectiveness of geftinib in China. Methods: A systematic review of cost-effectiveness of geftinib in China was conducted. We searched for Chinese literatures in "CNKI", "Wanfang data", and "VIP.com". Search pattern was "gefitinb" AND "cost or economic or expense" in abstract. Publication deadline was May 31th, 2015. Cost analysis (CA), cost-effectiveness analysis (CEA), cost-utility analysis (CUA), and cost-benefit analysis of gefitinib were included. NoteExpress 2.7 was used for literature management. Results: We retrieved abstracts of 39, 42 and 20 from CNKI, Wanfang and VIP respectively. Then 59 abstracts were selected to conduct abstract analysis after deleting duplications, followed by 15 selected to full-text analysis. At last, 7 studies were included. For first line treatment comparison, 1 CUA evaluating gefitinib and chemotherapy (paclitaxel+carboplatin) shows geftinib dominates the chemotherapy with an ICER of ¥-13499.7/QALY. For second line comparison, 2 CAs show costs of geftinib are much lower than comparators, 3 CEAs show gefitinib is cost effective compared to erlotinib with much lower costeffectiveness ratios, and 1 CEA shows docetaxel is dominated by gefitinib, which has much lower costs(¥23022 vs. ¥24390) and higher objective response rate(26.90% vs. 10.30%). ConClusions: Our systematic review demonstrates that Gefitinib is cost effective in both first and second line treatment of NSCLC in a Chinese setting.
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