Real-world costs during treatment of relapsed/refractory multiple myeloma vary greatly. Cost drivers include hospital admissions and acquisition costs of novel agents. Costs also vary by prognostic factors and treatment-related resource use. Future studies assessing the costs of combination therapy consisting of two or more novel agents are encouraged.

ObjectiveIncontinence 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.MethodA 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.ResultsWith 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.ConclusionImplementing 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. Furthermore, the study also highlighted that various areas of the continence care process lack data, which would be valuable to collect through the introduction of the NS in a study setting.

This case demonstrates the use of cost-effectiveness analysis at an early stage of health technology assessment to generate economic evidence for the use of companion diagnostics in treatment decisions and to support decision-making for their development.

Objectives: Docetaxel and Cabazitaxel are taxane chemotherapy approved in men with mCRPC after they demonstrated improved survival in first and second line respectively. If recent data suggested similar efficacy, these two taxanes have different safety profile and unit price, raising the question of their administration sequence. A cost-utility analysis comparing two sequences of treatment (Cabazitaxel followed by Docetaxel versus Docetaxel followed by Cabazitaxel) for first-line chemotherapy in metastatic prostate cancer was performed in the French context, using data from the CABADOC randomized trial. MethOds: The CABADOC study is a randomized trial with a cross-over design. Patients were randomized to receive either Docetaxel 75mg/m²/q3w x 4 followed by Cabazitaxel 25mg/m²/q3w x 4, or the reverse sequence. The economic analysis included a prospective collection of resources consumed (chemotherapy, hospitalizations, transportation, nurses and consultations) and utility data (using the EQ-5D questionnaire administered before cycle 1, cycle 5 and at the end of chemotherapy) alongside the trial. Costs were evaluated from the French collective perspective and horizon time was limited from the randomization date to the end of 2nd sequence chemotherapy. The ICER was calculated and sensitivity analyses were conducted. Results: From June 2014 to October 2016, 195 patients (median age of 70 years) were randomized in 17 centers. Patients received 3.8 ± 0.7 and 3.2 ± 1.5 cycles of chemotherapy during the first and the second period, respectively. The sequence Docetaxel-Cabazitaxel appears to be more effective (mean QALY per patient of 0.353 ± 0.025 versus 0.328 ± 0.063) and less expensive (mean cost per patient of 17 350 € ± 2955 versus 17 862 € ± 2320) as compared to the sequence Cabazitaxel-Docetaxel. cOnclusiOns: The sequence of treatment with Docetaxel followed by Cabazitaxel appears the optimal one for first line chemotherapy in metastatic prostate cancer from a cost-utility standpoint. NCT: NCT02044354.

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.