BackgroundThe objective of our study was to conduct a cost-effectiveness (CE) study of combined everolimus (EVE) and exemestane (EXE) versus the common clinical practice in Greece for the treatment of postmenopausal women with HR+/HER2- advanced breast cancer (BC) progressing on nonsteroidal aromatase inhibitors (NSAI). The combinations of bevacizumab (BEV) plus paclitaxel (PACL) and BEV plus capecitabine (CAPE) were selected as comparators.MethodA Markov model, consisting of three health states, was used to describe disease progression and evaluate the CE of the comparators from a third-party payer perspective over a lifetime horizon. Efficacy and safety data as well as utility values considered in the model were extracted from the relevant randomized Phase III clinical trials and other published studies. Direct medical costs referring to the year 2014 were incorporated in the model. A probabilistic sensitivity analysis was conducted to account for uncertainty and variation in the parameters of the model. Primary outcomes were patient survival (life-years), quality-adjusted life years (QALYs), total direct costs and incremental cost-effectiveness ratios (ICER).ResultsThe discounted quality-adjusted survival of patients treated with EVE plus EXE was greater by 0.035 and 0.004 QALYs, compared to BEV plus PACL and BEV plus CAPE, respectively. EVE plus EXE was the least costly treatment in terms of drug acquisition, administration, and concomitant medications. The total lifetime cost per patient was estimated at €55,022, €67,980, and €62,822 for EVE plus EXE, BEV plus PACL, and BEV plus CAPE, respectively. The probabilistic analysis confirmed the deterministic results.ConclusionOur results suggest that EVE plus EXE may be a dominant alternative relative to BEV plus PACL and BEV plus CAPE for the treatment of HR+/HER2- advanced BC patients failing initial therapy with NSAIs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0971-4) contains supplementary material, which is available to authorized users.

A423tions (i.e. PIER trial). The model assumes that patients discontinue treatment after the second year of treatment. Costs related to drug acquisition, administration, monitoring costs and blindness were considered in the analysis (2015). This model predicted: blind-years, quality-adjusted life-years (QALYs), and the direct costs from a payer perspective. Results: Treatment without delay was found to be more beneficial compared to "with delay" treatment in terms of QALYs (4,487 vs. 4,190) and blind-years (1,084 vs. 1,511). The total lifetime cost was calculated to be € 235 higher in patients treated without any delay, resulting in an ICER of € 790 per QALY gained (well-below the threshold of € 17,000). The higher drug acquisition cost observed in "without delay" arm was partially offset by the increased non-medical direct cost related to the "with delay" arm. ConClusions: Ranibizumab treatment of wAMD without delay seems to be a strongly cost-effective strategy in Greece.

modeled by assuming log-normal distributions. Patients were deemed eligible for apheresis with LDL-C levels ≥ 300mg/dL in primary prevention (PP) or ≥ 200mg/dL in secondary prevention (SP) according to Russian guidelines. The use of apheresis was calculated with and without evolocumab treatment over a lifetime horizon, with costs assigned to LLTs. A previously published decision analytic model was used to track the proportion of the cohort with history of events and to account for mortality. Results: The model predictions indicate that 3.1% (PP) and 34.6% (SP) of patients would receive apheresis at baseline. Mean survival was increased by 5.6 years, whilst the use of apheresis was reduced by 3.8 patient-years in evolocumab treated patients. Despite increased survival, treatment with evolocumab resulted in a per-patient saving of RUR 957,016 for the overall cost of LLTs. ConClusions: Evolocumab may lead to a significant reduction in apheresis use according to Russian guidelines and a subsequent savings in apheresis costs.

No abstract