Cost-Effectiveness Analyses of Targeted Oral Anti-Cancer Drugs: A Systematic Review

Smieliauskas, Fabrice; Chien, Chun Ru; Shen, Chan; Geynisman, Daniel M.; Shih, Ya Chen Tina

doi:10.1007/s40273-014-0160-z

Cited by 20 publications

(17 citation statements)

References 75 publications

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“…However, while in the past the focus for facing this problem was put on the development of costeffectiveness models, [3][4][5] recent projects concentrated on quantification of the actual clinical benefit derived from a new intervention. [6][7][8] The European Society for Medical Oncology (ESMO) has developed a standardised, generic, validated concept named the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS).…”

Section: How Might This Impact On Clinical Practice?mentioning

confidence: 99%

The European Society for Medical Oncology Magnitude of Clinical Benefit Scale in daily practice: a single institution, real-life experience at the Medical University of Vienna

et al. 2016

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BackgroundThe European Society for Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale (MCBS) has been designed to stratify the therapeutic benefit of a certain drug registered for the treatment of cancer. However, though internally validated, this tool has not yet been evaluated for its feasibility in the daily practice of a major center of medical oncology.MethodsThe practicability of the MCBS for advanced oncological diseases at the Clinical Division of Oncology, Medical University of Vienna, which constitutes one of the largest oncological centres in Europe, was analysed in a three-step approach. First, retrospectively collected data were analysed to gain an overview of treatments in regular use. Second, data were scored by using the MCBS. Third, the ensuing results were evaluated within corresponding programme directorships to assess feasibility in a real-life clinical context.ResultsIn the majority of tumour entities, the MCBS results reported earlier are consistent with daily clinical practice. Thus, in metastatic breast cancer or advanced lung cancer, there was a high level of clinical benefit for first-line treatment standards, and these results reflected well real-life experience. However, analyses based on the first version of the MCBS are limited if it comes to salvage treatment in tumour entities in which optimal sequencing of potential treatment options is of major importance, as in metastatic colorectal or renal cell cancer. In contrast to this, it is remarkable that certain novel therapies such as nivolumab assessed for heavily pretreated advanced renal cancer reached the highest level of clinical benefit due to prolongation in survival and a favourable toxicity profile. The MCBS clearly underlines the potential benefit of these compounds.ConclusionsThe MCBS is an excellent tool for daily clinical practice of a tertiary referral centre. It supports treatment decisions based on the clinical benefit to be expected from a novel approach such as immunotherapy in as yet untested indications.

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Section: How Might This Impact On Clinical Practice?mentioning

confidence: 99%

The European Society for Medical Oncology Magnitude of Clinical Benefit Scale in daily practice: a single institution, real-life experience at the Medical University of Vienna

et al. 2016

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“…Finally, health system‐related factors include availability of the medical staff, clarity and validity of the communication and information provided as well as adequate social, psychological and caregiver support . In a variety of patient populations, non‐adherence and non‐persistence have been associated with an increased consumption of healthcare resources, including an increased number of physician visits, higher hospitalization rates and longer stays .…”

Section: Introductionmentioning

confidence: 99%

Oral antineoplastic agents: how do we care about adherence?

Barillet

Prévost

Joly

et al. 2015

Brit J Clinical Pharma

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Aims Oral therapies, including hormone‐based or targeted therapies, have recently taken an increasing place in cancer treatment. In this context, a state of the art of the available studies dealing with the adherence of adult patients to oral anticancer treatment is warranted. The purpose of this review is to address (i) the association between assessment methods and measured adherence, (ii) the putative factors related to adherence and (iii) new ways of improving adherence to oral cancer therapies. Methods We conducted a literature‐based narrative review of studies obtained from Pubmed using medical subject heading terms and free‐text terms combining concepts related to oral anticancer medication and adherence. Results The analysis is based on 48 studies published since 1990, mostly assessing hormone‐based therapy in breast cancer and targeted therapies in chronic myeloid leukaemia. Various methods of adherence were reported including self‐report, medication measurement or combinations of methods. Adherence rates were found to vary from 14% to 100%. Beside patient related‐factors, adherence rate discrepancies were found to be dependent on the method used. Furthermore, there was no consensual definition of adherence even regarding the same methods, some of them tolerating a period of interruption during the treatment period. Finally, several studies addressing persistence found a progressive decrease in adherence with time. Conclusion Adherence to novel oral therapies is a major issue and further research is warranted to standardize adherence assessment in clinical studies better and to define better the most appropriate approaches to improve long term adherence in oncology practice.

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“…118 Improving patients’ abilities to adhere to orally administered cancer therapies is increasingly important as the use of these treatments is rapidly expanding, and is the standard of care for certain cancers. 119-123 Non-adherence to these treatments can have a substantial impact on disease progression, recurrence, and survival. 123 The CST-AET protocol could readily be adapted to address specific challenges to adherence for these treatments, such as complicated dosing schedules or difficult side effects.…”

Section: Discussionmentioning

confidence: 99%

Testing a behavioral intervention to improve adherence to adjuvant endocrine therapy (AET)

Shelby

Dorfman

Bosworth

et al. 2019

Contemporary Clinical Trials

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Adjuvant endocrine therapy (AET) is used to prevent recurrence and reduce mortality for women with hormone receptor positive breast cancer. Poor adherence to AET is a significant problem and contributes to increased medical costs and mortality. A variety of problematic symptoms associated with AET are related to non-adherence and early discontinuation of treatment. The goal of this study is to test a novel, telephone-based coping skills training that teaches patients adherence skills and techniques for coping with problematic symptoms (CST-AET). Adherence to AET will be assessed in real-time for 18 months using wireless smart pill bottles. Symptom interference (i.e., pain, vasomotor symptoms, sleep problems, vaginal dryness) and cost-effectiveness of the intervention protocol will be examined as secondary outcomes. Participants (N=400) will be recruited from a tertiary care medical center or community clinics in medically underserved or rural areas. Participants will be randomized to receive CST-AET or a general health education intervention (comparison condition). CST-AET includes ten nurse-delivered calls delivered over 6 months. CST-AET provides systematic training in coping skills for managing symptoms that interfere with adherence. Interactive voice messaging provides reinforcement for skills use and adherence that is tailored based on real-time adherence data from the wireless smart pill bottles. Given the high rates of non-adherence and recent recommendations that women remain on AET for 10 years, we describe a timely trial. If effective, the CST-AET protocol may not only reduce the burden of AET use but also lead to cost-effective changes in clinical care and improve breast cancer outcomes.

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Cost-Effectiveness Analyses of Targeted Oral Anti-Cancer Drugs: A Systematic Review

Cited by 20 publications

References 75 publications

The European Society for Medical Oncology Magnitude of Clinical Benefit Scale in daily practice: a single institution, real-life experience at the Medical University of Vienna

The European Society for Medical Oncology Magnitude of Clinical Benefit Scale in daily practice: a single institution, real-life experience at the Medical University of Vienna

Oral antineoplastic agents: how do we care about adherence?

Testing a behavioral intervention to improve adherence to adjuvant endocrine therapy (AET)

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