Cost‐Effectiveness of Real‐World Administration of Concomitant Viscum album L. Therapy for the Treatment of Stage IV Pancreatic Cancer

Abstract

Background. For patients receiving add-on Viscum album L. (VA) treatments for late-stage pancreatic cancer, an improved overall survival (OS) was observed. Only limited information regarding cost-effectiveness (CE) for comparisons between standard of care and standard of care plus add-on VA in stage IV pancreatic cancer treatment is available. The present study assessed the costs and cost-effectiveness of standard of care plus VA (V) compared to standard of care alone (C) for a hospital in Germany. Methods. An observational study was conducted using data from the Network Oncology clinical registry. Patients included had stage IV pancreatic cancer at diagnosis and received C or V treatment in a certified German Cancer Center. Cost and cost-effectiveness analyses (CEA) including the analysis of the incremental cost-effectiveness ratios (ICER) were performed from the hospital’s perspective based on routine data from the financial controlling department and observed data on OS. The primary result of the analysis was tested for robustness in a bootstrap-based sensitivity analysis. Results. 88 patients (C: n = 34; V: n = 54) were included, with a mean age 65.6 years and proportion of male patients 48.9%. Adjusted hospital’s total mean costs for patients from the C and V groups were €10068.97 (over an adjusted mean OS time of 7.1 months) and €12267.94 (over an adjusted mean OS time of 10.6 months), respectively. As to CEA analysis, a relevant total hospital’s savings of €260.81/month mean OS for V patients compared to C was calculated. The costs per additional OS month gained (ICER) with the V treatment compared to C were €628.28. Furthermore, a relevant hospital savings of €915.77 per mean hospital stay and additional costs of €75.09 per mean hospitalization day in the V group were observed compared to C. Conclusion. Based on this CEA analysis, from the hospital’s point of view, the costs per mean month of OS and per mean hospital stay were lower for patients under combinational standard of care plus VA compared to patients receiving standard of care alone for the treatment of stage IV pancreatic cancer. Further prospective cost-effectiveness studies are mandatory to reevaluate our findings.

Big Data and Real-World Data based Cost-Effectiveness Studies and Decision-making Models: A Systematic Review and Analysis

“…However, for the treatment regimen, it might be difficult to select a sample in a real-world setting where the treatment regimen is always complicated ( Schulman et al, 2013 ). Consequently, those studies aiming to compare different treatment regimens preferred to use a model approach that allows greater freedom in the choice of study and control groups ( Behar et al, 2017 ; Thronicke et al, 2020 ). This might be due to the fact that most of the studies with the model used sensitivity analysis to control for uncertainty.…”

Systematic analysis of mistletoe prescriptions in clinical studies

“…The 36 cohort studies can be divided into controlled and non-controlled studies. Of these, 29 studies (16 publications respectively) are designed as controlled studies (Augustin et al 2005 ; Bock et al 2004a , 2014 ; Beuth et al 2008 ; Friedel et al 2009 ; Grossarth-Maticek and Ziegler 2006a , b , 2007a , b , 2007 c, 2008 ; Matthes et al 2010 ; Schumacher et al 2003 ; Thronicke et al 2017 , 2020a ; Zaenker et al 2012 ) Of the studies published by Grossarth-Maticek, eight were randomized matched-pair studies, and eleven were non-randomized matched-pair studies. The remaining cohort studies are non-controlled (Brandenberger et al 2012 ; Oei et al 2019a , b ; Schad et al 2017 , 2018a , b ; Thronicke et al 2020b ).…”

<b><i>Viscum album</i></b> L. Therapy in Oncology: An Update on Current Evidence

“…Nevertheless, a current systematic review on the clinical efficacy of VA therapy indicates a significant improvement of survival for patients with lung cancer receiving VA therapy [27]. This evidence is supported by results from a multicentre RWD study revealing that the combination of chemotherapy and VA therapy significantly prolonged overall survival of stage IV non-small cell lung cancer patients and even at similar costs compared to chemotherapy alone [28, 29]. It is considered by the authors of this review that these results should be considered in new editions of current guidelines or in new guidelines, especially in the palliative field.…”

“…In addition, another multicentre RWD study of patients with pancreatic cancer showed prolonged survival rates, an improved HRQL, and a reduction in side effects of standard oncological treatment in the VA group [41]. The results of a first-ever published RWD cost-effectiveness study for patients with stage IV pancreatic cancer revealed that chemotherapy plus VA therapy was equally cost-effective compared to chemotherapy alone [29].…”