Cost-effectiveness of treating head and neck cancer using intensity-modulated radiation therapy: implications for cancer control program in India

Chauhan, Akashdeep Singh; Prinja, Shankar; Ghoshal, Sushmita; Verma, Roshan

doi:10.1017/s0266462320000677

Cited by 11 publications

(15 citation statements)

References 38 publications

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“…This value set of India has been generated based on data collected from 2409 participants across 5 states of India. Previously undertaken economic evaluations from India had either utilized Thailand specific value set to generate utility index values or had directly used QoL estimates from studies conducted in other countries [53] , [54] , [55] . The use of local preferences in the estimation of QoL values adds credibility in the assessment of QALYs.…”

Section: Discussionmentioning

confidence: 99%

Cost effectiveness of typhoid vaccination in India

Chauhan

Kapoor

Rana

et al. 2021

Vaccine

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Introduction World Health Organization has prequalified the use of typhoid conjugate vaccine (TCV) in children over six months of age in typhoid endemic countries. We assessed the cost-effectiveness of introducing TCV separately for urban and rural areas of India. Methods A decision analytic model was developed, using a societal perspective, to compare long-term costs and outcomes (3% discount rate) in a new-born cohort of 100,000 children immunized with or without TCV. Three vaccination scenarios were modelled, assuming the protective efficacy of TCV to last for 5, 10 and 15 years following immunization. Incidence of typhoid infection estimated under ‘National Surveillance System for Enteric Fever’ (NSSEFI)’ was used. The prices of vaccine and cost of service delivery were included for vaccination arm. Both health system cost and out-of-pocket expenditures for treatment of typhoid illness and its complications was included. Results TCV introduction in urban areas would result in prevention of 17% to 36% typhoid cases and deaths. With exclusion of indirect costs, the incremental cost per QALY gained was ₹ 151,346 (54,730–307,975), ₹ 61,710 (−5250 to 163,283) and ₹ 45,188 (−17,069 to 141,093) for scenario 1, 2 and 3 respectively. While, with inclusion of indirect costs, all 3 scenarios were cost saving. Further, in rural areas, TCV is estimated to reduce the typhoid cases and deaths by 19% to 36%, with ICER (incremental cost per QALY gained) ranging from ₹ 2340 (1316–4370) to ₹ 3574 (2057 – 6691) thousand (inclusive of indirect costs) among the 3 vaccination scenarios. Conclusion From a societal perspective, introduction of TCV is a cost saving strategy in urban India. Further, due to low incidence of typhoid infection, introduction of TCV is not cost-effective in rural settings of India.

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Section: Discussionmentioning

confidence: 99%

Cost effectiveness of typhoid vaccination in India

Chauhan

Kapoor

Rana

et al. 2021

Vaccine

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“…The Indian reference study for IMRT undertook the analysis from a societal perspective, using a lifetime horizon and discounting at a common rate of 3% and concluded IMRT to be a cost-ineffective intervention. 33 Details of the results from the selected EEs as originally reported are mentioned in online supplemental appendix 6b .…”

Section: Resultsmentioning

confidence: 99%

Validating the rigour of adaptive methods of economic evaluation

Chauhan,

Sharma,

Mehndiratta

et al. 2023

BMJ Glob Health

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BackgroundThere has been a lot of debate on how to ‘generalise’ or ‘translate’ findings of economic evaluation (EE) or health technology assessment (HTA) to other country contexts. Researchers have used various adaptive HTA (aHTA) methods like model-adaptation, price-benchmarking, scorecard-approach, etc., for transferring evidence from one country to other. This study was undertaken to assess the degree of accuracy in results generated from aHTA approaches specifically for EE.MethodsBy applying selected aHTA approaches, we adapted findings of globally published EE to Indian context. The first-step required identifying two interventions for which Indian EE (referred to as the ‘Indian reference study’) has been conducted. The next-step involved identification of globally published EE. The third-step required undertaking quality and transferability check. In the fourth step, outcomes of EE meeting transferability standards, were adapted using selected aHTA approaches. Lastly, adapted results were compared with findings of the Indian reference study.ResultsThe adapted cost estimates varied considerably, while adapted quality-adjusted life-years did not differ much, when matched with the Indian reference study. For intervention I (trastuzumab), adapted absolute costs were 11 and 6 times higher than the costs reported in the Indian reference study for control and intervention arms, respectively. Likewise, adapted incremental cost and incremental cost-effectiveness ratio (ICER) were around 3.5–8 times higher than the values reported in the Indian reference study. For intervention II (intensity-modulated radiation therapy), adapted absolute cost was 35% and 12% lower for the comparator and intervention arms, respectively, than the values reported in the Indian reference study. The mean incremental cost and ICER were 2.5 times and 1.5 times higher, respectively, than the Indian reference study values.ConclusionWe conclude that findings from aHTA methods should be interpreted with caution. There is a need to develop more robust aHTA approaches for cost adjustment. aHTA may be used for ‘topic prioritisation’ within the overall HTA process, whereby interventions which are highly cost-ineffective, can be directly ruled out, thus saving time and resources for conducting full HTA for interventions that are not well studied or where evidence is inconclusive.

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“…The median value of ICER along 2.5th and 97.5th percentiles was calculated using 999 Monte Carlo simulations. 32 Univariate sensitivity analysis was also undertaken to assess the effect each parameter on ICER. Univariate sensitivity analysis was done to assess the impact of uncertainty in individual parameters on the ICER value.…”

Section: Methodsmentioning

confidence: 99%

Cost Effectiveness of Bevacizumab Plus Chemotherapy for the Treatment of Advanced and Metastatic Cervical Cancer in India—A Model-Based Economic Analysis

Gupta

Nehra

Chauhan

et al. 2022

JCO Global Oncology

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PURPOSE Patients with advanced and metastatic cervical cancer have a poor prognosis with a 1-year survival rate of 10%-15%. Recently, an antiangiogenic humanized monoclonal antibody bevacizumab has shown to improve the survival of these patients. This study was designed to assess the cost effectiveness of incorporating bevacizumab with standard chemotherapy for the treatment of patients with advanced and metastatic cervical cancer in India. METHODS Using a disaggregated societal perspective and lifetime horizon, a Markov model was developed for estimating the costs and health outcomes in a hypothetical cohort of 1,000 patients with advanced and metastatic cervical cancer treated with either standard chemotherapy alone or in combination with bevacizumab. Effectiveness data for each of the treatment regimen were assessed using estimates from Gynecologic Oncology Group 240 trial. Data on disease-specific mortality in metastatic cervical cancer, health system cost, and out-of-pocket expenditure were derived from Indian literature. Multivariable probabilistic sensitivity analysis was undertaken to account for parameter uncertainty. RESULTS Over the lifetime of one patient with advanced and metastatic cervical cancer, bevacizumab along with standard chemotherapy results in a gain of 0.275 (0.052-0.469) life-years (LY) and 0.129 (0.032-0.218) quality-adjusted life-years (QALY), at an additional cost of $3,816 US dollars (USD; 2,513-5,571) compared with standard chemotherapy alone. This resulted in an incremental cost of $19,080 USD (7,230-52,434) per LY gained and $34,744 USD (15,782-94,914) per QALY gained with the use of bevacizumab plus standard chemotherapy. CONCLUSION Addition of bevacizumab to the standard chemotherapy is not cost effective for the treatment of advanced and metastatic cervical cancer in India at a threshold of 1-time per-capita gross domestic product.

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Cost-effectiveness of treating head and neck cancer using intensity-modulated radiation therapy: implications for cancer control program in India

Cited by 11 publications

References 38 publications

Cost effectiveness of typhoid vaccination in India

Cost effectiveness of typhoid vaccination in India

Validating the rigour of adaptive methods of economic evaluation

Cost Effectiveness of Bevacizumab Plus Chemotherapy for the Treatment of Advanced and Metastatic Cervical Cancer in India—A Model-Based Economic Analysis

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