Do Value Thresholds for Oncology Drugs Differ from Nononcology Drugs?

Bae, Yuna H.; Mullins, C. Daniel

doi:10.18553/jmcp.2014.20.11.1086

Cited by 47 publications

(47 citation statements)

References 62 publications

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“…Interestingly, although overall costs were not very different, survival difference between the transplantation and nontransplantation groups population decreased by about 6 months (See Appendix 2). With this change in survival benefit, the ICER doubles, although it remains within the range of many other cancer therapies [40]. It suggests that the patients who survive for at least 12 months without transplantation may be clinically distinct from those who underwent transplantation earlier and, as such, may not derive the same benefit from transplantation as those who survive at least 6 months.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Autologous Hematopoietic Stem Cell Transplantation for Elderly Patients with Multiple Myeloma using the Surveillance, Epidemiology, and End Results–Medicare Database

Shah

Winn

Lin

et al. 2015

Biology of Blood and Marrow Transplantation

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In the past decade, the number of autologous hematopoietic stem cell transplants (Auto HSCT) for older patients with multiple myeloma (MM) has increased dramatically, as has the cost of transplantation. The cost-effectiveness of this modality in patients over age 65 is unclear. Using the Surveillance, Epidemiology, and End ResultseMedicare database to create a propensity-score matched sample of patients over age 65 between 2000 and 2007, we compared the survival and cost for those who received Auto HSCT to those who did not undergo transplantation but survived at least 6 months after diagnosis, and we calculated an incremental cost-effectiveness ratio (ICER). Two hundred seventy patients underwent transplantation. Median overall survival from diagnosis in those who underwent transplantation was significantly longer than in patients who did not (58 months versus 37 months, P < .001). For patients living longer than 2 years, the median monthly cost during the first year was significantly different, but the middle and last year of life costs were similar. The median cost of the first 100 days after transplantation was $60,000 (range, $37,000 to $85,000). The resultant ICER was $72,852 per life-year gained. Survival after transplantation was comparable to that in those who underwent transplantation patients under 65 years and significantly longer than older patients who did not undergo transplantation. With an ICER less than $100,000/life-year gained, Auto HSCT is cost-effective when compared with nontransplantation care in the era of novel agents and should be considered, where clinically indicated, for patients over the age of 65.

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Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Autologous Hematopoietic Stem Cell Transplantation for Elderly Patients with Multiple Myeloma using the Surveillance, Epidemiology, and End Results–Medicare Database

Shah

Winn

Lin

et al. 2015

Biology of Blood and Marrow Transplantation

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“…Combining differences in costs and QALYs resulted in an ICER of £8005 per QALY. At the commonly cited lower willingness‐to‐pay ratio of £20 000 per QALY in the UK , the probability of ZA being cost‐effective is 0.64 (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

Cost‐effectiveness of zoledronic acid and strontium‐89 as bone protecting treatments in addition to chemotherapy in patients with metastatic castrate‐refractory prostate cancer: results from theTRAPEZEtrial (ISRCTN12808747)

et al. 2016

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ObjectiveTo evaluate the cost-effectiveness of adding zoledronic acid or strontium-89 to standard docetaxel chemotherapy for patients with castrate-refractory prostate cancer (CRPC). Patients and methodsData on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2 9 2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost-effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium-89 versus no strontium-89 (Sr89 vs. no Sr89). Costs were estimated from the perspective of the National Health Service in the UK and included expenditures for trial treatments, concomitant medications, and use of related hospital and primary care services. Quality-adjusted life-years (QALYs) were calculated according to patients' responses to the generic EuroQol EQ-5D-3L instrument, which evaluates health status. Results are expressed as incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves. ResultsThe per-patient cost for ZA was £12 667, £251 higher than the equivalent cost in the no ZA group. Patients in the ZA group had on average 0.03 QALYs more than their counterparts in no ZA group. The ICER for this comparison was £8 005. Sr89 was associated with a cost of £13 230, £1365 higher than no Sr89, and a gain of 0.08 QALYs compared to no Sr89. The ICER for Sr89 was £16 884. The probabilities of ZA and Sr89 being costeffective were 0.64 and 0.60, respectively.

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“…The WTP threshold of $150,000 generally used in the US follows World Health Organization recommendations that the upper limit for cost-effectiveness of an intervention should be considered to be approximately three times gross domestic product per capita 24 . However, ICERs for oncology treatments are more than double those of non-oncology treatments 27 , and recent oncology-specific studies have suggested that the "true" threshold should be considered to be above $150,000: surveys from academic oncologists 28 and observational analyses of patient behaviors 29 suggest that a threshold as high as $250,000 may be acceptable, particularly in the metastatic setting. Given the spiraling costs of healthcare in the US, which are approximately double that of other high income countries per capita, optimization of healthcare resources is increasingly important.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of nivolumab for the treatment of squamous cell carcinoma of the head and neck in the United States

Haddad

Cohen

Venkatachalam

et al. 2020

Journal of Medical Economics

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Aim: To assess the cost-effectiveness of nivolumab monotherapy for recurrent/metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) in the US. Methods: We constructed a cohort-based partitioned survival model for three health states (progression-free, progressed disease, and death). Using overall survival and progression-free survival data from the nivolumab and investigator's choice (IC) arms of the CheckMate 141 study, the proportion of patients in each health state was estimated by parametric modeling over a 25-year period. Cost, utility, adverse event, and disease management data inputs were obtained from relevant literature and applied to patients in each health state. A scenario analysis was conducted assuming increased uptake of subsequent immunotherapies. A one-way deterministic sensitivity analysis assessed the impact of variation in multiple parameters. A probabilistic sensitivity analysis in which probabilistic distributions were applied to each input during 1,000 model iterations was also conducted.

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Do Value Thresholds for Oncology Drugs Differ from Nononcology Drugs?

Cited by 47 publications

References 62 publications

Cost-Effectiveness of Autologous Hematopoietic Stem Cell Transplantation for Elderly Patients with Multiple Myeloma using the Surveillance, Epidemiology, and End Results–Medicare Database

Cost-Effectiveness of Autologous Hematopoietic Stem Cell Transplantation for Elderly Patients with Multiple Myeloma using the Surveillance, Epidemiology, and End Results–Medicare Database

Cost‐effectiveness of zoledronic acid and strontium‐89 as bone protecting treatments in addition to chemotherapy in patients with metastatic castrate‐refractory prostate cancer: results from theTRAPEZEtrial (ISRCTN12808747)

Cost-effectiveness analysis of nivolumab for the treatment of squamous cell carcinoma of the head and neck in the United States

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