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Everolimus plus exemestane versus bevacizumab-based chemotherapy for second-line treatment of hormone receptor-positive metastatic breast cancer in Greece: An economic evaluation study.

Kourlaba G, Rapti V, Alexopoulos A, Relakis J, Koumakis G, Chatzikou M, Maniadakis N, Georgoulias V - BMC Health Serv Res (2015)

Bottom Line: Primary outcomes were patient survival (life-years), quality-adjusted life years (QALYs), total direct costs and incremental cost-effectiveness ratios (ICER).The 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.The probabilistic analysis confirmed the deterministic results.

View Article: PubMed Central - PubMed

Affiliation: The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), National and Kapodistrian University of Athens, School of Medicine, Athens, Greece. kurlaba@hua.gr.

ABSTRACT

Background: The 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.

Method: A 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).

Results: The 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.

Conclusion: Our 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.

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Assumptions and indirect comparisons to obtain estimations for the overall survival of comparators
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Fig2: Assumptions and indirect comparisons to obtain estimations for the overall survival of comparators

Mentions: To estimate the PFS and OS for the comparators, relevant hazard ratios (HRs) were applied to the OS and PFS functions of EVE plus EXE. To be more precise, in the absence of head-to-head clinical trials between EVE plus EXE and the selected comparators (BEV plus PACL and BEV plus CAPE), indirect methods and assumptions, similar to those considered in the model submitted to the National Institute for Clinical Excellence (NICE) [15], were used to obtain estimates for HRs of the comparators against EVE plus EXE. The assumptions and indirect comparisons employed to calculate the corresponding HRs for OS and PFS are depicted in Figs. 2 and 3.Fig. 2


Everolimus plus exemestane versus bevacizumab-based chemotherapy for second-line treatment of hormone receptor-positive metastatic breast cancer in Greece: An economic evaluation study.

Kourlaba G, Rapti V, Alexopoulos A, Relakis J, Koumakis G, Chatzikou M, Maniadakis N, Georgoulias V - BMC Health Serv Res (2015)

Assumptions and indirect comparisons to obtain estimations for the overall survival of comparators
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4524048&req=5

Fig2: Assumptions and indirect comparisons to obtain estimations for the overall survival of comparators
Mentions: To estimate the PFS and OS for the comparators, relevant hazard ratios (HRs) were applied to the OS and PFS functions of EVE plus EXE. To be more precise, in the absence of head-to-head clinical trials between EVE plus EXE and the selected comparators (BEV plus PACL and BEV plus CAPE), indirect methods and assumptions, similar to those considered in the model submitted to the National Institute for Clinical Excellence (NICE) [15], were used to obtain estimates for HRs of the comparators against EVE plus EXE. The assumptions and indirect comparisons employed to calculate the corresponding HRs for OS and PFS are depicted in Figs. 2 and 3.Fig. 2

Bottom Line: Primary outcomes were patient survival (life-years), quality-adjusted life years (QALYs), total direct costs and incremental cost-effectiveness ratios (ICER).The 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.The probabilistic analysis confirmed the deterministic results.

View Article: PubMed Central - PubMed

Affiliation: The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), National and Kapodistrian University of Athens, School of Medicine, Athens, Greece. kurlaba@hua.gr.

ABSTRACT

Background: The 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.

Method: A 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).

Results: The 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.

Conclusion: Our 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.

Show MeSH
Related in: MedlinePlus