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Sorafenib Effectiveness in Advanced Hepatocellular Carcinoma

View Article: PubMed Central - PubMed

ABSTRACT

Survival after sorafenib initiation in newly diagnosed Medicare beneficiaries with hepatocellular carcinoma (HCC) is exceptionally short, suggesting that trial results are not generalizable to all HCC patients. The downsides of sorafenib use—high drug-related symptom burden and high drug cost—must be considered in light of this minimal benefit.

No MeSH data available.


Related in: MedlinePlus

Clinical benefit, toxicity, NHB, and DAC of sorafenib using the American Society of Clinical Oncology Value Framework [24]. The data for each parameter are shown above the bar. Clinical outcomes are taken from the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol trial [5]. Drug costs are the average cost for Medicare part D plans in 2014.Abbreviations: DAC, drug acquisition cost; NHB, net health benefit.
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Figure 4: Clinical benefit, toxicity, NHB, and DAC of sorafenib using the American Society of Clinical Oncology Value Framework [24]. The data for each parameter are shown above the bar. Clinical outcomes are taken from the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol trial [5]. Drug costs are the average cost for Medicare part D plans in 2014.Abbreviations: DAC, drug acquisition cost; NHB, net health benefit.

Mentions: Yet, even if our results do not apply to all newly diagnosed patients with HCC, they demonstrate that the results of the SHARP and Asia-Pacific trials do not describe the experience of sorafenib in all patients with advanced HCC. The recently published American Society of Clinical Oncology Value Framework recommends evaluating the clinical benefit (a composite of clinical efficacy and toxicity) against the drug acquisition cost and patient copay [23]. When this exercise is performed with the data from the SHARP trial (Fig. 4), the net health benefit of sorafenib is only 12 of 130 possible points (32 for a 35% improvement in survival, −20 for a substantially less well-tolerated drug, 0 bonus points). The Value Framework recommends displaying these 12 net health benefit points alongside the drug acquisition cost, which was on average $10,811 for a 30-day supply across Medicare part D plans in 2014 [24]. So although these Value Framework worksheets are intended to be subject to individual interpretation regarding the value of even small net health benefit scores, it is clear that even in the best-case scenario some patients might reasonably question the value of sorafenib.


Sorafenib Effectiveness in Advanced Hepatocellular Carcinoma
Clinical benefit, toxicity, NHB, and DAC of sorafenib using the American Society of Clinical Oncology Value Framework [24]. The data for each parameter are shown above the bar. Clinical outcomes are taken from the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol trial [5]. Drug costs are the average cost for Medicare part D plans in 2014.Abbreviations: DAC, drug acquisition cost; NHB, net health benefit.
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Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5016063&req=5

Figure 4: Clinical benefit, toxicity, NHB, and DAC of sorafenib using the American Society of Clinical Oncology Value Framework [24]. The data for each parameter are shown above the bar. Clinical outcomes are taken from the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol trial [5]. Drug costs are the average cost for Medicare part D plans in 2014.Abbreviations: DAC, drug acquisition cost; NHB, net health benefit.
Mentions: Yet, even if our results do not apply to all newly diagnosed patients with HCC, they demonstrate that the results of the SHARP and Asia-Pacific trials do not describe the experience of sorafenib in all patients with advanced HCC. The recently published American Society of Clinical Oncology Value Framework recommends evaluating the clinical benefit (a composite of clinical efficacy and toxicity) against the drug acquisition cost and patient copay [23]. When this exercise is performed with the data from the SHARP trial (Fig. 4), the net health benefit of sorafenib is only 12 of 130 possible points (32 for a 35% improvement in survival, −20 for a substantially less well-tolerated drug, 0 bonus points). The Value Framework recommends displaying these 12 net health benefit points alongside the drug acquisition cost, which was on average $10,811 for a 30-day supply across Medicare part D plans in 2014 [24]. So although these Value Framework worksheets are intended to be subject to individual interpretation regarding the value of even small net health benefit scores, it is clear that even in the best-case scenario some patients might reasonably question the value of sorafenib.

View Article: PubMed Central - PubMed

ABSTRACT

Survival after sorafenib initiation in newly diagnosed Medicare beneficiaries with hepatocellular carcinoma (HCC) is exceptionally short, suggesting that trial results are not generalizable to all HCC patients. The downsides of sorafenib use—high drug-related symptom burden and high drug cost—must be considered in light of this minimal benefit.

No MeSH data available.


Related in: MedlinePlus