ABSTRACT
Clinical trial EMR 62202-006 demonstrates prolonged median locoregional control (24.4 vs. 14.9 months), progression-free survival (17.1 vs. 12.4 months) and overall survival (49.0 vs. 29.3 months) for patients who receive cetuximab added to the comparator radiotherapy for locally advanced squamous cell carcinoma of the head and neck (LA SCCHN). In the Netherlands, hospitals receive reimbursement for cetuximab conditional on cost-effectiveness in daily practice. To estimate the real-world incremental cost per quality adjusted life-year (QALY) gained for radiotherapy + cetuximab over radiotherapy alone in first line treatment of LA SCCHN, a Markov model is constructed with health states "alive without progression", "alive following progression" and "death". Transition probabilities per month are estimated from clinical trial data and retrospectively collected real-world data from two Dutch head and neck cancer treatment centres (2007-2010, n = 141). 5-year, 10-year and lifetime horizons are used, without and with discounting (4 % costs, 1.5 % effects) to calculate incremental cost-effectiveness ratios. Two scenarios explore different assumptions on prognosis of real-world versus trial patients. Adding cetuximab to radiotherapy results in increased costs and health gains in both scenarios and across each of the time horizons. Incremental costs per QALY gained range between
Subject(s)
Carcinoma, Squamous Cell , Cetuximab , Cost-Benefit Analysis , Head and Neck Neoplasms , Radiotherapy , Aged , Antineoplastic Agents/economics , Antineoplastic Agents/therapeutic use , Carcinoma, Squamous Cell/economics , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Cetuximab/economics , Cetuximab/therapeutic use , Combined Modality Therapy/economics , Combined Modality Therapy/methods , Disease-Free Survival , Female , Head and Neck Neoplasms/economics , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/therapy , Humans , Male , Markov Chains , Middle Aged , Neoplasm Invasiveness , Netherlands , Prognosis , Quality-Adjusted Life Years , Radiotherapy/economics , Radiotherapy/methods , Randomized Controlled Trials as Topic , Retrospective Studies , Squamous Cell Carcinoma of Head and NeckABSTRACT
We performed a comprehensive cost calculation identifying the main cost drivers of treatment of chronic lymphocytic leukaemia in daily practice. In our observational study 160 patient charts were reviewed repeatedly to assess the treatment strategies from diagnosis till the study end. Ninety-seven patients (61%) received ≥1 treatment lines during an average follow-up time of 6.4 years. The average total costs per patient were 41,417 (539 per month). The costs varied considerably between treatment groups and between treatment lines. Although patients were treated with expensive chemo(immuno-)therapy, the main cost driver was inpatient days for other reasons than administration of chemo(immuno-)therapy.