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1.
Appl Health Econ Health Policy ; 16(1): 133-143, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28866822

RESUMO

BACKGROUND: The treatment of metastatic castration-resistant prostate cancer has changed with the introduction of radium-223, cabazitaxel, abiraterone and enzalutamide. To assess value for money, their cost effectiveness in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel from the Dutch societal perspective was investigated. METHODS: A cost-effectiveness analysis was conducted using efficacy, symptomatic skeletal-related event and safety data obtained from indirect treatment comparisons. Missing skeletal-related event data for cabazitaxel were conservatively assumed to be identical to radium-223. A Markov model combined these clinical inputs with Dutch-specific resource use and costs for metastatic castration-resistant prostate cancer treatment from a societal perspective. Total quality-adjusted life-years and costs in 2017 euros were calculated over a 5-year (lifetime) time horizon. RESULTS: Radium-223 resulted in €6092 and €4465 lower costs and 0.02 and 0.01 higher quality-adjusted life-years compared with abiraterone and cabazitaxel, respectively, demonstrating dominance of radium-223. Sensitivity analyses reveal a 64% (54%) chance of radium-223 being cost effective compared with abiraterone (cabazitaxel) at the informal €80,000 willingness-to-pay threshold. Compared with enzalutamide, radium-223 resulted in slightly lower quality-adjusted life-years (-0.06) and €7390 lower costs, revealing a 61% chance of radium-223 being cost effective compared with enzalutamide. The lower costs of radium-223 compared with abiraterone and enzalutamide are driven by lower drug costs and prevention of expensive skeletal-related events. Compared with cabazitaxel, the lower costs of radium-223 are driven by lower costs of the drug, administration and adverse events. CONCLUSION: Radium-223 may be a less costly treatment strategy offering similar gains in health benefits compared with abiraterone, cabazitaxel and enzalutamide in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel from the Dutch societal perspective.


Assuntos
Neoplasias da Próstata/economia , Rádio (Elemento)/economia , Androstenos/economia , Androstenos/uso terapêutico , Antineoplásicos/economia , Antineoplásicos/uso terapêutico , Benzamidas , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Masculino , Cadeias de Markov , Países Baixos , Nitrilas , Orquiectomia , Feniltioidantoína/análogos & derivados , Feniltioidantoína/economia , Feniltioidantoína/uso terapêutico , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Anos de Vida Ajustados por Qualidade de Vida , Rádio (Elemento)/uso terapêutico , Falha de Tratamento
2.
J Manag Care Spec Pharm ; 22(2): 163-70, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27015255

RESUMO

BACKGROUND: Prostate cancer is expected to account for approximately one quarter of all new diagnoses of cancer in American men in 2015. The cost of prostate cancer care is expected to reach $15.1 billion by the year 2020, up from $11.9 billion in 2010. Given the high burden of prostate cancer, health care payers are interested in quantifying the potential budget impact of new therapies. OBJECTIVE: To estimate the budget impact of enzalutamide for the treatment of chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) from a U.S. payer perspective. METHODS: A model was developed to assess the budget impact of enzalutamide for treatment of chemotherapy-naïve mCRPC patients in a hypothetical 1-million-member U.S. health plan over a 1-year time horizon. Comparators included abiraterone acetate, sipuleucel-T, radium Ra 223 dichloride, and docetaxel. Epidemiologic data, including National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) incidence rates, were used to estimate the number of chemotherapy-naïve mCRPC patients. Dosing, administration, duration of therapy, and adverse event rates were based on package inserts and pivotal studies. Drug costs were obtained from RED BOOK and Centers for Medicare & Medicaid Services (CMS) average sales price pricing files, costs of administration and monitoring from the CMS physician fee schedule, and adverse events from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project and published literature. Market shares were estimated for each comparator before and after adoption of enzalutamide. The incremental aggregate budget impact, per patient per year (PPPY), per patient per month (PPPM), and per member per month (PMPM), was calculated. One-way sensitivity analyses were performed. RESULTS: In a population of 115 chemotherapy-naïve mCRPC patients, adopting enzalutamide had an annual incremental budget impact of $510,641 ($4,426 PPPY, $369 PPPM, and $0.04 PMPM). Results were most sensitive to enzalutamide drug cost, size of the chemotherapy-naïve mCRPC patient population, and enzalutamide adoption rate. CONCLUSIONS: Results indicate a modest 1-year budget impact of adopting enzalutamide for chemotherapy-naïve mCRPC patients, partly because of the cost offset of a moderate incidence of adverse events and lack of additional required monitoring.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Neoplasias de Próstata Resistentes à Castração/economia , Acetato de Abiraterona/economia , Acetato de Abiraterona/uso terapêutico , Idoso , Antineoplásicos/economia , Orçamentos , Docetaxel , Custos de Medicamentos , Humanos , Masculino , Radioisótopos/economia , Radioisótopos/uso terapêutico , Rádio (Elemento)/economia , Rádio (Elemento)/uso terapêutico , Taxoides/economia , Taxoides/uso terapêutico , Extratos de Tecidos/economia , Extratos de Tecidos/uso terapêutico , Estados Unidos
3.
Glob J Health Sci ; 8(4): 1-9, 2015 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-26573043

RESUMO

OBJECTIVES: Prostate cancer (PC) is the most common cancer in Western countries. Recent advances in the treatment of metastatic castration resistant prostate cancer (mCRPC) have caused significant pressure on health care budgets. We aimed to exemplify this dilemma presenting an example, radium-223 (Xofigo®), and review the literature. METHODS: A 74-year-old man diagnosed with mCRPC was referred to our department in October 2014 for radium-223 therapy. We faced the following dilemma: is radium-223 standard therapy? Is it cost-effective? Medline was searched employing the following search criteria: "radium-223", "alpharadin", "Xofigo" and "prostate". Exclusion and inclusion criteria were applied. Guidelines and cost-effectiveness analyses were focused. We also searched the websites of ASCO, ESMO and ISPOR. The web was searched, using Yahoo and Google search engines, for Health Technology Assessments (HTAs). RESULTS: 181 publications were identified in the Medline database. Only four studies included the word "cost", three "economics" and none "budget" in heading or abstract. None of the publications were thorough of cost analysis (cost-effectiveness, cost-utility, cost-minimizing or cost-of-illness analysis). Six HTAs and eight national guidelines were identified. The cost per quality adjusted life years was indicated €80.000-94,000. HTAs concluded reimbursement being not recommendable or no ultimate statement could be made. One pointed towards a limited use with caution. CONCLUSION: Guidelines were based on data from randomized clinical trials (RCTs). Health economics was not considered when guidelines were made. Most HTAs concluded this therapy not cost-effective or there was insufficient data for final conclusions. Licensing and reimbursement processes should be run simultaneously.


Assuntos
Neoplasias de Próstata Resistentes à Castração/radioterapia , Radioterapia/economia , Rádio (Elemento)/uso terapêutico , Idoso , Análise Custo-Benefício , Humanos , Masculino , Radioisótopos/economia , Radioisótopos/uso terapêutico , Radioterapia/métodos , Rádio (Elemento)/economia
5.
Prog Urol ; 23(15): 1258-64, 2013 Nov.
Artigo em Francês | MEDLINE | ID: mdl-24183084

RESUMO

AIM: To describe drugs used in the non-hormonal treatment of metastatic prostate cancer. MATERIAL: Bibliographical search was performed from the database Medline (National Library of Medicine, PubMed) and websites of the HAS and the ANSM. The search was focused on the characteristics, the mode of action, the efficiency and the side effects of the various drugs concerned. RESULTS: The metabolic radiotherapy although under-used for this indication, kept a place at the beginning of the disease. Radium-223 chloride seems to have to occupy an important place in the coming years. The chemotherapy, the only recourse until very recently in the castration-resistant prostate cancer, must redefine its place partially. The denosumab provide an interesting alternative to bisphosphonates. CONCLUSION: The non-hormonal treatment of the metastatic disease of the prostate cancer is changing rapidly with the emergence of new molecules. Urologist must know perfectly these new drugs.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias da Próstata/terapia , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos/economia , Antineoplásicos/farmacologia , Conservadores da Densidade Óssea/uso terapêutico , Cisplatino/economia , Cisplatino/farmacologia , Cisplatino/uso terapêutico , Denosumab , Docetaxel , Etoposídeo/economia , Etoposídeo/farmacologia , Etoposídeo/uso terapêutico , Humanos , Masculino , Mitoxantrona/economia , Mitoxantrona/farmacologia , Mitoxantrona/uso terapêutico , Compostos Organometálicos/economia , Compostos Organometálicos/farmacologia , Compostos Organometálicos/uso terapêutico , Compostos Organofosforados/economia , Compostos Organofosforados/farmacologia , Compostos Organofosforados/uso terapêutico , Osteoporose/etiologia , Osteoporose/prevenção & controle , Neoplasias da Próstata/patologia , Ligante RANK/antagonistas & inibidores , Proteção Radiológica/métodos , Radioisótopos/economia , Radioisótopos/farmacologia , Radioisótopos/uso terapêutico , Rádio (Elemento)/economia , Rádio (Elemento)/farmacologia , Rádio (Elemento)/uso terapêutico , Estrôncio/economia , Estrôncio/farmacologia , Estrôncio/uso terapêutico , Radioisótopos de Estrôncio/economia , Radioisótopos de Estrôncio/farmacologia , Radioisótopos de Estrôncio/uso terapêutico , Taxoides/economia , Taxoides/farmacologia , Taxoides/uso terapêutico
6.
Ann Sci ; 68(3): 375-99, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21999093

RESUMO

This article discusses the intersection of science and culture in the marketplace and explores the ways in which radium quack and medicinal products were packaged and labelled in the early twentieth century US. Although there is an interesting growing body of literature by art historians on package design, historians of science and medicine have paid little to no attention to the ways scientific and medical objects that were turned into commodities were packaged and commercialized. Thinking about packages not as mere containers but as multifunctional tools adds to historical accounts of science as a sociocultural enterprise and reminds us that science has always been part of consumer culture. This paper suggests that far from being receptacles that preserve their content and facilitate their transportation, bottles and boxes that contained radium products functioned as commercial and epistemic devices. It was the 1906 Pure Food and Drug Act that enforced such functions. Packages worked as commercial devices in the sense that they were used to boost sales. In addition, 'epistemic' points to the fact that the package is an artefact that ascribes meaning to and shapes its content while at the same time working as a device for distinguishing between patent and orthodox medicines.


Assuntos
Publicidade/história , Embalagem de Produtos/história , Rádio (Elemento)/história , História do Século XX , Rotulagem de Produtos/história , Rotulagem de Produtos/normas , Embalagem de Produtos/economia , Rádio (Elemento)/economia , Ciência/história , Estados Unidos
7.
Med Klin (Munich) ; 102(7): 540-9, 2007 Jul 15.
Artigo em Alemão | MEDLINE | ID: mdl-17634872

RESUMO

BACKGROUND AND PURPOSE: Cost-benefit analyses are helpful in setting priorities for funding health-care programs. The authors studied the cost/benefit of treatment with radium-224 compared to the treatment without radium-224 in patients with ankylosing spondylitis (AS). MATERIAL AND METHODS: The data of a 2-year retrospective observational study were used to estimate cost/benefit of [224Ra] therapy. Twelve patients treated with [224Ra], complete recruit in AOK Saxony, matched (age, gender, employment status) with twelve patients receiving conservative treatment without [224Ra], were compared for lost productivity and direct medical costs, such as doctor visits, medication and hospitalization, 1 year before and after treatment. RESULTS: 1 year after the first i.v. injection of [224Ra], all cost factors in the case group were reduced compared to 1 year before treatment with [224Ra] (hospitalization 29.4%, doctor visits 23.5%, medication 9.4%, and lost productivity even 82.3%). The total costs decreased by an average of 3,870 Euros. Because of the small sample the differences showed a trend but were not significant. CONCLUSION: The use of [224Ra] in patients with AS seems to reduce lost productivity and direct medical costs, but additional studies based on more patients and long-term data are needed.


Assuntos
Rádio (Elemento)/economia , Espondilite Anquilosante/economia , Adulto , Idoso , Análise Custo-Benefício , Avaliação da Deficiência , Custos de Medicamentos/estatística & dados numéricos , Alemanha , Gastos em Saúde/estatística & dados numéricos , Humanos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Rádio (Elemento)/uso terapêutico , Encaminhamento e Consulta/economia , Estudos Retrospectivos , Espondilite Anquilosante/radioterapia , Tório
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