Inpharma 1666 - 29 Nov 2008

Cancer news from ISPORAthens, Greece November 2008

The following article highlights a selection of cancer- was €10 168, €6348 and €8190, for CVP, MCP andrelated pharmacoeconomic studies presented at the CHOP, respectively.11th Annual European Conference of the International Dasatinib for CML dominates in EuropeSociety for Pharmacoeconomics and Outcomes Treatment of chronic myeloid leukaemia (CML) withResearch (ISPOR), held in Athens in November. dasatinib provides better efficacy at a lower cost thanTrastuzumab value for money in early breast imatinib in Central and Eastern Europe, according to thecancer results of a cost analysis.4 Researchers assessed the cost

needed to achieve one complete cytogenic responseThe use of 1 year of trastuzumab therapy to treat earlywith dasatinib 140mg compared with imatinib 600 andbreast cancer was found to be cost effective compared800mg in patients with imatinib-resistant CML. Thewith standard care, according to the results of twoanalysis was conducted using the number of patientsMarkov model-based studies presented at ISPOR.needed to treat (NNT) to achieve one completeIn the first study, researchers estimated the costcytogenic response; the incremental cost of achievingeffectiveness of 1 year’s trastuzumab versus standardthis in 15 months was evaluated. To achieve onecare (observation following standard adjuvantcytogenic response, the NNT is 6.25 patients forchemotherapy) in early stage breast cancer in Portugal.1imatinib and 2.5 for dasatinib. The costs to achieve oneThe model assumed a hypothetical cohort of patientsresponse during 15 months of treatment are €363 172similar to those included in the HERA study, and(Czech Republic), €218 492 (Hungary), and €334 146considered both the healthcare payer and societal(Romania) lower for dasatinib compared with imatinibperspectives. Trastuzumab therapy increased800mg. Dasatinib retains its economic advantage whendiscounted life expectancy by 2.11 years (14.95 vscompared with imatinib 600mg. The incremental costs12.84 years) and by 2.01 quality-adjusted life-yearsto achieve one complete cytogenic response between(QALYs), compared with standard care. Direct andimatinib 600mg and dasatinib are €228 664 (Czechindirect costs were €61 839 and €19 759 withRepublic), €218 492 (Hungary), and €205 316trastuzumab and €40 559 and €25 391 with standard(Romania).care, corresponding with incremental cost-effectiveness

ratios (ICERs) of €10 067 and €10 595 (direct costs First-line sunitinib cost effective in renalonly) and €7789 and €7400 including indirect costs, cancerper life-year gained (LYG) and per QALY, respectively. According to a Swedish study, the use of sunitinib is aThe second study was a Dutch cost-effectiveness cost-effective option for the first-line treatment of renalanalysis that again estimated the use of trastuzumab for cancer compared with sorafenib, temsirolimus, and1 year compared with observation.2 From a health care bevacizumab plus interferon-α.5 The study used anperspective, the ICER for trastuzumab for a 55-year-old adapted Markov model created using data collectedpatient was estimated to be €19 463 per QALY. From a from clinical trials to compare the cost effectiveness ofsocietal perspective, the ICER was €14 867. As the above therapies, using resource costs specific toexpected, the ICERs improved with younger age. Sweden. Indirect efficacy comparison of sorafenib,Overall, the Dutch cost-effectiveness estimate was well temsirolimus, and bevacizumab plus interferon-αbelow the Dutch informal threshold of €80 000 per versus the interferon-α arm of clinical trials providedQALY. PFS and OS data. The 10-year ICERs for sunitinib versusRituximab addition worth it in follicular sorafenib were SEK120 300* per progression-free life-lymphoma year, SEK177 900 per LYG, and SEK210 200 per QALY

gained. Sunitinib dominated temsirolimus andRituximab has recently received European approvalbevacizumab plus interferon-α, given that both werefor use in combination with any chemotherapy. Theless effective and more costly. At a threshold of societaladdition of rituximab to CVP (cyclophosphamide,willingness-to-pay of SEK500 000 per QALY gained,vincristine, prednisolone), MCP (melphalan,sunitinib has the highest probability of being the mostchlorambucil, prednisone) or CHOPcost-effective therapy.(cyclophosphamide, doxorubicin, vincristine,

prednisolone) regimens increases quality-adjusted life Erlotinib switch in NSCLC may provideexpectancy and is highly cost effective, according to savingsresearchers from Spain.3 Their study used a Markov Switching from docetaxel or pemetrexed to erlotinibmodel based on three randomised controlled clinical as second or third line treatment for non-small cell lungtrials comparing the addition of rituximab to the above cancer (NSCLC) could provide annual savings for thechemotherapy regimens, compared with chemotherapy Portugese NHS that would range between €135 046alone, in patients with advanced follicular lymphoma. and €1 755 602 (docetaxel replacement) and €291 801The trial endpoints were progression-free survival (PFS) and €3 793 409 (pemetrexed replacement), with a gainand overall survival (OS). Medication and supportive in terms of QALYs.6 The cost-minimisation and cost-care costs and QALYs were estimated over a time period utility analysis employed a Markov model to evaluateof 10 years. From a Spanish National Health System the costs and benefits of second- and third-lineperspective, adding rituximab to chemotherapy treatment with erlotinib in advanced or metastaticincreased QALYs by 0.795, 1.129 and 0.971 years for NSCLC compared with docetaxel, pemetrexed or bestCVP, MCP and CHOP, respectively, compared with supportive care. A time horizon of 2 years and achemotherapy alone. The incremental cost per QALY Portugese NHS perspective were used. Costs weregained was €10 190, €6092 and €7855 for CVP, MCP updated to 2008, and an annual discount of 5% wasand CHOP, respectively. The incremental cost per LYG

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Inpharma 29 Nov 2008 No. 16661173-8324/10/1666-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Single Article

2. Essers BA, et al. Economic evaluation of trastuzumab for the adjuvant treatmentapplied to costs and utilities. Erlotinib treatment wasof HER2 positive early breast cancer in The Netherlands. 11th Annual Europeanassociated with a lower per patient cost (€26 478) Congress of the International Society for Pharmacoeconomics and OutcomesResearch : 472 abstr. PCN41, 8 Nov 2008.compared to docetaxel (€29 262) or pemetrexed

3. Rubio-Terres C, et al. Pharmacoeconomic analysis of the addition of rituximab(€32 762) and a higher per patient cost compared toto first-line chemotherapy treatment regimens in Spanish patients with advanced

best supportive care (€16 112). QALYs per patient were follicular lymphoma. 11th Annual European Congress of the InternationalSociety for Pharmacoeconomics and Outcomes Research : 481 abstr. PCN69, 8higher with erlotinib (0.250) compared with docetaxelNov 2008.(0.225), pemetrexed (0.241), or best supportive care 4. Nagy B, et al. An economic evaluation of dasatinib (Sprycel (Rm)) in chronic

(0.186). In the cost-utility analysis, erlotinib was phase chronic myeloid leukemia in central and eastern Europe. 11th AnnualEuropean Congress of the International Society for Pharmacoeconomics anddominant, being less expensive and more effective thanOutcomes Research : 358 abstr. CN8, 8 Nov 2008.docetaxel and pemetrexed. The base case analysis 5. Munir U, et al. Economic evaluation of sunitinib first-line for metastatic renalcell carcinoma versus sorafenib, temsirolimus and bevacizumab + interferon-alfaresults were confirmed by a sensitivity analysis to bein the Swedish health service setting. 11th Annual European Congress of therobust.International Society for Pharmacoeconomics and Outcomes Research : 468abstr. PCN29, 8 Nov 2008.* Swedish kronas

6. Negreiro F, et al. Economic analysis of erlotinib, docetaxel, pemetrexed and bestsupportive care as 2nd or 3rd line treatment of non-small cell lung cancer. 11th1. Macedo A, et al. Cost-effectiveness of treatment with trastuzumab in patientsAnnual European Congress of the International Society for Pharmacoeconomicswith early breast cancer from the Portuguese societal perspective. 11th Annualand Outcomes Research : 476 abstr. PCN52, 8 Nov 2008.European Congress of the International Society for Pharmacoeconomics and

801108241Outcomes Research : 472 abstr. PCN40, 8 Nov 2008.

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