Rising drug cost impacts on cost‐effectiveness of 2 chemotherapy regimens for intermediate‐risk rhabdomyosarcoma: A report from the children's oncology group

Cancer ◽  
2021 ◽  
Author(s):  
Heidi V. Russell ◽  
Yueh‐Yun Chi ◽  
M. Fatih Okcu ◽  
M. Brooke Bernhardt ◽  
Carlos Rodriguez‐Galindo ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Drug Cost ◽  
Intermediate Risk ◽  
Oncology Group

scholarly journals Phase III Randomized Study of 4 Weeks of High-Dose Interferon-α-2b in Stage T2bNO, T3a-bNO, T4a-bNO, and T1-4N1a-2a (microscopic) Melanoma: A Trial of the Eastern Cooperative Oncology Group–American College of Radiology Imaging Network Cancer Research Group (E1697)

2017 ◽  
Vol 35 (8) ◽  
pp. 885-892 ◽  
Author(s):  
Sanjiv S. Agarwala ◽  
Sandra J. Lee ◽  
Waiki Yip ◽  
Uma N. Rao ◽  
Ahmad A. Tarhini ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Eastern Cooperative Oncology Group ◽  
High Dose ◽  
Intermediate Risk ◽  
Oncology Group ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Risk Melanoma ◽  
High Dose Interferon

Purpose To test the efficacy of 4 weeks of intravenous (IV) induction with high-dose interferon (IFN) as part of the Eastern Cooperative Oncology Group regimen compared with observation (OBS) in patients with surgically resected intermediate-risk melanoma. Patients and Methods In this intergroup international trial, eligible patients had surgically resected cutaneous melanoma in the following categories: (1) T2bN0, (2) T3a-bN0, (3) T4a-bN0, and (4) T1-4N1a-2a (microscopic). Patients were randomly assigned to receive IFN α-2b at 20 MU/m2/d IV for 5 days (Monday to Friday) every week for 4 weeks (IFN) or OBS. Stratification factors were pathologic lymph node status, lymph node staging procedure, Breslow depth, ulceration of the primary lesion, and disease stage. The primary end point was relapse-free survival. Secondary end points included overall survival, toxicity, and quality of life. Results A total of 1,150 patients were randomly assigned. At a median follow-up of 7 years, the 5-year relapse-free survival rate was 0.70 (95% CI, 0.66 to 0.74) for OBS and 0.70, (95% CI, 0.66 to 0.74) for IFN ( P = .964). The 5-year overall survival rate was 0.83 (95% CI, 0.79 to 0.86) for OBS and 0.83 (95% CI, 0.80 to 0.86) for IFN ( P = .558). Treatment-related grade 3 and higher toxicity was 4.6% versus 57.9% for OBS and IFN, respectively ( P < .001). Quality of life was worse for the treated group. Conclusion Four weeks of IV induction as part of the Eastern Cooperative Oncology Group high-dose IFN regimen is not better than OBS alone for patients with intermediate-risk melanoma as defined in this trial.

Cost-effectiveness of adjuvant radiotherapy in intermediate risk endometrial cancer

2007 ◽  
Vol 106 (2) ◽  
pp. 388-393 ◽  
Author(s):  
N. Calloway Rankins ◽  
A. Alvarez Secord ◽  
E. Jewell ◽  
L.J. Havrilesky ◽  
J.T. Soper ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Cost Effectiveness ◽  
Adjuvant Radiotherapy ◽  
Intermediate Risk

Cost-effectiveness of obeticholic acid for the treatment of non-alcoholic steatohepatitis: an early economic evaluation

2021 ◽  
pp. e20210011
Author(s):  
Chanh-Phong Tran ◽  
John J Kim ◽  
Jordan J Feld ◽  
William WL Wong
Keyword(s):  
Cost Effectiveness ◽  
Drug Cost ◽  
Cost Effective ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Decompensated Cirrhosis ◽  
Obeticholic Acid ◽  
Potential Cost ◽  
Alcoholic Steatohepatitis ◽  
Early Results

Background: Currently, there are no pharmacological options available for the treatment of non-alcoholic steatohepatitis (NASH). In the 18-month interim analysis of an ongoing randomized, placebo-controlled phase 3 trial (REGENERATE), early results demonstrated that obeticholic acid (OCA) 25 mg significantly improved fibrosis with no worsening of NASH among patients with NASH and fibrosis compared to placebo (PBO). This study aimed to assess the potential cost-effectiveness of OCA compared to PBO in NASH patients. Methods: A state-transition model was developed to perform a cost-utility analysis comparing two treatment strategies, PBO and OCA 25 mg, from a Canadian public payer perspective. The model time horizon was lifetime with annual cycle lengths. Cost and utility parameters were discounted at 1.5% annually. The efficacy data were obtained from the REGENERATE trial, and costs and utilities were derived from other published literature. Probabilistic and deterministic sensitivity analyses were performed to test the robustness of the model. Results: Treatment with OCA led to reductions of 3.58% in decompensated cirrhosis cases, 3.95% in hepatocellular carcinoma, 7.88% in liver transplant, and 6.01% in liver-related death. However, at an annual price of CDN$36,000, OCA failed to be cost-effective compared to PBO at an incremental cost-effectiveness ratio of $815,514 per quality-adjusted life year (QALY). An 88% reduction in drug price to an annual cost of $4,300 would make OCA cost-effective at a willingness-to-pay threshold of $50,000/QALY. Conclusions: OCA failed to be cost-effective compared to PBO, despite demonstrating clinical benefits due to a high drug cost. A significant price reduction would be needed to make the drug cost-effective.

scholarly journals Achieving high value care for all and the perverse incentives of 340B price agreements

2018 ◽  
Vol 8 (2) ◽  
pp. 148-152 ◽  
Author(s):  
Melanie D. Whittington ◽  
Jonathan D. Campbell ◽  
R. Brett McQueen
Keyword(s):  
Cost Effectiveness ◽  
Drug Cost ◽  
Quality Adjusted Life Year ◽  
Negative Consequences ◽  
The Public ◽  
Department Of Health ◽  
Payer Perspective ◽  
Perverse Incentives ◽  
Pricing Schemes ◽  
Quality Adjusted Life

Section 340B of the Public Health Service Act requires drug manufacturers to enter into price agreements with the Department of Health and Human Services. These agreements result in variation in the price paid to acquire a drug by sector, which complicates the price used in cost-effectiveness analyses. We describe the transactions and sectors in a 340B agreement using a multiple sclerosis drug. Cost-effectiveness estimates were calculated for the drug using drug prices from the manufacturer and payer perspective. We found the amount paid to the manufacturer (340B price) was a good value ($118,256 per quality-adjusted life-year); however, from the payer drug cost perspective, good value ($196,683 per quality-adjusted life-year) was not achieved. Given that emerging value frameworks incorporate cost-effectiveness, these price variations may have downstream negative consequences, including inaccurate coverage and reimbursement policy recommendations. Upcoming policy changes to the 340B program should incentivize pricing schemes hinged on transparency and value.

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