ASCO 2011: Cost Effectiveness Abstracts Pancreatic Cancer, Chronic Myelogenous Leukemia, Follicular Lymphoma

These are the last of the very few chemotherapy drug cost-effectiveness studies at ASCO 2011. As noted in previous posts, there very few such studies.

1. Cost effectiveness of systemic therapies for Pancreatic Cancer: (abstract 6114) This study is an incremental cost study comparing the costs of gemcytibine(G), gemcytibine + capecitibine (G+C), gemcytibine + erlotinib (G+E), and FOLFIRINOX (FFX 5-FU, leucovorin, irinotecan and oxaliplatin).

The incremental cost-effectiveness ratios of G+C, G+E and FFX when compared to G were $82,982/QALY, $204,952/QALY and $154,323/QALY, respectively.

The cost of treatment in Canadian dollars was $29,5650 for G, $34,100 for G+C, $46,900 for G+E and $66,000 for FFX. Life expectance was .677 years for G, .76 years for G+C, .79 years for G+E and 1.005 years for FFX.

Medicynical Note: The limited benefit and significant toxicity of the additional treatments highlight our lack of an effective intervention for this diagnosis.

2. Comparison of costs of nilotinib and imatinib in chronic myelogenous leukemia (Abstract 6572) This is a drug company sponsored comparative efficacy study and concludes that the nilotinib is a cost effective alternative to imatinib.

Medicynical Note: The drug costs cited in this study appear to be 3/4 to 1/2 that experienced in the U.S. for example $602,605 over 17.3 years= $34,832/year. In the US costs are cited as between $48,000 and $98,000/year.

3. Cost effectiveness of cetuximab bevacizumab and panitumumab in metastatic colorectal cancer in patients with KRAS (wt) tumors: This is another incremental cost effectiveness analysis sponsored by a drug company. It found that cetuximab was more cost effective than the others in addition to FOLFIRI in patients with KRAS tumors.

Medicynical note: Increment cost effective studies do not add the base costs of FOLFIRI to the analysis. It’s uncertain what the total cost per QALY is compared with other regimens but the study does affirm that cetuximab adds close to $50,000 (conversion from £30,000) to the cost of a QALY.

4. Economic impact of rituximab as maintenance therapy in untreated follicular lymphoma: This drug company sponsored study based on a Markov model found that use of rituximab was cost effective. The cost of a QALY was between $17,000 and $35,000 depending on the relative risk reduction in time to progression.

Medicynical note: I don’t trust drug company studies that do not actually measure costs or outcomes. Using a “model” affords too much room to fiddle with results. Most follicular lymphoma patient do well with watchful waiting rather than immediate therapy. It’s doubtful, in my view, that this is a cost effective intervention.

See here for more discussion of the concept and the fact that other studies of maintenance rituximab show no survival benefit.

However, there was no significant difference in overall survival among the 3 groups, and 96% of the patients are still alive in each group. Whether overall survival will be improved “is currently unclear,”


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