Uyl-de Groot, C.A.

Cost-analysis of treatment of childhood acute lymphoblastic leukemia with asparaginase preparations: The impact of expensive chemotherapy (Article)

2013-05-01T00:00:00Z

Asparaginase is an expensive drug, but important in childhood acute lymphoblastic leukemia. In order to compare costs of PEGasparaginase, Erwinia asparaginase and native E. coli asparaginase, we performed a cost-analysis in the Dutch Childhood Oncology Group ALL-10 medium-risk group intensification protocol. Treatment costs were calculated based on patient level data of 84 subjects, and were related to the occurrence of allergy to PEGasparaginase. Simultaneously, decision tree and sensitivity analyses were conducted. The total costs of the intensification course of 30 weeks were $57,893 in patients without PEGasparaginase allergy (n=64). The costs were significantly higher ($113,558) in case of allergy (n=20) necessitating a switch to Erwinia asparaginase. Simulated scenarios (decision tree analysis) using native E. coli asparaginase in intensification showed that the costs of PEGasparaginase were equal to those of native E. coli asparaginase. Also after sensitivity analyses, the costs for PEGasparaginase were equal to those of native E. coli asparaginase. Intensification treatment with native E. coli asparaginase, followed by a switch to PEGasparaginase, and subsequently to Erwinia asparaginase in case of allergy had similar overall costs compared to the treatment with PEGasparaginase as the first-line drug (followed by Erwinia asparaginase in the case of allergy). PEGasparaginase is preferred over native E. coli asparaginase, because it is administered less frequently, with less day care visits. PEGasparaginase is less immunogenic than native E. coli asparaginase and is not more expensive. Asparaginase costs are mainly determined by the percentage of patients who are allergic and require a switch to Erwinia asparaginase.

Real-world health care costs of relapsed/refractory multiple myeloma during the era of novel cancer agents (Article)

2013-02-01T00:00:00Z

What is known and objective: High costs of novel agents increasingly put pressure on limited healthcare budgets. Demonstration of their real-world costs and cost-effectiveness is often required for reimbursement. However, few published economic evaluations of novel agents for multiple myeloma exist. Moreover, existing cost analyses were heavily based on conventionally treated patients. We investigated real-world health care costs of relapsed/refractory multiple myeloma in Dutch daily practice. Methods: A retrospective medical chart review was conducted for 139 patients treated between January 2001 and May 2009. Total monthly costs attributable to each cost component were described across all regimens and for bortezomib-, thalidomide- and lenalidomide-based treatment regimens. Results: Mean monthly total costs (€3,981) varied depending on the sequence of therapy (range: €442-€31,318). Significant cost drivers across all regimens included costs of therapy and hospital admissions. The acquisition costs for novel agents in particular accounted for 32% of mean total monthly costs. Prognostic factors associated with increased mean total monthly costs in multivariate regression analysis included low platelet counts (P = 0·01) and worsening performance status (P < 0·001). Mean total monthly costs of bortezomib- and lenalidomide-based regimens were significantly higher than those for thalidomide-based regimens in second, third and fourth treatment line. What is new and conclusions: Real-world costs during treatment of relapsed/refractory multiple myeloma vary greatly. Cost drivers include hospital admissions and acquisition costs of novel agents. Costs also vary by prognostic factors and treatment-related resource use. Future studies assessing the costs of combination therapy consisting of two or more novel agents are encouraged.

Real-world costs of autologous and allogeneic stem cell transplantations for haematological diseases: A multicentre study (Article)

2012-12-01T00:00:00Z

Haematopoietic stem cell transplantation (SCT) is an expensive lifesaving procedure, which is increasingly performed in patients with haematological diseases. Developments in the protocol for SCT have resulted in cost estimates that require updating.We aimed to calculate actual costs for SCT and to identify major cost drivers by means of a daily practice cost study. We randomly selected 191 patients treated at three university hospitals, who underwent an autologous (auto) SCT or allogeneic (allo) SCT in 2007, 2008 or 2009. Allo-SCT included sibling donors, matched unrelated donors (MUD) and umbilical cord blood (UCB). Resource use was collected from the hospital registration systems and medical files. The total costs included selection and harvesting of stem cells, transplantation and 1-year follow-up. The average costs per patient were 45,670 € for auto-SCT and 101,919 € for sibling allo-SCT. The costs of transplantations from unrelated donors were much higher: 171,478 € for allo-SCT-MUD and 254 689 € for allo-SCTUCB. Hospital inpatient days together with laboratory and other activities were the main cost drivers across all types of SCT. Besides, donor search costs were a large cost component in allo-SCT-sib (18 %) and allo-SCT-MUD (12 %). Real-world costs were above routine reimbursement and appropriate financing is necessary to guarantee the continuation of SCT. The costs calculated in this study provide reliable up-to-date input for cost-effectiveness studies and budget revision.

The costs of initial treatment for patients with acute myeloid leukemia in the Netherlands (Article)

2012-10-15T00:00:00Z

The aim of this study was to calculate the costs of the current initial treatment of acute myeloid leukemia. Resource use was collected for 202 patients who started with intensive chemotherapy in 2008 or 2009. The costs of the first induction course were significantly higher than the costs of the second induction course. Allogeneic transplantation from a matched unrelated donor was significantly more expensive than the other consolidation treatments. In-hospital stay was the major cost driver in the treatment of AML. Research regarding possibilities of achieving the same or better health outcome with lower costs is warranted.

Mapping QLQ-C30, HAQ, and MSIS-29 on EQ-5D (Article)

2012-07-01T00:00:00Z

Background. Responses on condition-specific instruments can be mapped on the EQ-5D to estimate utility values for economic evaluation. Mapping functions differ in predictive quality, and not all condition-specific measures are suitable for estimating EQ-5D utilities. We mapped QLQC30, HAQ, and MSIS-29 on the EQ-5D and compared the quality of the mapping functions with statistical and clinical indicators. Methods. We used 4 data sets that included both the EQ-5D and a condition-specific measure to develop ordinary least squares regression equations. For the QLQ-C30, we used a multiple myeloma data set and a non-Hodgkin lymphoma one. An early arthritis cohort was used for the HAQ, and a cohort of patients with relapsing remitting or secondary progressive multiple sclerosis was used for the MSIS-29. We assessed the predictive quality of the mapping functions with the root mean square error (RMSE) and mean absolute error (MAE) and the ability to discriminate among relevant clinical subgroups. Pearson correlations between the condition-specific measures and items of the EQ-5D were used to determine if there is a relationship between the quality of the mapping functions and the amount of correlated content between the used measures. Results. The QLQ-C30 had the highest correlation with EQ-5D items. Average %RMSE was best for the QLQ-C30 with 10.9%, 12.2% for the HAQ, and 13.6% for the MSIS-29. The mappings predicted mean EQ-5D utilities without significant differences with observed utilities and discriminated between relevant clinical groups, except for the HAQ model. Conclusions. The preferred mapping functions in this study seem suitable for estimating EQ-5D utilities for economic evaluation. However, this research shows that lower correlations between instruments lead to less predictive quality. Using additional validation tests besides reporting statistical measures of error improves the assessment of predictive quality.

An assessment of the external validity of mapping QLQ-C30 to EQ-5D preferences (Article)

2012-06-29T00:00:00Z

Background: Although cancer-specific Health-related Quality-of-Life measures are commonly included in randomized clinical trials or other prospective non-randomized clinical studies, it is rare that preference-based instruments are used, which allow the calculation of a Utility weight suitable for estimating Quality-adjusted Life-Years gained. Objective: To test the external validity of a previously published mapping algorithm to transform the EORTC QLQ-C30 questionnaire responses into EQ-5D-derived utilities by predicting EQ-5D utilities from QLQ-C30 scores. Study design and methods: Comparative retrospective data analysis of four multicentre, prospective clinical trials in Breast, Multiple Myeloma, Non-Hodgkin Lymphoma and Non-Small-Cell Lung cancer patients with, respectively, 219, 172, 132 and 172 patients. Regression analysis of individual pairs of EQ-5D and QLQ-C30 scores. Results: Although the internal predictive power of a previously published mapping equation was high, its external validity when tested on a set of unrelated external data sets in other cancers proved to underestimate both the mean and variance of the mapped EQ-5D utilities. Furthermore, it appears that the relationship between QLQ-C30 scores and EQ-5D values is not stable across the different data sets. Conclusions: Validation of the proposed algorithm in other external clinical data sets should be encouraged as well as the application of other more complex mapping methods to enhance accuracy of mapping. In the meanwhile, direct mapping from QLQ-C30 profiles to EQ-5D utilities using published algorithms should be performed with reservations.

Novel anticancer agents for multiple myeloma: A review of the evidence for their therapeutic and economic value (Article)

2012-06-01T00:00:00Z

Recent advances in oncology treatment have improved patient outcomes at the expense of increasing healthcare costs. The indication multiple myeloma is especially characterized by a recent and continuing flood of expensive novel agents. A review encompassing all elements necessary to perform an economic evaluation of novel agents for multiple myeloma was conducted for thalidomide, bortezomib and lenalidomide. Improvements in efficacy have led to a switch from conventional therapy to novel agents as standard therapy. Incremental cost-effectiveness ratios for novel agents alone or in combination with conventional agents were generally regarded to be within acceptable ranges. Conflicting results were reported for the incremental cost-effectiveness of bortezomib versus lenalidomide, as unresolved questions remain regarding their comparative effectiveness. Future economic evaluations will require an assessment of the cost-effectiveness of these agents in terms of sequence within the treatment paradigm and in combination with one another.

Adjuvant chemotherapy in stage III colon cancer: Guideline implementation, patterns of use and outcomes in daily practice in the Netherlands (Article)

2012-01-01T00:00:00Z

Background. Little is known about how well guidelines about adjuvant chemotherapy in colon cancer are followed in daily practice. We evaluated the current guideline, which is based on the MOSAIC trial, by examining implementation, treatment patterns and disease-free survival. Material and methods. We analysed a population-based cohort of 391 patients treated with adjuvant chemotherapy for stage III colon cancer in 20052006. Data were gathered from the Dutch Cancer Registry and medical records of 19 hospitals. Patients were classified according to whether or not they fulfilled MOSAIC trial eligibility criteria. Results. The administered regimens were: fluorouracil-leucovorin (17 patients), capecitabine (93), fluorouracil- leucovorin plus oxaliplatin (145), and capecitabine plus oxaliplatin (136). After its inclusion in national guidelines, oxaliplatin was prescribed in 16 hospitals within six months. Patients receiving oxaliplatin were younger and had less comorbidity than other patients. Dose schedules corresponded well with guidelines. Two-year disease-free survival probability of oxaliplatin patients meeting MOSAIC eligibility criteria was 78.4% (95% CI 72.584.3), which was comparable to MOSAIC trial results. Conclusion. Guidelines for adjuvant chemotherapy in stage III colon cancer are generally well followed in daily practice. However, uncertainty remains regarding the optimal treatment of elderly patients and patients with comorbidities, which underscores the need for practical clinical trials including these patients.

Naar gepast gebruik van geneesmiddelen (Article)

2012-01-01T00:00:00Z

Geneesmiddelen zijn niet alleen een belangrijke investering in de gezondheidszorg, maar vormen ook een aanzienlijke kostenpost. Wanneer bij de keuze om middelen collectief te vergoeden meer aandacht komt voor gepast gebruik, kan zelfs bij gelijkblijvend budget de totale opbrengst aan gezondheid worden vergroot.

Cost-effectiveness of treatment of childhood acute lymphoblastic leukemia with chemotherapy only: The influence of new medication and diagnostic technology (Article)

2011-12-01T00:00:00Z

Background: Survival for childhood acute lymphoblastic leukemia (ALL) has reached 80-90%. Future improvement in treatment success will involve new technologies and medication, adding to the pressure on limited financial resources. Therefore a retrospective cost-effectiveness analysis of ALL treatment with chemotherapy only according to the two most recent Dutch Childhood Oncology Group treatment protocols was performed. The most recent protocol ALL10 included more expensive medication (pegasparaginase) and implemented a new diagnostic technique (minimal residual disease levels) compared to the previous ALL9 protocol. Procedure: Fifty children from a single center cohort were included. All direct medical costs made during treatment, including those in satellite hospitals, were determined. Costs per life year saved (LYS) were calculated. The cost-effectiveness ratio of the most recent treatment protocol was determined. LYS were calculated based on national 5-year event-free survival. Results: Mean total costs were between $115,858 (ALL9) and $163,350 (ALL10) per patient. Hospital admissions (57%) and medication (11-17%) were important drivers of overall costs, and were higher in the most recent protocol ALL10. Costs per LYS were $1,962 (ALL9) and $2,655 (ALL10) and the cost-effectiveness ratio was $8,215. Conclusion: Treatment of childhood ALL with chemotherapy only is well within accepted ranges of cost-effectiveness. The use of new technology and more expensive medication in the most recent protocol ALL10 lead to higher costs but more LYS. In future (ALL) treatment protocols, costs in relation to effects should be taken into account in order to establish more cost-effective disease management without jeopardizing survival and quality of life.

Reducing disparities in breast cancer survival - The effect of large-scale screening of the uninsured (Article)

2011-09-01T00:00:00Z

Critical review of economic evaluations in multiple myeloma: An overview of the economic evidence and quality of the methodology (Article)

2011-07-01T00:00:00Z

Continued expansion in the availability of costly alternative therapies in multiple myeloma will enhance the role of economic evaluations in reimbursement decisions and amendments to the treatment guidelines. The quality of economic evaluations should be taken into account by clinicians involved in decision-making. A systematic review and critique of the methodology was performed to assess the trends and quality in economic evaluations in multiple myeloma to date. A literature search was conducted to identify full economic evaluations in multiple myeloma as of December 2009. Details of the economic evaluation methods applied were extracted. Each study underwent a quality assessment based on the Drummond checklist for appraisal of high-quality economic evaluations in health care. Eighteen published economic evaluations were identified. Stem cell transplantation in combination with intensive chemotherapy has been demonstrated to be cost-effective, while interferon alpha is generally ineffective at additional costs. Evaluations have become less frequent in the last decade, especially for newer therapies despite their important contribution to improvements in outcomes. The quality of the methodology applied and its documentation can be improved in many aspects. As users of the results of economic evaluations, clinicians involved in guiding decision-making should be critical of the quality of economic evaluations in multiple myeloma. To ensure access to and identification of high-quality studies, researchers conducting economic evaluations of future advances should strive towards evaluations that fulfil the Drummond criteria and are properly documented.

‘Dure’ diagnostiek en kankergeneesmiddelen: de andere kant van de ongelijkheid II de andere kant van de ongelijkheid II (Inaugural Lecture)

2011-05-20T00:00:00Z

Rede, in verkorte vorm uitgesproken bij de aanvaarding van het ambt van hoogleraar Health technology assessment aan het instituut Beleid & Management Gezondheidszorg van de Faculteit der Geneeskunde en Gezondheidswetenschappen, Erasmus Universiteit Rotterdam, op 20 mei 2011. ‘Dure’ diagnostiek en kankergeneesmiddelen: de andere kant van de ongelijkheid II gaat erover dat het beschikbaar komen van nieuwe mogelijkheden voor de behandeling van kanker niet automatisch inhoudt dat die bij alle patiënten worden toegepast. Integendeel, uit onderzoek blijkt dat zowel diagnostiek als nieuwe geneesmiddelen veelal lang zaam hun weg vinden naar mensen met kanker. Deze vertraging treedt zelfs op als de richtijnen van de medisch specialisten zijn aangepast. Uyl-de Groot houdt een pleidooi dat er meer kennis beschikbaar komt over de diagnostiek, inzet en de uitvoering van behandelingen en van de uiteindelijke resul taten in de vorm van overleving, kwaliteit van leven en kosten. De patiënten, de behandelaars, en niet in het minst de maatschappij vragen om volstrekte transparantie over de kwaliteit en doel matig heid van de geleverde zorg. Het inzetten van de juiste diagnostiek en behandeling is van cruciaal belang voor patiënt en maatschappij. Dit zal leiden tot verbetering in de kwaliteit van de zorg en meer doelmatigheid.

Effect of thalidomide with melphalan and prednisone on health-related quality of life (HRQoL) in elderly patients with newly diagnosed multiple myeloma: a prospective analysis in a randomized trial (Article)

2011-04-07T00:00:00Z

Thalidomide with melphalan/prednisone (MPT) was defined as standard treatment in elderly patients with multiple myeloma (MM) based on five randomized trials. In one of these trials, HOVON49, a prospective health-related quality-of-life (HRQoL) study was initiated in order to assess the impact of thalidomide on QoL. Patients aged >65 years with newly diagnosed MM were randomized to receive melphalan plus prednisone (MP) or MPT, followed by thalidomide maintenance in the MPT arm. Two hundred eighty-four patients were included in this side study (MP, n = 149; MPT n = 135). HRQoL was assessed with the EORTC Core QoL Questionnaire (QLQ-C30) and the myeloma-specific module (QLQ-MY24) at baseline and at predetermined intervals during treatment. The QLQ-C30 subscales physical function (P = 0.044) and constipation (P < 0.001) showed an improvement during induction in favour of the MP arm. During thalidomide maintenance, the scores for the QLQ-MY24 paraesthesia became significantly higher in the MPT arm (P<0.001). The QLQ-C30 subscales pain (P = 0.12), insomnia (P = 0.068), appetite loss (P = 0.074) and the QLQ-MY24 item sick (P = 0.086) scored marginally better during thalidomide maintenance. The overall QoL-scale QLQ-C30-HRQoL showed a significant time trend towards more favourable mean values during protocol treatment without differences between MP and MPT. For the QLQ-C30 subscales emotional function and future perspectives, difference in favour of the MPT arm from the start of treatment was observed (P = 0.018 and P = 0.045, respectively) with no significant 'time × arm' interaction, indicating a persistent better patient perspective with MPT treatment. This study shows that the higher frequency of toxicity associated with MPT does not translate into a negative effect on HRQoL and that MPT holds a better patient perspective.

Application of cost-effectiveness ana lysis to demonstrate the potential value of companion diagnostics in chronic myeloid leukemia (Article)

2011-03-01T00:00:00Z

Aim: A cost-effectiveness analysis was performed to assess the potential value of companion diagnostics in supporting treatment decisions for dasatinib and nilotinib in chronic myeloid leukemia. Materials & methods: A decision model was developed, and model inputs were taken from the literature and publicly available sources. The perspective of the healthcare sector in the Netherlands was used. Sensitivity and scenario analyses were performed to assess uncertainty in the results. Results: Companion diagnostics could improve health and reduce costs, despite the estimates being uncertain owing to limited evidence for comparative effectiveness between dasatinib and nilotinib. The results were sensitive to the cost of treatment, utility of progression and progression-free survival. Conclusion: This case demonstrates the use of cost-â€"effectiveness analysis at an early stage of health technology assessment to generate economic evidence for the use of companion diagnostics in treatment decisions and to support decision-making for their development.

A cost of illness and equality of life study in patients with B-cell chronic lymphocytic leukemia (CLL) in the Netherlands (Research Report)

2011-01-01T00:00:00Z

During the last decade the management of CLL was subject to progressive changes in diagnostic and prognostic procedures as well as the development of new alternative treatments. The aim of this study was to assess management, costs, quality of life and survival of CLL patients in daily practice. This information is becoming more important for reimbursement decsions, as new expensive drugs are only reimbursed when the incremental cost-effectiveness ratio lies within existing thresholds. Cost-effectiveness ratios are preferably calculated both in daily practice (or real world) setting and a clinical trial setting.

Well being of obstetric patients on minimal blood transfusions (WOMB trial) (Article)

2010-12-16T00:00:00Z

Background: Primary postpartum haemorrhage is an obstetrical emergency often causing acute anaemia that may require immediate red blood cell (RBC) transfusion. This anaemia results in symptoms such as fatigue, which may have major impact on the health-related quality of life. RBC transfusion is generally thought to alleviate these undesirable effects although it may cause transfusion reactions. Moreover, the postpartum haemoglobin level seems to influence fatigue only for a short period of time. At present, there are no strict transfusion criteria for this specific indication, resulting in a wide variation in postpartum policy of RBC transfusion in the Netherlands.Methods/Design: The WOMB trial is a multicentre randomised non-inferiority trial. Women with acute anaemia due to postpartum haemorrhage, 12-24 hours after delivery and not initially treated with RBC transfusion, are eligible for randomisation. Patients with severe physical complaints are excluded. Patients are randomised for either RBC transfusion or expectant management. Health related quality of life (HRQoL) will be assessed at inclusion, at three days and one, three and six weeks postpartum with three validated measures (Multi-dimensional Fatigue Inventory, ShortForm-36, EuroQol-5D). Primary outcome of the study is physical fatigue three days postpartum. Secondary outcome measures are general and mental fatigue scores and generic health related quality of life scores, the number of RBC transfusions, length of hospital stay, complications and health-care costs.The primary analysis will be by intention-to-treat. The various longitudinal scores will be evaluated using Repeated Measurements ANOVA. A costs benefit analysis will also be performed. The power calculation is based on the exclusion of a difference in means of 1.3 points or greater in favour of RBC transfusion arm regarding physical fatigue subscale. With missing data not exceeding 20%, 250 patients per arm have to be randomised (one-sided alpha = 0.025, power = 80%).Discussion: This study will provide evidence for a guideline regarding RBC transfusion in the postpartum patient suffering from acute anaemia. Equivalence in fatigue score, remaining HRQoL scores and physical complications between both groups is assumed, in which case an expectant management would be preferred to minimise transfusion reactions and costs.Trial registration: ClinicalTrials.gov NCT00335023, Nederlands Trial Register NTR335.

Incorporating equity-efficiency interactions in cost-effectiveness analysis - Three approaches applied to breast cancer control (Article)

2010-07-01T00:00:00Z

Background: The past decade, medical technology assessment focused on cost-effectiveness analysis, yet there is an increasing need to consider equity implications of health interventions as well. This article addresses three equity-efficiency trade-off methods proposed in the literature. Moreover, it demonstrates their impact on cost-effectiveness analyses in current breast cancer control options for women of different age groups. Methods: We adapted an existing breast cancer model to estimate cost-effectiveness and equity effects of breast cancer interventions. We applied three methods to quantify the equity-efficiency trade-offs: 1) targeting specific groups, comparing disparities at baseline and in different intervention scenarios; 2) equity weighting, valuing low and high health gains differently; and 3) multicriteria decision analysis, weighing multiple equity and efficiency criteria. We compared the resulting composite league tables of all approaches. Results: The approaches show that a comprehensive breast cancer program, including screening, for women below 75 years of age was most attractive in both the group targeting approach and the equity weighting approach. Such control programs would reduce disparities with 56% and at 1908 per equity quality-adjusted life-year gained. In the multicriteria approach, a comprehensive treatment program for women below 75 years of age and treatment in stage III breast cancer were most attractive, with both an 82% selection probability, followed by screening programs for the two age groups. Conclusion: In the three equity weighing approaches, targeting women below 75 years of age was more cost-effective and led to more equitable distributions of health. This likely is similar in other fatal diseases with similar age distributions. The approaches may lead to different outcomes in nonfatal disease.

The economics of improved cancer survival rates: Better outcomes, higher costs (Article)

2010-06-01T00:00:00Z

In 2006, over three million new cases of cancer were diagnosed in Europe. This number will increase in the coming years as a result of an aging population and population growth. Advances in the diagnosis and treatment of cancer have resulted in increased survival rates. Simultaneously, increasing costs of screening, diagnosis and the treatment of cancer could threaten the ability to ensure high-quality care and provide access to care for all patients. New genetic tests and biomarkers may help to identify those subtypes of patients that would be most likely to benefit from new cancer drugs. In our opinion, there is still much to gain in cancer diagnosis and treatment but these gains should be worth the costs

Chest CT and whole-body 18F-FDG PET are cost-effective in screening for distant metastases in head and neck cancer patients (Article)

2010-02-01T00:00:00Z

Abstract. The aim of the study was to define the cost-effectiveness of whole-body (18)F-FDG PET, as compared with chest CT, in screening for distant metastases in patients with head and neck squamous cell carcinoma (HNSCC). METHODS: In a multicenter prospective study, 145 consecutive patients with high risk factors for distant metastases and scheduled for extensive treatment underwent chest CT and whole-body (18)F-FDG PET for screening of distant metastases. The cost data of 80 patients in whom distant metastases developed or who had a follow-up of at least 12 mo were analyzed. Cost-effectiveness analysis, including sensitivity analysis, was performed to compare the results of (18)F-FDG PET, CT, and a combination of CT and (18)F-FDG PET (CT + (18)F-FDG PET). RESULTS: Pretreatment screening identified distant metastases in 21% of patients. (18)F-FDG PET had a higher sensitivity (53% vs. 37%) and positive predictive value (80% vs. 75%) than did CT. CT + (18)F-FDG PET had the highest sensitivity (63%). The average costs in the CT, (18)F-FDG PET, and CT + (18)F-FDG PET groups amounted to euro38,558 (approximately $57,705), euro38,355 (approximately $57,402), and euro37,954 (approximately $56,801), respectively, in the first year after screening. CT + (18)F-FDG PET resulted in savings between euro 203 (approximately $303) and euro 604 (approximately $903). Sensitivity analysis showed that the dominance of CT + (18)F-FDG PET was robust. CONCLUSION: In HNSCC patients with risk factors, pretreatment screening for distant metastases by chest CT is improved by (18)F-FDG PET. The combination of (18)F-FDG PET with CT is the most effective, without leading to additional costs.

Costs of haematological adverse events in chronic myeloid leukaemia patients: A retrospective cost analysis of the treatment of anaemia, neutropenia and thrombocytopenia in patients with chronic myeloid leukaemia (Article)

2009-08-03T00:00:00Z

Objective: The study aim was to assess costs of haematological adverse events (AE) related to pharmacologic treatment of chronic myeloid leukaemia (CML) patients. Methods: This was a retrospective cohort study using patient records of adults (n=91) with chronic-phase CML treated at a single university medical centre in the Netherlands. Occurrence of grade III/IV haematological AEs, defined according to CTC-NCI guidelines criteria, was derived from the laboratory registration. Mean age at time of diagnosis was 48 years; 56% male. A healthcare perspective was adopted. Cost estimates are presented in 2006 euros. Results: Average cost of an episode of anaemia was €1,572, of thrombocytopenia €2,955, and of neutropenia €1,152. The mean cost of febrile neutropenia amounted to €2,462. Conclusions: Treatment costs of AEs varied considerably. However, apart from the cost of anaemia, the results presented seem to be in line with information from the international literature. The key limitations of the study concern the relatively small cohort of patients at a single centre, the retrospective design and the various treatment regimens of CML during the follow-up.

Cost-effectiveness of temozolomide for the treatment of newly diagnosed glioblastoma multiforme (Article)

2009-06-01T00:00:00Z

Aim: To perform a systematic review on the costs and cost-effectiveness of concomitant and adjuvant temozolomide with radiotherapy for the treatment of newly diagnosed glioblastoma compared with initial radiotherapy alone. Methods: Electronic databases were searched for relevant publications on costs and cost-effectiveness until October 2008. Results: We found four relevant clinical trials, one cost study and two economic models. The mean survival benefit in the radiotherapy plus temozolomide group varied between 0.21 and 0.25 life-years. Treatment costs were between €27,365 and €39,092. The costs of temozolomide amounted to approximately 40% of the total treatment costs. The incremental cost-effectiveness ratios found in the literature were €37,361 per life-year gained and €42,912 per quality-adjusted life-year gained. However, the models are not comparable because different outcomes are used (i.e., life-years and quality-adjusted life-years). Conclusion: Although the models are not comparable according to outcome, the incremental cost-effectiveness ratios found are within acceptable ranges. We concluded that despite the high temozolomide acquisition costs, the costs per life-year gained and the costs per quality-adjusted life-year gained are comparable with other accepted first-line treatments with chemotherapy in patients with cancer.

Longitudinal changes in quality of life and costs in long-term survivors of tumors of the oropharynx treated with brachytherapy or surgery (Article)

2008-10-01T00:00:00Z

PURPOSE: Based on earlier studies we were interested in finding out if longitudinal assessment of quality of life (QoL) and costs in long-term survivors of oropharyngeal cancers treated with external beam radiation therapy and brachytherapy (BT) or surgery and postoperative radiotherapy showed a change in QoL over the years. Besides, we were curious to know how much the costs per life year and the QALY would be for this patient group. METHODS AND MATERIALS: Performance status scales: eating in public, understandability of speech, normalcy of diet, xerostomia and ability to swallow were determined in 2003 and 2005. In 2005, the responses to EORTC QLQ-C30, EORTC H&N35, and the Euroqol questionnaire were also measured. Costs and quality-adjusted life years (QALYs) were calculated. RESULTS: Eating in public, understandability of speech, and normalcy of diet significantly differed in favor of BT. Surgical patients experienced more speech, teeth, and mouth-opening problems. Mean costs and QALYs for BT were V16,112 and V56,060 and for surgery V26,590 and V93,275, respectively. CONCLUSIONS: QoL scores don’t change over time. Due to the number of admission days, surgery is more costly. Difference in costs for QALYs in favor of BT was observed.

Longitudinal changes in quality of life and costs in long-term survivors of tumors of the oropharynx treated with brachytherapy or surgery (Article)

2008-10-01T00:00:00Z

Purpose: Based on earlier studies we were interested in finding out if longitudinal assessment of quality of life (QoL) and costs in long-term survivors of oropharyngeal cancers treated with external beam radiation therapy and brachytherapy (BT) or surgery and postoperative radiotherapy showed a change in QoL over the years. Besides, we were curious to know how much the costs per life year and the QALY would be for this patient group. Methods and materials: Performance status scales: eating in public, understandability of speech, normalcy of diet, xerostomia and ability to swallow were determined in 2003 and 2005. In 2005, the responses to EORTC QLQ-C30, EORTC H&N35, and the Euroqol questionnaire were also measured. Costs and quality-adjusted life years (QALYs) were calculated. Results: Eating in public, understandability of speech, and normalcy of diet significantly differed in favor of BT. Surgical patients experienced more speech, teeth, and mouth-opening problems. Mean costs and QALYs for BT were €16,112 and €56,060 and for surgery €26,590 and €93,275, respectively. Conclusions: QoL scores don't change over time. Due to the number of admission days, surgery is more costly. Difference in costs for QALYs in favor of BT was observed.

Cost-effectiveness of temozolomide for the treatment of newly diagnosed glioblastoma multiforme: A report from the EORTC 26981/22981 NCI-C CE3 intergroup study (Article)

2008-03-15T00:00:00Z

BACKGROUND. The study aimed to compare the cost-effectiveness of concomitant and adjuvant temozolomide (TMZ) for the treatment of newly diagnosed glioblastoma multiforme versus initial radiotherapy alone from a public health care perspective. METHODS. The economic evaluation was performed alongside a randomized, multicenter, phase 3 trial. The primary endpoint of the trial was overall survival. Costs included all direct medical costs. Economic data were collected prospectively for a subgroup of 219 patients (38%). Unit costs for drugs, procedures, laboratory and imaging, radiotherapy, and hospital costs per day were collected from the official national reimbursement lists based on 2004. For the cost-effectiveness analysis, survival was expressed as 2.5 years restricted mean estimates. The incremental cost-effectiveness ratio (ICER) was constructed. Confidence intervals for the ICER were calculated using the Fieller method and bootstrapping. RESULTS. The difference in 2.5 years restricted mean survival between the treatment arms was 0.25 life-years and the ICER was €37,361 per life-year gained with a 95% confidence interval (CI) ranging from €19,544 to €123,616. The area between the survival curves of the treatment arms suggests an increase of the overall survival gain for a longer follow-up. An extrapolation of the overall survival per treatment arm and imputation of costs for the extrapolated survival showed a substantial reduction in ICER. CONCLUSIONS. The ICER of €37,361 per life-year gained is a conservative estimate. We concluded that despite the high TMZ acquisition costs, the costs per life-year gained are comparable to accepted first-line treatment with chemotherapy in patients with cancer.

Stem cell transplantation in Europe: Trends and prospects (Article)

2007-11-01T00:00:00Z

The aim of the present study was to identify trends in numbers of European patients treated with autologous and allogeneic haematopoietic stem cell transplantation (HSCT) as well as to provide anticipated transplant rates for the upcoming years. The following indications were considered: haematological malignancies (acute leukaemias, myeloproliferative disorders, lymphoproliferative disorders and multiple myeloma), solid tumours and non-malignant diseases. Numbers of patients treated from 1990 to 2004 were extracted from the European Group for Blood and Marrow Transplantation database, extrapolated to 2012 using mathematic models and adjusted to the literature study and expert opinion. In Europe, a 13% raise in HSCT utilisation is to be expected from 2005 to 2010, mostly due to the growing application of reduced-intensity conditioning regimens followed by allogeneic HSCT. Growing transplant rates are likely to exert health expenditure budgets and put pressure on health care providers and health insurers in Europe. Therefore, the rapid expansion would ideally imply a simultaneous increase in HSCT budgets.

A randomized trial of PET scanning to improve diagnostic yield of direct laryngoscopy in patients with suspicion of recurrent laryngeal carcinoma after radiotherapy (Article)

2007-11-01T00:00:00Z

The RELAPS study (REcurrent LAryngeal carcinoma PET Study) was designed to determine whether FDG-PET is of value in the selection of patients for direct laryngoscopy under general anesthesia in patients with suspicion of recurrent laryngeal carcinoma after radiotherapy. In a randomized controlled clinical trial the current diagnostic practice, i.e. all patients undergo direct laryngoscopy, will be compared to a strategy in which FDG-PET selects the patients for laryngoscopy. All eight head and neck cancer centers of the Dutch Head and Neck Oncology Cooperative Group NWHHT will participate in this multicenter trial. The study population consists of patients with clinical suspicion of recurrent T2-T4 laryngeal carcinoma after radiotherapy (without obvious signs of tumor) in whom a direct laryngoscopy under general anesthesia with taking of biopsies is indicated by the local physician. The primary efficacy endpoint is the difference in the number of futile indications for direct laryngoscopy between the conventional diagnostic arm and the FDG-PET based diagnostic arm. An indication for laryngoscopy is classified as futile if this laryngoscopy was negative and no recurrence was diagnosed within 6 months follow-up (gold standard). The FDG-PET based strategy may increase the risk of missing recurrent tumor compared to current practice. Safety endpoints include survival and morbidity due to laryngoscopy with taking of biopsies. Survival rates of both groups will have to be collected outside the time frame of the funded trial. Resectability of recurrent tumor and tumor negative surgical margins after total laryngectomy will be used as proxy endpoints. The trial will also compare quality of life and direct medical costs between both arms.

Free radial forearm flap versus pectoralis major myocutaneous flap reconstruction of oral and oropharyngeal defects: A cost analysis (Article)

2007-08-01T00:00:00Z

Objectives: The free radial forearm flap has replaced the pedicled pectoralis major myocutaneous flap and it has become the 'workhorse flap' used by many head and neck reconstructive surgeons for soft tissue reconstructions. Cost implications of radial forearm flap reconstruction within the context of the overall health care in a particular system need to be investigated particularly before it is labelled as 'costly only'. Design and Setting: Forty patients who underwent immediate free radial forearm flap reconstruction for oral or oropharyngeal soft tissue defects were matched with patients who underwent pectoralis major myocutaneous flap reconstruction for similar defects. The 2 years of which the overall management costs according to the hospital perspective were calculated were divided into four periods: operative period, the postoperative phase, follow-up during first year and follow-up during second year after discharge. Results: The total costs within the first 2 years were comparable at ∼50 000 euros. The lower costs of hospital admission (24 days versus 28 days; P = 0.005) in the postoperative phase outweighed the higher costs of the surgical procedure (692 min versus 462 min; P < 0.005) in radial forearm flap patients when compared with pectoralis major flap patients. Conclusions: Oral and oropharyngeal reconstruction with radial forearm flap is not more costly than pectoralis major flap reconstruction. Given the better functional outcome and the present cost analysis, reconstruction of oral and oropharyngeal defects is preferably performed using free tissue transfer.

A systematic review of economic analyses of pharmaceutical therapies for advanced colorectal cancer (Article)

2007-06-01T00:00:00Z

Colorectal cancer is one of the most common causes of cancer in the Western world. New drugs in the treatment of advanced colorectal cancer, such as irinotecan and oxaliplatin, have substantially increased the cost of treatment. A systematic literature review on the cost (-effectiveness) of pharmaceutical therapies for advanced colorectal cancer was conducted, in which 13 articles were included. The main topics were: orally versus intravenously administered fluoropyrimidine, raltitrexed, irinotecan and oxaliplatin. Additional information was collected on the cost (-effectiveness) of the monoclonal antibodies, cetuximab and bevacizumab. Only five articles had taken the societal perspective, in most articles no data on quality of life was presented, and only two reported the cost per quality-adjusted life year. As only a limited amount of information is available on the cost-effectiveness of pharmaceutical therapies for advanced colorectal cancer, there is a need for more cost-effectiveness studies. These studies are preferably performed by taking a societal perspective and including quality of life outcomes.

Longitudinal Changes in Quality of Life and Treatment Costs in Long-term Survivors of Tumors of the Oropharynx Treated with Brachytherapy or Surgery (Proceedings)

2005-10-01T00:00:00Z

Radiotherapie versus CO2-laserbehandeling voor de behandeling van het T1a glottisch larynxcarcinoom (Research Paper)

2002-01-01T00:00:00Z

In dit onderzoek werden de kosten en effecten van de meest voorkomende behandelingen voor het T1a larynxcarcinoom, radiotherapie en de CO2-laserbehandeling, met elkaar vergeleken. De kostenberekening werd gebaseerd op een inventarisatie van de totale medische consumptie tussen eerste bezoek en 2 jaar na de behandeling van patiënten die tussen 1995 en 1999 in het Vumc (Vrije Universiteit medisch centrum te Amsterdam) werden behandeld. Klinische effectiviteitmaten (locale controle, ziektespecifieke sterfte en larynxpreservatie), subjectieve stemkwaliteit (Voice Handicap Index) en de algemene gezondheidsgerelateerde kwaliteit van leven (COOP/Wonca kaarten) werden onderzocht. Gemiddeld bedroegen de totale kosten van de diagnose tot en met twee jaar na de behandeling met radiotherapie Euro 7253,-. Dit bedrag beslaat ook de kosten van de behandeling van een eventueel recidief of een goedaardige afwijking, wanneer deze zich binnen de beschouwde periode manifesteerde. Voor CO2-laserbehandeling bedroegen de kosten Euro 3865,-. Er waren geen verschillen op de klinische effecten. De algemene gezondheidsgerelateerde kwaliteit van leven toonde eveneens geen significante verschillen tussen de beide behandelmethoden. Met betrekking tot de stemkwaliteit werd een significant verschil gevonden tussen de beide groepen op de E-schaal (Emotional). Patiënten behandeld met de CO2-laser scoorden hierop significant beter dan radiotherapiepatiënten. Bovendien scoorden deze patiënten beter op één van de twee toegevoegde stellingen over last bij het slikken. Op de totaalscore van de VHI bestond echter geen verschil tussen de patiëntengroepen. Voor de betreffende patiënten is de radiotherapiebehandeling significant duurder dan CO2-laserbehandeling. Op basis van de gelijke effectiviteit en de kostenberekening van de beide behandelmethoden kan worden gesteld dat de behandeling met de CO2-laser een doelmatig alternatief is voor de behandeling met radiotherapie voor het T1a larynxcarcinoom.

Diagnostiek, behandeling en follow-up van het intermediair en hooggradig Non-Hodgkin Lymfoom. Kosten van protocollaire en niet-protocollaire behandelingen. (Research Paper)

2001-01-01T00:00:00Z

In dit onderzoek is een berekening gemaakt van de gemiddelde kosten van diagnostiek, behandeling en follow-up van patiënten met een non-Hodgkin lymfoom (NHL). Dit rapport is opgesteld in het kader van de opdracht van het ministerie van Volksgezondheid, Welzijn en Sport (VWS) aan het iMTA om in samenwerking met alle betrokken beroepsgroepen een landelijke klinische richtlijn voor het NHL te ontwikkelen, waarbij kosten-effectiviteitsoverwegingen in ogenschouw zijn genomen. In het voorliggende rapport wordt ten eerste een indicatie gegeven van de gemiddelde kosten in verschillende behandelingsgroepen (protocollair en niet-protocollair). Voorts biedt het rapport inzicht in specifieke kostenposten die ten behoeve van NHL-patiënten gemaakt worden, bijvoorbeeld de kosten van verschillende diagnostische opties.

Kosten van allogene stamceltransplantaties (Research Paper)

2001-01-01T00:00:00Z

Allogene stamceltransplantatie is een topspecialistische procedure die met succes kan worden ingezet in de behandeling van (hematologische) maligniteiten, met name bij leukemie. Van oudsher worden transplantaten van verwante donoren gebruikt, maar met de mogelijkheden om transplantaten van onverwante donoren te gebruiken, neemt de toepassing van allogene transplantaties toe. De tarieven die voor deze transplantaties gelden, liggen op dit moment rond de f 140.000,-. De vier Nederlandse ziekenhuizen die allogene transplantaties in een structureel programma uitvoeren, ervaren dit bedrag als verre van toereikend. Het aantal transplantaties neemt jaarlijks toe, maar de financiële mogelijkheden van de instellingen om aan deze "vraag" te voldoen, schieten ernstig tekort. Ter vergelijking: in Duitsland liggen de tarieven voor allogene transplantaties op dit moment op f 282.500,- (verwante donoren, exclusief kosten om de donor te vinden) en f 395.500,- (onverwante donoren, exclusief kosten om de donor te vinden). In Frankrijk is het tarief ongeveer f 285.000,-. Om opheldering te krijgen over deze discrepantie zijn in dit onderzoek de werkelijke kosten bepaald van het uitvoeren van allogene stamceltransplantaties, inclusief de follow-up tot maximaal twee jaar na de start van de behandeling en de kosten om een geschikte donor te vinden. Deze analyse is uitgevoerd in de vier Nederlandse centra die inmiddels een jarenlange ervaring hebben opgebouwd door het uitvoeren van een groot aantal allogene stamceltransplantaties (Universitair Medisch Centrum Utrecht, Academisch Ziekenhuis Rotterdam, Universitair Medisch Centrum St. Radboud te Nijmegen en Leids Universitair Medisch Centrum). De kosten zijn zoveel mogelijk bepaald op basis van gegevens van patiënten die zo'n transplantatie ondergingen. De kosten van een transplantatie met een transplantaat van een verwante donor bedragen ongeveer f 216.000,- per patiënt. Hierin is echter reeds rekening gehouden met het feit dat niet alle patiënten de twee beschouwde jaren overleven. Een patiënt die na twee jaar nog in leven is, heeft ongeveer f 231.000,- aan kosten gegenereerd. Voor transplantaties met onverwante donoren komen de kosten per patiënt op ongeveer f 334.500,- (en f 382.500,- indien de patiënt na twee jaar nog in leven is). De voornaamste reden waarom de kosten bij onverwante transplantaties hoger zijn, is dat de kosten om een geschikte donor te vinden belangrijk hoger zijn bij dit type transplantaties. De werkelijke kosten van allogene stamceltransplantaties zijn al met al belangrijk hoger dan de huidige tarieven. Om deze toponcologische procedure in de toekomst te kunnen blijven uitvoeren op het kwaliteitsniveau waarvoor de vier centra inmiddels garant staan, is het van het grootste belang dat de tarieven voor deze transplantaties worden bijgesteld.

Integral costs of head and neck oncology (in Dutch) (Research Paper)

1999-01-01T00:00:00Z

OBJECTIVES: In the Netherlands, budgeting systems allocate funds to finance academic care. For some highly specialized treatments, it is felt that the costs are not well reimbursed. This study compared hospital reimbursements for head-neck oncology with real costs. To reflect future care costs, costs of required improvements in the quality of care were also estimated. DESIGN: This study was based on 854 consecutive patients treated between 1994-1996 in two university hospitals. Full costs of medical consumption were determined. RESULTS: Costs of diagnosis, treatment and two years of follow-up of patients with a primary head or neck carcinoma summed up to f 47848 (E 21712). For patients with a relapsed carcinoma, this amount was f 61088 (E 27721). After two years, the relapse rate is 40%. Costs per new patient were therefore calculated as 1*47848 + 0.4*61088. The costs of 10 years of follow-up were f 755 (E 343) after correction for survival. In total, average costs per new patient were f 73344 (E 33282), which covered costs of treating the primary tumour, costs of treating relapsed tumours in 40% of all patients and the costs of 10 years of follow-up. The current reimbursement is f 26786 (E 12155). Costs of enhancing quality of care (including enlarging doctor's time) were f 3700 (E 1679) per new patient. CONCLUSIONS: Actual costs of treating head-neck carcinoma are 2.88 times higher than the hospital reimbursement. The actual costs for this type of highly specialized care are not covered by the reimbursement system, which should therefore be revised.

Economic evaluation of cancer treatments (Doctoral Thesis)

1995-09-20T00:00:00Z

Cancer is an important cause of illness and death, accounting for a high percentage of mortality in Western countries. In the Netherlands, about 30% of all deaths is due to cancel' and the prevalence, an indicator of the present burden of illness to society, is clearly rising (Coebergh, 1991). In the last decades cancer treatment has shown a rapid evolution. It is now a multidisciplinary treatment strategy incorporating surgery, radiotherapy, chemotherapy and immunotherapy. The high incidence and prevalence of cancer make this disease a major economic issue. The direct medical costs are considerable and are still rising due to the increased use of expensive drugs, radiotherapy equipment, the growing attention to various kinds of palliative interventions and survival success. In the Netherlands, the total direct medical costs of malignant cancer amounted to 1052 million dollars in 1988, that is 4.8% of total health care costs. About 60% of this expenditure was produced by inpatient hospital care, about 30% by outpatient hospital care and about 10% by non-hospital care (Koopmanschap et al., 1994). It is expected that in 2020, as a result of ageing, these costs will have increased much more rapidly than total health care costs. Finally, the high prevalence of morbidity, mortality and the consequent loss in production also cause high indirect costs.

Cost analysis and substitution of conventional treatment by autologous bone marrow transplantation for patients with (non) Hodgkin's lymphoma or acute myeloid leukemia (Research Paper)

1994-01-01T00:00:00Z

In a retrospective study we calculated the costs of introducing autologous BMT in the treatment of patients with malignant lymphoma and acute leukaemia in The Netherlands. The cost analysis has been performed in five university hospitals and one cancer centre, in a series of patients with intermediate and high grade non-Hodgkin's lymphoma (NHL) and patients with AML. Conventional treatment consisted of chemotherapy. The average costs of the conventional NHL treatment varied from US$3120 to U$12,900. The costs of autologous BMT amounted to US$40,220. In the AML group the costs of conventional treatment amounted to about US$11,040, as only 50% of the patients were treated further. The costs of autologous BMT including a follow-up period of 2 years, amounted to US$55,440. In The Netherlands the total number of autologous BMTs per year in these patient groups was estimated at 230; 180 in the NHL group and 50 in the AML group. The costs of introducing autologous BMT to the NHL group will vary between 4.93 and 6.68 million dollars and for the AML group these costs were estimated at 2.22 million dollars. As a result, the total extra costs of introducing autologous BMTs are expected to be between 7.15 and 8.9 million dollars.

Cost-effectiveness of autologous bone marrow transplantation in comparison to conventional chemotherapy in patients with non-Hodgkin's lymphoma (Research Paper)

1994-01-01T00:00:00Z

A prospective randomized clinical trial with simultaneous data collection for an economic appraisal was carried out to assess the effectiveness, quality of life and cost implications of ABMT vs standard chemotherapy in slowly responding patients with intermediate- and high-grade malignant non-Hodgkin's lymphoma (NHL). The patients had a partial response after three cycles of chemotherapy and had no evidence of BM involvement of NHL. The overall and disease-free survival at 3 years were 61% and 60%, respectively, in the ABMT group and 85% and 77% in the CHOP group (P = NS). Moreover, there were more (severe) complications and symptoms in the ABMT than in the CHOP group. The average costs of CHOP chemotherapy were significantly lower than the average costs in the ABMT group (CHOP: US$ 3118 vs ABMT: US$ 34,447). Considering long-term consequences the ABMT group was more expensive (US$ 34,580) and patients experienced 0.14 life years and 0.22 quality adjusted life years less than the CHOP group (discount rate 5%). As a result, changing therapy from CHOP to ABMT, as primary treatment in slow responders to CHOP, can not be recommended as the required additional investment does not produce health gains in terms of survival or quality of life.