Efficacy of meropenem as monotherapy in the treatment of ventilator-associated pneumonia

We performed a prospective, open label, randomized study in intensive care unit patients with ventilator-associated pneumonia (VAP) to determine the efficacy and safety of empiric intravenous (i.v.) meropenem monotherapy compared with the combination of ceftazidime plus amikacin. A total of 140 patients receiving mechanical ventilation and diagnosed with pneumonia were included in the study. Patients were randomized to receive either 1 g meropenem i.v. every 8 hours or 2 g ceftazidime i.v. every 8 hours plus 15 mg/kg amikacin daily, administered to patients with normal renal function as two daily doses. Satisfactory clinical responses (cure or improvement) were achieved at the end of treatment in 68.1% of meropenem-treated patients and 54.9% in the ceftazidime/amikacin-treated group (relative risk 1.25; 95% confidence interval >1.00, 1.55). When non-evaluable patients were excluded from the analysis, the satisfactory clinical response was 82.5% and 66.1% for the meropenem and ceftazidime/amikacin patients, respectively (p = 0.044). Logistic regression demonstrated that treatment with meropenem and both the basic traumatic and medical pathologies were significantly associated with a satisfactory response. Adverse events judged to be possibly or probably related to treatment were reported by seven (10.1%) patients in the meropenem group and by eight patients (11.3%) in the ceftazidime/amikacin group. The results of this study confirm that monotherapy with meropenem is well tolerated and provides superior efficacy to the conventional combination of ceftazidime and amikacin in combating VAP.     

Cost-effectiveness analysis of interferon as adjuvant therapy in high-risk melanoma patients in Spain

In the randomised clinical trial E1684, the administration of interferon (IFN) alpha-2b resulted in prolonged disease-free and overall survival in high-risk melanoma patients following surgical resection. However, and considering the cost and toxicity of IFN, the convenience of its widespread use should be evaluated. The aim of this study was to analyse the cost-effectiveness ratio of adjuvant therapy with IFN alpha-2b in melanoma patients versus an untreated control group. A Markov model was used to compare two hypothetical cohorts of 1000 patients aged 50 years, according to the clinical outcome of the E1684 study. The cohort of patients treated with IFN alpha-2b has an increased overall survival of 1.90 years during the patient's lifetime. The incremental discounted cost per life year gained of IFN versus observation is 9015 Euros according to the projection generated by the model. The sensitivity analysis demonstrated that changes in the most relevant study end-points do not modify the study outcome. In conclusion, in high-risk melanoma patients following surgical resection, the cost-effectiveness of IFN alpha-2b (at a dose of 20 MU/m²/day, 5 days per week for one month, followed by 10 MU/m² TIW, up to one complete year of therapy) versus an untreated control group is within the limits established in health economics to determine if adoption of a new treatment is economically justified and is comparable with other interventions in which cost-effectiveness is acceptable to the National Health System.     

Economic evaluation of linezolid versus teicoplanin for the treatment of infections caused by gram-positive microorganisms in Spain

The aim of this study was to perform a comparative cost-effectiveness analysis of linezolid vs teicoplanin (i.v., switching to oral/i.m. respectively) in Spain. A decision tree model was used with the results of a randomized, comparative, controlled clinical trial with linezolid vs teicoplanin in the treatment of infections caused by Gram-positive microorganisms, with a timeline of 31 days. The efficacy endpoint was the percentage of patients with clinical healing or improvement in their infection. Direct medical costs were included using Spanish 2005 prices. Average cost per patient, average cost-effectiveness ratio and several sensitivity analyses were carried out. In the intent-to-treat (ITT) analysis linezolid obtained a higher percentage of therapeutic success than teicoplanin (95.5% vs 87.6% respectively, p = 0.005), both with similar tolerability. The average cost per treated patient was euro 8,064.76 for linezolid vs euro 8,727.36 for teicoplanin, with an incremental cost of euro 622.59 (-7,6%). Linezolid yielded a lower average cost-effectiveness ratio, euro 8,444.78 (8,195.90 - 8,709.25) than teicoplanin, euro 9,962.74 (9,465.68 - 10,502.23), with a slight reduction in average cost per successfully treated patient of 15.2% ( euro 1,517.96). The results were robust to the sensitivity analysis. In conclusion, linezolid is a more cost-effective option than teicoplanin in the treatment of infections caused by Gram-positive microorganisms, since it offers superior clinical benefits with a lower use of associated resources.     

Cost-effectiveness of second-line treatment with irinotecan or infusional 5-fluorouracil in metastatic colorectal cancer

Background:It has been shown that irinotecan is superior toinfusional 5-fluorouracil (5-FU) in patients with advanced colorectal cancerafter 5-FU failure. In a recent trial, median survival was 10.8 months forpatients treated with irinotecan, compared to 8.5 months in patients receivinginfusional 5-FU. Considering the statistically significant but clinicallyrelatively small advantage of irinotecan over 5-FU, cost effectiveness shouldalso be part of treatment decision. Purpose:To relate the costs of each management approach tooverall survival in patients with metastatic colorectal cancer. Patients and methods:The healthcare costs and medical benefits(treatment-added survival) of second-line chemotherapy in patients (infusional5-FU: 129, irinotecan: 127) were compared. Data on overall survival were drawnfrom a multicenter randomised trial that compared infusional 5-FU (continuousinfusion, AIO, or LV5-FU2 regimens) to irinotecan alone. Costs were derivedfrom the accounting system in two university hospitals in Paris, France. Results:The range in total healthcare costs was 14,135 to 12,192US$ patient between management approaches, with irinotecan chemotherapycosting most and 5-FU-continuous infusion least. If survival was included asa treatment benefit, the cost-effectiveness ratio of irinotecan over 5-FUranged from 9,344 to 10,137 US$ per year of added survival. Conclusions:The least expensive management for metastaticcolorectal was 5-FU infusion but the additional cost of irinotecan wasbalanced by the added months of survival, with a cost-effectiveness ratioclose to that of other cancer treatments.     

Cost-effectiveness analysis of pemetrexed versus docetaxel in the second-line treatment of non-small cell lung cancer in Spain: results for the non-squamous histology population

Background  

The objective of this study was to conduct a cost-effectiveness evaluation of pemetrexed compared to docetaxel in the treatment of advanced or metastatic non-small cell lung cancer (NSCLC) for patients with predominantly non-squamous histology in the Spanish healthcare setting.     

Cost minimization analysis of treatment with intravenous or subcutaneous trastuzumab in patients with HER2-positive breast cancer in Spain

Purpose

To describe healthcare professional (HCP) and patient time and related costs associated with trastuzumab intravenous infusion (IV) and trastuzumab subcutaneous (SC) formulations in patients with HER2-positive early breast cancer.

Methods

This prospective, observational time, and motion study in three Spanish centers was run as a substudy of the PrefHer trial. We recorded active HCP time for trastuzumab SC and IV-related tasks and calculated HCP time as the mean sum of task times over 154 administrations (80 IV, 74 SC). We calculated mean patient infusion chair time and treatment room time. Staff costs were calculated using fully loaded salary costs based on Spanish salaries (€ 2012).

Results

The transition from trastuzumab IV to SC led to a 50% reduction in active HCP time [27.2 min (95% CI 21.8–32.6) vs. 13.2 min (95% CI 8.9–17.5) per cycle]. Time savings resulted from avoiding IV catheter installation and removal, line flushing, and drug reconstitution. SC administration led to a fivefold reduction (78–85%) in chair time and a fourfold reduction (59–81%) in patient treatment room time, resulting in 24 h free-up time in the total treatment course (18 cycles). Total estimated direct costs were € 29,431.75 and € 28,452.12 for IV and SC, respectively, a saving of € 979.60 over a full treatment course.

Conclusions

Trastuzumab SC provided substantial time savings for HCP and patients, and reduced staff costs vs. trastuzumab IV. Reducing the use of hospital facilities may result in further savings and improved quality of medical care.

     

Cost-effectiveness of human papillomavirus vaccination and screening in Spain

BackgroundIn Spain, prophylactic vaccination against human papillomavirus (HPV) types 16 and 18 is being offered free-of-charge to one birth cohort of girls aged 11–14. Screening is opportunistic (annual/biannual) contributing to social and geographical disparities.MethodsA multi-HPV-type microsimulation model was calibrated to epidemiologic data from Spain utilising likelihood-based methods to assess the health and economic impact of adding HPV vaccination to cervical cancer screening. Strategies included (1) screening alone of women over age 25, varying frequency (every 1–5 years) and test (cytology, HPV DNA testing); (2) HPV vaccination of 11-year-old girls combined with screening. Outcomes included lifetime cancer risk, life expectancy, lifetime costs, number of clinical procedures and incremental cost-effectiveness ratios.ResultsAfter the introduction of HPV vaccination, screening will need to continue, and strategies that incorporated HPV testing are more effective and cost-effective than those with cytology alone. For vaccinated girls, 5-year organised cytology with HPV testing as triage from ages 30 to 65 costs 24,350€ per year of life saved (YLS), assuming life-long vaccine immunity against HPV-16/18 by 3 doses with 90% coverage. Unvaccinated girls would benefit from organised cytology screening with HPV testing as triage; 5-year screening from ages 30 to 65 costs 16,060€/YLS and 4-year screening from ages 30 to 85 costs 38,250€/YLS. Interventions would be cost-effective depending on the cost-effectiveness threshold and the vaccine price.ConclusionsIn Spain, inequitable coverage and overuse of cytology make screening programmes inefficient. If high vaccination coverage among pre-adolescent girls is achieved, organised cytology screening with HPV triage starting at ages 30 to at least 65 every 4–5 years represents the best balance between costs and benefits.     

Cost-effectiveness analysis of antifungal treatment for patients on chemotherapy

Invasive fungal infections are fatal complications for patients on chemotherapy, and antifungal prophylactic treatment has been commonly recommended. Because its clinical and economic impact is not well known, we evaluated cost-effectiveness of anti-fungal treatment for patients who were neutropoenic as a result of chemotherapy. We constructed a hypothetical cohort of 40-year-old patients with acute myelogenic leukemia to evaluate years of life survived (YLS), costs (US$), and incremental cost-effectiveness ratio (US$/YLS). The following treatment strategies for fungal infections were compared: (1) prophylactic fluconazole strategy: oral fluconazole administration concurrently with chemotherapy; (2) empirical amphotericin B strategy: empirical intravenous amphotericin B administration at the point where fever is detected; and (3) no prophylaxis strategy: intravenous micafangin administration at the point where fungal infections is diagnosed. Baseline analyses showed that prophylactic fluconazole strategy involved higher costs but also longer YLSs (25,900 US$ and 24.08 YLS). The incremental cost-effectiveness ratio of prophylactic fluconazole strategy was 625 US$/YLS compared to no prophylaxis strategy, and 652 US$/YLS compared to empirical amphotericin B strategy. Baseline result was found to be robust through sensitivity analyses. Our study showed that concurrent administration of oral fluconazole during induction chemotherapy appears to ensure clinical benefits together with acceptable cost-effectiveness.     

Cost-effectiveness analysis in oncology

Physicians are faced with a burgeoning literature of economic studies.However, most physicians have little training in evaluating economicresearch. Economic studies involve a comparison of the costs and benefits ofalternative treatment options. To be of use for medical decision making,they should meet appropriate methodological standards. These include clearspecification of the research question and the perspective from which thestudy is being undertaken, comparison of relevant treatment options,identification and quantification of all important costs and benefits, theuse of discounting to allow for time preferences for costs and benefits, andsensitivity analyses to test the robustness of the studys results.Unfortunately, not all adhere to these principles. Physicians need to beable to understand and critically assess the quality of economic studies,and the applicability of the results to their own situation, in order toparticipate in medical policy decisions.     

营养支持对降低ICU肿瘤重症患者呼吸机相关性肺炎的临床效果

目的 探讨营养支持对降低ICU肿瘤重症患者呼吸机相关性肺炎的临床效果.方法 选取2018年6月至2019年9月间四川电子科技大学医学院附属肿瘤医院收治的90例行气管插管机械通气治疗的肿瘤重症患者,采用随机数字表法分为观察组47例和对照组43例.观察组患者采用早期肠内外营养支持,对照组患者采用常规营养支持,比较两组患者呼...     

肿瘤医院呼吸机相关性肺炎的真菌感染特点分析

目的:探讨肿瘤医院呼吸机相关真菌性肺炎(VAP-F)发生的临床与病原菌特点,为临床提供指导.方法:选取中山大学肿瘤防治中心2006-01-2009-09 ICU住院并行机械通气时间>48 h,ICU收治时间>7 d,且于ICU治疗期间始终未出现中性粒细胞缺乏、免疫抑制的肿瘤患者,排除输入性真菌感染或已行预防性抗真菌治疗者,其中拟诊真菌感染者为VAP-F组,其余设为对照组.结果:按标准共收集病历44例,VAP-F组20例,对照组24例,VAP-F发生率为45.45%(20/44).最常见菌为白色念殊菌12例(60.0%),近平滑念珠菌4例(20.0%),光滑念珠菌3例(15.0%).热带念珠菌1例(5.0%).所合并细菌以革兰阳性菌(64.7%)为主.两组间呼吸机通气时间、年龄及是否合并细菌感染差异有统计学意义(P<0.05),而患者体质量、是否行胃肠道手术、术前术后肺功能氧合指数(OI)及其变化等指标两组间差异无统计学意义.Logistic回归分析表明,是否合并细菌感染是吸机相关真菌性肺的独立危险因素.结论:肿瘤患者VAP-F的发生与是否合并细菌感染有关,若临床已行针对细菌治疗,建议同时行预防性抗真菌治疗.     

Cost-effectiveness analysis of sunitinib in patients with metastatic and/or unresectable gastrointestinal stroma tumours (GIST) after progression or intolerance with imatinib

Introduction  Sunitinib is a multiselective oral inhibitor of several tyrosine-kinase receptors that has demonstrated its efficacy in patients with metastatic and/or unresectable gastrointestinal stroma tumours (GIST) who were resistant to or intolerant to previous treatment with imatinib. The purpose of this study is to assess the cost-effectiveness of sunitinib vs. best supportive care (BSC) in GIST as a second-line treatment, from the perspective of the Spanish National Health System. Materials and methods  A Markov model was used to assess the cost effectiveness of sunitinib (50 mg/day, 4 weeks “on” and 2 weeks “off”) vs. BSC in GIST as a second-line treatment. Transition probabilities between the three health states considered in the model (progression-free survival (PFS), progression and death) were obtained from a clinical trial [Demetri et al. (2006) Lancet 368:1329–1338]. Health resource data (drugs, medical visits, laboratory and radiology tests, palliative care and adverse events) were obtained from an expert panel. Deterministic and probabilistic sensitivity analyses were conducted. Results  Projected PFS years, life years (LY) and quality of life adjusted years (QALYs) were higher for sunitinib compared with BSC: 0.50 vs. 0.24, 1.59 vs. 0.88 and 1.00 vs. 0.55. Mean costs per patient were €23,259 with sunitinib and €1,622 with BSC. The incremental cost-effectiveness ratios (ICERs) obtained were: €4,090/month PFS, €30,242/LY and €49,090/QALY gained. The most influential variables for the results were the efficacy and unit cost of sunitinib. Conclusions  According to the efficiency thresholds for oncology patients in developed countries, sunitinib is considered cost-effective vs. BSC with acceptable costs per LY and QALY gained. Currently not working at Pfizer Spain     

硼替佐米、地塞米松及沙利度胺方案治疗多发性骨髓瘤的成本与疗效分析

目的:探讨硼替佐米、地塞米松、沙利度胺方案（BDT）治疗多发性骨髓瘤（MM）的近期疗效、安全性及成本分析。方法:选取我院收治的初治及复发难治的MM患者40例,给予BDT方案化疗3周期,观察患者的治疗疗效、成本、不良反应的发生情况。结果:40例MM患者治疗后的骨髓瘤细胞、M蛋白、β2-MG下降及血红蛋白上升的指标均差异显著(P＜0.05);治疗后的总缓解率为75.0%,其中5例完全缓解,10例非常好的部分缓解,15例部分缓解,7例疾病稳定,3例疾病进展。治疗过程中未发生严重不良反应。BDT方案成本-效果比是867.3元,敏感度分析后成本-效果比是310.4元。结论:硼替佐米、地塞米松及沙利度胺方案治疗MM疗效优异,安全性可,价格适中,具有较好的临床应用价值。     

化疗联合CIK细胞回输治疗老年晚期非小细胞肺癌成本-效果分析

目的 探讨化疗联合CIK细胞回输治疗老年晚期非小细胞肺癌疗效和经济学价值,以期为老年晚期非小细胞肺癌的治疗提供参考。方法 晚期非小细胞肺癌患者56例,随机分为两组,在采取常规对症治疗的基础上,治疗组采用单药培美曲塞二钠化疗,二周期后序贯CIK细胞回输生物治疗一周期;对照组采用单药培美曲塞二钠方案化疗二周期。治疗结束后,计算两组平均成本及成本效果值。结果 治疗组完全缓解率为7.14%,有效率为69.7%;对照组完全缓解率为0%,有效率为32.1%。治疗组的治疗效果明显好于对照组,差异有显著性(P=0.008);两组的治疗成本分别为治疗组37 800元,对照组21 038元。治疗组的治疗成本明显高于对照组(P＜0.05),但治疗组的成本效果比C/E值低于对照组,差异有显著性(P＜0.05)。结论 采用CIK细胞回输生物治疗联合单药培美曲塞二钠化疗治疗晚期非小细胞肺癌疗效好,且经济学效果较单药化疗好,值得临床推广。     

Cost-effectiveness analysis of extended adjuvant endocrine therapy in the treatment of post-menopausal women with hormone receptor positive breast cancer

Five years of Tamoxifen (Standard TAM) is a common treatment option for early-stage, hormone receptor positive (HR+) breast cancer (BC). Extending Standard TAM by 5 additional years (Extended TAM) can improve survival and BC recurrences. In postmenopausal women, the use of extended aromatase inhibitors (Extended AI) after Standard TAM is an alternative to Extended TAM. This study examines the cost-effectiveness (CE) of extending Standard TAM with Extended TAM vs. Extended AI in postmenopausal HR+ early-stage BC patients. Three treatments were assessed: (1) Standard TAM; (2) Extended TAM; (3) Extended AI through a Markov model using a Canadian health system perspective, lifetime time-horizon, quality adjusted life years (QALYs), and a 5 % discount rate for future costs and utilities. Incremental cost-effectiveness ratios (ICERs) were calculated, and the impact of parameter uncertainty was assessed through probabilistic sensitivity analyses (SA) using conventional CE thresholds. The estimated total per person costs in 2012 Canadian dollars [$1.00 CAD = $0.99 US 2012] were the least for Extended TAM ($8,623 CAD) and most for Extended AI ($9,432 CAD). Extended AI was the most effective regimen, while Standard TAM was the least. Extended AI was cost-effective at conventional thresholds vs. Extended TAM (ICER: $3,402 CAD/QALY) which was robust to the SA. This study suggests that Extended AI and Extended TAM result in improved QALYs and lower healthcare costs vs Standard TAM. Extended AI results in the greatest improvement in QALYs and is the most cost-effective treatment alternative despite its higher drug costs.     

Cost-effectiveness of camrelizumab versus chemotherapy for the treatment of advanced or metastatic esophageal squamous cell carcinoma

BackgroundTo evaluate the cost-effectiveness of camrelizumab versus chemotherapy for patients with advanced or metastatic esophageal squamous cell carcinoma (ESCC) from the perspective of health system and to provide a basis for health decisions in China.MethodsA Markov model of 3 health states throughout the lifetime was established based on data from the ESCORT trial. Life-years, quality-adjusted life-years (QALYs), and lifetime costs were estimated. The time horizon of lifetime was 5 years and each model cycle represented 2 months. The cost and utility value adopted a 5% discount rate per year. One-way sensitivity analysis and probability sensitivity analysis were used to test the robustness of the results.ResultsThe results of the cost-effectiveness analysis revealed that the camrelizumab group produced a gain of 2.93 QALY, at a cost of $37,809.12 USD, and the chemotherapy group gained 2.85 QALY, at a cost of $3,7071.52 USD. Camrelizumab was more cost-effective than chemotherapy for patients with advanced or metastatic ESCC. The results of one-way sensitivity analyses showed that the cost of camrelizumab, cost of chemotherapy and utility of progression-free survival (PFS) state were the top three parameters influencing the model. The probability sensitivity analysis results showed that the results of the basic case analysis were stable.ConclusionsUnder the willingness to pay threshold of three times per capita GDP of China, camrelizumab as second-line treatment could provide more health benefits for advanced or metastatic ESCC in China.     

不同呼吸机管路集中消毒方式对肿瘤患者术后发生呼吸机相关性肺炎的影响

目的探讨呼吸机管路手工清洗与全自动清洗集中消毒方式对肿瘤患者术后呼吸机相关性肺炎(VAP)发生情况的影响。方法选取2010年9月至2014年9月间收治的377例术后应用呼吸机的肿瘤患者,按照其呼吸机管路集中消毒方式分为手工组(n=194)和自动组(n=183),对两组患者临床资料、VAP发生情况进行回顾性分析。结果手工组目测法和细菌检测法合格率分别为95.1%和91.4%,均显著低于自动组(P<0.05);自动组两种检测方法的合格率均为100.0%。手工组VAP发生率和千日感染率分别为12.9%和42.9‰,均显著高于自动组的3.8%和16.7‰(P<0.05)。结论全自动清洗在呼吸机管路集中消毒中具有灭菌效果好、工作效率高的优势,能够有效降低肿瘤患者术后VAP发生率,对于医疗质量的改善有着积极意义。     

Cost-effectiveness analysis of trastuzumab in the adjuvant setting for treatment of HER2-positive breast cancer

BACKGROUND: Adding trastuzumab to adjuvant chemotherapy provides significant clinical benefit in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. A cost-effectiveness analysis was performed to assess clinical and economic implications of adding trastuzumab to adjuvant chemotherapy, based upon joint analysis of NSABP B-31 and NCCTG N9831 trials. METHODS: A Markov model with 4 health states was used to estimate the cost utility for a 50-year-old woman on the basis of trial results through 4 years and estimates of long-term recurrence and death based on a meta-analysis of trials. From 6 years onward, rates of recurrence and death were assumed to be the same in both trastuzumab and chemotherapy-only arms. Incremental costs were estimated for diagnostic and treatment-related costs. Analyses were from payer and societal perspectives, and these analyses were projected to lifetime and 20-year horizons. RESULTS: Over a lifetime, the projected cost of trastuzumab per quality-adjusted life year (QALY; discount rate 3%) gained was 26,417 dollars (range 9,104 dollars-69,340 dollars under multiway sensitivity analysis). Discounted incremental lifetime cost was 44,923 dollars, and projected life expectancy was 3 years longer for patients who received trastuzumab (19.4 years vs 16.4 years). During a 20-year horizon, the projected cost of adding trastuzumab to chemotherapy was 34,201 dollars per QALY gained. Key cost-effectiveness drivers were discount rate, trastuzumab price, and probability of metastasis. The cost-effectiveness result was robust to sensitivity analysis. CONCLUSIONS: Trastuzumab for adjuvant treatment of early stage breast cancer was projected to be cost effective over a lifetime horizon, achieving a cost-effectiveness ratio below that of many widely accepted oncology treatments.     

Cost-effectiveness analysis of oxaliplatin compared with 5-fluorouracil/leucovorin in adjuvant treatment of stage III colon cancer in the US

BACKGROUND: The MOSAIC trial demonstrated that oxaliplatin/5-fluorouracil/leucovorin (FU/LV) (FOLFOX4) as adjuvant treatment of TNM stage II and III colon cancer significantly improves disease-free survival compared with 5-FU/LV alone. For stage III patients the 4-year disease-free survival (DFS) was 69% in the FOLFOX4 arm vs 61% in the LV5FU2 arm, P = .002). The cost-effectiveness of FOLFOX4 in stage III patients was evaluated from a US Medicare perspective. METHODS: By using individual patient-level data from the MOSAIC trial (median follow-up: 44.2 months), DFS and overall survival (OS) were estimated up to 4 years from randomization. DFS was extrapolated from 4 to 5 years by fitting a Weibull model and subsequent survival was estimated from life tables. OS beyond 4 years was predicted from the extrapolated DFS estimates and observed survival after recurrence. Costs were calculated from trial data and external estimates of resources to manage recurrence. RESULTS: Patients on FOLFOX4 were predicted to gain 2.00 (95% confidence interval [CI]: 0.63, 3.37) years of DFS over those on 5-FU/LV. The predicted life expectancy of stage III patients on FOLFOX4 and 5-FU/LV was 17.61 and 16.26 years, respectively. Mean total lifetime disease-related costs were $56,300 with oxaliplatin and $39,300 with 5-FU/LV. Compared with 5-FU/LV, FOLFOX4 was estimated to cost $20,600 per life-year gained and $22,800 per quality-adjusted life-year (QALY) gained, discounting costs and outcomes at 3% per annum. CONCLUSIONS: FOLFOX4 is likely to be cost-effective compared with 5-FU/LV in the adjuvant treatment of stage III colon cancer. The incremental cost-effectiveness ratio compares favorably with other funded interventions in oncology.     

Cost-effectiveness analysis comparing carboplatin and weekly paclitaxel with cisplatin and docetaxel in the treatment of advanced non-small cell lung carcinoma

Carboplatin plus weekly paclitaxel (CBDCA/wPTX) and cisplatin plus docetaxel (CDDP/DTX) are the standard regimens used in the first-line treatment of advanced non-small cell lung carcinoma (NSCLC), with no significant difference in efficacy between the two. However, because there has been no study of the cost-effectiveness of CBDCA/wPTX versus CDDP/DTX to data, we compared these two regimens in the present study. Expected costs were calculated based on data from patients with Stage III b/IV NSCLC who were treated with either CBDCA/wPTX or CDDP/DTX in the Nippon Medical School Hospital. Efficacy (1-year survival rate) was determined by pooled analysis of studies extracted from the database. The cost-effectiveness ratio was calculated from expected costs and 1-year survival rates for both the CBDCA/wPTX and CDDP/DTX regimens. The expected costs per patient of the CBDCA/wPTX and CDDP/DTX regimens were ￥2, 847, 514 and ￥3, 513, 195, respectively, with 1-year survival rates of 38.6% and 42.5%, respectively. Thus, the cost-effectiveness ratio for the CBDCA/wPTX and CDDP/DTX regimens is ￥6, 750, 863 and ￥8, 329, 054, respectively. These findings clearly suggest that, CBDCA/wPTX is a more cost-effective regimen than CDDP/DTX.