Comparative Cost-Effectiveness of Drugs in Early versus Late Stages of Cancer; Review of the Literature and a Case Study in Breast Cancer

PloS One
Evgeni DvortsinMaarten J Postma

Abstract

Many oncological drugs that are being used in the adjuvant setting were first submitted for reimbursement in the metastatic stage, with differences in incremental cost-effectiveness ratios (ICERs) in both settings having potential implications for reimbursement and pricing. The aim of this study is to identify a possible trend in the cost-effectiveness for the early/adjuvant and late/metastatic stages of oncological drugs through review and case study. We reviewed pairs of cost-effectiveness analyses of the same oncological drug in different stages for Scotland and the Netherlands. The case study in this report was directed at trastuzumab in the Dutch situation. Using a simplified Markov model, the cost-effectiveness in early and late stage of breast cancer was calculated and compared to the findings from the review. Comparable studies were found for cetuximab, bortezomib and bosutinib. Treatments in the late stage were found to be more expensive per QALY by a factor ranging from 1.5 to 12. The case study provided a similar result; late stage treatment was more expensive by a factor 10. Using, for example, a threshold of €80,000/QALY, the early stage of cetuximab, bosutinib and trastuzumab are deemed cost-effective, while their...Continue Reading

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Citations

Jul 20, 2016·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Ramon ColomerJoan Albanell
Mar 9, 2018·Journal of Clinical Gastroenterology·Shashank SarvepalliMadhusudhan R Sanaka
Apr 20, 2019·International Journal of Cancer. Journal International Du Cancer·Lucie VeronMarie-Christine Boutron-Ruault
Dec 6, 2019·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Jinani Jayasekera, Jeanne S Mandelblatt
Jul 10, 2017·Breast Cancer Research and Treatment·Xavier Ghislain Léon Victor PouwelsManuela A Joore
Nov 5, 2020·European Journal of Cancer Care·Susannah A JacobMichael B Barton

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