6597 Background: Determination of health preference is a common outcome measure used in economic evaluations and represents the societal valuation of the patient's health state. It can be measured with generic multi-attribute instruments. Multi-attribute health preference (HP) instruments have similar domains to oncology quality of life (QOL) instruments. It is possible that HP instruments may over or under estimate a patient's QOL. Methods: Consecutive breast cancer patients irrespective of stage and treatment attending an outpatient clinic were approached to enrol in a work productivity and QOL study. The Functional Assessment of Cancer Therapy- General (FACT-G) / -Breast (FACT-B), and the EQ-5D were used to assess QOL and HP, respectively. Total scores are 108 (FACT-G) and 148 (FACT-B). EQ-5D is a generic, multi-attribute instrument measuring health preference from 0 to 1 for 243 possible health states. The analysis was carried out post-hoc to investigate the ceiling effect with the EQ-5D and FACT. Results: A total of 151 patients with breast cancer participated in the study. Mean±SD age was 55.2±12.5 years and time since diagnosis ranged from 0.1 to 25.0 years. Mean±SD FACT-G and FACT-B scores were 79.3±16.6 and 105.2±21.6, respectively. A perfect score was observed in only one patient for the FACT-G, none for the FACT-B, and in 35 (23.2%) patients for the EQ-5D. Four EQ-5D health states accounted for half the sample, with perfect health being the most common. Mean±SD utility score was 0.80±0.16. A correlation test between the EQ-5D and both FACT scores demonstrated convergent validity (p<0.01). Conclusions: Ceiling effect was observed with the EQ-5D which has fewer questions and a smaller scale compared to the FACT. This may indicate that the EQ-5D is not as sensitive in a general breast cancer population. However, the mean utility score was comparable to other studies in women with breast cancer. Future studies should investigate the relationship between long term QOL and HP in a larger cohort of women with breast cancer taking into account disease stage and treatment strategy. No significant financial relationships to disclose.
We conducted an analysis of indirect costs alongside the LY.12 randomized trial in patients with relapsed or refractory (R/R) aggressive non-Hodgkin lymphoma (NHL). Lost productivity data for Canadian patients and caregivers in the trial were collected at baseline and with each chemotherapy cycle pre-transplant, using an adapted Lost Productivity questionnaire. Mean per patient indirect costs were CAD 2999 for patients in the GDP arm and CAD 3400 in the DHAP arm. A substantial majority was not working or had to reduce their workload during this treatment time. Salvage chemotherapy for R/R aggressive NHL is associated with significant indirect costs to patients and their caregivers.
To determine the publicly funded health care system lifetime cost-of-illness of spinal cord injury (SCI) from the perspective of the Ontario Ministry of Health and Long-term Care.Individuals hospitalized for their first SCI between the years 2005 and 2011 were identified and their health care costs were calculated using Ontario administrative health care data. From this information, lifetime costs were estimated using phase-based costing methods. The spinal cord injured cohort was matched to a non-spinal cord injured using propensity score matching. Net costs were determined by calculating the difference in costs between the two matched groups. Net costs were also presented for subgroups stratified by demographic characteristics.A total of 1,716 individuals with SCI were identified and matched in our study. The net lifetime cost of SCI was $336,000 per person. Much of the costs were observed in the first year post-SCI. The lifetime cost of SCI for individuals with a concurrent pressure ulcer at the initial hospitalization rises to $479,600. Costs were also higher for individuals with cervical or thoracic injury or requiring inpatient rehabilitation.Spinal cord injury is a substantial burden to the health care system. Our results are limited to the direct health care costs from the publicly funded health care payer perspective. Further analysis with a broader perspective is needed to understand the full economic impact of this catastrophic condition.
Abstract Background For novel cancer treatments, effectiveness in clinical practice is not always aligned with clinical efficacy results. As such it is important to understand a treatment’s real-world effectiveness. We examined real-world population-based comparative effectiveness of second-line ipilimumab versus non-ipilimumab treatments (chemotherapy or targeted treatments). Methods We used a cohort of melanoma patients receiving systemic treatment for advanced disease since April 2005 from Ontario, Canada. Patients were identified from provincial drug databases and the Ontario Cancer Registry who received second-line ipilimumab from 2012 to 2015 (treated) or second-line non-ipilimumab treatment prior to 2012 (historical controls). Historical controls were chosen, to permit the most direct comparison to pivotal trial findings. The cohort was linked to administrative databases to identify baseline characteristics and outcomes. Kaplan-Meier curves and multivariable Cox regression models were used to assess overall survival (OS). Observed potential confounders were adjusted for using inverse probability of treatment weighting (IPTW). Results We identified 329 patients with metastatic melanoma (MM) who had received second-line treatments (189 treated; 140 controls). Patients receiving second-line ipilimumab were older (61.7 years vs 55.2 years) compared to historical controls. Median OS were 6.9 (95% CI: 5.4–8.3) and 4.95 (4.3–6.0) months for ipilimumab and controls, respectively. The crude 1-year, 2-year, and 3-year OS probabilities were 34.3% (27–41%), 20.6% (15–27%), and 15.2% (9.6–21%) for ipilimumab and 17.1% (11–23%), 7.1% (2.9–11%), and 4.7% (1.2–8.2%) for controls. Ipilimumab was associated with improved OS (IPTW HR = 0.62; 95% CI: 0.49–0.78; p < 0.0001). Conclusions This real-world analysis suggests second-line ipilimumab is associated with an improvement in OS for MM patients in routine practice.
Background: Economic evaluations are an integral component of many clinical trials. Costs used in those analyses are based on the prices of branded drugs when they first enter the market. The effect of genericization on the cost-effectiveness (CE) or cost–utility (CU) of an intervention is unknown because economic analyses are rarely updated using the costs of generic drugs. Methods: We re-examined the CE or CU of regimens previously evaluated in Canadian Cancer Trials Group (CCTG) studies that included prospective economic evaluations and where genericization has occurred or is anticipated in Canada. We incorporated the new costs of generic drugs to characterize changes in CE or CU. We also determined acceptable cost levels of generic drugs that would make regimens reimbursable in a publicly funded health care system. Results: The four randomized controlled trials included (representing 1979 patients) were CCTG BR.10 (early lung cancer, adjuvant vinorelbine–cisplatin vs. observation, n = 172), CCTG BR.21 (metastatic lung cancer, erlotinib vs. placebo, n = 731), CCTG CO.17 (metastatic colon cancer, cetuximab vs. best supportive care, n = 557), and CCTG LY.12 (relapsed or refractory lymphoma, gemcitabine–dexamethasone–cisplatin vs. cytarabine–dexamethasone–cisplatin, n = 619). Since the initial publication of those trials, the genericization of vinorelbine, erlotinib, cetuximab, and cisplatin has taken place or is expected in Canada. Costs of generics improved the ces and cus of treatment significantly. For example, genericization of erlotinib ($1460.25 per 30 days) resulted in an incremental cost-effectiveness ratio (ICER) of $45,746 per life-year gained compared with $94,638 for branded erlotinib. Likewise, genericization of cetuximab ($275.80 per 100 mg) produced an icer of $261,126 per quality-adjusted life-year (QALY) gained compared with $299,613 for branded cetuximab. Decreases in the cost of generic cetuximab to $129.39 and $63.51 would further improve the icer to $150,000 and $100,000 per QALY respectively. Conclusions: Genericization of a costly oncology drug can modify the CE and CU of a regimen significantly. Failure to revisit economic analyses with the costs of generics could be a missed opportunity for funding bodies to optimize value-based allocation of health care resources. At current levels, the costs of generics might not be sufficiently low to sustain publicly funded health care systems.
Background: Psoriasis impacts many different areas of a patient's life, including work productivity. There is no information regarding lost productivity owing to psoriasis in a Canadian population. Objective: The objective of this study was to determine the lost productivity of Canadian patients with moderate to severe psoriasis. Methods: Seventy-nine consecutive Canadian dermatology patients were interviewed and completed the Work Productivity and Activity Impairment Questionnaire (WPAIQ). Results: On average, 2.2 hours (± 5.6 hours) were lost from work per week owing to psoriasis-related events. Absence from work may result in lost mean patient wages of C$2,270.84 per person per year. Total lost wages owing to moderate to severe psoriasis may cost up to approximately $749 million for all moderate to severe psoriasis patients in Canada. Conclusion: The results from our study indicate that moderate to severe psoriasis may have a substantial impact on the work productivity of patients with this disease.
