Background: Granulocyte-colony stimulating factors (G-CSFs) reduce the risk of chemotherapy-induced neutropenia. Lipegfilgrastim is a long-acting, once-per-cycle G-CSF, while Brazil's standard of care is short-acting filgrastim. A cost-effectiveness and budget impact analysis of lipegfilgrastim was conducted with filgrastim and once-per-cycle pegfilgrastim for adults at risk of neutropenia in Brazil. Methods: The decision model used national and clinical data to evaluate the costs and outcomes of each treatment. Costs included drug and medical expenses, outpatient and inpatient neutropenia treatments, and adverse events. Health outcomes included incidence of neutropenia-related events. For the budget impact analysis, health outcomes and costs for the pre/post-lipegfilgrastim scenarios were combined to identify expenditure with lipegfilgrastim's introduction. Results: Total cost per patient during a course of four chemotherapy cycles was
and SG outcomes from members of the general public who were asked to evaluate hypothetical health states. Two researchers, with a third acting as adjudicator, independently undertook the review of the literature, the inclusion/exclusion process and data extraction. Statistical analyses were performed on study arms (studies) for differences and/or correlation between utility scores derived from TTO and SG. RESULTS: Of the 170 publications yielded by the initial literature search, 19 pertinent articles were included in the present analysis, covering 24 disease categories, 77 studies and 17,515 subjects. The overall weighted mean health utility scores were 0.82 with TTO and 0.83 with SG. Studies reporting a greater than 10% absolute difference between the two measurement tools represented 13% (kϭ10), while 22% reported greater than 10% relative difference (kϭ17), 51% reported overall higher utility scores with SG (kϭ39) and 13% reported equal scores (kϭ10). The most common disease category, discussed in 8 studies covering 2,490 participants, was ocular disease. Spearman's rank test yielded significant positive correlation (r ϭ 0.924). CONCLUSIONS: The majority of studies displayed little difference in scores between the TTO and SG methods collected from the general public. A high positive correlation was observed between utility scores reported by the two methods.
At 5.5 years, initial SNM therapy was less costly ($23,504 vs. $27,720) and more effective than initial BTX (4.08 vs. 4.04 QALYs). Probabilistic sensitivity analyses that varied SNM and BTX success and repeat BTX injection probabilities and utilities, confirmed these results. Repeat injections and differences in AEs were responsible for most of the changing costs over time. CONCLUSIONS: Based on a more clinically comprehensive design and set of inputs than previous models, treatment with SNM may be more cost-effective than BTX, especially over longer periods of time.OBJECTIVES: Hyperphosphatemia leads to increased hospitalizations and mortality in End-Stage Renal Disease (ESRD). First-line therapy in Canada consists primarily of calcium carbonate (CC). We determined the incremental cost-effectiveness ratio (ICER) of the non-calcium phosphate binder lanthanum carbonate (LC) as second-line therapy, from a Canadian healthcare perspective. METHODS: A Markov model was developed to determine the cost-effectiveness of second-line LC after therapy failure on CC, compared with continued CC treatment; or alternatively with second-line Sevelamer (SH). Patient-level data (nϭ380) from a prospective randomized trial were used for LC and CC drug efficacy. For SH efficacy, an indirect comparison of eight clinical trials was used to calculate a dose-relativity between SH and LC of 2.7:1. Costs, quality of life, mortality and hospitalization rates were based on Canadian data. Univariate and probabilistic sensitivity analyses were performed. RESULTS: Modelling 1,000 dialysis patients, 378 (37.8%) did not achieve target serum phosphate (SP) levels (Յ1.78 mmol/L) with first-line CC therapy and were eligible for LC. Of these, 168 (44.4%) responded to LC therapy, resulting in 49 life years and 29 Quality-adjusted life years (QALYs) gained. The ICER of second-line LC treatment compared with continued CC treatment was CAN $13,200 ($4,600-$22,800) per QALY gained. Results were robust to plausible variations in model parameters. One-year drug costs per additional responder to second-line LC therapy were $2,600, compared to $4,300 for first-line LC. The model evaluating second-line use of LC vs second-line use of SH estimated that LC had similar efficacy but was 16% less expensive than SH. CONCLUSIONS: Second-line treatment with LC is cost-effective compared to continued therapy with CC; and is less expensive compared to first-line LC. LC had lower costs compared with SH, due to lower dose requirements for similar efficacy. These results reinforce current treatment guidelines to treat patients not achieving target SP levels on CC with secondline LC.
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