The results were sensitive only to large changes in analysis perspective or MTC. Based on the analyses, teriflunomide was cost-effective versus BSC or DMF with the common threshold values, was dominant versus other first-line RRMS treatments, and provided the greatest impact on investment. Teriflunomide is potentially the most cost-effective option among first-line treatments of RRMS in Finland.
A 3 3 5 -A 7 6 6 population-based MS survey for relapse rates. A network meta-analysis was conducted to estimate the comparative efficacy of each treatment versus placebo. Costs (in 2013 Euro) of drug acquisition, disease management, relapses, and AEs were from public databases and literature. Clinical and economic outcomes were projected over 30 years and discounted at 3.5% per year. Results: Over 30 years, treatment with PEG-IFN resulted in higher QALYs and cost-savings compared with all commercially available self-injectable DMTs in Ireland. Deterministic sensitivity analyses confirmed the results were robust. Probabilistic sensitivity analyses indicated that the incremental cost-effectiveness ratio was below the willingness-to-pay threshold (€ 45,000 per QALY) in > 85% of 5,000 replications versus all comparators. ConClusions: PEG-IFN is a cost-effective treatment for patients with RRMS in Ireland.objeCtives: Glybera is the first gene therapy drug for lipoprotein lipase deficiency (LPLD), which was approved by European Commission in 2012. Before the approval of Glybera, no effective treatment was available for LPLD. Patients with LPLD have to restrictively control fat intaken and are still more likely to suffer recurrent acute pancreatitis and eruptive xanthomas. Although Glybera can effectively improve the health conditoin of patients with LPLD, it is still controversial to price the gene therapy at 1.1 million euros. This study assesses the relative costs and effectiveness of Glybera compared to no treatment for LPLD from a societal perspective. Methods: We developed a Markov model that tracked a cohort of patients through the three disease states of LPLD progression, defined by the symptoms of pancreatitis. We evaluated the effectiveness of the noval gene therapy based on published clinical trial data. We derived quality of life utility scores and costs data for each disease state from the published literature. We estimated the discounted costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Univariate sensitivity analyses were conducted to assess the impact of parameter uncertainty on our results. Results: The incremental cost-effective ratio (ICER) of Glybera was € 51,789/QALY gained when compared with no intervention. Correspondingly, the net monetary benefit (NMB) is € 667,478, given the willingnessto-pay (WTP) is € 114,875. One-way sensitivity analyses were performed to investigate the model robustness. The analyses illustrated that the model was robust to the majority transition probabilities and utility of each health state. ConClusions: Although the price is high, Glybera is a cost-effective treatment for lipoprotein lipase deficiency compared with no treatment based on available clinical data. This conclusion is robust to sensitivity analyses.
Background: The assessment of performance status according to the classical Karnofsky or ECOG scales has been shown to be an effective predictor of outcome in several oncological studies. However, its application to patients over 70 years of age has limited utility and may uderrepresent the degree of functional impairment). Comorbidity and functional status according to ECOG, ADL and IADL have shown to be independent in older cancer patients. However, some degree of correlation between comorbidity and IADL has been reported before. Geriatric assessment is a time-consuming task sometimes difficult to perform by oncologists out of clinical trials. The experience of a single institution about elderly lung cancer patients in an out patient setting will be presented. Methods: For geriatric assessment the following characteristics were considered: • Comorbidity by means of Charlson and Kaplan Feinstein scores • Activities of daily living (ADL) • Instrumental activities of daily living (IADL) • Nutritional status by means of proteins/albumin levels and/or BMI • Cognitive mental status is examined with the Mini-Mental state • Expression of depression with the Geriatric Depression Screening • Scale (GDSS) • Family/Institutional support.Results: By Febrery/2007 seventy elderly lung cancer patients (pts) have been analyzed in our institution. The main descriptive characteristics were: median age 76 years (70-84 ); stage disease, II in 5.7 %, III in 45.8 % and IV in 57.1 % of the pts; distribution of performance status (ECOG) was: PS 0/10 %, PS 1/50 % and PS 2/40 %; sex: M (84 %) and F (16 %). Serum albumin level was lesser than 3.5 g/dl in 28 % of the patients. Comorbidity according to Charlson and Kaplan scales was presented in 74.2 % and 82 % of pts respectively. Ability in 51-99 % of ADL and IADL was able in 25 % and 39.7% of pts and was < 50 % in 8.8 % and 22.1 % of pts. Mini-Mental state was applied to 33 patients, 40 % of them obtained a punctuation < 25. Treatment administered was: surgery in 1 pt, radiotherapy alone in 2 pts, chemo-radiotherapy in 11 pts, chemotherapy alone in 55 pts and tyrosine-kinase inhibitor in 1 pt. Conclusions: The analysis is ongoing but the heterogeneity of the pts in these preliminary results suggests the importance to carry out a detailed evaluation of elderly lung cancer patients for detecting several situations not detectable by means of a conventional examination. A more completed analysis of comorbid, clinical, nutritional and social conditions will be presented at the meeting. Correlation between different factors and the influence of them on the outcome of the elderly patients will be examined.
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