ObjectiveS: According to World Bank, the Slovak Republic is an upper middle income country with a Gross National Income (GNI) per capita of US $3,950. The objective of this study was to calculate the total costs associated with MM. Subsequently, to evaluate the extent to which it is possible to obtain correct and reliable data from publicly available sources and compare cost data distribution with published MM studies from high income countries (e.g. US, EU). MethOdS: It was the retrospective analysis, conducted by using available electronic databases and direct data requests to state authorities. The "bottom-up" approach was performed that helped identify, quantify and value resources in a disaggregated way, so that each element of the costs was estimated individually and they were summed up at the end. Total costs were calculated for a model patient with MM during the first 12 months after confirmed diagnosis. ReSultS: The analysis showed that direct health care costs created 34% (€ 69 633) of total costs (€ 203 178) compare to 40% published by Ramon et al (2013) in EU. The indirect costs associated with cancer were the biggest part of the total costs (66%; € 133 534.60 for MM in Slovakia) in line with results by Ramon et al (2013). According to Fonseca et al (2017) MM treatment-related drug costs accounted for 28.5% in 2014 of total costs, which was similar to our analysis (21%, € 41 743) of total costs (€ 203 178). cOncluSiOnS: We found comparable distribution in costs for MM, considering methodology limitations across jurisdictions. Our study confirmed high difficulty in obtaining reliable cost data and results should be interpreted with caution. However, the study gives important feedback on cost data quality and availability in Slovakia, which have irreplaceable role in decision making process in healthcare.
Objectives: There is limited understanding of the resource utilization associated with AML pre and post midostaurin approval. The study objectives were to evaluate healthcare resource utilization between FLT3-mutated AML patients and FLT3wildtype AML patients, pre-midostaurin approval and among FLT3-mutated AML patients post-midostaurin approval. Methods: Retrospective medical charts from the Huntsman Cancer Institute (HCI) identified AML patients treated with 7+3 induction chemotherapy from 2007 to July 2018. FLT3-mutated patients (FLT3m) were treated with chemotherapy and midostaurin (mido) from May 2017 to December 2018. Historical FLT3m patients and FLT3-wildtype (FLT3-wt) patients, prior to midostaurin approval, comprise FLT3m pre-mido and FLT3-wt groups, respectively. Health resource utilization including number of inpatient, outpatient, emergency visits and length of stay were determined. Results: FLT3m mido, FLT3m pre-mido and FLT3-wt groups included 7, 39 and 61 patients respectively. Overall AML-related median inpatient and outpatient visits for FLT3m mido was 9 and 50 respectively. Overall median inpatient and outpatient visits for FLT3m pre-mido and FLT3-wt were not significantly different with 5 and 6 visits (p=0.1); 47 and 51 visits (p=0.4), respectively. Compared to FLT3-wt patients, consolidation therapy for FLT3m premido patients was shorter (78 vs 33 days, p=0.0015) and consisted of fewer cycles (3 vs 2 cycles, p=0.0009) respectively. As a result, during consolidation therapy, FLT3m pre-mido patients had significantly fewer overall hospital visits (4 vs 14 visits, p=0.0006). There were no significant differences in utilization between FLT3m premido and FLT3-wt groups during other treatment settings. FLT3m pre-mido patients also underwent transplant earlier than FLT3-wt patients after diagnosis (125 vs 186 days, p=0.0028). Conclusions: FLT3m pre-mido patients had fewer consolidation cycles and underwent transplant earlier than FLT3-wt patients. Utilization was significantly lower for FLT3m-pre-mido patients compared to FLT3-wt patients during consolidation regimen despite similar overall utilization.
Objectives: This study aimed to evaluate the long-term economic benefits of Alectinib versus Crizotinib in first-line treatment for anaplastic lymphoma kinase-positive (ALK+) advanced non-small cell lung cancer (NSCLC) from a China societal perspective. Methods: A Markov model was developed using partition survival methods and three health states: progression-free survival (PFS), post-progression survival (PPS), and death. Survival data were derived from ALEX trial, and parametric survival functions were selected for extrapolation based on the goodness of fit and clinical key opinion leaders (KOL) interview. Cost inputs for drugs (considering patient assistance programs), adverse events management, supportive care, and productivity loss were estimated from literature, public available price references, and KOL interview. Utility values were obtained from trial data and literature. Univariate and probabilistic sensitivity analyses were performed. Results: In a 30-year lifetime horizon, Alectinib was associated with 2.96QALYs, while Crizotinib was associated with 2.08QALYs. In comparison with Crizotinib, Alectinib had better health outcome (+0.88QALY) and marginal cost increase, yielding an ICER of 169,848CNY/QALY which is lower than the willingness-to-pay threshold of triple GDP per capita in China in 2017 (178,980CNY). Cost during PPS were considerably lower with Alectinib (-57%). Since central nervous system (CNS) metastasis incurred additional costs on treatments and productivity loss, CNS-related costs were also lower with Alectinib (-26%), saving 20% direct costs and 27% indirect costs. The CNS-related costs saving with Alectinib were even larger when taking a 24-months horizon (-39% direct costs and -46% indirect costs). Drug costs and PFS state utility were the main drivers. Conclusions: Alectinib significantly improved PFS and provided considerable incremental QALYs. Meanwhile, this drug also saved PPS and CNS-related costs, with its marginal cost increase being reflective of longer treatment duration in the PFS state. From a China societal perspective, Alectinib may be considered as a cost-effective therapy for the first-line treatment of ALK+ NSCLC patients.
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