A641and capecitabine monotherapy in terms of incidence of diarrhea, vomiting, stomatitis/mucositis. The hand-foot syndrome occurrred in less than 5% in case of tegafur. Tegafur (in monotherapy or in combination with calcium folinate) is less costly than capecitabine. The difference in costs in favor of tegafur monotherapy amounted to € 1,956.97 per 1 patient per 6 months or € 3,778.53 per year; of tegafur + calcium folinate -€ 2,168.12 and € 4,220.06 per 1 patient per 6 and 12 months, respectively. ConClusions: Tegafur is a cost-saving option compared with capecitabine with similar efficacy and safety.objeCtives: There is new RCT phase 3 clinical evidence that bendamustinrituximab (B-R) is more effective in terms of progression free survival compared to the standard of care CHOP-rituximab (CHOP-R) in indolent non-Hodgkin lymphoma (iNHL). Based on this RCT, we performed a cost-utility analysis of B-R compared to CHOP-R in the treatment of follicular iNHL (stage III and IV) in the Czech Republic. Methods: We developed a life-time Markov cohort model with 28-day cycle length and 5 health states, i.e. on treatment, rituximab maintenance (R-M), stable disease, progression and death. Additionally, we modeled adverse effects of treatment and four sub-states during progression (observation, imunochemotherapy, R-M, post R-M). Transition probabilities and utilities were derived from published literature. Resource use (costs) was calculated from health care payer's perspective in cooperation with major Czech hemato-oncologic experts. Costs and outcomes were discounted by 3.5%. Probabilistic sensitivity analysis (PSA) with 1000 iterations using a willingness to pay (WTP) threshold equal to 3 times GDP per capita (40 100 EUR) in the Czech Republic was performed. Results: Over a life-time horizon, B-R compared to CHOP-R brings additional 1.21 QALY (7.47 vs. 6.26) and 1.31 LYG (9.74 vs. 8.43). The incremental total costs were 1,368 EUR (total life time costs for B-R and CHOP-R were 43,080 EUR and 41,712 EUR, respectively). ICERs thus equal to 1,133 EUR/QALY and 1,044 EUR/LYG. The results of the PSA show that B-R is costeffective in 100% iterations under the WTP threshold; and simultaneously in 99.3% iterations is cost-effective while using threshold equal to 7,300 EUR. ConClusions: B-R proved that it is a highly cost-effective therapy in patients with follicular iNHL. The higher costs of initial bendamustin treatment are in the long-term horizon offset by substantial savings of progression costs. There is 100% probability of B-R being cost-effective at the selected WTP threshold.
BackgroundMerkel cell carcinoma (MCC) is a very infrequent and aggressive skin tumor with high recurrence and metastasis rates. MCC treatment is currently not well defined.Case presentationWe present the case of a 75-year-old woman who was diagnosed with MCC in 2010 and suffered a third relapse in 2012 which could not be treated surgically.ResultsThe patient began oral etoposide treatment reaching complete response after eight cycles and receiving a total of 11 cycles. As side effects, the patient suffered from neutropenia, candidiasis and mucositis, but after reducing the dosage to 50% it was well tolerated.DiscussionChemotherapy treatment in this setting is poorly defined. In this case, monotherapy treatment with oral etoposide was decided due to the patient’s age and comorbidities, achieving a very positive outcome.
Medline, PubMed, and EMBASE to identify full economic evaluations that compared different treatment strategies in postmenopausal women with primary breast cancer. Quality and modelling methodologies of included studies were assessed and summarised. Results: All the 31 included studies assessed surgery and none assessed PET as the initial treatment. Most included economic studies used a Markov model with life-time horizon and 1-year cycle length. Nine studies which included sub-group analysis for older women (over 65 years old) used similar economic models and transition states with younger women (50 to 65 years old). The key disease-related health states were disease-free, recurrence, and death. Recurrence was mostly separated into loco-regional and distant recurrence. ConClusions: This systematic review can inform the design of an economic model comparing PET with surgery as initial treatment in older women based on the following assumptions: (1) health states are applicable across age groups; (2) transition states for modelling surgery in the literature are transferable to model the same treatment for older women; (3) metastasis transition states including progression, progression-free, and death can be used to model the PET pathway. Future study will validate this model by using a longitudinal dataset of older women with primary breast cancer, and synthesize data from different data sources to populate this economic model. PCN138Cost EffECtivENEss of CEtuximab iN 1st-LiNE trEatmENt of ras WiLd-tyPE mEtastatiC CoLorECtaL CaNCEr iN sCotLaNd: a summary of thE submissioN to thE sCottish mEdiCiNEs CoNsortium
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