Some important methodological aspects for REA are approached in a similar way in many jurisdictions, indicating that collaboration on assessments may be feasible. Enhanced collaboration in the development of methods and best practices for REA between jurisdictions will be a necessary first step. Important topics for developing best practice are indirect comparisons and how to handle the gap between efficacy and effectiveness data in case good quality comparative effectiveness data are not yet available at the time of reimbursement decisions.
s213 time-dependent covariate to account for immortal time bias, the corresponding crude and adjusted HR increased to 1.665 (95%CI 1.459-1.901) and 1.683 (95%CI 1.407-2.014). Applying a causal (counterfactual) analysis using IPCW and replication yielded a HR of 1.067 (95%CI 1.020-1.115), which matched the results of a published randomized clinical trial. ConClusions: When using routine RWE data, DAGs can guide the identification of potential biases and variables that need to be controlled for. In our analysis, potential biases were substantial with different directions. Only the application of the target trial and replication approach in combination with a causal analysis matched data from clinical trials.
A473 among advanced ovarian cancer (OC) patients from two large US healthcare claims databases. Methods: The MarketScan Commercial Claims & Medicare (CCMC) and Surveillance, Epidemiology, and End Results-Medicare (SEER-M) databases were used to identify females aged ≥ 18 years diagnosed with advanced OC (including EOC, fallopian tube [FTC] and primary peritoneal cancer [PPC]) and receiving first-line treatment (i.e. the first claim for any chemotherapy within 90 days post-OC diagnosis) between 1/1/2010 and 12/31/2015. Patients were followed from their initial diagnosis of OC (i.e. index date) until death, loss-to-follow-up or end-of-study period to assess and compare their clinical characteristics and treatment patterns. Results: A total of 7,825 advanced OC patients were identified (N= 6,170 in CCMC, N= 1,655 in SEER-M). Majority of patients were diagnosed with EOC (CCMC: 89%, SEER-M: 80%), and the mean age (SD) at diagnosis was 59 (11) and 75 (6) years, respectively. The median follow-up time was 1.4 and 2.3 years, respectively. Staging information was only available for the SEER-M cohort; 65% of patients were diagnosed with stage III or IV disease. The mean (SD) time from index to initiation of first-line treatment was 35 (20) days in the CCMC cohort and 51 (19) days in the SEER-M cohort. Advanced OC patients most frequently received platinum-/taxane-based regimens, with carboplatin/paclitaxel used in 63% and 67% of patients, respectively. Bevacizumabcontaining regimens were utilized in 7% of CCMC OC patients and 5% of SEER-M OC patients, with bevacizumab/carboplatin/paclitaxel combination being the most common. ConClusions: Results: suggest that platinum-containing chemotherapy remains the standard-of-care for advanced OC patients in the US. Despite differences in age between the two OC cohorts, similar treatment patterns were observed.
The study was a retrospective analysis of DataSUS, a Brazilian Public Health System medical claims database. Patients were tracked by the ICD between July 2011 and June 2016. The disease costs were segmented between diagnostic and treatment costs, for each disease status, according to SUS list of procedures. The total costs of HCC were calculated by multiplying the mean annual frequency per patient of each performed procedure at each stage of the disease by its cost and added to the cost of the diagnostic procedures performed in the respective year. The costs were also projected for the next 5 years. Costs expressed in 2016 prices, exchange rate 1.00 USD = 3.19 BRL. ReSultS: 28,822 patients were identified. 11% of the sample was on initial stage, 13% on intermediate, 9% on advanced and 67% were already diagnosed on terminal stages, receiving only palliative care. In 2016, the costs for treating HCC were USD 7.6 million for 9,028 patients, reaching USD 8.7 million for 10,042 patients in 2021. The stage with the greatest economic impact was the intermediate, with average annual costs estimated at USD 3.04 million, followed by the advanced stage, with an average annual cost of USD 2.33 million. Regarding the economic impact per patient, the advanced stage had the higher costs (USD 2,821). cOncluSiOnS: More than 75% of the patients are already diagnosed in late stages, where there are no more curative treatment options, and 67% are already diagnosed in the terminal stage of the disease. Thus, the development of screening strategies for patients with hepatopathies and early diagnosis are essential to increase the number of patients diagnosed under curative conditions, where there may be optimization of health resources.
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