An Attempt to Quantitate “Value” In Medical Oncologic Therapy

Abstract

ObjectiveWe wanted to examine the incremental cost-effective ratio (ICER) for a variety of Food and Drug Administration (FDA) approved oncology drugs in the adjuvant or curative setting to determine the value provided.DesignWe examined the annualized incremental drug costs of a variety of FDA approved chemotherapeutic drugs used in an adjuvant or curative setting based on National Comprehensive Cancer Network (NCCN) category 1 practice guidelines for melanoma, Her2/neu over-expressive breast cancer, renal cell carcinoma, stage IIIA non-small cell lung cancer, myeloma, B cell lymphoma, and Hodgkin lymphoma. The studies we examined were randomized clinical trials on which the NCCN guidelines are based; we solely examined the incremental cost-effectiveness of the trial drug as we assumed that the costs of the health care provided were equivalent between the two treatment arms. We used a formula to determine the incremental cost-effectiveness ratio (ICER). The ICER compares a new intervention (C new) with its alternate (C alt) divided by the quality-adjusted life-years (QALY) that results from the new intervention (QALY new) versus the alternate (QALY alt) and is expressed as ICER = (C new-C alt)/(QALY new-QALY alt). The QALY’s were derived from what was reported in the study and based on the incremental disease-free survival.ResultsDrugs such as rituximab provide high value in the curative therapy for lymphoma. Drugs such as adjuvant dabrafenib and trametinib provide intermediate value in the treatment of melanoma, and similarly with maintenance lenalidomide in myeloma and adjuvant trastuzumab in breast cancer. Oncologic drugs that provide low value include adjuvant ipilimumab in melanoma, adjuvant sunitinib in renal cell carcinoma, adjuvant neratinib in breast cancer, adjuvant durvalumab in lung cancer, and brentuximab in the curative therapy for Hodgkin’s lymphoma.ConclusionThe ICER needs to be evaluated for newly approved FDA oncology chemotherapeutic drugs before incorporating them into routine clinical practice.

Cost‐effectiveness analysis of the new oncological drug durvalumab in Italian patients with stage III non‐small cell lung cancer

“…The cost-effectiveness of durvalumab has been investigated in two studies in the U.S., 12,13 as well as in other studies in Europe. [14][15][16] The aim of the present study was to analyze the potential cost-effectiveness of durvalumab consolidation therapy versus active follow-up (standard of care) after induction chemoradiotherapy for patients with unresectable stage III NSCLC and PD-L1 expression ≥1%.…”

“…The cost‐effectiveness of durvalumab has been investigated in two studies in the U.S., 12 , 13 as well as in other studies in Europe. 14 , 15 , 16 …”

Cost-effectiveness of consolidation durvalumab after chemo-radiotherapy in stage III non-small-cell lung cancer: A cost-effective change

“…Undoubtedly the introduction of durvalumab is to be considered as a practical change as consolidation treatment in patients responding to chemo-radiotherapy in inoperable stage III NSCLC, 3 but data concerning the cost-effectiveness of durvalumab in this setting are conflicting. Recently, Hancock et al 14 have examined the annualized incremental drug costs of a variety of Food and Drug Administration (FDA) approved chemotherapeutic drugs and among them, durvalumab was considered with a low value of ICER. On the contrary, different studies, 2,15–17 considered durvalumab in consolidation therapy as a cost-effective treatment, in the more general concept so treating earlier in the course of cancer progression can provide significant value with budgetary consequence.…”