Análisis del impacto presupuestario de denosumab para la prevención de eventos relacionados con el esqueleto en adultos con metástasis óseas de tumores sólidos en España

Seguí, Miguel Àngel; Durán, Ignacio; Roldán, Celia; Oyagüez, Itziar; gutierrez, L.A.; Gasquet, J. A.; Isla, Dolores

doi:10.1007/s40277-014-0039-6

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“…Foram localizados dois estudos de AIO que investigaram a introdução do denosumabe na prevenção de ERE. Um deles foi realizado considerando o cenário da Espanha (110) e o outro, da Áustria, da Suécia e da Suíça (111) . (110) .…”

Section: Análises De Impacto Orçamentáriounclassified

“…Neste cenário, foi considerado o uso dos três medicamentos: pacientes com câncer de mama ou pulmão e de próstata com boa resposta a bisfosfonatos As diferenças nos custos dos medicamentos analisados neste estudo, foram também identificadas por outros autores. Em países como Suécia, Áustria, Suíça e Espanha, os custos do denosumabe e do ácido zoledrônico foram semelhantes (110)(111) . Tais diferenças proporcionais podem estar relacionadas às taxas de importação de medicamentos como denosumabe; na política de mercado dos produtos, cujos lucros podem ser bastante variados; ou em formas de obtenção de medicamentos por meio da negociação de preços com a empresa fabricante.…”

Section: Cenário 5 (C5)unclassified

“…Nestes países, os custos dos medicamentos e de sua administração tornou os custos totais do tratamento semelhantes e, cuja eficácia superior do denosumabe em prevenir ERE contribuiu para o resultado. Entretanto, adotou-se um horizonte inferior ao do presente estudo (110,111) .…”

Section: Cenário 5 (C5)unclassified

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Análise econômica do denosumabe e dos bisfosfonatos no tratamento de pacientes com metástase óssea

Matuoka¹

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Introduction: Bone metastases are prevalent among patients with advanced cancer and may result in significant decrease in quality of life. Its treatment consists of pain alleviation and prevention of Skeletal Related Events (SRE), highly debilitating complications with multidimensional impact. Bisphosphonates and denosumab are the treatment of choice to prevent SRE. Both are high cost medications of chronic use, which requires cost effectiveness analyses to support decision making in resource allocation. Objectives: To conduct an economic analysis of bone-targeted agents for the treatment of bone metastases secondary to solid tumors. Methods: A Health Technology Assessment (HTA) with Cost-Effectiveness Analysis (CEA) and Budget Impact Analysis (BIA) was performed from the Brazilian Unified Healthcare System, over a 2-year time horizon. Data were collected from different sources and included national databases for different categories of costs, and scientific articles for effectiveness, measured by the proportion of SRE-free patients. The CEA was based on two Markov models: For patients with breast cancer, in which the treatment was based on denosumab, zoledronic acid or pamidronate; and for Other Solid Tumors (OST), based on the use of denosumab and zoledronic acid. In these models, four health states (with/without SRE, new SRE, and death), and their transition probabilities were considered. Results were expressed by means of Incremental Cost-Effectiveness Ratios (ICER), and the uncertainties were tested in deterministic and probabilistic sensitivity analyses. A BIA in five years was conducted considering different scenarios. Results: In the Markov model for breast cancer, pamidronate was the cost-effective strategy. In the zoledronic acid/pamidronate and denosumab/pamidronate comparisons, ICERs of R$ 5,935.70 and R$ 17,929.09 per SRE avoided were observed. In the OST model, zoledronic acid was the cost-effective strategy, and the ICER of denosumab compared with zoledronic acid was R$ 26,061.44 per SRE avoided. Sensitivity analysis confirmed the robustness of the model, as results remained unchanged. In the BIA, regardless of tumor type, the least costly scenario in five years was the one in which all patients received zoledronic acid. Conclusion:Considering the Brazilian healthcare setting, the CEA showed that pamidronate for breast cancer and zoledronic acid for OST were the cost-effective strategies.Denosumab coverage would result in substantial increase in treatment costs.However, in the decision-making process, factors beyond effectiveness, safety and costs should be considered, for example, acceptability, patients values and preferences, feasibility and equity.

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Section: Análises De Impacto Orçamentáriounclassified

Section: Cenário 5 (C5)unclassified

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Análise econômica do denosumabe e dos bisfosfonatos no tratamento de pacientes com metástase óssea

Matuoka¹

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Análisis del impacto presupuestario de denosumab para la prevención de eventos relacionados con el esqueleto en adultos con metástasis óseas de tumores sólidos en España

Cited by 1 publication

References 20 publications

Análise econômica do denosumabe e dos bisfosfonatos no tratamento de pacientes com metástase óssea

Análise econômica do denosumabe e dos bisfosfonatos no tratamento de pacientes com metástase óssea

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