Clinical and Economic Burden Associated with Anastomotic Leak After Colorectal Surgeries in the United Kingdom

Abstract

Objectives: Personalized medicine has become standard of care in directing treatment with tyrosine kinase inhibitors in locally advanced or metastatic NSCLC patients, but various testing methods for identifying EGFR mutations exist. We compared the clinical outcomes and budget impact of using the FDA-approved cobas ® EGFR Mutation Test versus Sanger sequencing for identifying EGFR mutations in locally advanced or metastatic NSCLC patients from a US payer perspective. MethOds: A decision-tree model was developed to compare testing methodologies and resulting treatment pathways in a hypothetical NSCLC US population health plan with 5 million covered lives and a baseline EGFR mutation prevalence of 16.6%. Model inputs included parameters describing mutation testing accuracy treatment response (EGFR inhibitor, standard chemo therapy or best supportive care). Inputs were based on published literature and Medicare fee schedule reimbursement. Outcomes of the model included patients with test failures (based on detection limits of testing), average patient survival time and budget impact. Results: Patients whose samples were tested with the cobas® EGFR Mutation Test were less likely to experience test failures due to unusable tissue samples compared to Sanger sequencing (6 test failures versus 57, respectively). Patients using the cobas® EGFR mutations testing received more appropriate care compared to Sanger sequencing (90% vs 82%, respectively), resulting in an average total survival increase of 0.6 months. Costs associated with diagnostic testing were $24,562 less than testing with Sanger sequencing, resulting in similar overall costs per member per month ($0.56). cOnclusiOns: Performing EGFR mutation testing with the cobas® EGFR Mutation Test has advantages from both patient outcomes and payer budget impact perspectives. By correctly identifying more patients for proper treatment with less test failures, the cobas® EGFR Mutation Test is a costeffective strategy for identification of EGFR mutations in locally advanced or metastatic NSCLC patients from a US payer perspective.Objectives: Approximately 7,000 Canadians have multiple myeloma (MM). Without effective treatment, patients can suffer from a constellation of disease-related symptoms that significantly reduce quality of life and survival. Management of stem cell transplant (SCT) ineligible MM patients is complex and varied. Maintenance therapies (MTs) after various induction regimens have been shown to improve response rate and progression-free survival. We sought to compare Canadian costs between two common approaches to MT, either bortezomib or lenalidomide, in MM patients ineligible for SCT. MethOds: The total annual drug cost of the two MT options were calculated and compared. Costs were based on 1.3mg/m 2 of bortezomib on days 1, 4, 8, 11 every three months, plus 50 mg of prednisone every other day, or 10 mg of lenalidomide on days 1 through 21 of each 28-day cycle. Administration costs including oncology nursing time and pharmacist workload, and pharmacy co...

Primary Medical Effects and Economic Impact of Anastomotic Leakage in Patients with Colorectal Cancer. A Middle-Income Country Perspective

“…Therefore, a survey of their primary medical effects and financial consequences represents an important guide for health professionals. [1][2][3][4][5]…”