Commentary: Chronic Lymphocytic Leukemia—The Price of Progress

Shanafelt, Tait D.; Gunderson, Heidi D; Call, Timothy G.

doi:10.1634/theoncologist.2010-0090

Cited by 9 publications

(7 citation statements)

References 6 publications

(1 reference statement)

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“…In this regard, the physician charge for a second opinion by a disease expert is a relatively low cost intervention($$600), roughly 1% of the average wholesale price of 6 cycles of first-line CLL therapy. 43 When a disease-specific expert is not available, patients should be managed according to published treatment guidelines developed by expert panels.…”

Section: Discussionmentioning

confidence: 99%

Hematologist/oncologist disease‐specific expertise and survival: Lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)

Shanafelt

Kay

Rabe

et al. 2011

Cancer

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Background The impact of physicians’ disease-specific expertise on patient outcome is unknown. While previous studies suggest a survival advantage for cancer patients cared for at high volume centers, these observations may simply reflect referral bias or better access to advanced technologies, clinical trials, and multidisciplinary support at large centers. Methods We evaluated time to first treatment(TTFT) and overall survival(OS) of patients with newly diagnosed chronic lymphocytic leukemia/small lymphocytic lymphoma(CLL) at a single academic center based on whether they were cared for by a hematologist/oncologist who sub-specializes in CLL(CLL hematologist) or a hematologist/oncologist with expertise in other areas(non-CLL hematologist). Results Among 1309 newly diagnosed patients with CLL cared for between 1999–2009, 773(59%) were cared for by CLL hematologists and 536 were cared for by non-CLL hematologists. Among early stage patients(Rai 0-I), median TTFT(9.2 vs. 6.1 years; p<0.001) and OS(10.5 years vs. 8.8 years; p<0.001) were superior for patients cared for by CLL hematologists. For all patients, OS was superior for patients cared for by CLL hematologists(10.5 years vs. 8.4 years; p=0.001). Physician’s disease-specific expertise remained an independent predictor of OS after adjusting for age, stage, sex, and lymphocyte count. Patients seen by a CLL hematologist were also more likely participate in clinical trials(48% vs. 16%; p<0.001). Conclusion Physician disease-specific expertise appears to influence outcome in patients with CLL. To the greatest extent possible, patients should be cared for by a hematologist/oncologist expert in the care of their specific malignancy. When not possible, practice guidelines developed by disease-specific experts should be followed.

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Section: Discussionmentioning

confidence: 99%

Hematologist/oncologist disease‐specific expertise and survival: Lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)

Shanafelt

Kay

Rabe

et al. 2011

Cancer

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“…GNP alone has shown some response with induction of apoptosis in some of these CLL cells. Phase II clinical studies conducted on 46 CLL patients concluded that while anti-VEGF therapy, including avastin, remains a viable therapy for CLL, using a single agent anti-VEGF monotherapy had limited activity in CLL patients, and combination therapy is a more feasible approach particularly for patients with relapsed/refractory CLL ( 61 ). The combination of monoclonal antibodies, such as anti-CD20 or rituximab, with other types of chemotherapy is another promising approach for treatment in CLL ( 62 ).…”

Section: Nanotechnology Applications In Different Types Of Leukemimentioning

confidence: 99%

Nanotechnology applications in hematological malignancies (Review)

et al. 2015

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A major limitation to current cancer therapies is the development of therapy-related side-effects and dose limiting complications. Moreover, a better understanding of the biology of cancer cells and the mechanisms of resistance to therapy is rapidly developing. The translation of advanced knowledge and discoveries achieved at the molecular level must be supported by advanced diagnostic, therapeutic and delivery technologies to translate these discoveries into useful tools that are essential in achieving progress in the war against cancer. Nanotechnology can play an essential role in this aspect providing a transforming technology that can translate the basic and clinical findings into novel diagnostic, therapeutic and preventive tools useful in different types of cancer. Hematological malignancies represent a specific class of cancer, which attracts special attention in the applications of nanotechnology for cancer diagnosis and treatment. The aim of the present review is to elucidate the emerging applications of nanotechnology in cancer management and describe the potentials of nanotechnology in changing the key fundamental aspects of hematological malignancy diagnosis, treatment and follow-up.

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“…Because most patients with CLL are not diagnosed or treated until they are over the age of 65 years,1 the cost of these therapies in the US are likely to be paid for by Medicare 10. In the Medicare patient population, diagnosis of CLL between 1998 and 2002 was associated with significantly increased costs of approximately $33,000 per year versus Medicare patients without a cancer diagnosis 11.…”

Section: Introductionmentioning

confidence: 99%

Economic implications of using bendamustine, alemtuzumab, or chlorambucil as a first-line therapy for chronic lymphocytic leukemia in the US: a cost-effectiveness analysis

Kongnakorn¹,

Sterchele²,

Salvador³

et al. 2014

CEOR

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BackgroundThe objective of this analysis was to evaluate the cost-effectiveness of using bendamustine versus alemtuzumab or bendamustine versus chlorambucil as a first-line therapy in patients with Binet stage B or C chronic lymphocytic leukemia (CLL) in the US.MethodsA discrete event simulation of the disease course of CLL was developed to evaluate the economic implications of single-agent treatment with bendamustine, alemtuzumab, or chlorambucil, which are indicated for a treatment-naïve patient population with Binet stage B or C CLL. Data from clinical trials were used to create a simulated patient population, risk equations for progression-free survival and survival post disease progression, response rates, and rates of adverse events. Costs from a US health care payer perspective in 2012 US dollars, survival (life years), and quality-adjusted life years (QALYs) were estimated over a patient’s lifetime; all were discounted at 3% per year.ResultsCompared with alemtuzumab, bendamustine was considered to be a dominant treatment providing greater benefit (6.10 versus 5.37 life years and 4.02 versus 3.45 QALYs) at lower cost ($78,776 versus $121,441). Compared with chlorambucil, bendamustine was associated with higher costs ($78,776 versus $42,337) but with improved health outcomes (6.10 versus 5.21 life years and 4.02 versus 3.30 QALYs), resulting in incremental cost-effectiveness ratios of $40,971 per life year gained and $50,619 per QALY gained.ConclusionBendamustine is expected to provide cost savings and greater health benefit than alemtuzumab in treatment-naïve patients with CLL. Furthermore, it can be considered as a cost-effective treatment providing health benefits at an acceptable cost versus chlorambucil in the US.

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Commentary: Chronic Lymphocytic Leukemia—The Price of Progress

Abstract: The study looks at the high cost of new treatments for chronic lymphocytic leukemia and calls for the consideration of a standardized and transparent method to determine the price of new drugs based on comparative effectiveness.

Cited by 9 publications

References 6 publications

Hematologist/oncologist disease‐specific expertise and survival: Lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)

Hematologist/oncologist disease‐specific expertise and survival: Lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)

Nanotechnology applications in hematological malignancies (Review)

Economic implications of using bendamustine, alemtuzumab, or chlorambucil as a first-line therapy for chronic lymphocytic leukemia in the US: a cost-effectiveness analysis

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