Cost-Effectiveness Analysis of Lenvatinib as a Treatment for Radioactive Iodine Refractory Differentiated Thyroid Cancer in the United States

Abstract

Objectives: The objective of this evaluation was to assess cost-effectiveness of pegfilgrastim compared to filgrastim when used as prophylaxis in subsequent chemotherapy cycles for patients who experience a neutropenic event (NE; absolute neutrophil count < 500/m3), consistent with Turkish regulatory indication. Pegfilgrastim was compared to filgrastim (5 days) for reducing incidence of FN events in patients receiving cytotoxic chemotherapy for solid tumors in Turkey. MethOds: An economic model was developed to assess cost-effectiveness of pegfilgrastim compared to filgrastim given for 5 days per cycle (short course based on Turkish clinical practice) in breast cancer patients receiving highly myelotoxic (≥ 20% FN risk) or moderately myelotoxic (10-20% FN risk) chemotherapy regimens. A Markov cycle tree was modeled comprising two components: a decision tree that tracks initial chemotherapy cycle and associated NE events, and a Markov model consisting of two phases. Phase 1 tracks FN events in subsequent chemotherapy cycles following an NE, while Phase 2 tracks long-term cancer-related survival. All analyses were performed from the payer perspective and included direct health care costs only. A lifetime time horizon was considered. Deterministic sensitivity analyses were conducted on key model parameters. Results: The average cost of treating an FN episode for a solid tumor was calculated as TRY8900[$4070] based upon consultation with Turkish clinicians. For highly myelotoxic regimens, switching to prophylaxis with pegfilgrastim after an NE was a dominant strategy (incremental cost: TRY-99 [$-45], incremental QALY: 0.03). ICER for medium myelotoxic regimens was TRY7920[$3622] (incremental cost: TRY55[$25], incremental QALY: 0.01); highly cost-effective based on WHO-recommended ICER threshold (GDP per capita = TRY22718[$10390]). Cost-effectiveness results were robust to deterministic changes in key model parameters (e.g. risk of FN in subsequent cycles, cost of FN). cOnclusiOns: Prophylaxis with pegfilgrastim for reducing incidence of FN after a first NE is either dominant or cost-effective compared to filgrastim (5 days).Objectives: Considering the increasing number of treatment options for metastatic breast cancer (MBC), it is important to develop high-quality methods to assess the cost-effectiveness of new anticancer drugs. This study aims to develop a global economic model that could be used as a benchmark for the economic evaluation of new therapies for MBC. MethOds: The Global Pharmacoeconomics of Metastatic Breast Cancer (GPMBC) model is a Markov model that was constructed to estimate the incremental cost per quality-adjusted life years (QALY) of new treatments for MBC from a Canadian healthcare system perspective over a lifetime horizon. Specific parameters included in the model are cost of drug acquisition, survival outcomes, and incidence of treatment-related adverse events (AEs) whereas global parameters are patient characteristics, health states utilities, disutilities and costs associated with treatmen...

Lenvatinib and sorafenib for differentiated thyroid cancer after radioactive iodine: a systematic review and economic evaluation

“…The searches for economic evidence identified 19 citations in total: 14 were obtained from the database searches and five were identified from other sources. Once duplicates were removed, 18 publications remained and, after assessment of the titles and abstracts, 10 publications 5,38,48,[158][159][160][161][162][163][164] were retrieved and a detailed assessment of their eligibility was undertaken.…”

“…Nine of these 10 publications were included in the review. The AG included four publications [158][159][160]163 that clearly met the inclusion criteria. The AG considered that the economic evidence for lenvatinib and sorafenib that had been submitted to the SMC 38,48 and CADTH 5,162 was also relevant to this review and so these four records, 5,38,48,162 one for each drug's individual submission to each regulatory agency, were included in the review.…”

“…A summary of the characteristics of the nine included publications 5,38,48,[158][159][160][161][162][163] is presented in Table 13.…”

“…Only the Wilson et al 161 publication was available as a full-text paper published in a peer-reviewed journal. Three of the included publications 158,159,163 were available only as abstracts, and one publication 160 was available as a poster. The submissions to the regulatory bodies in Scotland 38,48 and Canada 5,162 were available only as summary reports.…”

Health Utility Book (HUB)–Cancer: Protocol for a Systematic Literature Review of Health State Utility Values in Cancer

“…Additionally, 21 economic evaluations were identified. 55–75 No systematic literature reviews related to health utilities for thyroid cancer were identified. The screening process is summarized in Figure 1.…”