Cost-Effectiveness Model for Chemoimmunotherapy Options in Patients with Previously Untreated Chronic Lymphocytic Leukemia Unsuitable for Full-Dose Fludarabine-Based Therapy

Becker, Ursula; Briggs, Andrew; Moreno, Santiago; Ray, Joshua; Ngo, Phuong; Samanta, Kunal

doi:10.1016/j.jval.2015.12.018

Cited by 16 publications

(7 citation statements)

References 27 publications

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“…We identified eight studies where the progression-free state was separated into two different health states [ 9 , 21 , 32 – 37 ]. In one state, patients were under treatment without progression, while in the other state, patients were not treated and had no progression.…”

Section: Resultsmentioning

confidence: 99%

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Systematic Literature Review of Economic Evaluations of Treatment Alternatives in Chronic Lymphocytic Leukemia

Lorenzovici

Szilberhorn²,

Farkas-Ráduly³

et al. 2023

BioDrugs

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Background Economic evaluations are widely used to predict the economic impact of new treatment alternatives. Comprehensive economic reviews in the field of chronic lymphocytic leukemia (CLL) are warranted to supplement the existing analyses focused on specific therapeutic areas. Methods A systematic literature review was conducted based on literature searches in Medline and EMBASE to summarize the published health economics models related to all types of CLL therapies. Narrative synthesis of relevant studies was performed focusing on compared treatments, patient populations, modelling approaches and key findings. Results We included 29 studies, the majority of which were published between 2016 and 2018, when data from large clinical trials in CLL became available. Treatment regimens were compared in 25 cases, while the remaining four studies considered treatment strategies with more complex patient pathways. Based on the review results, Markov modelling with a simple structure of three health states (progression-free, progressed, death) can be considered as the traditional basis to simulate cost effectiveness. However, more recent studies added further complexity, including additional health states for different therapies (e.g. best supportive care or stem cell transplantation), for progression-free state (e.g. by differentiating between with or without treatment), or for response status (i.e. partial response and complete response). Conclusions As personalized medicine is increasingly gaining recognition, we expect that future economic evaluations will also incorporate new solutions, which are necessary to capture a larger number of genetic and molecular markers and more complex patient pathways with individual patient-level allocation of treatment options and thus economic assessments. Supplementary Information The online version contains supplementary material available at 10.1007/s40259-023-00583-9.

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Section: Resultsmentioning

confidence: 99%

“…We identified five studies that investigated first-line CLL patients who were not eligible for fludarabine-based therapy and received chlorambucil-based CIT regimens or chlorambucil alone [ 32 – 35 , 37 ]. All the studies were conducted in Europe and used data from the CLL11 trial.…”

Section: Resultsmentioning

confidence: 99%

Systematic Literature Review of Economic Evaluations of Treatment Alternatives in Chronic Lymphocytic Leukemia

Lorenzovici

Szilberhorn²,

Farkas-Ráduly³

et al. 2023

BioDrugs

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“…Based on the available evidence, obinutuzumab appears to offer an advantage over rituximab when combined with chlorambucil in patients with untreated CLL and co‐morbidities that are unsuitable for fludarabine‐based therapy. It has been approved and found to be cost‐effective when compared to R‐CLB in a number of countries (Becker et al , ; Blommestein et al , ; Casado et al , ; Paquete et al , ; Sinha & Redekop, ). Competition will shortly arise from ibrutinib monotherapy in this same patient population, however this agent remains too costly for many payers for use in the upfront setting (Sinha & Redekop, ).…”

Section: Discussionmentioning

confidence: 99%

A tale of two antibodies: obinutuzumab versus rituximab

2018

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While rituximab has dramatically improved outcomes for patients with CD20 malignancies for two decades, responses are not universal and resistance can develop. Obinutuzumab was developed to potentiate activity and overcome resistance. Pre-clinical data suggests obinutuzumab is superior to rituximab at effecting B cell depletion; however recent phase III clinical trial results have been mixed. The decision of which antibody to employ will probably be further complicated by the approval of a subcutaneous preparation of rituximab and several anti-CD20 biosimilars. Clinicians are now challenged with deciding whether to switch to obinutuzumab in approved settings, accepting the potential for increased toxicity and probable increased cost. The benefit conferred by obinutuzumab over rituximab may be context-specific and vary based on histological subtype and immune integrity. This comprehensive review will explore the preclinical differences, investigate the proposed pathogenesis of rituximab resistance, compare the employed dosing strategies and interrogate available clinical results to help inform practice.

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“…13 Typically, utility values are not generated by authors of oncology economic evaluations and have been taken from separate published studies using standard gamble or time trade-off (TTO). [14][15][16][17] Nevertheless, with increased use of the QALY as the key reported outcome, mapping tools were developed to allow the derivation of utilities from HRQOL instruments, such as the FACT-G mapping by Cheung et al 18 and the mapping of the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) by Pickard et al, 19 both of which were used by patients at different stages of various cancers. Direct measurements were also undertaken.…”

Section: Quality Of Lifementioning

confidence: 99%

Health Technology Assessment Challenges in Oncology: 20 Years of Value in Health

2019

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Background: Oncology treatments have changed from chemotherapies to targeted therapies and more recently immunooncology. This has posed special challenges in the field of health technology assessment (HTA): capturing quality of life (QOL) associated with toxicity due to chemotherapy, crossover upon progression in targeted therapy trials, and survival extrapolation for immuno-oncology drugs.Objectives: To showcase 20 years of Value in Health (ViH) publications in oncology.Methods: A review was undertaken of oncology articles published in ViH from May 1998 to August 2018. Full-length articles published in ViH with the keywords "oncology," "cancer," "h(a)ematology," and "malignancy" were included for review. Conference abstracts were excluded.Results: Four major themes were identified: (1) QOL and the development of multiple functional assessment of cancer therapy tools and mapping instruments; (2) analysis of clinical evidence using indirect comparisons, network analyses, and adjustment for crossovers; (3) modeling, Markov models, partitioned survival models, and extrapolation methods; and (4) financial implications and how to deal with uncertainty, introduction of conditional reimbursement, managed entry, and risk share agreements.Discussion: This review article highlights the important role ViH has played in disseminating HTA research in oncology. A few key issues loom on the horizon: precision medicine, further development and practical application of new QOL measures, methods for translating clinical evidence, and exploration of modeling techniques. For a better understanding of the complex interplay between access and financial risk management, ViH will no doubt continue to promote pioneering research in HTA and oncology.

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Cost-Effectiveness Model for Chemoimmunotherapy Options in Patients with Previously Untreated Chronic Lymphocytic Leukemia Unsuitable for Full-Dose Fludarabine-Based Therapy

Cited by 16 publications

References 27 publications

Systematic Literature Review of Economic Evaluations of Treatment Alternatives in Chronic Lymphocytic Leukemia

Systematic Literature Review of Economic Evaluations of Treatment Alternatives in Chronic Lymphocytic Leukemia

A tale of two antibodies: obinutuzumab versus rituximab

Health Technology Assessment Challenges in Oncology: 20 Years of Value in Health

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