Cost-effectiveness of sorafenib treatment in field practice for patients with hepatocellular carcinoma

Cammà, Calogero; Cabibbo, Giuseppe; Petta, Salvatore; Enea, Mario; Iavarone, M.; Grieco, Antonio; Gasbarrini, Antonio; Villa, Erica; Zavaglia, Claudio; Bruno, Raffaele; Colombo, M.; Craxı̀, Antonio

doi:10.1002/hep.26221

Cited by 93 publications

(86 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(30,31) Although nonmedication costs are a large contributor to overall costs for many other cancers, we were surprised to find medication costs through part D, were the largest contributor to the difference in costs between sorafenib-treated and control groups. This difference in relative contributions from medication costs might be related to patients' short life expectancy and limited time for other health care usage.…”

Section: Discussionmentioning

confidence: 95%

“…We included Medicare patients with continuous enrollment in Medicare Parts A and B from 12 months before diagnosis through the end of follow-up (December 31,2010), allowing up to a 3-month gap in coverage per year. We included SEER-Medicare patients with a diagnosis of HCC (International Classification of Diseases for Oncology, Third Edition, histology codes 8170-8175 and 8180 for HCC and site code C22.0 for liver).…”

Section: Patient Selectionmentioning

confidence: 99%

See 1 more Smart Citation

Survival and cost‐effectiveness of sorafenib therapy in advanced hepatocellular carcinoma: An analysis of the SEER–Medicare database

et al. 2016

View full text Add to dashboard Cite

Sorafenib is the only chemotherapeutic approved for treatment of advanced hepatocellular carcinoma (HCC). However, its effectiveness in patients with Child‐Pugh class B cirrhosis and any moderating effects of health system characteristics are unclear. We examined the survival and cost‐effectiveness associated with sorafenib in elderly patients with advanced HCC. We performed an analysis of Medicare beneficiaries with HCC diagnoses from 2007 to 2009. We compared advanced stage patients with HCC (American Joint Committee on Cancer stage III/IV) who received sorafenib within 6 months of diagnosis (and were otherwise untreated) to advanced stage patients with HCC who received no therapy (control). We performed univariate and multivariate analyses to identify predictors of survival. Incremental cost‐effectiveness ratios (ICERs) were calculated for sorafenib‐treated and control patients. We included 228 sorafenib‐treated patients and 870 control patients. The median survival of the sorafenib‐treated patients was 150.5 days versus 62 days for control patients. On multivariate analysis, significant predictors of improved survival were treatment with sorafenib (hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.57‐0.77), being seen at a National Cancer Institute–designated cancer center (HR, 0.77; 95% CI, 0.62‐0.97), and being seen at a transplantation center (HR, 0.77; 95% CI, 0.65‐0.93). Predictors of worse survival included stage IV disease (HR, 1.40; 95% CI, 1.24‐1.58), decompensated cirrhosis (HR, 1.49; 95% CI, 1.30‐1.70), and treatment in an urban setting (HR, 1.45; 95% CI, 1.21‐1.73.) Although sorafenib use was associated with a survival benefit (HR, 0.61; 95% CI, 0.47‐0.79) among patients with decompensated cirrhosis, the median survival benefit was 31 days, and it was not cost‐effective (ICER, $224,914 per life year gained). Conclusion: Sorafenib is associated with improved survival in elderly patients with advanced HCC; however, it is not cost‐effective among those with hepatic decompensation. (Hepatology 2017;65:122‐133).

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Patient Selectionmentioning

confidence: 99%

Survival and cost‐effectiveness of sorafenib therapy in advanced hepatocellular carcinoma: An analysis of the SEER–Medicare database

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Nevertheless, only sorafenib, a multikinase inhibitor, remains till date the sole approved drug in advanced HCC, based on the clinical benefit observed in properly selected patients enrolled in clinical trials [12,13] . With only three months of survival gain compared to placebo, many practitioners and country health authorities consider the cost-efficacy ratio of sorafenib somewhat insufficient [14][15][16] . In some emerging countries, the drug is not even approved for patients with advanced HCC.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of antiangiogenic efficacy in advanced hepatocellular carcinoma: Biomarkers and functional imaging

Bouattour

Payancé

Wassermann

2015

WJH

View full text Add to dashboard Cite

Many years after therapeutic wilderness, sorafenib finally showed a clinical benefit in patients with advanced hepatocellular carcinoma. After the primary general enthusiasm worldwide, some disappointments emerged particularly since no new treatment could exceed or at least match sorafenib in this setting. Without these new drugs, research focused on optimi zing care of patients treated with sorafenib. One challenging research approach deals with identifying prognostic and predictive biomarkers of sorafenib in this population. The task still seems difficult; however appropriate investigations could resolve this dilemma, as observed for some malignancies where other drugs were used.

show abstract

“…Since approval was granted to sorafenib, physicians have accrued a wealth of experience with the fine-tuning of sorafenib in their daily clinical practice, and several 'real-world' studies have continued to investigate the safety and efficacy of sorafenib. Among them is a multinational postmarketing study, GIDEON, and the Italian field-practice study by the Sorafenib Italian Assessment (SOFIA) study group [7][8][9][10][11], as well as a number of other studies in Europe and North America [12][13][14][15] . These real-world experiences have allowed us to assess sorafenib in patients who are not selected by strict clinical trial criteria but by physician judgment, including patients with comorbidities and those receiving concomitant medication.…”

mentioning

confidence: 99%

Refining Sorafenib Therapy: Lessons from Clinical Practice

et al. 2014

Self Cite

View full text Add to dashboard Cite

AbstrAct:Understanding the best use of sorafenib is essential in order to maximize clinical benefit in hepatocellular carcinoma. Based on Phase III and noninterventional study data, as well as our extensive experience, we discuss dose modification in order to manage adverse events, disease response evaluation and how to maximize treatment benefit. Sorafenib should be initiated at the approved dose (400 mg twice daily) and reduced/ interrupted as appropriate in order to manage adverse events. Dose modification should be considered before discontinuation. Appropriate tumor response assessment is critical. Focusing on radiologic response may result in premature sorafenib discontinuation; symptomatic progression should also be considered. If second-line therapies or trials are unavailable, continuing sorafenib beyond radiologic progression may provide a clinical benefit. Our recommendations enable the maximization of treatment duration, and hence clinical benefit, for patients. Keywords:• adverse event managementIt is well established that hepatocellular carcinoma (HCC) is a complex and heterogeneous disease that is affected by multiple genetic and epigenetic alterations [1]. In the overwhelming majority of patients, liver cirrhosis -another complex disease in its own right -is superimposed on HCC. As a result, the prognostic range for these patients varies considerably and continues to change for each patient at every time point over the clinical course of their disease. A meta-analysis of 30 clinical trials into which HCC patients were enrolled for palliative treatment reflects this heterogeneity. It demonstrated a high variability in survival among untreated patients and concluded that no single patient characteristic alone could predict outcome [2].The prognosis and treatment options for HCC are generally related to tumor stage and liver function at presentation [3,4]. In the west, approximately 30% of all patients with HCC are diagnosed in

show abstract

Cost-effectiveness of sorafenib treatment in field practice for patients with hepatocellular carcinoma

Cited by 93 publications

References 8 publications

Survival and cost‐effectiveness of sorafenib therapy in advanced hepatocellular carcinoma: An analysis of the SEER–Medicare database

Survival and cost‐effectiveness of sorafenib therapy in advanced hepatocellular carcinoma: An analysis of the SEER–Medicare database

Evaluation of antiangiogenic efficacy in advanced hepatocellular carcinoma: Biomarkers and functional imaging

Refining Sorafenib Therapy: Lessons from Clinical Practice

Contact Info

Product

Resources

About