Economic Evaluations of Medical Care Interventions for Cancer Patients: How, Why, and What Does it Mean?

Abstract

While the past decade has seen the development of multiple new interventions to diagnose and treat cancer, as well as to improve the quality of life for cancer patients, many of these interventions have substantial costs. This has resulted in increased scrutiny of the costs of care for cancer, as well as the costs relative to the benefits for cancer treatments. It is important for oncologists and other members of the cancer community to consider and understand how economic evaluations of cancer interventions are performed and to be able to use and critique these evaluations. This review discusses the components, main types, and analytic issues of health economic evaluations using studies of cancer interventions as examples.We also highlight limitations of these economic evaluations and discuss why members of the cancer community should care about economic analyses. (CA Cancer J Clin 2008;58:231-244.)

An economic evaluation of the war on cancer

“…Indeed, a large body of work has questioned the cost-effectiveness of recent cancer treatments (Berenson, 2005;Hillner and Smith, 2007;Kolata and Pollack, 2008;Shih and Halpern, 2008).…”

Modeling the Cost-effectiveness of Strategies for Treating Esophageal Adenocarcinoma and High-grade Dysplasia

“…Systematic assessment of incremental costs and effects requires consideration of natural history and interaction with practice, and this is particularly important for conditions such as esophageal adenocarcinoma which has multiple strategies and pathways for monitoring, diagnosis and management, all conditional on the stage of disease at presentation [22]. While costs might be of secondary concern to clinicians who primarily seek to optimize outcomes for individual patients, ultimately, resource allocation decisions do affect everyday clinical care in settings with budgetary pressures [23]. It is mandatory for regulatory bodies in Canada, UK, Australia and most of the Western world to evaluate cost-effectiveness of new technologies when considering potential government reimbursement.…”

Cost-effectiveness of febrile neutropenia prevention with primary versus secondary G-CSF prophylaxis for adjuvant chemotherapy in breast cancer: a systematic review

“…The adoption of various medical interventions depends partly on clinical benefit / risk profile and "value for money" among other factors (18,19) The assumed thresholds at which an intervention is assumed to be providing good value for money varies between nations as well as health authority jurisdictions and can also vary over time. The value for money of PP G-CSF in the identified studies was judged against commonly employed CE thresholds in the relevant jurisdictions (US$100,000 in the USA, £30,000 in the UK, and CAN$100,000 in Canada per QALY gained) but society and payers may adopt higher thresholds.…”

“…The value for money of PP G-CSF in the identified studies was judged against commonly employed CE thresholds in the relevant jurisdictions (US$100,000 in the USA, £30,000 in the UK, and CAN$100,000 in Canada per QALY gained) but society and payers may adopt higher thresholds. (18,19,20) For example, the World Health Organization (WHO) defines the "value for money" of interventions relative to gross domestic product (GDP) per capita and defines these as being; i) highly cost effective (< GDP /capita), ii) cost-effective (1-3 times GDP / capita) and iii) not cost effective (>3 times GDP / capita). (22) Value for money should therefore be considered within the context of acceptable and perhaps evolving "willingness to pay" (WTP) thresholds.…”

“…cost-effectiveness). (18,19,20) Cost-effectiveness / cost-utility analyses (CEA / CUA) examine the incremental costs per life-year (LY) or quality-adjusted life-year (QALY) gained with an intervention, and can help address the question of "value in cancer care". (21) Interventions associated with incremental costs per QALY gained below commonly utilized costeffectiveness (CE) thresholds (US$100,000 [1] in the USA, £30,000 in the UK, and CAN$100,000 in Canada per QALY gained) are deemed to provide "good value for money".…”