Low-value practices in oncology contributing to financial toxicity

Gyawali, Bishal

doi:10.3332/ecancer.2017.727

Cited by 18 publications

(15 citation statements)

References 38 publications

(44 reference statements)

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“…However, FT includes not only objective financial burden but also a measure of the degree to which financial burden impacts patient well-being. Previously thought of as a problem of low-and-middle income countries where most patients cannot afford treatment, FT has now become a serious problem even among high-income countries mostly because of the increasing costs of newer cancer drugs, such as targeted agents or immunotherapies [ 2 – 4 ].…”

Section: Introductionmentioning

confidence: 99%

A prospective survey of comprehensive score for financial toxicity in Japanese cancer patients: report on a pilot study

Honda¹,

Gyawali²,

Ando³

et al. 2018

ecancer

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BackgroundFinancial toxicity (FT) has a negative impact on the quality of life and survival of patients with cancer. The comprehensive score for FT (COST) questionnaire is a tool to measure FT which has already been validated in patients with cancer in the United States. However, the feasibility and validity of assessing FT using the COST questionnaire have not been established in non-US healthcare settings, including that in Japan.MethodsThis is a prospective pilot survey to ascertain the feasibility of using the COST questionnaire to evaluate FT in Japanese patients with advanced solid cancer who had been receiving chemotherapy for at least 2 months. The COST questionnaire was translated into Japanese using Functional Assessment of Chronic Illness Therapy methodology.ResultsOf the 12 patients approached, 11 (92%) responded to the questionnaire. The median COST score was 22 (range, 6–29; mean ± SD, 20.18 ± 8.17). Five (45%) and two (18%) patients suffered grade 1 (COST score 14–25) and grade 2 (COST score 1–13) FT, respectively. The COST measure demonstrated good internal consistency with a Cronbach α of 0.87.ConclusionsThe COST measure demonstrated good feasibility in measuring FT in the Japanese healthcare setting. Despite the existing universal health insurance system and ceiling amount for high-cost medical expenses, some Japanese patients experienced meaningful FT during chemotherapy. A prospective study is already underway to confirm the preliminary results (UMIN: 000025043).

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Section: Introductionmentioning

confidence: 99%

A prospective survey of comprehensive score for financial toxicity in Japanese cancer patients: report on a pilot study

Honda¹,

Gyawali²,

Ando³

et al. 2018

ecancer

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“…This study is another example of a remarkably effective cancer drug that will not be cost‐effective unless the drug price is discounted significantly . Financial toxicity of cancer medicine remains a well‐recognized problem resulting in patient bankruptcy and even poor prognosis, whether in high‐income countries or countries with public healthcare systems . Drugs may appear more affordable in high‐income countries (UK) than in the USA and middle‐income countries (China) .…”

Section: Discussionmentioning

confidence: 99%

Cost‐effectiveness analysis of cabozantinib as second‐line therapy in advanced hepatocellular carcinoma

Liao

Huang

Hutton

et al. 2019

Liver International

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Background: In the CELESTIAL trial for patients with advanced hepatocellular carcinoma (HCC), cabozantinib showed improved survival compared with placebo but comes at a price. We aimed to investigate the cost-effectiveness of cabozantinib for sorafenib-resistant HCC from the payer's perspective of the USA, UK and China. Methods:We developed Markov models to simulate the patients pre-treated with first-line sorafenib following the CELESTIAL trial. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated for the treatment with cabozantinib or best supportive care. The list price for drugs was acquired from the Red Book, the British National Formulary, West China hospital and reported literature. Adverse events, utilities weights, and transition likelihood between states were sourced from the published randomized phase III trial. A willing-to-pay threshold was set $150 000/QALY in the USA, $70 671/QALY (£50 000/QALY) in the UK and $26 481/QALY (3x GDP per capita) in China. Deterministic and probabilistic sensitivity analyses were developed to test the models' uncertainty. Results:In the base case, treatment with cabozantinib increased effectiveness by 0.13 QALYs, resulting in an ICER vs best supportive care of $833 497/QALY in the USA, $304 177/QALY in the UK and $156 437/QALY in China. The models were most sensitive to assumptions about transitions to progression with both cabozantinib and best supportive care, the utility associated with being progression free. These results were robust across a range of scenarios and sensitivity analyses, including deterministic and probabilistic analyses.Conclusions: Cabozantinib at its current cost would not be a cost-effective treatment option for patients with sorafenib-resistant HCC from the payer's perspective in the USA, UK or China. Substantial discounts are necessary to meet conventional costeffectiveness thresholds. K E Y W O R D S cabozantinib, cost-effective, hepatocellular carcinoma, incremental cost-effectiveness ratio, Markov model, second-line therapy S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Liao W, Huang J, Hutton D, et al. Cost-effectiveness analysis of cabozantinib as second-line therapy in advanced hepatocellular carcinoma. Liver Int.

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“…Financial toxicity, the major cause of which remains high drug pricing, is now a widely acknowledged problem in cancer medicine with major implications both for the patient and for health care systems [ 1 ]. Of various measures proposed to combat this challenge, an important strategy is the use of lower-priced drugs instead of expensive alternatives [ 2 ]. However, the oncology community seems to either ignore or more readily reject cheaper drugs in cancer care compared to more expensive alternatives.…”

Section: Does the Oncology Community Have A Rejection Bias When It Comentioning

confidence: 99%

Does the oncology community have a rejection bias when it comes to repurposed drugs?

Gyawali¹,

Pantziarka²,

Crispino³

et al. 2018

ecancer

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Among the various measures proposed to combat the challenge of financial toxicity in cancer care, an important strategy is the use of lower-priced drugs instead of expensive alternatives. However, the oncology community seems to either ignore or more readily reject cheaper drugs in cancer care compared to more expensive alternatives. In this commentary, we present three examples of lower-priced drugs rejected or ignored by the oncology community and contrast this with three expensive drugs where persistent optimism remained despite negative clinical trial results. We argue that all drugs be held to the same rigorous standards – this not only includes skepticism in the absence of sound evidence, but also the suspension of premature judgement as has happened in the cases of repurposed drugs.

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Low-value practices in oncology contributing to financial toxicity

Cited by 18 publications

References 38 publications

A prospective survey of comprehensive score for financial toxicity in Japanese cancer patients: report on a pilot study

A prospective survey of comprehensive score for financial toxicity in Japanese cancer patients: report on a pilot study

Cost‐effectiveness analysis of cabozantinib as second‐line therapy in advanced hepatocellular carcinoma

Does the oncology community have a rejection bias when it comes to repurposed drugs?

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