2 results
OP60 Ramucirumab In Gastric Cancer Treatment: An Economic Evaluation
- Annamaria Guglielmo, Oriana Ciani, Nicoletta Staropoli, Domenico Ciliberto, Rosanna Tarricone, Monica Giancotti, Marianna Mauro
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 33 / Issue S1 / 2017
- Published online by Cambridge University Press:
- 12 January 2018, pp. 26-27
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INTRODUCTION:
Gastric cancer (GC) is one of the most common malignancy and the third leading cause of cancer mortality worldwide. Currently, platinum-based and fluoropyrimidine-based combinations represent the milestone of front-line drug regimens. Unfortunately, there are few treatment options after failure of first-line therapy. Ramucirumab, a human IgG1 monoclonal antibody to VEGFR-2, has been recently approved in the European Union (EU) for use as monotherapy or in combination with paclitaxel as second-line treatment in patients with advanced GC with progressed disease. We performed a cost-effectiveness analysis of the Ramucirumab plus paclitaxel doublet versus paclitaxel alone in patients with previously treated advanced GC, based on results of the RAINBOW trial (1).
METHODS:A Markov model has been developed in order to estimate the Life Years Gained (LYGs) and the incremental cost-effectiveness ratio (ICER) for both treatments. The model adopted the Italian healthcare system perspective and the time horizon is that of the lifetime of a patient with an advanced GC. The model considered three distinct health states: stable, progression or death. Transition probabilities were extracted from the Kaplan-Meier curves provided in the trial and cubic/spline function was used to approximate the extrapolation of survival curves for each treatment cycle. An internal model validation was performed to validate the Overall Survival (OS) curves generated by our model simulation. We based our economic analysis on clinical data and resource consumption (drugs, drug administration, supportive care medications, disease monitoring and graded 3 or 4 adverse events) on the Italian setting (2,3). All costs were expressed in euros. Sensitivity analysis also have been performed.
RESULTS:This cost-effectiveness study demonstrated that, in 2nd-line therapy, the combination of ramucirumab with paclitaxel provides an incremental benefit (+1.54) at high incremental cost (EUR41,616) per LYGs.
CONCLUSIONS:At a threshold of EUR5,000 for LYGs, based on Italian perspective, ramucirumab plus paclitaxel had less probability of being cost-effective. To our knowledge, our study is the first modeling study from an Italian payer perspective and the first worldwide to examine ramucirumab as a 2nd-line treatment.
PP100 Economic Evaluation Of A New Non-Antibiotic First-line Treatment Of Recurrent Urinary Tract Infections
- Annamaria Guglielmo, Rocco Damiano, Oriana Ciani, Rosanna Tarricone, Antonio Cicione, Monica Giancotti, Marianna Mauro
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 33 / Issue S1 / 2017
- Published online by Cambridge University Press:
- 12 January 2018, pp. 118-119
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INTRODUCTION:
Urinary tract infections (UTIs) are common in female patients in general practice. These bacterial infections affect half of all women at least once in their life. Antibiotics are usually prescribed for UTIs, and continuous low antimicrobial prophylaxis is administered to patients at high risk of recurrent UTI (rUTIs) (1). However, a major concern arises due to the increased rates of severe treatment-related side effects and emergence of antimicrobial resistance, which makes rUTIs management more challenging while seeking the use of more expensive alternatives. On this basis, clinical evaluations of rUTI interventions should be accompanied by economic evaluations in order to guide healthcare policy and decision processes about healthcare resources allocation. The aim of this work was to perform a cost-effectiveness analysis of a novel effective non-antibiotic treatment option for prophylaxis of female patients with a history of rUTIs, based on intravesical administration of hyaluronic acid (HA) plus chondroitin sulfate (CS), as compared to recommended 1st-line antibiotic therapy (2).
METHODS:A cost-utility analysis was performed in order to estimate the effectiveness of each treatment, according to the number of UTIs annual episodes, and the incremental cost-effectiveness (ICER) for patients with UTI, starting from data collected during a multicentric observational case-cross-over clinical trial involving seven European centers (2). The economic model includes the costs of HA treatment and the costs associated with each UTI, such as costs of UTI diagnostics and antibiotic treatment, additional care by the elderly-care physician, additional nursing care, and hospitalizations, as well as the expected QALY, measured through the Short Form Health Survey (SF-36) questionnaires administered to patients, for both groups (3).
RESULTS:At this stage, preliminary findings suggest that HA plus CS is a cost-effective alternative to antibiotics for the treatment of recurrent UTIs, that could reduce UTIs events in female patients with a history of recurrent UTI at an acceptable cost.
CONCLUSIONS:The results of this study support the use of HA plus CS against antimicrobials as 1st-line therapy in the management of rUTIs.