Canadian Societal Perspective Research Articles

Smart connected insulin dose monitoring technologies versus standard of care: a Canadian cost-effectiveness analysis.

Aim: There is growing interest in novel insulin management systems that improve glycemic control. This study aimed to evaluate the cost-effectiveness of smart connected insulin re-usable pens or caps for disposable insulin pens versus pens without connected capabilities in the management of adult patients with Type 1 diabetes (T1DM) from a Canadian societal perspective. Materials & methods: The IQVIA Core Diabetes Model was utilized to conduct the analyses. Applying data from a non-interventional study, the connected insulin device arm was assumed to result in greater reductions (-0.67%) in glycated hemoglobin from baseline and fewer non-severe hypoglycemic events (-32.87 events/patient annually). Macro- and micro-vascular risks were predicted using the Epidemiology of Diabetes Interventions and Complications study data. Direct and indirect costs and utilities were sourced from literature. Key model outcomes included life years and quality-adjusted life-years (QALYs). Both costs and effects were annually discounted at 1.5% over a 60-year time horizon. Uncertainty was explored in scenario and probabilistic sensitivity analyses (PSA). Results: The connected insulin pen device was associated with lower mean discounted total costs (CAD221,943 vs 266,199; -CAD44,256), improvement in mean life expectancy (25.78 vs 24.29; +1.49years) and gains in QALYs (18.48 vs 16.74; +1.75 QALYs) over the patient's lifetime. Most scenario analyses confirmed the base case results. The PSA showed dominance in 99.5% of cases. Conclusion: For adults with T1DM in Canada, a connected insulin pen device is likely to be a cost-effective treatment option associated with greater clinical benefits and lower costs relative to a standard re-usable or disposable pen.

EE303 Cost-Utility Analysis of Roflumilast Cream for Plaque Psoriasis, Including Intertriginous, From the Canadian Societal Perspective

EE303 Cost-Utility Analysis of Roflumilast Cream for Plaque Psoriasis, Including Intertriginous, From the Canadian Societal Perspective

Preferences and Health-Related Quality-of-Life Related to Disease and Treatment Features for Patients with Hemophilia A in a Canadian General Population Sample

BackgroundCurrent treatments for hemophilia A in Canada include on-demand treatment as bleeds occur and regular intravenous prophylactic factor VIII (FVIII) infusions. The subcutaneous therapy emicizumab was recently approved for treatment of hemophilia A. The objective of this study was to estimate utility values associated with hemophilia A health and treatment states from a Canadian societal perspective, including preferences related to treatment efficacy and frequency and route of administration.MethodsA vignette-based time trade-off (TTO) utilities elicitation was undertaken in Canadian adults to compare preferences for six hemophilia health states describing prophylactic and on-demand treatment, with varying bleed rates and frequency of treatment administration. A convenience sample was recruited via market research panels and snowball sampling. Health state/vignette definitions were informed by clinical experience, clinical trial results regarding bleed frequency, and validated by qualitative interviews of hemophilia patients and caregivers (n=10). Utilities were estimated via an online, trained interviewer-guided, vignette-based TTO exercise, where respondents valuated health states describing hemophilia patients (adults or children) receiving subcutaneous prophylaxis, intravenous prophylaxis, and on-demand treatments. Analyses included a descriptive analysis by health state; a mixed-effects analysis of utility values adjusted for subcutaneous vs infusion-based therapies and number of bleeds; and for prophylactic regimens, an analysis of utilities by frequency of infusions or injections.ResultsTTO interviews were conducted with 82 respondents. Mean utilities [95% CI] were highest for subcutaneous prophylaxis (0.90 [0.87–0.93]), followed by intravenous prophylaxis (0.81 [0.78–0.85]), and on-demand treatment (0.70 [0.65–0.76]). In regression analysis, subcutaneous treatment health states were associated with a utility increment of +0.1112. Additional bleeds and more frequent infusions were associated with lower utility values (−0.0027 per bleed and −0.0003 per infusion).ConclusionSubcutaneous prophylaxis is associated with higher utility values compared to intravenous prophylactic and on-demand treatment, while increased bleeds and infusions are associated with reduced utility.

Comprehensive genomic profiling for non-small-cell lung cancer: health and budget impact.

Single-gene tests and hotspot panels targeting specific subsets of biomarkers constitute the Canadian genomic testing landscape for non-small-cell lung cancer (nsclc). However, newer testing options such as comprehensive genomic profiling (cgp) offer improved detection rates and identification of multiple classes of genomic alterations in a single assay, minimizing tissue requirements and turnaround time. The objective of the present analysis was to assess the health and budget impacts of adopting cgp testing for nsclc in Canada. This study assessed the impact of funding the cgp tests FoundationOne CDx and FoundationOne Liquid (Foundation Medicine, Cambridge, MA, U.S.A.) over a 3-year time horizon using a Canadian societal perspective for Ontario. Conventional testing strategies were summarized into two reference scenarios: a series of single-gene tests only, and reflex single-gene testing followed by a hotspot panel for negative results. Four adoption scenarios for cgp testing were considered: replacing all single-gene and hotspot panel testing, replacing hotspot panel testing only, use after negative single-gene and hotspot testing, and use of FoundationOne Liquid in individuals with insufficient tissue for conventional testing. When cgp testing was assumed to replace all conventional testing with 50% uptake, the budget impact per person per year ranged from $0.71 to $0.87, depending on the reference scenario, with a 3-year gain of 680.9 life-years and 3831 working days over the full cohort. Given the present testing landscape for patients with nsclc in Canada, listing cgp testing could optimize the selection of appropriately targeted treatments, and thus add life-years and productivity for this population, with a minimal budget impact.

PCN87 COST-EFFECTIVNESS ANALYSIS OF DABRAFENIB PLUS TRAMETINIB AS ADJUVANT TREATMENT FOR BRAF V600 MUTATION-POSITIVE MELANOMA AFTER SURGICAL RESECTION IN CANADA- A SOCIETAL PERSPECTIVE

The COMBI-AD trial demonstrated the efficacy and safety of dabrafenib plus trametinib (D+T) vs. placebo as adjuvant treatment of patients with BRAF V600 mutation-positive, high risk resected Stage III melanoma. This analysis evaluated the cost-effectiveness of dabrafenib and trametinib in this indication from a Canadian societal perspective. The cost-effectiveness of D+T versus observation (OBS, represented by placebo arm of COMBI-AD) was estimated using a non-homogeneous, semi-Markov cohort model with states for relapse-free survival (RFS), post-locoregional recurrence, post-distant recurrence (DR) receiving first-line treatment, and post-DR receiving second-line treatment. The incremental cost effectiveness ratio (ICER) was defined as the incremental cost per quality-adjusted life-year (QALY) gained. A 35-year time horizon was used. Transition probabilities for each six-month model cycle were estimated using data from COMBI-AD. Health-state utilities were estimated using EQ-5D index values collected in COMBI-AD and published sources. Direct costs of melanoma treatment (BRAF mutation testing, medication and administration costs for adjuvant and metastatic treatments, treatment of recurrence, and adverse events) and indirect costs of productivity losses were considered. Costs ($ CAN) and QALYs were discounted at 1.5% annually. In the base case D+T was estimated to result in a gain of 2.60 QALYs vs. OBS, at an incremental cost of $75,085. The ICER of D+T vs. OBS was $28,865 per QALY gained based on deterministic analyses and $29,520 based on the mean of probabilistic analyses. Results are sensitive to parametric distributions used for projecting long-term RFS. For patients with BRAF V600 mutation-positive, high-risk Stage III melanoma who have been surgically resected, D+T is projected to result in substantial gains in QALYs compared with OBS. At the current list price in Quebec, D+T is cost-effective vs OBS based on commonly-referenced threshold values. These results may be useful in deliberations regarding reimbursement and access to this treatment in Canada.

Cost Effectiveness of Once-Weekly Semaglutide Versus Once-Weekly Dulaglutide in the Treatment of Type 2 Diabetes in Canada.

ObjectiveThe aim of this study was to assess the cost effectiveness of semaglutide versus dulaglutide, as an add-on to metformin monotherapy, for the treatment of type 2 diabetes (T2D), from a Canadian societal perspective.MethodsThe Swedish Institute for Health Economics Cohort Model of T2D was used to assess the cost effectiveness of once-weekly semaglutide (0.5 or 1.0 mg) versus once-weekly dulaglutide (0.75 or 1.5 mg) over a 40-year time horizon. Using data from the SUSTAIN 7 trial, which demonstrated comparatively greater reductions in glycated hemoglobin (HbA1c), body mass index and systolic blood pressure with semaglutide, compared with dulaglutide, a deterministic base-case and scenario simulation were conducted. The robustness of the results was evaluated with probabilistic sensitivity analyses and 15 deterministic sensitivity analyses.ResultsThe base-case analysis indicated that semaglutide is a dominant treatment option, compared with dulaglutide. Semaglutide was associated with lower total costs (Canadian dollars [CAN$]) versus dulaglutide for both low-dose (CAN$113,287 vs. CAN$113,690; cost-saving: CAN$403) and high-dose (CAN$112,983 vs. CAN$113,695; cost-saving: CAN$711) comparisons. Semaglutide resulted in increased quality-adjusted life-years (QALYs) and QALY gains, compared with dulaglutide, for both low-dose (11.10 vs. 11.07 QALYs; + 0.04 QALYs) and high-dose (11.12 vs. 11.07 QALYs; + 0.05 QALYs) comparisons. The probabilistic sensitivity analysis showed that for 66–73% of iterations, semaglutide was either dominant or was considered cost effective at a willingness-to-pay threshold of CAN$50,000.ConclusionsFrom a Canadian societal perspective, semaglutide may be a cost-effective treatment option versus dulaglutide in patients with T2D who are inadequately controlled on metformin monotherapy.Electronic supplementary materialThe online version of this article (10.1007/s41669-019-0131-6) contains supplementary material, which is available to authorized users.

PCN170 - COST-EFFECTIVENESS OF TISAGENLECLEUCEL IN PEDIATRIC AND YOUNG ADULT PATIENTS WITH RELAPSED OR REFRACTORY B-CELL ACUTE LYMPHOBLASTIC LEUKEMIA: A CANADIAN SOCIETAL PERSPECTIVE

Tisagenlecleucel, a CD19-directed genetically modified autologous T-cell immunocellular therapy is pending regulatory approval for the treatment of pediatric and young adult patients with relapsed or refractory (r/r) B-cell acute lymphoblastic leukemia (pALL). The current study assessed the cost-utility of tisagenlecleucel in comparison with salvage chemotherapy for the treatment of r/r B-cell pALL from a Canadian societal perspective. The model included three health states: event free survival (EFS), progressive disease, and death. Using the partitioned survival model approach, the proportions of patients in each health state were determined by the area under the curves based on the fitted overall survival (OS) and EFS trial curves. The model used literature of ALL long-term survivors to inform the mortality risk after year 5 and conservatively assumed no difference in mortality risk across treatments. A 70-year time horizon was used to capture all the relevant costs and benefits associated with the treatments. Both costs and benefits were discounted at 1.5% per year. The model comparator was salvage chemotherapy. Costs, health state utility and treatment-related disutility inputs were obtained from Canada-specific databases and literature Tisagenlecleucel was associated with incremental life year (LY) gains of 13.46 years, incremental quality-adjusted life years (QALYs) gains of 11.74 years and an incremental cost of $135,758 when compared to salvage chemotherapy. The incremental cost-effectiveness ratio (ICER) for tisagenlecleucel vs. salvage chemotherapy was $11,567 per QALY gained. Deterministic and probabilistic sensitivity analyses supported the base-case findings and contributed to the robustness of the economic case. Tisagenlecleucel represents a clinically significant advancement in the management of r/r B-cell pALL and fulfils the unmet needs for this difficult-to-treat patient population. Compared with the current standard of care, tisagenlecleucel greatly prolonged survival, EFS, improved quality of life and is a cost-effective option for the treatment of r/r B-cell pALL.

Cost-effectiveness of everolimus for the treatment of advanced neuroendocrine tumours of gastrointestinal or lung origin in Canada.

In 2016, everolimus was approved by Health Canada for the treatment of unresectable, locally advanced or metastatic, well-differentiated, non-functional, neuroendocrine tumours (NET) of gastrointestinal (GI) or lung origin in adult patients with progressive disease. This analysis evaluated the cost-effectiveness of everolimus in this setting from a Canadian societal perspective. A partitioned survival model was developed to compare the cost per life-year (LY) gained and cost per quality-adjusted life-year (QALY) gained of everolimus plus best supportive care (BSC) versus BSC alone in patients with advanced or metastatic NET of GI or lung origin. Model health states included stable disease, disease progression, and death. Efficacy inputs were based on the RADIANT-4 trial and utilities were mapped from quality-of-life data retrieved from RADIANT-4. Resource utilization inputs were derived from a Canadian physician survey, while cost inputs were obtained from official reimbursement lists from Ontario and other published sources. Costs and efficacy outcomes were discounted 5% annually over a 10-year time horizon, and sensitivity analyses were conducted to test the robustness of the base case results. Everolimus had an incremental gain of 0.616 QALYs (0.823 LYs) and CA$89,795 resulting in an incremental cost-effectiveness ratio of CA$145,670 per QALY gained (CA$109,166 per LY gained). The probability of cost-effectiveness was 52.1% at a willingness to pay (WTP) threshold of CA$150,000 per QALY. Results of the probabilistic sensitivity analysis indicate that everolimus has a 52.1% probability of being cost-effective at a WTP threshold of CA$150,000 per QALY gained in Canada.

Cost-effectiveness of G5 Mobile continuous glucose monitoring device compared to self-monitoring of blood glucose alone for people with type 1 diabetes from the Canadian societal perspective

Aims: To evaluate the cost-effectiveness of real-time continuous glucose monitoring (CGM) compared to self-monitoring of blood glucose (SMBG) alone in people with type 1 diabetes (T1DM) using multiple daily injections (MDI) from the Canadian societal perspective.Methods: The IMS CORE Diabetes Model (v.9.0) was used to assess the long-term (50 years) cost-effectiveness of real-time CGM (G5 Mobile CGM System; Dexcom, Inc., San Diego, CA) compared with SMBG alone for a cohort of adults with poorly-controlled T1DM. Treatment effects and baseline characteristics of patients were derived from the DIAMOND randomized controlled clinical trial; all other assumptions and costs were sourced from published research. The accuracy and clinical effectiveness of G5 Mobile CGM is the same as the G4 Platinum CGM used in the DIAMOND randomized clinical trial. Base case assumptions included (a) baseline HbA1c of 8.6%, (b) change in HbA1c of –1.0% for CGM users vs –0.4% for SMBG users, and (c) disutilities of –0.0142 for non-severe hypoglycemic events (NSHEs) and severe hypoglycemic events (SHEs) not requiring medical intervention, and –0.047 for SHEs requiring medical resources. Treatment costs and outcomes were discounted at 1.5% per year.Results: The incremental cost-effectiveness ratio for the base case G5 Mobile CGM vs SMBG was $33,789 CAD/quality-adjusted life-year (QALY). Sensitivity analyses showed that base case results were most sensitive to changes in percentage reduction in hypoglycemic events and disutilities associated with hypoglycemic events. The base case results were minimally impacted by changes in baseline HbA1c level, incorporation of indirect costs, changes in the discount rate, and baseline utility of patients.Conclusions: The results of this analysis demonstrate that G5 Mobile CGM is cost-effective within the population of adults with T1DM using MDI, assuming a Canadian willingness-to-pay threshold of $50,000 CAD per QALY.

PCN90 - Cost Effectiveness of Trametinib as First-Line (1l) Treatment for Braf V600 Positive Advanced or Metastatic Melanoma — A Canadian Societal Perspective

PCN90 - Cost Effectiveness of Trametinib as First-Line (1l) Treatment for Braf V600 Positive Advanced or Metastatic Melanoma — A Canadian Societal Perspective

Cost-Effectiveness of Ruxolitinib Versus Best-Available Therapy for Medical Treatment of Myelofibrosis: Canadian Societal Perspective

AbstractAbstract 4255 Background:Ruxolitinib demonstrated significant clinical benefits for patients (pts) with myelofibrosis (MF) in two phase 3 COMFORT studies. Nevertheless, in countries where health technology assessments are conducted, cost-effectiveness is an important consideration. Economic evaluations play an increasingly important role in reimbursement decisions for new treatments. To help inform such decisions, an evaluation of the cost-effectiveness (CE) of adding ruxolitinib as a treatment for MF was conducted from a Canadian societal perspective. Methods:A Markov model was built to estimate the costs, health outcomes, and CE of ruxolitinib compared with investigator-selected best available therapy (BAT), which included conventional therapies or no treatment. Data were derived from pts enrolled in the COMFORT-II study and included high-risk or intermediate-2–risk pts according to the International Working Group for Myelofibrosis Research and Treatment risk categorization. For this analysis, response was defined as a ≥ 35% reduction in spleen volume (COMFORT-II primary endpoint) or absence of constitutional symptoms. Survival assumptions were derived from a historical comparison of patients in the phase 1/2 study (Verstovsek et al, Blood. 2012) that showed a benefit for those achieving a ≥ 50% reduction in spleen length (equivalent to 35% spleen volume reduction). The model simulated disease progression in a cohort of pts with MF through 4 different health states with a 12-week cycle and a lifetime time horizon: 1) responder; 2) nonresponder; 3) leukemic transformation (LT); and 4) death. In each time cycle, pts incurred cost and utility estimates associated with their health state. The model considered the resource and utility implications arising from treatments aimed at directly treating splenomegaly, namely splenic irradiation and splenectomy. The outcomes of the Markov model included costs over the time horizon (drug costs, costs linked to the management of adverse events, other medical costs, indirect costs), life years, quality-adjusted life years (QALYs), and time spent as a responder to treatment. Both a 1-way sensitivity analysis and a probabilistic sensitivity analysis were performed, using estimated ranges and probability distributions for each input parameter. Results:The results showed that ruxolitinib-treated pts with MF had a better clinical outcome but at an increased cost. The total average lifetime cost of treating a pt receiving ruxolitinib was $494,859 CAD, with drug costs of $205,484 and other medical costs of $217,527, the majority of which were resource costs. The total average lifetime cost of treating a pt receiving BAT was $421,755, of which $59,289 was drug costs. Indirect costs were higher for BAT pts, at $96,458, exceeding the figure of $71,848 for ruxolitinib pts (Table). The clinical results showed longer average overall survival for pts receiving ruxolitinib compared with pts receiving BAT (Verstovsek et al, Blood. 2012). The ruxolitinib-treated pts had 4.01 QALYs compared with 2.82 QALYs for those in the BAT arm. The overall incremental CE ratio (ICER) was $61,444 per QALY. The key model drivers were the resource cost for nonresponders and improved mortality in the intermediate-2–risk group. Adopting a $100,000 per QALY willingness-to-pay threshold showed that 100% of the simulations for ruxolitinib therapy would be cost-effective compared with BAT for the treatment of MF. The mean ICER from the simulations was $59,216 per QALY, which was similar to the deterministic average of $61,444. Conclusions:There has been a high, unmet need for an effective therapeutic option for pts with MF. The COMFORT-II study has shown that ruxolitinib is clinically effective and superior to BAT at reducing splenomegaly and disease-related symptoms and improving health-related quality of life. The present analysis suggests that compared with BAT, ruxolitinib is an economically acceptable treatment option. Continued long-term evaluation of survival and potential reduction in rates of LT will also impact the future CE of ruxolitinib.TableComparison of Total Lifetime CostsRuxolitinibBATTotal average lifetime cost$494,859$421,755Drug costs$205,484$59,289Other medical costs$217,527$266,008Indirect costs$71,848$96,458Total average patient outcomesQALY4.012.82ICER$61,444/QALY Disclosures:El Ouagari:Novartis Pharma: Employment. Knight:Novartis Pharmaceuticals Corporation: Consultancy; Novartis Pharmaceuticals Canada: Consultancy. Mendelson:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership.

Eltrombopag or Intravenous Immunoglobulin as a Bridge to Splenectomy in Adults With Chronic Idiopathic Thrombocytopenic Purpura: A Canadian Economic Analysis

Abstract Background Chronic idiopathic thrombocytopenia purpura (ITP) in adults is a potentially serious disorder affecting 6000 to 7000 Canadians. Initial treatment consisting of corticosteroids usually begins when the platelet count is persistently below 20 × 109/L or if the patient has bleeding complications. In cases in which corticosteroid resistance develops or in which they are contraindicated, splenectomy is the recommended second-line therapy. In many of these patients, intravenous immunoglobulin (IVIG; 1 g/kg/day for 2 days then 1 g/kg/day monthly) is often used as a bridge to surgery. Eltrombopag is a new orally administered agent that activates the thrombopoietic receptor and stimulates human megakaryocytes. Clinical trials have demonstrated that eltrombopag is safe and effective in the treatment of adults with chronic ITP. Therefore, it represents an attractive option to IVIG for use as a bridge to splenectomy. In this study, a cost-minimization analysis was conducted to test the hypothesis that eltrombopag is a cost-effective alternative to IVIG for this indication. Patients and Methods The economic analysis was conducted from the Canadian societal perspective using a 4-month time horizon. Estimates for direct medical costs in these patients were obtained from 6 hematologists from across Canada. The base case analysis considered direct costs for drug therapy, outpatient pharmacy fees, medical consultations and visits, laboratory and diagnostic procedures, as well as costs for secondary pharmacotherapy in cases in which the primary agent had to be discontinued because of side effects. For IVIG, the analysis also included visits to the infusion clinic, chair time to receive the infusion, nursing time, pharmacy preparation, as well as indirect costs (eg, time off work, patient travel). A 1-way sensitivity analysis was then undertaken on the key cost drivers to test the stability of the primary findings. Results Total direct and indirect costs for IVIG were $24,134 for 4 months of therapy with drug cost contributing to 84% of the total. In contrast, total costs for eltrombopag were approximately $14,651 for an overall savings of $9,543 per patient. The sensitivity analysis suggested that the base case findings were stable and were only modestly affected by variations in drug cost and duration of therapy. Conclusion Given its oral route of administration and cost-saving potential, eltrombopag would be an economically attractive alternative to IVIG when the intent of therapy is to create a bridge to surgery.

Economic evaluation of high-dose (80 mg/day) atorvastatin treatment compared with standard-dose (20 mg/day to 40 mg/day) simvastatin treatment in Canada based on the Incremental Decrease in End-Points Through Aggressive Lipid-Lowering (IDEAL) trial

The Incremental Decrease in End-Points Through Aggressive Lipid-Lowering (IDEAL) trial demonstrated incremental cardiovascular benefit of treatment with high-dose atorvastatin (80 mg/ day) versus standard-dose simvastatin (20 mg/day to 40 mg/day) in 8888 patients with a previous myocardial infarction (MI) over a median follow-up period of 4.8 years. To assess the cost-effectiveness of high-dose atorvastatin versus standard-dose simvastatin treatment in patients with a history of MI from a Canadian societal perspective. In a within-trial analysis, end point-related events, resources used and productivity losses occurring during the IDEAL trial were aggregated by treatment arm on an intention-to-treat basis to calculate the incremental cost per event avoided. Additionally, quality-adjusted survival was projected using a lifetime Markov model. Transition probabilities, workdays lost, use of study medication and cardiovascular hospitalization rates were based on IDEAL trial data. Hospitalization, study medication and productivity costs were included. Probabilistic and deterministic sensitivity analyses were performed. Compared with standard-dose simvastatin, atorvastatin 80 mg led to 0.099 fewer events per patient and cost savings over 4.8 years of treatment. Over a lifetime horizon, atorvastatin 80 mg led to 0.023 qualityadjusted life years (QALYs) gained per patient at an incremental cost of $26,795/QALY gained. The incremental cost-effectiveness ratio remained below $50,000/QALY in 78% of 1000 simulations. Exclusion of indirect costs resulted in an incremental cost-effectiveness ratio of $38,834/QALY. Results were relatively sensitive to baseline age, but robust with respect to sex, baseline low-density lipoprotein cholesterol levels, diabetes status and hospitalization costs. From a Canadian societal perspective, high-dose atorvastatin is cost-effective compared with standard-dose simvastatin in patients with a previous MI.

Cost-effectiveness of capecitabine in combination with oxaliplatin (XELOX) compared with FOLFOX for the treatment of metastatic colorectal cancer: A Canadian evaluation

e17502 Background: Capecitabine is an oral fluoropyrimidine used to treat patients with metastatic colorectal cancer (mCRC). Recent trials in 1st- and 2nd-line treatment have shown that capecitabine in combination with oxaliplatin (XELOX) is non-inferior to FOLFOX4 in terms of progression-free survival, overall survival and response rates. XELOX offers patients the advantage of treatment every 3 weeks rather than every 2 weeks without the need for lengthy infusions. This analysis evaluated the cost- effectiveness of replacing FOLFOX4 with XELOX for 1st- and 2nd-line treatment of mCRC from both Canadian healthcare system payor and societal perspectives. Methods: Based on evidence of non-inferiority of XELOX vs. FOLFOX4, cost-minimization analyses (CMA) were conducted using phase III clinical trial data. The CMA compared total cost associated with chemotherapy medications, administration of chemotherapy, and treatment related toxicities. For the societal perspective, patients’ costs and time were also included. The costs (or savings) were compared for 1st-line XELOX vs. FOLFOX4 and 2nd-line XELOX vs. FOLFOX4. Due to variation in Canadian clinical practice, sensitivity analyses using the FOLFOX6 regimen as a comparator were performed. Results: Cost savings per patient for XELOX vs. FOLFOX4 from a healthcare system payor perspective and a societal perspective are shown in the Table . XELOX was also associated with cost savings when compared with the simplified administration regimen of FOLFOX6. Reduced costs for chemotherapy administration and costs for patients’ time and travel primarily related to fewer clinic visits offset the increased drug acquisition cost of the XELOX regimen. Conclusions: Replacing FOLFOX with XELOX is associated with cost savings from the healthcare system payor and societal perspectives while preserving clinical efficacy. [Table: see text] [Table: see text]

A Cost-Utility Analysis of Losartan versus Atenolol in the Treatment of??Hypertension with Left Ventricular Hypertrophy

The LIFE (Losartan Intervention For Endpoint reduction in hypertension) study demonstrated a 13% relative risk reduction in the primary composite endpoint (myocardial infarction, stroke or death) for patients with hypertension and electrocardiographically diagnosed left ventricular hypertrophy (LVH) treated with losartan compared with atenolol. Losartan recipients also had a 25% relative risk reduction for stroke compared with atenolol recipients. Incorporating the results found in the LIFE study into an economic model, an incremental cost-effectiveness analysis was performed comparing losartan with atenolol in the treatment of 67-year old patients with hypertension and LVH. A Markov state transition model, based on published results of the LIFE trial (mean follow-up of 4.8 years), was utilised to extrapolate the outcomes observed in this trial to the patients' lifetime. Utility estimates for the associated health states were obtained from various published sources. Lifetime treatment costs were calculated adopting a societal perspective. Both costs and benefits were discounted and incremental cost-effectiveness ratios (ICERs) were estimated. One-way and probabilistic sensitivity analyses were performed. The estimated ICER for losartan versus atenolol was 1337 Canadian dollars per QALY gained (1 Canadian dollar =0.75 US dollars, 2002 values). This ICER was robust to extensive sensitivity analysis, demonstrating a 95% probability that the ICER would be <20,000 Canadian dollars per QALY gained. From a Canadian societal perspective, losartan appears to be a cost-effective alternative to atenolol in patients with hypertension and LVH. The estimated ICERs, including the sensitivity analyses, were within the range of cost-effectiveness ratios for various currently funded interventions and drugs in developed countries.